Chris Trimble Interview

Chris Trimble, Adjunct Professor, Tuck School of Business, Dartmouth College, United States, is an expert on making innovation happen in large organisations and has written four books. He is speaking at The King’s Fund Annual Conference 2012 on ‘The NHS innovation challenge: why adopting a reverse innovation approach will transform health care’.

What is a reverse innovation?

A reverse innovation is any innovation that is adopted first in the developing world. It does not matter where the companies are or where the innovators are, only where the first adopters are. Reverse innovation is counterintuitive. After all, it is easy to understand why a poor man would want a rich man’s product, but why would a rich man ever want a poor man’s product? Nonetheless, reverse innovation is on the rise. In fact, it will define the next phase of globalisation. Even though developing nations can only ‘catch up with’ the rich world on an income-per-capita basis, they do not follow the same paths of economic development as the rich nations that preceded them. Each will follow their own path. And, in many industries, they will jump ahead of the rich world. When they do, a door for reverse innovation is opened.

What can organisations and systems gain from using the reverse innovation approach? Are there any examples you can share with us? 

In rich-world health care systems, the number one challenge is budget. We have cutting-edge science and we have world-class therapies, but it is increasingly difficult to pay for it all. Some of the best ideas for solving this problem won’t come from the biosciences laboratories, they will come from remote clinics in places like India and Indonesia. If this sounds improbable, consider the following. If we want to figure out how to deliver quality services at dramatically reduced costs, why wouldn’t we look to places in the world where resources are most scarce? If we imagine that our established infrastructure and its many vested interests stand in the way of innovation, why wouldn’t we look to places in the world where the infrastructure is still under construction? And if we think it is a thicket of regulatory requirements that stand in the way of innovation, why wouldn’t we look to parts of the world in which the regulations are just being written? Reverse innovation is a pathway to new thinking and new creativity. The entry requirements are curiosity, open mindedness and a passport.

The reverse innovation example that first caught our attention was a portable ultrasound device developed for use in rural China. The device was a laptop computer with a USB ultrasound probe. The initial thinking was that such a device would be of no interest in the rich world, where expectations for image quality were much higher than the device could deliver. But, the device quickly found its way into the rich world, particularly in applications where space was constrained, such as in the back of an ambulance or in an emergency room.

Why do you place an emphasis on gaining skills in executing innovations and not just searching for the next big idea? 

The high degree of difficulty of executing innovations within established organisations is vastly underappreciated. Many organisations think they are already good at execution, but what they are referring to is execution of day-to-day operations. Comparing day-to-day execution to innovation execution is like comparing a simple somersault to a triple flip with a quadruple twist.

The reason that executing innovations inside established organisations is so hard is that there are deep and fundamental conflicts between innovation and ongoing operations. Furthermore, organisations are not designed for the former, they are designed for the latter. They are designed to be on time, on budget, and on spec each and every day.

What do you see as the main challenges for those wishing to innovate within a system like the NHS? 

The tendency within health care organisations is to imagine that innovation is about improved therapies, which is, in turn, reliant on advances in the biosciences. Today, however, we need to shift our attention to innovation in health care delivery. Here, it is crucial to recognise that you can’t achieve breakthrough innovation without breakthrough organisational design. Of course, it wouldn’t make any sense to reorganise a mammoth enterprise like the NHS on the basis of an experimental idea that may or may not work. Instead, innovations in health care delivery generally require dedicated teams that are organised quite differently – with distinct roles and responsibilities, distinct hierarchies, and distinct workflows. Many organisations try to initiate innovations on the cheap, with a handful of people making part-time contributions. The problem with this part-time approach is that it makes organisational redesign impossible. Only within a dedicated team can you redesign from a clean slate.

How can leaders support a culture of innovation? 

A culture of innovation is one in which every employee contributes to innovation. Many organisations are quite good at doing this. The key managerial tasks are stimulating creativity and motivating action. That said, leaders must set expectations properly. If every employee tried to take the initiative to move a breakthrough innovation forward, the result would be utter chaos. Day-to-day operations would be turned upside down. Some companies are very successful at telling everyone that they can be an innovator, but then face a major backlash when most of the ideas generated have to be deferred. The proper expectations are: every employee can generate ideas, and every employee can take the initiative in pursuit of small improvements in their own immediate area of responsibility. Companies that are particularly adept at setting expectations constantly remind employees that there is no such thing as a ‘small’ innovation. Every small improvement matters.

Chris Trimble’s most recent books

Reverse innovation: create far from home, win everywhere and The other side of innovation: solving the execution challenge.

His presentation at our Annual Conference will be available on our website from 3 December.