Competing Against Luck: The Story of Innovation and Customer Choice

by Clayton M. Christensen

Intensive care medicine offers a perfect example. In 1952 surgical pioneer Dwight Harken (who also happens to be the grandfather of coauthor Taddy Hall) noted that, while patients were routinely surviving increasingly complex surgical procedures, alarming numbers were dying in post-op recovery because patients were simply transferred from the surgical theater back to the general wards. There simply was no set of processes to ensure that fragile patients in critical care would receive the array of interventions required for survival. In short, the critical-care job had no owner within any one of the hospital’s established medical functions.4 The radical question Harken asked himself was, “How is it that everyone’s doing what they’re supposed to be doing, all of the hospital’s existing processes are functioning as designed—yet patients are dying?” Something wasn’t right. In posing the question, Harken created the space in his mind to continue to seek and find the answer. His ensuing insight enabled him to pioneer the concept of intensive care medicine as we know it, leading to the now ubiquitous intensive care unit that we’ve come to take for granted. This was only possible by the realization that the hospital’s preexisting processes were failing to deliver desired patient experiences—in this case, successful surgical recovery and survival. My colleague at Harvard Business School, Ethan Bernstein, spent two years away from HBS working with Elizabeth Warren to set up the Cons...