Did you know that out there in the world there are miniature blue penguins? Frankly I had no idea until I saw them for myself last week when I had the good fortune to visit Melbourne, Australia. I am a sucker for wildlife whenever I travel and I was hell bent for leather on seeing some koalas, wallabies and wombats, oh my, when I touched down Down Under.
But lo and behold, turns out that one of the top things to do in Melbourne is to visit the Little Penguins, a colony of over 32,000 little blue waddlers at the Southern tip of Victoria Province on Phillips Island, which juts out into the very rough waters of the Bass Strait between the Indian Ocean and the Tasman Sea. I swear I am telling you all this for a reason, so just stay with me.
Here’s what happens: you and a few hundred of your closest friends sit on the equivalent of high school football bleachers on the beach at sundown and watch the waves role in and out. By the time you are pretty well over watching the water crash over the rocks until it is too dark even to see that well, there appears in the distance a moving white object. And as the object gets closer, you realize it is not an object, but the very fat white bellies of a dozen or so Little Penguins (a species that is about a foot high, roughly 2- 3 lbs, and blue with white tummies) jamming like bats out of hell across the 20 yards or so of sand to their hillside burrows. And then another group of 10-15, then another. It is crazy. Imaging troop after troop of soldiers advancing towards the front, except it’s small blue penguins and the front is miles of grassy hillside habitat.
The penguin valets that manage the crowd estimate that about 3000 of these fat little dudes come ashore at this particular beach, taking the same route every single night. They scurry across the sand and up the remarkably steep and hilly terrain to their homes, traveling hundreds of yards and then, before sunrise, they head back out to the ocean to fatten up on fish and do it all over again. Every day. Every night. And apparently each penguin always takes the same route as he or she took the day before and tends to travel with the same little penguin posse on each trip. From birth to death. The naturalists who presided over the event said that the penguins are imprinted with the specific path to and from the ocean used by their mothers and then follow the same routine, same route, same drill, generation after generation. In other words, they are programmed to never change, even if a decision to move 5 feet to the left would make for an easier and safer path out to the sea and back towards home.
I was blown away by this Penguin Parade, as the locals call it, because it feels so ancient and pre-destined and permanent (although permanent it is not if global warming and habitat destruction continue apace). And damn they’re cute. And here, finally, is your punch line: it reminded me of so many organizations that do the same thing over and over again, reinforcing ancient paths and decisions year after year, in total defiance of the innovation that is going on around them. Just like the people who adopt virtual blinders in the face of the market and technology changes that will make them obsolete and ultimately kill their businesses, these adorable little penguins are on an eternal treadmill which has been programmed, in effect, to create their own set of blinders, even in the face of predators and structural barriers and risk that could be avoided if they considered their options. It felt so very metaphorical; there are so many organizations that run around saying they are innovating or sitting on the cutting edge but who really don’t commit to that in a meaningful way. Eventually they are going to get eaten by predators who have observed their well-traveled paths. And they are nowhere near as cute as fat blue mini-penguins.
Meanwhile, across town, I had the wonderful opportunity to visit with the Murdoch Children’s Research Institute (MCRI) housed at the Royal Children’s Hospital (RCH) in Melbourne. They are an incredibly smart and creative bunch and are so far out ahead on the innovation front, particularly around precision health, that I was embarrassed I didn’t know about it. We in America are always so sure we are the furthest ahead on the innovation front; but we are not always right and we are particularly guilty of donning those blinders that don’t allow us to see what other countries, even small ones, are doing to run right past us while we are busy holding closed meetings to convince ourselves that we are smarter than everyone else.
The very wonderful, if coffee-addicted, Dr. James Dromey, COO of MCRI, gave me a tour of the Royal Children’s Hospital (RCH) and I was blown away by the feel of it. The main floor feels a lot more like the Google campus main street than the usual hospital setting. And my favorite thing on the tour: in the main clinic waiting area, there is a very large enclosure where a meerkat habitat is situated. For those of you who remember your Lion King history, meerkats are not natives of Australia or generally, of children’s hospitals. But the RCH has built this great exhibit to keep the children captivated while they wait for some pretty miserable appointments. As you can imagine, it is a huge hit and surrounded by meerkat groupies at all times.
Meerkats are fun to watch because they are always active, running, digging, playing, but also watching. The meerkats struck me as the antithesis, in a way, of the penguins. In every standard meerkat group (and these groups run about 5-30 strong so not entirely unlike the penguins), there is always, always, always one meerkat whose job it is to be the lookout and to watch the horizon for signs of risk. The sentry meerkat climbs up on a high point and spends an hour or so simply looking all around, watching, scanning, observing in a quest to be sure the unit is preserved. When the sentry sees something worrisome, he signals to the group to get busy moving, digging, going underground, whatever it takes to be sure they are safe. When the hour is up, another meerkat takes the sentry post and so on and so on. The sentry’s job is, in effect, to understand the environment and to respond to it accordingly. Now that sounds like an organization committed to innovation, or at least action leading to self-preservation.
I got lucky and actually witnessed one of the meerkat “changings of the guard,” when one meerkat took over for another on the watchtower they had devised from a tree branch. Only when the new recruit was entirely ready to watch did the old guard step down. Someone was always at the ready, looking for what the future might hold and prepared to respond.
Now granted, the meerkats are largely playing defense. They are not offensively building walls to keep out bird of prey immigrants, but they do create alliances with other animals in a mutual protection scheme. Meerkats are known to build their dens with and share living space with African ground squirrels and yellow mongoose (mongeese?). While I can’t honestly tell you what the meerkats and their friends talk about while they are hanging out underground, I think it’s pretty interesting that they understand the value of improbable alliances, a highly evolved activity I always associate with effective innovators. It is a pretty sophisticated concept to recognize that one may not have all the answers and that joining with others who have different skills can render the entire activity greater than the sum of its parts. True innovators and those who have entirely embraced creative thinking do this wholeheartedly. Those afraid of innovation tend to stay in their own little cliques, rarely engaging with outsiders, not unlike those penguins who travel up and down the beach together with the same crew on the same track day after day, night after night. They say that doing the same thing over and over again and expecting a different outcome is the definition of insanity. I say it is the definition of planning for your own demise.
So as I think about this whole wild kingdom thing, I think about so many of us swirling around the healthcare world: the venture investors who always stick with the same set of co-investors or who invest lemming-like (or penguin-like) around buzzword trends without regard to true market dynamics or evidence of value; the health systems that know they have egregious medical error issues but have managed to continue to profit from the fee-for-service model that doesn’t exactly lend itself to fixing them; and, the health insurers that focus their energy on denying new approaches to treatment as long as they can, rather than sharing in understanding the underlying health economics that might warrant rapid adoption.
I also think about the entrepreneurs that travel down well-worn paths with the same crew, and the same assumptions as always, forgetting to be on the lookout for that which will surpass them on the way to the finish line. It’s hard not to notice that the well-worn path of the last few years is one loaded capital and lacking proof of outcome. So many entrepreneurs have learned to measure success by the amount of money they have raised and not by the impact and value they have created. I personally think we are in for a day of reckoning on this in the very near future. And while I do not wish ill on anyone, entrepreneur or investor, I do think we kind of have it coming. Too many have let their discipline slide just a bit too much, letting the echo chamber drown out the meerkat’s cautionary signal. I do so admire those entrepreneurs who bootstrap as long as they can and who deliver unbelievable bang for not a lot of bucks, particularly in this era when money is relatively easy to come by and multiples of magical thinking form the basis for valuation.
While in Melbourne I had the occasion to hear a presentation by Bruce Thomas, who splits his time between Novartis and the Gates Foundation (a weird combo perhaps but it seems to be working). Bruce spoke about a program he has been driving in China, India and Africa to address the very real and tragic scourge of tuberculosis (TB), a disease which has killed over 1 billion people and counting (about 1.8 million die per year). McDonalds has nothing on TB when it comes to customers served.
Led and funded by the Gates Foundation, and with only $20 million in total funding (less than most digital health Series B rounds), Bruce, his colleagues and a group of grantees have developed a revolutionary means of getting TB patients cured, despite their living miles from treatment clinics, having too few clinicians, and being notoriously non-compliant with the medications that can literally save their lives. The big innovation? Paper. But actually it was patient-centered design built around 99DOTS technology (a model developed by Microsoft Research) that helped overcome the complexity of the treatment process for people who basically gave up on getting better due to the very real difficulties in accessing treatment (often at long distances), confusion about the complex dosing regimen for the drugs they need to take even when accessible, and the stigma of being perceived as sick by friends and neighbors.
The Gates team working on this program developed a simple cardboard drug dispensing unit tied to any usable phone (cellular or not) that helps explain compliance in simple pictures, eliminates the need for most in-person visits, makes the visits efficient when they occur (e.g., doctors get red, yellow or green slips of paper that tell them if the patient has been non-compliant, sort of compliant or entirely compliant with the drug regimen, vastly shortening the visit), and removes risk of stigma through clever packaging that makes the drug packaging look like other products one would normally carry around. It’s quite a feat and one that was borne of a great deal of meerkat-like surveillance that led to great creativity and an entirely innovative approach that was not mired by technology or tradition. For their $20 million total investment, this program has resulted in about 200,000 patient enrollments, 45% improvements in drug adherence in evidence-based studies of its efficacy and a per patient cost of less than $10 for each six month period. Had this team kept their heads down, penguin-style, they would have spent a lot more money to get nowhere near as far.
We in healthcare innovation have a lot to learn from this example: understand your patient as well or better than you understand technology; simplicity is beautiful; capital efficiency, not cash, is king; measurement of outcome is paramount; don’t always take the well-worn path when a better one is available. And always remember to look up, see who is out to get you, and figure out how to out-maneuver them for the long-term.
So all in all a great wild kingdom experience for me and I did get some close up time with koalas and wallabies, though the wombats managed to elude me entirely. I read about a sanctuary where you can be a “Wombassador,” and that clearly is for me on the next trip, should I be lucky enough to return. And yet who would have thought it was the “Australian meerkats” that would leave the strongest impression? No wonder Timon got all that screen time.