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I think it’s important to reason from first principles rather than by analogy. The normal way we conduct our lives is we reason by analogy. [With analogy] we are doing this because it’s like something else that was done, or it is like what other people are doing. [With first principles] you boil things down to the most fundamental truths…and then reason up from there. – Elon Musk
First principles thinking, the practice of breaking down complex problems into their fundamental truths, has roots stretching back to ancient philosophy. Aristotle first formalised the concept, emphasising the importance of questioning all assumptions about the world and seeking foundational knowledge.
First Principles thinking is about creating new models of reality whereas analogy thinking is just comparing existing ones.
So if you want to , for example, set about improving the NHS, most people will start by analogy comparing how proposed improvements could build on the existing model.
First principles does away with that. We’d start with a fundamental truth – people get sick and eventually they will die. How might we prevent that? Build your thinking from there.
I was thinking about first principles this week on my visit to the Alder Hey Children’s Hospital in Liverpool, with the Disruptive Innovators Network. This wasn’t just a tour of a hospital; it was an immersion into their remarkable Innovation Lab – a hidden world beneath the bustling wards, a “batcave” where cutting-edge technology and disruptive thinking is transforming the lives of young patients.
I say first principles as Alder Hey doesn’t look like a hospital. From the exterior it resembles a kind of four star all-inclusive hotel and from the interior an airport (a good one – say Singapore Changi). Amazingly it doesn’t smell like a hospital either, they’ve designing out that medical smell that causes anxiety to any repeat in-patient.
Alder Hey’s dedication to innovation isn’t a recent phenomenon. Eight years ago, the Bromford Lab team recognised the hospital’s forward-thinking approach during their own visit. Even then, Alder Hey was pioneering the use of 3D printing to create models of spinal deformities, helping clinicians better understand and treat their patients. They were also exploring the potential of virtual reality, allowing surgeons to “step inside” a patient’s heart to visualise complex cardiac issues before surgery. These early examples illustrate a deep-rooted commitment to leveraging technology for the benefit of children.
A Culture of Innovation, From Top to Bottom:
The Innovation Lab isn’t just a showcase for impressive technology; it’s a testament to a culture where innovation thrives. Ideas are encouraged and nurtured, whether they originate from a seasoned surgeon or a frontline nurse. It’s a best in class model for any organisation seeking to foster a spirit of creativity and problem-solving.
It seems Iain Hennessey, the Co-founder & Clinical Director, is the guardian of that culture, and the fact he is a practicing clinician as well as a left-field innovator possibly imbues him with a power and authenticity that many internal innovation teams do not have.
The Batcave is an interesting concept – it’s physically modelled on the temporary ‘bat garage’ in The Dark Knight film in 2008 – as it’s literally bottom up in the basement of the hospital. This is pretty unique, meaning problems can flow up and down, and novel solutions are proposed upwards.
Hennessey admits it’s not perfect, that there’s always a ‘frozen middle’ that will be resistant to change, (“There are some things you can waste all your innovation firepower on – it can be like an innovation Stalingrad’) and that you take the early adopters as you find them. High potential opportunities for change can be identified by both patients, their families and staff, with the ideas triaged by the innovation team.
They’re not just fascinated by shiny new gadgets; they’re driven by a desire to make a tangible difference in the lives of children. This commitment to practical solutions is evident in their innovations:
- The Distancer: This simple yet effective tool, created using 3D printing, helps staff open doors and press buttons without direct contact, minimizing the spread of infection.
- Little Hearts at Home allows babies with serious heart conditions to be monitored remotely. Nurses record vitals at home, and the platform alerts Alder Hey’s cardiac team to any concerns. This reduces hospital stays, improves outcomes, and enhances the patient experience for families.
- ALDERHEY@NYWHERE is revolutionising children’s healthcare by creating a “hospital without walls.” This digital platform combines virtual and in-person care through remote monitoring, telehealth appointments, and personalised care plans. It aims to improve access, enhance the patient experience and shift towards preventative care, all while empowering children and families to actively manage their health.
So, why hasn’t this approach spread to other parts of the NHS, which still uses fax machines and pagers? (Hennessey points out that the biggest users of pagers are “Drug dealers, Hezbollah and the NHS”)
Just like the housing sector, innovation in the NHS faces hurdles due to its complex structure, with various stakeholders (providers, payers, patients) having different priorities. Financial constraints, regulatory hurdles, and risk aversion hinder adoption of new technologies and treatments. A fragmented system, lack of incentives, and resistance to change within the NHS further contribute to slow innovation uptake.
Innovations can and do spread, but innovation approaches rarely do as it’s as much about culture and hard work as process.
If you really wanted to solve a problem like the NHS, you’d go back to first principles.
Step into a new world rather than try and optimise the old.
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