Exothermic innovation: Look beyond start-up costs and focus on the energy needed to keep change progressing

Exothermic and endothermic reactions

All reactions require some external energy to get started, or else they would have happened already. Chemists use the term “activation energy” to describe the energy that is needed to start converting reactants into products. However, once their activation energy requirements have been met, there is a big difference between chemical reactions that are net energy releasing (exothermic) and those that are net energy absorbing (endothermic).

Figure 1 presents exothermic and endothermic chemical reactions, using double-pointed blue arrows to show how both require activation energy. Figure 1 also shows that exothermic reactions are net energy releasing because the energy level of their reactants is higher than the energy level of their products. A fire symbol is used to represent exothermic reactions in Figure 1 because a campfire is one example of an exothermic reaction. The ash produced by a campfire has less energy contained in it than the wood that burns, and the difference in energy is released in the form of heat and light.

Figure 1: Exothermic and endothermic chemical reactions

Conversely, endothermic reactions absorb energy because the energy level of their reactants is lower than the energy level of their products. Figure 1 uses a diamond symbol because making synthetic diamonds is an example of an endothermic reaction, where diamonds have more energy than the carbon powder used to produce them, and energy in the form of massive pressure and heat is required to make them.

Though activation energy is the first energy requirement of both exothermic and endothermic reactions, it is not the most important factor when considering their spread and sustainability. Put another way, it does not matter much whether one or five matches are needed to get an exothermic campfire started. As long as there is a sufficient supply of reactants, exothermic reactions can be self-fueling because the energy released by one reaction serves as the activation energy for subsequent reactions. In contrast, the moment that the supply of external energy is withdrawn from an endothermic reaction, it comes to a dead stop.

Exothermic and endothermic innovations

Just like chemical reactions, all innovations require some activation energy to get started, and then they release or absorb energy. While it is natural for innovators to focus on the costs and resources required to get an innovation off the ground, the steady-state energy requirements are what matter the most for sustainability and spread.

Table 1 presents a subset of the 587 interventions from the paper “Five‐hundred life‐saving interventions and their cost‐effectiveness” authored by Tengs et al. in the journal Risk Analysis in 1995. The diamond symbols are scaled based on the cost per life year saved of each intervention.

Table 1: Examples of exothermic and endothermic traffic and road safety interventions¹

Obviously, the costs (and cost-effectiveness) of these interventions would be different today than in the 1990s. However, Table 1 makes a point that is as relevant now as ever: interventions with similar objectives can have very different cost profiles.

In fact, Tengs and colleagues found that a minority of the interventions they studied — just over 10 per cent of the 587 interventions — had a cost per life year saved that was less than or equal to zero. In the language of this article, these would be fire-like exothermic innovations because they produced a benefit that exceeded their costs.

For most of the other interventions studied by Tengs et al., and for most innovations, it is a matter of deciding how much people are willing to invest on an ongoing basis to get the benefits they are seeking. Of course, there are diamond-like endothermic innovations that are beneficial and necessary. However, because they require a continuous source of energy, endothermic innovations should only be selected in the context of an ongoing commitment to support them, or at least a high likelihood of that commitment coming.

Though Tengs’ paper focused on costs, the energy inputs and outputs associated with innovations can take many forms, including money, time, human resources, social capital, or political capital.

Consider the uptake and spread of hand-held calculators in the late 70s and early 80s. After the cost of calculators dropped to a range that was affordable for many, people wanted a calculator as soon as they saw a work colleague or fellow student use one. The low cost made it possible for more people to get calculators, but the benefits in terms of increased accuracy and decreased time to perform calculations are what made them exothermic and self-spreading.

Once one looks beyond the initial “activation energy” investment and understands the difference between energy-releasing exothermic innovations and energy-absorbing endothermic innovations, exothermic options are the obvious choice. And generally, the best choice for any single stakeholder will be their most exothermic innovation option (e.g., the largest fire symbol in Figure 2).

Figure 2: Innovation choices informed by consideration of exothermic and endothermic characteristics

Different stakeholders have different perceptions of the same innovation option

Atul Gawande provides examples of what can be understood as exothermic and endothermic innovations from the 19th century in his essay Slow Ideas (Gawande, 2013). Gawande discusses how virtually every hospital in America and Britain adopted anesthetics within seven years of their introduction in 1846. On the other hand, though sepsis killed up to half of those who underwent major surgery at the time, Lister’s groundbreaking work on antiseptic surgery, published in 1867, was not rapidly integrated into practice. Gawande notes, “Although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure. Listerism, by contrast, required the operator to work in a shower of carbolic acid. Even low dilutions burned the surgeons’ hands.”

Gawande’s anesthesia and Listerism examples highlight two important points. The first is that the innovation that spread was beneficial from multiple perspectives. This makes sense — an innovation is not likely to be taken up and sustained if a stakeholder involved in its delivery or receipt does not view it as beneficial. Secondly, Gawande shows that an innovation that was highly exothermic from one perspective (Listerism saving the patients’ lives) may be less desirable, or even harmful, from the standpoint of another stakeholder (Listerism burning doctors’ hands). In other words, from the start, anesthesia was exothermic for both patients and surgeons while Lister’s method was exothermic for patients but had a downside for doctors.

Assuming some due diligence is done, all the innovations within a single stakeholder’s circle of options will be exothermic or endothermic from their perspective. However, other stakeholders may have different views. For example, Figure 3 shows how the most exothermic innovation option for Stakeholder 1 is unacceptable to Stakeholder 2.

Figure 3: Stakeholder 1’s preferred exothermic innovation is toxic to Stakeholder 2

Undoubtedly, part of how any given stakeholder assigns a “label” to an innovation depends on quantifiable facts. Stakeholders make choices based on evidence, including measurable benefits and costs. But it would be wrong to assume that the perceived innovation label is assigned solely based on hard facts and quantitative inputs. Colloquial evidence, including the culture, expertise, views, values, and realities that stakeholders experience, also has a significant effect (Lomas et al., 2005).

In practice, there are many non-exclusive labels that stakeholders might assign to innovation options. Table 2 presents five simplified labels that reflect significantly different perspectives alongside examples of the language a stakeholder may use if they have mentally assigned one of the labels to an innovation option.

Table 2: Simplified labels that stakeholders may apply to an innovation option

Leveraging dissent to identify options supported by multiple stakeholders

It is important to understand how stakeholders perceive innovations before there is an investment in implementation. For one thing, if an innovation option is viewed as toxic by a stakeholder who is involved in its delivery or receipt, the likelihood of long-term success is low.

Also, while it may be disheartening for a person or group proposing an innovation to hear negative responses to it, surfacing dissent among stakeholders early in the innovation process is a crucial step toward identifying options that are desirable and sustainable from multiple perspectives.

For example, Figure 4 shows how innovation option C is the best overall choice when the perspectives of Stakeholder 1 and Stakeholder 2 are both taken into account. Option C is not the most exothermic option (i.e., the largest fire symbol) for either stakeholder, but it is exothermic, self-fueling, and desirable from both stakeholders’ perspectives.

Figure 4: Stakeholder 2’s perspective helps identify a mutually agreeable innovation option among those articulated by Stakeholder 1

Even better, by serving as the reason for stakeholders to come together, the task of selecting an innovation can give rise to generative relationships which produce improved innovation options that no single stakeholder could have produced alone (Zimmerman & Hayday, 1999). The existence of new innovation option X in Figure 5, which is highly exothermic for both stakeholders, could not be foreseen in advance of the two stakeholders coming together. Innovation option X in Figure 5 is created by the interaction between the two stakeholders.

Figure 5: Working together, Stakeholder 1 and Stakeholder 2 generate the new innovation option X

Diversity, complexity, and innovation

Most innovations will involve and affect multiple stakeholders. For example, health innovations often involve and affect patients, families, physicians, nurses, allied health professionals, administrators, government policymakers, social service providers, private sector organizations, and others.

Though involving multiple stakeholders increases the time and effort required to find an innovation option that works for everyone, the greater the diversity of stakeholders, the better the innovation (Page, 2010). Teams, groups, and even societies innovate through the iterative application of perspectives and approaches to problem-solving and learning. Increasing diversity increases the number of options and approaches to solving a problem or responding to an opportunity (Page, 2010).

The incorporation of different stakeholders’ perspectives is also important for practical reasons. Rarely, if ever, will an innovation in a complex system be built from scratch. Innovations will often integrate existing building blocks of resources, assets, processes, and roles, modifying and connecting them to create something new that works in the current context. This simply cannot be done without the participation of the stakeholders most responsible for the building blocks.

Notwithstanding the benefits of involving stakeholders with different perspectives, as the number and nature of stakeholders increase, complexity increases, and it becomes harder to identify a subset of innovation options that stakeholders agree on (see Figure 6).

Figure 6: Increasing the number and nature of stakeholders decreases the overlap between all stakeholders’ supported options

In those cases, the innovation lead(s) need to acknowledge that significant time and effort and an inclusive process (Treviranus, 2018) will be needed to identify an innovation option that all stakeholders support.

Many excellent books and articles provide guidance about how to negotiate agreements when multiple stakeholders are involved in an activity or decision. In the context of this article, and with full attribution to “Getting to Yes” (Fisher et al., 2011), the key point is that the process is more about uncovering consensus than building consensus. If an innovation option is toxic to a stakeholder, or endothermic to the point that its costs (in all forms) vastly exceed its benefits, it is better to seek out other options than try to get the stakeholder to agree to something that just will not work for them.

Even when there is open and generative dialogue, it may not be possible to identify an innovation that all stakeholders support, or at least do not oppose. In such cases, exothermic potential can be a guide. If the only practical options are endothermic and require continuous investment, and stakeholders involved in their delivery or receipt do not support them, it may be better to pause than forge ahead.

This does not mean giving up forever. In complex systems, context changes constantly, and some external changes can be advantageous.

Change the context, change the perception of an innovation option

In Slow Ideas, Gawande notes that Lister’s antiseptic surgery spread decades after its introduction.

The key message to teach surgeons, it turned out, was not how to stop germs but how to think like a laboratory scientist. Young physicians from America and elsewhere who went to Germany to study with its surgical luminaries became fervent converts to their thinking and their standards. They returned as apostles not only for the use of antiseptic practice (to kill germs) but also for the much more exacting demands of aseptic practice (to prevent germs), such as wearing sterile gloves, gowns, hats, and masks. Proselytizing through their own students and colleagues, they finally spread the ideas worldwide. (Gawande, 2013)

Using the innovation symbols presented in Table 2, framing surgeons as scientists changed the surgeons’ views of antiseptic surgery from something toxic to a diamond worth investing in.

In addition to deliberate changes implemented by policymakers, professional associations, and other stakeholders, environments often change based on trends that emerge from complex systems. Many stakeholders feed and influence trends, but they are beyond any single stakeholder’s control. The trends are like waves that move across and through societies. Trends can be destructive or forces that carry innovations forward (see Figure 7).

Figure 7: Trends are like waves that can destroy or propel innovations

Emergent trends also explain why the best exothermic innovation developed this year is unlikely to be an effective and high-impact innovation ten years from now unless there is a process to adapt and update the innovation.

Catalysts and leadership

To summarize, and as noted by Heifetz & Linsky (2017), innovating in complex systems is hard. Multiple perspectives need to be taken into account, and even when an innovation that works for all stakeholders is identified, the context can change, requiring adaptation.

It is a wonder that change ever happens. But it does, thanks to the work of dedicated people who serve as leaders, animators, conveners, facilitators, knowledge brokers, advocates, and champions of innovation. These people are catalysts in that they take down or lower barriers to change.

Though their heroic efforts are admirable, there may not be enough catalytic leaders in the world to carry the burden of full-scale system-wide endothermic innovation in perpetuity. That is why exothermic options are so important. Focusing efforts on innovation options that are exothermic from multiple perspectives increases the likelihood that benefits will be realized without burning out the catalytic leaders we rely on to make the world a better place.

Acknowledgements

Sincere thanks to the people who have helped flesh out these ideas and refine how they are presented: Whitney Berta, Adalsteinn Brown, Jenna M. Evans, Kim J. Honey, Caroline Proctor, Michael J. Schull.

The illustrations in this article were created for a fee by Margarita Yudina.

References

Fisher, Roger, William L. Ury, and Bruce Patton. Getting to yes: Negotiating agreement without giving in. Penguin, 2011.

Gawande, Atul. “Slow ideas.” The New Yorker July 22, 2013. https://www.newyorker.com/magazine/2013/07/29/slow-ideas

Heifetz, Ronald, and Marty Linsky. Leadership on the line, with a new preface: Staying alive through the dangers of change. Harvard Business Press, 2017.

Lomas, Jonathan, Tony Culyer, Chris McCutcheon, Laura McAuley, and Susan Law. Final Report — Conceptualizing and combining evidence for health system guidance. Canadian Health Services Research Foundation, 2005.

Page, Scott E. Diversity and complexity. Princeton University Press, 2010.Treviranus, Jutta. “The three dimensions of inclusive design: Part one.” Medium (2018).

Zimmerman, Brenda, and Bryan Hayday. “A board’s journey into complexity science: Lessons from (and for) staff and board members.” Group decision and negotiation 8, no. 4 (1999): 281–303.

Endnotes

[1] The diamond symbol for the $310 cost for each of life saved by the public pedestrian safety information campaign is set at 100% and other diamond symbols are scaled down proportionately. In the absence of quantitative information about cost savings for the driver improvement school intervention, the fire symbol for it is the same size as the diamond symbol for the public pedestrian safety information campaign.