All too often, people associate “innovation” with a radical break from the past, what could more accurately be called “disruptive innovation.” Think of how big a change it was to go from the Encyclopaedia Britannica to the open-source Wikipedia, or how much better it is to use a crowdfunding site like Indiegogo compared to previous ways of raising start-up capital.

But innovations come in different forms. Most of the time, innovation is incremental, not disruptive. And that’s not a bad thing. In fact, it’s often a sound practice that over time results in significant improvements in a product or a service. A terrific example of this is the many improvements in health care that have come out of the Mayo Clinic. The Mayo Clinic itself, now celebrating its 150th anniversary, was in some ways a disruptive innovation. At a time when most doctors practiced solo, the Mayo brothers brought together doctors from a wide variety of disciplines to work together in a group practice and deliver integrated care.

Since then, however, most of the innovations arising from the Mayo Clinic have been incremental, not disruptive. And that’s by design. How they do incremental innovation, and why, is the subject of an article in this issue of SSIR, “Design or Disrupt?” by Gabriella Rosen Kellerman.

The article is a review of the new book Think Big, Start Small, Move Fast: A Blueprint for Transformation From the Mayo Clinic Center for Innovation, written by three founders of the Center for Innovation at Mayo, Nicholas LaRusso, Barbara Spurrier, and Gianrico Farrugia. “Is our Pediatric Phlebotomy Chair a disruptive innovation? … Probably not,” they write. “Although it did transform a patient experience, it’s hardly a game changer—and really, that’s by design. Tearing down everything and starting over is not an option in health care.”

Not only is it often unfeasible to introduce radical interventions in health care, the very process of creating advances in health care is often incremental, based on the scientific method that builds on a base of knowledge that others have created. The image that many people have of how scientific discoveries take place (for example, Sir Isaac Newton “discovering” gravity after being hit on the head by an apple falling from a tree) is not how scientific discovery typically takes place. It’s usually an incremental process done by teams, rather than an Aha! moment by a lone person.

All too frequently we forget that incremental change is how progress is often made. A good example of this is the way some people practice philanthropy. Rather than first investigating what has been learned about a particular problem— clean water, say, or sanitation—some philanthropists fund what seems to be a brilliant new strategy by a young social entrepreneur who came up with a novel idea.

This misguided approach to philanthropy is the subject of the article “Known Quantity,” by Achilles Kallergis and Alexandre Lembelet. In this article the authors argue that philanthropists need to base more of their funding decisions on social science, and less on fads and a fascination with the new. That isn’t to say that one shouldn’t experiment or take risks. But these gambles should be conducted with the knowledge of what has been done before.

Read more stories by Eric Nee.

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