Eliminating ‘innovation’?

Words matter. Different words convey different kinds of meaning. Meaning can vary, depending on context, and so our choice of words matters. For example, you would not describe a person as lazy simply because they were dozing on a chair. The word ‘lazy’ implies a judgement. In choosing to call a person lazy, as opposed to describing them as ‘resting’, we convey a negative judgement about them. If I approve of my colleague taking a nap during a meeting, I will describe them as resting. If I disapprove, I will describe them as lazy.

Similarly, you would not call something an ‘innovation’ unless it represents a positive step-change. The word ‘innovative’ is used to convey the idea that something is both new and better. The ‘innovative’ is intrinsically good and beneficial.  Otherwise, we would simply use a word like ‘new’ or ‘different’. At least, you’d think so, wouldn’t you?

Not so in surgery. The term ‘innovation’ tends to be used to describe anything that is new, and surgeons who are ‘innovators’ are usually lauded as examples of surgical virtue. They are pushing the boundaries of what is possible and improving care.

But things can, and do, sometimes go wrong. Using innovative surgical robots or implanting an innovative artificial windpipe can result in patient death. Innovative use of surgical mesh can lead to a lifetime of horrible discomfort.

The problem is that an innovation is by nature untested. So how can we balance getting the benefits of innovation whilst minimising the risks?

We argue, in our recent paper Hiding behind ‘innovation’: the case for regulated risk assessment in surgery that the first step has to be getting rid of the word ‘innovation’. This isn’t as pointless as it sounds.

As we know, words do matter. When we call a new technique or device in surgery ‘innovative’, we are making a statement that it is both new and beneficial, whether we intend to or not. But, given that it is new, how we know that it is beneficial? The most we can say is that we expect it will be.

Calling a new surgical practice innovative is misleading to patients, because they will assume there is benefit to it for which there is no evidence. Furthermore, it is very difficult to define what counts as innovative at any given time. This means any attempt to regulate innovation in surgery is doomed to fail.  How can you regulate something that cannot be defined?

So, why not just dispense with the word. A word that at best is ambiguous and at worst is willfully misleading. A word that can allow the unethical practitioner to evade regulatory scrutiny and deceive patients, allow the unthinking practitioner to cause unintentional harm in blissful ignorance, or allow the arrogant practitioner to cast themselves as hero.

Instead, let’s just call new things ‘new’. Let’s acknowledge in the language we use that new practices are untested. Let’s carry out a risk assessment every time we do something new in surgery and make it clear to patients what we are doing.

It sounds new. It sounds beneficial, and we think it will be.

But we would not call it innovative.

Paper

Hiding behind ‘innovation’: the case for regulated risk assessment in surgery 

Jonathan Ives, Giles Birchley, Richard Huxtable, Jane Blazeby