Healthy Optimism — September 15

Incremental change

Remember that thing where you’re supposed to give up one of your weekly coffees and put the $5 towards retirement or something like that? If the old-school financial bloggers are to believed (and really, who wouldn’t believe them?), it’s supposed to be the difference between driving a ’92 Ford Taurus and living in an extended-stay motel during retirement versus owning the Ford dealership and having to pick between the mountain house or the beach house.

Ok, so uh, it turns out that $5 a week over 30 years with an average annual return mirroring historical stock numbers isn’t going to buy you a place in Aspen. It’ll get you a simple but decent car (see the handy Morningstar calculator below for proof).

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But maybe — ok, probably — I misunderstood the intent behind that advice. It’s not the $5 that matters, it’s the incremental behavioral change of saying no to some thing AND the incremental change building a habit of “finding” extra money to save. Once I’ve figured out how to consistently save $5 a week, I can build on it.


Point is, incremental change matters. We should talk more about incremental change in health. We should be more excited about about incremental change. Not everything has to be “revolutionary.” Innovation can be incremental. Behavioral change can be incremental and still make a difference.

Rasu Shrestha, Chief Innovation Officer at University of Pittsburgh Medical Center, pointed this out on the podcast in talking about the existing healthcare system:

“A subtle 2 degree, 5 degree shift could in the long run make a remarkable difference with regards to whether you hit that iceberg and, you know, capsize that ship or not.

“The 2, 3 degree, 5 degree nudges that we’re talking about [are] how we’re making decisions, and at the end of the day that’s what innovation really is about. It’s making sure that you’re able to affect behavior change.”

Unlike one person saving only $5 a week, a series of 2 degree shifts propagated across entire hospital systems or patient populations will make a huge difference over time. In the case of health (instead of healthcare), those incremental changes could be the difference between staying healthy and hospitalizations or readmissions. Over time, as populations collectively make incremental changes (let’s go with the lazy examples of eating an extra serving of vegetables and walking slightly more), those habits will be propagated across the community and down to new generations. Behavioral evolution.


Sometimes it’s not slight changes in behavior but in productivity. Maybe because of new technology, maybe rearranging existing methods.

Health:Further 2017 pitch competition winner Twiage saves time for emergency medical personnel in two ways. One is truly incremental, getting the patient’s information from the ambulance to the receiving hospital quicker than current standards:

“If there’s a patient out there that’s having a heart attack or stroke, every second counts for that patient.”

The second time saver from Twiage is not incremental. According to Co-Founder YiDing Yu, the company’s platform can cut ambulance turnaround times by as much as 65%. Cutting something by more than half does not qualify as incremental, so I’ll leave that side of things alone.

With a heart attack or stroke, though, a few seconds — incremental in realtime terms — has the potential to be everything for the patient. Saving seconds is everything. Of course, the turnaround time is also significant for the same reason, just more dramatic.

So here, it’s not behavior but simply increased efficiency, giving a few added moments back where it matters.


Why am I bringing this all up? I guess what it comes down to is I’m kinda tired of everything that’s put in front of us being pitched as the next big thing. Look, I get it. I’m heavily involved in the marketing here at Health:Further and understand the need to catch people’s attention. Still, it gets old when EVERYTHING is turned into the most amazing thing ever. If everything is The Greatest, nothing is.

I think Coke has it right: Instead of making a big deal out of switching from Coke Zero (I’m going to be mourning that loss for a while, btw) to Coke Zero Sugar, they kept things calm. Which is good, because the new product isn’t really all that different from Coke Zero. It’s incremental.

Great! Let’s treat things as they are, especially when it comes to internal conversations within the health community. If there’s a new product that does something useful and can help turn the Titanic by 2 degrees, put it out there and celebrate it for what it does, not try to make it more than it is.

There’s nothing wrong with incremental. Not everything can change the world dramatically. Let’s not pretend otherwise.

I’d also argue that it’s especially important when it comes to health products. As Elisabeth Rosenthal points out in her powerful book An American Sickness, in many cases the FDA doesn’t require new drugs or devices to demonstrate superiority over existing products on the market as part of the approval process. Has that gotten the healthcare industry in the habit of overstating the newest thing, or is it just a product of human nature — we all want to make things as big and exciting as possible? Probably the latter if I’m being fair.

Either way, everyone who touches a product that affects our health needs to know what it is. Whether it’s clearly defining what “organic” food is, or laying out exactly how a health app can (and can’t) improve interactions between a patient and provider, or understanding the relative benefits of a newly approved drug, the producers of those products — I think — need to back off the hype machine.

Even small gains matter, so let’s own them, and work to aggregate them into massive change over time and distance. $5 might not buy a new Tesla, but once we’re in the habit of saving that much, we can make it $10, then $15…