"You can't tell people you ran nine miles and expect to ever be treated normally again." At least, according to Marc Parent writing his Newbie Chronicles article in the February 2012 issue of Runners World Magazine. "In the minds of most everyone…instantly you are done for, a gone. You are an "other," a "them." You'll never be one of the old again again…" I know what he means. Not just because I've taken up running - I'll let you know when I hit nine miles - but it's a universal truth isn't it? When you cross over from casual to extreme in anything, you run the risk of becoming a "them." Parent suggests, at least in running, there is a invisible line where people can imagine themselves running the same distance, say two or three miles. Beyond that line, you are into the extreme category.

That's the thing about extremes, they are hard to relate to. Extremes are what attract us to action movies. The idea of someone stowing away to Hong King, kicking a door down, two guns blazing, jumping over fire and rescuing the damsel works because it's a fantasy most of us won't ever live. Extremes can have a way of alienating people. If we can't imagine doing it, sometimes our reaction is to just shut down, or even to become defensive.

Innovations, particularly in conservative industries like healthcare, often trigger the latter reaction. What do you mean 'open a low cost self pay 24/7 clinic in a drug store'? That's not how we do things! And yet, Minute Clinics are popping up everywhere. Anyone remember when the iPhone first came out? The naysayers took to the blogs like…will… internet naysays are wont to do. It will never work, it doesn't even have 3g, they cried.

I've had a similar experience with my diet change. If you tell people you don't eat meat, they generally react favorably. Hey, good for you, that sounds healthy….I'm trying to eat better too. They can imagine themselves having a salad instead of a burger. When you tell someone you are vegan, a perceived extreme, they tend to take a step back and look at you funny. Why the hell would you do something like that? What do you eat, beans and rice? See what I mean about extremes?

Innovation has the same challenges. If you propose something small, iterative, then people can generally wrap their minds around it. Let's extend the hours of our clinic so people can come in after work. That's understandable, we can imagine working an hour later, or flexing staff times. Suggest virtualizing primary care through a series of Skype visits and smart phone apps and you are going to the the nine mile vegan reaction. Why the hell would we do something like that?

I'm increasingly of the opinion a lot of disruptive changes are happening outside of the healthcare industry, in the consumer space. I had an experience recently where I was showing off some consumer oriented health and fitness related apps - blood pressure monitoring, weight management, pulse, and personal health record solutions. All of these are free sites or smartphone apps. The response from industry insiders is usually something like not everyone is as geeky as you are Nick. Maybe, but then why have some of the apps been downloaded millions of times?

It's a catch 22 for healthcare. We are likely past the point of being able to make small tweaks to the model here and there. Regardless if the future holds ACOs, bundled payments, personal mandates or insurance exchanges, someone is going to be the iPhone of healthcare. Someone is going to do that thing the rest of us think is too extreme. They'll run 9 miles, in Parent's terms. The question becomes how we help get traditional provider organizations get onboard? Because, the bottom line is, as an industry, we need to get comfortable with rapid, extreme innovation. If we don't someone else will. Someone else will create the app that diagnoses your patients and allows them to Skype a primary care physician in India. Someone else will sell your patients a health monitoring service. Someone else is going to make money on your re-admissions. Someone else is going to offer a no wait urgent care clinic.