Course Syllabus (2024)

The course uses case histories of transformational advances to encourage and guide innovators in health care and other industries. After describing these ‘ends and means,’ this Syllabus summarizes a simple framework we use in the course, the required pre-class submissions and final paper.  (A downloadable version also includes the provisional schedule and assignments)

Ends and Means.

Popular media routinely tout imminent breakthroughs that often fizzle. We examine advances that indisputably changed medical practice in the last quarter of the 20th century. The case histories suggest that protracted, multiplayer innovations – not solitary breakthroughs – produce transformational results. Yet venturesome individuals who don’t follow the crowd remain crucial.

Engaging stories make the vast number of facts presented in the case histories memorable. But the course treats learning new facts mainly as a valuable byproduct. Instead, we rely on the case histories in two more subtle ways, namely:

Developing skills and judgment, particularly in recognizing opportunities and anticipating problems, adapting ideas from other domains, evaluating alternatives, etc. Learning by doing – or watching – is often crucial for developing ‘skills of the hand,’ such as changing a car tire. But for many ‘skills of the mind and heart,’ learning from past instances is more practical and feasible. For example, studying historical wars and battles has long been an essential part of training military leaders. Moreover, the skills and judgment emphasized go beyond particular techniques (which may become obsolete) and support more than just medical innovations.

Sharpening goals and aspirations. The case histories include stirring stories that showcase the romance of human progress. But they do not praise or preach. They include controversies about the overuse of antidepressants and expensive procedures. Great adventures, they remind us, require great risks and difficulties, and succeeding in what is safe and easy – or just financially rewarding — is not always uplifting. In the coronary bypass case, for example, we encounter a German researcher who fails to “meet the scientific expectations” of his boss, loses his job, switches from surgery to urology, joins the military, and becomes a prisoner of war. Eventually, he gets a Nobel prize but can never secure a professorship because he had not finished his PhD. The boss of the surgeon who performs the first successful bypass forbids him from doing another. An Argentinian who then does many bypasses at the Cleveland Clinic and comes to be known as the ‘father’ of the surgery ends up committing suicide after the institute he starts in his homeland cannot pay its bills.

While the setbacks and failures described may discourage some from attempting great leaps, the case histories should nevertheless inspire many prudent initiatives. Unlike hagiographies of larger-than-life pioneers, the stories have ‘ensemble’ casts. Stars appear but don’t dominate. Rather, the stories show how innovation accommodates a wide range of talents and temperaments. We will see how careful contributions that are not individually revolutionary or risky can, added up, make a significant difference. Therefore, the course should help shape and stimulate your aspirations — but not past your breaking points.

The course’s emphasis on skills, aspirations, and stories reflects my experience of teaching and researching entrepreneurship. Conversations with former students in my entrepreneurship classes suggest that startups’ emotional and visceral aspects and stories leave a more lasting impression than the analytical aspects. When I surveyed graduates of Harvard’s MBA program I asked what they wished they had better learned. Most responses related to skill development (learning to sell, for example) and exposure to the stresses of starting a business. Similarly, my research on high-growth companies suggests that a startup’s success depends more on the founder’s skill and determination than on creative business ideas and models.


A Note on Productive Knowledge provides a “simple walking stick”[i] for analyzing the case histories and discussing advances beyond health care. It treats innovation as a multiplayer process undertaken by and for the many, rather than as an elite, ‘star-centric’ activity. And the Note classifies the distinctive challenges of multiplayer innovation into functions such as goal setting, evaluation and testing, codification, and communication. Like tags and playlists in a music collection, the categories can help order and retrieve observations and inferences drawn from the case histories. The categories, or some version thereof, can also support life-long learning from and “thinking in cases.

The categorization, which (like the skills and attitudes targeted in this course) is designed for more than just medical innovation, will also help broaden the class discussions. For instance, we will discuss the generic challenges of codification along with the Prozac case history. Additional materials and preparation questions (see the daily assignments section of this syllabus) will stimulate these broader discussions, and an extensive optional reading list will help you dig more deeply if you wish.

Pre-class submissions.

The case histories contain specific questions after each section and at the end. Students are required to enter very brief answers (less than ten words) to the questions on an online form by 1 am of the day of each class. I will create slides from the submissions, which I will use to start and continue the class discussion.

The submissions require less than an hour of additional work over the term.

My experience suggests that this modest additional effort provides attractive returns, including: 1) Practice in confronting the uncertainties that innovators typically face. 2). Classes with fewer superficial comments because students are better prepared and, more importantly, have a point of view. 3). Broader participation:  the instructor can draw in the quieter students when the instructor has prior knowledge of their perspective on the case.

Final Paper.

Instead of a final exam, self-selected groups (of up to 3 students) will write papers describing and analyzing the development of a noteworthy (medical or non-medical) advance that has already proven its practical value. Like the final papers written for my entrepreneurship class (see the compilation, Tales from Successful Entrepreneurs) the papers should include: a description of what happened (the “story”); analysis of specific choices (that reflects what you learned in this); and general reflections and takeaways.