Innovation — whether in business, technology or health care delivery — is about figuring out how to do something in a new and better way. To succeed we must overcome innovation obstacles and challenges, where one of the most common challenges is the unknown. Fortunately, there are methods and tools for gaining most of the knowledge necessary to innovate; we will discuss some of them in this post.

Into the Unknown

By definition, when you're innovating, you're doing something that hasn't been done before — if not ever, at least by your organization. These things for which you and your organization lack experience represent a deficit that is part and parcel of innovation. This deficit has nothing to do with intelligence or work ethic. What we're talking about is knowledge that arises from relevant experience. Some call this deficit ignorance, which it is. A less dramatic term is knowledge deficit.

Knowledge deficits rarely arise when our organizations are in comfortable routines. In many organizations there is limited experience with overcoming knowledge deficits because what some think of as innovation is really refinement and incremental evolution of earlier, more substantive innovations. In some cases it seems there is no recognition that there are indeed gaps in the knowledge required to accomplish some new goal - while it may be difficult for some to acknowledge.

As a result of quirky predispositions, I've had a lot of experience with knowledge deficits. Starting in the 1980s, there was the first radiology information system based on networked PCs, a touch screen workstation for perfusionists, automated data analysis and reporting for numerous diagnostic systems. In the 1990s and early 2000s, this included fetal monitoring systems, ultrasound modality PACS, automating workflow in interstitial health care markets, patient monitoring systems, automated drug compounding systems, secure messaging, alarm notification and more.

Several years ago I became aware of some deep thinkers who have wrestled with ignorance or knowledge gaps pertaining to the practice of medicine and broader business and technology issues. A professor of surgery at the University of Arizona Medical School, Marlys Witte MD, has made a sustained study of medical ignorance. Stuart Firestein MD, the Chair of Columbia University's Department of Biological Sciences is another explorer of ignorance and sometime collaborator with Witte. David Ing, a systems scientist, business architect and management consultant has written a helpful blog post on inquiring systems and ignorance. From these thinkers we can learn about methods and tools for overcoming the unknown.

6 Categories of Ignorance

The following categories, from Witte, et. al., provide an effective framework for defining the scope of one's ignorance and working to replace that ignorance with knowledge.

  • Known unknowns:
    • The things we know we don't know form the foundation for our effort to eliminate knowledge deficits. We tend to know these things based on our experience in related or adjacent areas to our innovation or what we've learned from initial investigation of the innovation. The boundaries of these known unknowns should be probed in an effort to tease out unknown unknowns.
  • Unknown unknowns:
    • The things we don't know we don't know represent the biggest challenge to plugging knowledge deficits. Logic and reasoning are typically of little or no help here. Observation, feasibility work and consultation with experts are most effective.
  • Errors:
    • Things we think we know, but really don't are errors or mistakes. These are often assumptions or things we've determined are intuitively obvious. Experience shows us that many things in life are counter intuitive and such errors are difficult to overcome. Again, observation, feasibility work and consultation with experts can help identify and correct errors.
  • Unknown knowns:
    • Often there are a few things we don't know we know. This is always a pleasant but infrequent surprise.
  • Denials:
    • These are the things that are too painful to know, so we don't. Denials tend to be emotion-laden issues that are hard to consider like personnel issues, the results of visible organizational decisions or items in which we or others are emotionally invested.
  • Taboos:
    • This is dangerous, polluting or forbidden knowledge, another emotionally laden domain of ignorance. Some taboos are rightly forbidden. Most often, taboos define "unacceptable" choices or decisions within the organization. Those outside the organization (competitors, customers/patients, regulators, etc.) likely have a different view of taboos. The taboos in one organization may be the competitive advantage in another.

Determining the Scope of Knowledge Deficit

Innovation’s knowledge deficits encompass both the innovator and innovatee, i.e., the health care professional, patient or intended user of the innovation. This means that both the solution provider and those expected to adopt and use the innovation struggle with ignorance. Success necessitates filling the knowledge deficit for both innovator and innovatee.

Depending on the innovation, the knowledge gap is often a transitional thing. Once the innovation is developed and implemented, what was a big knowledge deficit becomes just another minor aspect of everyone’s job. Hiring new employees to fill specific knowledge gaps is often overkill and those employees end up laid off or moved into another job as their role in innovation adoption becomes absorbed by the rest of the team.

Many hospitals have created process or quality improvement departments that use LEAN or Six Sigma methods to evaluate current processes and develop innovations to achieve better outcomes. Manufacturers do this too with their Six Sigma black belts, Kaizen groups, etc. These process improvement techniques are very effective for innovations with low to moderate knowledge deficits. But it is not possible to overcome all knowledge deficits with these techniques. Depending on the innovation, some portion of the knowledge needed to succeed must be learned from trial and error or through the use of outside experts.

Arguably the agile software development process is an approach geared to slowly whittle away at knowledge deficits by breaking a system into many small pieces and applying trial and error. As each piece is designed, feedback from testing and prospective users provides the necessary experience to eliminate knowledge errors and to learn many of the things the team didn't know they didn't know. Unfortunately, such an approach does not transfer well to areas like governance and operations.

Tools and Methods

The first step in the process of overcoming the unknown is defining one's ignorance. The goal is to define boundaries around what it is that is unknown about the target innovation.

Start with mapping out what is known and unknown. Organize your map by topics, actors, sequence of events or process; use any logical framework that relates to the innovation and knowledge deficit at hand. Mind mapping software (e.g., xMind or TheBrain), process flow diagrams or just outlining, all work for defining knowledge deficits. Think about categories or frameworks that can help define the knowledge deficit. Examples include:

  • Workflow
  • Use environments
  • Actors
  • Technology
  • Finance (costs, budgets, etc.)
  • Governance/regulatory
  • Needs assessment
  • Manufacturing/procurement
  • Implementation

Filter these regions in your ignorance map through the 6 categories of ignorance listed above.

Observation Is Key

One of the most effective tools for filling knowledge deficits is observation. Don't ask prospective users how they would like an innovation to act or work (they won't know). Ask them about, and especially observe, the current process or methods that are intended to be transformed by the innovation. Now this is something about which they are experts. Once current methods are understood in detail (formal use cases are helpful here), questions for users on current shortcomings, problems, and alternatives to the status quo are much more effective.

Inquiring Systems

Another helpful tool is the set of inquiring systems provided by David Ing.

In his blog post, Ing describes what he calls Inquiring Systems (IS). These are mental models for thinking about and discovering knowledge. When evaluating the knowledge candidates for filling a deficit, think about the inquiring system used, its appropriateness for that situation and the quality of your end result. All knowledge candidates are provisional until they've been validated either through a similar situation or problem or within your innovation project.

  • The first way of knowing is based on objective views and building a consensus pertaining to the knowledge deficit
  • The second way of knowing is also based on objective views, using an analytic or deductive approach
  • Next we get into subjective views of reality where a range of views are captured and assessed
  • Challenge assumptions and different points of view with dialectic IS
  • The last model is a systems approach that encompasses all the previous methods.


In life and innovation, some things just have to be learned the hard way. This often means trial and error as various approaches are applied to a persistent knowledge deficit. Product development, and to a lesser extent process improvement, use a feasibility phase so that teams can try different things to gain experience. Unfortunately, the very nature of feasibility studies or phases precludes using this method to totally eliminate ignorance.

Ultimately, there are just two ways to gain the experiential knowledge your innovation demands: learning through trial and error to gain the necessary experience, or bring in an expert who has the experience. Often gaining experience and knowledge by trial and error is unavoidable. The biggest problem with trial and error is uncertainty. There is no way to know in advance the number of trials and the time required to conduct the trials, that will eliminate a particular knowledge deficit. Uncertainty about scope of effort and time translates into uncertainty about costs.

Depending on the issue, it can be quite cost effective to use an expert compared to the time and effort required to learn by trial and error. The chief advantage of gaining experience through experts is the ability to eliminate uncertainty; projects that eliminate knowledge deficits are often scoped on a not-to-exceed basis with set costs and time frames. If you’re using an expert, be sure things are organized so there’s a transfer of knowledge from the expert to your team.


Hindsight is 20/20 and many innovative solutions seem so logical once they’ve been figured out. The reality is that major portions of a knowledge deficit cannot be reasoned away. Innovation is hard, and ignorance (or more accurately, lack of relevant experience) is one of the key reasons. The processes described can bring a structured and manageable framework for overcoming knowledge deficits. Ultimately, however, experience gained through outside experts or through trial and error is required to eliminate innovation's knowledge deficits.


Vurson, KA, Larrick RP, Klayman, J.  January 2006, Skilled or unskilled, but still unaware of it: how perceptions of difficulty drive miscalibration in relative comparisons., Journal of Personality and Social Psychology

Ing, D. January 2012, The Meta-design of Dialogues as Inquiring Systems, Coevolving Innovations,