Among the many distressing things I saw in Nanded [India], one was the incredible numbers of patients with perforated ulcers. In my eight years of surgical training, I had seen only one patient with an ulcer so severe that the stomach's acid had eroded a hole in the intestine. But Nanded is in a part of the country where people eat intensely hot chili peppers, and patients arrived almost nightly with the condition, usually in severe pain and going into shock after the hours of delay involved in traveling from their villages. The only treatment at that point is surgical. A surgeon must take the patient to the operating room urgently, make a slash down the middle of the abdomen, wash out all the bilious and infected fluid, find the hole in the duodenum, and repair it. This is a big and traumatic operation, and often these patients were in no condition to service it. So Motewar [an Indian doctor Gawande visited] did a remarkable thing. He invented a new operation: a laparoscopic repair of the ulcerous perforation, using quarter-inch incisions and taking an average of forty-five minutes. When I later told colleagues at home about the operation, they were incredulous. It did not seem possible.
Motewar, however, had mulled over the ulcer problem off and on for years and became convinced he could devise a better treatment. His department was able to obtain some older laparoscopic equipment inexpensively. An assistant was made personally responsible for keeping it clean and in working order. And over time, Motewar carefully worked out his technique. I saw him do the operation, and it was elegant and swift. He even did a randomized trial, which he presented at a conference and which revealed the operation to have fewer complications and a far more rapid recovery than the standard procedure. In that remote, dust-covered town in Maharashtra, Motewar and his colleagues had become among the most proficient ulcer surgeons in the world.
I came across this story yesterday on a flight back from Austin, where I was speaking to a group about social media marketing — only instead of speaking to the group, I ended up speaking with them, and learning as much from them as they learned from me.
This happens most times I speak — it's how the world works now. If you're a top surgeon at one of the world's leading hospitals, you should expect doctors in India to teach you new ways of operating on ulcers. If you give talks on social media marketing, you should expect the people at your talks to introduce you to new ways of building businesses on Facebook. Innovation is now democratic.
This is a big change for businesses. Information monopolies — expertise — used to be a core competitive advantage for many companies. Now those monopolies are gone; almost everybody has access to the same information.
So, as an entrepreneur or a business owner, how do you deal with this shift? I think John Hagel has the answer. He explains:
We are moving from a world where the source of strategic advantage was in protecting and efficiently extracting value from a given set of knowledge stocks – what we know at any point in time. As knowledge stocks depreciate in value at an accelerating pace, the focus of economic value creation shifts to effective and privileged participation in knowledge flows. Finding ways to connect with people and institutions possessing new knowledge becomes increasingly important. Since there are far more smart people outside any one organization than inside, gaining access to the most useful knowledge flows requires reaching beyond the four walls of any enterprise.
When I think about what we need to do at HubSpot, I don't think much about building some ephemeral internal expertise — instead I'm focused on how we can become curators of expertise everywhere.