At our institute, we don’t just talk about innovation—we live it. Theories and strategies from some of the greatest thinkers on disruption and discovery guide our work daily. Below, we highlight key quotes from The Innovator’s Dilemma and The Idea Factory, showing how we intentionally follow their advice.

Compiled and coalesced by Will Knechtle

Freedom to explore

“Markets that don’t exist can’t be analyzed.” — The Innovator’s Dilemma

We encourage our teams and innovators to explore uncharted territories, recognizing that traditional market analysis may not apply to truly innovative ideas.

“Good management was the most powerful reason they failed to stay atop their industries.” — The Innovator’s Dilemma

Our institute cultivates a culture that challenges conventional management practices, allowing for flexibility and adaptability in the face of disruptive change. We do not teach a particular management method or software. We balance agile and waterfall methods.

“You get paid for the seven and a half hours a day you put in here, but you get your raises and promotions on what you do in the other sixteen and a half hours.” — The Idea Factory

We encourage our innovators to pursue passion projects and continuous learning outside of regular work hours, recognizing that breakthrough ideas often come from unexpected places.

“The Lab’s policy did not require us to get the permission of our bosses to cooperate.” — The Idea Factory

We require and maintain a degree of autonomy and freedom to collaborate without excessive bureaucratic oversight. Our managers, solutions architects, data engineers, and scientists share the same level of responsibility and fulfill different team roles depending on the project.

Organizational structure: separate yet aligned

“They allow the disruption organization to utilize all of the company’s resources when needed but are careful to make sure the processes and values were not those of the company.” — The Innovator’s Dilemma

We are separate but integrated. We benefit enormously from the IT and healthcare knowledge of the Healthcare System. We also gain from the freedom to research, teach, and learn, which comes from our organizational connection to Duke University. As such, our top priority is value creation for Duke Health and Duke. We fully align with the three-part academic mission to advance healthcare, research, and education.

“They place the disruptive technology into an autonomous organization that can be rewarded with small wins and small customer sets.” …

“What can work is to separate out the disruptive entity, protect it, and let it operate by a different set of rules than the core business.” — The Innovator’s Dilemma

We are organizationally dotted-line separate from the Health System part of Duke Health. This allows for different success metrics and shields our innovators from the pressures of the core business.

“Only the CEO can ensure that the new organization gets the required resources and is free to create processes and values that are appropriate to the new challenge.” — The Innovator’s Dilemma

We were originally funded directly by Duke’s Chancellor for Health Affairs and have maintained a direct line of communication and support from the Health System CEO. We are dependent on and grateful for our executive directorship.

“Once members of an organization begin to adopt ways of working and criteria for making decisions by assumption, rather than by conscious decision, then those processes and values come to constitute the organization’s culture. As companies grow from a few employees to hundreds and  thousands, the challenge of getting all employees to agree on what needs to be done and how it should be done so that the right jobs are done repeatedly and consistently can be daunting for even the best managers.” — The Innovator’s Dilemma

Our small size has helped us manage our work efficiently. Collaborators and executive leadership have remarked that our practical efficiency is a core strength and an example to the rest of the organization.

Innovation through human connection

“Watch what customers do, not just what they say.” — The Innovator’s Dilemma

Our mission is to innovate, which is steps beyond research, invention, and ideation. We are part of Duke aligned with DUHS so that we may observe actual customer behavior and real-time data – rather than relying solely on surveys, focus groups, or retrospective datasets. While we source problems directly from healthcare professionals who interact with patients and can observe actual behaviors and needs, we, in turn, observe the actual behaviors and needs of the healthcare professionals themselves. We pivot accordingly.

“Physical proximity, in Kelly’s view, was everything. People had to be near one another. Phone calls alone wouldn’t do.” — The Idea Factory

Being part of Duke Health and maintaining a mostly in-office policy is by design, allowing us to experience problems firsthand and develop solutions in collaborative spaces that foster face-to-face interactions and spontaneous innovation.

People: expertise and collaboration

“One crucial lesson from Bell Labs is that innovation doesn’t happen in isolation—it happens when experts from different fields interact to solve complex problems.” — The Idea Factory

We mirror this model by bringing together clinicians, engineers, data scientists, and health system leaders to work on innovation projects. Our focus on implementation science ensures that promising ideas aren’t just tested but actually embedded into real-world healthcare practice. We aren’t just about theoretical research—we build usable innovations that change how people receive care.

“Innovation is not the result of individual brilliance, but the collaboration of diverse minds.” — The Innovator’s Dilemma

Our institute prioritizes interdisciplinary collaboration, bringing together experts from various fields to tackle complex challenges.

Long-term thinking and research

“Good management often makes innovation harder, not easier, because it forces organizations to prioritize immediate returns over long-term breakthroughs.” — The Innovator’s Dilemma

DIHI does not rely on traditional ROI-based decision-making when selecting projects. Instead, it prioritizes learning, experimentation, and scaling high-potential innovations even if they don’t show immediate financial returns.

“If you want to create the future, you have to build the infrastructure that allows it to happen.” — The Idea Factory

In addition to the RFA projects or product/service innovation, we study data science and spend intensive time developing our technical infrastructure—our data pipeline and our data engineering framework. We advocate for the freedom to use open-source software and on-premise computing and test minimum viable products outside the Epic ecosystem.

“The most important scientific revolutions always start with someone asking the right question.” — The Idea Factory

Instead of focusing only on solutions, great innovators start by identifying the most important problems to solve—this is the foundation of our RFA process.

Final thoughts

“The men preferred to think they worked not in a laboratory but what Kelly once called ‘an institute of creative technology.’” — The Idea Factory