As I have lamented before, humans have a hard time with understanding numbers. On top of what appears to be this hard wired weakness are additional fundamental characteristics; the ability to discern order and patterns where none exist and the desire to control our environment (or at least feel as though we are in control). This issue fundamentally colors the way we view success and failure. Perhaps the most enlightening quote from the book came from IBM pioneer Thomas Watson who declared, "If you want to succeed, double your failure rate". This is based upon the assumption that major success is to a great degree based upon chance and it any game of chance, the more bets you place, the higher your chance of winning a wager.
I tried to think how this philosophy could play out in academic medicine. What would happen if I came to my department chair and told him I needed to fail more? What would happen if the Dean of the Medical School came to the Vice President of Health Sciences and asked to place failures on the balanced scorecard with the idea that more is better?
Intuitively I see the merits of making lots of small bets, understanding that many if not most will fail. This is a concept which Nassim Taleb championed in the financial markets. He strongly pushed the wisdom of bleeding a little bit all the time, suffering many small failures, showing patience required to land a really big fish. However, such behavior is not really possible within the confines of large organizations with large vested interests in no fundamental change. True "game changing" innovation means putting the large investment in the old game at risk.