Most people tend to think of innovation – whether applied to healthcare or to any other walk of life – as something that involves technology.  And, of course, in many cases it does.  But if we limit our notions of innovation to cool technical gadgets, or blockbuster pharmaceuticals, or even radical systems for collecting, analyzing, and sharing insights from “big data,” we’re missing a tremendous amount of innovation’s true meaning.

You see, innovation is not just a product – a device or pill or the “Internet of Things” – it is also a process that leads up to that product.  And that process has a series of complex steps that we don’t yet fully understand.  Among these steps is for us to utilize the important functions of our minds that are crucial for innovative thinking.  These are commonly referred to, collectively, as “higher-order thinking.”  But we only use this type of thinking on rare occasions (e.g. about five percent of the time) and then, we don’t always use it when we really need it.  The other 95 percent of our thinking is typically spent in routinized, “automatic,” task-oriented thought.

In his landmark book, Thinking, Fast and Slow, Nobel Prize-winning author Daniel Kahneman refers to the differences between this System 2 (higher order) and System 1 (routinized) thinking. [1]  By default, System 1 dominates the thinking habits of everyone – even the most intelligent, highly educated, innovative, and talented people in the world.  Absent any sort of stimulus toward System 2, we are fundamentally a System 1 thinking species.  That means that, by our very nature, we are not overly innovative – at least not during the vast majority of our thinking time.

Cognitive Buoyancy™ (CB) was developed to change all that – to disrupt the default mode of thought.  Not radically, mind you, but incrementally.  CB is defined as the measure of an individual’s propensity to access higher-order thinking.  Examples of this type of thinking include metacognition, critical thinking, mindful reflection, empathy, and “thinking outside the box.”  We all have the ability to think in these ways; the trouble is we don’t always do so when we need to. 

Everyone has an innate level of CB; but that level (I hypothesize) can not only be measured…it can also be developed and increased.  Future pilot studies are planned to generate data that will help confirm this.  CB levels can be raised by way of conditioning through stimulus and response.  And doing so can make you a more innovative thinker – not only in general, but also at vital times when it’s most important for you to be innovative.  For example, at those times when you’re (often subconsciously) deciding what to eat or drink, whether to sit or exercise, when to take your prescribed medication, or how to solve a long-standing health problem.

Cognitive Buoyancy is not just for those of us who are trying to get healthier.  It is also meant to help those who are providing healthcare to us – doctors, nurses, health coaches, and many others.  One of the first pilot studies for CB is scheduled to be run at a hospital seeking to reduce the incidence of diagnostic errors among physicians who must perform such diagnoses.  Its belief is that even a trained and experienced doctor is likely to do a better job by exploring the imagination, at the point of observing symptoms, for alternative possible explanations.  Otherwise, a clinician is most likely to simply settle on the first conclusion that pops into his or her mind.

This exploration is one form of higher-order thinking that leads to innovative results.  It can be stimulated by the physician asking herself not just “what disease do these symptoms suggest?”  But probing further, “what else might they indicate?”  When another doctor asks, and then answers, the first question…and then simply ceases to explore once he gets an acceptable answer, he is sometimes wrong about the actual cause of the observed symptoms.  While such diagnostic errors are not the norm, they can occur as often as 15 percent of the time. [2]  And, in a significant portion of those cases, the result is injury – or even death – to the patient.

Cognitive Buoyancy is a construct that will be tested in dozens of different applications in healthcare alone.  And it is a factor that can have a positive impact on health outcomes through its use by doctors, nurses, insurers, employers, product designers, family caregivers, and of course by patients themselves.  It is not at all an advanced type of technology; rather, CB is an innovation of the simplest form.  It’s all about ascending from the more common, default lower cognitive pathways, and rising up to the “high road” of a more buoyant form of thinking.

Charlie Garland is an innovation thought leader who designed Cognitive Buoyancy as well as application strategies for its use in health improvement.  He is working with HITLAB to engage healthcare organizations globally, testing which of these approaches is optimal for a variety of challenges: reducing diagnostic error, improving health education, enhancing patient safety, and much more.


[1]     Kahneman, D. (2011). Thinking, fast and slow. New York: Farrar, Straus and Giroux.

[2]    Graber, ML. (2013). The incidence of diagnostic error in medicine. BMJ Qual Saf 2013; 22:ii21-ii27 doi:10.1136/bmjqs-2012-001615.