Innovation depends on more than having a good idea. A new approach must also earn acceptance from the people expected to use it, and that process can take years. In his account of introducing arthroscopy and other ideas in orthopedic surgery, Lanny Johnson, M.D. describes what it means to pursue innovation while facing skepticism, professional resistance, and limited early recognition.
His experience offers a practical lesson for anyone working to introduce change: overcoming resistance to innovation requires evidence, patience, persistence, and a willingness to let an idea develop beyond its original form.
Why people resist new ideas
A new idea can be difficult to accept when it challenges established practice. People who have spent years developing expertise in one approach may question why it should be replaced. In medicine, where decisions can affect patient care, skepticism also raises an important question: does the proposed innovation offer a sound reason to change?
Dr. Johnson experienced this tension while introducing arthroscopy, a technique that allows surgeons to examine and treat structures inside a joint through small openings using a camera and specialized instruments.
The technique did not immediately gain broad acceptance. Dr. Johnson recalls that surgeons questioned the point of looking through a small opening when they could open the joint and see the area directly. The familiar approach had an obvious appeal, while the newer technique required practitioners to reconsider how surgery could be performed.
The resistance was not limited to technical questions. Dr. Johnson describes facing criticism from colleagues and professional organizations as he pursued the technique. He says he was excluded from the Michigan Orthopedic Society for 11 years and later encountered further resistance within a sports medicine organization.
These experiences illustrate how innovation can challenge professional expectations as well as established methods.
For someone introducing a new idea, the response can be discouraging. Yet criticism alone does not establish whether an idea is useful or ineffective. The more productive question is whether the concerns can be examined, answered, and tested against evidence.
The lesson is to distinguish reasonable scrutiny from automatic rejection. New ideas should be evaluated carefully, but established practice should not be treated as beyond question simply because it is familiar.
How innovation moves from an idea to adoption
An idea, an invention, and an innovation are related, but they are not identical. An idea proposes a possibility. An invention turns that possibility into something tangible. Innovation involves getting the new approach accepted and used.
That final step can be the most difficult.
Dr. Johnson’s account of arthroscopy illustrates how adoption can lag behind technical development. He traces early interest in the technique to the 1960s, recalls its presentation at a major orthopedic meeting in 1968, and says he performed his first arthroscopy in 1972. Motorized instruments followed in 1978.
Despite this progress, he recalls that a 1982 survey found only half of orthopedic surgeons considered arthroscopy a good idea, with adoption lagging further behind approval.
The figures he recounts offer a useful distinction: agreeing that a new technique has merit is not the same as changing how one works.
Adoption may require practitioners to learn new skills, obtain unfamiliar equipment, revise established routines, and develop confidence in the results. Even when a concept appears promising, these practical demands can slow its use.
Dr. Johnson’s experience also shows why the earliest version of an innovation should not be confused with its eventual form. The instruments and cameras available during the early years of arthroscopy differed from those that developed later.
A new technique may initially seem awkward or impractical because the supporting technology has not matured. That possibility deserves consideration, although it does not mean every early idea will eventually succeed.
For innovators, the practical task is to make progress visible. Explain what the idea is intended to accomplish, demonstrate what can be achieved with the current version, and identify what still needs improvement. Adoption is more likely to be a process than a single moment of acceptance.
Why timing matters when introducing change
An idea can be rejected because it is poorly supported. It can also struggle because the people, tools, or circumstances needed to use it are not ready.
Dr. Johnson’s early work with electronic medical records illustrates the importance of timing. He describes developing a system in 1980 that contained more than 4,000 cases. It included touchscreen patient-history intake and the ability to print a history for review.
He recalls that patients, including older adults, responded positively to the system. Yet the work received limited attention.
His experience raises a useful distinction between demonstrating that something can work and creating the conditions for it to spread. A promising early system may still need better technology, wider awareness, institutional support, or a practical route to adoption.
The same issue appears in his account of measuring pain. In 1990, Dr. Johnson conducted and published a study involving 1,000 consecutive cases, measuring pain rather than pain tolerance. He recalls that the work attracted little exposure.
These examples show that recognition does not necessarily arrive in proportion to the effort invested or the importance an innovator places on an idea.
Timing, visibility, and readiness can affect how a proposal is received. But limited attention is not proof that a project was ahead of its time, just as early enthusiasm is not proof that it will succeed.
A useful response is to examine what is missing. Does the idea need stronger evidence? Is the technology ready for practical use? Is the intended audience able to understand the proposal? Would a smaller demonstration make its potential easier to evaluate?
Those questions help an innovator decide whether to improve the idea, change the way it is presented, find collaborators, or wait for circumstances to change.
Build credibility through documentation and evidence
Persistence matters, but persistence alone is not enough. An innovator also needs a credible record of what was done, why it was done, and what the results showed.
Dr. Johnson recommends documenting the work carefully. His advice includes reviewing existing literature, keeping good medical records, collecting visual evidence, being transparent, drawing reasonable conclusions, and publishing findings.
These practices serve a practical purpose. They allow other people to examine the proposal rather than relying solely on the innovator’s confidence in it.
A disciplined approach to documentation can include:
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Reviewing previous work. Establish what is already known and explain how the proposed idea differs from existing approaches.
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Keeping clear records. Document methods, observations, and results so the work can be evaluated later.
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Using visual evidence where appropriate. Images and other records can help explain what was done and what was observed.
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Being transparent about limitations. Separate what the evidence demonstrates from what remains uncertain.
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Publishing the findings. Give others an opportunity to examine the work, question its assumptions, and build on it.
Dr. Johnson also describes the difficulty of publishing work that challenges established thinking. He recalls examples of surgical innovations that struggled to find a place in established journals.
The broader lesson is that rejection from a publication or institution does not, by itself, settle the merits of an idea. Nor does persistence guarantee that a rejected proposal is correct. The evidence still has to withstand scrutiny.
In medicine especially, that distinction matters. A novel technique must be assessed for its safety, effectiveness, and appropriate use. An innovator’s personal experience can explain why an idea deserves examination, but it cannot replace rigorous evaluation.
Credibility grows when claims are proportionate to the evidence and other people can assess the work independently.
Let the innovation evolve beyond its first version
An early version of an idea often looks different from the approach that eventually develops. Dr. Johnson argues that critics can focus too narrowly on the first iteration and fail to consider how the concept might improve.
He compares this tendency with early automobiles and aircraft. The first versions of a technology do not necessarily resemble the more developed forms that follow. In his account, arthroscopy provides a similar example: cameras and instruments continued to change after the technique’s introduction.
The principle is not that every rough prototype deserves adoption. It is that an idea should be assessed in context, including its current limitations and the realistic possibilities for development.
Dr. Johnson’s experience with shoulder surgery offers a more specific illustration. In 1982, he used metal stapling to treat shoulder dislocation by fixing the anterior capsule. He later saw a similar treatment objective pursued with suture anchors in 2021.
The techniques were not identical. The example shows how a clinical objective can persist while the means of achieving it change.
For innovators, this creates an important distinction between the purpose of an idea and the details of its first implementation. If the initial method proves difficult to use, the underlying problem may still deserve attention. Different materials, tools, or techniques may offer another route.
A constructive response to criticism is therefore to ask what, precisely, has failed. Is the central concept unsound, or does the current version have limitations that could be addressed? Which parts of the idea are essential, and which could change?
This approach leaves room for improvement without treating the original proposal as automatically correct. It allows an innovation to develop in response to evidence, practical experience, and the contributions of others.
Collaboration can help an idea reach further
Innovation rarely develops in isolation. Other people may recognize possibilities the original inventor did not anticipate, adapt a concept to different circumstances, or build the infrastructure needed to extend its use.
Dr. Johnson describes James Andrews as a surgeon he influenced and credits Andrews with expanding ideas into a large institute and other facilities. In Johnson’s telling, the outcome illustrates how a shared vision can take an idea beyond the work of one individual.
Collaboration can make a difference at several stages. Colleagues can challenge assumptions, help assess evidence, identify practical problems, and develop a technique in ways its originator did not foresee. Organizations can also provide the resources and structure needed to turn a promising approach into established practice.
That does not mean every collaborator will agree on every detail. Useful collaboration often involves disagreement, particularly when people have different expertise or responsibilities. The goal is to make the idea stronger, not to protect it from scrutiny.
Innovators can encourage this process by explaining their reasoning, sharing relevant documentation, acknowledging uncertainty, and remaining open to changes that improve the proposal.
They should also recognize that an idea’s eventual form may differ from the original. The contribution of an innovator is not always to create the final version. Sometimes it is to identify a problem, demonstrate a possible solution, and give others a starting point.
Practical lessons for overcoming resistance to innovation
Dr. Johnson’s experiences point to several actions that can help people introducing new ideas.
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Define the problem clearly. Explain what the current approach fails to address and what the proposed change is intended to accomplish.
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Make the case with evidence. Use records, observations, demonstrations, and relevant published work to support the proposal.
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Expect questions. Treat reasonable criticism as an opportunity to identify gaps and improve the idea.
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Separate the concept from its first version. Determine which limitations are fundamental and which might be addressed through further development.
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Be patient about adoption. Technical progress, professional acceptance, and widespread use may occur at different times.
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Invite collaboration. Seek people who can test assumptions, offer different expertise, and help develop the idea further.
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Remain willing to revise. Persistence is most useful when combined with a willingness to respond to evidence.
These actions cannot guarantee acceptance. Some ideas will prove impractical, some will require substantial revision, and others may never find a suitable application. The point is to give a proposal a fair, evidence-based evaluation rather than allowing either enthusiasm or resistance to determine the outcome in advance.
Frequently asked questions
Why is it so hard to introduce a new idea?
A new idea can challenge established routines, professional assumptions, and familiar ways of working. People may also have legitimate questions about its practical value, reliability, or risks. Addressing those concerns requires more than enthusiasm for the idea.
Does resistance mean an innovation is a bad idea?
No. Resistance alone does not establish whether an innovation is good or bad. The proposal needs to be evaluated on its evidence, limitations, and intended purpose. Some ideas withstand scrutiny; others need revision or should not be adopted.
How long does it take for an innovation to be accepted?
There is no single timeline. Acceptance depends on the idea, the evidence available, the readiness of the people expected to use it, and the practical requirements of adoption. Dr. Johnson’s account of arthroscopy describes a process that unfolded over many years.
What is the difference between invention and innovation?
An invention creates something new, while innovation involves bringing a new idea or approach into practical use. An invention may exist without being widely adopted. Innovation includes the work needed to establish its use and adapt it to real circumstances.
How should innovators respond to criticism?
They should examine the substance of the criticism, answer questions with evidence where possible, and acknowledge limitations. Criticism can expose weaknesses that need attention. It should neither be dismissed automatically nor treated as definitive proof that an idea cannot work.
Why is documentation important when developing a new idea?
Documentation creates a record that other people can examine. It helps explain what was done, what was observed, and how conclusions were reached. In clinical settings, careful records and appropriate evidence are especially important when evaluating a new technique.
Can an idea succeed if its first version fails?
Possibly. The original approach may have limitations that can be addressed through changes in design, tools, or implementation. However, a failed version does not automatically prove that the underlying idea is sound. Further development still requires evaluation.
What role do collaborators play in innovation?
Collaborators can test assumptions, contribute expertise, identify problems, and develop applications beyond the original proposal. They may help an idea progress further than its originator could have taken it alone.
What if an innovation never gains widespread acceptance?
Limited adoption does not, by itself, explain why an idea failed to spread. It may reflect practical limitations, insufficient evidence, poor timing, or other barriers. Reviewing what happened can help determine whether to revise the idea, pursue a different application, or stop development.
What to do next
Overcoming resistance to innovation is not about insisting that every new idea is right. It is about making sure ideas are examined fairly and that promising ones have a credible path toward development.
Dr. Johnson’s experience offers a reminder that the process may be long and that recognition is not guaranteed. For anyone introducing change, the practical priorities are clear:
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Document the work from the beginning.
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Support claims with evidence that others can evaluate.
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Listen to criticism without letting it automatically decide the outcome.
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Improve the idea when its limitations become clear.
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Give adoption time, while continuing to assess progress.
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Work with others who can help develop and test the proposal.
An idea may change considerably between its first appearance and its eventual application. Its value depends on what it can demonstrate, how well it responds to scrutiny, and whether it can become useful in practice.
