What INSI Tells Us about Healthcare Innovation

John Keats called it “negative capability”: the ability to remain in uncertainty, mystery, and doubt without the “irritable reaching after fact and reason.”

It is a beautiful phrase. It is also a leadership discipline.

Negative capability is not indecision. It is not passive. It is not the absence of rigor. It is the strength to stay present when the answer is not yet obvious. It is the discipline to resist premature certainty. It is the ability to sit inside complexity long enough for a truer pattern to emerge.

Healthcare needs this kind of leadership now.

There is little debate that the American healthcare system needs more than improvement around the edges. We spend more on healthcare than any other advanced nation, yet our outcomes continue to lag behind our peer countries. The system is filled with extraordinary people doing deeply meaningful work, but the structure itself has become almost immovable. Regulation, reimbursement, fragmentation, quality concerns, legacy technology, clinical risk, political pressure, and entrenched incentives all pull against fundamental change.

In that kind of environment, it is tempting to look for a magic pill.

For some, that magic pill is artificial intelligence.

To be clear, AI matters. It is already creating real opportunities across healthcare administration, claims processing, member engagement, documentation, call center support, clinical workflow, and operational efficiency. With our partner, the Health Plan Alliance (HPA), we spent the past year working with leaders across regional health plans as they identified use cases where AI could reduce friction, improve decision-making, accelerate service delivery, and free up human talent for higher-value work.

These are important gains. They are practical, needed, and real.

But they are not enough.

Technology, even technology as powerful as AI, does not transform systems on its own. Leaders do.

This is where the real work begins.

The leadership challenge beneath the technology challenge

Healthcare is not short on intelligent people. It is not short on expertise. It is not even short on ideas.

Healthcare doesn’t lack imagination in the abstract. It lacks the leadership conditions that allow imagination to move through the system without being diluted, delayed, or defended against.

In highly regulated, highly complex environments, leaders are often rewarded for caution. They are trained to reduce risk, protect the core, preserve trust, and avoid harm. These instincts matter. In healthcare, recklessness is not innovation. Lives, livelihoods, and public trust are at stake.

Yet, the same leadership instincts that protect the current system can also preserve its dysfunction.

When every decision requires more evidence, more alignment, more review, more certainty, and more precedent, innovation slows to a crawl. The organization may still produce pilots, workshops, roadmaps, and use cases. It may even celebrate innovation publicly. But underneath, the system remains largely unchanged.

This is what the INSI, the Innovation Navigation Styles Inventory, helps us see.

INSI was designed to reveal how leaders show up when innovation becomes real. Not theoretical innovation. Not innovation as a slide deck. Real innovation: the kind that requires tradeoffs, courage, ambiguity, experimentation, and disciplined follow-through.

INSI isn’t a personality test or a leadership assessment. Rather, INSI surfaces the principles and preferred competencies that leaders naturally rely on under innovation conditions. It shows how they navigate risk, speed, feedback, resilience, empathy, vision, focus, and growth.

In other words, INSI helps reveal the intangibles of innovation: the hidden leadership practices at play when decisions get hard.

We saw this in action at the HPA AI Impact Accelerator, and what we learned from that cohort is instructive far beyond one program.

What the HPA cohort revealed

The HPA cohort showed strong promise. Not because everyone led the same way, but because they did not.

Some leaders moved quickly but needed stronger anchoring in long-range vision. Others were deeply relational but less inclined to drive bold outcomes. Some were adaptive, scrappy, and energized by experimentation but needed more structure to land and scale their ideas.

That diversity is not a problem. It is capacity.

The mistake many organizations make is assuming innovation requires everyone to align around one dominant style. It doesn’t. In fact, the opposite is often true. Innovation requires contrast. It requires leaders who can see differently, challenge differently, recover differently, and make sense of uncertainty from multiple angles.

The HPA cohort’s strongest shared domain was Scrappiness: adaptability, resilience, experimentation, and persistence. This matters. Scrappiness is essential in AI work because no organization has the full playbook yet. Leaders have to test, learn, reframe, and keep moving.

But scrappiness alone will not scale transformation.

Without Focus, Vision, and Achievement, experimentation can fragment. Pilots can multiply without landing. Energy can outpace coherence. Momentum can become motion without strategic consequence.

That was one of the most important insights from the work: this cohort had the will to move, but needed stronger scaffolding to translate movement into durable innovation outcomes.

The group also showed strong relational capacity. Empathy and Advisory were among the strongest tilts. These leaders listen. They collaborate. They seek input. They understand the importance of trust and stakeholder engagement.

That is a powerful asset in healthcare.

But relational strength can also become a hiding place. Leaders who are highly attuned to others may hesitate to push. They may overvalue harmony at the expense of clarity. They may keep people engaged but avoid the sharper edge of commitment.

Healthcare transformation requires both empathy and edge.

The future will not be built by leaders who simply impose change on exhausted systems. Nor will it be built by leaders who keep waiting for everyone to feel ready. The work is more nuanced. Leaders must be able to listen deeply and still move decisively. They must hold complexity without becoming captive to it.

That is negative capability in action.

The positively disruptive leader

A positively disruptive leader does not tear things apart for the thrill of disruption. They challenge what is settled in service of what is possible.

They understand that the old system contains wisdom. Healthcare’s caution, discipline, regulatory rigor, clinical standards, and ethical guardrails exist for good reasons. The goal is not to discard them. The goal is to build something better with full respect for what the current system has been trying to protect.

This is the difference between destructive disruption and positive disruption.

Destructive disruption says: break the system.

Positive disruption says: understand the system so deeply that you can make its most broken patterns obsolete.

The positively disruptive leader has the capacity to live in the tension between what is and what could be. They can see the human cost of the current system without demonizing the people inside it. They can hold a future vision without pretending the path will be simple. They can move with urgency without losing ethical grounding.

In INSI terms, this kind of leader draws from multiple principles at once.

They need Vision to see beyond the current operating model.

They need Risk capacity to test what has not yet been proven.

They need Focus to prevent experimentation from scattering.

They need Empathy to keep transformation rooted in real human needs.

They need Feedback to learn without defensiveness.

They need Resilience to keep going when the system resists.

They need Achievement to turn purpose into measurable progress.

And they need Scrappiness to work through constraints without making constraints the excuse.

This is not a common leadership profile. But it can be developed. That is the hopeful part.

The deeper healthcare opportunity

The next era of healthcare innovation cannot be limited to automating administrative burden, as valuable as that may be. If AI simply makes the current system faster, it may also make the current system more entrenched.

The real opportunity is bigger.

What if healthcare decisions moved closer to the person receiving care?

What if price transparency became part of the point of decision, not an afterthought?

What if administrative processes were redesigned around trust rather than suspicion?

What if AI helped eliminate the invisible tax of complexity for members, patients, providers, and staff?

What if regional health plans, providers, employers, regulators, and communities could collaborate around a new operating model for health, not just healthcare payment?

These questions cannot be answered by technology alone. They require leaders who can sit in uncertainty without grabbing too quickly for the nearest available answer. They require leaders willing to ask better questions before locking into familiar solutions.

That is why negative capability matters.

In healthcare, the “irritable reaching after fact and reason” often shows up as the demand for certainty before action. Another study. Another committee. Another benchmark. Another proof point from someone else. Another reason the timing is not right.

But transformation does not begin when uncertainty disappears. It begins when leaders develop the capacity to move responsibly within it.

What INSI makes visible

The power of INSI is that it gives leaders a map for this work.

It shows where a leader or team naturally has strength. It shows where they may over-rely on familiar competencies. It shows where the organization has latent capacity that is present but not yet embodied. And it gives teams a shared language for the tradeoffs that usually remain invisible.

This matters because innovation often fails at decision points, not the idea stage.

The idea exists. The use case exists. The business case may even exist. Then, the leadership system takes over.

Do we move now or wait?

Do we protect the core or test the edge?

Do we listen longer or decide?

Do we scale the pilot or study it again?

Do we let one team carry the work, or do we build enterprise capacity?

Do we use AI to optimize the current system, or do we use it to imagine a fundamentally better one?

These are not technical questions. They are leadership questions. And they are exactly the kinds of questions the intangibles reveal.

What healthcare leaders must build now

The HPA cohort points to a broader truth for healthcare leaders navigating AI and transformation.

First, leaders need to use contrast as a learning engine. The goal is not to make every leader the same. It is to help leaders understand one another’s instincts and stretch through difference.

Second, leaders need to pair scrappiness with discipline. Experimentation is essential, but it needs scaffolding, governance, focus, and clear learning loops.

Third, leaders need to turn relational strength into executional clarity. Empathy is not the opposite of accountability. In the best leaders, empathy makes accountability more precise by keeping the work connected to real people and real consequences.

Fourth, leaders need to stretch in small, repeated ways. Transformation is not built in annual retreats. It is built through micro-moments in which leaders choose to ask a harder question, make a clearer commitment, absorb feedback, or name what is changing.

Finally, leaders need to stop treating leadership development as separate from AI strategy. Coaching leaders toward stronger innovation capacity is foundational to AI adoption. If the leadership system cannot move, the technology will not scale.

The work ahead

Healthcare does not need more theater around innovation. It needs leaders who can make innovation real inside the operating environment they actually inhabit.

That means honoring the complexity of healthcare, not pretending it away.

It means building interoperability not just between systems and data, but between leaders, functions, incentives, and decisions.

It means creating spaces where executives can tell the truth about what is hard, where they are stretched, and where the current system pulls them back into old patterns.

It means using AI not as a shiny object, but as a forcing function to ask deeper questions about what healthcare is meant to become.

The work ahead will require courage. But not the loud kind.

It will require the quieter courage of negative capability: the courage to remain present inside uncertainty, to resist false closure, to listen for what is emerging, and to move before the whole path is visible.

The leaders who can do that will not simply implement AI. They will help reimagine healthcare.

And that is the real promise of this moment.