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The Transformational Tale of the P-51 Mustang and What it Means for Healthcare


The development of the World War II fighter plane has lessons for how to manage innovation in healthcare.

Feby Abraham, Ph.D.

Feby Abraham, Ph.D.

I’ve always been an avid learner and found professional inspiration in historical accounts of the development of some of our culture’s earliest successes in innovation. Most recently, I’ve been captivated by stories of the Allied Forces’ air strategy during World War II, which many are learning about as AppleTV’s Masters of the Air unfolds each week.

In learning more about the innovation journey that inspired the P-51 Mustang — a critical fighter plane introduced during World War II — I found parallels to our industry and the innovation story being written in healthcare today.

The introduction of the P-51 Mustang marked a significant shift in the Allied bombing campaign. Previously, American bombers ventured into enemy airspace unaccompanied by fighter support and faced staggering losses from persistent enemy fighter attacks. But the Mustang changed that. Its ability to accompany bombers to and from their targets reduced loss rates significantly. By early 1944, with Mustangs escorting large-scale bombing missions, loss rates — once as high as 16% — often fell below 1%. This improvement was evident not only in the number of bombers and crewmembers saved. It also in boosted the morale of bomber crews, who felt more secure with the Mustang's presence. The Mustang increased the number of bombers reaching their intended targets, effectively crippling the German war machine's industrial capacity, and cementing its status as one of the most effective fighter escorts of the era.

What can healthcare leaders learn from the P-51 Mustang?

Empower visionaries and creatives who address problems through innovation

Every transformational innovation begins with a visionary leader. Dutch Kindelberger, the president of North American Aviation, recognized the need for a superior long-range fighter aircraft and was committed to achieving this goal. Edgar Schmued, an aeronautical engineer, was the brains behind turning the vision into reality. His designs combined cutting-edge aerodynamics with elegance, culminating in the iconic P-51 Mustang. Bob Chilton's daring test flights were crucial in validating the Mustang's design and capabilities. Each played an important role in bringing the P-51 Mustang to life.

Challenge existing industry approaches

At the core of innovation lies disruption. To drive change, effective leaders must be willing to make controversial decisions and question established norms. The P-51 Mustang faced the following significant obstacles:

  • Difference of assumptions, 'bomber theory.' The P-51 Mustang challenged the prevailing assumption in the Air Force that bombers were the principal means of attack. This theory favored marginal resources for bombers like the B-17 Flying Fortress over long-range aircraft (thus assume loss ratios are what they are and achieve the objective through increasing the pie of bombers).
  • Bias against nonindigenous products. The initial Mustangs were powered by US-made Allison engines. There was hesitation in adopting the British Rolls-Royce Merlin engine, which might overshadow American technological prowess.
  • Misaligned incentives in procurement. Documented cases show that procurement processes often favored incumbents, presenting another hurdle for the Mustang.

Cultivate the evangelists who help break barriers and champion adoption

So often the focus of innovation tends to focus on the creators and the products or solutions. The success of groundbreaking innovation often depends as much on its champion evangelists who take the initial concept and make it realize its transformative potential in the real world. In the Mustang’s story, an evangelist who stood out was Tommy Hitchcock, whose persistent advocacy led to critical improvements in the aircraft, most notably the integration of the Rolls-Royce Merlin engine. Further, he was instrumental in advocating for the need for a long-range fighter in front of British and American military leadership. Similarly, there were the aces of the sky such as Don Blakeslee who demonstrated the capabilities of the P-51 in combat and drove its wider adoption.

Be ready when opportunity arises

‘Black Thursday,' October 14, 1943, marked a critical moment for the P-51 Mustang. Following the heavy casualties suffered by American bombers during a raid on Schweinfurt, Germany, the need for a long-range fighter became evident. Robert Lovett, the assistant secretary of war for air, released a report underscoring this necessity. This situation set the stage for the Mustang to be reconsidered as a viable solution. Once given the opportunity, the P-51, with its new Merlin engine, exceeded expectations. Its long range, combined with superior speed and agility, allowed it to escort bombers deep into Europe and back, drastically reducing losses.

As healthcare leaders, be it as an incumbent organization building or scaling its innovation capability or a startup focused on creating novel solutions, we can take inspiration from the P-51 Mustang and the core elements of this breakthrough innovation story to advance our organizations, models of care and industry.

Feby Abraham, Ph.D., is executive vice president and chief strategy officer of Memorial Hermann Health System in Houston.

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