The Small ‘i’ of Innovation: How Incremental Change Fuels Big Impact — Paul Sanford
When people hear the word innovation, they often think of game changers. iPhones, mRNA vaccines, electric vehicles. The capital “I” kind of innovation. But in my experience, the most transformative changes often start small. Quiet, continuous, even incremental. What I call the small “i” of innovation.
That’s the kind of innovation I’ve been most drawn to over the course of my career, particularly in healthcare, an industry where even small shifts can unlock tremendous value. A five trillion dollar ecosystem does not require radical disruption to see meaningful change. It requires relentless curiosity, practical imagination, and a willingness to keep learning.
That mindset feels even more relevant as we look at the future. With the rise of AI and the reinvention of business models, the companies that will move fastest are not always the ones chasing the biggest breakthroughs. They are the ones willing to break complex systems into smaller, manageable pieces, test what works, and build from there. In many ways, AI is accelerating the need for small “i” thinking. It rewards iteration, learning, and continuous refinement over one-time transformation.
That’s why I’ve chosen to advise two early stage, privately held insurtech startups, OpenNetworks and Oxbridge Health. Each is using innovation not just as a buzzword, but as a tool for real systemic change.
At OpenNetworks, innovation shows up through technology. Their mission is to rewire a broken American healthcare system by making access and payments more transparent, more human, and more functional for everyone in the system. My role as strategic advisor involves helping them form the provider networks, the hospitals, physicians, and clinics, that ground their offering in reality. A tech solution is only as strong as the relationships it is built on.
At Oxbridge Health, the model itself is the innovation. Their Episode Benefit Plans offer a new way to structure and pay for care, using episodes of care instead of the traditional fee for service model. It is a shift in how employers and employees engage with healthcare, one that drives down costs and increases predictability. I provide guidance on strategic partnerships and technology solutions that make their model scalable and sustainable.
Both of these companies are pushing at the edges of possibility, trying to solve what they can within a deeply flawed system. They are innovating around the edges to move the center. And that, to me, is where some of the most meaningful progress happens.
Throughout my career, I have seen this kind of innovation play out in countless ways. In business operations. In customer experiences. In employee engagement. I have learned that innovation is not just about invention. It is about asking better questions, testing assumptions, and being open to better ways of doing things. It is about learning, breaking, fixing, and learning again.
That process is deeply human. It is iterative, collaborative, and inclusive. It only works when you involve diverse voices. Technologists, clinicians, operators, strategists. You do not innovate in isolation. You innovate by listening, by challenging, and by staying relentlessly curious.
We are all learning in real time right now. The pace of change, particularly with AI, means no one has all the answers. The advantage goes to those who are willing to experiment, to take small steps, and to build momentum over time.
And sometimes, those small innovations add up to something much bigger than you expected.
In a system as massive and complex as healthcare, a small improvement can translate into billions of dollars saved, lives made easier, and outcomes dramatically improved. That is the power of the small “i”. And it is why I will keep showing up, advising, supporting, and learning, wherever innovation is happening.
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