004 | WHAT DOG DOESN’T BARK?
When things change, watch what stays the same.
Resistance to change signals opportunity.
Resistance to change signals opportunity.
Resistance to change signals opportunity.
5 min read · Commercial strategy · 26 Aug 2026
CHANGE GETS OUR ATTENTION
A competitor launches. Guidelines are updated. New evidence emerges. A transformative technology arrives.
Naturally, we ask what will change.
Which products will win? Which new skills will matter? Which behaviours will disappear? What new opportunities will emerge?
A competitor launches. Guidelines are updated. New evidence emerges. A transformative technology arrives.
Naturally, we ask what will change.
Which products will win? Which new skills will matter? Which behaviours will disappear? What new opportunities will emerge?
A competitor launches. Guidelines are updated. New evidence emerges. A transformative technology arrives.
Naturally, we ask what will change.
Which products will win? Which new skills will matter? Which behaviours will disappear? What new opportunities will emerge?
What will we all do differently?
These questions direct our attention towards the things that move. But often, an interesting clue is standing perfectly still.
These questions direct our attention towards the things that move. But often, an interesting clue is standing perfectly still.
These questions direct our attention towards the things that move. But often, an interesting clue is standing perfectly still.
ABSENCE IS EVIDENCE
In Arthur Conan Doyle’s Silver Blaze, Sherlock Holmes solves the mystery partly because of something that doesn’t happen.
In Arthur Conan Doyle’s Silver Blaze, Sherlock Holmes solves the mystery partly because of something that doesn’t happen.
In Arthur Conan Doyle’s Silver Blaze, Sherlock Holmes solves the mystery partly because of something that doesn’t happen.
Everyone else focuses on the evidence that is present. Holmes notices the evidence that isn't.
Everyone else focuses on the evidence that is present. Holmes notices the evidence that isn't.
Everyone else focuses on the evidence that is present. Holmes notices the evidence that isn’t.
A watchdog didn’t bark. So the intruder was probably someone the dog knew.
A watchdog didn’t bark. So the intruder was probably someone the dog knew.
A watchdog didn’t bark. So the intruder was probably someone the dog knew.
The same principle can be useful in strategy.
When something significant changes, we expect consequences. So when an expected consequence fails to appear, it’s worth asking why.
The same principle can be useful in strategy.
When something significant changes, we expect consequences. So when an expected consequence fails to appear, it’s worth asking why.
The same principle can be useful in strategy.
When something significant changes, we expect consequences. So when an expected consequence fails to appear, it’s worth asking why.
What doesn’t happen is the clue to unexplored opportunity.
HEALTHCARE HAS MANY SILENT DOGS
Our industry changes constantly. But a breakthrough doesn’t automatically change behaviour.
Clinicians can understand new guidance without following it. Proven innovations can be adopted rapidly in some settings and slowly in others.
Our industry changes constantly. But a breakthrough doesn’t automatically change behaviour.
Clinicians can understand new guidance without following it. Proven innovations can be adopted rapidly in some settings and slowly in others.
Perhaps the barrier was never the one everyone assumed.
Greater efficacy hasn't removed uncertainty. Simpler administration hasn't removed fear of getting the decision wrong. A new option is clinically easier but operationally harder.
Perhaps the barrier was never the one everyone assumed.
Greater efficacy hasn’t removed uncertainty. Simpler administration hasn’t removed fear of getting the decision wrong. A new option is clinically easier but operationally harder.
Remove an influence and watch what remains.
Every change is an experiment. It alters part of the environment while leaving other things untouched.
In the age of AI, expertise is abundant. But abundance in one area causes scarcity in another. So what hasn’t changed?
Every change is, in some sense, an experiment. It alters part of the environment while leaving other things untouched.
In the age of AI, expertise is now abundant. But abundance in one area causes scarcity in another. So what hasn’t changed?
What persists after great change reveals what was really holding the system in place. And exposes what is still scarce and valuable.
What persists after great change reveals what was really holding the system in place. And exposes what is still scarce and valuable.
THE DOG may have GOOD REASON NOT TO BARK
When expected change doesn’t happen, it’s tempting to label the people involved as slow adopters, laggards or otherwise change-averse.
But clinical inertia can reflect patient factors, environmental constraints and legitimate clinical judgement.
When expected change doesn’t happen, it’s tempting to label the people involved as slow adopters, laggards or otherwise change-averse.
But clinical inertia can reflect patient factors, environmental constraints and legitimate clinical judgement.
If the old behaviour still makes sense after the world around it has changed, something is keeping it sensible.
Find that something.
Look for the incentive that remains. The constraint nobody removed. The need the innovation didn’t solve. The fear the evidence didn’t displace. The behaviour that still makes perfect sense.
That's where the underlying structure becomes visible. And where you may well find opportunity and untapped value.
Find that something.
Look for the incentive that remains. The constraint nobody removed. The need the innovation didn’t solve. The fear the evidence didn’t answer. The behaviour that still makes perfect sense.
That’s where the underlying structure becomes visible. And where you may well find opportunity and untapped value.
SUMMARY | resistance to change signals opportunity
Big changes are difficult to miss, which means everyone else is looking at them too.
The less obvious opportunity may be found in whatever should move but can't.
Big changes are difficult to miss, which means everyone else is looking at them too.
The less obvious opportunity may be found in whatever should move but can’t.
What dog doesn’t bark?
DAVID Insight 004 | WHAT DOG DOESN’T BARK?