Table 2 Lessons learned

• The philosophy of ‘test everything with controlled experiments’, i.e., the consistent and systematic implementation and integration of evaluation into the entire development and application of treatments and innovations is equivalent to the philosophy of ‘randomize the first patient’ principle in medicine, that was introduced more than 40 years ago. However, this has met much more resistance in medicine

• Technological advances and the availability of large-scale data makes it tempting to abandon randomized trials, while randomization is precisely what has turned out to be so useful for the most successful technology companies

• Rather than hindering innovation, randomized trials fostered improvements to products and revenue

• The most innovative technological field has recognized that systematic series of randomized trials with numerous failures of the most promising ideas leads to sustainable improvement

• Various parallels exist in the application of randomization, including the importance of selecting the best evaluation criterions (outcome measures)

• Even tiny changes should ideally undergo continuous and repeated evaluations in randomized trials and learning from their results may be indispensable also for healthcare improvement