Professionals dread mediocrity, but the good can be the enemy of great when greatness is all is we aim for. Today begins a 30-day experiment in creative writing that starts with a look at the blocks posed by perfection.
Twelve years ago I completed a randomized controlled trial that was the first community-based trial to look at how you could use the Internet in community setting with youth. It was fraught with problems. Each setting was different, the computers were different in each setting, there were varied configurations of spaces, and the youth centres (where the study was run) were all different.
It was a mess.
It also gave me the knowledge and insight into what it really means to do community-based eHealth and the challenges that we ought to consider when doing realistic studies with youth and information technology. That pilot trial served as the precursor for a bigger, more complex study that was done in schools (PDF) (for many of the reasons cited above). Yet, what we learned by doing that trial was barely shared outside of a few presentations. It was never published.
The reason? It wasn’t perfect. Yes, the design was pretty solid, but there were too many inconsistencies in the settings and populations to present anything to the world and no one would publish it. That might have been true, but since that study was completed I’ve been asked consistently how to do community-level eHealth research. Review the literature and you’ll find few examples, probably for the reasons that I experienced. The research is almost never “great”, yet we fail to share the good. And in doing that, we limit our chance to become great.
We researchers and public health folk are not comfortable with failure (even if it might be better framed as something else) and spend an inordinate amount of time working to create bulletproof studies that pass peer review. The problem, is that peer review by its very nature is about looking at findings relative to what has been done before or the current standard, not what could be. It isn’t about innovation.
It is no surprise that we find there to be such a gap in the amount of innovation that actually takes place in settings where peer review reigns as the dominant mode of assessment like universities (although we see it in business too — see last link).
Pressure can help spark innovation. Too much pressure kills creativity, while too little eliminates the necessary focus to innovative.
What the right balance is depends on the context, which means being able to try things and fail. To many of my colleagues feel that they cannot afford to fail because of the pressure to “get it right” the first time due to an absence of resources like available grant funding. This is exacerbated by a peer review system that rewards conservative approaches to knowledge generation and, as I’ve noted before, experience doing the same thing rather than adventuresome work doing something different. Add to that, an educational layer that reinforces very modest approaches to practice and research and you have a recipe for non-innovative thinking.
Failing to fail or letting good and great be enemies of each other is part of the problem. One solution is to get things out there, experiment and get the feedback from a community on whether or not you’re hitting the right note.
Over the next 30-days, I’m going to be looking at these issues in great depth, in simple terms and everything in between as I take up a challenge from another innovator, Seth Godin, who has been inspired by the work of Ralph Waldo Emerson to write a blog-a-day and just get ideas out there. In academic terms this is crazy, but in a world that is changing fast and not always for the good, crazy is a kind of innovation that we might need more of.
Commercial products relying heavily on branding to entice their purchase and use in a crowded marketplace. Is this something that the health sector should consider and, if so, what might it look like?
I’ve just spent a rare free weekend in Chicago walking around, taking in the sights, and doing what a lot of other people do when they travel to another country or city: shop. It is hard to avoid some shopping when down in the Loop on Saturday or Sunday as that is what much of Chicago’s core is made for. The same can be true of most major centers, if you exclude the office buildings that are often semi-vacant on weekends.
A brief tour of many of the shops, from the discounters (Filene’s Basement, TJ Maxx, and Nordstrom Rack) to the mid-range stores (Macy’s) to the higher end department stores (Nordstrom) and the many boutiques, one is easily amazed by the abundance of goods on sale. But what intrigued me as I stood and watched what was around me was that many of the branded goods available at all of these places (including many of the boutiques) were the same. Big names in fashion were at all of them. And the products themselves were virtually indistinguishable from one another except for 1) price and 2) seasonality.
The first is perhaps the most obvious, but as one who is not as attuned to the seasons in fashion beyond the warm-weather/cold weather distinction as many, it the second part that I find most interesting. What makes last year’s $150 pair of Lacoste sunglasses worth $25 this year is nothing other than its seasonality. In other words, they are last year’s model and no longer as coveted.
It struck me that we do this in the health sciences all the time. If your reference list isn’t up to date, people question the sources and the validity of the findings. While probably appropriate for work in basic and clinical sciences, it seems less true for health promotion. It also seems less appropriate for areas where there is great complexity.
Brands also matter with regards to where something is published. A premium is placed on scholarly work that is published in journals with high impact factors over those that are in lesser-known journals. The underlying assumption here is that the more people cite something and the more we believe a source to be high quality the higher the quality the knowledge. The strength of the brand of sources like JAMA, Science, the New England Journal of Medicine and the Lancet exceed the rest of the health field.
While this respect for such “brands” sounds reasonable, there are many problems associated with it. Most notable among these is that they publish a certain type of knowledge in a particular format that adheres to particular models of discovery and rewards particular ways of expressing information. This has advantages, but it also creates path dependencies that shape knowledge itself and restrict the sharing of other forms of knowledge. In doing so, there is some assumption that the “best” knowledge (i.e., that which fits with the brand) looks a certain way and fits a certain way.
An alternative is to create different brands, just as we see in the marketplace for clothing and other retail goods. Apple, once a brand favored by a small, but fervent group of supporters in the early 80′s, is now the world’s most valued brand. It was the small, scruffy underdog and now is the leader. The same might be said for other forms of knowledge. If we were to package health promotion into a form that had the same appeal as other sources, could we create a demand and cache for it in a manner that drew people to it? And would this be a good thing?
I’m not sure. But I do believe it is possible. A colleague of mine once did a study looking at factors that predicted uptake and citation of research knowledge in a particular domain by looking at study qualities across a number of dimensions including design, home institution, discipline and others. After all was considered only one factor predicted uptake: the study used an acronym. Yep, if you branded your study it was more likely to achieve uptake than if you didn’t. To my knowledge this data was never published, presumably because it was so embarrassing to us scientists as it provided evidence that evidence isn’t just what drives our work. Whether it holds over time is worth considering, but it does suggest that brands might matter.
Marketers and companies work hard to distinguish themselves in a crowded marketplace. In a world where there are literally tens of thousands of venues for publishing our findings that are chosen every week, the market is filled. And do we want to rely only on the big brands to fill our knowledge? If so, we run into the same scenario as I did shopping by seeing the same brand everywhere and, because of that, seeing its value discounted because there is so much of it and it expires quickly.
The comparison is not perfect, but neither is it outrageous. Could branding knowledge and knowledge translation be coming to an inbox, book, or library near you?
Being innovative requires a sense of the system that innovation takes place and the design sensibilities to make change last. Are we letting innovation lie to us?
I’ve been on the road much of the past three weeks and one stop I was very glad to make was to my hometown of Calgary, Alberta.
The city is nestled in the Alberta foothills with a view of the Rocky Mountains and an hour’s drive from some of the most beautiful prairie, mountain, and river-filled countryside you’ll find. The city I grew up in has been widely known as an innovator, particularly on issues of the environment. It’s light-rail transit system is powered by wind-generated electricity. Everywhere, there were examples of innovative technologies and conversations about innovation in the news and visible as one drives through the city. Calgary’s vigorous culture of outdoor activity, the natural beauty of the Bow Valley combined with a historical connection to land for food and lifestyle has made it hard to ignore the role of the natural environment in everyday life.
And yet, driving through this city — one that has nearly tripled in size since I was born there — it is hard to not see the innovation forest and trees disconnect. Yes, there are waste diversion programs and hybrid cars and more transit, but the city continues to grow (literally) well beyond its traditional borders into territory that was once farmland with barely an eyeshot of the city. I’ve always known Calgary as a physically large urban centre, but the rampant push towards making more suburbs seems at odds with the desire for a liveable, environmentally responsible city.
Calgary is not alone. As I fly to my home in Toronto, the same conversations are taking place and there, like out West, there is the belief that innovation will save the day. As fuel prices spike as they have over the past few days (and reasonably can’t be expected to lower much anytime soon), I find it hard to imagine how innovation is going to reduce costs and impact for people in the short term.
Whether it is on the issue of the environment, improved knowledge translation in health, or better social design for services, innovation can be seen as the answer. If we just come up with the best idea, the thinking goes, we will be able to solve anything. We are creative people, we can do it.
I actually think this is the lie we tell ourselves to avoid going where real innovation is needed and that is: personal and social change. Without a systems approach and a design for those systems, we will continue to ride our horse (to pick up a Calgary stereotype) in the wrong direction. More clever ways to reduce the impact of our lives on the environment doesn’t change that we’ve created systems that pollute and damage the environment in the first place by design.
Creating sophisticated knowledge translation systems aimed at getting the “right information to the right person as the right time” sounds sexy, but doesn’t work unless there is a system designed to support people in accessing that information when they need it and having the time and space to process that information to make meaning of it. Otherwise, we are just shovelling bits at people and making ourselves feel better because we developed something that, on the surface, looks good, but in reality doesn’t address the bigger picture.
If the forest and trees are part of the natural environment, then we need to consider them both at the same time — literally and metaphorically — in the systems we work in and do so with intent (design) otherwise we will continue to perpetuate the lies that innovation allows us to tell ourselves so well.