Have We Turned the Page on Social Science Research for Health?

Turning the Page on Social Science and Health Research

Over the last two weeks social science researchers across Canada began receiving the decisions from last autumn’s competition for a Social Science and Humanities Research Council (SSHRC) funding award. SSHRC is the principal funder of social science research in Canada, although notably is not in the business of funding heath-related research, which is supposed to be funded by the Canadian Institutes for Health Research (CIHR). [Full disclosure: I currently hold grants from both of these organizations]. The problem is that CIHR was born from a policy and programming body and the former Medical Research Council and has a rather awkward relationship with social science research given its medical focus. It has funded some social science programs, but not in a manner that has enabled social scientists to comfortably explore the range of issues that they might have under traditional SSHRC funding programs, particularly when social issues are not always obviously health issues (e.g., poverty, education) and can easily be dismissed as not being relevant in spite of the evidence that they are.  Yet, SSHRC has decided to forgo any funding of health-related projects due in part to the absence of funding to support it when there are presumably options through CIHR or the disease-specific health charities like the Canadian Cancer Society, the Lung Association and others.

Yet, these options are not suitable. In a manifesto entitled “The end of medical anthropology in Canada” a group of leading social scientists painted the picture of the situation in grim terms in University Affairs. Although medical anthropology is the focus of the piece, the authors might as well be speaking for social sciences in general:

Health is inherently social and cultural. SSHRC has always understood this; CIHR, we fear, does not. We face the possible extermination of one of the most vibrant, high-demand and policy-relevant health disciplines, the only scholarly field that places culture at the centre of the analysis of health and that characteristically does so in both national and international contexts. In a multicultural, settler society with a substantial aboriginal population, and in a world where health is at the core of developmental, political and social issues in so many countries, where Canada otherwise wishes to have an impact, does this make any sense?

This brings me back to the beginning of this post and the announcement of the results of the last competition. Looking at the funding numbers released by SSHRC, a discouraging picture emerges. In 2011-12, 37 per cent of all applications in the open competition were deemed fundable, yet only 22.5 per cent were funded. These numbers are similar t0 2010-11, when 36  per cent were deemed fundable and 22 per cent were funded. What is not mentioned in these numbers was the level at which these grants were funded in the first place. I am a 2010-11 recipient of funding from SSHRC — meaning my grant proposal was within the top 22 per cent of all applications for that year — and the amount I received was approximately half of what I requested. That means that I had to take half of my budget and throw it away. So yes, I was successful providing I did either half of the research or found money elsewhere. I did the latter and my pocketbook is none the better for it.

Consider the implications of this change in funding. With one in five projects funded and many of those that are funded at levels well below what was requested the motivation for researchers is one of the first casualties. Researchers know that funding is tight and that it is highly competitive, but few alternative sources for research grants that lay outside of specific disease-focused areas, social scientists young and old are faced with little option. This creates another set of affected parties: students and trainees. Research funding not only supports the scientists themselves in many cases (see my previous posts on this), but those seeking to become scientists themselves or those who seek to get better acquainted with research. In health sciences and policy, this means just about everyone enrolled in such programs.

Now consider all of this in light of a trend towards increasing graduate education numbers. At the academic institution I am affiliated with (like many of its peers), the enrolment numbers are set to nearly double across many of the professional programs associated with health practice and policy in the coming years. Increased demand for training opportunities from the public has created a means for universities to cash in. Of course, what these students will do when they get there is unclear (let alone when they graduate), but it cannot be much in the way of research — at least as it pertains to social science and health. The funding is simply not there to support the kind of broad-based inquiry into the social factors that influence health, illness and well-being anymore. We have, as I call it, reached ‘the Turn’.

The Turn is that point where the system changes irrevocably towards a new direction. It is like a ‘tipping point‘.  Dwindling numbers of social scientists working from funding from an institutional budget (e.g., tenure-stream faculty positions) + a doubling of the student cohort * half of the research dollars makes for rather toxic math. The Turn will fundamentally shape the way social science inquiry is done and the kind of questions that get asked. As question foci change, the quality of the research shifts, and the depth of inquiry is reduced, so too will the real impact that social science has on our health.

The gap between what we know, what we do, and what we can do to prevent illness, treat sickness, and promote well-being will grow.

Anecdotally speaking, this trend is not unique to the social sciences, but it is amplified in this domain. Social sciences in Canada and abroad are consistently funded at lower levels than that of basic research (see here for a starting point). But what is interesting is that many of the problems that we face within health require social science knowledge and research to address and social science — from knowledge translation, social network studies, technology adoption, innovation, management, to policy implementation and beyond .

Prevention of disease and chronic illness is often a social phenomenon (e.g., hand washing). Even the act of taking the best of basic science and translating it into practice or policy options (or other scientific research) is a social act that draws on social science research to execute. Social determinants of health are social in nature and require social science to understand their impact. Designing the policy and programmatic interventions that support creating a healthier society also falls to social science research and practice.

What will our health landscape look like without the ability to take what we know and translate it into action? Worse yet, what if we simply are unable to even know what to do because the research and evidence isn’t there in the first place to translate into anything? Without another turn towards something more positive in our research support, we are about to find out.

* Photo Turn the Page by Miaboas used under Creative Commons License from Deviant Art.


Common Sense, Complexity and Leadership

Bye, Bye Common Sense

Great leaders are often ascribed traits that include ample common sense. But what passes for common sense is often a grab bag of miscellaneous, inconsistent ideas that are context dependent and less useful in the complex environments where leadership is called for most. 

common sense |ˌkɑmən ˈsɛns|

noun

good sense and sound judgment in practical matters: use your common sense | [ as modifier ] : a common-sense approach.

Today Research in Motion announced that its founder Mike Lazaridis and his co-CEO Jim Balsillie would be relinquishing their roles with the company. In their place, a ‘pragmatic, operational-type guy ‘was installed. Presumably, Thorsten Heins has the common sense to lead RIM after the founders lost theirs. Yet, the pragmatic, common sense that RIM is looking for might not be what they need given the complexity of the environment they are leading in.

Common sense is a false lure in complex systems. In his recent book, Everything is Obvious *Once You Know the Answer, social network researcher  and Yahoo! Research scientist Duncan Watts eloquently critiques the concept of common sense, illustrating dozens of times over how “common sense” doesn’t fare so well in decisions that go beyond the routine and into the complex. Indeed. the very definition of the term implies that the problems that common sense works towards addressing are relatively simple and pragmatic.

Certainly, navigating daily social conventions might lend itself well to what we might call common sense. Watts refers to sociologist Harry Collins’ term ‘collective tacit knowledge‘ that is encoded in social norms, customs and practices of a particular world to describe common sense. However, what becomes common is a byproduct of many small decisions, dynamic and flexible changes to perspective, an accumulation of knowledge gained from small experiments over time, and the application of all of this knowledge to particular, context-dependent, situations. This constellation of factors and its interdependent, contextual overlap is why artificial intelligence systems have such a difficult time mimicking human thought and action. It is this attention to context that is most worth noting for it is this context that keeps common sense from being anything but common:

Common sense…is not so much a worldview as a grab bag of logically inconsistent, often contradictory beliefs, each of which seems right at the time but carries no guarantee of being right any other time.

Watts goes on to argue:

Commonsense reasoning, therefore, does not suffer from a single overriding limitation but rather from a combination of limitations, all of which reinforce and even disguise one another. The net result is that common sense is wonderful at making sense of the world, but not necessarily at understanding it.

Thus, we often concoct a narrative about the way something happens that sounds plausible, rational and be completely wrong. Throughout the book, Watts shows how often mistakes are made based on this common sense approach to solving problems.

When it comes to RIM, some have pointed to the late Steve Jobs’ assertion that they would have difficulty catching up to firms like Apple given that the consumer market is not their strength, the enterprise market is. Yet, Steve Jobs didn’t let the fact that Apple was a computer company stop him from making music players (the iPod), mobile phones (the iPhone) or becoming book, music and movie vendors (iTunes). A read of Steve Jobs’ biography by Walter Isaacson reveals a man who was able to lead and be successful through what appeared to be common sense, yet was decidedly uncommon among media and technology leaders. That is why Apple is where it is and why so many other technology companies lag behind them or simply disappeared.

The reason is that common sense in leadership looks as simple in hindsight only, not in foresight or even in the present moment. This is one of the big points that Watts makes. He uses the example of Sony’s MiniDisc system that, when introduced, had all of the hallmark features of the innovations that Apple introduced (novel, high quality, portable, smaller, visible advantages over the alternatives), yet it was a spectacular failure. Canadian management consultant Michael Raynor has called this the strategy paradox. When qualities such as vision, bold leadership, and focused execution — all the commonsensical aspects of great leaders — are applied to organizations it can lead to great success (Steve Jobs and Apple) or resounding failures (RIM?).

Strategic flexibility, making small adjustments consistently, and imaging scenarios for the future in an ongoing manner are some of the potential ways to limit the damage from common sense (or use its advantages more fully). This requires feedback mechanisms and close monitoring of program activities, developmental evaluation, and a willingness to tweak programs and design on the go (what I call: developmental design) . It’s not a surprise that this incremental approach to development is consistent with the way change is best produced in a complex adaptive system.

By recognizing that common sense is less than common and is certainly not consistent, program designers, developers, evaluators and other professionals will be better positioned to provide true leadership that addresses challenges and complexity rather than adds to the complexity and creates more problems.

Photo: Goodbye to Common Sense Space by Amulet Dream from Deviant Art


Advice for a Scholar Seeking a Life in Academia

Educating the Academic

The need to train professionals, educate citizens and advance knowledge of our world has never been less, yet the academic environment where this takes place is changing at a pace where its easy to question what one is to do to contribute to its mission. In this continuing series on life in academia, I offer some advice for those seeking to join its ranks as I step away from this life after two decades spent immersed in it. 

As a professor at a world-class research university in a dynamic and challenging field of study I have the privilege of meeting some of the brightest young minds around. The many roles that a professor can take — as educator, learner, scientist, advocate or activist – are highly attractive to many of these ‘bright minds’ so it is no surprise that I get asked a lot about how they can join the academy.

Not surprisingly, many of them aspire to become full-time professors. In this latest instalment of the Alien Shores series looking at the changing world of academia I provide some advice for those interested in getting into the profession that I am about to transition away from.

Shortly after I started my undergraduate studies I discovered psychology and found a “home” for the ideas I had about organizing with people and making a splash in the world. Soon after learning about the field and the opportunities I came to the conclusion that I wanted to be a professor. Throughout my career I studied to be a professor, seeking to apprentice under my advisor, not just take direction. He was the Chair of my department and very generous with his time and knowledge, sharing much (within all appropriate and ethical bounds) about life in the academy. He gave me an unvarnished, true account of the ups and downs of academic life and prepared me as best he could for the challenges ahead. I studied and learned and watched everything and even then it only did me so much good. The field is changing so quickly and professorial life is transforming far faster than anyone thought.

So as I leave the profession in a full-time capacity, what can offer someone who, like me, wants to get into this line of work? To the scholar who seeks a life in academia I offer this:

1. The world outside of the university is a minefield: proceed with extreme caution and pack all the right equipment. I’ve been told by more than one leader in my field “you shouldn’t attempt community-based research until you have tenure“. They were right. But I am very glad I didn’t listen and tried it out, but then my risk tolerance is a bit skewed.In terms of logistics, CBR consumes vast amount of time, is poorly appreciated, nearly impossible to resource appropriately, has time schedules that wreak havoc on your life, and offers nowhere near the academic value commensurate with the energy involved. It is also fun, creative and connects you to the world in ways that traditional research can rarely do. When you are starting out it is very difficult to weigh the pros and cons of doing this kind of work so my advice is, if you’re going to do CBR, get a team — a good one — and find collaborators with experience who can help you along. It is very hard to go it alone.

How about knowledge translation? If you want to get your knowledge into anything other than a report, academic journal or conference presentation, you are on your own unless KT is the explicit focus of your research. Why? It is hard, has little value inside the academy and you will not be given the supports to do it anywhere close to the way it deserves. At the same time, it too is fun. Among the highest honours I’ve been given is when people — the public, practitioners, or policy makers (even other academics) — tell me that they used something that I developed to solve a problem and it added value to their work. I care far less if people find my work clever, exquisitely crafted, or even “cutting edge” if it doesn’t lead to use at the end of the day.

Like CBR, find like minds and work together. Network and build on to the communities of people who are interested in your work and pay no heed to the naysayers. I’ve been told that the Internet had no future for helping people change behaviour and now regularly get challenged on my use of social media as a legitimate tool for KT. If you are reading this, then you already know that this medium works. Is it better than other tools? That depends and that’s why we do the work — to find out.

2. Don’t believe everything you read, see or hear from leaders in your institution or field. It’s too easy (and natural) to look at the head of an organization and take what they say as representing the direction they are heading. I would take the words of a senior director with a funding agency, university president, Dean or politician to heart and expect to see the changes that they spoke of. They aren’t lying, but the mechanism they use is flawed. In academia, nearly everything is directed through peer review, meaning that leadership might define the problems, but researchers determine the manner in which they are solved.

I recall sitting on a grant review panel where one of the criteria for a strong grant was a clear knowledge translation plan and seeing proposal after proposal being lauded as excellent with KT plans that included nothing more than a commitment to write the findings in a peer review journal or present at a conference. I spoke up and challenged these as weak examples of KT and the panel review coordinator agreed, but my peers saw that as appropriate and therefore the projects were favourably rated. Why would academics see it this way? See #1.

3. Your peers are your allies and your enemy. Innovation is nearly impossible by peer review. Despite challenges and commentaries on the weakness of the system, it persists and thrives in academia. Peer review has been challenged as sexist (PDF), dangerous, and almost antithetical to innovation. By its very nature, peer review is designed to judge research based on the best current evidence and the status quo, not by what could be. Indeed, to judge a proposal by imaginaries created from possible futures, rather than evidence is tantamount to academic misconduct in the peer review system.

If peer review was a drug it would never be allowed onto the market - Drummond Rennie, deputy editor of the Journal Of the American Medical Association (cited in Smith (2010))

A descriptive analysis of submissions to peer reviewed academic journals found little reason to believe that the editorial peer review process improves the quality of research presented in the literature. They conclude:

At present, little empirical evidence is available to support the use of editorial peer review as a mechanism to ensure quality of biomedical research. (Jefferson et al. (2007))

Much more research is needed on this, but the work done to date isn’t positive for those seeking to do things differently. At the same time, in actually doing research, peers can be extremely useful and even necessary to getting things done and done well (see point #1). Finding some intellectual or practice peers is a critical step towards warding off loneliness in a profession that can be extremely isolating if you let it. Many academics are saddled with being the only person that studies “X” in their department, providing few allies. Find your tribe, wherever they are in and out of academia or your department or institution. Joining professional societies and getting active in them is a great way to ‘hang with your peeps’ that have common interests and build your network.

Your peers are your allies, but they are also your enemies. And as the comic Pogo quoted:

I have met the enemy and he is us

4. It doesn’t get better (unless you make it so). The anti-bullying movement directed towards the gay and lesbian community is framed around the idea that it gets better. Maybe for them, but the same rules are far from true within academia. Too often have I see people drawn by the idea that things get better once you get a long-term contract, or a tenure-track position, or tenure, or a promotion, or a grant or a publication… and all of that is one big lie. I have watched people work just as hard if not more so with success and achieve little in the way of happiness or change in status. In my last two years  as a F/T professor I had over $2M in grants and published more than a dozen peer-reviewed papers, book chapters and monographs, while supervising a team of more than 23 full-time people. I got a teaching award*, a raise, and invitations to speak at keynote events. I was as successful as I ever was going to get and I was getting more miserable by the day.

Once the initial glean of the publication or successful grant application wears off, it is back to normal. This is traditional behavioural economics research and stands up in practice.

Why is this the case? Partly, because the degrees of difference between the work is so hard to perceive and the scales that people use to judge work is highly skewed, everything gets treated the same or we use conventional scales to measure unconventional products. In some places, a $500K contract is viewed less positively than a $100K peer-reviewed grant (see previous points for reasons), which is disheartening to see or experience. Also, because it is so difficult to judge the impact of a paper, they are all viewed in the same light so your Magnum opus might be treated the same as a paper you cared very little about. No one cares like you do and that is sometimes difficult to accept.

(* The teaching award was an exception, that did more to buoy my spirits than anything I’ve experienced in my career, largely because it was completely from the heart by a group of students and faculty who went out of their way to say “thanks”. That was one of those cases where simply being nominated meant the world to me. That I won was just icing).

5. Make small changes often, rather than rock the boat at once. When I became a professor, I knew from day #1 what kind of things I wanted to see different. That we have students — particularly graduate students — sitting in desks in rows listening to someone talk at them for hours is an afront to learning. Armed with educational theory,  two certificates in post-secondary teaching, experience teaching in secondary school, and years of experience as a student, I was going to change the classroom. Having done lots of research, studied knowledge translation, and worked in the community, I was ready to transform the way research could be done. In both cases, I jumped in full-tilt within the means I had available.

And then the system bit back.

It wasn’t so much that anyone or thing resisted, but rather massive change at once is stressful and it was hard to handle all the unexpected consequences of making major changes simultaneously. I study complexity and teach behaviour change so I should know better. If I was to start again, I’d still do it all — but just in smaller chunks over time. But then, I knew I didn’t have much time so that might be part of the problem.

6. Figure out who you want to love you, because it can’t be everyone. Jack of All Trades is a very lonely person inside the university walls, and is loved outside of them. Academia rewards (and punishes) the expert. When you are the right fit, your specialization is golden. “Great, we were looking for someone who studies this exact ______” is wonderful to hear when you are at the institution — maybe one of a handful in the world — that is looking to hire someone with that specific set of skills and interests. There is a lot of ego-stroking in academia when you first get called “an expert” and that is a big part of the problem. We want to be loved and respected, we’ve worked pretty damn hard to be good at something, and we want the recognition. Being an ‘expert’ gives some of this to us.

But if you want to have impact outside in the world, your expertise is going to be limited. That’s OK, but one has to remember that it is indeed rare when someone presents with a highly specialized topic that is widely accessible outside of academia. Broad-based skills are useful in the world beyond the academy and are easier for n0n-academics to comprehend. Thus, people either need to be skilled communicators outright or do the kind of work that is relevant to the community from the outset, using the language of that community. The public — or other professionals or policy makers — will love you, but not necessarily the academy. It’s reasons why fields like community development, program evaluation, social design, and health promotion have a hard go of it in academia: they comprehensive fields that tend towards breadth, not depth. Yet, these skills are needed desperately to solve a certain class of problems. Both specialization and broad-based scholarly skills are useful, its just they are not appreciated equally in all settings.

Telly Sevalas’ Kojak character would ask: “who loves ya, baby?“. You need to ask the same question and accept that it won’t be everyone.

7. You can learn a lot from the military. For many of us in academia, the thought of modeling ourselves after the military in any way is a bit unpalatable. Yet, if you can get past the armed conflict part of their work, military folk have a lot of lessons to teach us faculty. Here are some of them:

- You cannot successfully fight on any more than two fronts at the same time. Thus, if you want to develop diversified program of research, it needs to have two major themes and no more. I had three major programs of research and it was too hard to manage. By program of research, I mean a series of linked projects operating under one general theme — the kind of thing that you will be asked to articulate when you apply for a career award or certain grants. I was too ambitious and excited and it was costly in terms of my mental health and wellbeing.

- “No battle plan survives contact with the enemy” (see points #3 and #8 to identify the enemy — hint: its you and me). You can’t plan your career with an expectation that it will unfold as you outline. Plans are just vague roadmaps to keep you pointed in a direction, not a vision of the exact future ahead. One has to approach the work as developmental in nature.

- Protect your supply lines. From Ghengis Khan to Napoleon to Hitler, the lessons of protect your supply lines comes through in the history books (along with “don’t be a mass-murdering megalomaniac psychopath”). You need to plan for a long haul and make sure that you have the supplies — people, equipment, social support, and emotional fortitude — to operate in cycles that often go in years, not months. For example, taking on a student as an advisor means that you need to have the future supplies for the work itself (1-5 years or more of direct contact depending on the degree) and the years afterward when they apply to graduate school, jobs, grants and beyond.

Academia is designed for the tenured professor who is dedicating a life to the institution and the profession, but the reality is that there is little support for these roles. Thus, you are asked to supply a set of projects and studies that may require you respond to questions, publish papers, or support trainees and staff in various ways well beyond the funding cycle or your contract.

8. Determine how much your soul is worth and price it accordingly. Academia is not a job-space, it is a calling. If you’re thinking of clocking in 9-5 and leaving what you do at the office at the end of the day you are in the wrong business. Indeed, you probably won’t do good work because ideas come at all hours and they need attention when they ask for it. The freedom that comes from this job is a blessing and curse and how it plays out is really up to you. I personally have no problem diving in full-tilt in a period of flow to my work, but it needs to be done consciously and with permission. Otherwise, your friendships, love life, relationships with family and yourself will suffer, sometimes greatly. I know this firsthand.

While I dropped a lot of things from my sometimes unreasonable standards I did decide where my line was and stuck to it. There was one project that I steadfastly refused to rush, skimp on, reduce or limit and I held fast to that. There were a handful of people who I also would ensure they had my fullest attention whenever I met with them no matter what. These were staff or students whom I would give priority to over anything else and I hoped would never feel that I rushed them or ignored them. That was the price of my soul. When career demands started to haggle with me on this price most vociferously, I knew it was time to go. You need to know when your time to go is or be prepared to hold your price.

9. Treat your gas tank like you would handle winter driving conditions (always leave something in the tank). Going all out is something of myth — “give it 110%”, “winners never quit”, “give it your all”. It never stops. When I started, there were a few “quiet times of year” in the academic calendar. Usually early November, January and February, May and July. Now, that doesn’t exist. New Year’s Eve between 11pm and 1am is about it for quiet in the life of an academic. You can keep on going all the time if you allow work to drive your life and demand you use the full tank of gas. The emails rarely stop, the funding opportunities are never-ending, and there are always manuscripts to write, read and review. No matter what kind of joy you derive from your work, always leave something in reserve. Just like winter driving in Canada — you need a little gas left in the tank both for safety, but to ensure that your fuel lines don’t freeze (see supply lines issue above).

I, too often, gave it my all and suffered for it. By “all” I don’t mean hold back creative energy, passion, enthusiasm, or yourself, but rather make sure that you can replenish what you have in whatever way possible. Take a day (or a few) off, read for fun, or exercise (see next point). It need not be a lot, but do something to leave something in the tank and know when you’re getting low. You’ll always be asked to give more; resist.

10. Get out…a lot. Exercise. No really, do it. See movies, listen to music, watch plays, get physical with people in any way appropriate and possible. Use your body, mind and soul to extend outside of your work. See the world that you’re trying to influence even if that influence is a long way from the lab bench you work at or theoretical proposition you are putting forth. My biggest failings were letting work take over too often and neglecting the parts of myself that were important. Your important others — partners, children, friends, pets — will let you know in obvious or subtle ways that you’re neglecting them, but that message can only be heard if you are attentive. As for yourself? That’s even harder as the internal voice can be easily squelched or rationalized out. And if you lose yourself, you’re not much to anyone else.

What makes academic work so insidious from a self-care standpoint is that there are rewards for working hard – more grants, more publications, more recognition — but as you’ll not from #4, the yellow brick road only leads to Oz.

If you’ve read this far, you are either determined to learn about academia or in need of much more to read in your life. So if you are looking for something a little more inspirational, I would recommend the following:

PhD Comics. Yorge Cham’s delightful take on academia is so funny because it is so close to reality.

Dance Your PhD: There are a lot of efforts out there to make even the most arcane subject matter entertaining. Scour the web and delight in some of the most ridiculous things you’ll see tied to your dissertation topic and its a few minutes — or hours — well wasted.

An academic life is not for everyone, but it can be a wonderful space if you’re prepared. Do your research (on the job itself), be true to yourself and those close to you, and get supports. If you do and bring a smile to your day, you’ll probably do OK in this life.


How Systems and Design Thinking Can Address Violence Against Women

The Never Ending Campaign

Twenty-two years ago a 25-year old male walked into the Ecole Polytechnique in Montreal and killed 14 women in a hate crime that injured scores, devastated families and friends of the victims, wounded a school, city and country, and change my life forever. Today, men and women across Canada (and beyond) pause to take stock of the relations between the sexes, the role of violence in our society, and to honour women as they remember the events of that day.

I don’t remember where I was when I heard the news in its fullest. It came out in spurts as these things tend to do when there are so many unknowns happening and much activity. I did know that the enormity of what happened at the Ecole Polytechnique that December 6th took a long time to sink in. Reports on the news that there had been a shooting on a college campus were scary enough, but as  details emerged that it was women who were specifically targetted and as the depth of the carnage unfolded, I felt a profound sense of loss and kinship as many of the victims could have been my peers. This was not just a mourning for the victims themselves, but a loss of innocence (and ignorance) that I never regained. That day changed my life in ways that I wouldn’t come to understand until many years later.

The Montreal Massacre as it was called led me, for the first time in my life, to feel a sense of shame for what I was (a man), not just who I was or what I had done. I didn’t commit the crime, nor did I do anything to stoke the fires of hatred in Marc Lepine, but I started to question what role my society had in the killing and me by extension as male member of that society. That feeling of shame was profound, slow-building and completely opened myself up to a world that I had been too ignorant of. It raised many questions in me about sex, gender roles and my own place within both of those topics.

I was (and am) lucky. I had the fortune to be born into a family of strong women who cared for me and set great examples of what and who humans could be. From my Mom to my cousins, aunts and my grandmothers, I had a remarkable number of female role models to look up to. But I was also born into a society where sexist imagery, jokes, and patriarchal power dynamics were (and are) dominant. Without the openness to discuss these things, challenge them, and with few male role models who did, it was easy to absorb messages —  from mainstream media (movies, TV, magazines), the fashion world, professional sports, and pornography that portrayed women as subservient, sex objects (instead of sexual beings), and weaker-thans — and to hold those positions as unchallenged or taken in uncritically. It was hard to reconcile what I saw in my family with what I saw everywhere else, but somehow these poles just sat in my conscious and unconscious self.

December 6, 1989 changed that and brought those two perspectives into collision.

My world opened up that day and the role that sexism and violence plays in everyday life became apparent and obvious in ways it hadn’t before. Ever since then, the role that violence, sexism, inequality and the insidious ways that these forces are manifest has been at the front of my consciousness. I haven’t always known what to do with these issues, but I have tried to make a difference and continue to be true with myself and others in addressing them whenever I have an opportunity to. This has brought me to many moments with other men that have been uncomfortable; sometimes I’ve done the right thing and spoke out and other times I haven’t. I’m not proud of the latter moments, but I at least know what I didn’t do wasn’t helpful.

Being aware is the first step. But awareness is only a first step and as a researcher, designer, and citizen I demand more.

I have since come to understand those feelings I had that December day and channel them into something productive, but it wasn’t easy. For example, it is sometimes difficult to reconcile activities that are expressions of a certain type of masculinity with those that lead to sexist oppression or intimidation. Sports is a great example of highlighting the best and worst of masculine behaviour. It is too easy to jump towards oppressing men just as men have (sometimes unwittingly or unknowingly) oppressed women.  Attacking men isn’t the answer.

While I think I am aware of how my social position can negatively influence my interactions with others, I certainly do not have the answers for what to do. What I do know is that I need to be vigilant as the system that props up psychological and physical violence against women is powerful indeed. The White Ribbon Campaign (illustrated above) is laudable, but it is a short-burst effort to raise awareness. It isn’t 365 days long and in our minds it should be.

So what should the vigilant, conscientious man do? The following list comes from the Say No to Violence campaign which operates parallel to the White Ribbon Campaign in Canada. It suggests a series of small, but very important steps that men can tangibly take to address this issue in practical terms, but hints at a larger systems answer:

1.  Think about the kind of man you want to be: kind, responsible, one that shares equally in family life and respects women and girls.

2.  Be respectful towards women, girls, and other guys.  Sexism and homophobia hurts us all.

3. Ask first.  Whether it’s holding hands, kissing, or more, it’s important to communicate and seek consent.

4. Never use coercion, threats, or violence in your relationships with others.

5. Wear a white ribbon and pledge to never commit, condone, or remain silent about violence against women and girls. Visit our website to order ribbons.

6.  Teach your students and the youth in your community about gender equality and healthy, equal relationships.

7.  Be a good role model and share with the boys and young men around you the importance of respecting women and girls. Visitwww.itstartswithyou.ca to find out how.

8.  Learn about the impact of violence against women in your community.  Volunteer with a local shelter or a women’s organization.

9.  Challenge and speak out against hurtful language, sexist jokes, and bullying, in your school, community, workplace, or place of worship.

10.  Link your website to ours or place a banner for our It Starts With You Campaign on your website or blog and help us spread the word.

11.  Accept your role as a man in helping to end violence against women. It affects everyone.

12.  Start a White Ribbon Club or Campaign in your school or community. Visit our website to find out how.

13.  Order our awareness materials and help educate others in your school, community, or workplace about men’s violence against women and girls.

14.  Watch our collection of powerful digital stories to learn about the important connection between masculinity and gender equality.

15.  As a community leader, policy maker, funder, or NGO staff member, read our issue brief to learn about the important role that men and boys can play in ending gender-based violence.

16.  As a father or a family member, teaching the boys in your life about healthy equal relationships helps you do your part in creating healthy families and strengthening family bonds.

These suggestions all can help. Perhaps not surprisingly to readers of this blog, I would argue that there is a big role for systems and design thinking here. It’s one thing to be the change you wish to see in the world, but like Mohandas Ghandi who said this first, you need to change the system and design a strategy for doing it with others for that change to take root with others and spread. Campaigns like White Ribbon are one start. Another is to create the kind of sex and gender-positive organizations (including schools) that provide the scaffolding for allowing people to be themselves to the fullest without fear of violence, discrimination or abuse.

Yet another is to support women (and men) in being able to talk about these issues openly without judgement; design interaction spaces for dialogue just as some are trying with the occupy movement. As a man thinking back on the events of December 6th, 1989 I can remember feeling so alone in my ability to have conversations about the subject matter that didn’t resort into a guilt-trip (for being a man), seeing the event as the act of a lone, crazy individual (being dismissive), or just invoking a sense of despair at the complexity of it all (giving up). There was and is something that can be done. It’s just that it won’t change overnight and is an issue so entrenched into our society that it will be hard to untangle, but it can be done. This is a more wicked problem that it needs to be, but it nonetheless is one. In addressing its root causes and its superficial and deep consequences, we need to think bigger, smarter and act in ways that fit with a complex system.

So where to? From a systems perspective there are things we can do:

  1. Follow the list above — as many or as few items as possible — and do it as often as possible. Small, coordinated steps instill change in ways that don’t disrupt the system to create a backlash, nor does it let it the status quo rule;
  2. Share your experiences (maximize feedback, evaluate), learn from others and integrate this learning into your life and adapt your strategies based on this feedback. Keep changing, evolving and learning;
  3. Get diverse: bring in those that might have new perspectives and might not be the most obvious champions for women’s safety and gender equity and equality (improve learning). Some of the greatest insights and opportunities may come from going beyond the realm we’re familiar with;
  4. Find specific issues and topics that a wide range of people can see themselves in (create an attractor and probe) and make it something that people can self-organize around. Rather than ‘set the agenda’, throw out ideas and nurture the ones that people gravitate to and leverage that momentum into something that can emerge;
  5. Try being oblique (in your strategy). Consider indirect routes to tackling the issue as sometimes thorny, complex issues are best tackled indirectly through other channels (e.g., sports)
  6. Be persistent. Systems change doesn’t happen quickly except in times of great crisis and chaos and not always to our advantage. Steady and continuous will win the day.
From a designer’s perspective, we can help by determining the position of the problem and finding out what it really is.
  1. Spend time finding out what the problem is. Is it violence? Is it something that leads to violence? Is it a structure that leads to something that leads to violence? Asking why a LOT can help. Designers spend a lot of time problem finding.
  2. Frame the issue in the context of the people involved. Get empathic. Men, consider what life might be like living in fear of violence, being denied opportunities because of your sex, or what it would be like to have your value judged solely by how you look or what you could do for the opposite sex. Take sides — both sides — and see imagine what it is like to be a women who is stalked, abused, neglected or ignored. Alternatively, consider what it might be like for a man to get so caught up that he physically assaults someone he genuinely loves, or imagine what it would feel like not to have love at all and to hate those that do. Contemplate what it might be like to be a child to see the two people she or he loves most nearly kill one another in a rage that often feels like you caused it or growing up with the idea that another sex is inferior because that’s all you’ve been told. None of these are particularly pleasant, but only when we can see the whole issue — including that of victims and perpetrators and see them with empathy, compassion and understanding can we design solutions that might alleviate the problem;
  3. Develop solutions with those most affected –  and this might mean involving men more than women sometimes (which is the exact opposite of what we do now). The solutions might not reside in the most obvious place and maybe it means stepping out of the conventional spaces into something a little more uncomfortable, yet closer to the problem;
  4. Prototype. Try things out and evaluate what happens when you do something. Small, safe-fail experiments allow you to learn as you go rather than aim to change the entire system at once, offering a lot of options for innovation.

Today, as we remember the lives lost and damaged from the events of December 6th and the global challenge that this represents, consider taking up the challenge and perhaps together we can systems think and design our way to a healthier, more equitable world for men and women alike.

Imagine how we can create a system that makes the unthinkable truly so. As designers, envision what we could do if we engaged people in the design challenge to reimagine our sex and gender roles in a healthier image.

Yesterday, I wrote about how women are becoming the leaders in our complex world. The issue of violence against women is an area where men can step up and show some leadership too. Indeed, it is a space for all of us to take charge and lead. Let’s step it up.

And for men? Wear your ribbon proud today and carry that thought with you the remaining 364 days of the year.

White Ribbon, worn


Women and Leadership in Times of Complexity

We Can Do It by J. Howard Miller

“The Sisters Are Doin’ It For Themselves” – Aretha Franklin & The Eurythmics

The old cliches of where a woman’s place ought to be have changed to mean: anywhere she wants to be. Women are poised to drive change in the age of complexity leading us all to consider why this might be the case and what we can learn from it.

There was a time when women repeated the line in graphic artist J. Howard Miller‘s famous piece: We Can Do It! Now, as Aretha and Annie sing, they are doing it for themselves…and in spades. The ‘it’ is leading and innovating in times of great complexity and change and not necessarily by role, but by action. When the challenges of ‘wicked problems‘ become great and pervasive, it is women not men who are stepping up to lead and that might have a lot to do with design. How?

Design and design thinking is fundamentally about strategies used to create, shape and influence. There are many definitions of the concept, but generally speaking it is about finding / clarifying problems at their root, framing them within a larger context, and addressing them using empathic methods. Quite often this involves intense engagement with the issue and those whom the issue most affects and these are areas where women are doing well.

Drawing on the growing literature base on design thinking and a series of ongoing interviews I have done as part of the Design Thinking Foundations project, there are three areas that sit at the core of this way of approaching problems. As it turns out, women are pretty good at all of them:

  1. Empathy. Getting to learn more about the person / people who are designing for / with by stepping into their shoes is a powerful vehicle for gaining insight into the nature of the problem at hand, its frames, and possible ways forward. Research looking at males and females consistently shows women expressing higher levels of emotional empathy than men (e.g,  ). More recent work has begun to explore the ways in which women relate empathically to others, whereas men are more prone to what can be called Machevellian tendencies;
  2. Literacy. By this I refer to a constellation of skills that sit at the intersection of craft and knowledge to address a particular problem. A designer’s literacy most often includes creativity and the ability to analyze problems. These skills can fall within artistic realms, but also scientific and mathematical realms. Here in Canada, a recent report on the state of education finds that boys are lagging in literacy scores and, for the first time, science scores. They are tied with girls in math. The report (PDF-summary) adds greater weight to the shifting nature of boys and girls.
  3. Engagement. Designers — whether they are introverts or extroverts — need to be able to engage in diverse social situations in order to create useful products and services. Early work on online social networks is suggestive of this, building on a body of work looking at the strength of associations between gender, emotion and socialization (see 2010 chapter of the same name)

It used to be that women would express these three areas in social roles that were of lower status than men and generally following male leads (e.g., homemaker, assistant). However, the balance is starting to shift and women are no longer waiting for men to give things up, they are taking things for themselves. Indeed, women are becoming the new leaders and are designing themselves lives that will keep them in this position for the foreseeable future if indeed design is the new competitive advantage as has been suggested by Roger Martin at the Rotman School of Business in Toronto.

Lest we think this is isolated to Canada or the United States, the rise of women and girls is being seen globally. Earlier this year, the Economist explored how Asian women are marrying less and marrying later. One of the reasons is that they are no longer tied to men in the same way and are less willing to fill a role that sees them often as less than in their marriages. Indeed, Asian women are eschewing the practice altogether in rates never before seen and may be on the cusp of instilling deep and profound social change.

A lot of Asians are not marrying later. They are not marrying at all. Almost a third of Japanese women in their early 30s are unmarried; probably half of those will always be. Over one-fifth of Taiwanese women in their late 30s are single; most will never marry. In some places, rates of non-marriage are especially striking: in Bangkok, 20% of 40-44-year old women are not married; in Tokyo, 21%; among university graduates of that age in Singapore, 27%.(Economist,  August 20, 2011)

One of the reasons is that women are more often placed in roles of great social complexity in the family/social sphere, yet without the power to make key decisions. This might mean child raising (often held as the ideal example of complexity), negotiating and planning social engagements, and doing much of the emotional maintenance in relationships. While these are not universal and suggestive of stereotype, there are libraries full of research that have found these roles tend to be persistent and consistent across most Western countries. Until now.  These are also the kinds of skills that are needed in complex systems and to create means to navigate through them.

Women are no longer satisfied (nor should they be) with the roles assigned to them by men, but are shaping and crafting new ones for themselves and reclaiming and challenging outdated, sexist ones. A terrific example of this is the SlutWalk movement that started in Toronto in reaction to public statements by a police officer aimed at helping prevent rape that placed blame on victims, suggesting that women “stop dressing like sluts”. Here, women just took action and men followed.

As societies, we will (and do) need leaders and innovators who know how to manage complexity well and design solutions and women may be the first place to look because they are doing it already.


Social Media and the Limits to Growth

Social Media, Social Noise?

Social media provides a virtual firehose of content that surpasses anything we’ve had access to before. But is this sea of content becoming too much to manage and what does this mean for knowledge-driven enterprises as the barriers to content creation drop almost as low as they are for consumption?

I added some new friends to Facebook this week. To my knowledge, there weren’t any that left my roster. I also had quite a few new people follow me on Twitter. This blog was visited a few hundred times and even my other, less widely publicized blogs got some traffic. So too did millions of others. Despite there being holidays North and South of the Canada-US border, people still were reading and writing and so, too, was the rest of the world.

Dana Meadows’ classic work in system dynamics, The Limits to Growth, has served as a treatise on the problem of the “more of everything” mindset for a generation and continues to inspire work in the environmental movement. It may be time to dust off our copies of Meadows’ book (or pick up her newer, posthumously published one, Thinking in Systems) and consider what this means for social media.

The argument is pretty straightforward: “more of everything” thinking to solve problems leads to dynamic shifts in our system that have unintended consequences. If our current capacity to handle information — whether in quantity or quality — is a certain level now, adding more input will result in a change in this capacity. These changes are often non-linear in nature. Consider the example of lifting weights at the gym. You might do 10 repetitions of an exercise where the first 7 feel comparably similar and then grunt and push your way through the final three with difficulty that gets exponentially more difficult with each additional rep. This is an example of a type of distribution of experience that social media operates in.

Complex dynamic systems, of which social media is indeed one, frequently operate using Pareto distributions of activity, not the standard normal one.  What this means in complexity terms is that when we start to feel that it is hard to handle things, the gap between our current capacity and maximum capacity is actually very small not something far off. I believe we are getting close.

What this means is still a mystery. We humans are remarkably adaptive and if the information layer is too thick in one area of our life, we will compensate in others. Unfortunately, this means neglecting other activities, whether that be face-to-face relations with others, hobbies, other interests, travel and so on. Another compensatory response is to distribute attentional resources differently. That is, spend less time in depth on issues to allow for greater breadth.

All of these are problematic when many of the challenges we face require more sophisticated thinking, contemplative inquiry, and the space to bring diverse perspectives to bear. Complex problem solving is difficult because it often requires working with others, considering different perspectives, listening deeply and broadly; all of which take time, which is something we are taking less of more and more. In public health, we’re doing a bad job of serving as role models in caring for ourselves and giving us the time to contemplate these big problems. A fascination with social media, while helping us consider the role of relationships, could also be undermining our already fragile state of attentional awareness.

I recently experimented with the new service Path, which allows you to build a deep relationship with others using social media. It was among the shortest experiments of my social media career. Interesting idea, but the wave of content that it helped unleash was too much, too soon. What I am worrying about is spending less time on things, not more. In embracing social media as a tool to support complex decision making and learning I am realizing that there is an ironic twist in that it, in some cases, is reducing my ability to do so.

In striving to create better wayfinding strategies, I am getting lost.

These are design problems, wicked problems, and ones that we will need to tackle soon lest we have more of everything and wind up with lots of nothing.


Standing Out / Outstanding: The Standards Problem

Building up to be unique...just like everyone else?

Human service providers live in paradox by stressing best practices while wishing for some recognition of the unique qualities that they bring. Can being unique be the standard we need?

Recently, I was with a colleague discussing the challenges that universities are facing with respect to the twin issues of curtailing costs and expanding revenues. Standing out is getting to be more important than ever.

What captured our attention was the great irony that we are at a time when there is such a great drive to standardize when the marketplace is so crowded. The very competitive advantage that comes with being unique is being subsumed under pressure to be like everyone else.

In education, health sciences, and social and human services we are seeing this remarkable drive towards things such as accreditation of programs, implementation of best practices throughout the curriculum, and certification of activities that once did not require it. The underpinning logic is that having some kind of benchmark and standard that all programs or activities of a similar nature can adhere to will ensure that there is sufficient quality for the consumer of such programs.

While there are certainly activities where standards and consistency work well (for example, I don’t really want the pilot of my next flight expressing his creativity through the way he maneuvers the airplane), these standards or best practices are based on a view that the world is relatively simple, or a least principally ordered. The Cynefin Framework can help identify certain conditions where these type of systems thrive.

However, in fields like health promotion, community psychology, the arts, much of social work, and those working in the open systems found in communities and many organizations, order is a fleeting condition and unstable.

To be good at what you do in these domains, whether it is hosting a design charrette or doing community-based research, one has to pay considerable attention to subtle difference and adjust a strategy accordingly. This customization of activity — which does not require a wholesale abandonment of what has been done before  - are the very things that signify empathy, create connection, and represent a true mark of competence in this domain. Being different across settings and conditions — standing out — is what makes a service outstanding.

This tension or paradox is something that could benefit from much more exploration and might serve as something for universities and professions to consider taking seriously. Ironically, the establishment of much of what “best practice” seeks to achieve might be accomplished through celebrating difference.

** Photo Unique by rossaroni used under Creative Commons License from Flickr


Trying to Innovate? Try Empathy

Let's imagine what its like to be each other

Designers often point to empathy and collaboration as two essential activities in their creation process with clients. It now appears that these two are more linked than it first appears.  
Collaboration is increasingly becoming among the most “essential” of terms for those working in public health or any other field related to wellbeing. This is for good reason given that much of the environment is which this field operates in involves complex problem solving. And complex problems, those with multiple causes and consequences that are highly dependent on context, require multiple perspectives to adequately address.
Collaboration is a means of engaging the necessary diversity to problem-solve effectively. Adam Richardson from Frog Design recently compared collaborative activity to being a “team sport”. I find the analogy fitting, because a team sport is something that is highly engaging when you’re playing it. When you are on the field of play in a game like football (soccer) or hockey, the focus is on the ball/puck and attractor patterns that build around it. When control of the ball (or puck) is yours, the decision to move alone with it or share it with your teammates is strategic, but in the moment, with the aim of achieving (and scoring) a goal.
Team members don’t contemplate their relationship with others as “collaboration” while playing the game, they simply play the game. Although most of us have played some type of team sport, few of us are really skilled at collaboration and fewer are prepared for it when it comes about. Why is that?
Richardson’s HBR post provides some points to jump off on. He suggests the following key points to consider:
1. Collaboration is a process not an event. We need to be more attuned to the rhythms and pace of others if we are going to be successful at working together. Syncing these and understanding when they are not working together is important and this means paying attention.
2. Helping people warm up to collaboration. Socializing is natural, but many of the contexts we do this in terms of collaboration are not by themselves natural. It is important to get people in the right frame of mind and sometimes this means mixing things up.
3. What is good for collaboration is also good for innovation. What makes someone a good innovator is a willingness to take risks and to build trust. The former is something that comes from personality, experience and support. The latter adds empathy.
Getting these ducks in a row is a problem of design, not just a practice of design. Not only are we not designing spaces for collaboration (both social and physical), we are not designing the intellectual space for it. A study reported through Science Daily and presented at the annual meeting the American Psychological Society in Washington  suggests that students are nowhere near as empathic as their counterparts were in the latter part of the 20th century.
“We found the biggest drop in empathy after the year 2000,” said Sara Konrath, a researcher at the U-M Institute for Social Research. “College kids today are about 40 percent lower in empathy than their counterparts of 20 or 30 years ago, as measured by standard tests of this personality trait.”
The report goes on to show how perspective-taking, a key component in empathy (and in good design practice) is becoming less familiar or practiced by students today compared to the 1970′s:
Compared to college students of the late 1970s, the study found, college students today are less likely to agree with statements such as “I sometimes try to understand my friends better by imagining how things look from their perspective” and “I often have tender, concerned feelings for people less fortunate than me.”
It is perhaps not surprising that another recently posted article on innovation suggests that large corporate structures where impersonal relations are formed are not conducive to innovation.
Perhaps this all comes down to the relationship qualities that we’ve used since we were kinds. Find and build a tribe of people who you trust and like and spend time with them, get to know them, and invite new people in whenever possible to mix things up. If that is the case, then the way we work in the health and wellness sector is surely in trouble where we don’t curate information and customize our knowledge for others, and we don’t support the kind of relationship building that equates to robust knowledge translation.
I can sympathize with my colleagues who face this problem. But the key is whether or not I can empathize with them.

Thinking Different Requires Different Thinking

Think Different

Novelty, innovation and doing things differently are seen as the key to competitive advantage and scientific discovery. How we think is as important as what we do and use of the term thinking might be one of the most valued things we do of them all.

Recently Tony Golsby-Smith wrote on the Harvard Business Review blog about the potential contributions of those from non-traditional disciplines (aka: the Humanities) to improving innovation. He states:

People trained in the humanities who study Shakespeare’s poetry, or Cezanne’s paintings, say, have learned to play with big concepts, and to apply new ways of thinking to difficult problems that can’t be analyzed in conventional ways.

The reason? those in the humanities and related disciplines are trained to consider “what if?” questions at the outset. Golby-Smith adds:

This is because our educational systems focus on teaching science and business students to control, predict, verify, guarantee, and test data. It doesn’t teach how to navigate “what if” questions or unknown futures. As Amos Shapira, the CEO of Cellcom, the leading cell phone provider in Israel, put it: “The knowledge I use as CEO can be acquired in two weeks…The main thing a student needs to be taught is how to study and analyze things (including) history and philosophy.”

Ouch. That has to sting for those who just spent $80K on an MBA to get to the C-suite.

But this is not just about business, it extends to a lot of sectors, including health. The focus — almost tyranny — of evidence in health systems has created the same kind of mindset that we see in the scenario described above and the absence of “what if” thinking. Evidence, as it is distilled and presented in the health sector, tends be used to guide actions based on what has happened on the past, not the future. In many cases this is perfectly reasonable and, indeed, ideal (life saving even!), yet evidence can be used as a blunt instrument in areas where precision and learning from the past do not apply. Much of health policy and public health fall into this realm.

To understand this requires another different kind of thinking beyond discipline to areas of transdisciplinary arenas like that of systems thinking. Systems thinking is not systematic thinking, rather it is a different way of seeing problems. It is the difference between hard and soft systems, described by Peter Checkland as the following:

The key difference between them, little understood as yet in the literature, is that the hard tradition assumes that systems exist in the world and can be engineered to achieve declared objectives. The soft tradition assumes that the world is problematical, always more complex than any of our accounts of it, but that the process of enquiry into the world can be engineered as a learning system…

What Checkland suggests is that we can create systematic ways of knowing about the complexity around us and that is what (soft) systems thinking is about. Another way of looking at these problems is using the Cynefin Framework, which illustrates areas where hard systems thinking might prove useful and where a “softer” (to use Checkland’s terms) might be more appropriate.

But neither of these particular models are useful without the shift in thinking outright. Until one starts to see systems, to acknowledge complexity, and to devise ways of organizing that recognize both of these in the way in which knowledge is produced, curated, translated and integrated this is a moot point. Further, until one considers applying such thinking consciously and with in intent to shape the world around us, which I would describe as (partly) design thinking , we will continue to use evidence, the past, and the wrong questions to get the answers we look for (not the answers we want) in addressing health-related challenges and issues.

Taking up the point that Golsby-Smith makes in HBR, getting new players into the mix is one start. I have some others:

  1. Teach thinking. We rarely get taught how to think in school, just what to think and why to think about it. The two are very different. Include systems and design thinking in courses aimed at training people who work in areas of complexity. Whether it is in formal school settings or continuing education environments, don’t assume that people know about these thinking approaches or that they will pick them up quickly. The non-linear, highly contextualized nature of complex systems and the strategies used to navigate through them are difficult for most people trained in the Western scientific tradition. Yet, the rewards are great for those willing to persevere.
  2. Take the boundaries of discipline and their points of confluence seriously. While a “hot topic”, transdisciplinarity — working at the intersection of disciplines, not just at the margin of them, is important. Understanding where you come from — in terms of training, experience, life philosophy — helps place you within a system of enquiry and enables you to see boundaries. Too often we fail to acknowledge boundaries at all, assuming that evidence is universal and understood across settings and contexts, which isn’t true.
  3. Build in diversity..and support it. Humanities scholars and engineers working together? Why not. However, throwing people together isn’t the same as nurturing an environment where diversity is respected. Scott Page’s work on diversity and complexity has looked at the dialogical nature of this relationship and how one feeds the other. Creating — designing — environments that bring the best of diversity out is something that requires much attention and brings many rewards.
  4. Thinking is a participatory sport.Although thinking is most often considered a solitary, cognitive activity, support for teams and wide engagement with thinking-related materials and methods is the way to support true integration of knowledge and learning. It is one thing to think of systems, it is another to really experience them. One strategy I’ve tried with some success is to have systems learners use photographs or videos or other arts to capture the tacit and everyday expressions of systems in their lives. When learners go beyond what the evidence tells them, see systems for themselves, and share that with others they are better able to point to spaces where new thinking can generate innovations and how what is known matches with what is possible.

Understanding not only what we think about, but how we think about it in relation to the issues we face is important if we are derive strategies that take the complexity of human systems into account. Teaching for thinking and not for knowledge in itself requires different thinking and acting. The question is: Are we ready and willing to do this? Most people love change so long as they don’t have to do anything different. Hopefully, our health and research systems are different. And if not, how can we inspire the thinking to make them so?

*** Photo Think by jon_skilling used under Creative Commons Licence from Flickr


The Know-Do Gap in Knowledge Translation Human Resources

Lots of thinking, not as much doing

Knowledge translation is about putting evidence into practice, but what about putting practices into place that support evidence creation and the people who are in charge of this? Until this missing link is addressed, our knowledge-practice gap will not shrink anytime soon.

Knowing is not enough; we must apply. Willing is not enough; we must do – Goethe

There is a widely held, mistaken belief that knowledge translation (KT) is all about knowledge. During my post doctoral work on KT and systems science I came to know just how strongly this view is held and how faulty it is in terms of practice. Spend time observing how people actually generate, share and take in knowledge and you’ll see that the actual content is a small part of the equation. Quality relationships, networks of people working together, and the right systems and environments in place to facilitate interaction of those people and ideas is what moves knowledge into action.

I was part of a review team that looked at the evidence for knowledge translation and how it fit within cancer communications and we found that much of what has been published focuses on content, not context. While good, appropriate and timely content is a necessary factor in KT, it is hardly sufficient if there are no people or environments where that knowledge can be appropriately contemplated, learned and applied. This is knowledge integration and it requires people and systems working together.

The systems part is tricky enough and has received growing attention over the past decade (see the linked paper above for a short history of knowledge-to-action research), but it is the human side that remains neglected. To make matters worse, it is our future leaders who are bearing the brunt of this lack of attention.

Consider three examples that presented themselves to me over the past week:

1. A young, bold, charismatic and clear communicator with all the skills, knowledge and enthusiasm and desire to be a knowledge broker who is working on the latest of a string of one-year contracts for different organizations. How is this person supposed to be effective at building relationships when she has to start over in a new role in a new organizational every 12 months?

2. A knowledge mobilizer who speaks highly of his team and role on an enthusiastic, dynamic project aimed at transforming academic knowledge into useful, usable, and accessible forms for policy makers and how he is going to miss it as his contract is up (because his part of the project was funded for just one year). What is going to happen to his knowledge when he leaves?

3. A knowledge generator and health promoter who brings a talent for engaging the community and building networks between disparate voices and groups contemplates what it means to be told in one breath that her work (and that of her team and their projects) is so highly valued and impactful and with the next breath that the project will not be funded again, because it is only a one-year initiative. Are those networks she helped create going to grow without someone paying attention to the whole and not just the parts?

These are not content issues, they are human resource issues and systems ones. All the wonderful research scientists do and the amazing innovations that clinicians introduce are not going to amount to anything lasting without someone to carry the torch and to pay attention to getting that knowledge into practice. The knowledge-to-action system is too complex, too fast moving, and attentional resources are too thin to expect that all this can be done on its own without some forethought and committed focus on KT.

And KT and the relationships necessary for true knowledge integration are not things that can be compartmentalized and squished into one year contracts.

What Allan Best, Bob Hiatt and the panel we worked with found (as have others) is that the content itself needs systems in place to do support its integration into practice. These are human systems and those are built on relationships, and relationships are contiguous, not arbitrary or episodic. Yet that is how we view these activities given the way we structure projects and roles for people working in KT.

We are starting to pay more attention to the way in which content is created now it is time to pay as much attention to how it is translated in real human terms and create the same kinds of supports for people that we try to do for content. Otherwise, the young leaders I profiled above will leave the system and take with them their enthusiasm, energy and, ironically, their knowledge leaving us with little more than a name (KT).

 

*** Photo “Thinker” by dirvish used under a Creative Commons License from Flickr


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