Design (re)Thinking Health Systems
Posted: May 10, 2013 Filed under: design thinking, knowledge translation, public health, systems thinking | Tags: design thinking, gigamapping, global health, health and wellbeing, health systems, Julio Frenk, knowledge translation, public health, science, system dynamics, systems thinking, visual thinking Leave a comment »
How might we design health systems to promote health and wellbeing and not just treat illness and disease and manage infirmary and chronic conditions? What if health systems were about health?
If we were to apply design thinking to health systems, what might be do?
In a previous post, I suggested that knowledge translation is too important to be trusted solely to health professionals, partly because they have largely failed to take up the charge. Taking a step back — a systems thinking perspective — one realizes that to design better knowledge translation, we need to design better health systems.
Julio Frenk, Dean of the School of Public Health at Harvard, believes this too. In a 2010 paper published in PLOS Medicine, Frenk comments on the state of health systems and examines how we might re-think them in light of global health challenges.
Health systems are the main instrumentality to close the knowledge–action gap. To realize this potential, it will be necessary to mobilize the power of evidence to promote change. Yet all too often reform efforts are not evaluated adequately. Each innovation in health systems constitutes a learning opportunity.
Frenk’s article is an invitation to engage in systems and design thinking about health. Both approaches invite pause to consider what the problem is in the first place. For design thinkers, problem scoping is the first step.
For systems thinkers this is akin to setting the boundaries around the problem.
Once we set the boundaries and find the appropriate problem, we then frame it appropriately for design. Problem definition is something often over-looked or under appreciated, but is the core of effective problem solving and design.
If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions – Albert Einstein
Health systems are typically defined in light of professional services and policies aimed at making the sick well. They are essentially illness and disease (sick care) systems. This conceptualization, still dominant in the professional and policy discourse in many Western countries, places medicine at the centre of health services with the allied disciplines working alongside, but rarely ventures its gaze beyond the institutions of care or the conditions such institutions are designed to treat.
Frenk, writing in PLOS Medicine, suggests its time to expand our view of what makes a health system if we are to truly promote and sustain global health and see three key points as provoking such re-thinking:
First, health has been increasingly recognized as a key element of sustainable economic development [1], global security, effective governance, and human rights promotion [2]. Second, due to the growing perceived importance of health, unprecedented—albeit still insufficient—sums of funds are flowing into this sector [3]. Third, there is a burst of new initiatives coming forth to strengthen national health systems as the core of the global health system and a fundamental strategy to achieve the health-related Millennium Development Goals.
In order to realize the opportunities offered by the conjunction of these unique circumstances, it is essential to have a clear conception of national health systems that may guide further progress in global health.
Frenk offers some suggestions:
Part of the problem with the health systems debate is that too often it has adopted a reductionist perspective that ignores important aspects. Developing a more comprehensive view requires that we expand our thinking in four main directions.
First, we should think of the health system not only in terms of its component elements (like human resources, financing, hospitals, clinics, technologies, etc.) but most importantly in terms of their interrelations. Second, we should include not only the institutional or supply side of the health system, but also the population. In a dynamic view, the population is not an external beneficiary of the system; it is an essential part of it.
It’s important to note the mention of the role of the population and its dynamical impact on the system. As populations change dramatically in their composition and form of residency within countries, including a greater movement to urbanization, so too will the myriad factors that influence health systems. The people are the system and thus it will change as populations change. While Frenk lists this as one point of many, it is a radical departure for reductionists or those who see health systems as being about care, not people.
A third expansion of our understanding of systems refers to their goals. Typically, we have limited the discussion to the goal of improving health. This is, indeed, the defining goal of a health system. However, we must look not only at the level of health, but also at its distribution, which gives equity a central place in assessing a health system. In addition, we must also include other goals that are intrinsically valued beyond the improvement of health. One of those goals is to enhance the responsiveness of the health system to the legitimate expectations of the population for care that respects the dignity of persons and promotes their satisfaction. The other goal is fair financing, so that the burden of supporting the system is distributed in an equitable manner and families are protected from the financial consequences of disease.
Frenk’s third challenge is to affirm the very point of health systems at all.
While not explicitly speaking of systems thinking or design thinking, there is much that both fields have in common with Frenk’s argument. Design thinkers might ask: What have we hired our health system to do?
Frenk argues that our health systems must go well beyond just making gains in measured health outcomes towards dignity, respect and social justice.
Finally, we should expand our view with respect to the functions that a health system must perform. Most global initiatives have been concerned mainly with one of those functions, namely, the direct provision of services, whether they are medical or public health services. This is, of course, an essential function, but for it to happen at all, health systems must perform other enabling functions, such as stewardship, financing, and resource generation, including what is probably the most complex of all challenges, the health workforce.
Frenk did not identify specific solutions, but did pose some key questions for health systems design.
If we were to take this challenge up as designers and systems thinkers, what might we do? Here are some suggestions for inquiry:
- Consider new definitions of health like the one posed in the British Medical Journal that emphasizes looking at the social and environmental influences on health beyond just the absence of physical symptoms. Further inclusion of a psychology of human flourishing might add to this definition.
- Map out a new system visually with people at the centre, not professionals or institutions. What does that look like? Tools like a Gigamap might provide the kind of multi-media, multi-sensory visual way to conceive of the interrelationships that make up health system. System dynamic models can help this out as well.
- Engage people across this system to validate this map and co-create possible future models that could serve to shape discussion at multiple levels and mobilize civil society to support healthy environments.
- Create small scale, safe-fail / fail-forward, prototypes of small-scale innovations that can be tested, developmentally designed, and rapidly re-developed as needed to start shifting the system as a whole.
Designing health requires designing health systems. Applying new thinking and envisioning a system that is dynamic, comprised of people and just institutions is a start.
Photo: Bartolomeo Eustachi: Peripheral Nervous System, c. 1722 shared by brain_blogger used under Creative Commons Licence
The Importance of Journalism to Public Health: 10 Years After SARS How Are We Doing?
Posted: April 4, 2013 Filed under: public health, social media, systems thinking | Tags: developmental design, developmental evaluation, evidence, health communications, health reporting, Helen Branswell, journalism, Julie Leask, media, public health, social media, systems thinking, Wayne MacPhail 2 Comments »
Risk communication in public health with Julie Leask
If a health scare manifested itself in the world and there were no journalists to cover the story, what would the impact on the public be?
That is a question that lingered with me throughout the start of the 2013 Ontario Public Health Convention (TOPHC) which began with a morning dedicated to improving public health communication. Opening up the conference was a series of linked keynote presentations from a risk communications researcher (Julie Leask); a former newspaper editor, journalism professor and social media advocate (Wayne MacPhail), and one of Canada’s leading health specialist reporters (Helen Branswell).
The Academic’s Perspective
Keynote speaker Julie Leask (pictured above) and her colleague Dr. Claire Hooker (a good friend of mine) have been looking at the ways journalists engage in risk communication with the public on matters of public health from immunization to SARS to understanding the health priorities of professionals. In 2010 they published a paper looking at how the media covers health topics and argued that the health professions need to be aware of how stories are made, communicated and to be an active partner with reporters if they are to have positive impact in moments of health scares.
“It’s too late when the crisis comes up” – Julie Leask speaking on the need for public health to get engaged with the public using social media
In a previous post I wrote about how journalism is the fourth estate of medicine and public health. Journalists are the storytellers that the public listen to and are charged with looking at a problem from many perspectives to develop that coherent narrative that speaks to their audience. These are qualities that most scientists and public health professionals don’t bring to their jobs, nor are they always expected to or even should. As such, journalists play an important role for this very reason.
Nonetheless, the health sector has an uneasy relationship with journalism. Health professionals – particularly researchers — poorly understand the world of journalists and sometimes view the profession with suspicion. Julie Leask and her colleagues have found this to be the case, but argue that it is no reason to shy away from engaging the public using the tools that are comfortable to journalists. She spoke to the invaluable role of specialist health journalists in acting not only as producers of high quality health content in the news, but also guardians against low quality content making into press. In speaking to her research, she pointed out that specialist health journalists help educate their peers and editors on health issues, which are often complex and require more than a passing understanding of context to communicate well, as key gatekeepers for quality in the health landscape.
The Editor’s Perspective
To this end, Wayne MacPhail, a former editor of the Hamilton Spectator, argued that public health has a near ethical imperative (my choice of term) to be in the social media space to not only promote good health, but counter and challenge myths and misinformation. This isn’t some naive pronouncement that we’ll eliminate the snake oil sales or quackery that proliferates in the public sphere and media, but rather a simple observation that we have no chance of making impact if we are not even engaged in the space at all.
Like Leask, MacPhail says that it’s too late to engage the public when a health crisis comes up and that public health needs to be in the conversation stream before that happens.
The Reporter’s Perspective
Reporting through SARS to today: Helen Branswell
Helen Branswell, a reporter from The Canadian Press, rounded out the panel and spoke frankly about the dwindling resources and rapidly changing landscape in journalism. She was on the front lines of reporting the 2003 SARS outbreak and showed a picture taken during that time of an empty newsroom and remarked how that the scene is the same now only for different reasons (limited budgets due to decreased ad revenue and the related shift to digital information on the web being two such reasons, among others).
Branswell paints a bleak picture of the present and future in many areas of health journalism. Stories are increasingly being covered by general reporters who may treat the story the same as they would a traffic incident, political story, or crime; journalists who are unlikely to know the context and details that are critical to communicating the nuances present in health matters. Interns are replacing some full time or veteran reporters in the newsroom and there are only a handful of specialists in practice.
Pressures from time, budget and competing interests in the newsroom are all contributing to an environment where quality health reporting is threatened.
What Next?
I asked the panel what they thought public health should do to ensure that the healthy stories are reported well and there was little answers. Helen Branswell said, truthfully and somewhat cheekily: “buy newspapers”. She reminded us that we should be paying for the quality content and supporting good journalism in practice if we want it to survive, which is hard to argue against.
But that alone will not do all the work needed to preserve good journalism. I spoke to another conference attendee, a formally trained journalist who is now working with a research firm, about the ways in which journalists have helped other organizations craft their messages and engaging the public citing the Calgary Police Service’s social media team as an example. This pointed to ways in which journalists can make a difference in matters of public health and social services.
Yet, what about investigative journalism? What about the potential conflicts that come from being paid to report on issues that might be critical of the organization who does the paying (e.g., Ministries of Health, Departments of Public Health, Universities and colleges etc..)? This model doesn’t solve that, but it is at least another option.
Yet, the examples from public health taking this challenge of working with journalists up are few. Many still believe that social media is another means of broadcasting, which misses the mark. Others still view social media, journalism, engaging with the public through the media, with suspicion on the grounds that much of the work out there is not evidence based.
But what evidence did we have when SARS hit us 10 years ago? We had lots of epidemiological data on infectious disease, but that was only part of the story. Many of the leading health scientists were adapting their models, creating new ones and only after the disease left did we really have a full sense of what happened. We learned as we went.
This is what social media is all about, too. The lessons from major health events — disasters, outbreaks, and pandemics — parallel social media. It is innovation space at its clearest and thus there is an imperative to view it as innovation space with the tools and lenses that best support movement within complex adaptive system. From a communications standpoint, social media and the tools of modern journalism (and the style of communication they employ) are one thing to consider. Developmental design and evaluation are also among these tools combined with systems thinking.
Linear thinking and action will not work in a complex system and as this panel pointed out, there is much reason to be concerned if we are not prepared to communicate and support those that communicate well in such times when — not if — they come back.
Ten years after SARS how better off are we? And if we are better, how are we communicating that to the public?
Handbook of Systems and Complexity in Health
Posted: January 16, 2013 Filed under: complexity, innovation, public health, systems science, systems thinking | Tags: book, Carmel Martin, complexity, health, Joachim Sturmberg, public health, systems thinking, wicked problems 3 Comments »
Handbook of Systems and Complexity in Health
A brilliant and comprehensive new book has been launched that brings together the best scholars working in the area of systems thinking and complexity and applying it to health.
The book description can be found here along with a link to the abstract for a chapter I co-authored with Andrea Yip looking at the overlap between design thinking and systems science and complexity. This chapter takes a design lens on previous work developing the CoNEKTR model for engagement in complexity and health.
It’s a big book, but well worth a look if you’re wrestling with complexity and systems thinking in health and social innovation.
The Quality Metric in Education
Posted: January 15, 2013 Filed under: education & learning | Tags: cognition, complex adaptive systems, complexity, education, educational design, evaluation, graduate education, innovation, knowledge translation, learning, metrics, psychology, Sir Ken Robinson, systems thinking, teaching, university 1 Comment »
What goes on the pedestal of learning?
What is quality when we speak of learning? In this third post in series on education and evaluation metrics the issue of quality is within graduate and professional education is explored with more questions than answers about the very nature of learning itself.
But what does learning really mean and do we set the system up to adequately assess whether people do it or not and whether that has any positive impact on what they do in their practice.
What do you mean when you say learning?
The late psychologist Seymour Sarason asked the above question with the aim of provoking discussion and reflection on the nature and possible outcomes of educational reform. Far from being glib, Sarason felt this question exposed the slippery nature of the concept of learning as used in the context of educational programming and policy. It’s a worthwhile question when considering the value of university and professional education programming. What do we mean when we say learners are learning?
The answer to this question exposes the assumptions behind the efforts to provide quality educational experiences to those we call learners. To be a learner one must learn…something.
The Oxford English Dictionary defines learning this way:
learning |ˈlərniNG|
noun
the acquisition of knowledge or skills through experience, practice, or study, or by being taught: these children experienced difficulties in learning | [ as modifier ] : an important learning process.
• knowledge acquired in this way: I liked to parade my learning in front of my sisters.
This might sufficiently answer Dr Sarason except there is no sense of what the content is or whether that content is appropriate, sufficient, timely or well-supported with evidence (research or practice-based); the quality of learning.
Knowledge translation professionals know that learning through evidence is not achieved through a one-size-fits-all approach and that the match between what professionals need and what is available is rarely clean and simple (if it was, there would be little need for KT). The very premise of knowledge translation is that content itself is not enough and that sometimes it requires another process to help people learn from it. This content is also about what Larry Green argues: practice-based evidence is needed to get better evidence-based practice.
How do we know when learning is the answer (and what are the questions)?
If our metric of success in education is that those who engage in educational programming learn, how do we know whether what they have learned is of good quality? How do we know what is learned is sufficient or appropriately timed? Who determines what is appropriate and how is that tested? These are all questions pertaining to learning and the answers to them depend greatly on context. Yet, if context matters then the next question might be: what is the scope of this context and how are its parameters set?
Some might choose academic discipline as the boundary condition. To take learning itself as an example, how might we know if learning is a psychology problem or a sociology problem (or something else)? If it is a problem for the field of psychology, when does it become educational psychology, cognitive psychology, community psychology or one of the other subdisciplines looking at the brain, behaviour, or social organization? Successful learning through all of these lenses means something very different across conditions.
Yet, consider the last time you completed some form of assessment on your learning. Did you get asked about the context in which that learning took place? When you were asked questions about what you learned on your post-learning assessment:
- Did it take into account the learning context of delivery, reception, use, and possible ways to scaffold knowledge to other things?
- Did your learner evaluation form ask how you intended to use the material taught? Did you have an answer for that and might that answer change over time?
- Did it ask if your experience of the learning event matched what the teachers and organized expected you to gain and did you know what that really was?
- Did you know at the time of completing the evaluation whether what you were exposed to was relevant to the problems you needed to solve or would need to solve in the future?
- Did you get asked if you were interested in the material presented and did that even matter?
- Was there an assumption that the material you were exposed to could only be thought of in one way and did you know what that way was prior to the experience? If you didn’t think of the material in the way that the instructors intended did you just prove that the first of these two questions is problematic?
Years of work in post-secondary teaching and continuing professional education suggests to me that your answer to these questions was most likely “no”, except the very last one.
These many questions are not posed to antagonize educators (or “learners”, too) for there are no single or right answers to any of them. Rather, these are intended to extend Seymour Sarason’s question to the present day and put in the context of graduate and professional education at a time when both areas are being rethought and rationalized.
Learning to innovate (and being wrong)
A problem with the way much of our graduate and professional education is set up is that it presumes to have the answers to what learning is and seeks to deliver the content that fills a gap in knowledge within a very narrow interpretation. This is based on an assumption that what was relevant in the past is both still appropriate now and will be in the future unless we are speaking of a history lesson. However, innovation and discovery — and indeed learning itself — is based on failure, discomfort and not knowing the answers as much as building on what has come before us. There is no doubt that a certain base level of knowledge is required to do most professional and scientific work and that building a core is important, but it is far from sufficient.
The learning systems we’ve created for ourselves are based on a factory model of education, not for addressing complexity or dynamic systems like we find in most social worlds. We do not have a complex adaptive learning system in place, one that supports innovation (and the failures that produce new learning) because:
If you’re not prepared to be wrong, you’ll never come up with anything original. – Sir Ken Robinson, TED Talk 2006
The above quote comes from education advocate Sir Ken Robinson in a humorous and poignant TED talk delivered in 2006 and then built on further in a second talk in 2010. Robinson lays bare the assumptions behind much of our educational system and how it is structured. He also exposes the problem we face in advancing innovation (my choice of term) because we have designed a system that actively seeks to discourage wide swaths of learning that could support it, particularly with the arts.
Robinson points to the conditions of interdisciplinary learning and creativity that emerge when we free ourselves of the factory model of learning that much of our education is set up, “producing” educated people. If we are assessing learning and we go outside of our traditional disciplines how can we assess whether what we teach is “learned” if we have no standard to compare it to? Therein lies the rub with the current models and metrics.
If we are to innovate and create the evidence to support it we need to be wrong. That means creating educational experiences that allow students to be wrong and have that be right. If that is the case, then it means building an education system that draws on the past, but also creates possibilities for new knowledge and learning anchored in experimentation and transcends disciplines when necessary. It also means asking questions about what it means to learn and what quality means in the context of this experimental learning process.
If education is to transform itself and base that transformation on any form of evidence then getting the right metrics to evaluate these changes is imperative and quality of education might just need to be one of them.
Image: Shutterstock
Design Thinking: Thinkers, Science and Practice
Posted: September 6, 2012 Filed under: design thinking, systems science, systems thinking | Tags: AIGA, Bruce Nussbaum, community of practice, design, design education, design research, design thinking, DMI, education, evaluation, experiment, metacognition, practice, psychology, research, social innovation, systems thinking, William Storage 1 Comment »
If to think and be aware of those thoughts (to think about thinking) is a defining feature of what it means to be human, why is it such a challenge to think about types of thinking? An answer to that question might help explain why design thinking is so difficult to translate into action and scholarship and why it continues to be the recipient of intense criticism and boosterism.
The other day a colleague reminded me of an essay on the demise of design thinking that I commented on in an earlier post . The post by William Storage adds further to the growing list of critiques of design thinking and ends this way:
In short, Design Thinking is hopelessly contaminated. There’s too much sleaze in the field. Let’s bury it and get back to basics like good design. Everyone already knows that solution-focus is as essential as problem-focus. Stop arguing the point. If good design doesn’t convince the world that design should be fully integrated into business and society, another over-caffeinated Design Thinking book isn’t likely to do so either.
Storage is right to argue that another book will not convince people of the merits of design or design thinking (which is different), but I can’t imagine it is just because of its merits. There appears to be something that troubles people with picking up metacognitive concepts.
Thinking about (Design) Thinking
Metacogntion is thinking about thinking and concepts like design thinking and systems thinking are, at their most basic, about the thought processes involved in contemplating systems or design. What commentators like Storage and Bruce Nussbaum are railing against is how this more sophisticated concept of design thinking (design metacognition if you will) has over time become synonymous at best, but a wholesale replacement at worst with a set of tools and creativity exercises.
Here we see the gap between the methods and their methodology.
Systems thinking, having had a few decades jump on design thinking seems to be faring better in that its common use is treated more as a metacognitive exercise than just a method, but only slightly. Why does adding thinking to something make it so difficult to communicate?
There is a reductionist push towards making thinking — design thinking, systems thinking, critical thinking, visual thinking — into a discussion of methods and tools. The concern, not unfounded, is that concepts like design thinking is pitched as a set of very simple techniques to provoke innovation while being stripped of its genuine innovation potential and reflective capacity, ironically removing the “thinking” part of the approach. These tools are manifest expressions of thinking and facilitators of it, but they are not thinking on its own.
The business and evidence of thinking
Maybe this is our fault for not putting thinking into the development of these concepts from the start. For example, the field of design suffers greatly from a lack of scholarship and theory around its methods and approaches. Designers are a practical bunch and seek to create and build things over theorizing and submitting their own processes to research. There are notable exceptions to this of course, but overall it is safe to say given design’s pervasiveness in our world that we know relatively little about it.
Systems thinking (as it applies to human systems) is in a different position, almost an opposite position. Whereas design thinking has come from a long history of practice with little formal research supporting it, systems thinking has emerged largely from academia and has far less empirical support for its applications to social affairs.
Another issue is economic. The drive for innovation-led market advantages in many fields is pushing anything to support such activity — something design thinking can do — into high demand. Markets abhor vacuums so they get filled and early markets favour the swift and bold, not necessarily quality. As my doctoral advisor once told me when I was hesitating on publishing my research: “people remember the first, not necessarily the best“.
Thus, we have entire business enterprises founded on teaching people design thinking without much depth in their process or intellectual foundations to support their work. They are out there in spades and contributing to the reasoned distrust, frustration and dislike of design thinking by many who could be its biggest advocates. Whether that’s hopeless or not remains to be seen.
Where to?
So what is to be done? One option, that taken by Bruce Nussbaum, is to consider design thinking a failed experiment and seek alternative terms and concepts that capture the essence of what it does to improve innovative thinking, but in a manner that is less distorted. The challenge here is that, even if a new term does supplant design thinking, what is to prevent that concept from being co-opted and distorted as well with the same innovation-related market drivers in place?
Some argue that by formalizing design thinking into accredited programs, designations, certificates or degrees can assure quality just as we’ve started to see creep into the field of evaluation,. This presumes that have an empirically supported or widely agreed definition of what design thinking is and what are its core competencies. It also presumes we have the faculty with these skills and in positions to train people using methods tested to produce specific outcomes. Neither of these is true at present. This is the equivalent of suggesting that artists must have art degrees. Some artists do, but many do not and there is little to distinguish the difference in quality of the work between them.
A third option, the more complicated one and the most flexible, is to consciously build a community of practice around design thinking aimed at improving the scholarship, research and communications about design thinking to enable the wider world to learn about it, debate it, and apply it. This is already starting to form through such venues as the Design Thinking LinkedIn group and the Design Thinking Network. To that end, we could see a tremendous opportunity for professional organizations such as DMI and AIGA to contribute to this by opening themselves up to the wider community in the focus of their events and training options. By increasing commitment from those doing design and design thinking to education and contemplative inquiry into their craft we are naturally developing a field of practice that forms an attractor basin for better thinking and action.
Some further suggests to this point:
- Follow what psychology did after the American Psychological Association President George Miller suggested they “give away psychology” to the world. Psychology was once an elitist, opaque field of therapy and science and now is widely taught, incorporated into nearly every human-centred discipline, and is founded on a strong scientific and practice base. Democratize design thinking.
- Enlist creative professionals from fields like environmental studies, public health, social work, and education into the design thinking fold beyond traditional design disciplines. Get those living the spirit of Herb Simon who are out there trying to actively change current conditions into preferred ones — the social innovators, the public servants, the entrepreneurs of every stripe — to contribute their stories and insights on design thinking and get those into the public sphere for debate and dialogue.
- Fund and support more research programs beyond examples of my own modestly-supported Design Foundations project , which has sought to study design thinking by interviewing those experts that do it and the literature on its practice across disciplines. And rather than proclaim design thinking’s success and power, prove it and document it.
- Evaluate the programs that teach it, the processes used and determine what works, under what context, and document what happened along the way so we can learn more and be better at advocating for the power of design than simply proclaiming its worth.
Let’s contemplate more, study more, and reflect more about design thinking and maybe we’ll become better design thinkers.
What are your thoughts? Comment below.
How Serious Are We About Learning?
Posted: July 26, 2012 Filed under: behaviour change, education & learning, health promotion, innovation, public health | Tags: behaviour change, Dan Pink, discovery, education, innovation, Jonah Lehrer, knowledge integration, learning, mindfulness, organizational change, psychology, public health, Robert Scott Root-Bernstein, social innovation, social systems, Steven Johnson, systems thinking, Toronto, University of Toronto 6 Comments »
How Serious Are We About Learning?
When journalist and book author Daniel Pink tweeted the above image the other day it provoked thinking about what real learning means and what it takes to achieve it. We produce enormous amounts of knowledge, yet struggle to put it into use, but we also teach much and learn little because the systems we’ve designed for education and experience don’t match our expressed interest and rhetoric around learning.
In my graduate course on behaviour change I would ask students on the first day why they were taking the class in the first place. Aside from the few students for whom the course was required everyone else was doing it by choice because there were many others to choose from. So why would they choose this one?
The answers would vary, but inevitably I’d hear over and again that students love learning and wanted to understand more about behaviour change, because they were interested in change and some would even say they were good at it and wanted to help others do it.
These are all well-meaning and said in a spirit that I think was honest and true. Except the reality is that it is likely a big, huge lie and one that we all share in its telling.
I would counter with two things:
- Loving the idea of learning something new is different than actually seeking out learning opportunities and that most of us love the former, but are not so enthused about the latter;
- The only people who regularly welcome change are babies with soiled diapers.
To illustrate the first point I simply ask people to consider the last conference they went to where there were options on what sessions to attend. How many of the sessions did they attend that featured content that confirmed or gently extended what they already knew versus content that was new? If you’re a health promoter doing community engagement work, sessions on Bayesian modelling for epidemics might offer far more learning than a session on working with diversity in communities (particularly if that is what you already do). Even more, how often do people go to sessions from people they know or have already seen speak? Chances are, many.
One could argue that there are subtleties that a conference presentation might offer on a familiar topic that are worth attending and while I would say that has merit, most learning that has impact is uncomfortable at some level. It extends our thinking, challenges our beliefs, or re-arranges our worldview — in ways small and large.
Wanting knowledge and living learning
Many people will say “I love change”, but that is usually in the context that everyone else is changing, not them. When I was the boss and said “things must change” it was very different than when my staff or my boss would say “things must change“. As a behaviour change educator and intervener, I need to be mindful of my own ironies and resistance to change. So should we all.
The same thing goes for knowledge. Academics are famous for ending studies with “more research is needed”. We never seem to have enough knowledge. There are two problems with this idea.
The first is that, in dynamic and evolving environments, we will never have perfect knowledge that fits like a glove, because the contexts are always novel. This isn’t to say that evidence isn’t useful, but ‘good enough’ knowledge might be a more reasonable demand than ‘best evidence’ in many of the situations where complexity is high and so is change. That’s why data gathering techniques like developmental evaluation aren’t attractive to those who need certainty.
But there is another problem with the knowledge quest and that is one of integration. In our efforts to seek more knowledge, are we integrating what we are learning from what we already have? Are we savouring the data we collect, the articles we read, the Tweets and blogs that get forwarded are way?
We quest for more, but should we quest for better?
A newly published paper synthesized research on event horizons on memory and found that shifts in activities around an event — boundaries — can prompt forgetting and recall. We remember transitions between activities, but they also prompt forgetting depending on the mindfulness associated with the act. When we are deluging ourselves with more data, more media, more everything, we are increasing the potential remember rate, but due to the volume of content, I would surmise that we are increasing the forget rate much more. Simply reflect on your high school or undergraduate education and ask yourself if you remember more than you forgot about what you learned.
We are so busy with our search for new knowledge that we interrupt opportunities to learn from what we have.
Serious learning means non-doing
Returning to the tweet from Dan Pink, it’s worthwhile considering what it means to learn and the systems we have in place to facilitate learning. The tweet links to a discussion of how German companies give their employees five days of off-site continuing education each year. This concept of Bildungsurlaub is a leave designed to allow employees to stretch their thinking and integrate something new. Not only is off-site learning important, but the time associated with integrating material is critical.
A read of the literature on innovation and research shows consistently how time off, quiet time, slow time and down time all contribute to discovery. Robert Scott Root-Bernstein’s brilliant Discovering, Jonah Lehrer’s Imagine, or Steven Johnson’s Where Good Ideas Come From are all books that dive deep into creative production and show that great discoveries and innovations come from having time (with limits) to integrate material to learn. Freedom to create, explore and sit and mindfully reflect are all united concepts in the pursuit of good learning. Not everything requires this, but big concepts and bold ideas do from mathematics to science to social science and philosophy.
Yet, at an organizational and systems level, where is the support for this? Even university faculty (the tenured ones at least) who have generous vacations and sabbaticals are finding themselves crunched for time between the fight for one of the ever-fewer grants, increasing numbers of students and teaching demands, and the added push to ensure knowledge is translated. The image of faculty sitting and reading and thinking is truly an imagination. Most of my colleagues in academia do little of this, because they are out of time.
In the corporate and non-profit world this is worse. Every hour and day is to be accounted for. The idea of sending people off to learn and to think seems anathema to productivity, yet research shows incredible powers associated with taking a break and doing less and not more.
Getting serious about learning
To illustrate the scope of the problem, the University of Toronto holds one of the finest academic library systems in the world and has over 11.5 million books and 5.7 million microform materials. It is one university (of many) in one city. Add in the local Toronto public library system, the network of universities and other libraries it is connected to, local and global bookstores and all the content freely available online that is not part of this system and I challenge anyone working in social innovation or public health to say with conviction that there is a lack of knowledge out there on any important topic. Yes, we don’t know it all, but we don’t do nearly enough with what we do know because there is so much.
We will not read it all nor can we hope to synthesize it all, but we can do much with what we have. Just looking at my own personal library of physical books (not including all I have in the digital realm between books and papers) it’s easy to see that I have more than enough knowledge to tackle most of what I am facing in my work. Most of us do. But do we have the wisdom to use it? Do we have the systems — organizations and personal — that allow us to take the time and soak this in, share our ideas with others, and be mindful of the world around us enough to learn, not just consume?
When we spend as much time creating those spaces, places and systems, then we can answer “yes” to the question of whether we’re serious about learning.
Enough knowledge here?
Marketing Metaphors of Meaning in Complexity
Posted: July 17, 2012 Filed under: behaviour change, complexity, marketing, systems thinking | Tags: Bruce Mau, complexity, Dave Snowden, design, design thinking, empathy, marketing, metaphor, narrative, public health, public policy, Rory Sutherland, storytelling, systems change, systems thinking, TED, tobacco control Comments Off
Metaphors and storytelling are ways to navigate through complex, inter-related ideas in a way that brings coherence and delight to them in narrative form. Stories are not just for children, but a serious tool for bringing complexity to life, making it accessible and usable to a world that can benefit from learning more about it.
Have you ever found yourself curled up in bed with a book that you can’t put down or found yourself up much later than you’d planned because of a TV program or movie you got caught up in? Ever have the same experience with a piece of academic writing? How about a technical report? I’ll bet the answer is yes to the former examples more than the latter (if there is a yes at all to the second two). Books — mostly, but not always, fiction books — magazine and newspaper, articles, poems and even blog posts thrive on a narrative that takes you a journey even if you don’t know the destination. That narrative, if its engaging, has consistency, a tone, a flow and a ‘texture’ that makes it enriching. It is perhaps the reason why so much scholarly writing is so dull: the texture is rather dry and lacks appeal.
Not all scientific articles require such appeal. Indeed, the standardized methods of reporting experiments can be very useful in interpreting results and deriving meaning from complicated interactions. Yet, this application of the standard model of writing from science to other areas is perhaps taking scholarly work to places it didn’t need to go. Or perhaps it is preventing us from going places we need to go.
In terms of complexity, one of those places it needs to go is into widespread discourse on public policy, health promotion, and social program planning. Storytelling and metaphors are one vehicle.
Making metaphors and embodied cognition
A recent Scientific American blog post by explored the role of metaphors in some depth, bringing attention to some of the early work of psycholinguist pioneers George Lakoff and Noam Chomsky in looking at the role of embodied cognition, a concept where a metaphor actually gets integrated into the body (literally or figuratively). In the column Samuel McNerny looks at the history of the idea and the use of metaphor, drawing on interviews, literature and recent research.
As Lakoff points out, metaphors are more than mere language and literary devices, they are conceptual in nature and represented physically in the brain. As a result, such metaphorical brain circuitry can affect behavior. For example, in a study done by Yale psychologist John Bargh, participants holding warm as opposed to cold cups of coffee were more likely to judge a confederate as trustworthy after only a brief interaction. Similarly, at the University of Toronto, “subjects were asked to remember a time when they were either socially accepted or socially snubbed. Those with warm memories of acceptance judged the room to be 5 degrees warmer on the average than those who remembered being coldly snubbed. Another effect of Affection Is Warmth.” This means that we both physically and literary “warm up” to people.
Metaphors like “warming up” are therefore representations of real phenomena that become figurative in certain scenarios. McNerny adds:
The last few years have seen many complementary studies, all of which are grounded in primary experiences:
• Thinking about the future caused participants to lean slightly forward whilethinking about the past caused participants to lean slightly backwards. Future is Ahead
• Squeezing a soft ball influenced subjects to perceive gender neutral faces as female while squeezing a hard ball influenced subjects to perceive gender neutral faces as male. Female is Soft
• Those who held heavier clipboards judged currencies to be more valuable and their opinions and leaders to be more important. Important is Heavy.
• Subjects asked to think about a moral transgression like adultery or cheating on a test were more likely to request an antiseptic cloth after the experiment than those who had thought about good deeds. Morality is Purity
The challenge for complexity in social life is coming up with the right metaphor and finding one that is embodied within the systems we seek to influence.
Telling systems stories
One of the best examples of the use of storytelling and metaphors to explain complexity comes from Dave Snowden of Cognitive Edge with his humourous, insightful look at order and the art of organizing a children’s party.
What Snowden does is anchor something new (complexity) in a familiar frame of reference (a children’s party). While this is not something that directly translates to how we operate social organizations such as “warming up” does to explain relations between people, it offers something close.
Anchoring the novel in the familiar. Childhood is the one universal we adults all share. Travel the globe and watch children interact and you’ll see patterns repeated everywhere. Emotion is another universal: joy, fear, anger, contentment, curiosity, and such are all platforms that can be used to create and share stories about our world. For those of us working in communities, we need to understand what universals exist in those realms. This means paying deep attention to the systems we are a part of.
In short: systems thinkers may need to be participant observers to the systems they wish to influence and learn about the big and small things that drive them.
As systems are large, complicated and complex, it is unreasonable and perhaps impossible to know everything necessary to successfully navigate through it and maneuver the leverage points necessary to create responsible, sustained systems change. To do so, we need to enlist others and that means getting complexity into the minds of many operating in the system and not just a few ‘systems thinkers’.
We need to get better at telling stories and marketing metaphors of meaning.
Learning storytelling from marketers
Marketing is largely about identity and stories about identity. Marketers want to influence what you do (choose, use, purchase, etc..) and how you experience what you do when you do it. To do this, they know the importance of design and the stories to accompany that design. Design, when done well, is partly about creating empathy with those who are to benefit from the products of design and the best products out there are ones that apply empathy and guide behaviour at the same time. Steve Jobs and his design team led by Jonathan Ive were (are) famous for doing this at Apple.
In an earlier post I mentioned the work of Rory Sutherland and his discussion of tobacco use as an illustration of the ways in which failing to empathize with a product user’s life can change the impact of policies and programs aimed to improve it. The case (made in the video below) is that there are some real, tangible benefits to smoking that get ignored when we aim to snuff it out (bad pun intended). For public health to enhance its effectiveness, we need to pay attention to these benefits and find ways for people to derive them in healthier contexts.
But listen to what Sutherland says not only here, but in another of his TED talks he points to ways in which small changes can have enormous consequences if done in a systems-forward manner (my term, not his).
What Sutherland does is not just provide good ideas, but tells good stories. Like Dave Snowden, he captures our interest and makes us want to think about concepts like behavioural economics and marketing just as Snowden inspires thinking about the differences between order and chaos.
Not all of us can be great storytellers or funnymen (and women), but we need to take this seriously if we wish to use complexity and systems thinking to advance change in our world purposefully, because massive change is happening whether we want it or not. The key is whether we will be telling stories in the future of how we helped shepherd change that helped us be more resilient and thrive or let these forces shape us in ways that caused unnecessary problems. It is, as Bruce Mau said, not about the world of design, but the design of the world.
Complexity and the Senseless Marketing of the Future
Posted: July 16, 2012 Filed under: complexity, systems science, systems thinking | Tags: climate change, complex adaptive systems, complexity, environment, FastCoExist, foresight, futurists, innovation, marketing, marketing complexity, mindfulness, networks, Pareto distribution, resilience, simplicity, social networks, systems thinking Comments Off
Futurists take what we know now and project into the future ideas about things will be like years from today using the models that have worked consistently up to now. Those models applied to human systems are changing quickly making marketing the future based on them senseless and potentially dangerous.
Earlier this past week a post on FastCoExist caught my attention and brought to mind why I have such an uneasy relationship with futurists and futures as a field. The post, 8 Ways the World Will Change in 2052, is look at the next 40 years written by Jorgen Randers, a professor of climate strategy at the BI Norwegian Business School and written with all the confident swagger that typifies futurists making statements about what is to come. After all, it’s hard to draw an audience (and the benefits that comes with that) when you don’t have a confident answer on your subject matter — even if that answer is wrong. In this latest post in the series on marketing complexity I look at futurists and their predictions and what it could mean for making sense of the threats and opportunities we will face in the years to come.
The Mathematical Problem of Futures and Complexity
The FastCoExist article paints a picture of a world that looks a lot like the one we have today, just with some shifts in economic and social structures. It suggests that much will remain the same even though a few key things will change, but our general relations will remain constant. It is that consistency that raises my concerns about futurist thinking (not all, to be sure) and its use of the data today to make predictions tomorrow. There is an assumption of linearity that weaves its way through the narratives spun by futurists that do not fit with how complex systems behave, nor does it account for the network effects created by interconnected systems.
Where I live now (Toronto), we have seen an almost uninterrupted heat wave for more than three weeks and that is forecast to continue for the week to come. This is the hottest year in recorded history (video), and as this short news clip shows the implications are many. At our current level of focus the implications may seem slight: changing growing conditions for gardens, better cottage swimming weather, brown lawns etc.. But at another scale and perspective, the interconnections between these things will start to reveal themselves if the pattern continues.
It is here where I see futurists getting it wrong as their predicts rest on largely linear trajectories of change and scientific knowledge that uses linear models to create predictions. The mistake is taking linear phenomenon and grafting that knowledge on to complex cases, while another mistake is taking science that works for static things and applying it to dynamic objects.
Complexity often produces change curves that follow a Pareto distribution, which is a way of accounting for things like ‘tipping points’, and is rarely linear in its effects for long periods of time. As the news report mentions, Toronto has an average temperature of 3.5 degrees higher than normal in a single year. It could be an aberration, but when we see record-breaking temperatures for years on end that looks like a pattern forming.
Climate change is not just about things getting warmer, cooler, wetter or dryer. From a human standpoint, how we adapt to these changes is what counts and in a networked world is that adaptations happen simultaneously and in a dynamic, interconnected manner. That means that many things change at the same time and that the relationship between dynamic objects means that the overall quantity and rate of change in the system is likely to be logarithmic (exponential) not additive.
Reframing change models: the language of complex systems.
If we are to create models that are more useful to us, we need to develop them with complexity in mind, think in systems and act as designers. To do this requires a change in the thinking models we use and the ways we communicate these models to the wider world. Yet, it isn’t as alien as it seems; we do it all the time with ourselves in explaining our social lives.
- A child goes from being peaceful and quiet to a tantrum in a matter of seconds.
- A calm, composed individual bursts into tears at a seemingly random event.
- A polite, warm conversation quickly turns cold at the slightest mention of a particular phenomenon
In many of these cases the ’cause’ might not be obvious. An example I use with my students is this:
Imagine a couple in their bedroom and one partner sees a wayward sock that has been left on floor and gets intensely angry at the other partner upon discovery of the sock. Why? Is is that the sock on the floor is so problematic that it reduces an otherwise peaceful environment into a space of conflict? Is the sock really that bad? Or is the sock a catalyst for something else? Does it represent something (or many things) that are embodied in the sock being left carelessly on the floor? Does the sock serve as a vessel for accumulated grievances and stressors only loosely related to its position on the floor?
This example of the sock illustrates how a Pareto distribution of social tensions in a relationship could be expressed. It points to how the most ‘obvious’ linear answer might not always be the case even if initial appearance suggest a relationship.
Explaining the reasons for problems opens a door to solving them. But we can do more.
The power of weak signals
The way to interject into a complex system is not to pay attention to everything all of the time, but to small things that show patterns. Eric Berlow has a remarkable 3 minute TED talk that illustrates how signals can be extracted from networks to reveal simplicity in complexity. A 2008 paper in the journal Physical Review shows the ways in which weak signals can be detected by reducing the overall volume of information or nodes in a network.
But what to pay attention to? This is where mindful evaluation and attention comes in. Mindfulness is not just a way to connect to one’s inner life, but also the outer world around us. A mindful approach to monitoring and evaluation means watching what happens around us and positioning tools, metrics and data gathering processes to give us the necessary feedback on our systems around us. To take the example of the couple’s conflict over the sock, paying attention within the relationship to minor conflicts, areas of tention, and moments of release earlier could have diffused energy enough to mean the sock was just a sock.
In social systems, this means paying attention to areas of intersection where natural tensions occur due to difference. These differences could be perspective, attitude, knowledge, beliefs or capabilities. These points of intersection are often where novelty emerges and innovation takes place, but they are also where deeper problems can begin. Constant, evolving and dynamic methods of data collection that recognizes change in non-linear and linear forms is more likely to enable the sorts of weak signal detection that can help us see the future more clearly.
That can help us make sense of future possibilities, rather than make empty predictions that guide what we do now at the expense of paying attention to what might come (and what is really happening).
Empathy: The Ultimate Design + Systems Challenge
Posted: July 1, 2012 Filed under: art & design, complexity, design thinking, psychology, social systems, systems thinking | Tags: complexity, contemplative inquiry, design, design thinking, empathy, mapping, mindfulness, perspective taking, psychology. social psychology, social determinants of health, social justice, systems thinking, visual thinking, visualization 4 Comments »
Empathy is a central feature of good human-centred design, yet is often practiced narrowly. Visualization with systems thinking and mindfulness are three additional features that can transform empathy from a simple tool to a vehicle for transformation by connecting us less to absolute problems and more to relative ones.
In today’s Globe and Mail newspaper online, the oft controversial columnist Margaret Wente offered an op-ed piece called I have ‘white people’s problems,’ and you probably do too. The column refers to an article in The Atlantic by Anne-Marie Slaughter looking at how women today still struggle to be successful at work, family and personal life simultaneously. Both Wente and Slaughter take pains to point out that they lead privilidged lives, yet that privilige does not shield them from experiencing social problems in a way that is both unique to their situation and widely shared by women across the social spectrum.
A read of the comments for both articles shows how much of a hot-button issue this is for people (Wente’s article had more than 700 comments within hours of being uploaded) and includes much discussion of the racist/non-racist/classist over and undertones to the content and topic. It might be tempting to rush in and judge these two articles for dwelling on the pains of a privileged few in light of problems of poverty, food insecurity, safety, sexual and gender-based violence, and absence of healthcare experienced by the greater number of people on this earth.
Yet, if we look at the issues as they are with less judgement we can see the reaction to these articles less as a battle of ideas, but an unconscious attack on empathy. There is this perverse pleasure for some in pointing out the arrogance, ignorance, or neglectfulness in others, but such criticism (sometimes falsely veiled as critique or critical thinking) often fails to deeply connect to empathy beyond the pale. How then do we promote empathy in such conditions?
Perspective Taking: It’s (Relative) Promise and Perils
As Micheal Marmot and others have shown consistently with evidence is that relative inequities, inequalities and health disparities are as significant or more so than absolute ones. Whatever challenges you face they are exacerbated by how you see yourself in relative position to those who deem closest to you. Saying: “it could be worse” works when you see your peers as worse off than you or your equal, but it doesn’t work as well when you’re surrounded by people you perceive to be in better shape. Thus, we have an issue that is both absolute and relative based on real and perceptive differences working simultaneously. In the case of Wente and Slaughter’s articles, most of us (the 95-99% not represented in these perspectives) see them to be in better shape and that has consequences for us and them.
Peter Coleman and faculty at the International Project on Conflict and Complexity have looked at how relative position and empathy fit together in the context of peace-building and mediation and have found that there are spaces where taking into account the lives of others can increase conflict, not dampen it. Of the many examples cited in their work (including Coleman’s recent book) is a decade-long initiative to build bridges between anti-abortion and pro-life advocates in the Boston area and how efforts to build empathy between these two foes often served to antagonize and create bigger gaps in position rather than closing them. These problems, often seen as intractable, represent about 5% of all the ones we face, but their effect is enormous.
Recent studies in social psychology have confirmed that bridge building requires more than just seeing the other side, it requires being heard (PDF – Bruneau & Saxe (2012), Journal of Experimental Social Psychology). A study by Kraus and colleagues (PDF) found that social distance can have an impact on the way that people empathize and the conclusions that they draw when trying to place themselves in the position of others.
Your Grief is Not the Same as My Grief
The above heading comes from a statement uttered in a group counselling context and has forever stuck in my head. It recognizes that we all experience things in a unique way, yet it was uttered in a spirit that suggests we can still come to share that experience in a manner that can build solidarity and connection.
This points to the ultimate design challenge: creating greater connection through empathy without widening social distance.
One might think this would be easier given that empathy is one of the principle tools of design, yet my experience suggests that designers might be more apt to identify this as important and have strategies to get to it, there is still much to be done. But as we all design for ourselves and some of us for others, imagining another’s perspective requires understanding both that another perspective exists and where in relation that perspective sits to your own. It is here that we need more than an empathic lens or a design lens, but a systems lens as well.
Visualization: Placing Empathy
Systems thinking provides cognitive tools for understanding entire domains and the relationships within it. Systems mapping takes these ideas and makes them visual by providing an architecture for that understanding. Visualization provides the means to connect these two worlds by providing a design sensibility with a systems perspective. The figure below illustrates this position.
Mapping the positions held or visualizing them allows an idea to be represented in a manner that invites dialogue and open comparison. Rather than keeping one’s perspective locked within their own mind, a visual representation allows both the individual and those who they seek (or we seek) to build empathy with the tools to better frame the position each holds relative to one another. Doing so goes beyond imagining what it would be like to walk in anothers’ shoes and actually sees it and allows us to test assumptions.
From here, a contemplative approach to inquiry based on mindfulness can allow people to sit — literally or figuratively — with this data and envision the positions in new ways. Contemplating the meaning of what a particular perspective holds can enable a perspective taking that goes beyond seeing this head on and perhaps sees it from above, below, behind or inside and gets us away from our forward orientation bias.
By redefining the space in which the problem exists by literally creating that space on the page or screen we can better see beyond our current position to imagine how things previously deemed impossible might exist. Returning to the original example, this means seeing that one can hold much privilege and social advantage and experience the world in a manner that feels as violated, limiting and stressful as someone of lesser absolute means. It can also facilitate the reverse perspective. In doing so, this type of visualizing + empathy + contemplative inquiry has the means to take away much of the judgement and see things as they are without reducing or amplifying problems beyond their current context.
In doing so, perhaps we can better see us all as interconnected members of a system with pains and hurts and joys and skills rather than devote more energy that is necessary to judging others and less on making lives better for everyone.
Drive out fear
Posted: May 28, 2012 Filed under: social systems, systems science, systems thinking | Tags: innovation, management, organizations, social science, systems thinking, W. Edwards Deming Comments Off
Business leaders: when I use the word "culture", do you screw up your face and say "Love and peace, man"? I'm no aging hippie; in any case, I was born 10 years too late to be part of that movement. Business culture is no wiffly-waffly discretionary add-on. It's central to effectiveness and business improvement. I do admit a fondness for better communication, greater self-awareness, lots more empathy and way less fear in the workplace (man), but this comes out of a firmly held view that there is huge scope for workplaces to be more humanised, which will have a huge impact on effectiveness.
