Category: innovation

design thinkingeducation & learningevaluationinnovationresearch

Design Thinking & Evaluation

Design Thinking Meets Evaluation (by Lumaxart, Creative Commons Licence)

This morning at the American Evaluation Association meeting in San Antonio I attended a session very near and dear to my heart: design thinking and evaluation.

I have been a staunch believer that design thinking ought to be one of the most prominent tools for evaluators and that evaluation ought to be one of the principal components of any design thinking strategy. This morning, I was with my “peeps”.

Specifically, I was with Ching Ching Yap, Christine Miller and Robert Fee and about 35 other early risers hoping to learn about ways in which the Savannah College of Art and Design (SCAD) uses design thinking in support of their programs and evaluations.

The presenters went through a series of outlines for design thinking and what it is (more on that in a follow-up post), but what I wanted to focus on here was the way in which evaluation and design thinking fits together more broadly.

Design thinking is an approach that encourages participatory engagement in planning and setting out objectives, as well as in ideation, development, prototyping, testing, and refinement. In evaluation terms, it is akin to action research and utilization-focused evaluation (PDF). But perhaps its most close correlate is with Developmental evaluation (DE). DE is an approach that uses complexity-science concepts to inform an iterative approach to evaluation that is centred on innovation, the discovery of something new (or adaptation of something into something else) and the application of that knowledge to problem solving.

Indeed, the speakers today positioned design thinking as a means of problem solving.

Evaluation , at least DE, is about problem solving by collecting the data used as a form of feedback to inform the next iteration of decision making. It also is a form of evaluation that is intimately connected to program planning.

What design thinking offers is a way to extend that planning in new ways that optimizes opportunities for feedback, new information, participation, and creative interaction. Design thinking approaches, like the workshop today, also focuses on people’s felt needs and experiences, not just their ideas. In our session today, six audience members were recruited to play the role of either three facets of a store clerk or three facets of a customer — the rational, emotional and executive mind of each. A customer comes looking for a solution to a home improvement/repair problem, not sure of what she needs, while the store clerk tries to help.

What this design-oriented approach does is greatly enhance the participant’s sense of the whole, what the needs and desires and fears both parties are dealing with, not just the executive or rational elements. More importantly, this strategy looks at how these different components might interact by simulating a condition in which they might play out. Time didn’t allow us to explore what might have happened had we NOT done this and just designed an evaluation to capture the experience, but I can confidently say that this exercise got me thinking about all the different elements that could and indeed SHOULD be considered if trying to understand and evaluate an interaction is desired.

If design thinking isn’t a core competency of evaluation, perhaps we might want to consider it.



complexityinnovationknowledge translationpublic healthsocial systems

Restoring Sanity in Health Communications


Yesterday television commentators, satirists, comedians, provocateurs Jon Stewart and Stephen Colbert hosted the Rally to Restore Sanity on the Washington Mall. The event was described as a counter to what has been seen as a rising tide of hostility and incivility in the media.

We’re looking for the people who think shouting is annoying, counterproductive, and terrible for your throat; who feel that the loudest voices shouldn’t be the only ones that get heard; and who believe that the only time it’s appropriate to draw a Hitler mustache on someone is when that person is actually Hitler. Or Charlie Chaplin in certain roles.

The event, which I didn’t attend or see, has received a lot of news coverage that has, perhaps ironically and predictable, been all over the map choosing to focus on the “insane crowd” , the “lighthearted rally“, or the “comedic call for calm” (video).

But as the media grasps for their sound bites, the coverage ironically provides a perfect example of one of the central things  the Rally was intended to highlight: oversimplification and amplification of extreme perspectives that mislead and mis-represent reality.

If we amplify everything, we hear nothing.

These words from Jon Stewart point to the problem of lack of differentiation in signal strength when we communicate messages.

The press is our immune system. If it overreacts to everything we eventually get sicker.

When everything is important, nothing is important.

That is part of restoring sanity in any communication platform. Certainly when we consider innovation in health and social services. How often are recommendations for action large, unwieldy and full of detail? Everything is important and everything is critical. Attend a major public health conference and you’ll come away feeling that there are dozens of “top” priority items to tackle. This is not to suggest that there is lots of work to be done in lots of areas, but its easy to see why we’re having a hard time motivating policy makers, the public, and generalist health practitioners to action when they get these kinds of messages.

What results is that we wind up with gimmicks like football players wearing pink shoes to raise awareness for breast cancer. That might be a good idea, but it is also a costly one. Breast cancer is one of many areas that spends a lot of money to bring in a lot of money. Anecdotally, I’ve told by those in the know that many health charities in Canada send upwards of 80% of their charitable intake to the companies running the campaigns for the reason that they can’t run it themselves.

I agree that good campaigns require sophisticated talent (which requires investment), but as a donor I find the story behind these statistics reprehensible. But the bottom line in this case is around marketing and getting that message louder and bigger. As more distractions come in, more content is generated and people’s attentional resources get ever more taxed, being louder and bolder is seen as the viable strategy for getting messages — political or health — out.

But there are other ways.

Developing relationships, true relationships, with your intended audience might be a better way. It is not a simple* way like most of the loud-speaker marketing uses, rather it is a complex, more nuanced way of getting the word out. It’s also the way that most of us learn and develop trust networks. The difference is that these relationships and networks are far more robust and adaptive to complex conditions than the straightforward thrust of traditional simple marketing strategies. They will last much longer than the campaigns used to generate the messages in the first place.

When resources are tight and the number of people competing for those resources is greater than ever, a communication strategy that is cost-effective over the long-term, robust, adaptive and brings people and ideas closer together is a good bet. Time to restore not only sanity, but relationships in our work.

* simple does not equal easy or effortless.

behaviour changecomplexityeducation & learninginnovationpublic health

Time and Chance Doesn’t Happen to Us All


Again I saw that under the sun the race is not to the swift, nor the battle to the strong, nor bread to the wise, nor riches to the intelligent, nor favor to those with knowledge, but time and chance happen to them all. – Ecclesiastes 9:11

According to the bible, we are all subject to the randomness of life and the effects of time, regardless of our status, knowledge or skill. There are many days when that doesn’t seem true at all.

For those working in creative fields or knowledge working environments, time is something that is a critical ingredient for influencing the products that emerge from those settings. Time is needed to find information, process it, and make sense of it, particularly if that information is of a complex nature.

In the health sector, evidence-based decision-making is considered the gold standard. It stands to reason that using the best knowledge accumulated from what we’ve already done is a good idea when people’s health is at the centre of attention. But how often do we actually have the time to do actually get evidence, process it, and sense-make around it to apply it in a reasonable way? My informal read on my colleagues in the research and clinical practice fields is that the answer: none. Go to any meeting and nearly all the participants are at some point checking their Blackberry or iPhone in the meeting itself, or right before or immediately after. These are the times when we used to talk to each other, ask questions about each other, and build social relationships.

Now, its addressing the mountain of email that seems to be growing.

Chance, those opportunities to take advantage of spontaneous emergence of information, is also lost. By being so focused on the information coming in through mobile devices, or in one’s own memory, we lose opportunities for the sense-making that enables us to discover new things.

So we have this remarkable paradox where the demands for more, better, appropriate, timely knowledge is greater than ever on problems that are becoming ever-more complex with more tools to generate and sort this information, and no time to actually use it effectively.

In my health behaviour change course we look at literature on changing all kinds of behaviour from eating, physical fitness, smoking, sexual health promotion, and beyond, but not time. Perhaps it is time for that to change, for if that element changes, the chance that it will lead to improved health and innovation might increase along with it.

innovationsystems thinking

Over Educated and Under Developed For Innovation

This past week I had the true privilege of attending a High Table Dinner with some of the University of Toronto’s future leaders from Trinity College. The guests, some faculty, but mostly students, came from many different disciplines and ranged from first year undergrads to doctoral students who were well on their way in their dissertation studies.

Before, during and after the meal, we had the chance to mingle and chat, and in those discussions I was reminded of how out of sync much of the university system is with those seeking to innovate, but also how much promise there is in the future.

No more was this evident in the conversation that starts of with some variant on the topic “what do you study? teach? do?” As this was a very educated, enthusiastic and curious crowd, my simple answers were not sufficient. “I am a professor in the School of Public Health” was not going to cut it. So, I told people. And they listened. And they asked me a lot of questions. And as I was answering them, the absurdity of much of what I did, have done, and continue to do with my students became more readily apparent.

For example, I spoke of my education and the various degrees and certifications that I had when asked about my career track and background. As I tallied things from my undergraduate degree through to my post-doctoral training, the numbers started to add up, as did the designations, and soon I was faced with a fact that I graduated in GRADE 27.

Some students had no idea that there even were things like “post-docs” and the concept that someone would spend all these years getting a PhD and then feel the need to get further training beyond that seemed unreal. And yet, when I chose to get a post-doc, which I loved doing, I was told that it was soon to be the new standard for education. My colleagues in the basic sciences will often to two post-docs.

Consider that for a minute. We are advocating that young minds spend their most creative years, when they are enthusiastic, energetic, and ready to challenge the system getting entrained in the system, working for others, and being told that — no matter how bright they are — they are not qualified to contribute to the scholarly world in an official capacity. It reminds me of a TED talk by Sir Ken Robinson, where he quite rightly points to how we (the university system) create a model where everyone is measured against the PhD and basically how far away one becomes from one (more or less).

Once graduated, students have invested so much time, energy, money and opportunity costs into the system, they become beholden to anything that keeps them from losing this potential investment. It rewards them from keeping the status quo alive, even if they don’t like it.

On a personal note, I’ve spent the first few years post-post-doc imagining that, despite my best efforts to see through it, there had to be SOMETHING that I was missing about the way the system functions that, if I just stuck with it, would produce the results of change I wanted. I could really contribute to the greater good, while doing good work within the system that was academia in the form that I knew it to exist. At least, that’s what I thought.

A few years later, I realize much more about how the system is designed to perpetuate itself. As one who trained in complex systems and psychology, none of this should have been a surprise to me, but it was (and sadly, still is). Yet, what I saw in the youth that gathered around the room that night earlier this week was little evidence of this status quo. There were students — two in fact — that had the audacity to take Biochemisty and English. Some who were combining social sciences and the humanities, languages with applied sciences, and professional programs with non-professional-oriented studies. Why? Because they had the opportunity to learn provided through their education at the U of T.

My word to them was to embrace this. The world needs it. Here, as a professional scientist, I hear all the time that we need to innovate, that innovation and social innovation is the way forward. These are words I completely support, yet look beneath the surface and you’ll see that language couched in a way that doesn’t really challenge the system, but rather asks it to make a small change with the hopes that big things will happen. Maybe. But that is making the assumption that the system is designed for innovation in the first place, and the mere fact that in all those 27 years of education I was never once taught how to communicate with any audience other than my peers suggests that the system is more problematic than we think.

The school I teach at trains leaders in public health, yet there are no courses in leadership, which is on par with nearly every other school of its kind (some exceptions of course) in the country and continent. We are expected to engage in detailed, thoughtful knowledge translation when we’re not taught to do anything but our own discipline and taught no skills to communicate beyond it. Few schools offer this. As a faculty, team science or real transdisciplinary or applied or community-based research is considered novel as a side project , but not something that one gets rewarded for and certainly not something that suits a serious researcher.

These young learners have acquired much knowledge and will gain much more as they continue their studies. Hopefully they learn some other lessons along the way and maybe start working to solve these problems earlier, rather than grabbing more degrees towards making them stick.

education & learninginnovationpublic health

The Art of Public Health

The Art of Public Health Conference: October 1, 2010

Creativity and its close relative, innovation, is everywhere in public discourse. There is a wide recognition that the way we’ve always done things isn’t working for a lot of the problems we face. Reductionist science and the normal science that it is a part of has helped public health out a lot, eradicating diseases, prolonging our lives, made us happy, has enabled us to feed the world (or large parts of it), and provided answers to many of our most vexing questions.

Except many of those diseases, once thought to be slain, are coming back, there is deep concern that our next generation might not live as long as the current ones, wealth hasn’t equalled happiness,  food insecurity is endemic, and we are still taking more than a generation to translate simple knowledge into practice.

Innovation and creativity are needed to see these problems in a new light, which may lead to insights, discoveries and better strategies for taking what we know into what we do. Artists’ and designers live on creativity; it is their lifeblood. Art is the very act of creation and design is doing so with intent, so bringing this world to public health is a natural fit for those seeking ways of addressing the thorny, wicked problems of public health.

This Friday October 1st, the Dalla Lana School of Public Health will be hosting The Art of Public Health conference . Organized by students interested in exploring the intersection of artistic creativity and its application to public health science and practice, this conference will serve to remind and inspire us about the power of art in what we do. Specifically:

The Art of Public Health’ Conference will focus on an emerging and innovative area in public health: arts-based approaches to public health areas, including research, knowledge translation, evaluation and community development.

The conference website reminds us that the very roots of the words within much of what we do are tied to art and creative exploration:

art (arht) noun:  the use of skill and imagination in the creation of aesthetic objects, environments, or experiences that can be shared with others

pub∙lic (pubh-lik) adjective: of, pertaining to, or affecting a population or a community as a whole

health (helth) noun: a state of complete physical, mental and social well-being

art of public health (arht of pubh-lik helth) idea: the use of skill and imagination applied toward the creation of a state of complete physical, mental and social well being affecting a population or community as a whole

For those of you in Toronto, the registration is free and information can be found here. For those unable to attend, the conference organizers have a Twitter feed . Some further details and contributions will also be available through the main conference website and the home of the Youth Voices Research Group.

innovationsystems science

Systems (Science): Sexy and Not So Much

Recently I was discussing what I do with someone relatively unfamiliar to my research, yet in the same field and I described my interest in systems thinking, knowledge translation, and eHealth and how they go together. Somehow in the conversation the term “sexy” was used to describe these fields along with “hot” and “upcoming”. It’s nice to be at the forefront of a field — or three — but it also has some downsides.

One of the downsides is that rigor often gets displaced by enthusiasm. Even fields like knowledge translation, which first emerged in the mid 1990’s (and far earlier than that if you’re willing to consider different terms), is just now evolved to the point where it is widely accepted and supported as a legitimate area of research. There is still much work that calls itself KT that is really just dissemination with a different name, but the concept of KT at least has some respect.

So too, does the idea of systems thinking. With recent special issues in respected journals like the American Journal of Preventive Medicine and American Journal of Public Health and full monographs from the National Cancer Institute, the idea of transmitting systems science from the backwaters of public health to the forefront is close to reality.

eHealth was sexy too, but too much investment matched with too little patience for good evidence quickly burned through much of the potential that consumer-directed eHealth had for making transformative differences on a broad scale. No worry, mHealth is here and that is quickly proving to be as “hot” as eHealth was ten years ago.

The problem is that “hot” and “sexy” terms often presage their demise in respected discourse before too long. I was once told by a senior official with a large health NGO that he’d given up on eHealth because he knew it didn’t work. This was 2002. Most of the best evidence hadn’t been generated yet and already people had thrown in the towel.

Knowledge translation is having its problems too, because the evidence of a shortening from “evidence to effect” is hard to generate. Often, KT requires systems level changes and systems thinking to create the conditions to generate effective KT practice. That suddenly transforms something that is “sexy” into something difficult and much less so in the eyes of those who are responsible for implementation of KT plans.

Systems science as it is applied to health is in greater danger because the scale and scope of change required to generate good evidence is often at a scale that is prohibitive. Take gambling as one potential public health problem. Governments are now deriving enormous revenue from gambling, while the social costs seem to rise with it. So important is gambling to provincial government revenues in most Canadian provinces that the only way to really change is to change the system as a whole. Diabetes care, mental health, and public nutrition and food security are other issues that are complex and of a scope that requires a true systems-level intervention to effectively address. Suddenly, when you speak of connecting the private sector to the public sector, changing regulations, building true KT systems within these areas, supporting public health education and practice, and tackling the social inequalities that are propped up by a current system of organization, systems don’t seem as sexy.

Furthermore, in the case of systems, KT, or eHealth, acknowledging complexity in the way we handle things, and considering problems from a systems perspective, means hard work, different time horizons, and truly working collaboratively across disciplines and settings. That is hard stuff and it sure isn’t sexy.

There are lots of areas within the health system that are not sexy, but few are seen less interesting than issues that were once viewed as sexy, but now not so much. That’s the danger with systems, knowledge translation and eHealth.