Category: innovation

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.

innovationsocial media

KTExchange Blog Goes Live

This week sees the launch of the Knowledge Translation Exchange Blog , a welcome addition to the digital discourse on knowledge translation and health. The KT arena, a space that often gets filled with voices trying to push something akin to some aggressive form of dissemination with a fancier name, can really use some of what the Research into Action group at the University of Texas School of Public Health is doing and discussing. It’s about integrating knowledge translation into the very fabric of what we do in the health sciences, public health and clinical practice.

KT is not just an add-on, but something that requires integration into the planning, learning, evaluation and dissemination of knowledge. Surprisingly, this is a hard concept for a lot of people to grasp (or perhaps just a hard concept to apply in practice given how few people actually do it). It is not, as some might suggest, dissemination dressed up. It is about considering knowledge in context and framing potential audiences for that knowledge at the outset, defining research questions that align with the needs of the user, and creating capacity within research environments to develop proposals and do the research necessary to fit with these needs.

This past weekend I was reminded how basic this is to most people OUTSIDE of the health sector, and yet how foreign it is to the health system. I was visiting family and friends and, as often happens in such settings, people ask what I do. In conversation about building bridges between diverse actors the reaction typically is not one of surprise or novelty, but more like “of course”. What captures people’s attention is my work in using eHealth tools like iPhones and social media as the mechanism. While those things are of interest to my professional colleagues, the fact that bridges are being built is what draws the most attention. That’s telling.

Best wishes to the KTExchange team on their new blog and for a field where doing KT may one day not be seen as novel, but an integral part of what we do in the the health sector.

complexitydesign thinkingeHealthinnovationscience & technology

Creating the Future Through Systems-Design Thinking

Back to the Future

Arturo Muente-Kunigami wrote in the World Bank’s Information and Communication Technology blog about the challenge of innovation and putting new information technology into practice in governments worldwide. Muente-Kunigami writes:

Most governments that introduce ICTs in their service delivery structure have basically applied technology to the exact same workflow they had before, replacing papers with emails and signatures with digital certificates. But ICTs in general – and broadband in particular – do not just improve the efficiency of governments. They have the potential to transform how governments work, redefining their relationship with citizens and expanding the array of services and transactions that could be provided and implemented.

This, however, is a very risky proposition for governments. And if most private companies rely on analytical thinking due to their overall aversion to risk, governments in most developing countries have a much less functional innovation system (in many cases, equivalent to a “copy-paste” function to be applied to “best practices” in other countries).

This is basically a ‘back-to-the-future’ problem: how to use the past to shape the future? How do we create best practices in areas where there are constant shifts, changes and altered contexts? Marty Neumaier would argue that we can’t. This is a design problem, not a knowledge transfer one. Muente-Kunigami also recognizes the potential for design thinking here and argues that governments need to follow their private sector peers in applying it to ICT and innovation:

So what is design thinking for governments anyway? It is not that much different than its private sector equivalent. It is about going back to the basics. And I mean the basics, trying to understand what citizens need from their governments (yes, that far back) and then answering the question: how could governments (hopefully, leveraging the new set of technologies and devices that exist today – and their spread among the general population) be able to satisfy these needs? Then, it is all about building prototypes, testing, trial and error, and of course a good set of evaluation and feedback mechanisms2.

This scary territory for a lot of organizations, particularly governments where decisions are not only shaped by history, but capital P politics. It’s also a language problem: Design gets equated with style instead of substance. Innovation is something done in business, not social and public services. Technology is something for wealthy nerds, not everyday citizens.

Marty Neumaier, Bruce Mau, Roger Martin and other design thinkers have been trying to shape this attitude, but it is an uphill battle. Language is one barrier, thinking differently is another. Both are challenges that I’ll address in future blogs, but the one I want to focus on here is the concept of best practices and the pull of the past on the present. Indeed, this is as good of an example of the power of an idea that you can find. Ideas may be the most powerful concept in human thinking as they shape the cognitive space that we inhabit by illustrating what is, what was, and what could be.

It is when what was becomes what could be that problems occur, particularly in the space of complex systems, which is where a great deal of government’s work is. Best practices is one of those ideas that is seductive because it reduces variation and provides a blueprint for how to handle problems. Indeed, best practices are pretty good when your problems are simple, or maybe even complicated at a very low level of abstraction, but lousy when you get into the realm of complexity.

Another point that Muente-Kunigami hints at is the systems problem; that is, the need to design systems to accommodate change. Implementing ICT-based strategies into a system straight-away is a recipe for failure. Technical systems do not enhance functionality without corresponding changes in social systems. An organizational shift in the way ICT is deployed is necessary if there is much chance of these tools and technologies living up to their potential. This, too, requires design thinking —  in creating usable technologies and receptive social systems (including those that are literate enough to take advantage of them).

I would also argue that this approach requires an evaluation approach that supports incremental evaluation and rapid-response feedback like we see in developmental evaluation (PDF), which I discuss elsewhere.

Taken together, the future of government may well be in design, but to create this future we need both the systems and design thinking to make it one day be the past.

education & learningevaluationinnovationresearchscience & technology

Openness and The Problem With Collaboration

Openness & Collaboration

Collaboration is everywhere. It’s fast becoming one of the highest virtues to strive for in media, health sciences, business. Whether it is crowdsourcing, groundswells, public engagement, participatory research, or e-democracy, collaboration is hot.

Why? One of the main reasons has to do with the mere fact that we are facing an increasing array of complex problems that have multiple sources, where no one person/group has the all the answers, and where large-scale social action is required if there is any hope of addressing them. The proposed solution is collaboration.

Collaboration is defined as:

collaboration |kəˌlabəˈrā sh ən|
1 the action of working with someone to produce or create something : he wrote on art and architecture in collaboration with John Betjeman.
• something produced or created in this way : his recent opera was a collaboration with Lessing.
2 traitorous cooperation with an enemy : he faces charges of collaboration.
collaborationist |-nist| noun & adjective (sense 2).
ORIGIN mid 19th cent.: from Latin collaboratio(n-), from collaborare ‘work together.’

At the root of the term is (from the Latin): co-labour — working together. That sounds great in theory and indeed, if we are working in a social environment (physical or electronic) we are very likely collaborating in some manner. Social media for instance is built upon collaboration. The picture posted along with this blog was courtesy of psd on Flickr and used under a Creative Commons Licence (thank you!), which encourages collaboration and remixing. Knowledge translation is a another concept that has collaboration at its very foundation. It’s commonplace to see it and, in the world of academic heath sciences, it is considered to be an important part of the work we do.

On the surface of things, my colleagues and I collaborate a lot. But a second glance suggests that this might be overstating things — a lot. The reason has to do with collaboration’s precondition: openness.

Openness is defined (selectively) as:

open |ˈōpən|
1 allowing access, passage, or a view through an empty space; not closed or blocked up : it was a warm evening and the window was open | the door was wide open.
• free from obstructions : the pass is kept open all year by snowplows.

2 [ attrib. ] exposed to the air or to view; not covered : an open fire burned in the grate.

3 [ predic. ] (of a store, place of entertainment, etc.) officially admitting customers or visitors; available for business : the store stays open until 9 p.m.

4 (of a person) frank and communicative; not given to deception or concealment : she was open and naive | I was quite open about my views.
• not concealed; manifest : his eyes showed open admiration.

Let’s consider these definitions for a moment within the context of health and social services, the area I’m most familiar with.

Allowing access refers to having the ability to gain entry to something — physical or otherwise. That might be simple if collaboration is with members of the same team — but what about when you have people from other teams? Other disciplines? Having worked on a project that focuses on interdisciplinary collaboration between teams of researchers I can vouch that it is not something to be taken for granted. Developing a collaborative approach to research, particularly in teams, is something that takes a long time to foster. Then there is confidentiality, rules and regulations about whom has access to what. Even in teams that are open to true collaboration, sometimes the rules that govern institutions don’t allow researchers to engage across settings to access data.

Having something “not blocked up” sounds good, but anyone looking for collaboration knows that there are a lot of preconceived ideas about what that means in practice. For example, are certain people expected to get credit even if they don’t offer anything substantive ? There are conventions for authorship that often grant those who lead the lab a prime authorship position with little attention to the amount of effort on a paper.

What about being “exposed to the air or to view; not covered”? This could mean open to new ideas or ways of working. Sure, it sounds nice to say that you’re open to ideas and suggestions, but what about real practice? Resistance to new ideas is how innovation is thwarted, but it also protects interests within an organization and with individuals. As the saying goes:

The only people who welcome change are wet babies

Lastly, frank and communicative action is a part of openness and if there is anything that represents the converse of that it is academic publishing. It probably should strike people as surprising how often scientists report positive results in the academic literature, but it doesn’t. Why? There is a well-known publication bias — whether real in terms of editorial bias or in terms of self-selection away from publishing negative trials. Another issue is that collaboration is hard, it’s not well funded (that is, the collaboration part — the science itself sometimes is), and it takes a long time to produce something of value. The reason is that it is based on normal human relationships and they don’t fit a timeline that’s particularly ‘efficient’.  It’s also hard to be frank when your reputation and funding is on the line.

So collaboration will continue to soar as an idea, yet until we acknowledge the challenges in an open, frank manner (as the term suggests) we are going to see a marginal benefit for science, health and innovation.


Lessons in Innovation from Sting


This week I had the good fortune to see Sting perform live with the Royal Philharmonic Concert Orchestra not once, but twice. The show was designed around a re-working of some of the great hits and more obscure songs from the deep catalogue of Sting and the Police. While many artists have incorporated symphonic elements into pop or rock music, very few have opted to orchestrate a tour of three-hour performances where songs have been re-worked to suit a wholly different format.

Whether Sting’s music is your cup of tea or not, it is hard not to be impressed with this feat. One of the reason’s I’ve followed Sting’s music since before I was a teen was that he brings so many different elements into each album, both musically and lyrically. A sample of his catalogue will find music that has elements of punk, reggae, jazz, classical, country, Arabic, Celtic, and even an entire album tribute to 16th century “pop” musician John Dowland. His bands typically involve musicians trained in different disciplines, yet can work across formats to accommodate this broad spectrum of sounds.

As a former school teacher and fan of literature, Sting incorporates passages and themes from a wealth of literary sources. One will also find psychoanalytic references, political commentary, Biblical references, and even comedy. He’s been nominated for Grammy Awards, Academy Awards, and had top hits on the Pop, Country and Classical charts in the same decade. It’s quite impressive and also instructive for those looking to innovate and do so over a period of time as Sting has.

Firstly, Sting works with good people. His bands have featured some of the best musicians in the world, not only because of their ability to play their instruments well, but because they can play across different genres. For example, rather than recruit the best Rock drummer, he aims to recruit the best drummer who can play Rock music.

He also recruits people who challenge him and, sometimes, are better than him. Sting is an excellent guitarist and bassist, but will go out of his way to get musicians who play those instruments in a manner that improves his own play.

Another thing he does is provide ‘features’ for his band to showcase their work. Musicians like jazz trumpeter Chris Botti, sax player Branford Marsalis, guitarist Dominic Miller, and singer Joy Rose are just some of the artists that have benefited from this treatment having worked with Sting over the years.

Even though his various bands are made up of individuals, he treats each like an integrated unit made up of stars. Although some members get solos and great profile, these individualized moments pass quickly to allow the audience to remember that each person is part of a bigger entity. At one of Sting’s concerts you know you’re seeing great artists play, but you also realize you’re watching an entire band. Watching interviews with his players, you get the sense that they all feel a part of a team and as respected individuals.

None of this success would be possible without a vision, integration, discipline and the flexibility in the path to achieving that vision. In the case of Sting, the vision is tied to an idea of what a song could be by crafting a structure that allows words to come to life with the music, and the discipline to integrate these two parts of the song together. However, the manner by which the song is composed, its subject matter, and the length and tempo of the songs – including the instruments used to create the music — is always fluid and fits with the context. Sting discussed some of this work during the concert as he has elsewhere.

As an artist, Sting has entertained millions. As an innovator, he has the opportunity to educate millions more. The lessons from this former schoolteacher are many for those of us working with teams and hoping to create products that not only last decades, but transform and evolve during this time into something unique and special.

eHealthhealth promotioninnovationpublic healthsocial media

Mobile Health Promotion and Web 3.0

Telephones of the Distant Future by Catmachine.

This week the MaRS Discovery District in Toronto is hosting NetChange Week, which describes itself as being “A week exploring tech for change” .

(follow comment on Twitter using #ncwk).

Yesterday’s focus was on mobile technologies and the ways in which they’ve been used to promote health and facilitate fundraising and knowledge development with non-profits. A series of innovations and novel forms of engagement were proposed, most notably in the area of sexual health.

Toronto Public Health presented work on a sexual health promotion program that uses proximity marketing through Bluetooth technologies. Health promoters with TPH go into the (mostly) gay community, particularly bars and clubs, wearing monitors that allow people to opt-in to receive Bluetooth-transported messages directly to their phones. The messages, contained in a GIF format so they can be viewed at a later time, provide a discrete way to deliver sexual health information specifically suited to the gay population.

Another similar program came from Black Cap, which has sought to engage the black community in Toronto through a variety of sexual health programs aimed at men who have sex with men and youth. The latter program involves a group of youth opinion leaders / health promoters who use text messages and their personal social networks to spread positive health messages in the community. Thus far, the program appears to be creating a buzz and leading to some action.

A third presentation from Lisa Campbell Salazar, a health promoter working with TakingITGlobal (among others), presented her research on youth and mobile technologies. Although the survey was not all focused on health issues, they certainly provided highlights (details of the survey can be found here).

One of the most salient findings from this survey was that mobile tools provide youth with a safe, accessible way to offer peer support to one another and connect in real time in situations where their health risk behaviour takes place. As TPH Health Promoter Michelle Hamilton-Page said in her presentation:

No one who is coming up to our booth is having sex at the moment, they need information for later when they are. Mobile phones provide a means to do that.

This is the bottom line for mobile technologies and health promotion. It provides support where people are — literally and figuratively — rather than where we wish them to be. Where we wish them to be are in places where we don’t have to work too hard to reach them (or are not complex): clinics, traditional media spaces, office buildings. Traditional media is usually passive, it can be crafted in boardrooms and office buildings, with little need to actually engage the community your trying to reach*. It is harder to do that with mobile messaging (although there are examples where this works in practice — TPH’s messages are crafted in advance, but the way they are delivered by an ambassador in the community adds that customized component that is part of the message. Black Cap’s youth opinion leaders custom craft their own messages on the fly using guidelines).

*- although even traditional media tries to solicit input before deploying things into the field.

Traditional, developer-designed, limited-authored websites (Web 1.0) allowed us the opportunity to broadcast messages in new ways to an enormous population. Social media enabled people to not only take part in a conversation, but initiate and re-create dialogical spaces and express themselves in ways that transcend text to pictures, video and other creative media (Web 2.0). Mobile technologies combine both of these earlier phases and enable conversations to take place where people are physically situated, freed of wired connections (Web 3.0). Here, the concept of ‘web’ is truly a network, a spiderweb of connections that are poised to promote health and engage the public in new ways.

It is here that the future of health promotion,  and public health more broadly, lies.

A Web of Digital Health Promotion