Category: public health

Public and population health

behaviour changebusinesspublic healthsocial mediasystems science

Genetic engineering for your brand

on April 5, 2018

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DNA doesn’t predetermine our future as biological beings, but it does powerfully influence it. Some have applied the concept of ‘DNA’ to a company or organization, in the same way, it’s applied to biological organisms. Firms like PWC have been at the forefront of this approach, developing organizational DNA assessments and outlining the principles that shape the DNA of an organization. A good brand is an identity that you communicate with yourself and the world around you. A healthy brand is built on healthy DNA.

Tech entrepreneur and writer Om Malik sees DNA as being comprised of those people that form the organization:

DNA contains the genetic instructions used to build out the cells that make up an organism. I have often argued that companies are very much like living organisms, comprised of the people who work there. What companies make, how they sell and how they invent are merely an outcome of the people who work there. They define the company.

The analogy between the DNA of a company as being that of those who make it up is apt because, as he points out, organizations reflect the values, habits, mindsets, and focus of those who run them. For that reason, understanding your organizations’ DNA structure might be critical to shaping the corporate direction, brand and promoting any type of change, as we see from the case of Facebook.

DNA dilemma: The case of Facebook

Facebook is under fire these days. To anyone paying enough attention to the social media giant the issue with Facebook isn’t that it’s happening now, but why it hasn’t happened sooner? Back when the site was first opened up to allow non-university students to have accounts (signaling what would become the global brand it is today) privacy was a big concern. I still recall listening to a Facebook VP interviewed on a popular tech podcast who basically sloughed off any concerns the interviewer had about privacy saying the usual “we take this seriously” stuff but offering no example of how that was true just as the world was about to jump on the platform. I’ve heard that same kind of interview repeated dozens of times since the mid-2000’s, including just nine months before Mark Zuckerberg’s recent ‘mea culpa’ tour.

Facebook has never been one to show much (real) attention to privacy because its business model is all about ensuring that users’ are as open as possible to collect as much data as possible from them to sell as many services to them, through them, about them, and for others to manipulate. The Cambridge Analytica story simply exposed what’s been happening for years to the world.

Anyone who’s tried to change their privacy settings knows that you need more than a Ph.D. to navigate them* and, even then, you’re unlikely to be successful. Just look at the case of Bobbi Duncan and Katie McCormick who were outed as gay to their families through Facebook even though they had locked down their own individual privacy settings. This is all part of what CEO Mark Zuckerberg and the folks at Facebook refer to as “connecting the social graph.”

The corporate biology of addiction

In a prescient post, Om Malik wrote about Facebook’s addiction to its business model based on sharing, openness, and exploitation of its users’ information mere weeks before the Cambridge Analytica story came out.

Facebook’s DNA is that of a social platform addicted to growth and engagement. At its very core, every policy, every decision, every strategy is based on growth (at any cost) and engagement (at any cost). More growth and more engagement means more data — which means the company can make more advertising dollars, which gives it a nosebleed valuation on the stock market, which in turn allows it to remain competitive and stay ahead of its rivals.

Whether he knew it or not, Malik was describing an epigenetic model of addiction. Much emerging research on addiction has pointed to a relationship between genes and addictive behaviour. This is a two-way street where genes influence behaviour and behaviour influences a person’s genes (something called epigenetics). The more Facebook seeks to connect through its model, the more it reinforces the behaviour, the more it feels a ‘need’ to do it and therefore repeats it.

In systems terms, this is called a reinforcing loop and is part of a larger field of systems science called systems dynamics. Systems dynamics have been applied to public health and show how we can get caught in traps and the means we use to get out of them.  By applying an addiction model and system dynamics to the organization, we might better understand how some organizations change and how some don’t.

Innovation therapy

The first step toward any behaviour change for an addiction is to recognize the addiction in the first place. Without acknowledgment of a problem, there can’t be much in the way of self-support. This acknowledgment has to be authentic, which is why there is still reason to question whether Facebook will change.

There are many paths to addiction treatment, but the lessons from treating some of the most pernicious behaviours like cigarette smoking and alcohol suggest that it is likely to succeed when a series of small, continuous, persistent changes are made and done so in a supportive environment. One needs to learn from each step taken (i.e., evaluate progress and outcomes from each step), to integrate that learning, and continue through the inevitable cycling through stages (non-linear change) that sometimes involves moving backward or not knowing where along the change journey you are.

Having regulations or external pressures to change can help, but too much can paralyze action and stymie creativity. And while being motivated to change is important, sometimes it helps to just take action and let the motivation follow.

If this sounds a lot like the process of innovation, you’re right.

Principled for change

Inspiring change in an organization, particularly one where there is a clear addiction to a business model (a way of doing things, seeing things, and acting) requires the kind of therapy that we might see in addiction support programs. Like those programs, there isn’t one way to do it, but there are principles that are common. These include:

  1. Recognize the emotional triggers involved. Most people suffering from addictions can rationalize the reasons to change, but the emotional reasons are a lot harder. Fear, attraction, and the risk of doing things differently can bubble up when you least expect it. You need to understand these triggers, deal with the emotional aspects of them — the baggage we all bring.
  2. Change your mindset. Successful innovation involves a change of practice and a change of mindset. The innovator’s mindset goes from a linear focus on problems, success, and failure to a non-linear focus on opportunities, learning, and developmental design.  This allows you to spot the reinforcing looping behaviour and addiction pathways as well as what other pathways are open to you.
  3. Create better systems, not just different behaviour. Complex systems have path-dependencies — those ruts that shape our actions, often unconsciously and out of habit. Consider ways you organize yourself, your organization’s jobs and roles, the income streams, the system of rewards and recognitions, the feedback and learning you engage with, and composition of your team.  This rethinking and reorganization are what changes DNA, otherwise, it will continue to express itself through your organization in the same way.
  4. Make change visible. Use evaluation as a means to document what you do and what it produces and continue to structure your work to serve the learning from this. Inertia comes from having no direction and nothing to work toward. We are beings geared towards constant motion and making things — it’s what makes us human. Make a change, by design. Make it visible through evaluation and visual thinking – including the ups, downs, sideways. A journey involves knowing where you are — even if that’s lost — and where you’re going (even if that changes).

Change is far more difficult than people often think. Change initiatives that are rooted solely in motivation are unlikely to produce anything sustainable. You need to get to the root, the DNA, of your organization and build the infrastructure around it to enable it to do the work with you, not against you. That, in Facebook terms, is something your brand and its champions will truly ‘Like’.

 

* Seriously. I have a Ph.D. and am reasonably tech literate and have sat down with others with similar educational backgrounds — Ph.D.’s, masters degrees, tech startup founders — and we collectively still couldn’t figure out the privacy settings as a group.

References: For those interested in system dynamics or causal loop modeling, check out this great primer from Nate Osgood at the University of Saskatchewan. His work is top-notch. Daniel Kim has also written some excellent, useful, and practical stuff on applying system dynamics to a variety of issues.

Image credit: Shutterstock used under license.

complexityeducation & learningevaluationinnovationknowledge translation

You Want It Darker?

on November 11, 2016

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It is poetic irony on many levels that weeks after Leonard Cohen releases his album about the threat of death that he passes on, mere days after we saw the least poetic, most crass election campaign end in the United States with an equally dramatic outcome. This points to art, but also to the science of complexity and how we choose to approach this problem of understanding– and whether we do at all — will determine whether we choose to have things darker or not. 

A million candles burning for the love that never came
You want it darker
We kill the flame

Canadian-born and citizen-of-the-world poet, literary author, and songwriter Leonard Cohen passed away last night and the words above were part of his final musical contribution to the world. It is fitting that those words were penned at time not only when Cohen was ill and dying, but also as we’ve witnessed the flames of social progress, inclusion, and diversity fall ill.

Donald Trump is the president-elect of the United States, a fact that for many is not only unpalatable, but deeply troubling for what it represents. A Trump presidency and the social ills that have been linked to his campaign are just the latest sign that we are well into a strange, fear-ful, period of history within Western democracies. His was not a win for ideas, policy, but personality and as a vector for many other things that simply cannot be boiled down exclusively to racism, sexism, celebrity, or education — although all of those things played some part. It was about the complexity of it all and the ability for simplicity to serve as a (false) antidote.

No matter what side of the political spectrum you sit, it’s hard to envision someone less suited to the job of President of a diverse, powerful nation like the United States than Donald Trump using any standard measure of leadership, personality, experience, personal integrity or record of public conduct. Yet, he’s in and his election provides another signal that we are living in complex times and, like with Brexit, the polls got it very wrong.

We are seeing global trade shrink at a time when globalization is thought to be at its highest. We are witnessing high-profile acts of hatred, discrimination and abuse at at time when we have more means to be socially connected across contexts than ever before. We are lonely when the world and connection is at our fingertips.  It is a time of paradox and when we have so many means to cast light on the world, we seem to find new ways to kill the flame.

It is for this reason that those who deal with complexity and seek positive social change in the world need to take action lest things get darker.

Complexity just got real

The election of Donald Trump and the Brexit vote are two examples that should serve to wake-up anyone who seeks greater accounting of complexity in the making of social decisions.

This is not about voting for a Republican President or for citizens wanting greater control of Britain, it’s about understanding the premise of which those decisions were based on. The amount of cognitive dissonance required to assume that Donald Trump has the qualities befitting a leader of a country like the United States is truly astounding. And just like Brexit, the theories and models proposed post-event by the same people who predicted the opposite outcome pre-event will be just words, backed with too little understanding of complexity or why things actually happened.

Those who understand complexity know that these simplistic explanations are likely to be problematic. But that doesn’t make us better people, but it does mean we have certain responsibilities.

Complexity rhetoric vs science

For those who rely on complexity science as a means of understanding these kinds of events its now time to start matching the science to our rhetoric so we can back up the talk. In crude, but truth-speaking pop culture parlance: “This shit just got real“.

As complexity and systems thinking has gained attention in social science and policy studies we are seeing much more attention to the idea of complexity. Yet, the level of rhetoric on social complexity has overwhelmed any instances of evidence of how complexity actually is manifest, emergent, harnessed, or accounted for in practical means.

This isn’t to say that the tenets of complexity for understanding social systems aren’t true, but rather we don’t know that it’s true for sure and to what extent in what situations. I write this as a true-believer, but also as one who believes in science. Science is about challenging our beliefs and only if we cannot refute our theories through our best efforts can claim something is true. Thus, if we can’t show consistently how the principles of complexity are employed to make useful choices and inform the documentation of some of the outcomes related to our actions based on those choices, we are simply making fables not flourishing organizations, communities and societies.

Showing our work

Without something more than rhetoric to back our claims up we become no better than a politician claiming to make America great again because we’ve got great ideas and will be the greatest president ever because we have great ideas.

This is not about reverting to positivist science to understand the entire world, but about responsible practice in evaluation and research that allows us to document what we do and explore the consequences in context. Powered by complexity theory and the appropriate methods, we can do this. Yet, too often I hear reference to complexity theories in presentations, discussions and papers without any reference to how its been used in real terms (and not just extracted from some other realm of science like bee colonies, natural ecosystems and simulation models) to influence something of value beyond serving as an organizing framework.

Like little kids in math class: we need to show our work.

How did complexity manifest in practice in this case? What methods were used to systematically document the process? How does this fit / challenge the theories we know? These are questions that are what responsible scientists and evaluators ask of their subjects and its time to do this with complexity, regularly and often. No longer can we give it the relatively unchallenged ride it’s been given since first being introduced as a viable contributor to social theory about 20 years ago.

The reasons have to do with what happens when we stop trying to understand complex systems.

Evaluators and social sciences’ new moral imperative

As the US election was unfolding I became aware of some prescient, wise words that were uttered by former US Supreme Court Justice David Souter speaking at a town hall prior to the last election. His words were chilling to anyone paying attention to the world today. In the quote and interview (see link) he says on the matter of government and democracy:

What I worry about is that when problems are not addressed, people will not know who is responsible.

His words are not just about the United States or even politics alone. The further we get from understanding how our social, economic, political and environmental systems work the more we all become vulnerable to the kind of simplistic thinking that leads us to someone that embodies H.L. Mencken’s mis-paraphrased words*:

There is always an easy solution to every human problem — neat, plausible, and wrong

It is our duty as scientists and evaluators to show the world the work of the programs, policies and initiatives that are aimed at changing systems — no matter what that system is. We need to be better at telling the story of programs using data and communicating what we learn to the world. It’s our role to show the work of others and to let others see our work in the process. By doing so we can make a contribution to helping address what Justice Souter meant about people not knowing who is responsible.

And like Mencken’s message, our answer won’t be one that is all that neat, but we if we approach our work with the wisdom and knowledge of how systems work we can avoid Mencken’s trap and avoid presenting the complex as simple, but we will go further and illustrate what complexity means.

It is our moral duty to do this. For if not us, who?

People do understand complexity. Anyone with a child or garden knows that there is no ‘standard practice’ that applies to all kids or any years’ crop of vegetables all the time in all cases. It’s evident all around us. We have the tools, theories and models to help illuminate this in the world and a duty to test them and make this visible to help shed that light on how our increasingly complex world works. Without that we are at risk of demagogues and the darker forces of our nature taking hold.

We have the means for people to see light through the work of those who build programs, policies and communities to illuminate our world. In doing so we not only create the candles as Leonard Cohen speaks of, but the curiosity and love that keeps that flame burning. We can’t kill the flame.

And we could use some love right now.

Thanks Leonard for sharing your gifts with us. I hope your art inspires us to reflect on what world you left to better create a world we move to.

*Mencken’s original quote was: “Explanations exist; they have existed for all time; there is always a well-known solution to every human problem — neat, plausible, and wrong.” Alas, this doesn’t make as pithy, Powerpoint worthy comment. Despite the incorrectness of the paraphrased quote attributed to Mencken, it’s fair to say that in many organizations we see this as a true statement nonetheless.

Image Credit: Shutterstock, used under licence.

knowledge translationsocial systemssystems thinking

When More is Less: The Information Paradox

on September 22, 2016

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There is a point at which information ceases to increase knowledge and understand and begins to undermine it, creating a paradox. When information on nearly anything is more abundant than ever the choices we make about how to engage it become more important than ever. 

The Information Age has been described as the period where industrial production was replaced by knowledge production as the key driver of social and economic benefit for society. Underpinning the thinking behind the information age (and the digital revolution that accompanies it) is that having more information, more access to it and improved tools to use it to solve problems will improve life for everyone. Presented with a choice to have access to more information or less people will almost always choose more.

More information leads to more options, which equals more choice and more choice is about freedom and that is seen as an inherent social good derived from the capitalist system, which further leads to better choices, more freedom and greater happiness overall. At least, this is what we’ve been led to believe and Barry Schwartz explains this quite eloquently in the opening of talk embedded later in this post.

This is the theory of change that underpins information theory as its played out in modern capitalist societies. It’s also the source of many of our modern paradoxes and problems.

Systems of influence: The case of the ePatient

I’ve stopped going to health-related hackathons and design jams altogether for the simple reason that one can almost always guarantee that one third or more of the solutions generated will be some form of app or information-focused tool. These well-meaning, creative tools are part of a consumer health movement that is all about putting information in the hands of patients with the idea that putting information in the hands of patients is the key to empowerment and better health outcomes, except they rarely lead to this promised land.

Few are better at explaining — and indeed living — this reality than Dave deBronkart or ‘e-Patient Dave’ who has been a tireless advocate for better information tools, access and engagement on health for patients. His Ted Talk captures the spirit of the movement nicely.

With all due respect to the positive sentiments around what the ePatient movement is about, it is based on a series of assumptions about health systems, patients and health itself in ways that don’t always hold. For certain patients, certain conditions, and certain contexts having more information delivered in the right format is indeed empowering and may be life saving as deBronkart’s story illustrates. But what’s often missing from these stories of success are the many layers of assumptions and conditions that underpin information-driven healthcare.

A few years ago I interviewed a patient who spoke about his experience with health care decision-making and information technology and his response was that having more information didn’t make his life much better, rather it made it even more complicated because with more access to more information he had more responsibility related to that information.

“I don’t know what to do with it all and there’s an assumption that once I know (this health information) I am in a position to do something. I don’t have the foggiest idea what to do, that’s why I am going to see (the health professionals) because that is what their job is for. They are the ones who are supposed to know what is to be done. It’s their world, not mine.”

This case is less about deferral to authority, but about resources (e.g., knowledge, skill, time, networks, etc..) and expectations around what comes with those resources. When you are unwell the last thing you want is to be told you have even more work to do.

The assumptions around personal health information and decision-making are that people have:

1) access to the data in the first place, 2) time, 3) information gathering tools, 4) knowledge synthesis tools, 5) skill and knowledge of how to sift, sort, synthesize and sense-make all the information obtained (because it may be in different formats, incomplete, or require conversions), 6) access to the people and other knowledge and skills required to appropriately sense-make the data, 7) the resources to act on whatever conclusions are drawn from that process, 8) a system that is able to respond to the actions that are needed and taken (and in a timely manner), 9) the personal willpower, energy, and resolve to persist through the various challenges and pushback from the system to resist the actions taken, 10) social support (because this is virtually impossible to do without any support at all) and 11) the motivation and interest in doing all of this in the first place.

Dave deBronkart and his peers are advocating for patient engagement on a broader level and that includes creating spaces for patients to have the choice as to what kind of information they use or not. This also means having choice to NOT have information. It’s not about technology pushing, but having a choice about what to access, when and how. That’s noble and often helpful to those who are used to not having much say in what happens, but that, too has problems of its own.

The paradox of choice

Barry Schwartz’s work (pdf) doing and synthesizing research on consumer decision-making puts truth to this lie that more choice is better. Choice options add value only to a certain point after which they degrade value and even subvert it altogether. The problem is that choice options are often ‘all or nothing’ and may be addictive if left unconstrained as we’ll see below.

Schwartz addresses the matter of decision-making in healthcare in the above video and points to the shifting of responsibility away from experts to everyone. Perhaps it is not surprising that we are seeing an incredible backlash against expert-driven knowledge and science in a way that we’ve not seen in over a hundred years. This is at a time when the public has access to more scientific data — the same data that scientists and other experts have — through open data and open access scientific publications to validate the claims by experts.

As discussed in a previous post, another feature of this wealth of information is that we are now living in what some call a post-truth political climate where almost anything goes. Speaking on the matter of science and climate change former Alaska Governor and Vice Presidential candidate Sarah Palin suggested that, when compared to Dr Bill Nye (the Science Guy and a rocket scientist — yes, a real rocket scientist ), she is as much of a scientist as he is.

Why have science when you can have opinion?

Distracted driving on the information superhighway

Recent data from Canada shows that year-over-year growth in smartphone use at 24% to over two thirds of the population with 85% reporting some form of mobile phone ownership. One of the key features of modern smartphones is the ‘always on’ nature of their tools and alert systems allowing you to bring maps, address books, a digital library, video and audio telephony, and the entire Internet in your pocket.

The distractions that come from the tools meant to deliver information are becoming crippling to some to the point of distancing us from our humanity itself. The title of a beautiful, sad piece in New York Magazine by Andrew Sullivan put this into perspective: I used to be a human being. (We will come back to this in a future post.)

But even if one still feels human using information technology, its a different experience of humanity than it once was. Behaviour change writer and coach Tony Schwartz (I’m not sure if he’s related to Barry), writing in the New York Times magazine, noted how his use of information technology was affecting his ability to, ironically, glean information from something simple as a book.

One evening early this summer, I opened a book and found myself reading the same paragraph over and over, a half dozen times before concluding that it was hopeless to continue. I simply couldn’t marshal the necessary focus.

He goes on to explain what is being exchanged for the books he had aspired to read:

Instead of reading them, I was spending too many hours online, checking the traffic numbers for my company’s website, shopping for more colorful socks on Gilt and Rue La La, even though I had more than I needed, and even guiltily clicking through pictures with irresistible headlines such as “Awkward Child Stars Who Grew Up to Be Attractive.”

We can laugh at the last bit because most of us have been online and lured by something we thought was impossible or ridiculous and had to inquire about. Link bait is not new or particularly clever, but it works. It works for a variety of reasons, but largely because we need to inhabit the same space to work as well as to play. The problem comes when these worlds cross-over into one another.

For example, I recently was shopping for a safe (no, it’s not to store my non-existent millions, but rather protect hard drives and enhance data security) and wanted to return to a story I’d read in the Guardian for a different blog post. As I returned to pull the URL for this I found the page looking like this:

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All of a sudden I am confronted with shopping choices amidst a quest for a URL.

Information wealth: A Faustian bargain to knowledge poverty?

“We willingly accept the loss of concentration and focus, the division of our attention and the fragmentation of our thoughts, in return for the wealth of compelling or at least diverting information we receive.”

Tony Shwartz’s comments above and below point to what we know about how information works in our brain. We can try and resist, but the evolutionary reasons we pay attention to things and the biological limitations we have to processing it all are most likely to trump any efforts to resist it without substantial shifts to our practices.

Endless access to new information also easily overloads our working memory. When we reach cognitive overload, our ability to transfer learning to long-term memory significantly deteriorates. It’s as if our brain has become a full cup of water and anything more poured into it starts to spill out.

I wish I had the answers to what these are. Schwartz, has proposed a digital vacation. As beneficial as it was for him, he was also willing to admit that it’s not a perfect strategy and that he still spends too much time online, too distracted. But, its better.

Comedian Louis C.K. has taken to ‘quitting the internet’ altogether and, in a touching moment of reflection (as he often does with wit), notes how it has improved the relationship with his daughters.

It’s these relational aspects of the new information technology and how it impacts our world that concern me the most and creates the most troubling paradox: the tools that are designed to bring us together might just be making it harder to be together and pushing us apart from each other and ourselves. This is what I will look at in the next piece in this series on paradox.

Image credit: Information by Heath Brandon used under Creative Commons License and by author

 

 

behaviour changecomplexitypublic healthsocial innovation

Confusing change-making with actual change

on May 3, 2016

658beggar_KeepCoinsChange

Change-making is the process of transformation and not to be confused with the transformed outcome that results from such a process. We confuse the two at our peril.

“We are changing the world” is a rallying cry from many individuals and organizations working in social innovation and entrepreneurship which is both a truth and untruth at the same time. Saying you’re changing the world is far easier than actually doing it. One is dramatic — the kind that make for great reality TV as we’ll discuss — and the other is rather dull, plodding and incremental. But it may be the latter that really wins the day.

Organizations like Ashoka (and others) promote themselves as a change-maker organization authoring blogs titled “everything you need to know about change-making”. That kind of language, while attractive and potentially inspiring to diverse audiences, points to a mindset that views social change in relatively simple, linear terms. This line of thinking suggests change is about having the right knowledge and the right plan and the ability to pull it together and execute.

This is a mindset that highlights great people and great acts supported by great plans and processes. I’m not here to dismiss the work that groups like Ashoka do, but to ask questions about whether the recipe approach is all that’s needed. Is it really that simple?

Lies like: “It’s calories in, calories out”

Too often social change is viewed with the same flawed perspective that weight loss is. Just stop eating so much food (and the right stuff) and exercise and you’ll be fine — calories in and out as the quote suggests — and you’re fine. The reality is, it isn’t that simple.

A heartbreaking and enlightening piece in the New York Times profiled the lives and struggles of past winners of the reality show The Biggest Loser (in parallel with a new study released on this group of people (PDF)) that showed that all but one of the contestants regained weight after the show as illustrated below:

BiggestLoser 2016-05-03 09.17.10

The original study, published in the journal Obesity, considers the role of metabolic adaptation that takes place with the authors suggesting that a person’s metabolism makes a proportional response to compensate for the wide fluctuations in weight to return contestants to their original pre-show weight.

Consider that during the show these contestants were constantly monitored, given world-class nutritional and exercise supports, had tens of thousands of people cheering them on and also had a cash prize to vie for. This was as good as it was going to get for anyone wanting to lose weight shy of surgical options (which have their own problems).

Besides being disheartening to everyone who is struggling with obesity, the paper illuminates the inner workings of our body and reveals it to be a complex adaptive system rather than the simple one that we commonly envision when embarking on a new diet or fitness regime. Might social change be the same?

We can do more and we often do

I’m fond of saying that we often do less than we think and more than we know.

That means we tend to expect that our intentions and efforts to make change produce the results that we seek directly and because of our involvement. In short, we treat social change as a straightforward process. While that is sometimes true, rare is it that programs aiming at social change coming close to achieving their stated systems goals (“changing the world”) or anything close to it.

This is likely the case for a number of reasons:

  • Funders often require clear goals and targets for programs in advance and fund based on promises to achieve these results;
  • These kind of results are also the ones that are attractive to outside audiences such as donors, partners, academics, and the public at large (X problem solved! Y number of people served! Z thousand actions taken!), but may not fully articulate the depth and context to which such actions produce real change;
  • Promising results to stakeholders and funders suggests that a program is operating in a simple or complicated system, rather than a complex one (which is rarely, if ever the case with social change);
  • Because program teams know these promised outcomes don’t fit with their system they cherry-pick the simplest measures that might be achievable, but may also be the least meaningful in terms of social change.
  • Programs will often further choose to emphasize those areas within the complex system that have embedded ordered (or simple) systems in them to show effect, rather than look at the bigger aims.

The process of change that comes from healthy change-making can be transformative for the change-maker themselves, yet not yield much in the way of tangible outcomes related to the initial charge. The reasons likely have to do with the compensatory behaviours of the system — akin to social metabolic adaptation — subduing the efforts we make and the initial gains we might experience.

Yet, we do more at the same time. Danny Cahill, one of the contestants profiled in the story for the New York Times, spoke about how the lesson learned from his post-show weight gain was that the original weight gain wasn’t his fault in the first place

“That shame that was on my shoulders went off”

What he’s doing is adapting his plan, his goals and working differently to rethink what he can do, what’s possible and what is yet to be discovered. This is the approach that we take when we use developmental evaluation; we adapt, evolve and re-design based on the evidence while continually exploring ways to get to where we want to go.

A marathon, not a sprint, in a laboratory

The Biggest Loser is a sprint: all of the change work compressed into a short period of time. It’s a lab experiment, but as we know what happens in a laboratory doesn’t always translate directly into the world outside its walls because the constraints have changed. As the show’s attending physician, Dr. Robert Huizenga, told the New York Times:

“Unfortunately, many contestants are unable to find or afford adequate ongoing support with exercise doctors, psychologists, sleep specialists, and trainers — and that’s something we all need to work hard to change”

This quote illustrates the fallacy of real-world change initiatives and exposes some of the problems we see with many of the organizations who claim to have the knowledge about how to change the world. Have these organizations or funders gone back to see what they’ve done or what’s left after all the initial funding and resources were pulled? This is not just a public, private or non-profit problem: it’s everywhere.

I have a colleague who spent much time working with someone who “was hired to clean up the messes that [large, internationally recognized social change & design firm] left behind” because the original, press-grabbing solution actually failed in the long run. And the failure wasn’t in the lack of success, but the lack of learning because that firm and the funders were off to another project. Without building local capacity for change and a sustained, long-term marathon mindset (vs. the sprint) we are setting ourselves up for failure. Without that mindset, lack of success may truly be a failure because there is no capacity to learn and act based on that learning. Otherwise, the learning is just a part of an experimental approach consistent with an innovation laboratory. The latter is a positive, the former, not so much.

Part of the laboratory approach to change is that labs — real research labs — focus on radical, expansive, long-term and persistent incrementalism. Now that might sound dull and unsexy (which is why few seem to follow it in the social innovation lab space), but it’s how change — big change — happens. The key is not in thinking small, but thinking long-term by linking small changes together persistently. To illustrate, consider the weight gain conundrum as posed by obesity researcher Dr. Michael Rosenbaum in speaking to the Times:

“We eat about 900,000 to a million calories a year, and burn them all except those annoying 3,000 to 5,000 calories that result in an average annual weight gain of about one to two pounds,” he said. “These very small differences between intake and output average out to only about 10 to 20 calories per day — less than one Starburst candy — but the cumulative consequences over time can be devastating.”

Building a marathon laboratory

Marathoners are guided by a strange combination of urgency, persistence and patience. When you run 26 miles (42 km) there’s no sprinting if you want to finish the same day you started. The urgency is what pushes runners to give just a little more at specific times to improve their standing and win. Persistence is the repetition of a small number of key things (simple rules in a complex system) that keep the gains coming and the adaptations consistent. Patience is knowing that there are few radical changes that will positively impact the race, just a lot of modifications and hard work over time.

Real laboratories seek to learn a lot, simply and consistently and apply the lessons from one experiment to the next to extend knowledge, confirm findings, and explore new territory.

Marathons aren’t as fun to watch as the 100m sprint in competitive athletics and lab work is far less sexy than the mythical ‘eureka’ moments of ‘discovery’ that get promoted, but that’s what changes the world. The key is to build organizations that support this. It means recognizing learning and that it comes from poor outcomes as well as positive ones. It encourages asking questions, being persistent and not resting on laurels. It also means avoiding getting drawn into being ‘sexy’ and ‘newsworthy’ and instead focusing on the small, but important things that make the news possible in the first place.

Doing that might not be as sweet as a Starburst candy, but it might avoid us having to eat it.

 

 

 

behaviour changebusinessinnovationknowledge translation

The hidden cost of learning & innovation

on February 8, 2016

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The costs of books, materials, tuition, or conference fees often distort the perception of how much learning costs, creating larger distortions in how we perceive knowledge to benefit us. By looking at what price we pay for integrating knowledge and experience we might re-valuate what we need, what we have and what we pay attention to in our learning and innovation quest. 

A quote paraphrased and attributed to German philosopher Arthur Schopenhauer points to one of the fundamental problems facing books:

Buying books would be a good thing if one could also buy the time to read them in: but as a rule the purchase of books is mistaken for the appropriation of their contents.

Schopenhauer passed away in 1860 when the book was the dominant media form of codified knowledge and the availability of books was limited. This was before radio, television, the Internet and the confluence of it all in today’s modern mediascape from Amazon to the iPhone and beyond.

Schopenhauer exposes the fallacy of thought that links having access to information to knowledge. This fallacy underpins the major challenges facing our learning culture today: quantity of information vs quality of integration.

Learning time

Consider something like a conference or seminar. How often have you attended a talk or workshop and been moved by what you heard and saw, took furious notes, and walked out of the room vowing to make a big change based on what you just experienced? And then what happened? My guess is that the world outside that workshop or conference looked a lot different than it appeared in it. You had emails piled up, phone messages to return, colleagues to convince, resources to marshall, patterns to break and so on.

Among the simple reasons is that we do not protect the time and resources required to actually learn and to integrate that knowledge into what we do. As a result, we mistakenly look at the volume of ‘things’ we expose ourselves to for learning outcomes.

One solution is to embrace what consultant, writer and blogger Sarah Van Bargen calls “intentional ignorance“. This approach involves turning away from the ongoing stream of data and accepting that there are things we won’t know and that we’ll just miss. Van Bargen isn’t calling for a complete shutting of the door, rather something akin to an information sabbatical or what some might call digital sabbath. Sabbath and sabbatical share the Latin root sabbatum, which means “to rest”.

Rebecca Rosen who writes on work and business for The Atlantic argues we don’t need a digital sabbath, we need more time. Rosen’s piece points to a number of trends that are suggesting the way we work is that we’re producing more, more often and doing it more throughout the day. The problem is not about more, it’s about less. It’s also about different.

Time, by design

One of the challenges is our relationship to time in the first place and the forward orientation we have to our work. We humans are designed to look forward so it is not a surprise that we engineer our lives and organizations to do the same. Sensemaking is a process that orients our gaze to the future by looking at both the past and the present, but also by taking time to look at what we have before we consider what else we need. It helps reduce or at least manage complex information to enable actionable understanding of what data is telling us by putting it into proper context. This can’t be done by automation.

It takes time.

It means….

….setting aside time to look at the data and discuss it with those who are affected by it, who helped generate it, and are close to the action;

….taking time to gather the right kind of information, that is context-rich, measures things that have meaning and does so with appropriate scope and precision;

….understanding your enterprises’ purpose(s) and designing programs to meet such purposes, perhaps dynamically through things like developmental evaluation models and developmental design;

….create organizational incentives and protections for people to integrate what they know into their jobs and roles and to create organizations that are adaptive enough to absorb, integrate and transform based on this learning — becoming a true learning organization.

By changing the practices within an organization we can start shifting the way we learn and increase the likelihood of learning taking place.

Buying time

Imagine buying both the book and the time to read the book and think about it. Imagine sending people on courses and then giving them the tools and opportunity to try the lessons (the good ones at least) in practice within the context of the organization. If learning is really a priority, what kind of time is given to people to share what they know, listen to others, and collectively make sense of what it means and how it influences strategy?

What we might find is that we do less. We buy less. We attend less. We subscribe to less. Yet, we absorb more and share more and do more as a result.

The cost of learning then shifts — maybe even to less than we spend now — but what it means is that we factor in time not just product in our learning and knowledge production activities.

This can happen and it happens through design.

CreateYourFuture

Photo credit by Tim Sackton used under Creative Commons License via Flickr.

Abraham Lincoln quote image from TheQuotepedia.

food systemsjournalismpublic healthsocial mediasystems science

Frogs, Pots, Blogs and Social Media

on December 30, 2015

Frog_and_saucepan

Our information landscape has been compared with our diets providing an ample opportunity to compare what we ‘consume’ with how we prepare food and perhaps draw on the analogy of the frog and the boiling point of water. Are we slowly killing our ability to produce independent thought through vehicles like blogs as we draw our gaze to and focus on the social media stream?

Iranian-Canadian blogger Hossein Derakhshan was one of the few who opposed the state-imposed media messaging about what was (and has been) happening in Iran. For that, he was jailed. Writing in the Guardian news service, Darakshan, once referred to as Iran’s ‘Blogfather’, discusses how blogging enabled him to be this voice and how he’s become increasingly concerned with how that option is getting slowly silenced not necessarily by governments but by social media.

Darakhshan’s perspective on social media is made all the more interesting because of his role as a prominent blogger before his arrest and the 6-year prison term that disrupted that role, offering something of a time-travel experiment in social media that he illustrates with a story from the Qur’an (known as the tale of the Seven Sleepers).

Upon his return online, Darakhshan noticed that the patchwork quilt of perspectives that were present in the blogosphere was being replaced by ‘The Stream’ that social media provides.

This stream is no longer about a diversity of perspectives, but rather something custom-tailored to meet our preferences, desires, and the needs of corporations seeking to sell advertising, products and services that align with their perception of what we want or require. This stream also allows us to shield ourselves from perspectives that might clash with our own. Groups like ISIS, he suggests, are enabled and emboldened by this kind of information vacuum:

Minority views are radicalised when they can’t be heard or engaged with. That’s how Isis is recruiting and growing. The stream suppresses other types of unconventional ideas too, with its reliance on our habits.

The Stream & our information diet

What’s interesting about The Stream is that it is about bits and bites (or bytes) and not about meals. Yet, if we consider the analogy of information and food a little further we might find ourselves hard-pressed to recall the snacks we had, but (hopefully) can recall many memorable meals. Snacking isn’t bad, but it’s not memorable and too much of it isn’t particularly healthy unless it’s of very high-quality food. With no offence to my ‘friends’ and ‘follows’ on social media, but most of what they produce is highly refined, saccharine-laden comfort food in their posts and retweets, with a few tasty morsels interspersed between rants, cat videos, selfies, and kid pictures. To be fair, my ‘offerings’ aren’t much better when I look across many of my recent Tweets and posts as I am no more than a box of sugar-topped Shreddies to others’ Frosted Flakes. (Note to self when composing New Years Resolutions, even if they are likely to fail, that I need to add less sugar to my stream).

Yet, we are living an age of information abundance and, like food abundance (and the calories that come with it), we are prone to getting obese and lethargic from too much of it. This was the argument that political communicator Clay Johnston makes in his book The Information Diet. Obesity in its various forms makes us slower, less attuned, more disengaged and often far less mindful (and critical) of what we take in whether it’s food or information. And like obesity, the problem is not just one of personal choice and willpower, it’s also about obesogenic systems that include: workplaces, restaurants, communities, markets and policies. This requires systems thinking and ensuring that we are making good personal choices and supporting healthy, critical information systems to support those choices.

The Stream is actually antithetical to that in many regards as Darakhshan points out. The Stream is about passing content through something else, like Facebook, that may or may not choose to pass it on to someone at any given time and place. I’ve noticed this firsthand over the holiday season by finding “Getting ready for Christmas” messages in my Facebook feed on Boxing Day and beyond.

The problem with The Stream is that everything is the same, by design, as Darakhshan notes in an earlier post on his concerns with his new post-imprisonment Web.

Six years was a long time to be in jail, but it’s an entire era online. Writing on the internet itself had not changed, but reading — or, at least, getting things read — had altered dramatically. I’d been told how essential social networks had become while I’d been gone, and so I knew one thing: If I wanted to lure people to see my writing, I had to use social media now.

So I tried to post a link to one of my stories on Facebook. Turns out Facebook didn’t care much. It ended up looking like a boring classified ad. No description. No image. Nothing. It got three likes. Three! That was it.

An information food web

Diversity of perspective and content is critical for healthy decision-making in complex systems. Our great problems, the wicked ones from terrorism to chronic disease to mass migration to climate change, will not be solved in The Stream. Yet, if we push too much toward creating content in social networks that are no longer controlled by users (even if the content is produced by users) and designed to facilitate new thinking, not just same thinking, our collective capacity for addressing complex problems is diminished.

Wicked problems will not be solved by Big Data alone. We cannot expect to simply mine our streams looking for tags and expect to find the diversity of perspective or new idea that will change the game. As Ethan Zuckerman has pointed out, we need to rewire our feeds consciously to reflect the cosmopolitan nature of our problems and world, not just accept that we’ll choose diversity when our information systems are designed to minimize them.

Much like a food web, consideration of our information ecosystems in systems terms can be useful in helping us understand the role of blogging and other forms of journalism and expression in nurturing not only differences of opinion, but supporting the democratic foundation in which the Web was originally based. Systems thinking about what we consume as well as produce might be a reason to consider blogging as well as adding to your social media stream and why more ‘traditional’ media like newspapers and related news sites have a role.

Otherwise, we may just be the frog in the boiling pot who isn’t aware that it’s about to be cooked until it’s too late.

Postscript

It is interesting that Darakhshan’s piece caught my attention the day after WordPress delivered my ‘Year in Blogging’ review to my inbox. It pointed out that there were just 4 posts on Censemaking in 2015. This is down from more than 90 per year in past calendar years. Clearly, I’ve been drawn into the stream with my content sharing and perhaps it’s time to swim back against the current. This blog was partly a response. Stay tuned for more and thanks for reading.

Image: Frog & Saucepan used under Creative Commons License via Wikimedia Foundation.

journalismknowledge translationpublic healthscience & technology

The Power, Peril and Promise of Health Journalism

on February 14, 2015

Online Prescription Concept

The Toronto Star, Canada’s most widely read newspaper known for its investigative reporting gifted anti-vaccination audiences armament by using poor science to point to a spurious connection between an HPV vaccine and illness. The issue points to journalism’s power to shape the discourse of health issues and it points to the power, promise and peril associated with good (and not so good) science reporting. 

With great power comes great responsibility – Uncle Ben, Spiderman

It started with a story

On Thursday February 5th, 2015 the Toronto Star, Canada’s most widely read newspaper that has a reputation for solid investigative journalism, published an story that connected the experience of young girls and negative health effects with the receiving the Gardasil HPV vaccine. The story was immediately and widely criticized by experienced science journalists and health professionals alike, who argued that it was based on terribly flawed science.

The Toronto Star’s reaction was to defend itself, arguing in many different fora that they indeed mentioned that there was little scientific evidence that supported the link between the vaccine and the negative health effects being discussed in the article. The problem is that these links are buried deep in the article and certainly are not its focus: the hypothesized harms are.

Two days later, the Star published a follow-up op-ed letter which was authored by two health professionals and co-signed / supported by dozens of Toronto’s leading physicians condemning the original article. However, by that time the damage is likely to have been done and one more bit contribution to the fictitious ‘evidence’ for vaccine harms had been added to the anti-vaccine movement’s war chest.

Perpetuating harm

This matter of poor reporting is not a trivial issue. The fraudulent science performed by Andrew Wakefield linking autism to vaccines helped spur an evidence-thin anti-vaccination movement. Today, we are seeing the resurgence of diseases once thought to be eliminated in North America (like measles) because so many people are not having their children vaccinated. Jenny McCarthy is among the celebrities who have taken up the cause of anti-vaccination and has written about and spoken at length about what she sees as the connection between autism and vaccines, using her son’s experience as an ‘example’. Oprah Winfrey, perhaps unwittingly, gave McCarthy a platform to speak about her beliefs on her show offering wider possible credibility to something that has been thoroughly discredited in the scientific literature (PDF).

For the Toronto Star, it was bad enough that the story was published — and is now online, likely for all time in various forms thanks to the Web — but what made it worse was that the Star was so vigorous in its defence of it, unwilling or unable to recognize their role in public health. Medical evidence champion, author, physician and columnist Ben Goldacre was among the many who counter-attacked, pointing to what he called The Star’s ‘smear campaign‘ against the story’s critics.

For an interesting discussion of the issue of just how the Star got it wrong, listen to Vox health reporter Julia Belluz, interviewed on the CBC’s radio show The Current. Belluz, a past MIT Knight Journalism Fellow, is one of a dwindling number of journalists who understand the practice of reporting, science, and medicine and wrote a stellar critique of the Toronto Star article, but as importantly makes the case for why there is a need for specialized, trained, supported journalists out there doing this kind of work.

…and health

I’ve argued in the past that journalism is very much a pillar of public health. When it fails, so does public health. Journalism is not and should not be an arm of public health for the very independence that good, professional journalism strives to maintain is a reason it’s often called the fourth estate, keeping governments and other forces in check to ensure they are not abusive. Yet, that distance is also what makes it a part of public health. Public health is better for journalism and journalism certainly can benefit from health stories as they continue to be popular and sought after by readers.

As a group, scientists and many clinicians are not great at communicating what they do, why their research is important to others outside their field, and what the implications of their findings are for the public and science as a whole. Some are, most are not. It’s for this reason that the entire sub-field of health sciences focused on knowledge translation, exchange and mobilization has emerged. Just as we value the ability of a graphic designer to make visuals come alive, so too have we learned to value those with the skills to communicate information well and that is what journalists are trained and paid to do. They are a big part of this process, or at least should be.

Healthy journalism, healthy science, healthy people

Science journalism is too important to be ignored. There is much skepticism of journalists by scientists and clinicians and indeed, as the Toronto Star shows, journalists sometimes get things wrong. But its one thing to get it wrong through errors of judgement or interpretation it’s quite another to get things wrong by design. The Toronto Star has some good health reporters, but they weren’t the ones on this story. Nor did they bring in the health reporters to consult on this or other health professionals prior to publication– at least as far as one can tell.

The importance to the public’s health of good reporting requires that health and science journalists have more than a rudimentary knowledge of the topics they are covering. What’s strange is how we understand this with our sports reporting, weather forecasts and foreign correspondents. You wouldn’t watch someone who has little understanding of a sport covering it in depth, would you? It’s one thing to read scores, it’s another to provide investigative and deep coverage of a game if you don’t know the players, the rules, the criteria for quality and success and so forth.

Why do we do this with health journalism and science?

Yet, journalism is under pressure and no doubt the Toronto Star, for whatever genuine contrition they experience from what happened, have to like that they are being talked about. The reason is that journalism is under threat for market reasons, the Internet and the changing ways we get our news. It is, as Jürgen Krönig wrote way back in 2004, “A crisis of the Fourth Estate”. That crisis is only getting worse.

As anyone interested in public health, we need to take actions to ensure that the fourth estate is protected, supported and not ignored. Our health might just depend on it.

Image: iStockphoto, used under licence.

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