Category: knowledge translation

art & designdesign thinkingknowledge translationresearchscience & technology

Design and Science: An Opportunity for Knowledge Translation and Exchange??

Design of Science or Science of Design

IDEO’s CEO Tim Brown recently observed a renewed interest in design within science, but is that same feeling reciprocated and, if so, what does that mean for both fields?

Tim Brown, author and CEO of the renowned design firm IDEO, recently posted on the firm’s blog some observations he had on the relationship between design and science.

In that post, he asks some important questions of both designers and scientists.

I wonder how much might be gained if designers had a deeper understanding of the science behind synthetic biology and genomics? Or nanotechnology? Or robotics? Could designers help scientists better see the implications and opportunities of the technologies they are creating? Might better educated and aware designers be in a position to challenge the assumptions of the science or reinterpret them in innovative ways? Might they do a better job of fitting the new science into our lives so that we can gain more benefit?

The question of the relationship between designers and the science used to inform the materials or products they us is one that will play out differently depending on the person and context. However, I would welcome the opportunity for designers to challenge much of what science — and I use that term broadly — does, particularly with regards to the application or translation of scientific research into policies and practices. Indeed, this is a frontier where designers have tremendous opportunities to contribute as I’ve discussed elsewhere.

Knowledge translation and translational research are two of the most vexing problem domains in science, particularly with health. Despite years of efforts, scientists haven’t been able to advance the integration of what is learned into what is done at a rate that is acceptable to policy makers, practitioners and the public alike. The problem isn’t just with scientists, but the way the scientific enterprise has been engineered.

Scientists haven’t had to consider design before. Tim Brown asks further questions about what it might be like if they did:

If scientists were more comfortable with intuitive nature of design might they ask more interesting questions? The best scientists often show great leaps of intuition as they develop new hypotheses and yet so much modern science seems to be a dreary methodical process that answers ever more incremental questions. If scientists had some of the skills of designers might they be better able to communicate their new discoveries to the public?

In this case, it might be the chance for designers to step up and consider ways to work with those in science to create better institutional policies, laboratories, and collaborative environments to foster the kind of linkages necessary for effective knowledge translation.

Knowledge translation models, such as the widely cited one conceived of by the Canadian Institutes for Health Research, are both process and outcome oriented; ideal for designers. KT is a designed process and the more it is approached through the lens of design thinking, the greater likelihood we’ll get a system that reflects its intentions better than what we currently have.

behaviour changehealth promotionknowledge translationpublic health

Health Communication in the Age of Pamphlets

Although social media is all around us, there is a tendency to forget that it is still new and, in the case of public health, very new. What would / did our health communications system look like if it was designed for pamphlets instead of apps, door-to-door visits instead of Facebook, and libraries instead of websites?

I was at a meeting today and caught the phrase “health communication in the age of pamphlets” as a frank, but concerning assessment of how much we rely on models of communication that emphasize written text, paper-based materials, professionals handing them out or information racks as the distribution channel, and authority and fear as the driver.

If we designed our communications systems for pamphlets, we might have a system that looks like this:

1. Public health officials (mostly physicians) would tell the public what was good for them, how to act in case of emergencies, and they would be doing it with confidence.

2. That confidence would come from experience and some evidence and both of those would have largely complete information, or at least good enough information.

3. Messages would be crafted using mostly text in language (almost exclusively English, except maybe French in some cases here in Canada) that was authoritative and technical.

4. Information could be easily found in doctors offices and some public libraries (you wouldn’t want to put too much information in the library because there are no health professionals there).

5. The conditions that caused illness were straightforward, could be diagnosed and treated and that the reasons people got sick in the first place was that they were largely not taking care of themselves.

It seems to me that this system isn’t that different than what we have now.

The only difference is that people have options and that is what they are seeking. They are also seeking relationships,
…are recognizing that illness is caused by social as well as other determinants,
…that their peers and lay helpers have a lot to offer,
…that professionals’ knowledge is limited, but that they are still very important for specific things,
…that they would rather be in partnership with health professionals than not
…there are limits to what we know and that being an informed consumer is an important skill in the world these days
… that there are as many questions as answers.

Information technology, networks, and a newfound sense of empowerment is changing a lot and maybe soon it will change public health communications.

behaviour changecomplexityeHealthinnovationknowledge translation

The Face-to-Face Complexity of eHealth & Knowledge Exchange

The Public Health Agency of Canada‘s 2010 Knowledge Forum on Chronic Disease was held last night today in Ottawa with the focus on social media. The invitation-only affair was designed to bring together a diverse array of researchers, practitioners, policy developers, consultants and administrators who work with social media in some capacity. There were experts and non-experts alike gathered to learn about what the state of the art of social media is and how it can support public health. By state of the art, I refer not to the technological side of things, but rather the true art of public health, much like that discussed earlier this year at the University of Toronto.

Last night began with a presentation from Leanne Labelle that got us all thinking about how social media is radically different in the speed of its adoption and breadth of its social impact drawing inspiration from this video from Eric Qualman’s Socialnomics website.

Today we got down to business and started working through some of the issues that we face as a field when adopting social media. I would probably consider myself among the most experienced users in the audience, yet still gained so much from the day. Although I learned some things about how to use social media in new ways, what I learned most was how others use it and what struggles they have. This is always a useful reminder.

What stuck out was a presentation and related discussion from Christopher Wilson from the University of Ottawa’s Centre on Governance and a consultant on governance issues. In speaking about the challenges of doing collaboration, Christopher pointed to the problems of a ‘one-size fits all’ strategy using a diagram illustrating the fundamental differences between engagement at a small scale (under 25 people) and what is the mass collaboration that folks like Clay Shirky, Don Tapscott, and others write about. His diagram looks like this:

Technology Spectrum of Social Collaboration by Christopher Wilson

What Wilson stressed to the audience was the role that complexity plays in all of this. Specifically, he stated:

The more complex and interdependent things become, the more people need to be aware of the changing context and the changes in shared understanding.

As part of this, groups are required to engage in ways that enable them to deal with this complexity. In his experience, this can’t be done exclusively online. He further stated:

As complexity increases, the need for offline engagement increases.

I couldn’t agree more. In my work with community organizing and eHealth promotion, I’ve found the most effective means of fostering collaboration is to blend the two forms of knowledge generation and exchange together. The model that my research team and I developed is called the CoNEKTR (Complexity, Networks, EHealth, and Knowledge Translation Research Model).

This model combines both face-to-face methods of organizing and ideation, with a social media strategy that connects people together between events. The CoNEKTR model has been applied in many forms, but in each case the need to have ways to use the power of social media and rich media together with in-person dialogue has been front and centre. Using complexity science principles to guide the process and powered by social media and face-to-face engagement, the power to take what we know, contextualize it, and transform it into something we can act on seems to me the best way forward in dealing with problems of chronic disease that are so knotted and pervasive, yet demand rapid responses from public health.

complexityemergenceknowledge translationpublic healthsystems science

Evidence Democratization in Complex Systems

In the social media and marketing world there is a concept called “brand democratization”, which refers to the notion of having your customers contribute to and partly shape a brand’s identity. Marty Neumeier, who has written extensively on branding, asserts that a brand isn’t what the producers of the product say it is, but rather what the customers say it is.

The notion that the meaning and identity of a brand is outside of the control of those that develop a product is unsettling for many in business. Social media only amplifies this feeling. A social media consultant I work with once relayed a story about how a client (a big company) once asked how they could use social media to control their message more effectively and how unsettled they were to hear that “control” is not what social media is about and frustrated at the thought that they were no longer in the driver’s seat.

To some extent, we are seeing the same thing take place in the health sector, particularly in areas of great complexity. As complex chronic conditions become more prevalent and the number of people with multiple chronic conditions represent a larger proportion of the population (a near inevitability in societies with aging demographics and better health care), complexity will gain a greater place in our health care policy discourse.

Evidence-based medicine holds very clearly a sense of what is good and not-so-good quality content. Hierarchies abound and medical students are taught early on about what the best evidence is and how it is generated. The problem with the “best evidence” in health care is that it typically comes from studies focused within a rather narrow contextual band of activity using designs that aim for simplicity, not complexity. In standard research programs the aim is to reduce variation, not embrace it.

This is nearly the opposite of complex systems, where variation is, to a point, the key to learning and adaptation. Making sense within a complex system requires deep appreciation of context and an understanding of one’s position within the system. However, because such positions are relative, the ability to hold “expertise” in a system is limited. Indeed, there are many who occupy positions where they have great knowledge and the ability to re-interpret and generate evidence as opposed to only a few.

Does this create evidence democratization? When there is so much information from many sources, a need for contextualized feedback and many actors with useful experience and knowledge occupying different positions related to a problem, it seems that the answer is “yes”.

Social media operates within an environment of complexity due to the widescale involvement of diverse actors working in a coordinated, yet sell-organized manner, across many boundaries within multiple overlapping contexts. What is “true” within a social media sphere is only made so by the application of that knowledge within a particular context. A blog only has meaning to its creator and her or his audience, not the entire system. Yet, the actors engaged with that content may take it and rework it, retweet it, or post it in a new environment, where it is transformed into something else. If that “something else” has value, it lives onward.

In health contexts, that value might be very different depending on the condition and the manner in which that knowledge is applied. From a traditional evidence-based health approach, this is utterly terrifying. How can evidence be re-interpreted? What are the harms associated with taking something from one context and applying them to another for which it wasn’t designed? These are concerns, yet it is hard to imagine that there isn’t also some potential value in exploring ways in which this plays out in chronic and complex conditions given that the evidence is rarely that “hard” going in.

Are we on the cusp of a new wave of evidence democratization? And if so, are we going to be healthier as a result of it? More innovative? Or in deep trouble?

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.