Category: complexity

behaviour changecomplexityeHealthemergence

eHealth Isn’t Rocket Science…But Maybe it Should Be

For those of us in the eHealth area and working in Ontario, these are dark days. While the opportunities for electronic tools can make a substantial different to patient care, health promotion, and health innovation are greater than ever, the events surrounding eHealth Ontario, it’s former CEO, its governance, and its outputs have made eHealth a bad word in many circles. When a term that could stand for innovation, quality, accessibility and efficiency is equated with $25K speeches and Choco Bites, we’ve got problems.

But as Andre Picard wrote in the Globe and Mail, it wasn’t about the Choco Bites. The eHealth ‘boondoggle’ is about most everything, but what it was supposed to do. It became about the technology and not about designing a system to support the health and wellbeing of the public and the delivery of care by professionals. But when it became about the technology, we relied on well-worn and inefficient means of building it because people thought it was too important and too big not to trust to the ‘experts’. The problem is, the experts in this system are designing things to make money as their first priority, not health. The result? Large, inefficient systems that are technology first and people second, meaning they don’t do the job.

It is understandable that people might feel a little overwhelmed trying to imagine how a computer system could connect all the myriad paper records together to provide timely, accurate and secure information to physicians and care providers all across a large province like Ontario. It may be this very feeling that has inspired the decisions to pursue such outlandishly expensive electronic solutions that, to date, appear to have little value for dollar.

We’ve seen this before. The Canadian Firearms Registry was one example. So have been the examples of various database programs to support child welfare programs and track paroled sexual offenders. More often than not, these become big expenses with outcomes that are less than stellar.

Building databases is complicated, but it isn’t rocket science. Maybe it should be.

In the Shadow of the Moon is a remarkable documentary that looks at the race to the moon as told by the only men who had ever stepped foot on it. What stood out for me in that film was how, with some inspiration, determination, and resources, the U.S. was able to mobilize its talent to go from rockets that blew up on the launch pad to sending men to the moon multiple times to win the Space Race. This was a feat of innovation that was staggering. 40 years later, the Ansari X-Prize was awarded to the first team “to build and launch a spacecraft capable of carrying three people to 100 kilometers above the earth’s surface, twice within two weeks.” It set off a new phase in commercial space flight. Just as Charles Lindberg won the Orteig Prize, which initiated transcontinental air flight, the X-Prize has initiated a new industry. Yet, at the end of all that, we remember the people and the amazing things they did much more than the technologies they used to get there.

Maybe we need the X-Prize for eHealth. What if we enabled the power of collective thinking, self-organization, and the motivation that comes from winning a prestigious prize? What new ideas would we come up? How much money would we save? The X-Prize was $10M and kick-started a $300M nascent market for commercial space travel. eHealth Ontario has spent more that $650M and achieved little.

Bring on the rocket scientists, our health system apparently needs them.

behaviour changecomplexityenvironmentfood systemssystems science

The limits to individual action

I’m writing this from a Starbucks. With free wireless Internet, decent cafe Americanos and fast breakfast foods that are both reasonably healthy, tasty and not too expensive, its one of the few chains I look for when I’m in need of a place to sit down when a comparable locally-flavoured establishment isn’t available. As someone who both works long (and often early) hours and travels a lot, places that offer decent food and drink and productivity space are valued above almost anything.  When you don’t have time to shop for healthy foods for home and have to eat out it can take a real toll on your health.

I bring with me a travel tumbler, reusable bags and even portable chopsticks to eat with. I buy local and responsibly whenever possible, and when eating at home I aim to buy items with little packaging and, what packaging there is gets recycled with the food waste organics separated and composted in biodegradable bags. When I took the David Suzuki Foundation challenge I got high marks. All is well– right? No. And that’s why climate change and protecting our environment is truly a grand challenge that requires a systems approach. Grand challenge problems refer to exceptionally difficult tasks that stretch the limits of any one group to be able to address them. They are the complex problems that have no single source or simple solution.

No matter what I’ve done to address climate change and help the environment, I am only making a small difference. I’ve been reminded by that because of one product: The Starbucks Vivanno.

This morning my wife and I had a Starbucks Vivanno — a fruit smoothie that is reasonably healthy and pretty decent food option if you’re pressed for time and want some low-fat protein — which is no easy task at the best of time, particularly if you don’t eat meat. If you’ve watched people make these things, they are messy and they are designed for a disposable cup – one that is outside of the regular size cups that a person brings around with them, making it difficult to use the reuasble cup option. This leaves us with a lot of options: 1) Take the disposable cup and make more waste, 2) find a very large cup and bring that around, adding bulk to your bag, 3) don’t drink smoothies at all and either not eat or eat something unhealthy.

Thinking about this a little further, one realizes how tied up layers upon layers of issues are in this drink.

> Why aren’t there other food choices available? (this speaks to the market, to innovation, to location — an easy thing to overlook when you live in downtown Toronto)

>Why am I so busy that I can’t make a decent healthy meal at home? (issues: work demands; social expectations; lack of funding for university research requiring me to work long hours; the expectations of my employer, employees, students and colleagues — requiring me to work long hours; my personality; availability of healthy foods in local grocery stores; ability to cook something I want to eat and meets my nutritional needs)

>Why can’t stores serve drinks in reusables? (issues: cost, breakage, theft, no proper recycling options, people’s busy schedules and need to ‘take away’, no exchange program for containers)

>Why can’t we just get better travel mugs? (issues: our bags are already making us look like sherpas with laptops, pens, books, workout gear, batteries and so forth; they cost a lot for a good one — or you buy a cheap one and add more waste when it breaks, market, etcc.)

These are just four questions with lots of issues — there are many more that you can probably think of. I write this from downtown Toronto, Canada. There are more than 20 other Starbucks locations within a 30 minute walk from my current location and dozens of other coffee shops, pastry places and food outlets to choose from. In some ways, this is really a luxurious problem to have. What about places where you have to drive to get somewhere? What about rural communities where one or two shops is all you have? Yes, the cultural standards will change in each place, but the more I look at this the easier it is to see how I can become the David Suzuki poster boy and still make only a dent on the environment without considering these myriad other issues that influence how a simple product (a cup) becomes a complex issue.

complexityemergencesocial mediasystems science

Wikipedia and the Limits of Co-Creation(?)

This week my eye caught a blog post from New Scientist magazine speculating that Wikipedia might be heading for a fall. When I saw Fast Company add to the argument, it seemed that there was more than just passing interest in the research that spawned the article.  Wikipedia, the most widely used encyclopedic source in the world, has become the go-to place for people interested in both mainstream and obscure facts. In my view, it has become to information repositories what Google has become to the search; namely the first place people go when they need something specific.

Yet, Wikipedia is slowly losing its momentum. As Jim Giles reports, there is research from the Palo Alto Research Center in California (the once Xerox PARC for those who know about the early innovation in computing, design and systems there for many years) suggesting that : “The number of articles added per month flattened out at 60,000 in 2006 and has since declined by around a third. They also found that the number of edits made every month and the number of active editors both stopped growing the following year, flattening out at around 5.5 million and 750,000 respectively.”

The article speaks to the problems that Wikipedia is having with maintaining control and how it is limiting co-creation in some small, but persistent ways by exercising more editorial control over content and thereby reducing the number of words that were generated by members in total over those generated by Wikipedia editors. To some, the answer might be “so, what?”. Maybe this is a good thing that there is more control over the content, particularly given its wide interest? Although this has merit, there is a risk that by creating a content system that is more tightly controlled that Wikipedia is limiting the very power of self-organization and community building that made it so popular in the first place.

Co-creation is about developing a partnership between creators to truly collaborate on the text. This need not be equal in terms of time and energy — there is always some who are far more enthusiastic about a topic than others and will therefore take a larger role in writing — but that partnership needs to exist. Perhaps Wikipedia leaders need to get back to revisiting the very concepts that made them successful. The beauty of the wiki — and a popular one like Wikipedia — is that it:

1) provides a critical mass of engaged users;

2) encourages a diversity of voices participating in the conversation;

3) provides opportunities for expertise to be shared and leveraged;

4) offers a coordinating mechanism to bring together this diversity keeping the system closer to the ‘edge of chaos’ ;

5) promotes self-organization;

6) which increases the likelihood that new ideas will emerge from the collaborations.

These are all hallmarks of strong, creative, and (mostly) effective communities and fits very well with the lessons learned from complexity science and systems thinking. It also is what has made them so popular and widely used. Perhaps the leadership at Wikipedia has forgotten that.