Posted on September 29, 2009
Yesterday I had the privilege of speaking to Cancer Care Ontario‘s LEARN community of practice meeting in Toronto about social media and how it could be used to support their health promotion (specifically tobacco control) work with youth and young adults. This group does a lot of work with young adults so information technologies are not alien to them (indeed, many had blogs, Facebook pages and other social media tools), yet they were still uncertain about how best to use these tools and why they might want to in the first place. In preparing for the presentation and in the subsequent discussion afterwards I had this overwhelming sense of having been here (and there) before. It was, as Yogi Berra famously said: deja vu all over again.
My first study on the Internet was conducted in 1995, a time when the World Wide Web was just becoming known outside of academia and the best option for social support was UseNet groups. With a friend of mine, we did the first (to my knowledge) global survey on the use of the Internet for social support (note: this is why its important to publish your results as soon as you get them, otherwise it will never happen 😦 . I did, however, present findings at the Prairie Undergraduate Research Conference at the University of Winnipeg, perhaps the most remarkable event in support of student scholarship in psychology (or any other discipline) I’ve witnessed. But I digress…)
As I moved along in my career, I continued to work with the Internet as a tool — from discussion boards to interactive smoking cessation support tools and using qualitative methods and design principles to large randomized trials. All along I would hear (and still do) comments like “isn’t that (technology) stuff just for fun?” or “why would anyone want to use that?” .
The same pattern keeps repeating. 20 years ago if you were to describe using email as a serious means of communicating – something that one should devote work time to – most employers would scoff. Now, email is integrated deeply into the very fabric of nearly every knowledge-based enterprise to the point that the corporate market for mobile services to deliver email to its workforce is in likely in the billions. 10 years ago if you were found in your office searching the World Wide Web for content of a serious (i.e., work-related) nature, a similar scoff might come. Now? Open access journals are becoming top publishing venues in their field (see the Journal of Medical Internet Research in the Health Services Research area as one example) and tools like Google Scholar are invaluable resources for scientists and practitioners alike. The LEARN group gets this. They are the ones who are trying things out and trying to push the boundaries of their organizations, changing mindsets and considering whether or not social media is for them or not and in what measure.
A few months ago I spoke to another, similar group of health practitioners about eHealth and asked the audience about their experience using social media. Many of these settings — particularly public health units — didn’t allow Facebook or YouTube to be accessed. Presumably, it was to avoid people doing things that weren’t serious work. This all reflects a mindset pattern that repeats in many organizations — public health or otherwise: people don’t see how the new technology can help because it is not obvious (or they haven’t even tried it), therefore it is dismissed as irrelevant or even banned outright.
The challenge here — and one that I take up — is about lowering these barriers through education. I think it is imperative that those of us (perhaps you, dear reader) who work in social media and eHealth help others to support their efforts to change the culture of their organizations. The LEARN folk are doing this, just as I did so with them. No matter how much we as ‘experts’ like to showcase new tools, we are the early adopters and massive social change will not happen until we inspire the next wave of people to take it up. One forum for this is at the eHealth Promotion social network, a Ning group formed out of the experiences at this year’s Health Promotion Summer School in Toronto, that was on the very topic of teaching people about eHealth in public health. Best of all, when we get these new adopters joining into the discussion and familiar with the tools, they can also help us determine what doesn’t work with these tools, what their limits are, and even what risks they bring in a manner that is informed, constructive and not dismissive.
If public health is going to be innovative, that is doing things that haven’t been done or in new ways to address emerging problems, then it needs to understand social media. What and how much it adopts it is really a matter of need and circumstance, but as I pointed out in my talk yesterday, we cannot wait for the evidence to come in to make that leap. Last year, the research on Web-Assisted Tobacco Interventions (perhaps the leading domain of public eHealth research) finally reached a point where we could say with some confidence that the principal of using the Web to support smoking cessation and prevention is evidence-based. That was more than 15 years after the birth of WWW.
Are we going to have to wait another 15 years before public health widely adopts tools like microblogging (e.g. Twitter) or considers the use of mobile messaging and video or social networks in its work? By then the evidence might be in and if that is what it takes to get this adopted or accepted it will be deja vu all over again, and that’s not a good thing.
Posted on September 27, 2009
One of my favourite quotes is from Giuseppe Tomasi di Lampedusa‘s posthumously published novel: The Leopard. The story is about a artistocratic family and their fall from the ranks in society. In the book there is a marvellous quote that reflects the most fundamental challenges of system dynamics:”If we want things to stay as they are, things will have to change.”
At its core, the message is that we cannot avoid change by standing still, rather only through change can we hope to achieve consistency. And that, is unlikely. We lose our position unless we move along with everyone else, even if in the process of moving it appears as if we are standing still. (Just think of cars on a highway. Two cars driving side-by-side at the same relative speed will look to each other as if they are not moving much at all, when in reality they may be cruising at a very high rate of speed).
We are rarely aware of the speed at which we are traveling, that is the rate of change that is taking place around us and within us. The human body renews itself many times over throughout the lifespan. Our cells are brand new, yet our looks appear at first to be quite similar from day to day. That is, until someone uncovers a picture of us as a child, a youth, a twenty-, thirty-, any-something that is far enough removed from our current state that we realize the profound change that has taken place.
Systems are enormously difficult to change for that very reason. There is not only constant movement, but lots of it and the impact of each component on everything else is different, dynamic and inconsistent. I am currently helping graduate students in public health learn about systems and, while the teaching is fun and the students are interested, the challenge to communicate the language of systems in a manner that is easy to understand is difficult. Indeed, there is little reason why teaching complexity science should be simple given that one of the principles of systems science is that complex problems require complex solutions.
But thankfully one of the other features of complex systems is the presence of paradox. And one of the tools I’ve found works wonderfully is mindfulness-based reflection. Mindfulness is the process of ‘standing still’ by calming the mind and attending the signals around us without trying to influence them. Remarkably, by keeping still and just paying attention to what is around you without ascribing feelings, thoughts, or attitudes towards something we can learn a great deal about what is going on around us. This is a strategy that has been highly effective as a technique in addressing complex health conditions like chronic pain and addictions and training those who work in areas like this.
The question I have is this: How do we get our social institutions and communities to do the equivalent of paying attention to its breath and relaxing its mind to see the systems that they are a part of in order to initiate healthy change?
That is the challenge I am putting to my students and myself and to you too, dear reader.
Posted on September 19, 2009
It’s been a busy week and one that has focused on means and ends and provided me with many examples of how those two things get confused and become de-linked.
I started the week off in Vancouver with meetings focused on my ongoing research looking at collaboration and outcomes associated with the study and evaluation of the Life Sciences Institute at the University of British Colombia. Our research is trying to ascertain the means from the ends — and even what those ends are or should be. Does increasing interaction between scientists of different disciplines produce more research? better research? different research? and if so, is this a factor of the people?, the setting?, facilitators within the LSI and outside?, something else? or some combination? It’s the kind of problem that makes researchers squirm or jump (thankfully, I’m in the latter).
These kinds of means and ends are important for not only research, but understanding innovation in practice and creating better strategies to facilitate that. Nowhere was that more clear than in the two days of presentations and discussion at Medicine 2.0, perhaps the most important gathering of people — researchers, clinicians, decision makers, patients and advocates — interested in learning more about how collaborative e-tools brings about change. Events like these are dangerous; for those in eHealth and those outside it.
For those outside, the danger comes from having a group of innovators share with the world how ‘Web 2.0’ tools can facilitate self-organization, community engagement, and patient involvement in ways that challenge the status quo quickly and with tremendous force. As I tell my students in my Health Behaviour Change course at the U of T : the only people who truly welcome change are wet babies.
Take the eHealth Ontario debacle, which continues to roll along. It now has come to the attention of the public that Ontario already has an eHealth record system linking close to 100 facilities only it is focused solely on child health (i.e., those under the age of 19), when its spent millions on developing a completely new one, presumably for the other part of the population (?). What is required here is changing the tools to address a larger population, but more importantly, changing a mindset that there needs to be new tools, rather than adapting existing ones. The means (a centralized database for health records in this case) is confused with the end (a healthier province & a more efficient and effective health care system). A quest for getting the ‘right’ means or getting a particular ‘means’ is delaying our ability to move towards the healthy end.
From the inside eHealth, these kinds of events are dangerous for reasons that are not that different than those of outsiders. In this case, there is a tendency to focus on the means without consideration of the environment in which those methods are deployed. At Medicine 2.0 there were talks ranging from a focus on patient support needs and portals, public health support strategies, wiki-based clinical practice guidelines, and a variety of ways to engage various audiences with tools like Facebook and Twitter. In nearly every presentation the focus was on the novel ways in which technology could facilitating change. Yet in the audience and at the breaks these presenters (myself included) found ourselves talking less about the tools, but the organizational cultures and shifts that need to take place to make these tools work. Indeed, the tools can do a lot, but without an organizational mindshift within our health and public health systems, even the most innovative, responsive and affordable tools will not truly make the change that is espoused.
We are clear on our end, now its time to reconsider our means in light of the tools and the culture that exists around them.
Posted on August 29, 2009
This was a remarkable week for me for many reasons, most of which had to do with getting a new slant on reality or a new view of some of the systems that I am a part of and those that I am not.
I had the pleasure to spend four days in Bogota, Colombia meeting with the amazing folk at CINTEL and presenting at the 4th Encuentro de Invsestigacion Innovation e Ingernieria on Techno-wellbeing. I had the privilige to share the work that the Youth Voices Research Group is doing on health promotion with youth and our integrated eHealth model for community engagement including our Food4Health and Public Health Gambling Projects.
The first morning of meetings I was writing at my computer and then got up to look out the window of my hotel at the bustling morning rush hour of Bogota. As I was admiring the dogs playing in the park, the roar of the motorcycles and the beauty of the tree-lined boulevards outside my window I felt my back go into massive spasm. It hurt so much that I could hardly move. Realizing that I could not stand at the window in pain forever I fought through the ‘lightning bolts’ and managed to get to my bag where I had Advil tablets to manage the pain. But even at the best of times, it hurt – a lot. Over the past week the pain has subsided considerably, although I am still not 100% and probably won’t be for a few more days. But the pain isn’t the story here as much as the revelation it brought to me about the role that accessibility plays within the systems we engage in. Even simple things like stairs became a real pain (literally!) to take. Where I normally bound up the stairs two at a time, I found myself gingerly lifting one leg at a time up each step.
On my first day back home I had to shuffle on my way to the office. In process of shuffling, I realized how I had ‘become’ one of ‘those people’ who walk so slowly that I often get frustrated at in my effort to go somewhere quickly. My back should get better soon, but what hopefully remains is the lessons that this brought (including the one about taking better care of myself to prevent this from happening). As a systems thinker, I see these lessons or affirmations as including:
1. Diversity of perspective is critical. Just in one morning shuffle to the university I realized massive design flaws in the city I live in that favour the able-bodied. For example, some of these street lights can’t be adequately navigated in time if you can’t walk at a normal pace. Another big flaw is the heavy weight of the front doors of my building. I damn near pulled my back out again just opening the doors, which are exceptionally heavy.
2. Accessibility has many forms. Public health leaders are getting better at recognizing the social barriers to health engagement created by issues of race, social class, sex and gender, and geography. But one thing that can easily get lost is physical accessibility via disability. In eHealth for example, we often create elaborate websites that have tiny fonts that people with limited eyesight can’t see. Ever try reading a Blackberry or iPhone for long periods of time? It’s only for the good-sighted. Or we make assumptions that people can sit at computer and type (like I am now) and don’t have bad backs (like I did).
3. The mundane is where the action is. In systems we are often attracted to events, because that’s where the action appears to be. Yet, the mundane activities of a system is where most activities happen. For example, tying your shoes is something that happens every day and is never paid attention to until you break your shoelace or (in my case) hurt your back. In order to prepare for systems change, we need to anticipate how change might occur within the everyday actions in the system.
4. The edge of chaos always shifts. Creative systems tend to function at the edge of chaos, yet this edge has a dynamic position. My personal creative edge took a major directional change this week when my back went out. I continued to creatively navigate through my world, but instead of imagining new possibilities that hadn’t been created before, I found my creative edge focused on trying to get close to my former level of equilibrium on day-to-day activities like walking, shoe tying, and just getting dressed.
As I move into a new Fall term and am about to teach a new course on systems science these lessons are particularly apt. While I don’t think I’ll get my students to throw their back out, I will have them imagine how their current assumptions about a system can radically change with a very simple shift in vantage point, making the invisible visible.