Tag: health promotion

complexityinnovationsocial innovation

The Ecology of Innovation: Part 2 – Language

Idea Factories or ecologies of innovation?

Idea Factories or ecologies of innovation?

Although Innovation is about producing value through doing something new or different than before, the concept is far from simple when applied in practice by individuals and institutions. This second in a series of articles on innovation ecology looks at the way we speak of innovation and how what we talk about new ideas and discovery shapes what we do about it. 

“Language can be a way of hiding your thoughts and preventing communication” – Abraham Maslow

Innovation is one of the few concepts that offers little benefit contemplated in the abstract. We innovate on specific things with an eye to application, maybe even scaling that idea broadly. Humans innovate because the status quo is no longer satisfying, is unacceptable or has changed so we strive to come up with new ways of doing things, novel processes and tools to make the current situation a preferred one.

Thus, we are designers seeking our client, customer and creation through innovation and we do this through our words and actions — our language. Indeed, if one agrees with Marty Neumeier‘s assertion that design is the discipline of innovation and Greg Van Alystne & Bob Logan’s definition of design as “creation for reproduction” then our language of innovation is critical to ensuring that we design products and services that have the potential to reproduce beyond an idea.

Language matters in innovation.

To illustrate, lets look at how language manifests itself in the communication of ideas using an example from public health. In a paper entitled Knowledge integration: Conceptualizing communications in cancer control systems I co-authored with my colleagues Allan Best and Bob Hiatt, we looked at the way language was used within a deep and broad field like cancer control in shaping communications. This was not merely an academic exercise, but served to illustrate the values, practices and structures that are put in place to support communicating concepts and serves to illustrate how innovations are communicated.

Innovation as product

What we found was that there are three generations of cancer communications defined by their language and the practices and policies that are manifested in or representative of that language. The first generation of terms were traced up to the 1990’s and were characterized by viewing knowledge as a product. Indeed, the term knowledge products can be traced back to this period. Other key characteristics of this period include:

  • The terminology used to describe communications included the terms diffusion, dissemination, knowledge transfer, and knowledge uptake.
  • Focus on the handoff between knowledge ‘producers’ and knowledge (or research) ‘users’. These two groups were distinct and separate from one another
  • The degree of use is a function of effective packaging and presentation presuming the content is of high quality.

The language of this first generation makes the assumption that the ideas are independent of the context in which they are to be used or where they were generated. The communication represented in this generation of models relies on expertise and recognition of this. But what happens when expertise is not recognized? Or where expertise isn’t even possible? This is a situation we are increasingly seeing as we face new, complex challenges that require mass collaboration and innovation, something the Drucker Forum suggests represents the end of expertise.

Innovation as a contextual process

From the early and mid-1990’s through to the present we’ve seen a major shift from viewing knowledge or innovation as a product to that of a dynamic process where expertise resides in multiple places and sources and networks are valued as much as institutions or individuals. Some of the characteristics of this generation are:

  • Knowledge and good ideas come from multiple sources, not just recognized experts or leaders
  • Social relationships media what is generated and how it is communicated (and to whom)
  • Innovation is highly context-dependent
  • The degree of use of ideas or knowledge is a function of having strong, effective relationships and processes.

What happens when the context is changing consistently? What happens when the networks are dynamic and often unknown?

Systems-embedded innovation

What the paper argues is that we are seeing a shift toward more systems-oriented approaches to communication and that is represented in the term knowledge integration. A systems-oriented model views the design of knowledge structures as an integral to the support of effective innovation by embedding the activities of innovation — learning, discovery, and communication — within systems like institutions, networks, cultures and policies. This model also recognizes the following:

  • Both explicit and implicit knowledge is recognized and must be made visible and woven into policy making and practice decisions
  • Relationships are mediated through a cycle of innovation and must be understood as a system
  • The degree of integration of policies, practices and processes within a system is what determines the degree of use of an idea or innovation.

The language of integration suggests there is some systems-level plan to take the diverse aspects within a set of activities and connect, coordinate and, to some degree, manage to ensure that knowledge is effectively used.

Talking innovation

What makes language such a critical key to understanding innovation ecologies is that the way in which we speak about something is an indication of what we believe about something and how we act. As the quote from psychologist Abraham Maslow suggests above, language can also be used to hide things.

One example of this is in the realm of social innovation, where ideas are meant to be generated through social means for social benefit. This process can be organized many different ways, but it is almost never exclusively top-down, expert-driven. Yet, when we look at the language used to discuss social innovation, we see terms like dissemination regularly used. Examples from research, practice and connecting the two to inform policy all illustrate that the language of one generation continues to be used as new ones dawn.  This is to be expected as the changes in language of one generation never fully supplants that of previous generations — at least not initially. Because of that, we need to be careful about what we say and how we say it to ensure that our intentions are reflected in our practice and our language. Without conscious awareness of what we say and what those words mean there is a risk that our quest to create true innovation ecosystems, ones where innovation is truly systems-embedded and knowledge is integrated we unwittingly create expectations and practices rooted in other models.

If we wish to walk the walk of innovation at a systems level, we need to talk the talk.

Tips and Tricks

Organizational mindfulness is a key quality and practice that embeds reflective practice and sensemaking into the organization. By cultivating practices that regularly check-in and examine the language and actions of an organization in reference to its goals, processes and outcomes. A recent article by Vogus and Sutcliffe (2012) (PDF) provides some guidance on how this can be understood.

Develop your sensemaking capacity by introducing space at regular meetings that bring together actors from different areas within an organization or network to introduce ideas, insights and observations and process what these mean with respect to what’s happened, what is happening and where its taking the group.

Some key references include: 

Best, A., Hiatt, R. A., & Norman, C. D. (2008). Knowledge integration: Conceptualizing communications in cancer control systems. Patient Education and Counseling, 71(3), 319–327. http://doi.org/10.1016/j.pec.2008.02.013

Best, A., Terpstra, J. L., Moor, G., Riley, B., Norman, C. D., & Glasgow, R. E. (2009). Building knowledge integration systems for evidence‐informed decisions. Journal of Health Organization and Management, 23(6), 627–641. http://doi.org/10.1108/14777260911001644

Vogus, T. J., & Sutcliffe, K. M. (2012). Organizational Mindfulness and Mindful Organizing: A Reconciliation and Path Forward. Academy of Management Learning & Education, 11(4), 722–735. http://doi.org/10.5465/amle.2011.0002C

Weick, K. E., Sutcliffe, K. M., & Obstfeld, D. (2005). Organizing and the Process of Sensemaking. Organization Science, 16(4), 409–421. http://doi.org/10.1287/orsc.1050.0133

*** If you’re interested in applying these principles to your organization and want assistance in designing a process to support that activity, contact Cense Research + Design.

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Attack on Anti-vac – Toronto Public Health vs. Jenny McCarthy

Yesterday I posted on the story of Toronto Public Health tweeting a call for its followers to voice concerns to the TV show “The View” about the recent hiring of Jenny McCarthy, a prominent anti-vaccination advocate, as its new co-host. Today, Nicole Ghanie-Opondo reflects more deeply on what kind of impact such tweeting really has and the role of public health in voicing its concerns from that of an insider. What should we expect from these Tweets? What really drives change? Why is there resistance to engaging the public and how can we professionally do so in the complicated, messy work that comes with social media engagement? Huge questions to ask and the fact that people like Nicole and her blog collaborator Corey are doing it speaks to how much change potential we can expect. One of the best blog reads you’ll find on this topic.

Public Health and Social Media

I wanted to keep quiet on this issue, being the pioneer and former voice of Toronto Public Health’s Twitter for 3 years…but I think in the spirit of reflection – let’s blog on!

Cameron Norman explains the issue really well in his post ‘Public Health and Social Media: Catching Fire from Small Sparks. Here’s another opinion via Jim Garrow on why governments should have an opinion, as junk scientists do. To sum it up, Toronto Public Health tweeted at Jenny McCarthy regarding her anti-vaccine views and requested The View to change their mind about having her as a host.

2013-07-24 08.17.32 pm

My biased opinion.

I love my public health peeps and especially adored the pioneering and willing spirit Toronto Public Health had in the early days of its foray into social media. Like family, bureaucracy and public health practioners come with their own baggage. One large piece of baggage around public health messaging…

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Evaluating Health Promotion Social Media Strategies for Public Health Impact

How is social media stacking up?

How is social media stacking up?

I recently spoke at an interactive workshop presentation at the 2013 Ontario Public Health Convention (TOPHC) looking at social media use in public health and the strategies available for evaluating those strategies in practice. The talk was focused on the tools, methods and approaches and the inherent challenges in dealing with a dynamic social communication environment.

Here are the slides from that presentation.

Evaluating Health Promotion Social Media Strategies for Public Health Impact

Image: Shutterstock (used under licence)

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Contemplating Better Public Health: Perspective is Everything

Design No Smoking

Cigarette smoking remains among the most significant and pernicious global public health challenges. On World No Tobacco Day it’s time to consider re-designing our approach to public health and tobacco control in the hopes of meeting this challenge and others like it more effectively.

Today is World No Tobacco Day and offers us an opportunity to take a pause and think about the ways in which we approach tobacco control as an example for public health.

Marketing funnyman Rory Sutherland,  and smoker, makes a terrific observation about smoking and its power to promote quiet contemplation in one of his recent TED talks (which is well worth watching for many reasons, only some related to tobacco use):

“Ever since they banned smoking in the UK in public places I’ve never enjoyed a drinks party ever again. The reason… is when you go to a drinks party and you hold up a glass of red wine and you stand up and talk endlessly to people sometimes you don’t actually want to spend the whole time talking. It’s really, really tiring. Sometimes you just want to stand their silently, alone with your thoughts. Sometimes you just want to stand in the corner and stare out of the window.

Now the problem is now that you can’t smoke, if you stand there and stare out of the window on your own you’re an antisocial, friendless idiot.

If you stand there and stare out of the window on your own with a cigarette, you’re a fucking philosopher.”

In this  tongue-in-cheek presentation, Sutherland inadvertently hits on a powerful reason to smoke, but not for the reason you might first imagine. It is less about social perspective, but internal perspectives of the self and the opportunity to better acquaint oneself with them.

Sutherland speaks to the perception of others in this talk, but I am more interested in what this act of contemplation — the ‘fucking philosopher’ aspect of smoking for some and why public health sometimes gets it wrong when it comes to tobacco control, but could get it right with mental health with the right design.

Over the past year I’ve made a concerted effort to better understand the motivations and habits of cigarette smokers from the perspective of a designer, not a public health researcher. In doing so I have sought to pay greater attention — as Rory Sutherland does — to the actual experience of smoking. And what I have noticed is the powerful contemplative effect it has on many smokers.

By no means is this a by product of cigarettes, and I certainly cannot endorse their use on health grounds, but one positive by-product of the act of smoking is greater attention to the self in the moment. Sutherland speaks to how a cigarette gives him the license to take time out of a busy party and contemplate, reflect, and gain some perspective that might seem odd or “antisocial” without the prop created by a cigarette.

Strange that we seem unable to develop the same habits and social acceptance of everyday contemplative acts in public, yet fully recognize this as legitmate with smokers even if we question the device used to precipitate the “time out”.

Smokers take breaks throughout the day to engage their cigarettes. Even in cold weather, they will go outside and sit or stand for 10 minutes just to indulge their habit, compulsion or pleasure, sometimes in small groups. This act of smoking provides a sense of community (with other smokers), contemplative space, and a pause from the everyday rush of life. Indeed, as they engage in activities that threaten their physical health they also engage in an activity that is very healthy for their mental well-being.

This is potentially another area that requires further investigation both from a positive standpoint (designing healthy space for contemplative inquiry or reflection) and looking at negative impacts of our well-intentioned efforts to curb tobacco use. While the loss of potential smoking peers has been examined, I could not find any research that examines the loss of contemplative time and its impact on smokers who quit. Doing so firstly acknowledges that cigarette use has benefits, which is problematic for many in public health. It also means getting into a zone of complexity whereby we need to consider how something that is so demonstrably toxic to the human body and others around the smoker can have potentially positive effects in other ways.

From a design perspective, how might we apply the lessons from cigarette use to mental health promotion? How might we design programs, spaces, places, and social conventions that promote the quiet contemplative acts that smokers gain from taking that cigarette break and offer potentially great value to tobacco users without creating harmful effects for others? How can we promote the quitting of smoking without the loss of the contemplative benefits that come with the act of lighting up?

Engaging design, complexity and imagining the systems that influence them both might yield considerable insight into how we manage other public health problems and how we might better promote mental health in the protection of physical well-being.

Photo No Smoking Poster 1 by Sempliok used under Creative Commons License from Deviant Art.

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Social Media and Health: Leaders(hip) and Followers(hip)

Social media is finally catching on with healthcare, public health, and  health promotion. With a few recent articles published in the academic literature to rest on, academic health sciences has finally (and I might argue, begrudgingly) conceded that 900+ million users and $100B valuations (Facebook), and thousands of messages exchanged every milisecond (microblogs like Twitter and Sina Wiebo) might have some value for the public beyond entertainment.

If you note how long it took the health sector to start using the telephone as a serious means of engaging their patients or the public, this is lightning-quick adoption. Still, the barriers to adoption are high and the approach to using the technology is scattered. Indeed, just like the start of Internet-delivered telehealth (or cybermedicine (PDF), which has now evolved into eHealth), there is a mad rush to get liked, followed or some other metrics that most health professionals barely understand.

And that is part of the problem.

Meaningful Social Media Metrics

What is a meaningful metric for social media and health? A recently published article in Health Promotion Practice suggested four metrics that are taken from social marketing and applied to social media. These Key Performance Indicators (KPI’s) are:

  • Insights (consumer feedback)
  • Exposure (media impressions, visits, views, etc..)
  • Reach (# people who connect to the social media application)
  • Engagement (level of interaction with the content)

These are reasonable, but to to the uninitiated I would suggest a few words of caution and commentary to this list.

Firstly, the insights suggested by Neiger and colleagues “can be derived from practices such as sentiment analysis or data mining that uses algorithms to extract consumer attitudes and other perspectives on a particular topic” (p.162). While not incorrect, this makes the job sound relatively simple and it is not. Qualitative analysis + quantitative metrics such as those derived from data mining are key. Context counts immeasurably in social media use. It’s only in situations where social media is used as a broadcasting tool that gross measures of likes and sentiment analysis work with little qualification.

Even that is problematic. Counts of ‘likes’, ‘visits’, ‘follows’ and such are highly problematic and can be easily gamed. I am ‘followed’ on Twitter by people who have tens of thousands of followers, yet virtually no presence online. Most often they are from marketing fields where the standard practice is to always follow back those who follow you. Do this enough and pretty quickly you, too can have 23,000 followers and follow 20,000 more. This is meaningless from the perspective of developing relationships.

Engagement is the most meaningful of these metrics and the hardest to fully apply. This category gets us to consider the difference between “OMG! AWESOME!” and “That last post made me think of this situation [described here] and I suggest you read [reference] here for more” as comments. Without understanding the context in which these are made within the post, between posts (temporally and sequentially), and in relation to a larger social and informational context, simple text analysis won’t do.

Social Media Evidence: Problems and More Problems

One of the objections to the use of social media by some is that it is not evidence-based. To that extent I would largely agree that this is the case, but then we’ve been jumping out of airplanes with parachutes despite any randomized controlled trial to prove their worth.

Another article in Health Promotion Practice in 2011 highlights potential applications for social media and behaviour change without drawing on specific examples from the literature, but rather on theoretical and rhetorical arguments. An article published in the latest issue of Perspectives on Psychological Science highlights the current state of research on Facebook, which is timely given that its IPO is set for today. That review by Wilson and colleagues illustrates the largely descriptive nature of the field and offers some insight on to the motivation of Facebook users and their online activities, but rather little in what Facebook does to promote active change in individuals and communities when they leave the platform.

The answer to whether social media like platforms such as Facebook ‘work’ as methods of promoting change is simply: we don’t know.

Does social media provide support to people? Yes. Does it inform them? Yes to that too. Does that information produce something other than passive activity on the topic? We don’t know.

In order to answer these questions, health sciences professionals, evaluators, and tech developers need to consider not just followership, but leadership. In this respect, it means creating changes to the way we gather evidence, the tools and methods we use to analyse data, and the organizational structures necessary to support the kind of real-time, rapid cycle evaluation and developmental design work necessary to make programs and evidence relevant to a changing context.

As Facebook launches into its new role as a public company it is almost assured to be introducing new innovations at a rapid pace to ensure that investor expectations (which are enormous) are met. This means that today’s Facebook will not be next month’s. Having funding mechanisms, review and approval mechanisms, a staff trained and oriented to rapid response research, and an overall organizational support system for innovation is the key.

Right now, we are a long way from that. Hospitals are very large, risk averse organizations; public health units are not much different. They both operate in a command-and-control environment suited for complicated, not complex informational and social environments. Social media is largely within the latter.

Systems thinking, design thinking, developmental evaluation, creativity, networks and innovation: these are the keywords for health in the coming years. They are as author Eric Topol calls the dawning of the creative destruction of medicine.

The public is already using social media for health and now the time has come for health (care, promotion and protection) systems to get on board and make the changes necessary to join them.

knowledge translationscience & technologysocial systemssystems science

Have We Turned the Page on Social Science Research for Health?

Turning the Page on Social Science and Health Research

Over the last two weeks social science researchers across Canada began receiving the decisions from last autumn’s competition for a Social Science and Humanities Research Council (SSHRC) funding award. SSHRC is the principal funder of social science research in Canada, although notably is not in the business of funding heath-related research, which is supposed to be funded by the Canadian Institutes for Health Research (CIHR). [Full disclosure: I currently hold grants from both of these organizations]. The problem is that CIHR was born from a policy and programming body and the former Medical Research Council and has a rather awkward relationship with social science research given its medical focus. It has funded some social science programs, but not in a manner that has enabled social scientists to comfortably explore the range of issues that they might have under traditional SSHRC funding programs, particularly when social issues are not always obviously health issues (e.g., poverty, education) and can easily be dismissed as not being relevant in spite of the evidence that they are.  Yet, SSHRC has decided to forgo any funding of health-related projects due in part to the absence of funding to support it when there are presumably options through CIHR or the disease-specific health charities like the Canadian Cancer Society, the Lung Association and others.

Yet, these options are not suitable. In a manifesto entitled “The end of medical anthropology in Canada” a group of leading social scientists painted the picture of the situation in grim terms in University Affairs. Although medical anthropology is the focus of the piece, the authors might as well be speaking for social sciences in general:

Health is inherently social and cultural. SSHRC has always understood this; CIHR, we fear, does not. We face the possible extermination of one of the most vibrant, high-demand and policy-relevant health disciplines, the only scholarly field that places culture at the centre of the analysis of health and that characteristically does so in both national and international contexts. In a multicultural, settler society with a substantial aboriginal population, and in a world where health is at the core of developmental, political and social issues in so many countries, where Canada otherwise wishes to have an impact, does this make any sense?

This brings me back to the beginning of this post and the announcement of the results of the last competition. Looking at the funding numbers released by SSHRC, a discouraging picture emerges. In 2011-12, 37 per cent of all applications in the open competition were deemed fundable, yet only 22.5 per cent were funded. These numbers are similar t0 2010-11, when 36  per cent were deemed fundable and 22 per cent were funded. What is not mentioned in these numbers was the level at which these grants were funded in the first place. I am a 2010-11 recipient of funding from SSHRC — meaning my grant proposal was within the top 22 per cent of all applications for that year — and the amount I received was approximately half of what I requested. That means that I had to take half of my budget and throw it away. So yes, I was successful providing I did either half of the research or found money elsewhere. I did the latter and my pocketbook is none the better for it.

Consider the implications of this change in funding. With one in five projects funded and many of those that are funded at levels well below what was requested the motivation for researchers is one of the first casualties. Researchers know that funding is tight and that it is highly competitive, but few alternative sources for research grants that lay outside of specific disease-focused areas, social scientists young and old are faced with little option. This creates another set of affected parties: students and trainees. Research funding not only supports the scientists themselves in many cases (see my previous posts on this), but those seeking to become scientists themselves or those who seek to get better acquainted with research. In health sciences and policy, this means just about everyone enrolled in such programs.

Now consider all of this in light of a trend towards increasing graduate education numbers. At the academic institution I am affiliated with (like many of its peers), the enrolment numbers are set to nearly double across many of the professional programs associated with health practice and policy in the coming years. Increased demand for training opportunities from the public has created a means for universities to cash in. Of course, what these students will do when they get there is unclear (let alone when they graduate), but it cannot be much in the way of research — at least as it pertains to social science and health. The funding is simply not there to support the kind of broad-based inquiry into the social factors that influence health, illness and well-being anymore. We have, as I call it, reached ‘the Turn’.

The Turn is that point where the system changes irrevocably towards a new direction. It is like a ‘tipping point‘.  Dwindling numbers of social scientists working from funding from an institutional budget (e.g., tenure-stream faculty positions) + a doubling of the student cohort * half of the research dollars makes for rather toxic math. The Turn will fundamentally shape the way social science inquiry is done and the kind of questions that get asked. As question foci change, the quality of the research shifts, and the depth of inquiry is reduced, so too will the real impact that social science has on our health.

The gap between what we know, what we do, and what we can do to prevent illness, treat sickness, and promote well-being will grow.

Anecdotally speaking, this trend is not unique to the social sciences, but it is amplified in this domain. Social sciences in Canada and abroad are consistently funded at lower levels than that of basic research (see here for a starting point). But what is interesting is that many of the problems that we face within health require social science knowledge and research to address and social science — from knowledge translation, social network studies, technology adoption, innovation, management, to policy implementation and beyond .

Prevention of disease and chronic illness is often a social phenomenon (e.g., hand washing). Even the act of taking the best of basic science and translating it into practice or policy options (or other scientific research) is a social act that draws on social science research to execute. Social determinants of health are social in nature and require social science to understand their impact. Designing the policy and programmatic interventions that support creating a healthier society also falls to social science research and practice.

What will our health landscape look like without the ability to take what we know and translate it into action? Worse yet, what if we simply are unable to even know what to do because the research and evidence isn’t there in the first place to translate into anything? Without another turn towards something more positive in our research support, we are about to find out.

* Photo Turn the Page by Miaboas used under Creative Commons License from Deviant Art.