Tag: health

public healthstrategic foresight

Futuring the Past

on February 7, 2019
Flat Earth to Measles: Did We See That Coming?
In the first month of 2019 the United States saw more measles cases than it did in all of 2010. This disease of the past was once on its way to extinction (or deep hibernation) is now a current public health threat, which prompts us to think: how can our futuring better consider what we came from not just what it might lead to?

Measles was something that my parents worried about for me and my brothers more than forty years ago. Measles is one of those diseases that causes enormous problems that are both obvious and also difficult to see until they manifest themselves down the road. Encephalitis and diarrhea are two possible short-term effects, while a compromised immune system down the road is some of the longer-term effects. It’s a horrible condition, one of the most infectious diseases we know of, and also one that was once considered to be ‘eliminated’ from the United States,Canada and most of the Americas (which means existing in such small numbers as not worthy of large-scale monitoring).

In the first month of 2019 there have been more measles cases tracked than all of 2010. The causes of this are many, but largely attributable to a change in vaccination rates among the public. The fewer people who get vaccinated, the more likely the disease will find a way to take hold in the population — first of those who aren’t protected, but over time this will include some of those who are because of the ‘herd protection’ nature of how vaccination works.

Did We See That Coming?

Measles hasn’t featured prominently in any of the foresight models of the health system that I’ve seen over the course of my career. Then again, twenty-five years ago, it would have been unlikely that any foresight model of urban planning would have emphasized scooters or bicycles — old technologies — over the automobile as modes of transportation likely to shape our cities. Yet, here we are.

Today, those interested in the future of transportation are focused on autonomous cars, yet there is some speculation that the car — or at least the one we know now — will disappear altogether. Manufacturers like Ford — the company that invented the mass-market automobile — have already decided they will abandon most of their automobile production in the next few years.

The hottest TV show (or rather, streamed media production) among those under the age of 20? Friends (circa 1994).

Are you seeing a trend here?

What we are seeing is a resurgence of the past in pockets all throughout our society. The implications of this are many for those who develop or rely on futurist-oriented models to shape their work.

One might argue that a good model of the future always assumes this and therefore it isn’t a flaw of the model, but rather that, as William Gibson was quoted as suggesting: the future is here, it’s just not evenly distributed yet. The Three Horizon Framework popularized by McKinsey has this assumption built into it from the beginning. But it’s not just the model that might be problematic, but the thinking behind it.

Self-Fulfilling Futures

Foresight is useful for a number of things, but I would argue very little of that benefit is what many futurists claim. The arguments for investing in foresight is that, by thinking about what the future could bring we can better prepare ourselves for that reality in our organizations. This might mean identifying different product lines, keeping an eye out for trends that match our predictions, improving our innovation systems and “the impact of decision-making“.

Why is the case? The answer — as I’ve been told by foresight and futurist colleagues — is that by seeing what is coming we can prepare for it, much like a weather forecast allows us to dress appropriately for the day to account for the possibility of rain or snow.

The critique I have with this line of thinking is that: do we ever go back and see where our models fit and didn’t fit? Are foresight models open to evaluation? I would argue: no. There is no systematic evaluation of foresight initiatives. This is not to suggest that evaluation needs to concern itself with whether a model gets everything right — that the future turns out just as we anticipated — but whether it was actually useful.

Did we make a better decision because we saw a possible future? Did we restructure our organization to achieve something that would have been impossible had we not had the strategic foresight to guide us? These are the claims and yet we do not have evidence to support it. Such little evaluation of these models has left us open to clinging to myths and also to an absence of critical reflection on what use these models have (and also a wasted opportunity to consider what use they could have).

Yes, the case of Royal Dutch Shell and its ability to envision problems with the global oil supply chain in the late 1960’s and early 70’s through adopting a foresight approach gave them a step up on their competitors. But how many other cases of this nature are there? Where is the evidence that this approach does what it’s proponents claim it does? With foresight being adopted across industries we should have many examples of its impact, but we do not.

Layering Influence and Impact

Let’s bring it back to public health. There is enormous evidence to point to the role of tobacco use and lifetime prevalence of a litany of health problems like cancer and cardiovascular disease, yet there are still millions who use tobacco daily. Lack of retirement savings is a clear pathway to significant problems for health, wellbeing, and lifestyle down the road. The effects of human behaviour on the environment and our health have been known for decades (or millennia, depending on your perspective) to the point where we are now referring to this stage of planetary evolution as the Anthropocene (the age where humans influence the planet).

We can see things coming in various degrees of focus and yet the influence on our behaviour is not certain. Indeed, the anticipation of future consequences is only one element of a large array of factors that influence our behaviour. Psychologists, the group that studies and support the evidence for behaviour change, have shown that we are actually pretty bad at predicting what will happen, how we will react to something, and what will influence change.

Many of these factors are systemic — that is tied to the systems we are a part of. This is our team, family, organization, community, and society, and time — the various spheres outlined in Bronfenbrenner’s Social-Ecological Model. This model outlines the various ‘rings’ or spheres that influence us, including time (which encompasses them all). It’s this last ring that we often forget. This model can be useful because it showcases layers of impact and influence, including from our past.

Decision Making in the Past

By anchoring ourselves to the future and not considering our past, our models for prediction, forecasting, and foresighting are limited. We are equally limited when we use the same form of thinking (about the future) to make our models about the past. In this case, I think of Andrew Yang who recently spoke to the Freakonomics podcast and pointed out how our economic thinking is rooted in past models that we would never accept today. He’s wrong — sort of. We do accept this and it is alive and well in many of our ways of thinking about the future.

In speaking about how we’ve been through economic patterns of disruption, he points out that we are using an old fact pattern to inform what we do now as if the economy — which we invented just a few hundred years ago — has these immutable laws.


The fantasists — and they are so lazy and it makes me so angry, because people who are otherwise educated literally wave their hands and are like, “Industrial Revolution, 120 years ago. Been through it before,” and, man, if someone came into your office and pitched you an investment in a company based on a fact pattern from 120 years ago, you’d freakin’ throw them out of your office so fast.

Andrew Yang, speaking on Freakonomics

Foresight would benefit from the same kind of critical examination of itself as Yang does with the economy and our ways of thinking about it. That critical examination includes using real evidence to make decisions where we have it and where we don’t have it – we establish it.

Maybe then, we might anticipate that measles are not gone. Let’s keep our eye out on polio, too. And as for a flat earth? Don’t sail too far into the sunset as you might fall off if we don’t factor that into our models of the future.

Image Credit: “Flat Earth | Conspiracy Theory VOL.1” by Daniel Beintner is licensed under CC BY-NC-ND 4.0. To view a copy of this license, visit: https://creativecommons.org/licenses/by-nc-nd/4.0

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.

 

 

 

complexityeducation & learningemergenceevaluationsystems thinking

Developmental Evaluation and Mindfulness

on January 20, 2014

Mindfulness in Motion

Mindfulness in Motion?

Developmental evaluation is focused on real-time decision making for programs operating in complex, changing conditions, which can tax the attentional capacity of program staff and evaluators. Organizational mindfulness is a means of paying attention to what matters and building the capacity across the organization to better filter signals from noise.

Mindfulness is a means of introducing quiet to noisy environments; the kind that are often the focus of developmental evaluations. Like the image above, mindfulness involves remaining calm and centered while everything else is growing, crumbling and (perhaps) disembodied from all that is around it.

Mindfulness in Organizations and Evaluation

Mindfulness is the disciplined practice of paying attention. Bishop and colleagues (2004 – PDF), working in the clinical context, developed a two-component definition of mindfulness that focuses on 1) self-regulation of attention that is maintained on the immediate experience to enable pattern recognition (enhanced metacognition) and 2) an orientation to experience that is committed to and maintains an attitude of curiosity and openness to the present moment.

Mindfulness does not exist independent of the past, rather it takes account of present actions in light of a path to the current context. As simple as it may sound, mindfulness is anything but easy, especially in complex settings with high levels of information sources. What this means for developmental evaluation is that there needs to be a method of capturing data relevant to the present moment, a sensemaking capacity to understand how that data fits within the overall context and system of the program, and a strategy for provoking curiosity about the data to shape innovation. Without attention, sensemaking or interest in exploring the data to innovate there is little likelihood that there will be much change, which is what design (the next step in DE) is all about.

Organizational mindfulness is a quality of social innovation that situates the organization’s activities within a larger strategic frame that developmental evaluation supports. A mindful organization is grounded in a set of beliefs that guide its actions as lived through practice. Without some guiding, grounded models for action an organization can go anywhere and the data collected from a developmental evaluation has little context as nearly anything can develop from that data, yet organizations don’t want anything. They want the solutions that are best optimized for the current context.

Mindfulness for Innovation in Systems

Karl Weick has observed that high-reliability organizations are the way they are because of a mindful orientation. Weick and Karen Sutcliffe explored the concept of organizational mindfulness in greater detail and made the connection to systems thinking, by emphasizing how a mindful orientation opens up the perceptual capabilities of an organization to see their systems differently. They describe a mindful orientation as one that redirects attention from the expected to the unexpected, challenges what is comfortable, consistent, desired and agreed to the areas that challenge all of that.

Weick and Sutcliffe suggest that organizational mindfulness has five core dimensions:

  1. Reluctance to simplify
  2. Sensitivity to operations
  3. Commitment to resilience
  4. Deference to expertise
  5. Preoccupation with failure

Ray, Baker and Plowman (2011) looked at how these qualities were represented in U.S. business schools, finding that there was some evidence for their existence. However, this mindful orientation is still something novel and its overlap with innovation output, unverified. (This is also true for developmental evaluation itself with few published studies illustrating that the fundamentals of developmental evaluation are applied). Vogus and Sutcliffe (2012) took this further and encouraged more research and development in this area in part because of the lack of detailed study of how it works in practice, partly due to an absence of organizational commitment to discovery and change instead of just existing modes of thinking. 

Among the principal reasons for a lack of evidence is that organizational mindfulness requires a substantive re-orientation towards developmental processes that include both evaluation and design. For all of the talk about learning organizations in industry, health, education and social services we see relatively few concrete examples of it in action. A mistake that many evaluators and program planners make is the assumption that the foundations for learning, attention and strategy are all in place before launching a developmental evaluation, which is very often not the case. Just as we do evaluability assessments to see if a program is ready for an evaluation we may wish to consider organizational mindfulness assessments to explore how ready an organization is to engage in a true developmental evaluation. 

Cultivating curiosity

What Weick and Sutcliffe’s five-factor model on organizational mindfulness misses is the second part of the definition of mindfulness introduced at the beginning of this post; the part about curiosity. And while Weick and Sutcliffe speak about the challenging of assumptions in organizational mindfulness, these challenges aren’t well reflected in the model.

Curiosity is a fundamental quality of mindfulness that is often overlooked (not just in organizational contexts). Arthur Zajonc, a physicist, educator and President of the Mind and Life Institute, writes and speaks about contemplative inquiry as a process of employing mindfulness for discovery about the world around us.Zajonc is a scientist and is motivated partly by a love and curiosity of both the inner and outer worlds we inhabit. His mindset — reflective of contemplative inquiry itself — is about an open and focused attention simultaneously.

Openness to new information and experience is one part, while the focus comes from experience and the need to draw in information to clarify intention and actions is the second. These are the same kind of patterns of movement that we see in complex systems (see the stitch image below) and is captured in the sensing-divergent-convergent model of design that is evident in the CENSE Research + Design Innovation arrow model below that.

Stitch of Complexity

Stitch of Complexity

CENSE Corkscrew Innovation Discovery Arrow

CENSE Corkscrew Innovation Discovery Arrow

By being better attuned to the systems (big and small) around us and curiously asking questions about it, we may find that the assumptions we hold are untrue or incomplete. By contemplating fully the moment-by-moment experience of our systems, patterns emerge that are often too weak to notice, but that may drive behaviour in a complex system. This emergence of weak signals is often what shifts systems.

Sensemaking, which we discussed in a previous post in this series, is a means of taking this information and using it to understand the system and the implications of these signals.

For organizations and evaluators the next step is determining whether or not they are willing (and capable) of doing something with the findings from this discovery and learning from a developmental evaluation, which will be covered in the next post in this series that looks at design.

References and Further Reading: 

Bishop, S. R., Lau, M., Shapiro, S., & Carlson, L. (2004). Mindfulness: A Proposed Operational Definition. Clinical Psychology: Science and Practice, 11(N3), 230–241.

Ray, J. L., Baker, L. T., & Plowman, D. A. (2011). Organizational mindfulness in business schools. Academy of Management Learning & Education, 10(2), 188–203.

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.

Weick, K. E., Sutcliffe, K. M., Obstfeld, D., & Wieck, K. E. (1999). Organizing for high reliability: processes of collective mindfulness. In R. S. Sutton & B. M. Staw (Eds.), Research in Organizational Behavior (Vol. 1, pp. 81–123). Stanford, CA: Jai Press.

Weick, K.E. & Sutcliffe, K.M. (2007). Managing the unexpected. San Francisco, CA: Jossey-Bass.

Zajonc, A. (2009). Meditation as contemplative inquiry: When knowing becomes love. Barrington, MA: Lindisfarne Books.

psychologypublic healthresearch

Designing for Empathy and Health

on July 29, 2013

Transparent Contemplation

Seeing Inside Others

When does common sense make little sense? How do we sense-make evidence when it seems to make little sense? The answers could lie in getting inside the heads of those we seek to influence and designing our communications for empathy and health.

Evidence in public / health

Last week there was a brief uproar in the mainstream media and on Twitter created by a tweet from Toronto Public Health to their Twitter followers suggesting they contact the producers of the TV show The View and protest their recent hiring of Jenny McCarthy a a co-host. Ms McCarthy is an outspoken critic of childhood vaccinations in spite of overwhelming evidence to show that they generate enormous benefits over the relative and small risk for many conditions and for promoting the falsified science used to prop up the myths that they cause autism (which is her primary concern).

That post led to much discussion, including posts on Censemaking and the Public Health and Social Media blog (reposted here) and Twitter on the challenges of communicating evidence, engaging the public, and the role of public health in these conversations. Watching comedy duo Penn & Teller offer a humourous if angry take on evidence for vaccinations and health might make the risks and benefits obvious, yet this isn’t the case. Why?

It turns out, that some of these supposed obvious connections still don’t impact those who support the anti-vaccination movement. Indeed, evidence from Australian researchers shows that engaging these audiences does relatively little to influence their behaviour. To some, they may be immune to the evidence (pardon the pun).

In a qualitative study of parents on their pro and anti-vaccination beliefs, the authors found a complex mix of beliefs that governed how information was received and processed. For example, expectations of guilt at the thought that a child would fall ill because of something that could have been prevented due to a vaccine or conversely due to a vaccine side-effect were prominent in the findings.

What arose in the dialogue arising from the Jenny McCarthy / Toronto Public Health flurry was familiar territory: health professionals using the moment to logically persuade the public to choose vaccination, hand-wringing over why people fail to believe evidence or why they believe celebrities, the awful use or mis-use of evidence in the media, and gasps of collective frustration at how out of sync public health is in its engagement with the public on these issues.

What was missing was empathy.

Stories trump evidence

The above quote has been uttered many times in public health circles when the use of evidence in health communication emerges in conversation. Journalists know this and that is why they tell stories in their reportage and not “just the facts”. All one needs is a story about the human experience on one side of an argument and all the evidence to suggest it is an anomaly or rare event gets covered over. It’s why we bristle at news stories of violent crimes  and fear for our safety despite wildly declining crime rates throughout countries in the ‘developed’ world.

A Problem of Perspective

Public health professionals — indeed all of us in any field — need to get out more. It’s easy to scoff at the ignorance of people when you have an advanced degree, spend great amounts of time contemplating or generating evidence, see the health effects of faulty reasoning firsthand, and associate with many others who share the same view. It’s obvious what the right course of action is.

But obvious is a matter of perspective. Health professionals tend to design their materials for themselves. Looking at much of what is developed for health promotion and communication with the public, we might make some assumptions:

  1. People are able to read and understand health related materials (and they like to read in the first place)
  2. They like printed materials and learn best from text
  3. They trust scientists, physicians and health professionals for information on health issues above all
  4. Health is something they think about a lot and always want to learn more about issues
  5. The public is invested in carefully weighing evidence claims to make the right choice
  6. Health behaviour change is a linear, knowledge-driven process

There are more, but let’s examine these briefly. I am not going to dive deeply into the evidence for each of these points (that is for another day) rather ask you to consider how true these are in your observations.

I Want to Believe

These are all assumptions and mostly based on a rational, linear model of decision making and behaviour. They are based on a model that correlates knowledge, expertise and authority and assumes that people respond to such authority. It emphasizes the use of media that is appropriate (and historically priviliged) for academic and technical communications, not public consumption.

On that last point, many educated professionals — particularly academics — are shocked to find people that neither need or want to read. Yet, we propel print materials and websites at people in text form to audiences that we imagine value the same things.

When you study health for a living or treat people with health problems you spend your entire day thinking about health. It may come as a surprise to realize that many others don’t really care much about their health until it’s compromised. They aren’t constantly mired in decisions about evidence, long-term implications of daily decisions, or the social determinants of their wellbeing. Health is just another thing to think about among many.

If we are to be better at communicating with our audiences, we need to empathize more and design our messages, media and services in ways that reflect the reality they perceive and the one they live in knowing that might not be the same thing and nor is it necessarily the same one we live in and perceive.

It also means confronting some big questions about what we are doing in the first place.

What is the destination and the journey we wish to take with the public? Do they want to take it with us in the first place? And if not, what might we do to inspire people to want what we have to offer — and do so in a manner that promotes what they want to accomplish, not just what we want them to.

This avoids us taking the approach to dealing with people who don’t speak our language by talking slower and louder as if they are deaf and stupid rather than unfamiliar with our native tongue.

This is the realm of design and empathic design thinking about communications and perhaps its time to start bringing more of it into our work. Maybe then we might not be so surprised when the obvious answers are no longer so.

Photos: Cameron Norman, Joe Ross (used under Creative Commons License via Flickr)

complexityinnovationpublic healthsystems sciencesystems thinking

Handbook of Systems and Complexity in Health

on January 16, 2013

Handbook of Systems and Complexity in Health

Handbook of Systems and Complexity in Health

A brilliant and comprehensive new book has been launched that brings together the best scholars working in the area of systems thinking and complexity and applying it to health.

The book description can be found here along with a link to the abstract for a chapter I co-authored with Andrea Yip looking at the overlap between design thinking and systems science and complexity. This chapter takes a design lens on previous work developing the CoNEKTR model for engagement in complexity and health.

It’s a big book, but well worth a look if you’re wrestling with complexity and systems thinking in health and social innovation.

complexitysystems thinking

Marketing the Narrative of Complexity

on July 6, 2012

Sunset 2007-1Complexity, by its very nature, is not a simple concept to communicate, yet it is increasingly becoming one that will define our times and may be the key to ensuring human survival and wellbeing in the years to come. If society is to respond to complex challenges the meaning of complexity needs to be communicated to the world in a manner that is understandable to a wide audience. This is the first in a series of posts that are looking at the concept of complexity and the challenges and opportunities with marketing it to the world.

Across North America this week the temperatures are vastly exceeding normal levels into ranges more akin to places like India or East Africa. The climate is changing and regardless of what the causes are the complexities that this introduces require changes in our thinking and actions or human health and wellbeing will be at risk. To follow Einstein’s famous quote:

“We can’t solve problems by using the same kind of thinking we used when we created them”

Many U.S. States are suffering hurricane-like after-effects from a Derecho that hit last week, knocking out power at a time when temperatures are into the high 90’s and low 100’s. Derechos are rapid moving hot air systems that are difficult to predict and can only be anticipated under certain conditions. The heat wave combined with the lack of air conditioning and supplies left 13 dead, maybe more. The heat wave is continuing and is expected to last throughout the weekend.

But this post is not really about the weather, but the challenges with complexity that it represents and how we need to be better understanding what complexity is and how to work with it if we are to survive and thrive in the years to come.

Blog interrupted

It’s ironic that this post was delayed by blackout. I live in Toronto, Canada and we have a remarkably stable power supply, yet last night and through this morning I was without power  due to suspected overheated circuits attributed to high air conditioning use, shutting down my Internet and everything else with it. In many parts of the world, this kind of blackout is commonplace and a fact of daily living, but not here…yet. This fortuitous bit of timing illustrates the fragility of many of our systems given the reliance on power to fuel much of what we do (e.g., cooking, food storage, Internet, traffic signals, lighting, etc..).

Virtually all of the infrastructure of modern life (here and increasingly globally) is tied to electricity. If you’re interested in imagining what would happen if it all shuts off, I’d highly recommend reading The World Without Us by Alan Weisman. Weisman uses a complexity scientist and futurists’ tool called a thought experiment to craft a book about what New York City would look like if humans suddenly disappeared. The book illustrates how nature might take over, how the underground subways would flood and collapse because of the millions of litres of water needed to be pumped out of it each day, and how certain human-built structures would decay over time (some far faster than we might hope).

Thought experiments take data from things that have happened already, theories, and conjecture and project scenarios into the future based on the amalgam of these. It provides some grounded means of anticipating possible futures to guide present action.

From present delays to future/tense

The Guardian asked a number of scientists working on climate about whether this current spate of extreme weather events is attributable to global warming. The scientists offered a range of answers that (not surprisingly) lacked a definitive statement around cause-and-effect, yet the comments hint at a deep concern. These anomalous conditions are starting to move further towards the end of the normal curve, meaning that they are becoming less statistically plausible to be caused by chance. What this means for the weather, for climate, for our economies is not known; all we have is thought experiments and scenarios. But the future is coming and we may want to be prepared by helping create one we want, not just one we get.

Unfortunately, we cannot wait for the data to confirm that global warming is happening or determine that we are contributing to it and to what degree. This is not just a weather issue; the same situation is playing itself out with issues worldwide ranging from healthcare funding to immigration policies and migration patterns. Interconnected, interdependent and diverse agents and information forms are interacting to create, emergent patterns of activity.

It is for this reason that weather patterns — despite being one of the most monitored and studied phenomenon — can’t be accurately predicted outside of a few hours in advance, if at all. There is too much information coming together between air flows, humidity, land forms, physical structure and human intervention (e.g., airplane contrails) interacting simultaneously in a dynamic manner to create a reliable model of the data. David Orrell’s book Apollo’s Arrow is a terrific read if you want to understand complexity in relation to weather (and more) or see his talk at TEDX on YouTube.

Two’s company, three’s complexity (and other analogies)

The above heading is taken from a title of another book on complexity and tries to simply point to how adding just a little bit of information (another person to a conversation perhaps) can radically alter the experience from being simple or complicated to complex. Just thinking about planning a night out with two people vs. three and you’ll know a little of what this means.

Analogies and metaphors are ways in which complexity scholars commonly seek to convey how the differences in conditions represent varying states of order. Brenda Zimmerman and others write about putting a rocket to the moon as being complicated and raising a child as being complex. One of my favourites is Dave Snowden‘s video on How to Organize a Children’s Party. One of the reasons we resort to analogies is that we need a narrative that fits with their experience. All of us were children and some of us have had them as parents so we can relate to Zimmerman and Snowden’s ideas because we’ve experienced it firsthand.

We haven’t experienced anything like what is anticipated from global warming. In the Americas, parts of Europe and Asia we are enormously fortunate to have entire generations that don’t know what it’s like to be hungry, have no healthcare, be without electricity, or have no access to safe water and proper sanitations. Stories about children’s parties might not bring these scenarios home. It is why Weisman’s book is so clever: it makes a plausible scenario fiction.

Science fact as science fiction

The role of fiction might be the key to opening the marketing vault to complexity. Scott Smith and others have been exploring how the use of science fiction helped pave the way for some of today’s modern technologies and innovations. By weaving together fantasy narratives and imaginations on the future, technologists have managed to re-create these tools for current life. Witness the Tricorder Project that seeks to develop the same multifunction health and information tool used by Dr. McCoy on Star Trek.

We are making headway with complex information as witnessed by the popularity of infographics and data visualizations. But there is much more to be done.

Complex problems require complex solutions. Artists, designers, scientists, marketers, journalists and anyone who can communicate well can play a role. Making complexity something that people not only know about, but want to know about is the task at hand. In doing so, we may find people reaching for and advocating for complex solutions rather than stop-gap, band-aid ones like buying a car with better fuel economy as the main strategy to combat carbon emissions.

It’s been done before. Marshall McLuhan wrote about esoteric, yet remarkably insightful and complex topics and became a household name in part to his appearance in Woody Allen‘s Annie Hall. Our media landscape is far more complex now (no pun intended) to think that a single appearance of any complexity superstar (if one existed) would change public perception of the topic in the same way that McLuhan’s did for his theories on media. Yet, Al Gore’s An Inconvenient Truth might have done more to get people talking about the environment than anything. And while Gore is not known for his witty storytelling, his slide show did a good job.

To begin our journey of marketing complexity we need to come up with our stories so that we can tell ones that are pleasant, rather than the ones that are less so. And if you want one that fits this latter category, I strongly recommend reading Gwynn Dyer’s chilling Climate Wars. Instead, let’s get closer to living what Peter Diamandis and Steven Kotler write about in Abundance.

The future is ours to write.

For more books and resources on complexity, check out the library page on Censemaking.

behaviour changeeHealthhealth promotioninnovationpublic health

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

on May 18, 2012

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.

1 2 3 … 5