Tag: information technology

art & designcomplexityinnovationsocial innovationsystems science

Seeking simplicity among complexity? Go Dutch!


In a world awash in content and the resulting complexity that comes when it all intersects the viable options for how to manage it remain few. The Dutch De Stijl art and design movement might offer some lessons on dealing with complexity that we can apply beyond products to creating beautiful, functional, and effective services, settings and policy options.

Are you informed about the world? Chances are the answer to that question is both no and yes. There’s no question that you’re informed, the question might be more on what you’re informed about, to what extent, whether that’s of your interest (and relevance and need) and whether it’s an accurate (and useful) depiction of the world around you. That’s a much more complicated set of questions with a troubling set of answers. But one group (the Dutch) may have found some solutions… but we’ll get to that in a moment.

First let’s look at what we’re up against: data streams of distraction.

Data streams of distraction

Consider the many information sources we’re presented with daily.

Consider mine in no particular order, starting with digital : Email (multiple accounts), two course management portals, Instagram, Twitter (two accounts), LinkedIn, Facebook, Facebook Messenger, Whats App, comments on my website or Facebook company page, about 2 dozen apps (on my iPhone and iPad), myriad websites I visit, text messages and, oh yes, occasionally the phone will ring. Next, there’s physical magazines, books, radio or music streams and television, too. Looking out my window I see cranes and buildings and billboards from my downtown loft apartment (and hear birds singing, above it all).

I also encounter real-life human beings, too and they have things to share and more information for me. Funny, that.

This is based on what I choose to look at (even if some choices are rather constrained, such as knowing there is only one way to reach someone and that means engaging with a particular media form I intensely dislike — I’m talking about you, Facebook). Travelling through my day, others will approach and engage, I’ll encounter new things that present themselves and will be handed, shown, flashed or spoken to plenty of other information. The volume of information keeps growing with every encounter.

Then there’s the information stored in memory, the remnants of all of those other days, experiences, and a lifetime of events and information.

This will all happen in real-time, refer to present situations, the past, many possible futures, contain truths, lies, myths and be incomplete in parts all over. It is, in short, a perfect representation of complexity. And it’s causing us a lot of problems.

Information overload

The term ‘information(al) overload’ has been coined to describe the exposure to too much information or data. Information overload and the design problems that information abundance provides has contributed to . Engineers, the builders of much of our critical infrastructure (including, ironically, information technology), know this firsthand and are growing in their concern over how they see that influencing their work. In 2012 the IEEE published a book (PDF) that looked deeply at the role of information overload where the authors note that information overload is not just when people seek new information, but when it information searches for them. The authors argue that:

Information overload “places knowledge workers and managers worldwide in a chronic state of mental overload. It exacts a massive toll on employee productivity and causes significant personal harm, while organizations ultimately pay the price with extensive financial loss”

Annual Reviews, an academic publisher of multidisciplinary research, was motivated to write a piece on information overload in their industry (PDF), noting the present problem is partly one of removing intermediaries:

“…the removal of the intermediary (typically the librarian, but sometimes the publisher) from the information seeking chain…means we are all librarians now, and have to behave like them—constantly reviewing and validating data.”

That takes a lot of work. Both of these works are from 2011-2012 and since then the continued expansion of broadband and mobile technologies, facilitated by cameras and cheaper access to technology, has only added to the amount of information available. The content generation capacity of the public has increased, the consequences are no different, and the solutions fewer.

Perversely, one of the strategies we use to battle overload is to throw more content at the problem as Tom Fishburne shows in this cartoon. We create greater complexity by adding more complexity.  This is the tension. We want to add more information to clarify, rather than strip it away, and end up doing the opposite.

Yet, there may be hope and it is rooted in pragmatism and a desire for beauty: the Dutch design movement, De Stijl.

Designing away complexity: going Dutch


To the untrained eye (which, until a few weeks ago, was mine until I met Corrie van Walraven) the image above would suggest a modern styled home built in the last 20 or 30 years.  Rietveld Schröder House, pictured, was actually built in 1924 and reflects a Dutch design ethos that’s continued through to today of keeping things clean, organized, efficient, flexible, and beautiful.

By many standards the Netherlands has shown itself to be an expert in complexity. Holland is among the most densely populated countries in the world, manages to grow food, survive and thrive in a physical environment that shouldn’t even exist (it is, after all , situated mostly under water). They’ve become masters of adaptation, because they’ve had to be. Dutch design reflects much of this and De Stijl is a perfect example.

Though Dutch design has had many facets and movements De Stijl remains popular partly because of it’s ability to create simplicity amid complexity while creating beauty. Beauty in a designed artifact means it has an evident function, but also elicits a positive aesthetic experience. As Steven de Groot’s research has shown, beauty does not only have intrinsically attractive qualities, but its presence in organizations can lead to higher productivity, employee retention and satisfaction, and overall institutional effectiveness.

Beauty provides an experience of positivity, generally free from confusion, and often clarity. It is lack of clarity and the presence of confusion that is what complexity often brings. Anything that can increase the first and reduce the second while remaining adaptive to the realities of complexity (e.g., information seeking you out) and the data stream is something worth paying attention to; that’s where De Stijl and examples like the Rietveld Schröder House provide guidance.

The house, pictured above, was designed to create a fluid, adaptive space that could configure to a variety of situations and evolve over time. It deals with the amount of content — people, furniture — adaptively, within the boundaries of its walls, in ways that preserve form and function, yet do not get bound too tightly to any particular model. Another distinction is that it is designed to provide the least distinction between the indoor and outdoor spaces. Thus, the design feels somewhat less visible through its simplicity.

Coherence within boundaries

What the De Stijl movement does well is integrate complex ideas together, beautifully, and subscribing to a design philosophy that mirrors Dieter Rams’ belief that we should design as little as possible. De Stijl is about creating coherence – beneficial coherence in complexity terms — within boundaries. It’s work doesn’t seek to integrate the outside and inside (indeed, the criticism of the Rietveld Schröder House is that it doesn’t integrate well within the neighbourhood), but it does exceptionally well within the boundaries of its walls.

What we can take from this is the emphasis on internal coherence within our informational and organizational spaces, because those are the areas we can place boundaries. Systems thinking is all about boundary setting otherwise the focus becomes incoherent. This means being deliberate about where we set up our personal boundaries, professional boundaries and learning boundaries, but in keeping with De Stijl, keeping those flexible and adaptive and always moving, yet in a system that strives for coherence. One of the reasons information overload happens is because we have too much to create coherence with and because we’ve lost what our intention was with the information in the first place.

So a takeaway is this: be intentional about what you’re looking for and what you use. Be mindful of the things that give you coherence in your work and life and create a learning space where you can adapt. Strategy and purpose can help determine this — connect to this. Use the principles of Dutch design through De Stijl to design the conditions that support meaning making.

And if you want a great example in the personal realm, check out another creative thinker with Dutch lineage, Leisse Wilcox, on how self-love through better personal, environmental and social design (my word, not hers) can make you a happier person. That might be the best design you can create of them all.

Acknowledgements: A big thank you to Corrie van Walraven for sharing with me a piece on the De Stijl movement that inspired this post. Corrie’s a great representative of how wonderful the Dutch are and her generosity of spirit and great job as a host is greatly appreciated.

Image Credits: Author and Rietveld Schröder House by frm_tokyo used under Creative Commons License via Flickr.

knowledge translationsocial systemssystems thinking

When More is Less: The Information Paradox


There is a point at which information ceases to increase knowledge and understand and begins to undermine it, creating a paradox. When information on nearly anything is more abundant than ever the choices we make about how to engage it become more important than ever. 

The Information Age has been described as the period where industrial production was replaced by knowledge production as the key driver of social and economic benefit for society. Underpinning the thinking behind the information age (and the digital revolution that accompanies it) is that having more information, more access to it and improved tools to use it to solve problems will improve life for everyone. Presented with a choice to have access to more information or less people will almost always choose more.

More information leads to more options, which equals more choice and more choice is about freedom and that is seen as an inherent social good derived from the capitalist system, which further leads to better choices, more freedom and greater happiness overall. At least, this is what we’ve been led to believe and Barry Schwartz explains this quite eloquently in the opening of talk embedded later in this post.

This is the theory of change that underpins information theory as its played out in modern capitalist societies. It’s also the source of many of our modern paradoxes and problems.

Systems of influence: The case of the ePatient

I’ve stopped going to health-related hackathons and design jams altogether for the simple reason that one can almost always guarantee that one third or more of the solutions generated will be some form of app or information-focused tool. These well-meaning, creative tools are part of a consumer health movement that is all about putting information in the hands of patients with the idea that putting information in the hands of patients is the key to empowerment and better health outcomes, except they rarely lead to this promised land.

Few are better at explaining — and indeed living — this reality than Dave deBronkart or ‘e-Patient Dave’ who has been a tireless advocate for better information tools, access and engagement on health for patients. His Ted Talk captures the spirit of the movement nicely.

With all due respect to the positive sentiments around what the ePatient movement is about, it is based on a series of assumptions about health systems, patients and health itself in ways that don’t always hold. For certain patients, certain conditions, and certain contexts having more information delivered in the right format is indeed empowering and may be life saving as deBronkart’s story illustrates. But what’s often missing from these stories of success are the many layers of assumptions and conditions that underpin information-driven healthcare.

A few years ago I interviewed a patient who spoke about his experience with health care decision-making and information technology and his response was that having more information didn’t make his life much better, rather it made it even more complicated because with more access to more information he had more responsibility related to that information.

“I don’t know what to do with it all and there’s an assumption that once I know (this health information) I am in a position to do something. I don’t have the foggiest idea what to do, that’s why I am going to see (the health professionals) because that is what their job is for. They are the ones who are supposed to know what is to be done. It’s their world, not mine.”

This case is less about deferral to authority, but about resources (e.g., knowledge, skill, time, networks, etc..) and expectations around what comes with those resources. When you are unwell the last thing you want is to be told you have even more work to do.

The assumptions around personal health information and decision-making are that people have:

1) access to the data in the first place, 2) time, 3) information gathering tools, 4) knowledge synthesis tools, 5) skill and knowledge of how to sift, sort, synthesize and sense-make all the information obtained (because it may be in different formats, incomplete, or require conversions), 6) access to the people and other knowledge and skills required to appropriately sense-make the data, 7) the resources to act on whatever conclusions are drawn from that process, 8) a system that is able to respond to the actions that are needed and taken (and in a timely manner), 9) the personal willpower, energy, and resolve to persist through the various challenges and pushback from the system to resist the actions taken, 10) social support (because this is virtually impossible to do without any support at all) and 11) the motivation and interest in doing all of this in the first place.

Dave deBronkart and his peers are advocating for patient engagement on a broader level and that includes creating spaces for patients to have the choice as to what kind of information they use or not. This also means having choice to NOT have information. It’s not about technology pushing, but having a choice about what to access, when and how. That’s noble and often helpful to those who are used to not having much say in what happens, but that, too has problems of its own.

The paradox of choice

Barry Schwartz’s work (pdf) doing and synthesizing research on consumer decision-making puts truth to this lie that more choice is better. Choice options add value only to a certain point after which they degrade value and even subvert it altogether. The problem is that choice options are often ‘all or nothing’ and may be addictive if left unconstrained as we’ll see below.

Schwartz addresses the matter of decision-making in healthcare in the above video and points to the shifting of responsibility away from experts to everyone. Perhaps it is not surprising that we are seeing an incredible backlash against expert-driven knowledge and science in a way that we’ve not seen in over a hundred years. This is at a time when the public has access to more scientific data — the same data that scientists and other experts have — through open data and open access scientific publications to validate the claims by experts.

As discussed in a previous post, another feature of this wealth of information is that we are now living in what some call a post-truth political climate where almost anything goes. Speaking on the matter of science and climate change former Alaska Governor and Vice Presidential candidate Sarah Palin suggested that, when compared to Dr Bill Nye (the Science Guy and a rocket scientist — yes, a real rocket scientist ), she is as much of a scientist as he is.

Why have science when you can have opinion?

Distracted driving on the information superhighway

Recent data from Canada shows that year-over-year growth in smartphone use at 24% to over two thirds of the population with 85% reporting some form of mobile phone ownership. One of the key features of modern smartphones is the ‘always on’ nature of their tools and alert systems allowing you to bring maps, address books, a digital library, video and audio telephony, and the entire Internet in your pocket.

The distractions that come from the tools meant to deliver information are becoming crippling to some to the point of distancing us from our humanity itself. The title of a beautiful, sad piece in New York Magazine by Andrew Sullivan put this into perspective: I used to be a human being. (We will come back to this in a future post.)

But even if one still feels human using information technology, its a different experience of humanity than it once was. Behaviour change writer and coach Tony Schwartz (I’m not sure if he’s related to Barry), writing in the New York Times magazine, noted how his use of information technology was affecting his ability to, ironically, glean information from something simple as a book.

One evening early this summer, I opened a book and found myself reading the same paragraph over and over, a half dozen times before concluding that it was hopeless to continue. I simply couldn’t marshal the necessary focus.

He goes on to explain what is being exchanged for the books he had aspired to read:

Instead of reading them, I was spending too many hours online, checking the traffic numbers for my company’s website, shopping for more colorful socks on Gilt and Rue La La, even though I had more than I needed, and even guiltily clicking through pictures with irresistible headlines such as “Awkward Child Stars Who Grew Up to Be Attractive.”

We can laugh at the last bit because most of us have been online and lured by something we thought was impossible or ridiculous and had to inquire about. Link bait is not new or particularly clever, but it works. It works for a variety of reasons, but largely because we need to inhabit the same space to work as well as to play. The problem comes when these worlds cross-over into one another.

For example, I recently was shopping for a safe (no, it’s not to store my non-existent millions, but rather protect hard drives and enhance data security) and wanted to return to a story I’d read in the Guardian for a different blog post. As I returned to pull the URL for this I found the page looking like this:


All of a sudden I am confronted with shopping choices amidst a quest for a URL.

Information wealth: A Faustian bargain to knowledge poverty?

“We willingly accept the loss of concentration and focus, the division of our attention and the fragmentation of our thoughts, in return for the wealth of compelling or at least diverting information we receive.”

Tony Shwartz’s comments above and below point to what we know about how information works in our brain. We can try and resist, but the evolutionary reasons we pay attention to things and the biological limitations we have to processing it all are most likely to trump any efforts to resist it without substantial shifts to our practices.

Endless access to new information also easily overloads our working memory. When we reach cognitive overload, our ability to transfer learning to long-term memory significantly deteriorates. It’s as if our brain has become a full cup of water and anything more poured into it starts to spill out.

I wish I had the answers to what these are. Schwartz, has proposed a digital vacation. As beneficial as it was for him, he was also willing to admit that it’s not a perfect strategy and that he still spends too much time online, too distracted. But, its better.

Comedian Louis C.K. has taken to ‘quitting the internet’ altogether and, in a touching moment of reflection (as he often does with wit), notes how it has improved the relationship with his daughters.

It’s these relational aspects of the new information technology and how it impacts our world that concern me the most and creates the most troubling paradox: the tools that are designed to bring us together might just be making it harder to be together and pushing us apart from each other and ourselves. This is what I will look at in the next piece in this series on paradox.

Image credit: Information by Heath Brandon used under Creative Commons License and by author



food systemsjournalismpublic healthsocial mediasystems science

Frogs, Pots, Blogs and Social Media


Our information landscape has been compared with our diets providing an ample opportunity to compare what we ‘consume’ with how we prepare food and perhaps draw on the analogy of the frog and the boiling point of water. Are we slowly killing our ability to produce independent thought through vehicles like blogs as we draw our gaze to and focus on the social media stream?

Iranian-Canadian blogger Hossein Derakhshan was one of the few who opposed the state-imposed media messaging about what was (and has been) happening in Iran. For that, he was jailed. Writing in the Guardian news service, Darakshan, once referred to as Iran’s ‘Blogfather’, discusses how blogging enabled him to be this voice and how he’s become increasingly concerned with how that option is getting slowly silenced not necessarily by governments but by social media.

Darakhshan’s perspective on social media is made all the more interesting because of his role as a prominent blogger before his arrest and the 6-year prison term that disrupted that role, offering something of a time-travel experiment in social media that he illustrates with a story from the Qur’an (known as the tale of the Seven Sleepers).

Upon his return online, Darakhshan noticed that the patchwork quilt of perspectives that were present in the blogosphere was being replaced by ‘The Stream’ that social media provides.

This stream is no longer about a diversity of perspectives, but rather something custom-tailored to meet our preferences, desires, and the needs of corporations seeking to sell advertising, products and services that align with their perception of what we want or require. This stream also allows us to shield ourselves from perspectives that might clash with our own. Groups like ISIS, he suggests, are enabled and emboldened by this kind of information vacuum:

Minority views are radicalised when they can’t be heard or engaged with. That’s how Isis is recruiting and growing. The stream suppresses other types of unconventional ideas too, with its reliance on our habits.

The Stream & our information diet

What’s interesting about The Stream is that it is about bits and bites (or bytes) and not about meals. Yet, if we consider the analogy of information and food a little further we might find ourselves hard-pressed to recall the snacks we had, but (hopefully) can recall many memorable meals. Snacking isn’t bad, but it’s not memorable and too much of it isn’t particularly healthy unless it’s of very high-quality food. With no offence to my ‘friends’ and ‘follows’ on social media, but most of what they produce is highly refined, saccharine-laden comfort food in their posts and retweets, with a few tasty morsels interspersed between rants, cat videos, selfies, and kid pictures. To be fair, my ‘offerings’ aren’t much better when I look across many of my recent Tweets and posts as I am no more than a box of sugar-topped Shreddies to others’ Frosted Flakes. (Note to self when composing New Years Resolutions, even if they are likely to fail, that I need to add less sugar to my stream).

Yet, we are living an age of information abundance and, like food abundance (and the calories that come with it), we are prone to getting obese and lethargic from too much of it. This was the argument that political communicator Clay Johnston makes in his book The Information Diet. Obesity in its various forms makes us slower, less attuned, more disengaged and often far less mindful (and critical) of what we take in whether it’s food or information. And like obesity, the problem is not just one of personal choice and willpower, it’s also about obesogenic systems that include: workplaces, restaurants, communities, markets and policies. This requires systems thinking and ensuring that we are making good personal choices and supporting healthy, critical information systems to support those choices.

The Stream is actually antithetical to that in many regards as Darakhshan points out. The Stream is about passing content through something else, like Facebook, that may or may not choose to pass it on to someone at any given time and place. I’ve noticed this firsthand over the holiday season by finding “Getting ready for Christmas” messages in my Facebook feed on Boxing Day and beyond.

The problem with The Stream is that everything is the same, by design, as Darakhshan notes in an earlier post on his concerns with his new post-imprisonment Web.

Six years was a long time to be in jail, but it’s an entire era online. Writing on the internet itself had not changed, but reading — or, at least, getting things read — had altered dramatically. I’d been told how essential social networks had become while I’d been gone, and so I knew one thing: If I wanted to lure people to see my writing, I had to use social media now.

So I tried to post a link to one of my stories on Facebook. Turns out Facebook didn’t care much. It ended up looking like a boring classified ad. No description. No image. Nothing. It got three likes. Three! That was it.

An information food web

Diversity of perspective and content is critical for healthy decision-making in complex systems. Our great problems, the wicked ones from terrorism to chronic disease to mass migration to climate change, will not be solved in The Stream. Yet, if we push too much toward creating content in social networks that are no longer controlled by users (even if the content is produced by users) and designed to facilitate new thinking, not just same thinking, our collective capacity for addressing complex problems is diminished.

Wicked problems will not be solved by Big Data alone. We cannot expect to simply mine our streams looking for tags and expect to find the diversity of perspective or new idea that will change the game. As Ethan Zuckerman has pointed out, we need to rewire our feeds consciously to reflect the cosmopolitan nature of our problems and world, not just accept that we’ll choose diversity when our information systems are designed to minimize them.

Much like a food web, consideration of our information ecosystems in systems terms can be useful in helping us understand the role of blogging and other forms of journalism and expression in nurturing not only differences of opinion, but supporting the democratic foundation in which the Web was originally based. Systems thinking about what we consume as well as produce might be a reason to consider blogging as well as adding to your social media stream and why more ‘traditional’ media like newspapers and related news sites have a role.

Otherwise, we may just be the frog in the boiling pot who isn’t aware that it’s about to be cooked until it’s too late.


It is interesting that Darakhshan’s piece caught my attention the day after WordPress delivered my ‘Year in Blogging’ review to my inbox. It pointed out that there were just 4 posts on Censemaking in 2015. This is down from more than 90 per year in past calendar years. Clearly, I’ve been drawn into the stream with my content sharing and perhaps it’s time to swim back against the current. This blog was partly a response. Stay tuned for more and thanks for reading.

Image: Frog & Saucepan used under Creative Commons License via Wikimedia Foundation.

eHealthpublic healthsocial media

eHealth / mHealth And Privacy Will Never Coexist

Erasing Privacy?

There is some debate right now in the tech world about whether or not there is or will be two Internets: one that is the domain of computers and one that is the domain of mobile devices. If you’re like me, there is only one Internet that involves both.

Throughout the day I access information using a variety of devices from different places that combine wired and wireless Internet. Much of my Facebook updates are done on a Blackberry, while my Tweets might come equally from my laptop, iPod or that same Blackberry. I don’t think about what I am using when I engage the Internet world and that’s pretty common.

But this past week a joint statement by Google and U.S. mobile service provider Verizon pointed to the idea that these two ways of accessing the Internet are distinct and they are seeking to create dialogue about rules on how we engage each ‘Internet’. This statement, summarized and discussed by Elliot van Buskirk on Wired.com , basically points to a preference by both companies for some kind of restricted (controlled) form of wireless Internet. This is about net neutrality, the concept that all traffic on the Internet is treated equally, regardless of who you are and what content you are producing or consuming.

Google has responded to the criticism on their own blog and go to point out that their apparent repudiation of the idea of net neutrality on the wireless web is a myth.

Net neutrality is a big issue and one that is worth paying attention to even if you are not a ‘techie’. It is not my intention to discuss it here, but rather discuss another piece of media that got me to this issue and to a place of thinking that privacy and eHealth are an impossible pair.

How did I get there? The inspiration came from Mitch Joel’s Twist Image podcast, Six Pixels of Separation. If you’ve never listened to it before, it is well worth an hour to drop in** and hear someone who is quite articulate about social media issues explore in a casual, but engaging way the social mediasphere. The last episode (#215), was particularly good. Actually, scary might be a better term. Why? In one hour, Joel and his guests discussed, over sushi, a range of issues that, for me, cemented the fact that eHealth and privacy will never coexist. Ever.

They did this without actually using the term eHealth or mHealth (mobile health), but for those of you in this area of work you’ll immediately know why I came to this conclusion. Interestingly, none of the issues that they covered were new to me (aside from the Google-Verizon one). But I had never heard them all discussed in the same narrative in a manner that got me to imagine the future in the way I did when I listened to it. What it did was showcase the already loose controls we have on our “regular” online data, stored in website host servers and ISP provider databases and how these already poor provisions are nothing compared to wireless data, where our data providers and devices give up every little piece of information about us every time we engage in this “other” Internet — the one that has Verizon and Google so interested in controlling/influencing.

The example used to point this out was a health one — albeit a hypothetical one — and it shows just how vulnerable we can be, particularly if you imagine someone posting all of your search data online. This is a real threat. These things happen. Just look at what is going on with the current Wikileaks / Afghan war documents.

I have no suggestion for how to address this and, frankly, I don’t really see any solution that will work to address privacy in eHealth/mHealth; the problem is too embedded. Having some faceless corporation holding our confidential information or some government bureaucracy doing the same are two lousy options. This is the price we pay for convenience, for the power that information has in helping us keep well and for the tools that allow us to connect to others. It’s a big price and no doubt there will be some who listen to this podcast and view the topic through an eHealth light and start questioning whether its worth it. But unless we go back to paper with all we do, I don’t see an option for addressing it in any practical manner. We’ve paid the price of admission to the fair that is eHealth/mHealth and now we need to pay it off with the cost of running the show.

** I like Joel’s style and frankness about media issues, but I will say that his podcast — particularly those that are cross-labeled as ‘media hacks’ episodes — features occasional off-colour jokes among his guests in dialogue (often including fellow social media marketing leaders like Julien Smith, Chris Brogan, and Hugh McGuire) that smack of sexual inappropriateness that I think is unnecessary, beneath him and frankly add no value to the show or his brand. These are relatively mild, but still not worth it. To them I say: Swear all you like guys, but cut out the sexual joking around. It cheapens the whole experience and makes you smart guys look like sophomoric jocks when you do it.

education & learningpsychologysocial mediasocial systems

Libraries, Literacy and the Learning Imperative


I’ll bet that if you sat down with three people – someone over the age of sixty, someone 30 – 60, and someone under the age of 30 — and asked them about their experience with the library they would tell you stories that would hardly resemble one another. Let’s imagine what those stories might look like.

For those oldest of these participants, they might speak of the libary as a reference centre; a special place that a small, but strong population frequented as they grew up (largely due to lower literacy rates among peers and a small knowledge work-based population);  a place to borrow books that you could not get anywhere else (because there weren’t many bookstores growing up); as a quiet, clean and almost stern place to visit, much like a monastery; and they might describe a book in almost ‘savoury’ language given that, when growing up, there was not a lot of other media forms out there and few distractions from the book once you had it to enable you to dive into it fully. Librarians might be recalled as people who keep order over the place and enforce the ‘quiet’ policy (the stereotypical woman with the long skirt, glasses and the hair in a bun comes to mind).

The person in the middle aged bracket might speak of their experience with the library as a place where they had storytime as a kid; found books to help them with school (because many in this age bracket are of a generation where homework and post-secondary education became popular); you can get books (and later VHS & DVD’s) for free, even though there are bookstores all over the place including big-box ones; it was one of the earliest places to access the Internet if not at home or work and sometimes a place where you could get help with searches on health, political or legal issues; and they might describe books and media as something that are commonplace and part of an everyday landscape that are consumed and returned without much thought because it exists in so much abundance. Librarians to this generation did all kinds of stuff from read you stories, help you with a term paper, and mostly help you find things from the vast array of sources in the library.

The last person, the under-30, would have a different experience. A library might have been one of the only rooms in their school for group-work, because the school was crowded and not set up for the kind of group work that is commonplace for that generation because it was likely built in the 1950’s, 60’s or 70’s; it provides a place to study for exams at university; it is one of many places with free Internet and computers (for when yours is in the shop getting fixed); and while it is full of books, periodicals and journals, those paper copies are only accessed as a last resort because they take so long to get and search through; A librarian is the person you go to when the computer won’t work or you need directions to the bathroom.

Is this familiar? To be sure, these are caricatures, but they speak to the shift in how libraries are viewed and their role in society.  Seth Godin, who’s blog is one of the few ‘must reads’ on my list, recently wrote about the future of the library.

What should libraries do to become relevant in the digital age?

They can’t survive as community-funded repositories for books that individuals don’t want to own (or for reference books we can’t afford to own.) More librarians are telling me (unhappily) that the number one thing they deliver to their patrons is free DVD rentals. That’s not a long-term strategy, nor is it particularly an uplifting use of our tax dollars.

Here’s my proposal: train people to take intellectual initiative.

Seth’s proposal is one that cuts across all three of the characters that I described above. The marvel of tools like Twitter and other social media tools is that they help provide you answers to questions you never thought to ask. Libraries can support this by training people to use information resources and networks to take the initiative to ask questions and create answers more effectively in a manner that is effective for people to find and to understand. In short, the future of the library is also what it always has been about: literacy.

Literacy describes a constellation of learning skills, mental model development tools, and methods of expressing ideas to effectively engage with the social and informational landscape around us. This could be in its most basic forms of reading and writing, or learning about science, computers, or media. It can be on issues of health, information seeking or take forms like ‘meta-literacies’ such as eHealth literacy, which combines all of these forms together.

It is for that reason that the news yesterday that the Canadian Council on Literacy, an advocate and innovator on literacy issues in Canada and internationally, was told that its federal funding (it’s greatest source) would be canceled as of March 31st, 2010. It strikes me that in an era where information is plentiful (even overwhelming in its volume) and the demands (and necessity) for citizens to use information from a variety of sources to make ever-more complex decisions that this is a move backwards.

Perhaps if citizens take up this cause of literacy and support Seth Godin’s renewed mission for libraries we might not have to watch as more literacy organizations, including libraries, disappear because it seems to me that their opportunity to shape a knowledge-driven, learning culture has never been greater than it is now.

behaviour changeeducation & learningeHealthhealth promotionpublic health

eHealth Deja Vu All Over Again

"This social media stuff is like eHealth deja vu all over again"

"This social media stuff is like eHealth deja vu all over again"

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.

behaviour changeeHealthpublic health

eHealth and the Means-Ends Problem

Prescribing ChangeIt’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.