Tag: public health

complexityinnovationsocial innovation

The Ecology of Innovation: Part 2 – Language

Idea Factories or ecologies of innovation?

Idea Factories or ecologies of innovation?

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

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

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

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

Language matters in innovation.

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

Innovation as product

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

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

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

Innovation as a contextual process

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

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

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

Systems-embedded innovation

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

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

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

Talking innovation

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

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

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

Tips and Tricks

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

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

Some key references include: 

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

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

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

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

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

journalismknowledge translationpublic healthscience & technology

The Power, Peril and Promise of Health Journalism

Online Prescription Concept

The Toronto Star, Canada’s most widely read newspaper known for its investigative reporting gifted anti-vaccination audiences armament by using poor science to point to a spurious connection between an HPV vaccine and illness. The issue points to journalism’s power to shape the discourse of health issues and it points to the power, promise and peril associated with good (and not so good) science reporting. 

With great power comes great responsibility – Uncle Ben, Spiderman

It started with a story

On Thursday February 5th, 2015 the Toronto Star, Canada’s most widely read newspaper that has a reputation for solid investigative journalism, published an story that connected the experience of young girls and negative health effects with the receiving the Gardasil HPV vaccine. The story was immediately and widely criticized by experienced science journalists and health professionals alike, who argued that it was based on terribly flawed science.

The Toronto Star’s reaction was to defend itself, arguing in many different fora that they indeed mentioned that there was little scientific evidence that supported the link between the vaccine and the negative health effects being discussed in the article. The problem is that these links are buried deep in the article and certainly are not its focus: the hypothesized harms are.

Two days later, the Star published a follow-up op-ed letter which was authored by two health professionals and co-signed / supported by dozens of Toronto’s leading physicians condemning the original article. However, by that time the damage is likely to have been done and one more bit contribution to the fictitious ‘evidence’ for vaccine harms had been added to the anti-vaccine movement’s war chest.

Perpetuating harm

This matter of poor reporting is not a trivial issue. The fraudulent science performed by Andrew Wakefield linking autism to vaccines helped spur an evidence-thin anti-vaccination movement. Today, we are seeing the resurgence of diseases once thought to be eliminated in North America (like measles) because so many people are not having their children vaccinated. Jenny McCarthy is among the celebrities who have taken up the cause of anti-vaccination and has written about and spoken at length about what she sees as the connection between autism and vaccines, using her son’s experience as an ‘example’. Oprah Winfrey, perhaps unwittingly, gave McCarthy a platform to speak about her beliefs on her show offering wider possible credibility to something that has been thoroughly discredited in the scientific literature (PDF).

For the Toronto Star, it was bad enough that the story was published — and is now online, likely for all time in various forms thanks to the Web — but what made it worse was that the Star was so vigorous in its defence of it, unwilling or unable to recognize their role in public health. Medical evidence champion, author, physician and columnist Ben Goldacre was among the many who counter-attacked, pointing to what he called The Star’s ‘smear campaign‘ against the story’s critics.

For an interesting discussion of the issue of just how the Star got it wrong, listen to Vox health reporter Julia Belluz, interviewed on the CBC’s radio show The Current. Belluz, a past MIT Knight Journalism Fellow, is one of a dwindling number of journalists who understand the practice of reporting, science, and medicine and wrote a stellar critique of the Toronto Star article, but as importantly makes the case for why there is a need for specialized, trained, supported journalists out there doing this kind of work.

…and health

I’ve argued in the past that journalism is very much a pillar of public health. When it fails, so does public health. Journalism is not and should not be an arm of public health for the very independence that good, professional journalism strives to maintain is a reason it’s often called the fourth estate, keeping governments and other forces in check to ensure they are not abusive. Yet, that distance is also what makes it a part of public health. Public health is better for journalism and journalism certainly can benefit from health stories as they continue to be popular and sought after by readers.

As a group, scientists and many clinicians are not great at communicating what they do, why their research is important to others outside their field, and what the implications of their findings are for the public and science as a whole. Some are, most are not. It’s for this reason that the entire sub-field of health sciences focused on knowledge translation, exchange and mobilization has emerged. Just as we value the ability of a graphic designer to make visuals come alive, so too have we learned to value those with the skills to communicate information well and that is what journalists are trained and paid to do. They are a big part of this process, or at least should be.

Healthy journalism, healthy science, healthy people

Science journalism is too important to be ignored. There is much skepticism of journalists by scientists and clinicians and indeed, as the Toronto Star shows, journalists sometimes get things wrong. But its one thing to get it wrong through errors of judgement or interpretation it’s quite another to get things wrong by design. The Toronto Star has some good health reporters, but they weren’t the ones on this story. Nor did they bring in the health reporters to consult on this or other health professionals prior to publication– at least as far as one can tell.

The importance to the public’s health of good reporting requires that health and science journalists have more than a rudimentary knowledge of the topics they are covering. What’s strange is how we understand this with our sports reporting, weather forecasts and foreign correspondents. You wouldn’t watch someone who has little understanding of a sport covering it in depth, would you? It’s one thing to read scores, it’s another to provide investigative and deep coverage of a game if you don’t know the players, the rules, the criteria for quality and success and so forth.

Why do we do this with health journalism and science?

Yet, journalism is under pressure and no doubt the Toronto Star, for whatever genuine contrition they experience from what happened, have to like that they are being talked about. The reason is that journalism is under threat for market reasons, the Internet and the changing ways we get our news. It is, as Jürgen Krönig wrote way back in 2004, “A crisis of the Fourth Estate”. That crisis is only getting worse.

As anyone interested in public health, we need to take actions to ensure that the fourth estate is protected, supported and not ignored. Our health might just depend on it.

Image: iStockphoto, used under licence.

eHealthinnovationpublic healthsocial innovationsocial media

Seeing the lights in research with our heads in the clouds

Lights in the clouds

Lights in the clouds

Some fields stagnate because they fail to take the bold steps into the unknown by taking chances and proposing new ideas because the research isn’t there to guide it while social innovation has a different twist on the problem: it has plenty of ideas, but little research to support those ideas. Unless the ideas and research match up it is unlikely that either area will develop.

 

Social innovation is a space that doesn’t lack for dreamers and big ideas. That is a refreshing change of pace from the world of public policy and public health that are well-populated by those who feel chained down to what’s been done as the entry to doing something new (which is oxymoronic when you think about it).

Fields like public health and medicine are well-served by looking to the evidence for guidance on many issues, but an over-reliance on using past-practice and known facts as the means to guide present action seriously limits the capacity to innovate in spaces where evidence doesn’t exist and may not be forthcoming.

The example of eHealth, social media and healthcare

A good example of this is in the area of eHealth. While social media has been part of the online communication landscape for nearly a decade (or longer, depending on your definition of the term), there has been sparse use of these tools and approaches within the health domain by professionals until recently. Even today, the presence of professional voices on health matters is small within the larger discourse on health and wellbeing online.

One big reason for this — and there are many — is that health systems are not prepared for the complexity that social media introduces.  Julia Belluz’s series on social media and healthcare at Macleans provides among the best examples of the gaps that social media exposes and widens within the overlapping domains of health, medicine, media and the public good. Yet, such problems with social media do not change the fact that it is here, used by billions worldwide, and increasingly becoming a vehicle for discussing health matters from heart disease to weight management to smoking cessation.

Social innovation and research

Social innovation has the opposite problem. Vision, ideas, excitement and energy for new ideas abound within this world, yet the evidence generation to support it, improve upon it and foster further design innovations is notably absent (or invisible). Evaluation is not a word that is used much within this sphere nor is the term research applied — at least with the rigour we see in the health field.

In late May I participated in a one-day event in Vancouver on social innovation research in Vancouver organized by the folks at Simon Fraser University’s Public Square program and Nesta as part of the Social Innovation Week Canada events.Part of the rationale for the event can be explained by Nesta on its website promoting an earlier Social Frontiers event in the UK:

Despite thriving practitioner networks and a real commitment from policymakers and foundations to support social innovation, empirical and theoretical knowledge of social innovation remains uneven.

Not only is this research base uneven, it’s largely invisible. I choose to use the word invisible because it’s unclear how much research there is as it simply isn’t made visible. Part of the problem, clearly evident at the Vancouver event, is that social innovation appears to be still at a place where it’s busy showing people it exists. This is certainly an important first step, but as this was an event devoted to social innovation research it struck me that most attendees ought to have already been convinced of that.

Missing was language around t-scores, inter-relater reliability, theoretical saturation, cost-benefit analysis, systematic reviews and confidence intervals – the kind of terms you’d expect to hear at a research conference. Instead, words like “impact” and “scale” were thrown out with little data to back them up.

Bring us down to earth to better appreciate the stars

It seems that social innovation is a field that is still in the clouds with possibility and hasn’t turned the lights on bright enough to bring it back down to earth. That’s the unfortunate part of research: it can be a real buzz-kill. Research and evaluation can confirm what it means for something to ‘work’ and forces us to be clear on terms like ‘scale’ and ‘impact’ and this very often will mean that many of the high-profile, well-intentioned initiatives will prove to be less impactful than we hope for.

Yet, this attention to detail and increase in the quality and scope of research will also raise the overall profile of the field and the quality and scope of the social innovations themselves. That is real impact.

By bringing us down to earth with better quality and more sophisticated research presented and discussed in public and with each other we offer the best opportunity for social innovation to truly innovate and, in doing so, reach beyond the clouds and into the stars.

Photo credit: Lightbulb Clouds by MyCatkins used under Creative Commons License. Thanks Mike for sharing!

behaviour changecomplexitypublic healthsocial systemssystems thinking

The New Zombie

Zombie stare

They are among us and hungry for brains

Zombies are attacking us; not for brains, but for attention. The consequences of this is that they are everywhere and sucking the intelligence out of human systems. 

Forget orange, zombie is the new black.

Zombies are hot. TV shows, books and films about zombies are more popular than ever, and this time of year the public’s attention to the undead is at its nadir. The CDC in the United States even got into the act by using zombies as a health promotion vehicle to support emergency preparedness. From zombie walks to art shows, the staggering brain-eating, brain-less are everywhere.

Yet, there is a new breed being formed that doesn’t eat brains and has them, but may not be using them well and they are all around us everywhere.

They walk among us

Look around and what do you see? People online, on the phone, texting and walking and driving, being everywhere except where they are. Examples of people walking into fountains or falling into a sinkhole while on the phone are often seen as comi-tragic, yet they belie a remarkably powerful trend towards disengagement from the world around them. Charlene deGuzman and Miles Crawford‘s beautiful and disheartening short film I Forgot My Phone plays this for further comic and sad effect as they portray a day in the life of someone paying attention to those not paying attention to anything away from their screen. The film highlights the modern paradox of being more connected than ever, yet overwhelmingly alone.

Emerging research is showing remarkable spikes in risks associated with mobile phone use and injury and mortality. We might laugh at people falling into holes or bumping into things, but only when it hurts the ego and not the body. This is serious stuff. Keep in mind that we don’t see non-reported injuries (e.g., someone bruising their head) and the many near misses between person and object — including cars, which have their own epidemic of problems with texting and attention.

Indeed, zombies embody paradox: a brainless being that is undead seeks brains to stay unalive. Whether they are alive or dead depends on where you stand and that is what makes them a complex character despite their surface-level simplicity.

Brains…need…more…(use of science) brains….

Zombie Science

Zombie Science?

While it might be easy to point to those on phones, zombie behaviour occurs elsewhere in places where the effects are far less comic and just as dangerous. The latest issue of The Economist features a cover story on the problems science is having with it credibility and quality control. Some of this is due to what I would call zombie-like behaviour: mindless attention in a manner that restricts awareness and appreciation of one’s immediate context and the larger system to which that behaviour occurs.

The recent expose by science journalist John Bohannon published in the journal Science exposes zombie-like thinking in how open-access science journals accept and reject papers. Bohannon’s inquiry was prompted by questions about the way fees were charged for open access journals (which is how they can remain open to the public) and the peer review require to advance publication. Presumably, an article has to pass review from peer professional scientists before it is accepted and then the fee is paid. No acceptance, no fee (except for perhaps a small application processing charge).

As profiled in an interview with the CBC radio show The Current

Bohannon wanted to find out whether fee-charging open access journals were actually keeping their promise to do peer review — a process in which scientists with some knowledge of a paper’s topic volunteer to check it for scientific flaws…

…In the end, what he concluded was that “a huge proportion” of the journals were not ensuring their papers were peer reviewed.

Even in cases where peer review happened, it didn’t always function correctly. For example, the Ottawa-based International Journal of Herbs and Medicinal Plants clearly sent the paper out to be reviewed by real scientists, who pointed out some flaws, Bohannon recalled. Even so, when Bohannon submitted a revised version of the paper without correcting any of the flaws, it was accepted.

Bohannon’s approach and findings are not without some problems of their own, but they don’t much change the conclusion that there are deep problems within the scientific enterprise.

Much of what Bohannon found can be attributed to greed, but a great deal of it is due to bad scientific practice. As a consultant who is also a publishing researcher and ‘recovering’ academic I know the enormous amount of energy that goes into publishing an academic article in a scholarly journal. As one who is sent between 4 to 5 manuscripts to review from legitimate journals per month I know the demands that are placed on reviews. We also publish far too much for the system to handle. Writing in the Chronicle of Higher EducationMark Bauerlein and colleagues look closely at the ‘avalanche’ of publishing and shed light on many reasons why the problems that the Economist and Science occur (Note: I’d strongly encourage you to read through the comments as it is as instructive as the article itself).

They are everywhere

To add to the examples of zombie culture I need only look to my own daily life outside of science and  mobile phones. Just the other day I witnessed the following example at a community meeting that was organized in part to discuss the expenditure of funds to make a better living area for people in a building:

Presenter: “…and I am pleased to conclude that the new furniture for the outdoor spaces is going to be made by a company that created the same products at [place] out of recycled materials. We will expect to have the new furniture here in 6 to 8 weeks. Any questions?”

First question: “I love the work you’ve done. Can you tell me when the furniture will be here?”

Sadly, I have many other stories that show that many people are not paying attention. They are sitting through workshops and not picking up basic concepts (even after having asked for it and having been given it multiple times over), asking for materials that were already shared on multiple occasions, suggesting ideas that were already discussed and agreed upon over because that person didn’t engage in the discussion and so on. This happens not because people are stupid, but because they are disengaged.

A simple search through statistics compilations finds enormous material on what kind of inputs we expose ourselves to and its impact on attention. There is more coming at us in quantity and context and that is undoubtedly influencing quality of processing and engagement. I can speak of this personally and through observation. The amount of times I find people not hearing what is said, processing it effectively, or even remembering something said is staggering.

It’s not surprising. We are alerted everywhere: a text message, a phone call, a Facebook message, an email, an app alert, someone coming by the office, external noise outside, and visual noise everywhere. The explicit and ambient signals we are exposed to in a day is staggering. Clay Shirky suggests it’s not that we have too much information, it’s that our filters are failing. I think it’s now both and one reinforces the other.

Coming back…a look at systems

While individuals are distracted, they are products of distracted systems. To look at one part of the science zombie situation, professors are now asked to publish more than ever, get grants from a dwindling pool, teach more students than ever and in more crowded conditions and with greater social needs, and to find ways to make their research more accessible to different audiences while engaging more with the communities of interest affected by that research. All of this takes time. Add to that the probability that the professor her/himself has to raise their own salary and that the only way to do this is to be very successful at the above-mentioned tasks and you get someone who is stressed and overtaxed.

Mindfulness-based approaches do not change any of that, but they can help strengthen the filter. By being more individually mindful, but more importantly create mindful organizations. Building resilient tribes of social innovators and the leadership communities to steward them is another. Granting ourselves the time to reflect, sensemake and listen to the systems we work in is also key. By listening better, we are better able to design systems that are innovative, responsive and humane by building them to human scale.

All well and good you might say, but how? That’s what’s to come in some future posts as we look at designing better systems and making them more attractive so people stay engaged.

Stay tuned….and watch out for zombies.

Photo credit: Zombie Walk 2012 SP by Gianluca Ramalho Misiti used under Creative Commons License

complexitydesign thinkingpublic healthsystems sciencesystems thinking

Systems Thinking Perspectives on CQI and Public Health

Mapping the system

Mapping the system

Systems thinking involves taking account of where you stand, what you’re doing, and where the bounds of your influence and influences are. By learning how to think about systems, we are better able to design strategies to ensure that our engagements are producing the most beneficial results for our efforts and when combined with design thinking we gain further opportunities to shape the systems closer to what we aspire them to be.

I recently was invited to speak to the first meeting to advance CQI (Continuous Quality Improvement) in public health in Ontario (Canada) on the topic of systems thinking. The one day workshop was aimed at bringing together members from nearly every public health unit in the province to meet and discuss issues related to quality improvement and public health.

In twenty minutes we did a whirlwind through some of the key features of systems that are relevant to quality improvement by looking at the nature of systems (chaotic, complex and ordered) and steps that can be taken to understand them in terms of setting the appropriate targets, methods and tools for defining and assessing quality within such systems.

Understanding systems

By understanding the nature of systems we can avoid the trap of using linear metrics for non-linear problems. Much of the literature on quality improvement has its roots in manufacturing, which are largely linear systems that seek to predict, control and emphasize efficiencies and the elimination of waste. Yet, public health is largely about complexity. In a complex system, what might be considered inefficiencies could be natural byproducts of the system itself and cannot be necessarily avoided. Further, such ‘noise’ could be sources of innovation or weak signals that indicate something significant is to come.

Public health operates in a tricky space because it deals with highly complex problems and systems and linear, straightforward ones simultaneously.

Below is a summary set of slides used to highlight the talk (the original slides were more visual, but those don’t help you out if you hadn’t been in the room).

(For those who read this blog through subscription, you may not see the above presentation in your feed so here is the link)

Building Quality Into Systems Design

One of the central points I made was that systems can be (partly) designed and that developmental design is a process that integral to optimal functioning in a complex system. By paying attention to what is going on and the relationships that form within the system the feedback is set to allow for intentional development of the system itself. This does not assure control, but it allows for positive influence rather than being solely reactive to whatever the system produces. This is necessary if one is to promote quality and ensure quality not just measure it as if it was a static object.

Whether one uses linear, quantitative measures or more non-linear, multi-method approaches to assessing the quality of a public health product or service, the key is knowing what kind of system you are operating in.

My takeaway points were:

•CQI depends on seeing quality as embedded in and a product of systems;
•Systems are defined by where you stand in relation to them and how variation operates within the system;
•Where you stand determines your metrics for quality;
•Your metrics feed your improvement and (re)define quality by influencing where you stand.
The process then repeats iteratively and in an ongoing manner just as one repeats the use of the strategies below:
•Pay attention / pay intention;
•Map your system to intentions, people, settings, contexts based on what you see;
•Collect relevant, timely, useful data based on the context of your operations and strategy (build on what you map);
•Engage in collective sense-making of the data;
•Design & redesign your programs.
By setting up the appropriate processes and structures to monitor, assess, sense-make, and design programs in congruence with the type of systems programs and services are operating in, not only with public health professionals be better equipped to assess quality, they will be producing it along the way (and creating a learning organization in the process).
design thinkingfood systemspublic healthsocial systemssystems science

Systems and Design Thinking Go to the Ballpark

Fenway Park #boston #redsox #baseball #stadium

A recent trip to baseball’s legendary Fenway Park provided the ideal example of understanding systems and how they can create public health problems like obesity through structural means. Being aware of these systems, their boundaries, and their activities can help us better find the causes of individual activity by looking at what encourages behaviour and not just at what people do.

Take me out to the ballgame… and into systems

I am not an obsessive sports fan, but I do enjoy athletics and watching a variety of sporting events.  When it comes to the sport of baseball, I grew up as a Boston Red Sox fan. As a fan of the Red Sox I always dreamt of attending a game at Fenway Park, home of The Green Monster and perhaps the most eclectic and endearing stadium as you’ll find in pro sports anywhere in the world, so when I had the chance to see the Sox face off against their rivals the New York Yankees in Boston I was overjoyed.

When I found out I was going I decided in advance that I would take in the fullest experience possible even down to the food. I am generally a mindful eater, preferring ethical, local and healthy options whenever possible so opting for an evening of beer, steamed hot dogs and ice cream was something as out of the ordinary as touring a legendary ballpark. But then, Fenway Park is not your your ordinary ballpark.

Thus began a look at systems thinking through the lens of food, design and culture. While this started being about a night at a baseball game it ended up being about so much more.

On the menu:

  • Fenway ‘Monster Dog’
  • Samuel Adams Draught Beer
  • Ice cream* served in a Boston Red Sox mini baseball helmet with Oreo cookie sprinkles (*soft serve – I have no idea if there is any real cream in it, or what is in it at all)
  • Popcorn

Take me out to the ball game #boston #redsox #fenway #stadium

An Anthropologist at Fenway

While I was at Fenway Park to enjoy America’s pastime, I couldn’t shut down the systems thinker, design thinker and psychologist parts of me. Add to the fact that I was attending it with a journalist with a health science and anthropology focus (who was seeing her first baseball game ever) and the experience quickly became a cultural study.

So what did we find? Entering the stadium via Yawkey Way one is immediately surrounded by souvenir and food vendors that, despite initial appearances, are nearly identical and plentiful. The same hats, shirts and banners are available at nearly every souvenir kiosk and nearly the identical foods related at most of the food vendors. Even though Fenway Park’s menu on the web suggests a variety of food options, the reality is that most vendors sell the same things, or near variants of them.  Hot dogs, burgers, fries and pretzels are dominant. Sometimes there’s ice cream.

You are enveloped in sales for products everywhere. It is nearly impossible to go anywhere in that ballpark save for the stairwells that some product isn’t in your face — for sale or advertisement.

Food is everywhere. I don’t think I’ve ever seen more food vendors anywhere per square feet in my life.

One of the things you notice quickly — by design — are the myriad ads lining the outfield fence. My companion was quick to note that Coca Cola had among the most noticeable of these ads (see photo above), which is far less ominous than the giant Coca Cola ad/bottle at San Francisco’s AT&T Park. A look to the other side will find a Budweiser sign prominently displayed (see photo below). Along the outfield wall one finds ads for other purveyors of foods laden with fat, excessive calories, salt and sugar.

None of this would come as any surprise to someone like Yoni Freedhoff, a bariatric medical professional** and prolific blogger on the relationship between (mostly fast, unhealthy) food and health (problems) and its marketing to the public. Dr. Freedhoff has made a social media career of pointing out how our food system is skewed towards particular types of products, quantities and how it is all pushed covertly and not-so-subtlely to all of us — including children — throughout our daily lives. I don’t know if Yoni’s a baseball fan, but he would certainly boo the visual team at Fenway.

Red Sox Win #fenway #boston #redsox #yankees #baseball

The hidden and not-so-hidden effects of systems

If one views the environment within and around the stadium and the game as a system, there is much that can be taken away from the experience I had at Fenway.

The availability of products is what is the explicit manifestation of the system on food choices. Fenway is a closed system so unless you smuggled some food from home, the only options for what to eat is determined by the management of the stadium. That substantially limits what you have available. While there are dozens of vendors throughout the stadium, I was shocked at how much of it was repeated as if to say: “You said no the first time; how about now? And now? And now?”. It wears you down, particularly if you spent a day walking through the city and up and down the stairs at the stadium with thousands of others.

Hot Dogs were available at nearly every second or third vendor; so was beer and nearly everyone sold pop. Salted peanuts, popcorn and pretzels were also highly available. Hamburgers? Maybe every 4th or 5th vendor. Ice cream? Maybe about every 7th vendor. Apparently there are some healthy options available at a single location on Yawkey Way, outside the stadium proper. I didn’t see them, but I am told they are there.

The option is to spend thousands and get yourself a private luxury box or admittance to the private club where there is better quality food…at a price. For the common fan, these are simply too inaccessible.

These are the more obvious manifestations of the food system. But then there are the more insidious, subtle effects that influence food choices that are built into the experience. A professional baseball game is about 4 hours long if you consider the pre and post event ceremonies that take place. This can be longer if the game itself goes into extra innings or is high scoring . In a town like Boston, you can reasonably add another hour to the beginning and end of that due to transit time.  It’s not unreasonable to want to eat during all of this.

While the options for eating are not that healthy (or rather, are positively UNhealthy) the effect of these choices go beyond any guilt for having consumed a lot of empty calories. The foods themselves are designed to create more desire.

I’m not just speaking of the neurobiological impact of fat and salts on the brain (which is sufficient enough), but the actual feelings that these foods create. Hot dogs are served on white bread and actually make you feel hungry not long after you’ve eaten it, not full. The popcorn is so salty you need something to drink and the absence of any visible water fountains (a design choice) you reach for something like beer or soda/pop. More calories, more sugar and more profit.

Just imagine sitting there watching the game, hungry and thirsty and seeing a gigantic Coke or Budweiser sign lit up like a firework over a bland green wall? No ads for tap water that I could see (or means of getting it save for bringing your emptied beer cup into the bathrooms to fill it up in the bathroom sink).  And the bathrooms themselves? They are down a long corridor, down the stairs and along another corridor. So at least you get some exercise in place of the convenience.

Making design visible

Some have claimed that great design is invisible; implying that it is so useful that no one even notices it (see the latest issue of Wired for this argument writ out as the ‘Age of Invisible Design’). In the case of Fenway Park — and the many hundreds of stadiums like it around North America – the design choices are both obvious and invisible and in both case influence our health. What struck me when watching what was going around me was that this same situation plays out (pun intended) every night across the major leagues (and all major professional sports), but also at shopping malls and food courts across North America.

In most of these venues the volume of people is high, traffic is congested, and the ability to literally see all the choices before you is difficult. What you visually rely on are things that light up — to help us navigate our way — and those are not shaped like broccoli florets, bananas, or bowls of Quinoa. When you are designing fast food you are also bound by very limited preparation space, while refrigeration and disposal capacity is limited. It’s hard to make wholesome, interesting food that isn’t whole on its own — like fruit — without the space to do it. Frozen weenies don’t require a lot of work to prepare. Creating the space for this in the first place is critical.

And if there was space to prepare the food, where will people wait? The concourses of most arenas are not designed for you to wait for your sandwich or salad to be prepared unless you get ready-made (which can be done to high quality, nutritional and taste standards, but often is not).

And space costs money. I can assure you that at every mall, stadium and food pavilion there is a cost-per-square-foot calculation done that makes the cheap-and-easy solution much more profitable than slow food. Yet, there is a real health cost to these decisions and one we fail to add to the calculus of our wellbeing.

Next time you are out at the ballgame pay attention to what is around you, how you are being shaped by advertising, design and time. We all have choices in the matter, but over time they stop feeling like it and become more challenging to make. Consciously choosing to have a hot dog at the game knowing all you know about what the food is, why it is served, who it serves as well as how it is served is a decision open to those who are aware and have the means to absorb all of the costs. Sadly, this represents too few of us.

So will our designs and health hit a grand slam or strikeout?

(As for the game? The Red Sox won with a grand slam home run in the 8th inning, unlike my stomach)

** the original post mistakenly referred to Dr. Freedhoff as a surgeon. See comments below or find out more about his work by clicking here.

art & designenvironmentpublic health

Design Space in Public Health

EmabarcaderoFountainIf design is everywhere humans are and shapes our interactions in the built environment, which dictates how we interact with the world around us should it not be considered important enough to be a part of public health?

I recently picked up a copy of the architecturally-inspired Arcade Magazine because of its theme on Science, Art and Inquiry. Inside was a piece by Andrew Dannenberg, Howard Frumpkin and Daniel Friedman. The first two are MD’s and the last author an architect and all are from the University of Washington . In that article, they outline a case for why design and public health should go together. The audience for the piece are those interested in architecture.

Indeed, Arcade’s purpose is to “incite dialogue about design and the built environment”. It makes me wonder why we don’t have something that “incites dialogue about design and public health?”.

Yet, I couldn’t help but think that same piece should be published in a public health space. In the article, the authors outline a few of the key areas where design can contribute to public health.

Among the first of these areas is promoting physical activity and the role that design can play in building and planning for spaces that encourage people to move in healthy ways:

Working together with public health professionals and planners, designers can help remedy what urban theorist Nan Ellin calls “place-deficit disorder,” starting with the basics – stairways, sidewalks, landscapes and contiguous urban spaces – which they can compose to attract greater pedestrian use.

Designing for resiliency is another of the areas where good design can benefit the public by creating a solid urban infrastructure to literally weather the storms that come upon us:

Evidence-based design can help reduce vulnerability and enhance the resilience of buildings and infrastructure, but most importantly, the communities who depend on them.

They also look at the role of design in enhancing sustainability and as a means for assisting environmental health while shaping the demand for sustainable products:

Designers possess the unique skills, knowledge and practices to specify the use of benign materials across scales based on life cycle analysis, energy conservation, carbon management, and environmental and health impacts. As designers expand these practices, they educate their clients, inform the public and shift the market.\

Lastly, they focus on how design can contribute to reducing social inequities by drawing on evidence looking at the connections between space and wellbeing for those in low-income neighbourhoods:

Recent studies demonstrate that links between greater access to green space and lower mortality are more pronounced among the poor than the wealthy. Housing initiatives that offer better homes for low-income persons, workplace design that protects workers, and universal design that improves access for activities by persons with disabilities—these practices benefit vulnerable populations and offer designers unlimited opportunities to help foster fuller, healthier lives.

Expanding the discourse of design and public health

It was refreshing to read a ‘conversation’ between public health and design and some taking the issue of space and health seriously from a design point of view. Some, like Emily Pilloton and her Project H design others have sought to use design as a bridge to social wellbeing by looking at space as being about communities and economics. Her video below explains how she has taken a design-driven approach to her work in promoting new sustainable ways to engage her adopted community of Bertie county.

Both of these examples of design in public health take a place-based approach, however there is much that can be done with designing the experience of health beyond place. Jon Kolko’s group at AC4D looked at design and homeless in their book Wicked Problems.  Andrew Shea has looked at the link between graphic design and social good in his book, which is explained further in his TEDX talk below. The design firm IDEO has been working on social good projects now for a few years through its IDEO.org platform and program.

  Bringing public health in

What seems to be missing and that the article in Arcade did and that was bring public health in. Emily Pilloton, Jon Kolko, Andrew Shea and many other terrific socially-minded designers are changing the way the public thinks about public health. Public health needs to be doing this too. It is striking that we have so few public health professionals — Drs Andrew Dannenberg and Howard Frumpkin as exceptions — doing the kind of design-oriented research and publishing in this area. It is ripe and public health and design both need it.

I don’t expect a lot of public health folks read Arcade, but maybe they should. And maybe we should be reading more about design in public health publications too.