September 3, 2009

Forget About The Bottom Line(s) – What’s The Top Line?

Posted by gregwolff under Social Capital | Tags: , , , , , |
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In conjunction with the Social Capital Conference held this week in San Francisco, I’ve been reviewing the industry’s latest and most comprehensive attempt to quantify the “value” or impact of social enterprises.  The IRIS Standards were developed through collaboration between Acumen Fund, the Rockefeller Foundation, Google.org, the Salesforce.com Foundation, and other highly respected “Impact Investors.”

On the first day of the conference, everyone from Sonal Shah, leader of the White House Office of Social Innovation (yes,  things have changed in Washington!), to Willie Foote of Root Capital, cited the emerging IRIS Standards as an important step towards accountability, transparency and visibility in social enterprise that will give individuals and organizations the ability to compare projects within and across sectors to identify what really works.

Consisting of 200 distinct measures plus an additional 152 “submetrics,” the IRIS Standards provide a comprehensive list of qualitative and quantitative metrics across six broad sectors of social enterprise – Energy & Environment, Education, Healthcare, Agriculture, Microfinance and Community Development.  There’s only one problem.  Despite all this complexity, the IRIS metrics fail to define social value or capture the essence of what it means to “impact” an individual’s life.  Let me explain by way of example.

In 2004 I supported a couple of students from Stanford and UC Berkeley in a project looking at the core issues of poverty in the United States when more than 12% of the population has been below the poverty level since 1960. In conjunction with the Annie E Casey Foundation, these students interviewed a wide range of individuals across the US who were currently living in poverty or had been living in poverty and had made the transition to become  self supporting members of society.

The students heard a wide variety of heart wrenching.  Single mothers who had been raised in poverty, former rock stars who had achieved great financial success then fallen into the downward spiral of drug addiction, factory workers whose jobs had gone overseas, and many more.

The stories of people who escaped poverty were no different from those still trapped in the downward cycle except for one common thread. Everyone of the “escapees” had had an “AHA” moment where they went from being the one receiving assistance to providing assistance to someone else. In one case, a mother feeding her children with foodstamps started showing other mothers how to shop wisely – buying potatoes and powdered milk instead of chips and soda so that their foodstamps lasted the whole month and their children didn’t go hungry. In another case, a former convict enrolled in yet another job training program started acting as a mentor to students just entering the program.

Whatever the details, the same pattern emerged.  When an individual helped someone else, they soon found themselves working their way out of poverty.  Sometimes this moment came after years of cycling from one failed job to another or repeated bouts of drug addiction.  In other cases, it happened within a few months of finding themselves at the bottom rung of our rugged capitalism.

So what’s the secret?  What is it about these success stories that fails to show up in the IRIS metrics?  Well, if you’ve ever been in a position to apply for government aid, you know how humbling this can be.  Faced with an “AID worker” who represents a seemingly all-powerful government, you are almost forced to prove that you are destitute and have nothing of value to offer in exchange for some food and shelter.

This relationship between Aid worker and beneficiary is often toxic.  Despite the best of intentions, the message sent to the recipient of aid is that they have no value.  It’s only when they stumble into a situation where they can help another that they find some value within themselves.  That kernel of self worth provides a building block upon which they can, with lots of hard work, become a full fledged, productive member of society.

In a pure market exchange, the money paid by the buyer to the sell provides a direct measure of the relative value of a transaction.  Aggregating these sales becomes the revenue or “Top Line” for a companies financial balance sheet.  In order to calculate impact, we likewise need some notion of the value of an exchange between the provider and a client or beneficiary that can be aggregated into a “top line” of impact.  The IRIS Standards do include measures for number of employees, student enrollment, amount of purchases from small producers, and a few other indirect measures of opportunities for individual participation in the economy. However, none of the current measures comes close to tracking the fundamental social concept of helping another.

I agree that the IRIS Standards represent a step forward for the emerging social capital markets, but until we find some way to talk about and aggregate this most basic unit of social capital, the self value that comes from being able to help another, we as individuals and organizations, will likely remain unsatisfied with approaches to “measuring impact.”

 

July 1, 2009

Open Space for Knowledge

Posted by gregwolff under Academy, MORE, SharedRecords, TiddlyWiki, UnaMesa, Uncategorized | Tags: , , , |
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Since founding the nonprofit UnaMesa Association I’ve struggled to find an easy way to communicate our mission.  In this blog posting, I explore a new approach to explaining the mission of UnaMesa by analogy with organizations like POST (Peninsula Open Space Trust) that purchase natural lands  on behalf of the community and turn them into parks and preserves.

First, here’s the old approach where I start by describing the big picture.

Usually I start by pointing out that society faces tremendous challenges in providing education, healthcare, and social service in our current political economy. Most people understand and agree.  Some even go on to express their unease about living in a society that generously rewards bankers and athletes but pays teachers poorly.  Most people also “get” the difference between technology and service when I give the example of cell phones changing every year, but going to see a doctor or sitting in a classroom not changing much in 50 years.  They see the improvements brought about in their personal lives by technology, however, going to a doctor seems to become ever more painful.

So far, so good.

People generally understand the problems we’re trying to solve and even understand that you can’t “pay” someone to truly care about serving their students, patients, or clients.  Then I say something like “we’re moving from an industrial economy to a service economy.”

At this point, most people nod but you can see their eyes glazing over a bit.

Then I might point out that the current mechanisms for market based pricing don’t actually work for intangibles because there’s an infinite supply of anything digital (information, music, software).  [Three problematic concepts -- "market pricing", "intangibles", "infinite" ] Not only that, but the value of a service, such as education and healthcare depends on both the intangible information and the quality of the interaction between the provider and the client.  [People may like or dislike their teachers, but they don't explicitly think about quality of interaction or really think through the notion that a student must play an active role in the process. You can't pour knowledge into a student's head the way you pour oil into an engine.]  But since the value of an interaction is not visible in the form of cash or other rewards, there’s very little incentive for organizations to really improve the interactions through innovation.  In fact, the economics are such that innovative providers who care enough to try to improve the system usually get penalized in the form of fewer billable hours, fewer reimbursements, or more time away from their private lives.  [Lot's of poorly understood concepts there: incentives, innovation, economics....]

By now most people have turned away to find a more engaging conversation partner.

Then comes the real kicker, transitioning to an innovative service economy requires a new approach to pricing.  A dynamic system that can make visible the value of interactions to both provider and client.  Perhaps using the equivalent of complex numbers (AKA imaginary numbers like the square root of -1) where one component represents the tangible good (supply/demand) and the other represents the intangible (information/quality) parts of the exchange.  Except for true fellow geeks, that’s pretty much a show stopper for the audience.  [And even the geeks are as likely as not to go off on a number theory tangent.]

For the few kind souls that remain, I can finally get to the point – UnaMesa plays the role of a “market maker” for service innovation.  We facilitate and promote better services by “buying” and maintaining software, web services, and other intangibles that support 2-way interactions between providers and clients.  We aim to help create a robust system for the exchange of intangibles and foster service innovation that truly values and makes visible the value of better experience for both providers and clients.

For example, SharedRecords.org is a free, online service for securely storing and sharing medical records, transcripts, and any other information that a doctor, teacher, or social worker needs in order to care for a client.  By making the infrastructure freely available, we ensure that the digital version of the information can be retrieved wherever and whenever needed but it’s always under the control of the client and their providers.  Instead of fighting with the bureaucracy of a hospital or school to get access to their records, clients give the equivalent of a receipt to their caregiver who can instantly access the relevant documents.  From the SharedRecords point of view, timely access to your medical or educational history should be the equivalent of roads, bridges, and waterways, part of the basic infrastructure that we all take for granted.  It should not be a point of competition between service providers.

The alternative approach: UnaMesa as an Open Space for Knowledge

The Peninsula Open Space Trust (POST) , and similar conservation organizations, protect natural lands by purchasing private property and converting it into preserves and park lands that benefit the larger community in perpetuity.  In Silicon valley and the larger San Francisco Bay Area, these organizations have played a critical role in maintaining the beautiful landscape and large tracts of wild areas despite the tremendous pressures of commercial development.  The open space supports a vibrant natural ecology that benefits everyone living in the area.

Similarly, the UnaMesa Association seeks to protect and maintain intangible property that supports a healthy knowledge ecology.  We acquire private “intellectual property” on behalf of the community and encourage compatible uses of that knowledge to serve the public interest.  Because UnaMesa is a “not for profit”  organization, individuals and organizations can trust that their use of the software, services, books, or other intangible properties will not be subject to “monetization” by a private property holder who could deny them access or demand royalty payments.

This trust encourages people to build upon the property held by UnaMesa in order to continually improve and add to the knowledge.  Unlike the physical property held by POST, UnaMesa’s goal is not preservation.  Rather we seek continual improvement of an ever expanding knowledge space.  Whereas access to physical property must be limited to avoid the degradation that comes with usage, intangible property and knowledge benefit from widespread & unlimited use.  Fixing a bug in a software program, re-using a lesson plan, or sharing best practices in maintaining medical records benefits all community members.  This is just the opposite of real property where consuming an apple or chopping down a tree makes it unavailable for anyone else.

So, UnaMesa acquires intellectual property, maintains it and makes it accessible to the community while promoting compatible uses that increase the pool and value of knowledge.

Similar to POST, we operate as a Trust to hold intellectual property in the public interest and work with the broader community to identify properties of interest and solicit the resources necessary to acquire those properties.  In some cases, this might mean getting a compatible license rather than acquiring the copyright directly.  These licenses are analogous to “conservation easements” and other arrangements that POST might use to protect natural lands.

The TiddlyWiki community is a good example of this whole process.  TiddlyWiki is a piece of wiki software that runs directly in a web browser.  It’s a bit like the software behind Wikipedia except it does not require any server side software.  This means that any individual or organization can create their own wiki and have complete control over how that wiki operates.  They can share the wiki with others by simply sending them an HTML file.  No Internet connection is required to view or to add to the information.  UnaMesa acquired the TiddlyWiki core software in 2007 from Osmosoft, a small software development group.  This ensured that the TiddlyWiki software remained accessible and supported by the community even after Osmosoft was purchased by British Telecom later in the year.  Over time, the number and types of uses has continued to grow and evolve.   TiddlyWiki is now used in a wide variety of settings, including by students and teachers sharing class notes, doctors maintaining medical notes, and as a tracking tool for engineering project managers  – in addition to the core function of being a personal notebook.  UnaMesa supports this community by hosting a software and knowledge repository at TiddlyWiki.org, paying for maintenance and improvement to the core code, and responding to requests for help on the newsgroups.  In return, community members contribute “plugin” software that improves the function of TiddlyWiki, templates and example documents for others to use, and plenty of support to each other through the online forums.

Just as POST is not the only conservation group, UnaMesa is not alone in trying to create an open space for knowledge.  Creative Commons has done a tremendous job in drafting and promoting copyright licenses (e.g. “easements”) that encourage reuse and distribution.  The Free Software Foundation, the Apache Foundation, and the Mozilla Foundation are the better known examples of groups that promote the development and distribution of open source software.  I liken these groups to agricultural or land use coops where a group of farmers might come together to protect their access to water or build a shared processing plant.

The primary focus of the software foundations lies in developing specific pieces of sofware.  They’re generally run by and for the developers to spell out the rules of how software updates are contributed, who gets to decide what code goes in the “official” release, etc.  To my knowledge, however, these organizations do not generally pay developers for their contributions, they do not focus on the needs of service providers (e.g. education, healthcare, social services), and they do not seek to acquire other types of intangible property that would serve the larger community.

UnaMesa is still a very young organization and very much an experiment in ways to improve service innovation.  We believe that there’s a tremendous and productive middle ground for innovation and knowledge that lies between the extremes of private “free” property.  The conservation model of POST provides some interesting analogues for us to follow.

In the end,  UnaMesa wants to do two things:

  • Make sure that the developers, writers, teachers, and other creative folk can earn a decent living, while
  • Encouraging and promoting widespread access to knowledge that’s necessary for delivering the best possible education, healthcare and social services

In other words, we want to help create the foundation for a healthy service economy where we, as a society, can see and make decisions based more on the quality of interactions and rely less on the industrial notions of supply and demand.

Well, I’m still not sure if the POST analogy works better.  Will have to try it out at the next dinner party and see how many people fall asleep.  Sure can’t be worse than the old approach!

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June 19, 2009

How to deliver healthcare information via mobile phones?

Posted by gregwolff under Healthcare, MORE, Mobile | Tags: , , |
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We often hear about the lack of access to drugs and other medical treatments in the developing world.  However, for many people in underserved areas, the problem is not lack of expensive drugs but the lack of access to basic medical knowledge that causes needless suffering, pain, and death.  All the drugs and treatments in the world won’t help cure diseases without the knowledge of when and how to use them.
Recognizing this fact more than 35 years ago, Hesperian published a small book called Where There Is No Doctor.  It immediately became a “cult classic” for Peace Corps volunteers, international aid workers, and community health workers.  Translated into 70+ languages, this practical and down to earth guide has saved countless lives and greatly reduced suffering around the world from headaches to broken ankles, worms, the common cold, and everything in between.

Last year the Bill and Melinda Gates Foundation asked Hesperian to update this wonderful little livesaver for the 21st century.  First and foremost this means reworking the content (HIV/AIDS did not exist when version 1.0 was published).  It also means using new technologies, such as mobile phones and the Internet, to develop and distribute the material.

As Hesperian’s technology partner on this project, we face the daunting task of helping them figure out what it means to deliver safe and effective healthcare information via mobile phones.  Last year Hesperian did a few experiments with SMS text messaging.  They quickly determined that 160 characters was just enough information to be dangerous.  Sure that pain in your tummy could be just indigestion which can be cured with antacids.  On the other hand, it could be appendicitis which requires immediate surgery.  160 characters just isn’t enough to safely distinguish between cases like these and provide appropriate information.

Fortunately, many other groups are working hard to figure out what “mHealth” (mobile health) means and how best to create good systems of care.  For example, some projects have tried using interactive voice response systems, recorded messages sent in response to an SMS, in order to deliver healthcare information.  We’re still investigating these but to date nothing has emerged as a clear winner.  (For a good overview of mHealth efforts, see the recent UNF / Vodafone report prepared by VitalWave consulting.)

Today, most of the money and attention has been going towards collecting data from the field rather than delivering knowledge to the point of care.  For example, the EpiSurveyor product from Datadyne has been used by the WHO in 13 countries in sub-Saharan Africa to collect epidemiologic data from mobile phones and PDA’s.  It’s easy to understand why the WHO, policymakers, other aid organizations, and national officials might to collect the data on illness in order to allocate resources effectively.  However, data collection does little or nothing to help a person with an illness.  They simply become another data point used to generate statistics and plead for more funding.

The real promise of mHealth  rides on a two-way system where knowledge about diseases and treatments flows down to the individual point of care while epidemiologic data flows up to the regional and national care centers.  That promise comes down to the details of the interaction between a health-care worker and a patient.  How can we use technology to inform that interaction with timely, relevant, and accurate knowledge?

The first version of Where There Is No Doctor succeeded because it took a narrative approach to healthcare knowledge.  Instead of listing diseases and treatments, it provides a context for the dialogue between patients and healthcare providers.  It ties healthcare information into the local communities with home remedies (gargling with salt water instead of buying cough drops) and explain how environmental factors, like clean water, affect health.  Each interaction was illustrated with a series of simple diagrams that supported readers with low levels of literacy.  How can we take that contextual information and recreate meaningful dialogues on the limited screen of a mobile phone?  Finding an answer will take lots of work in the field.  Going together with partners to health workers in real-life communities, getting their thoughts on what works and what doesn’t work, asking them to try early prototypes, and continually improving interaction in response to their voices.  All this means that the content development effort becomes substantially harder.  Instead of creating pages of printed information, the Hesperian staff has to create the equivalent of short stories or scripts for each topic.  Chunks of information that can be packaged and delivered to field workers in conjunction with partners.  If you have experience or ideas on what works, please contact us.  We’re actively looking for partners on this project.

Community health workers will continue to serve as the eyes, ears, and hands of the national and international health organizations for the foreseeable future.  Mobile technologies promise to empower those workers by informing them with the most effective tools and treatments available.  Now the question is how to deliver on that promise.  We believe that Hesperian’s strong reputation for working with underserved communities to provide practical, useful, and accessible information gives this project a good shot at delivering on that promise of better health for all.

 

May 11, 2009

Innovations in US Education

Posted by gregwolff under Education | Tags: , , |
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“Two years ago, Barr had asked L.A.U.S.D. to give his charter-school-management organization, Green Dot Public Schools, control of Locke, and let him help the district turn it around. When the district refused, Green Dot became the first charter group in the country to seize a high school in a hostile takeover.” -From The Instigator published in The New Yorker May 10, 2009

This weekend, the New Yorker and the New York Times profiled some radically effective innovations in US public schools. The dreadful state of many US urban schools has been a stain on America’s conscience for many years. The quote above comes from The New Yorker profile of Steve Barr and his Green Dot Public Schools. Writing in the New York Times, David Brooks reviewed the very successful Harlem Children’s Zone project.

These projects present fine examples of what’s possible and. perhaps. what we should expect from our students and teachers. The Harlem Children’s Zone and Locke High School also demonstrate the tremendous power and resolution of individuals in the face of adversity. One hopes that they will usher in a wave of change schools across the country so that getting high-quality education for our children does not require civil unrest and mass protests in each school district. Unfortunately. the prospects look dim for widespread, radical re-making of existing schools through either peaceful or hostile means. However, new technologies and emerging social structures may bring about a silent revolution in education.

In their book “Disrupting Class,“  Christensen et al. offer an insightful analysis of the problems:

“The fact that schools are in the lower-left world of disagreement helps us understand why certain remedies that reformers have experimented with in the past have not worked. The model asserts, for example, that financial incentives, like pay-for-performance schemes for teachers, will not work. Most of these schemes have failed because their efficacy is predicated upon a modicum of agreement on what is wanted and how to get there. The board of almost every school district has a vision statement and strategic plan for how to achieve its vision. But the boards find that these rarely cause their diverse constituents to line up and cooperate in pursuit of those plans. Instead, they get caught up in the daily conflict and compromise that are inherent in the lower-left realm of disagreement. The scary thing about this situation is that democracy—the primary tool that the law allows—is effective only in the upper-right circumstance, when there already is broad, preexisting consensus on what is wanted and how the world works. And what is worse, like all the tools in the matrix’s culture quadrant, democracy is not an effective tool for radical change. So is it possible that changing public schools is impossible?”

In this quote, Christensen is referring to a simple diagram where one axis is degree of agreement on goals (what people want from education) and the other axis is the amount of shared understanding of how the world works. Christiansen argues that moving from the lower left (no shared goals or common understanding of how to achieve them) to the upper right (general agreement on both what the community wants and how to get there) requires some “strong-arm” techniques such as Barr’s “hostile takeover.”  While such methods can be shown to work, sometimes by outside players like Barr, other times by a strong mayor asserting control over a district, they don’t scale well and are not easily repeatable.

While Christiensen remains pessimistic about the prospect of directly changing existing schools, he’s quite optimistic that these schools and the nature of education will soon change. The main point of the book is that a major disruption is already occurring in education but happening outside the traditional school framework. He cites many examples in other industries to show that these innovations will soon (within the next 5-10 years) bring about major changes in traditional education. For example, he extrapolates from current data to predict that in less than 10 years 50% of student “seat-miles” in post-secondary schools in the US will be student driven, online courses. (UnaMesa’s Student Notebook and Virtual Interactive Classroom pilot projects are very small examples of free tools that might help support these types of student driven, online courses.)

I recommend reading the whole book for anyone interested in the topic. The numerous analogies and stories from other industries make this work especially accessible to education outsiders and people with a Silicon Valley perspective.

Disrupting Class : How Disruptive Innovation Will Change the Way the World Learns (Clayton M. Christensen, Curtis W. Johnson and Michael B. Horn)

Here are a few clips that seem most relevant to this discussion. Those of you with small children may be most interested in the Hart and Risley study cited below which shows that talking to your infant before 12 months of age dramatically increases their IQ (as measured at age 3).

Chapter 1: Every student learns in a different way. This idea—that students have different learning needs—is one of the cornerstones of this book. A key step toward making school intrinsically motivating is to customize an education to match the way each child best learns. As we explain in this first chapter, schools’ interdependent architectures force them to standardize the way they teach and test. Standardization clashes with the need for customization in learning. To introduce customization, schools need to move away from the monolithic instruction of batches of students toward a modular, student-centric approach using software [ed. and mobile] as an important delivery vehicle.

…

In public education, the influence that teachers’ unions can wield over textbook and instructional software adoption decisions looms so large that many would-be school reformers have abandoned hope of significant change. We suspect, however, that when disruptive innovators begin forming user networks through which professionals and amateurs—students, parents, and teachers—circumvent the existing value chain and instead market their products directly to each other as described above, the balance of power in education will shift. Administrators, unions, and school boards will capitulate to the fait accompli of larger and larger numbers of students acquiring and using superior, customized learning tools on their own. This also points to a road forward for those venture capitalists, foundations, and philanthropies that hope to invest with impact in education.

…

Hart and Risley tracked the cognitive achievements of the children in their study as they grew older. They administered the Stanford-Binet IQ test to these children at age 3 and found a powerful, direct correlation coefficient of .6 between the number of words the child had heard and the size of the child’s vocabulary. When they eliminated “business talk” from the word count that the children had heard and looked only at what they termed “extra talk” (discussed below), the coefficient of correlation between the words spoken to the child and the child’s measured IQ was .78—about the highest correlation that could plausibly be measured.
…
Cognitive capacity is developed in infancy: the children of lower-income, poorly educated, inner-city parents are trapped in a multigenerational cycle of educational underachievement and poverty. If their parents are not prone to engage in sophisticated, fully adult extra talk, their children will start school seriously disadvantaged and fall further behind from there. The children’s self-confidence and enthusiasm for academic effort, in turn, will dissipate so that by the time they become parents, they inflict the same disadvantages on their children. This is, unfortunately, a generally sound explanation for why improving inner-city schools has proven to be an almost insurmountable problem.
…
But there is hope. One of the most important findings of the Risley-Hart study was that the level of income, ethnicity, and level of parents’ education had no explanatory power in determining the level of cognitive capacity that the children achieved. It is all explained by the amount of language dancing, or extra talk, over and above business talk, that the parents engaged in. It accounted literally for all the variance in outcomes. “In other words,” summarized Risley, “some working, poor people talked a lot to their kids and their kids did really well. Some affluent business people talked very little to their kids and their kids did very poorly. . . . And there is no variance left for race either. All the variation in outcomes was taken up by the amount of talking, in the family to the babies before age 3.

One could very well argue that the Harlem Children’s Zone and Green Dot schools provide empirical validation of this theory. Improve the child’s overall environment and you can bring their performance up to be on par with the most well off in society. Let’s hope we can find ways to bring about that change without widespread civil unrest!

-Greg

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April 6, 2009

Responding to the financial crisis through Service Innovation

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The recent financial crisis highlights the need for social service agencies to do more with less funds. Meeting that enormous challenge requires significant innovation in the way that hospitals, clinics, schools, and other social organizations serve their communities.  The recent financial stimulus package calls for billions of dollars to be spent converting hospitals and clinics to use Electronic Medical Records (EMR) systems.  Billions more will be spent on charter schools and other attempts to improve education.  In spending these huge sums, the administration hopes to save money in the long run and provide better education for Americans.

The ServiceLink project led to the SharedRecords service, an innovation in how community organizations can simply and securely share information.

Good care requires freely accessible infrastructure for sharing information. The ServiceLink project led to the SharedRecords service, an innovation in how community organizations can simply and securely share information.

We all hope that the administration’s efforts will succeed and the money spent will be considered a good investment by future generations.  Unfortunately, experience shows that you can’t always buy the best ideas especially in social services where we don’t have good ways to measure quality, set prices, or even really understand what might be meant by supply and demand.  Consider health care costs, where several studies estimate that in the US 1/3 of all medical costs are attributable to administrative overhead.  (For example see Woolhandler et al and related discussions in the New England Journal of Medicine.)  Much of these costs involve enormous amounts of paper being sent back and forth between providers, insurers, and patients.  The current system pits these groups against each other in competitive and often antagonistic relationships where each is fighting for a bigger slice of a fixed number of dollars.  Insurers deny claims and force additional overhead onto providers, providers respond by limiting the time they spend on each patient, and patients are left with mountains of debt searching the internet to find somebody who can explain their conditions in plain language.  EMR vendors enter this scene with their own competitive goals, gain market share and beat out the other vendors, which create strong incentives for them to create “silos” of data that don’t interoperate well with systems other than their own.  They sell their proprietary systems to hospital administrators looking to reduce the cost of billing and increase revenue.  Increasing the quality of patient care and improving the working conditions for doctors and nurses gets lip service but doesn’t show up on the bottom line.  (Our studies and other ancedotal evidence suggest that EMR systems actually reduce the productivity of physicians who now spend more time navigating around the computer system and less time interacting with patients.)

In this environment, it’s hard to see how subsidizing the purchase of EMR systems will change the fundamental economics of health care.  For fundamental infrastructure like gathering and sharing information, I like to use the analogy of roads and waterways.  Consider a road between a person’s home and their job.  If that road is a public road, anyone can use it and everyone benefits from the reduced cost of transportation.  They also benefit from access to services stations and other businesses located along the road and innovations in vehicles built to travel on the road.  On the other hand, consider instead a private toll road where the road owner has the incentive to charge whatever the market will bear, control what service stations and other businesses can be accessed from the road, and dictate the terms of travel.  (Note Texas is apparently considering using some of the recent stimulus money to build toll roads.)
In the case of private toll roads, most of the benefits of improved transportation are captured by the toll road operator instead of enjoyed by the whole community.  In particular, lack of access and barriers to interoperability reduce the overall levels of exchange and innovation in the community and thereby diminish the wealth of the community.

Partly for these reasons, UnaMesa focuses on ways to create freely accessible infrastructure necessary to support team based public services.  UnaMesa projects facilitate and support innovation in three main areas:

  • data gathering and sharing through flexible combinations of paper, web, and mobile phones
    • Example: free SharedRecords service for simple and secure sharing of records between clinics, schools, and other care providers
  • cost effective connections between providers and clients
  • access to knowledge communities that deliver contextually relevant information through peers and domain experts
    • Example: helping the non-profit publisher Hesperian create a 21st century version of “Where There is No Doctor,” a work that has been translated into 80 languages and is the number one requested text for healthcare workers, peace core workers, and community leaders in hard hit areas of the world

Please see our quarterly newsletter for details on current projects.

Recently we’ve been thinking about what more we can do during this time of financial uncertainty to support the rapid adoption of existing innovations that can lower costs while increasing quality.  In the US, the SharedCare plan of Whatcom county provides a good example of what is possible within today’s environment.  The SharedCare plan uses a combination of Personal Health Records, EMR systems, and local community groups to support cooperation which makes it possible for all the agencies in Whatcom county to share information and deliver better care.  One approach to scaling this innovations envisions UnaMesa or another organization purchasing the component software systems and related material on behalf of the community. By so doing, we could quickly make those services available to providers in other communities for free or at very low cost.  Other ideas include creating repositories of forms and related business processes so that organizations can easily share and adopt the best tools and practices for gathering and processing data.

What do you see as practical next steps for bringing about fundamental improvements to social services?  Do you see opportunities where UnaMesa could make an impact?  If so, please comment below or contact me: GregWolff at unamesa.org.

 

February 24, 2009

Rewarding good service to strengthen communities

Posted by gregwolff under TiddlyWiki
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The TiddlyWiki community has provided some good feedback and interesting discussions since my previous post. First, a number of people have taken the time to fill out and submit the feedback form. A big thank you to all those folks. You can see a snapshot of responses on the summary feedback page.

Secondly, Alex Hough and Morris Gray provided some really great commentary on the overall process. Here’s my takeaway from those discussions:

  1. Feedback forms tend to be associated with the commercial interactions of a customer – worker relationship rather than the “neighborly” or peer-to-peer relationships which dominate in the TiddlyWiki groups and other communities.
  2. We should be looking for feedback mechanisms that help bind the community more closely in a common cause rather than comparative or competitive mechanisms, such as rankings, that tend to separate people.

These comments helped put into words some of the concerns voiced regarding the introduction of any type of assessment measures. They also help lay out the challenges for us and everyone else working to improve social services.

One approach prompted by the above thinking involves asking people to use the TiddlyWikis they create as a tool to acknowledge and demonstrate the help they received from the community. To some extent, this already happens informally. For example, if Alice asks a question about using or writing a plugin, and Bob responds with some help, Alice will often post the new plugin back to the group, sometimes in the same thread. We’re now considering how we might extend that practice and make it easier for both sides.

Thanks, everyone, for your comments. Keep them coming and we’ll keep trying things until we find something that really works.

-Greg

 

February 17, 2009

Rewarding Good Service

Posted by gregwolff under TiddlyWiki
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Have you ever posted a question to a newsgroup and received a helpful response?

Has a teacher ever spent some extra time with you or your child?

Are these everyday occurrences becoming more or less common in modern society?

My own experience suggests that doctors, nurses, teachers, journalists, and even open-source programmers have become less willing or able to create such personalized experiences.  I do believe that most people want to provide a very high level of caring and compassionate service, but they find themselves under increasing pressure to “save time” even as the complexity and difficulty of their jobs continues to increase.  Modern society sacrifices personalized care on the altar of efficiency.

It doesn’t have to be this way.  Instead of paying people based on the time they spend, we could figure out ways to pay them based on the quality of the experiences they create.  Suppose, for example, that the pay for a social service worker or a customer support person was directly tied to the feedback from the people they assist.

We already do this to some extent.  In many regions, waiters and waitresses earn tips that depend in part on the dining experience of the patrons and in part on local customs or expectations.

From society’s point of view, reward and good service is a means to an end.  The end should be allocating knowledge and resources to create the best experiences (the most “value”) for members of the society.   Doing that probably requires more than simply making pay dependent upon feedback.  We should go a step further to ensure that the feedback mechanisms result in better pairings between providers and clients.  For example, visual learners might do better with visually oriented teachers and vice versa.

To achieve better pairings, we could do a few things:

  • make the feedback public so that (potential) clients can make more informed decisions when seeking services
  • likewise provide reliable information about clients to providers in advance
  • give both providers and clients a choice in pairings

What does it mean to “give providers and clients a choice”?  There are several answers to this question.  One method used in matching medical students to residency training positions involves students selecting 3 or 4 preferred locations and then the providers “choosing” students through a matching process.  Two sided auctions, where clients and providers “negotiate” a price would be another example.  Something like this already goes on in online groups where people with a question post it to the list and other people (“the providers”) choose which questions they want to answer.  Yahoo Answers and others have experimented with this method where the poster adds a dollar amount they are willing to pay for an answer to the question.

At the UnaMesa Association, the problem of rewarding good services affects us directly.  As part of serving the community, UnaMesa Associates often answer questions and provide other assistance through online groups.  Unfortunately, currently we have no principled method for gauging the value of the assistance being provided.  This means that decisions often come down to very rough guesses about what we could do to best serve the community.  Should we spend more time answering community questions or should we spend more effort on developing new features?  Which features should we add?  Who could we serve better?

In an effort to do better, we’re starting a little experiment in getting feedback from community members who have been assisted by UnaMesa Associates.  This will be an optional feedback form for those who have received help.  Unlike most such surveys, we plan to use this feedback to partially determine compensation to be paid to the associate.  Furthermore, we’re not limiting the feedback just to current associates, but allowing people to provide feedback on help received from others who may or may not be affiliated with the UnaMesa Association.  If and when these people become affiliates of the association, they will be eligible for “back pay” based on such feedback.

In addition to simple feedback, we also allow people to donate money to those who have helped them.  These tax deductible (in the US) donations will go directly to support the designated associate in addition to the funds provided by the UnaMesa Association.  Over time we hope this process helps us to serve the community better.

Here are a few things we expect might happen:

  • Associates will include “How’s my driving” style tag lines that invite people to give feedback on the help they receive
  • Associates will be more likely to help people who have provided feedback in the past, and even more likely to help people who have donated
  • Community members may start tailoring their request to specific associates who have received good feedback (all feedback will be aggregated and posted on a regular basis)
  • As a group we’ll see what types of questions and help generate the most positive feedback and factor that into future decisions about where to spend UnaMesa resources.

You can see our initial attempt on the UnaMesa support wiki: http://support.unamesa.org/FeedbackForm

Of course, we all recognize that money isn’t everything.  Society has also found ways to reward good service in addition to base pay.  Doctors enjoy a certain level of prestige, organizations recognize excellent teaching through awards, and answering questions on a newsgroup and other altruistic acts can boost your reputation both online and offline.

Yet these ad hoc methods don’t provide much help when it comes down to allocating resources on a daily, quarterly, and annual basis.  We hope to find methods that really do change the system and, for example, encourage students and teachers to form mentoring relationships that go beyond standardized testing.  If you know of other approaches worth considering, please provide a link in the comments.  We’d really love to find something that works.

 

January 26, 2009

Creating the tools for Disrupting Class

Posted by gregwolff under Uncategorized
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Almost everyone I know complains about the sorry state of schools in the US.  In “Disrupting Class,” Clayton Christensen, Curtis Johnson, and Michael Horn offer a unique and well researched perspective on the crisis, how we got here and what we can do about it.  One passage in particular stood out for me:

“… investing in technological platforms that will enable children to create tutorial tools for each other, that help parents to create tools for their children and others’ children, and that make it easy for teachers to create tools for their students and for other teachers will have extraordinary impact. This is because we learn most deeply when we teach others. Funding the development of these platforms and the user networks within which these learning tools can be exchanged will be financially rewarding for investors and socially rewarding for philanthropists. Remember that students, parents, and teachers are desperate to be able to diagnose and resolve their own learning problems and teaching deficiencies. These are highly motivated people who in the past have been trapped in interdependent systems that stymie custom solutions at every turn.”

Disrupting Class : How Disruptive Innovation Will Change the Way the World Learns (Clayton M. Christensen, Curtis W. Johnson and Michael B. Horn)
- Highlight Loc. 3937-44

That short paragraph gives voice to the motivation for the Student Notebook project, the Virtual Interactive Classroom and similar efforts to create tools that put the power to shape and share educational materials directly in the hands of students and teachers.  Christensen et al. also argue that “user-generated student-centric” tools will become mainstream by 2014 when online courses will have a 25% market share in high schools as predicted by their substitution curve analysis.

Thanks to Gunnar Counselman for recommending the reading, I would highly recommend this book to anyone interested in improving our educational system.  It also helps to illustrate the role of service innovation in bringing about positive change.

Scene from a VIC lesson

Scene from a VIC lesson

 

January 15, 2009

Unlocking the power of teams

Posted by gregwolff under Uncategorized
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“This inauguration isn’t about me. It’s about all of us.”
-US President-elect Barack Obama

There’s a deep shift taking place in how we view our political economy. Like the shifting of the tectonic plates that make up the earth’s crust, we cannot directly see this shift but only observe the indirect effects when the tension becomes great enough to cause sudden movements. In geology we feel the shaking and see the flattened buildings caused by earthquakes. In politics we see massive crowds and the and unlikely election of a black man to be president of the United States. In economics we see knockdowns in the credit market and the bankruptcy of revered financial institutions. For people living through these events, they seem like random, unexpected changes in the normal course of life yet the underlying forces are always active, constantly pushing those plates in a particular direction.

For the political economy, by which I mean the western systems of market based exchange and national governments, those forces are pushing us away from the industrial era “Producer / Consumer” viewpoint towards an information era “Provider / Client” understanding of ourselves and our society. In the place of buyers and sellers competing against each other in a marketplace, we see bloggers and readers talking to each other in a blogosphere, or we have people writing software and people using software working together on open source projects.

The rise of microfinance illustrates the importance of social connections relative to individualistic capitalism.

The rise of microfinance illustrates the importance of social connections relative to individualistic capitalism.

It’s not as if markets are going away or bloggers can live on a daily dose of web links. Instead it’s a recognition that much of what individuals value and consider important cannot be readily produced in factories or measured in markets. While this has always been true, recent changes in information technology have made some of these hidden values visible AND  have greatly expanded the opportunities for social interaction thus bringing a dramatic increase in the wealth of social connections.

Yochai Benkler and other economists have been studying this phenomenom for a few years. In “The Wealth of Networks“, Prof. Benkler argues that what he calls, “Peer Production” should be considered on par with other modes of production.

When compared with the dominant capitalist viewpoint, this “connectionist” viewpoint provides some interesting insights into making sense of our world, especially when we look at education and healthcare. From the capitalist point of view, a student “buys” an education (or the state purchases the education on their behalf) produced by a school. Every student has a “right” to the same product.

From a connectionist point of view, students build relationships with teachers, mentors, and other students in the pursuit of shared learning goals. Instead of a school producing an education, we have a team producing an experience in which the student plays a central role. Every student has the opportunity to create a positive experience for themselves AND their team.

A few months ago the potential for a profound impact on education became clear to me when I had the good fortune to meet Gunnar Counselmann, the CEO of the non-profit TeamPlay Foundation. Gunnar and his financial backer, Baron Davis, are passionate about the importance of connections in education -  especially in poor, urban school districts in the US.

Starting with schools in Oakland, CA, TeamPlay uses information technology to connect students with a team of mentors and peers – think “Facebook for Mentors.” While TeamPlay has just completed an initial pilot project and is still building out their tool, response has been overwhelming from both students and mentors. Mentors especially like the notion that they are part of a team and are not solely responsible for the student. It also helps that the modern technological tools available allow the students and mentors to build up relationships using email, mobile phones, and other tools that fit into their busy lives.

I’ve been so impressed with Gunnar and his vision that we’ve started discussions on how UnaMesa might help develop the information infrastructure that supports these teams and how it might apply to other services, such as caring for an elderly patient or someone with a critical illness.

President-elect Obama, clearly understands the rising power of social connections. When he says the inauguration “isn’t about me…” he is not just being modest. This election, and his campaign in particular, depended on the actions of people around the country coming together to connect with each other on a local level in their own way and with their own passions. The Obama campaign was able to use information technology to facilitate those connections and create good experiences for the participants.

For everyone’s sake, let’s hope the President-elect and his team are right and that local connections which powered his campaign can also be used to power a fundamental shift for the better in how we view ourselves and how we participate in educating our children, caring for our sick, and creating new economic opportunities.

 

January 8, 2009

Happier 2009 & Lessons from 2008

Posted by gregwolff under Academy, Social Enterprise, Uncategorized
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Welcome to the UnaMesa blog for 2009.  Starting with the new year, we’re making a few changes here at the UnaMesa Association.  First and foremost, we will be striving to more clearly communicate the goals, as well as the results, of our efforts to create innovations that improve team based public services.  Gone from this blog are the detailed, overly technical weekly blog posts from our conference calls. These can still be found, however, on our project wiki. In their place, I and other UnaMesa Associates will be posting regular updates on our projects.   These  blog postings will be part of a larger communications strategy put into place with the goal of helping social service organizations learn about and benefit from tools like TiddlyWiki and SharedRecords.  You’ll be hearing more about this strategy in coming weeks.  (Thanks to Barak of Rassak.com for helping us develop a more effective approach to communications.)
To begin the new year, I’d like to describe a bit of what is meant by team based public services and highlight a few learnings from our projects in 2008.
  • Public services include education, health care, and the other fundamental benefits that communities provide to their citizens
  • Team based means that the recipient (or “client”) interacts directly with the providers of a service and plays a key role in delivery of the service.  For example, a student must play an active role in and interact directly with teachers in order to get the benefits of an education.   (This contrasts with public utilities, such as sewer systems or roadways, where there is little or no interaction between the client and the provider.)
Ignorance and lack of access to information are the biggest challenges facing team based public services.  For example, health-care workers cannot provide appropriate treatment for a patient without knowing that patient’s medical history.  Similarly, teachers cannot provide the best education to students when they lack textbooks and other basic resources.
I originally started work on this problem in 2004.  As a fellow in the Digital Vision Program at Stanford University, I was surprised to learn that these problems were not unique to the developing world and emerging economies.  Public services in the US and other developed nations also suffer from these problems with the end result being individuals who are sicker, less educated, and less happy than would be possible with an increased level of resources.  (Bhutan, where “Gross National Happiness” is more prominent than GNP, may be an exception.)
Clayton Christensen and his coauthors of “Disrupting Class: How Disruptive Innovation will Change the Way the World Learns” lays out the serious barriers to improving a public service like education.  The UnaMesa Association takes a page out of the Christensen playbook by focusing on innovations at the grassroots level.  In particular, we focus on providing tools for gathering and sharing information in communities where the providers and beneficiaries are not currently using any information technology -  such as a child resources center that uses only paper records and file folders to manage their data.  Christensen calls this “competing with non-consumption” and  gives many examples where solutions that work here “at the bottom” disrupt the status quo (because of their radically lower costs) and can go on to change the way industries or public sectors function (by changing expectations).
In 2008, UnaMesa participated in three projects focused specifically on decreasing ignorance and increasing access to information.
  • The UnaMesa Academy pilot project in Oakland, California looked at  helping staff members of social service organizations incorporate free, digital tools into their processes for gathering information and recording client interactions
  • The Virtual Interactive Classroom in Bangladesh used a combination of video broadcasting and mobile phones to bring high-quality English courses to students who have never been in a physical classroom
  • The Student Notebook project in Ontario, Canada gave students a private, automatically updating copy of the teacher’s presentation materials and  resources which gave students an unprecedented ability to make and share their own  notes and create unique learning experiences suited to how they learn best.  (See the professor’s blog post on his view of this pilot project.
In this post, I’d like to touch on a few learnings from the Academy project.  (See the links above and http://tasks.projects.unamesa.org/Summary2008 for detailed information on all the UnaMesa projects.)
Originally we envisioned the UnaMesa Academy as tackling a paradox of social service organizations.  Our research and that of others has shown that these organizations could save a significant amount of time and money by using digital tools in place of or in combination with paper filing systems.  Today staff members and clients spend a lot of time pulling paper charts out of filing cabinets, filling out redundant paper forms, putting charts back into filing cabinets, looking for misplaced files, and faxing documents back and forth.  Simply scanning those paper forms and making them available electronically can substantially reduce the workload, make sure that information is never lost, and make more time available for providing care.
The paradox is that the social service organizations never have the time or money to invest in  researching and implementing the digital systems.  Even if it would save them time and money tomorrow, they are so busy and cash strapped today that they don’t have time or resources to even think about changing.
The idea of the Academy was to break this paradox by working directly with staff members of several organizations on their problems “today.”  Give them free tools and free support to help reduce their workload and figure out collectively what’s the best way to gather and share the information needed to serve their clients.  Then, as these best practices took root in their organizations, help the solutions grow and spread to other organizations in the same field.  The goal was a very low cost, low risk approach to incorporating digital tools into their workflow that could be spread virally from organization to organization.
The current process for tabulating tutoring notes and progress reports

The current process for tabulating tutoring notes and progress reports at AICRC

What we found was that, yes, organizations could greatly benefit from digital tools.  The picture on the left shows the current “sorting” step in the workflow process at AICRC (American Indian Child Resources Center) which participated in the initial Academy pilot.  (A big thanks to AICRC for their willingness to work with us and to try something a little bit different.)

However, we also found that saving money and even saving time was not particularly a strong motivator for participation.  Instead, the biggest factor cited by staff was a desire to “Go Green” by reducing paper usage.

We also found that once people started with digital data collection, they got excited about the new possibilities for organizing the information to better serve their clients.  (The sorting process as shown in the picture would be done automatically with digital data and would allow the organization to sort and view data in completely new ways.)

Mostly we found that the original idea of the Academy – to gather multiple organizations together – was simply not possible logistically.  We also found that organizations were very reluctant to consider widespread changes in their overall workflow.  Instead, they much preferred very narrow or incremental changes, such as collecting contact information digitally while keeping other forms on paper.  This approach would minimize the impact on their existing operations.

Based on these findings, we’re looking at an alternative approach to introducing innovations in data gathering and sharing.  This new approach focuses on creating specific digital tools for the very common data needs of many social service organizations, such as collecting contact information.  We now think that we can create a small library of robust, digital forms complete with web based storage and processing which will work with existing paper based worfklows.  Organizations can immediately adopt these specific forms and see benefits without disrupting their existing workflow. (There will be a few options for them as far as customizing the forms, for example, with the organization’s name and pre-filled data.)  This base of template forms will then serve as a path for continually introducing and incorporating more effective tools for gathering and sharing data.

Eventually, we plan to integrate this work with the OpenRosa project to allow data gathering by mobile phones as well as web based interfaces and paper forms.    In this effort, our goal can best be summed up as “the right information at the right time to the right people“.

As always, we welcome your comments and suggestions.

-Greg

 

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