Crossposted from Forbes, thanks Ashoka!

Over the last few decades, we’ve seen bachelor’s degrees skyrocket—between 2000 and 2010 alone, enrollment in degree-granting institutions jumped 37%. But there are thousands of people—particularly, young people from low-income backgrounds—who are missing out. By age 24, only 9% of students in our nation’s bottom income quartile earn a bachelor’s degree, compared to 75% of their peers in the top quarter. Similarly, African American students are earning degrees at half the rate of white students; Latino students earn at one-third the rate. How can we reconcile such glaring disparities?

Published 12/2/14

There is a crisis in the public consultation world.

Citizens have lost confidence in public consultations. They feel jaded. They no longer trust their decision makers, whether it be business leaders, politicians, or bureaucrats. They think that if—for example—there is a proposed real estate development, it will happen whether they have a say in it or not.

The current state of public consultations leaves a lot to be desired. Public meetings have become a stage to vent frustrations and a crusade for causes that often have no bearing on the project or proposal under consideration. People who don’t enjoy unpleasant, politically charged meetings do not attend, choosing to spend their evenings elsewhere. As a result, it is unlikely that the audience at public meetings accurately represents the sentiments of the broader community.

This is a shame. Public consultation is a key aspect of participatory democracy. Consultation is rooted in the idea of the knowledgeable persuasion of fellow residents, not the coercion, or the sneaking behind the backs, of peers. Engaging the public in a manner that inspires trust, confidence and collaboration is crucial to the long-term success of our communities—and beyond. Meaningful public consultations can enhance the ability of people to affect public policy development and political decision-making in their communities.

 

The Promise of Online Consultations

The ability to easily connect people with issues by bringing public consultation online holds great promise. Online tools can encourage greater participation in public consultations. They offer proponents additional ways to hear the voice of community members and talk with them through a less formal dialogue. They also provide another method to gauge public opinion to inform decision-makers. As a result, online public consultations can be more constructive.

1. Convenience, Expediency and Flexibility

Online consultation platforms can help engage people in more meaningful ways. Each resident has their own life, with multiple activities and responsibilities. They often don’t want to go to a public meeting that requires travel and a significant investment of time. Some people feel overwhelmed by the need to concurrently listen, reflect and respond immediately to information at a public hearing. They prefer having additional time to digest and reflect on the issues in question.

Online consultations are less limited by constraints such as place, time, mobility and other access restrictions. They offer the practical convenience of 24/7 access and location flexibility. Residents can research, reflect, engage, edit, and respond to issues on their own time, at their own pace and in their own places. They can take the time to review a proposed development during their lunch break at work and comment on it from their kitchen once the kids are asleep.

2. Enhanced Deliberation

Online consultations also provide opportunities for enhanced deliberation. The Internet eliminates several barriers and can reduce the peer pressure and social cues that limit participation in face-to-face meetings. Allowing residents to contribute to the discussion from the location of their choice helps to overcome the awkwardness and shyness that keeps some people from speaking in larger groups.

Online dialogue can also helps to overcome stereotypical and prejudicial cues based on a resident’s age, gender, ethnicity and socio-economic background. Reducing these communication barriers facilitates the participation of people who otherwise may exclude themselves from public consultations.

The asynchronous nature of online consultation allows for large-scale, many-to-many discussions and deliberations. The discussion threads allow readers to review and contemplate what others have said on without the pressures of time that often results in simplistic and heated real-time discussions. Even if they do not actively post, the ability to listen and see what others have said is an important part of the deliberative process.

Rather than condensing a conversation into an evening or even a day, online consultations allow for prolonged discussion lasting up to three weeks. This allows for diverse points of view to be more fully explored. Additional consultation time also allows for a sense of trust to be established as rapport between participants grows over time.

3. Increased Civic Awareness

Online consultations also increases civic knowledge. The web-based nature of the consultation platform encourages residents to access additional
information through customized pages and external links. This allows people to review
information about the policy issues, proposals or topics being discussed.

The ability to access additional information on-demand provides a level playing field for residents, enabling equal access to information and closes information gaps. This helps to increase resident awareness, enriches public debate, and leads to more fruitful discussions and better outcomes.

4. Reach Different Demographics

For many people, online technologies are a convenient, efficient means of interaction. This is especially true for younger generations, who see the Internet as an integral part of their daily lives. Indeed, if they cannot connect online, they may not connect at all. Thus, excluding online consultations means excluding a large and growing segment of the community.

However, although computer and Internet access is near ubiquitous in many households, there remains a significant part of the population without access to a computer or the Internet at home. Engaging online therefore, should be seen as an adjunct—not a replacement—to more traditional face-to-face meetings and forums.

5. Affordability

Engaging online also provides cost efficiencies when engaging with large numbers of or widely dispersed people. Online tools can distribute information to a dispersed audience quickly and relatively cheaply. You do not need to rent a meeting room, prepare printed documents or provide refreshments.

The cost and speed of processing large volumes of feedback is also significantly reduced when using online community engagement methods. This makes acknowledgement, analysis and feedback more efficient, timely, and cost-effective.

 

From Promise to Reality

 

 

 

 

The Internet offers great potential in bringing people together to discuss common concerns and exploring issues from varying perspectives. To help realize this promise, a new generation of online platforms like PlaceSpeak are offering new opportunities to enhance genuine consultation and public participation in local decision-making. The ultimate goal is to overcome the current crisis in public consultation by providing a safe online space to conduct meaningful dialogue on important issues.

 

 

 

About the Author

Yuri Artibise is the Director of Community Engagement for PlaceSpeak, an online platform that is advancing online public consultation by allowing citizens to influence the process in an open, safe, secure and transparent manner. PlaceSpeak works with various governments, industry, and non-governmental organizations to promote meaningful evidence-based online decision-making. Learn more at www.PlaceSpeak.com

Published 12/16/14

Thanks to the International Civil Society Center for this summary of their recently released report Diversify, Adapt and Innovate: Changing ICSO Business Models. Find the full report here.

DIVERSIFY, ADAPT & INNOVATE from animanova on Vimeo.

In 2013, the International Civil Society Centre’s report Riding the Wave identified global trends likely to cause disruption in international civil society organisations (CSOs). We saw political disruption as the space for civic action decreases; technological disruption given the effects the digital revolution has on CSOs; and planetary disruption as climate change affects the CSOs’ missions. These disruptions call for changes in the business models of CSOs.

Throughout 2014, we took this work further and looked at changes needed in existing CSO business models in order for organisations to remain viable. The results are presented in this year’s report Diversify, Adapt and Innovate. View the main messages watching this brief video.

We looked at the business models widely used, such as Child Sponsorship, Project Support and Campaigning. We also identified evolving models that have the potential to become mainstream in the future, among them Online Brokerage and Social Enterprise. These and other new models call for CSOs to be more entrepreneurial, flexible and open to partnerships.

The pace and direction of change affecting CSOs is hard to predict. Some disruptions may obstruct successful and well-established business models within a few years whereas others may evolve over a longer period. For CSOs to stay ahead in this transition, we make six main recommendations:

• Strengthen market analysis: Systematically scan the market for data, insights and trends. Be strategic in your response.
• Focus on added value: Take a look at each stage of your business processes and the costs involved. Question whether each stage offers significant added value.
• Test new models: Test and evaluate new business models outside your mainstream business processes. Accept and manage risks.
• Develop networks and consortia: Engage in strategic partnerships connecting organisations with complementary skills and contacts. Promote your mission above other organisational interests.
• Accelerate speed of innovation: Strengthen your ability to make quick decisions. Embrace change, streamline governance and delegate powers.
• Make strategic use of unrestricted funds and reserves: Invest in developing innovative ways of funding your work. Drive down the use of unrestricted funds for overheads and subsidies to existing projects.

CSOs will need to get out of their tight organisational frameworks and turn themselves into open platforms attracting wider support and delivering stronger impact. In short, they will choose influence over control. The CSOs of the future will develop new forms of partnerships with actors inside and outside their sector in order to deliver major contributions to tackling global issues.

Implementing new business models will require a critical assessment of – and major changes in – CSOs’ organisational culture. In 2015, the Centre will therefore work on Building an Organisational Culture of Change aiming to provide recommendations to CSOs on how to develop their organisational cultures in line with the requirements of a fast changing outside world.

Do not hesitate to contact us if you have questions or are interested in being part of this!
www.icscentre.org / mail@icscentre.org

 

About the Author

Burkhard Gnärig, Executive Director, International Civil Society Centre
As a former CEO of terre des homes Germany, Greenpeace Germany and Save the Children International, as an adviser to Amnesty International, CARE, Oxfam, Plan and other leading ICSOs and as the co-founder and Executive Director of the International Civil Society Centre Burkhard Gnärig has a unique overview on developments in the civil society sector.

 

The International Civil Society Centre helps the world’s leading international civil society organisations (ICSOs) maximise their impact for a sustainable and more equitable world.
The International Civil Society Centre works with ICSOs to develop strategies for successfully navigating change. We scan the horizon for exciting opportunities; enable learning and cooperation among ICSOs and their stakeholders; support ICSOs with developing effective leadership and promote robust accountability to strengthen ICSOs’ legitimacy. The Centre is a not-for-profit organisation fully owned by the organisations it serves. We strive to set high standards in management, governance and strategy for ICSOs and the wider sector.

Published 2/13/15 by Caroline Fiennes of Giving Evidence

Charities produce masses of evidence about their effectiveness but we suspect that much of that research is missing (unpublished), ropey (uses poor research methods), unclear (so you can’t tell whether it’s ropey or not) or you can’t find it (because it’s only published on the website of an organisation you’ve never heard of: there are virtually no central indexed repositories). It’s thought that fully 85% of all medical research is wasted in ways like this.

This damages beneficiaries in two ways. First, donors and other operational charities can’t reliably get feedback on whether a particular type of work is effective, so may avoidably implement or fund something suboptimal. And second, the research consumes resources which could perhaps be better spent delivering something which does work.

Hence Giving Evidence, a UK-based organisation aiming for charitable giving to be based on sound evidence, works on availability, quality, findability and clarity of charities’ research.

We know that much charity research is unpublished: when I was a charity CEO we researched our impact, and when the results were good we published them, and when they weren’t we didn’t. I’d never heard of publication bias but I had noticed that bad results make for bad meetings. In our defence, we were just responding rationally to badly-designed incentives.

We suspect four reasons that charities don’t publish their research.

• First, incentives, as outlined.
• Second, they may think that nobody’s interested. By analogy, a campaign in the UK to get grant-makers to publish details of all their grants (which few do) found that many foundations were open to doing this but simply hadn’t realised that anybody would want them.
• It’s unclear where to publish even if you want to: there are few repositories or journals, and no standard ways of ‘tagging’ research online to make it findable.
• Commercial confidentiality given that charities often compete for funding and government contracts.

This first study focuses on UK charities supporting people with mental health issues: the extent and causes of non-publication. Subject to further funding we’ll look for publication bias: whether the chance of research being published depends on who does it, how positive the answer is, and whether it involves feedback from ‘beneficiaries’.

On research by charities being hard to find and unclear, Giving Evidence is working with charities in criminal justice. We’re creating a standardised, structured abstract to sit atop any research report by charities (detailing, for example, what the intervention was, what kinds of people were served and where, what the research was (sample size, how they were selected), what outcomes were measured, the results, the unit cost). It may detail whether feedback was used in the intervention design and/or data collection. This abstract borrows heavily from the checklists for reporting medical research which are thought to have markedly improved the usefulness and quality of medical research. We’re also looking at creating, not a central repository as such, but open meta-data to allow charities to tag their research online and a central search ‘bot’ (rather like this) through which donors, charities, practitioners and policy-makers can rapidly find it. This would also improve the ability of tax-payers, beneficiaries and anybody else to see research which affects them, and to see the gaps where more research is needed.

And on charities research being ropey, we’re working with a foundation to assess the quality of research that their grantees produce. Quality of charities’ research has also barely been assessed. We know of just one study: a UK foundation found that about 70% of research it received from grantees was what it called ‘good’ and some appeared to be totally fabricated.

Medicine has made great strides by enabling front-line practitioners to make decisions based on sound evidence – since in their world, like ours, the right best course of action isn’t always evident. Hence medicine devotes considerable resource to figuring out how much research is ropey, and why, and fixing it. They have whole teams devoted to improving research reporting, to make it clearer. Other teams look at ‘information infrastructure’ to ensure that evidence can be rapidly found; and many people study non-publication and selective publication of clinical research and work on rooting it out. This is very much supported by front-line ‘beneficiaries’: one of the most ardent advocates to get all clinical trial data released is MumsNet, an online community who realise that their lives and children are directly affected.

Finding the true effect of programmes is a type of science – fundamental to which is that results should be repeatable, and not flukes. Mainstream science is reliant on a growing movement to make data about experiments and results transparent and open so that people can see whether they can repeat the results. The social science behind charitable programmes is precisely the same: the methods and results need to be clear and findable enough to see whether results can be repeated, and indeed whether the research is robust enough for that the conclusions to be valid

Thus meta-research – research about research – is essential to improving decisions. Far from just technical and dry, good meta-research can help improve and save real beneficiaries’ lives.

Giving Evidence’s meta-research and work on the information infrastructure are, we think, important steps. We’ll report later on what we find.

If you are interested in investigating these problems in sectors where you operate, or in getting involved in Giving Evidence’s work, do contact admin@giving-evidence.com

___________

Caroline Fiennes is Director of Giving Evidence, and one of the few people whose work has featured in both The Lancet and OK! Magazine. She is author of acclaimed book It Ain’t What You Give, It’s The Way That You Give It.

This talk (17 min) rattles through the issues of quality and incentives in charities’ research.

 

February 24, 2015
Keith Kozloff

 

Take the following case: In January, 2014, the Overseas Private Investment Corporation (OPIC), which is the U.S. Government’s development finance institution, received a detailed written complaint about a project it financed in Liberia. The complaint was submitted by two CSOs on behalf of aggrieved Liberian parties, and it alleged a variety of human and labor rights abuses.  Allegations include contamination of drinking water, physical coercion and insecurity of workers, abusive labor practices, and disruption of livelihood of value chain suppliers.

In response, OPIC management requested that its Office of Accountability conduct a thorough review of the allegations and the actions taken by OPIC and its client, with a view of learning lessons for future projects.   The review was completed in September, 2014, and generated several recommendations for strengthening feedback channels.  The review, however, also identified several challenges facing them:

• The company had established project grievance mechanisms and channels for corporate-community communications but the effectiveness of these channels may have been compromised by concerns of reprisals, weak overall communications in a far flung enterprise, rapid company expansion, and management turnover.
• Affected stakeholders were not made aware of OPIC’s Office of Accountability until OPIC no longer had a financial relationship with the project.
• By the time that the Office of Accountability conducted its review, the company had exited Liberia, and the ability to vet allegations about past human rights abuses was largely limited to one-sided and coached testimony from aggrieved parties.
• Liberia’s post-conflict/weak governance environment compromised oversight from government authorities and created incentives to characterize past events in a manner to obtain financial gain.

The Liberia case illustrates both the opportunities and challenges associated with mobilizing different channels of stakeholder feedback in the service of protecting human rights.  There is growing recognition among investors and project developers in emerging market countries about the value of obtaining feedback from affected stakeholders, including customers, workers, value chain suppliers, and local communities affected by project construction or operations.   Although some natural reluctance remains about receiving adverse information, actively soliciting systematic stakeholder feedback offers a means for developers to manage risks related to corporate reputation, operating costs, and liability.   Even more, such feedback can lead to financial benefits from constructive community engagement and partnerships, as well as from previously unidentified opportunities for maintaining and growing markets for goods and services.

For that subset of project developers that receive financing via an international financial institution (IFI), such as the World Bank Group’s International Finance Corporation, dedicated channels for receiving feedback are often established through IFI policies:

• IFI clients may be required to consult with affected communities early and often, especially if the intended project is expected to have significant social or environmental effects.
• IFI clients may be required to establish project Grievance Redress Mechanisms (GRMs), which are locally-based, project-specific formalized systems to accept, assess, resolve, and respond to feedback or complaints.
• IFI clients typically conduct stakeholder consultations to inform their Corporate Social Responsibility programs.
• IFI managements conduct due diligence and monitoring site visits, maintain communication channels such as hotlines, and consult with local civil society.
• Most IFIs have created accountability mechanisms, which are offices within the IFI that are independent of financing activities and have authority to assess, mediate, and review complaints and disputes.

There is a natural hierarchy/priority in mobilizing different mechanisms.  All else equal, it is far preferable to receive and respond to feedback before concerns escalate into formal complaints or overt disputes.  The first line of defense is thus bilateral interactions between IFI clients and affected stakeholders such as community consultations and grievance mechanisms.  If these approaches prove insufficient, then feedback channels operated by IFI managements may be needed.  As a last resort, the accountability mechanism may be mobilized.  By that point, however, positions have often hardened and trust has broken down.

Increasing visibility and awareness of international principles of human rights is creating new opportunities and challenges for channels of citizen feedback. The roles and responsibilities that governments and businesses have with respect to human rights are becoming increasingly recognized internationally. The UN Guiding Principles on Business and Human Rights (so-called “Ruggie Principles”) include operational principles around three pillars –the State duty to protect, the corporate responsibility to respect, and access to remedy.  Businesses are increasingly recognizing that there are financial risks associated with conflicts around human rights issues.

Broadly speaking, the ecosystem of channels for protecting and respecting human rights as related to business activity overlaps with citizen feedback mechanisms.  This ecosystem includes indigenous approaches dispute resolution, the courts (both conventional and specialized mediation/arbitration courts) project and corporate grievance mechanisms, as well as processes conducted by public sector ombudsmen and human rights offices, IFI accountability mechanisms, and CSOs.  Such channels are particularly important in post-conflict or otherwise weak governance environments, although such environments may also challenge their effectiveness for technical, logistical, or institutional reasons.  While each of the three pillars requires effective channels of communication for their implementation, feedback mechanisms have so far tended to be used most for “access to remedy” purposes; that is, they become activated once an overt dispute has emerged.

The Liberia case reinforces the value of establishing feedback mechanisms in environments with risks to human rights, and ensuring that they are effective in providing timely, confidential, and actionable communications.

 

 

About the Author

 

Dr. Keith Kozloff served from January, 2011, through September, 2014, as Director of Accountability at the U.S. Overseas Private Investment Corporation.  Previously, he was Senior Environmental Economist at the U.S. Treasury Department’s Office of International Affairs

 

Crossposted from Ashoka Changemakers 3/10/15

Closing the loop both the ‘right thing and smart thing.’

(Washington, D.C.) – On March 10, Feedback Labs, a consortium of leading domestic and international organizations in the for-good sector, released the first version of its flagship product, the Feedback Toolkit.  The Toolkit helps organizations improve the way they listen to their constituents to be more responsive to the people they are trying to serve – and ultimately to improve outcomes.  Development of the Toolkit was led by founding Labs member Ashoka Changemakers in collaboration with other founding members including Keystone Accountability, Development Gateway, and GlobalGiving.  Platform was developed by District Design Group, and strategic advice and funding were provided by the Rita Allen Foundation.

Purpose of the Toolkit

As Fay Twersky, Phil Buchanan, and Valerie Threlfall wrote in the spring 2013 issue of the Stanford Social Innovation Review, Labs members believe that listening to constituents “isn’t just the right thing to do; it’s the smart thing to do.”  The Toolkit represents Feedback Labs’ first step toward helping aid agencies, foundations, and governments both listen and act:  What do our constituents want to make their lives better?  Are we helping them get it?  If not, what should we do differently?  For the past year, Feedback Labs has been building a network of practitioners, policy makers, technology platforms, and funders that aim to invert the top-down tendency of aid, philanthropy, and even governments.  Labs members argue that constituents themselves should be in the drivers seat, with experts in a supporting role during the program selection and design process.

How it works

The Feedback Toolkit has two parts: the Feedback Quiz, and the Resource Library. The Quiz is a diagnostic to help you determine where your organization is strongest and weakest along the Feedback Loop. We developed this Quiz in partnership with Keystone Accountability, and it is based on the Constituent Voice Methodology. The Quiz gives you a Feedback Score, and then presents you with a curated list of resources from the Resource Library.

Three kinds of resources populate the Resource Library: Tools (Feedback tools that are cross-listed on the Feedback Store), Guides (how-to guides pertaining to closing feedback loops in specific contexts) and Examples (short case studies of organizations with closed feedback loops, featuring Guides and Tools).

Walking the Talk:

Feedback Labs itself has learned a great deal during the development and launch process about closing feedback loops.  Dennis Whittle, who helps coordinate the work of Labs members, says, “We are calling this release of the Toolkit ‘Version 0.9’ to signal that we intend to walk our own talk and update it soon.  In fact, we will be taking the Feedback Quiz for the Toolkit on a monthly basis, and will be publishing our score. We will also be publishing and responding to all of the feedback you send us here. We commit to responding to your feedback within 48 hours.”

The Labs seeks feedback and invites participation in the following ways:

1)              Feedback Quiz has built in feedback opportunities

2)              Feedback button on feedbacklabs.org

3)              Email us at toolkit@feedbacklabs.org

4)              Tweet (and share!) at @feedbacklabs

“With every new idea that has the potential to be transformative, there is a tendency to jump exclusively into the doing. But for change to be sustained, it is critical to capture and share learning about experiences on the ground,” said Elizabeth Christopherson, President and CEO of the Rita Allen Foundation. “We are excited to see the Feedback Labs Toolkit harness emerging learning about new ways of seeking feedback and acting on it. We hope that it will inspire and inform further experiments to make the social sector more responsive and ultimately more effective.”

Looking ahead

In future iterations of the Toolkit, Feedback Labs plans to implement a profile system, so that individual users and organizations can easily track their progress, and compare themselves against their peers. Additionally, Feedback Labs plans to facilitate communities of interest and other features such as video chats to allow users to engage in deeper conversation with other Toolkit users who are facing similar challenges.

“The scores, benchmarking, and custom resource suggestions are an incredible asset for our team,” said Reem Rahman, Knowledge Manager at Ashoka Changemakers. “As we try to become more agile at improvement and increasing our impact, we will have each team member take the quiz, and seek to improve our results over time.”

 

About the Rita Allen Foundation

The Rita Allen Foundation invests in transformative ideas in their earliest stages to leverage their growth and promote breakthrough solutions to significant problems. The Foundation uses strategic philanthropy to promote civic literacy and engagement, as well as to support young leaders in the sciences and social innovation.

Posted on 4/23 by Bridget Landry of the Business Innovation Factory

RWJF Narrative Playbook from Business Innovation Factory on Vimeo.

 

In healthcare, numbers matter.  They are the measures of physical condition – blood pressure, temperature, height and weight – in a patient profile. They govern the amount of time a provider spends with each patient daily (for medical residents, an average of eight minutes) in order to elicit the information needed for assessments and diagnoses.

Increasingly, research shows that a vital aspect of that information is the patient context: the environments, values, relationships and experiences that shape who patients are and how they live. This context directly impacts health, and shapes the challenges patients face in striving to be well; communicating about life outside the four walls of healthcare is thus integral to healthcare that addresses patients’ individual needs.

Doing so without established frameworks, however, can be challenging  – especially when quantitative measurements are also crucial and time is short. In confronting this potential challenge, healthcare narrative methods (also referred to as storytelling) are proven, useful tools. They provide the frameworks to create better feedback loops among patients, providers and their caregivers and to ensure that patients’ needs are continuously identified and addressed.

What Is Healthcare Narrative?

Narratives are the systems of stories that compose our human histories and identities; healthcare narrative methods are the carefully designed prompts and processes that elicit these stories, in ways that positively impacts health, care, and healing.

Narrative methods are by nature versatile. Patients, providers, or caregivers can use them. They facilitate processing thoughts and emotions related to healthcare experiences, identifying patterns affecting health or healthcare choices, or reflecting on clinical interactions (and course-correcting when necessary). They include the acts of articulating, reflecting on, listen to, and sharing the stories of our experiences.

With support from the Robert Wood Johnson Foundation, the Patient Experience Lab at the Business Innovation Factory united thirty thought leaders in healthcare narrative methods for a Healthcare Narrative Participatory Design Studio (PDS). In this facilitated space, participants identified and shared healthcare narrative best practices. Several areas of opportunity for healthcare narrative use emerged:

• Ensuring that lines of communication are functioning optimally and continually, so that a patient’s context is understood and adequately addressed by his or her provider in plans for care.
• Enabling communication that allows patients to advocate for their needs, and to allow all parties to process their healthcare experiences in a way that contributes to their well-being.

Below are only two examples of the many healthcare narrative methods that address these areas of opportunity.

Others, including peer-to-peer sharing, expressive arts (e.g. theater and role-playing, visual arts), and active listening, are detailed in the Healthcare Narrative Playbook. Created to codify the insights from the Participatory Design Studio, the Playbook is a practical resource that provides context-specific strategies for healthcare narrative method use.

 illustration by Rachel Brian

Examples of Narrative Methods, Use and Impact

1. Personal Narrative: the act of telling one’s own stories, both to understand contexts and to reveal needs for care and healing. Stories can be elicited through key questions that invite patients, providers and caregivers to reflect on their lives outside of clinical settings.

Some sample questions to elucidate the stories and contexts that influence the care we give and receive:

• Who are the most important people in your life right now?
• Have there been any significant changes in your life recently? In your relationships? Lifestyle? Finances? Neighborhood?
• What are five things you couldn’t live without?
• What do you hope to be remembered for?

Answering these questions – in writing or conversation, or through other mediums that facilitate expression – and sharing the responses informs the feedback loop between patient and provider with the context that results in effective care plans.

For example: prior to an appointment, a patient might reflect on the story of his life over the past six months, answering the question, “Have there been significant changes in your life recently?” in writing. He realizes that he has moved twice, endured the loss of a parent, and changed jobs; he feels stressed, exhausted, and disoriented.

Because the patient realizes this before his appointment, he brings it up with his provider. The provider subsequently creates a plan of care that includes resources for emotional support; the patient resolves to seek counseling and feels his needs were acknowledged.

This is only one example of the potential use of the personal narrative method – which also isn’t limited to patients. Providers and caregivers can also use questions like those above to elicit their priorities for care. A provider might reflect on the reasons he was drawn to healthcare in the first place and build rapport with patients by sharing how they affect his perspective; a caregiver might realize that her other priorities, like kids’ sports schedules, affect when and how she addresses a sick parent’s medical needs.

1. Journaling: Recording thoughts, feelings, experiences and behaviors can reveal patterns that affect health, and research has also shown that the act of journaling in itself reduces stress and improves well-being.

Examples of journals with the potential to improve health outcomes by closing the feedback loop between patients and providers include:

• Health Journal: Patients or caregivers record key aspects of health both in and out of clinical settings. Record symptoms, fluctuations in mood, stressful events, medication changes, etc. Review and look for patterns, use for reference during appointments and other clinical interactions. Refer to when advocating for needs.
• Stress Journal: Patients, providers, or caregivers write for a short time about their most upsetting experiences – e.g. failed treatments, surprising diagnoses. Crafting the stories of these experiences provides emotional catharsis and clarity.

Impact of Narrative

If the stories of our lives define and reveal who we are, healthcare narrative is nothing simpler, or more transformative, than the use of those stories as informational resources to improve care and healing. A relevant narrative, when shared purposefully, has the potential to inform, reveal, heal, or inspire in ways that contribute to better health outcomes – adding a human lens that enriches healthcare experience without detracting from the essential data and time frames.

 

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About the Author: 

 Author Bio: Bridget Landry is the Patient Experience Lab Associate at the Business Innovation Factory; she   writes, learns, shares, and connects to support the Patient Experience Lab’s work.  The Patient Experience Lab works with our healthcare system and national funders to explore individuals’ experiences of health and wellness, and to use those insights to design transformative new business models that enable healthy lives. 

At the Business Innovation Factory we rely on the co-creation of feedback loops with real-world users, in order to design systems that we all want to be a part of. Interested in learning more about us? Learn more about the work of the Patient Experience Lab here, or follow us on Twitter @BIFpxl.

Crossposted from Accountability Lab
5/1/15

Crossposted from Community Solutions
5/14/15

By utilizing data, communities are creating systems that are built for learning in order to change and improve as they go, helping them prioritize resources, identify gaps and match people to the best housing opportunities to fit their needs.

This post is the final in a series about the elements of a coordinated assessment and housing placement system (CAHP). This post offers an overview of data collection and communication, which plays a vital role in the housing referral process. We’ll also take another look at Take Down Targets, which are helping to drive results as we push on toward an end to veteran and chronic homelessness.

This series has explored the key elements of a well functioning coordinated assessment and housing placement system for ending homelessness in a community. We’ve talked about the overall value of a coordinated system, the importance of assessment (a common way of understanding who is experiencing homelessness and what they need), and the role of navigation and case conferencing to help people get through the housing process as quickly as possible. Today, we turn to the most important quality of a CAHP system–– it is built for learning.

Imagine a community that assesses everyone on its streets by name, works with each person hand in hand to complete each step of the housing placement process, and quickly matches people to the best housing options to fit their needs. We would all agree that a strong CAHP system is designed to do these things. But now imagine that this community has no mechanism in place for evaluating the system it has built — no way of using all the by-name data it collects, or analyzing and measuring outcomes in line with that data. Despite having a strong system in place, this community would have no meaningful way of improving, or even of identifying potential areas of improvement.

In short, this community would be frozen. It could never perform any better or worse than it performed the day it built its system.

Zero: 2016 communities from Los Angeles to Rhode Island are taking the critical steps necessary to develop a system that will help them achieve and maintain an end to veteran and chronic homelessness by collecting by-name information on their homeless neighbors, streamlining the housing placement process, and removing barriers to entry to get people off the streets and into housing as quickly as possible. But these communities are also designing systems built for learning so that they can change and improve as they go.

By aggregating by-name information gathered during assessments in an actionable, centrally accessible databases, communities can ensure that all local case workers, housing navigators and service providers have access to up-to-date information for every person experiencing homelessness, regardless of when or by whom they were assessed. This database can allow communities to track the progress of individual people toward housing, including the process of obtaining needed documents during case conferencing. Done well, it can also enable tracking of housing vacancies and available resources.

An actionable database can also provide an important benefit to the CAHP system itself: by tracking people through the housing process and aggregating those results, it can provide performance data and identify red flags, whether in the form of populations that are falling through the cracks or specific logjams in the housing process. These flags can help a community know where to focus its improvement efforts.

This is the difference between data for judgment and data for improvement. Data for judgment is data that a community collects and reports but never utilizes. It leads only to a number– a big picture snapshot, perhaps once or twice a year– that does little to help a community move specific people through the housing process or fix solvable problems in real time. Data for improvement, on the other hand, allows communities to track their performance and make meaningful, data-informed adjustments. This second type of data enables evaluation, troubleshooting and process improvement across a community’s entire housing placement system, helping communities prioritize resources, identify gaps and ensure that individuals or families experiencing homelessness are referred to housing opportunities that best fits their needs.

Given that preferences, needs and protocols vary by community, the most actionable database should be easy to customize at the local level. The system should be automated and web-based, HIPAA-compliant and ensure that the personal information of each person experiencing homelessness is carefully protected while still accessible to all local agencies involved in the housing process. Some communities have built such a database into their existing HMIS systems. Others have created new, centralized databases designed specifically to facilitate the housing process. Within both approaches, communities have achieved central access across agencies through a shared release of information that all people experiencing homelessness sign at the time of their assessment.

Last month, Zero: 2016 communities confirmed and committed to their Take Down Targets, establishing one of the most integral pieces of data in their efforts to end homelessness. These targets represent the total number of veterans experiencing homelessness who will need to be connected to permanent housing in order to end veteran homelessness by the end of this year, and the total number of individuals experiencing chronic homelessness who need to be connected to permanent housing in order to end chronic homelessness in these communities by the end of 2016.

Once these Targets are established, communities can set monthly housing placement goals by determining how many veterans or people experiencing chronic homelessness need to be placed in permanent housing each month in order to in order to stay on track toward their goals of ending veteran and chronic homelessness within the Zero: 2016 timeframe. Actionable databases, optimized for system-wide learning, are among the most powerful tools for tracking progress toward a community’s Take Down Target and making course corrections.

Published 5/5/15, crossposted from Disrupt&Innovate
Co-author: Renee Ho and Dennis Whittle

Intermediation is not going away but it is changing and we should all agree that’s for the better. It’s changing in two fundamental ways:

1. Who is intermediating?
2. How are they intermediating?

In the old paradigm, large organizations such as the World Bank, the United Nations, CARE, Save the Children, and the Red Cross hired the experts to i) analyze problems and ii) design solutions. They then iii) mobilized the money to fund those solutions, iv) hired the staff or consultants to deliver the solutions; and then finally v) organized any monitoring and evaluation.

The who and how are changing for i) through v)…

Intermediation is becoming localized and decentralized, even individualized. Caught up in increasingly complex and fragmented systems of multilevel governance, regular individuals and local civil society groups are initiating increased control over their lives.

In the new world order, service delivery doesn’t just happen. Regular people provide feedback to service providers, both to improve service delivery and promote social accountability. In the Philippines, Checkmyschoolengages parents, teachers, and students to identify school issues and engage government to respond. In the United States, SeeClickFix empowers citizens to report and track issues in their community that they want fixed.

About a decade ago, many slums weren’t mapped. If slums didn’t exist on maps, neither did their millions of inhabitants, and governments were not held accountable to provisioning these areas. Participatory community-based slum mapping has taken off, spreading from India to developing countries around the world. Talk to regular people from the slums and they can easily tell you what they intimately know, places that need improved roads, waste collection, or street lighting.

From this perspective, localized and decentralized intermediation is the smart thing to do. It provides new platforms for citizen engagement that, in turn, provides timelier, more accurate, and contextually significant evidence for government or ICSO decision-making.

From a donor perspective, today, regular people can go online to give or lend directly to the projects (GlobalGiving) or even people (GiveDirectly, Kiva Zip) they care about. In 2013, regular Americans gave $240.6 billion to charitable organizations. Most of them don’t really know what happened to this money. In the new world order, the degrees of separation between donor and recipient can be radically reduced in a way that increases transparency and accountability.

New forms of ICT are revolutionizing how this intermediation is happening. Organizations likeFrontlineSMS and Ushahidi have developed tools like text-messaging software to improve two-way communication between regular people and donors or project implementers. Simple hand-held GPS devices and platforms like OpenStreetMap are allowing local slum knowledge to percolate up.

The affordability and usability of these technologies allows instances of intermediation to happen more rapidly. Funders and implementers can monitor and learn from their projects in real-time, allowing them to adapt and fix quickly, increasing both efficiency and social impact.

New technologies are also creating and operating along much more horizontally and socially connected networks. Twitter and Facebook are examples of how social network effects compound the rate at which information and knowledge are disseminated (and intermediated).

What does this “new” intermediation mean for existing stakeholders– for citizens (“beneficiaries”), for government or local CSOs, for individual donors, and for ICSOs?

For one, everyone needs to access and use the technologies in order to be heard (citizens, local CSOs) and to listen (government, individual donors, and ICSOs). Citizens have to be able to use basic SMS technology. Funders have to be able to receive, aggregate, and analyze these citizen voices.

Particularly for citizens and local CSOs, they need to strategically enter social networks in a way to take advantage of heuristic decision-making or combat it. They need to enter social networks to share knowledge, amplify their voices, and yes–get funding. Some of these networks are horizontal. Some of these networks are vertical. Most will be some combination of the two.

[In steps the new ICSO.]

The existential crisis of the ICSO is over-hyped. The ICSO’s intermediation is not obsolete. Rather, it needs to be reconfigured to improve and strengthen what is already happening– a new, smarter democracy in the age of multi-level governance. The ICSO will aid the use of intermediation technologies. It will connect citizen voices to new and existing social (and political) networks. It will reinvent itself.

Welcome, ICSO Version 2.0. We’re pleased to meet you.