Re-Designing Healthcare: The Race is On

Today I had a fantastic, far-reaching chat with a couple of entrepreneurs about the emerging field of healthcare redesign.  We talked about designing user experiences the way we design products; the difficulty the healthcare sector has in following fresh approaches through into implementation and how design-thinkers who are focused on problem-solving over profit can make a living doing what they do best (and what society sorely needs).

I've had many such chats over the past several months; in fact, there's a whole emerging field of healthcare designers who are doing projects, bridging the gap between such fields as social media and health service delivery, essentially trying to adapt our healthcare model to the 21st Century reality.  At the same time, I've talked to many policy makers, searching for new solutions but wary of committing to anything in politically and financially volatile times.  I've sat down with health service providers who are anxious to see systematic change but concerned about what that change will do to their niche areas/"clients"/jobs.  You'll find a bunch of them meeting here.

There's a real appetite for new approaches to healthcare in Canada, with players in different spaces touching different parts of the elephant, but not connecting in the middle.  The question on everyone's lips is: "how do we close the gap?"

When I first wrote this piece on how social entrepreneurs will be tomorrow's innovation consultants, I had healthcare (in particular, mental health) in mind.  Health is at the root of everything - family life, productivity, even commuting is tied to how healthy we are and where our headspace is at.  It just so happens that healthcare costs take up the biggest chunk of government spending, too.

The same goes for this piece on the changing nature of Government Relations - the emerging spaces for PR/GR folk to play in ties to health management and increasingly, design.  As the landscape around health, healthcare consumption and society at large grows increasingly dense, we need a map to find our way towards the destination of a modern, sustainable healthcare system.

So, with all this in mind, here's what I see happening next:

- These healthcare designers/social entrepreneurs will increasingly find each other through networking events or online and begin to realize they have an entire community of health-problem finders looking for a home.

- Smart healthcare providers/stakeholders will start walking the walk on innovative health landscape mapping/service provision, applying new approaches and ideas from varying fields to healthcare delivery/user experience.

- As some of the healthcare design folk connect with these stakeholders (either as hires or on contracted out projects), it will become increasingly clear just how profitable this design field can be.

- Existing consultancies will start growing into this market space, competing for both healthcare design work and healthcare design talent.

- As competition grows/demand runs up against the ability of existing funding to match, health design stakeholders will increasingly push against policy makers to get with the times.  New healthcare management and design businesses will crop up (treading ground first covered by The Courtyard Group) and existing players will try to catch up.   

- Seeing the chance for good policy and political wins (and recognizing the risk of not doing anything), Political Parties will start paying closer attention.

- Some of the original batch of healthcare design-thinkers will start valuing profit more that problem-solving, as will newbies to the field seeing the opportunity to find success in a growing field.  At the same time, there will be a large percentage of players who continue to see accomplishment as the goal, rather than wealth.  "I solved that" will become the new "I built that", which in itself replaced the feudal "I inherited that."

- It'll take time and a few iterations, but healthcare as we see it now (a product/service to be consumed) will be transformed more into a partnership that involves individuals, their employers, doctors, holistic health providers and other proactive providers.

The big question now is: Who are the far-sighted players who are going to recognize and benefit from this trend first?  Which employers are going to snatch up the amazing, innovative talent that exists out there but is not presenting itself in a traditional way?

What will the resulting innovations look like?  I'd love to tell you more, but the future is a bit like a stereogram; unless you're invested in the idea, I can't guarantee you'll see that third dimension.

The race is on; whichever providers/designers win in the short term, we will all benefit in the big picture.

Roads Converging on the Way Forward

 

I don't know Chrystia Freeland, nor really anything about her.  Toronto Centre isn't my riding; I have no skin in the upcoming nomination game.  I do, however, have a lot of interest in people who take the time and push their envelopes, look at the broader map of the issues of our time and place them in an historical context.

 

On that front, I am perfectly comfortable with posting her piece on this humble blog; it's the kind of thing you'd find here anyway.  All the hyperlinks below are to posts of my own with what I feel is overlapping content. 

 

I find it incredibly encouraging that more and more people are coming forward with a similar vision of where we're going.  Sooner or later, though, we most realize that there's a difference between knowing the path and walking the path.

 

 

The path leading to middle-class prosperity

 

One thread has run through my work over the past two decades – a growing conviction that we are living through a profound, global economic shift, comparable in its scale and scope with the industrial revolution. The combined impact of globalization and technological change is radically transforming the world economy, national economies, urban economies, and the economic lives of each one of us.

This reshaping of the global economy is the big story of the 21st century. No one person, and indeed no one country, can stop it – and we shouldn’t want to. But it is equally wrong to think this deep economic shift will inevitably or easily or naturally deliver the widely-shared prosperity which is the bedrock of western liberal democracy.

 

If you believe otherwise, look back two centuries to an earlier great upheaval that reshaped the world – the industrial revolution. It can be tempting to take comfort from that history. After all, for all its dark satanic mills, ultimately, the industrial revolution worked out pretty well. All of us in the western world are healthier, taller – well, there are a few exceptions! – richer, freer and live longer than our early 19th-century ancestors.

 

But here’s the rub. It took two deep depressions – the Great Depression of the 1930s and the Long Depression of the 1870s – two world wars, and Communist revolutions in Russia and in China before we figured out how to make the industrial revolution work for the vast majority of the population. And it also took the invention of a whole new set of institutions – pensions, public education, public health care, social welfare, trade unions, and even mass democracy itself.

 

When it comes to today’s economic revolution, a very small and very lucky and very smart group of people is already benefiting. I call this global community of economic winners the plutocrats, and they were the subject of my recent book.

 

But the other side of the coin is the devastating hollowing out of the middle class in the western industrial democracies. Traditional middle class jobs are being made redundant by the technology revolution or outsourced to lower-wage economies.

 

Figuring out how to make today’s vast economic transformation work for the middle class is the central political issue of our time. Without a prosperous, secure middle class, our national economy can’t flourish in the long-term. Our democratic society won’t endure, either.

 

Today’s conventional wisdom is deeply cynical about politics. We portray our elected officials as trivial buffoons at best and as scandal-ridden, self-dealing parasites at worst. What we have lost is our belief that our government represents us all, and that we, collectively, can use it to address the big challenges of our time.

 

If you believe in democracy – and who doesn’t? – that lost faith is a tragedy. We all desperately need to re-engage with our democratic system, in all its messy glory, and elect leaders whom we charge with the job of solving the 21st-century’s greatest tasks, first and foremost making our new economy work for the middle class.

 

Over the past few years, as I have been working through these issues for my book, I have felt their urgency ever more strongly. Diagnosing the problem is an important first step, but it isn’t enough. We need to do something about it.

 

The place for me to do that is at home, in Canada. As the lucky beneficiary of the Canadian public education system, Canadian health care, and Canadian scholarships, I owe our country everything.

We are good at rolling up our sleeves and getting the big things profoundly right. At a time when the rest of the world is struggling to live with one of the human consequences of globalization – mass immigration – Canada is a model for how to make a multicultural, multilingual community really work. We can do the same when it comes to ensuring middle class prosperity in the 21st century.  Indeed, we are much better at this than the United States, where income inequality has become an economically and socially devastating chasm. We can’t let that happen to us.

 

We know some of things we need to do. As University of Ottawa economist Miles Corak has shown, social mobility is one of the casualties of rising income inequality and the hollowing out of the middle class. We must do everything we can to lean against that trend, particularly investing in public education, starting in preschool. Second, we need to become the world’s most attractive destination for entrepreneurship. As traditional middle class jobs vanish, we need to build a platform that makes it easy for driven, inventive Canadians to take risks and create new ones. Third, we need to find ways to realign business incentives with public ones. Toronto is leading the way here, with initiatives like the MaRS Centre for Impact Investing, but there is a lot more to be done.

 

Toronto itself is a central part of this story. It is a vibrant, diverse, world-class city, which has not yet become a gilded, gated community for the plutocrats, with no room for the middle class, as is happening so quickly in so many of the world’s other metropolises. We need a proud, ambitious, bold, urban vision for Toronto as the world’s magnet for the creative, thriving middle class – precisely what Jane Jacobs found when she moved here nearly half a century ago.

 

To do this, we need a new vision of politics and what it can and must accomplish.

 

Chrystia Freeland is a candidate for the Liberal party nomination in Toronto Centre. She is a former senior editor at Thomson Reuters and The Globe and Mail.

 

Communicating Change: Disruptive Leadership From the Grassroots Up

We can't be creative if we refuse to be confused. Change always starts with confusion." 

- Margaret Wheatley

Don't fire until you see the whites of their eyes.

To keep the blade sharp, you have to periodically walk along it.

Sound familiar?

Risk means doing things that are unpredictable, taking chances, walking the wire without a net.  We want the benefits that come from risk (new innovations, new policy solutions, the first place medal) but not the consequences of potential failure.  When it comes to teams, bosses are increasingly becoming risk-adverse; new investments and new ideas aren't being supported as they could be.  They're relying on more interns and contracts that can be let go of quickly if they mess up and no or little money lost.

What about those who do take risks, push the envelope, push buttons?  There are lots of those, but if you look carefully they aren't so much about taking risks as they are confident in their ability to avoid or download risk to others.  Look at the Senate Scandals; even now the likes of Duffy and Brazeau remain defiant.  Look at any of the other political scandals across the country - nobody is saying they took a risk and it didn't pay off as they thought it would, they're denying risk at all, or placing the blame for failure on others.

 

Look at Lehman Brothers.  Look at the polling industry.  Hell, look at our democratic malaise.  These folk aren't being bold or innovative; they're puffing up their plumage and trying to deflate criticism.  It's a huge difference; more and more energy is being spent on image, not accomplishment.  More and more blame is being placed on the staffer, the consumer, the voter.  When people are blamed for inaccurate polling results instead of methodology, we have an emperor's cloak problem write large.

To fix this, leaders need to be willing to take risks - not the self-serving kind, but the policy risks that may not have precedent and will need to be tested through pilots, revisited and worked through various iterations to get them right.  Look at the work Guardly is doing with Neighbourhood Watch as an example of what this looks like in practice.

 

Leaders need to equally be empowering, too - not looking for their team to fail so they can replace them with better people, but encouraging them to experiment and supporting them through the trial-and-error learning process.  Failure should never be the end of the road - instead, it should be a stepping stone to perfection.  What have we learned?  What can we avoid in the future?  What new horizons have been uncovered as we break down the walls of convention? 

 

At the same time, teams and constituents need to be equally willing to work with leaders at all levels.  We've got a bad habit in Canada of voting people and Parties out, rather than voting anything in.  "I will undo stuff the last guy did that you don't like" isn't a "why" and it's not leadership, but it what we keep asking for.  Ask you and you shall receive, etc. 

 

"What I stand for" is vastly different from "what I stand against" but we seem to have mixed the two up in the same way that we forget that "talking to" (messaging) isn't the same process as "talking with" (communication). 

 

Of course, communication isn't easy, nor is it common.  Most Comms positions these days are focused on messaging rather than a back-and-forth flow involving understanding and compromise.

 

I'd argue that true communication is the biggest challenge we face, and face poorly given the impact it has on our lives.  Communication requires all those soft skills we have trouble quantifying; empathy, lateral thinking, iterative thinking, design thinking.  It demands us to put something on the table first, freely, without the certainty of receiving anything in return; it means having a bit of faith in what the person opposite can do, given the right supports along the way.

 

True communication is a scary concept, a step into the unknown, a leap of faith.

 

Which leads me to one last quote to tie this up in a bow:

 

Do one thing every day that scares you.

 

Mental Health: The Competitive Opportunity that Doesn't Go Away

"All human societies contain inventive people. It's just that some environments provide more starting materials, and more favorable conditions for utilizing inventions, than do other environments."

- Jared Diamond, Guns, Germs and Steel

 

At a time when Europe was a series of fragmented, competing silos mired in a Dark Age, China was a technological superpower with a strong, centralized government.  China built greater ships, established trade with lands as far away as Africa and grew in both wealth and influence.

 

Yet as we know, it was European explorers on tiny ships that introduced the New World to the Old World, resulting in centuries of European dominance on the global stage.

 

How did this happen?

 

As control of all China's activities was held tightly in the hands of a few elite at the top, it was whim and personal inclination that determined the course of the nation's engagement.  Literally, someone at the top of the food chain in the Chinese government decided they didn't like the sea trade (or someone in charge of the sea trade) and killed it. 

 

Meanwhile, Christopher Columbus, entrepreneur that he was, tried sponsor after sponsor after sponsor before he landed on Spain to fund his expedition - and even then he had to try twice.  With the minimal resources he was able to wrangle, Columbus was incredibly lucky his exposition succeeded.  We like to pat successful entrepreneurs on the back and show them off as examples of how persistence pays off, but that's largely a delusional myth.  It was fortune more than anything that delivered a win for Columbus and the Spanish Crown; human resource challenges, weather and all sorts of factors could very easily have derailed the explorer's plans and left him a failure.  Spain would have regretted their investment and moved on.

 

Remember - Columbus wasn't the first European to reach the Americas; Vikings and possibly Basque fishermen were there first, but lacked the appropriate resources and logistical support to gain a lasting foothold.  There may have been thousands of Columbus' in Europe, Asia and even Africa who tried to find support for similar expeditions, but we don't know about them because they weren't successful.

 

The two worlds were bound to connect; random trial-and-error would have made it happen eventually.  If one Chinese mandarin had changed his mind, or if Columbus had failed to find that one backer, or someone else had been more successful, history could have been incredibly different.  The end result would be more or less the same - a global economy striving for equality with some players faring much better than others.  Only the names of the winners would change.

 

So, what's this have to do with mental health?

 

Consider:

 

Chrysler

 

In the United States, psychiatric hospital admissions of Chrysler employees actually went down 12 percent one year over another, and their length of stay in mental hospitals dropped 22 percent, due to that company’s efforts to achieve higher rates of earlier detection through better psychiatric health benefit programs and greater success in matching diagnosis and treatment methods.

Husky Injection Molding Systems

 

Husky Injection Molding Systems of Bolton, Ontario estimates it has saved $8 million in reduced absenteeism, higher productivity, and better use of resources, from a $4 million investment in employee well-being and a healthy workplace environment. 

 

Absenteeism rates in 1999 were 2.25 days per Husky employee per year, compared to the Canadian average of 5.7 days per year

 

Lots and lots of people are wringing their hands around the costs of occupational mental illness; lots of reports have been commissioned and discussions had.  Governments have started the herculanean task of addressing this elephant in the room, but it's slow-going and lots of stakeholders have other priorities.

 

But it's a few bold businesses that are actually taking the risk and making this happen.  The risk is paying dividends with fewer sick employees, greater productivity and better HR morale - which in turn results in stronger, more resilient companies.

 

Yet here in Canada, we have a government that thinks natural resource exploitation is the silver bullet for economic success and is starving all other programs to focus on this one basket.  They're also stamping out any opposition and risk assessment of their singular focus.

 

Kind of like the Chinese did with sea trade.

 

Proactive occupational mental health is going to happen and, really, that ship is already starting to sail.

 

As it stands now, Canada isn't onboard.  If we don't want to end up being a China of the Knowledge Economy, now's the time for our government to get over it's fear of troubled waters and dive in.

 

Stephen Harper Reads WAKATA

 

“The government is also examining opportunities to streamline its web presence by making it easier for Canadians to find and access government information on the web through a single entry point,” explains the federal budget.

 

 

Creating an online service hub that makes it easier and more intuitive for users to determine and access the services that they want is actually a really good idea - one I've discussed before:

 

- Digital Government service platforms that facilitate information access

 

- Using mobile device Aps like Guardly as a model to bring services (online and in person) that much closer to end users

 

- Building on the model of video games to create a "hub world" that adds value and empowers service users to develop skills at the same time as accessing services

 

 

That's okay - I'm totally fine with the Prime Minister cribbing my ideas.  A bit of recognition, though, would go a long way towards encouraging other engaged citizens to share their innovative ideas for streamlining service or improving productivity or fostering innovation.

 

But yeah, there's a chance Harper isn't cribbing from me; he could be cribbing from the US.  Or Australia.

 

Either way, it just goes to show that innovation doesn't happen in a vacuum - progressive ideas happen through collaboration and sharing.

 

Of course, the concerns raised in the article above are valid; the Harper government has a history of shrinking public access to information; they've curtailed the Census, they've denied bureaucrats the right to speak, defunded NGOs they don't like, built up cones of silence around Parliamentary activity and are even stifling their Caucus.

 

Canadians should be very concerned that Harper and co will continue to starve knowledge in their drive to develop The Master Switch.  The trick isn't to get mad and fight against the very idea of improving online service access, though - that would defeat the underlying progressive purpose.  Instead, the goal should be to get creative.

 

People do have trouble accessing public services in their present format.  They do spend tons of time online.  And they like online stuff that is both informative, fun and rewarding.  Better service presentation would reduce duplication, gaps and overlaps (and related costs) and making engagement rewarding will encourage people to be proactive.

 

How do you get the public engaged in service reform using modern technology and use a bit of charm offensive to build political traction at the same time?

 

Smart political operatives will be seeking partners to answer those questions and have a plan in place for the next election. 

Mental Health: A Business Opportunity You'd be Crazy to Miss

Only a decade ago, to suggest mental health was a critical issue for Canadian businesses would have seemed ludicrous. That sentiment seems to be rapidly waning. With its announcement earlier this month of a national standard to help businesses put in place policies that improve employees’ psychological health, Ottawa highlighted what many had long suspected: There are far too many Canadians with mental illness for the business community to ignore them.

 

Know how business has begun to realize supporting gay rights is, well, good business and is starting to go where early adapters in society have already gone? 

 

Mental health is a bit like that. 

 

We're just passing the innovators stage, with programs like the federal psychological workplace standards now available for consumption.  The early adapters who turn this trend into business opportunities soon will reap the rewards - as will everyone, as this is one of those shifts in social conscious that help everyone move forward.  

 

Many a smart advocates and entrepreneur are there already.   

 

If you want to learn more, let me know.

My Idea of Canada

Today, under a glorious sun and with a fresh breeze blowing, I took a walk through the main campus of U of T.  The old, elegant stone buildings had a faintly musty smell that carried on the wind.  History brushed against each sense in turn.

The campus itself was alive, vibrant with students basking in the warm sun, tossing a ball, heading to or from class or quietly reading a book in the shade of an ancient tree.  A couple pairs of professors sat on benches, dissecting world events.  There were more than a few parents accompanying March Break Uni tour kids, eyes wide with trepidation or excitement about what the future holds for them - which is probably a bit of both.

There were youth in short shirts, tank tops or no tops,  taking the first chance to bare skin in months.  There were fashion statements galore - prep, Emo, indie, worldly.  I saw a girl in hejab riding a skate board and one fellow in formal wear.  I noticed the variety of appearance, first - the diversity of ethnicity came next.  The crowd was a rich mix of lineages; East Asian, South Asian, Middle Eastern, First Nation, African, even a few folk of decidedly Northern European descent.

What a wonderful thing it is, I thought to myself, to be able to walk around a place of learning, the shore where new ideas lap at established wisdom, freely.  What a gift to be surrounded by so much diversity and find it encouraging, not threatening.

To me, that's Canada.

I was downtown to see a friend in hospital.  The friend is a University student; it was thinking about her that led me to walk the campus.  This friend had been struck suddenly, frighteningly by an illness the doctors were still trying to decipher.

My friend was lucky to live in this country, and especially lucky to live in a city with so many hospitals.  I shudder to think what could have happened if she'd lived somewhere without an established, public health care system.   More than that, the open communication between our hospitals and professionals across the system means there is a good chance that, if her illness has been dealt with elsewhere, that knowledge will make its way to her doctors.  This friend takes comfort in knowing that her academic year is not automatically in jeopardy.  I take comfort in knowing her life is in good hands.  We have a system, and people in that system, who understand that sometimes, things like this happen.  The goal is to accommodate success, not punish misfortune.

That's my Canada, too.

During a recent election campaign, I managed a GOTV team on E-Day that consisted entirely of New Canadians from India.  I thought it fantastic that, even before they had wrapped their heads around a whole new culture and world view, these young men were excited to participate in our democracy.

One of our poll clerks was of African extraction.  It was the first real black person my team had the opportunity to interact with.  One of these fellows, a young Sikh with a turban and beard, bravely told me he felt uncomfortable dealing with the black man.  My advice was this: don't ever let fear define you.  Fear closes doors, cuts off opportunities.  I reminded this gent that he, too, looked different from others around him.  When you get down to it, we all do - the questions is whether we focus on those differences, or instead appreciate our basic human similarities.

He took the poll and ended up having some great chats with the clerk, breaking down a barrier and opening up a new opportunity to understand.  In so doing, my Sikh friend embraced the best that Canada has to offer.

Yesterday, I had the privilege to chat with Justin Trudeau; he'd just given a speech on an idea we enthusiastically share - the idea of Canada.  The same day, I had a brief message from Federal Minister Tony Clement, thanking me for sharing an idea on staff transition strategies with him.  How many places in the world can an average citizen freely engage with not just politicians, but politicians from opposing Parties?

   - Life-long learning, available to everyone.

   - Strength through diversity.

   - Universal health care that’s there when you need it.

   - An unwavering commitment to overcome differences and share opportunities.

   - Accessible, transparent, collaborative governance.

That’s what Canada means to me.