Monday, March 10, 2008

Democratization 2.0

I heard a great talk last week by Andrew McAfee, a professor at Harvard Business School, about Web 2.0 and, as he terms it, Enterprise 2.0. This expanded into a discussion of the inherent democratization that occurs in the 2.0 environment, from which Andy rhetorically raised the question of how reliable and accurate this kind of approach is. Of course, my immediate response was, "Compared to what?" He then reminded us about the "contest" in 2005 that was held comparing Wikipedia to the Encyclopedia Britannica. The two sources were found to be equally accurate, until several hours later, when the mistakes on Wikipedia had been corrected!

This reminded me of a post I wrote several weeks ago about my hope to create the organizational equivalent of a wiki. And, of course, it relates to all the stuff I have been boring you with about BIDMC SPIRIT. The underlying premise is that a democratic approach to problem identification and problem solving is what makes it possible for a complex organization to discover ways to improve. As Steven Spear notes, the alternative method -- trying to design the perfect complex system in advance using the traditional business hierarchical approach -- is unlikely to produce a sustainable and efficacious solution, especially in an environment characterized by structural change.

Can health care institutions learn this approach to adaptation and improvement? The jury is still out.

7 comments:

Anonymous said...

The 'Business Insight' section of the Wall St. J. yesterday had some interesting articles on how companies don't do a very good job of knowledge management (or of integrating IT into their business strategy). They specifically cite tools such as internal corporate blogs and wikis, and companies such as Nokia and P&G who have made progress in this area.
Here's another area for you to pioneer in health care, Paul! I am beginning to more fully understand how valuable it can be to have a CEO from outside the field - we are so darned hide-bound in health care. Go for it!

nonlocal MD

e-Patient Dave said...

I don't mean to pepper this with "blogger linkbait" but I chose to add links for people who are new to this idea and want to learn more. Click or not, as you see fit.

> trying to design the perfect complex system in advance
> using the traditional business hierarchical approach
> is unlikely to produce a sustainable and
> efficacious solution, especially in an environment
> characterized by structural change.

Characterize by constant change is more like it. Can't emphasize that enough.

When I was a pup of a product manager decades ago, we could sit in product planning meetings, look at our customers' needs, go think about it, write a spec, hire engineers, develop the product, and test it, and when we launched, the market would be essentially the same as when we'd sat in those meetings. No more.

It's not just that the hierarchical approach doesn't work - it's that the "waterfall" approach to development (develop this, get it done, then develop the next thing and get that done, etc) has brontosaurus-level agility. Agile is the only thing that works anymore. And, as classmate & serial entrepreneur Chris Herot has blogged more than once, "Iterate in the marketplace, not the conference room."

For SPIRIT it's not a "market," it's an audience from whom we want adoption of the concepts. The point is just as valid. A big part of "participatory medicine" (related to e-patients), especially online communities like ACOR, is about letting the consumers of healthcare decide what they think ought to be discussed. "Iterate THIS," they might say. :)

In a very real sense, your employers are consumers of the organization's policies, and certainly have something to say.

Web 2.0 means we get to say.

Anonymous said...

This is kind of "out there" since I am not a computer person, but my nephew, a Google engineer, was recently one of the chief honchos for the launch of Google Sites, which supposedly is an easy way to start an organizational intranet or wiki page. Perhaps this could be used on an informal basis by several of your departments as they work on projects? Like I said, I really don't know what I'm talking about, but here's the link:

http://sites.google.com/

Good luck.

Barbara K. said...

Applause, applause. I wish your enlightened willingness were more widespread in the for profit world. Two phrases I've gotten fond of lately are: "We have to invent our way forward," and "Fail fast."

Gilles said...

You wrote: "The underlying premise is that a democratic approach to problem identification and problem solving is what makes it possible for a complex organization to discover ways to improve."

My great friend, Tom Ferguson, MD, understood that this approach was the best way for hospitals to improve the quality of care delivered to patients. He was himself a cancer patient and for many years he looked for ways to systematically improve care by involving patients, nurses & doctors at every level. If you are interested in the research he conducted you can contact me directly . Just leave an email at webfeedback_at_acor.org. His project was aptly titled "Patient Initiated Quality Improvement Program". His untimely death probably delayed the inevitability of his conclusions. We, the e-Patients Working Group, would love to see his work be put to use in a forward-looking medical institution.

--
Gilles Frydman
ACOR.org
e-Patients.net

Marie said...

Paul, would you share what tools or systems you are using to collect callouts in the SPIRIT program? As you mentioned 1/31, not all have access to computers.
Thanks so much,
Marie

Kevin Shea said...

Just joining this conversation, coming over from the industrial side, with experience in process improvement and deploying enterprise 2.0 solutions.

We dealt with process change of a large complex system within a hierarchical business structure. We had the chance to observe 2 different implementation models occurring at the same time. One I would call an open emergence model, based in a truly democratic approach to workspace development that was dependent on self organization, and the other based on a controlled emergence model, in which the workspace was defined within a framework, with a set of rules. The controlled emergence model was based on the idea that some structure/discipline would provide guidelines and would quickly lead to innovation and participants controlling the context.

The results were the open emergence model lead to a mish mash of competing ideas that never materialized in addressing the complex issue. It was somewhat effective in team scale level, but lacked the integration that was necessary in large scale. The controlled emergence model took time to develop, but lead to a highly integrated environment that ultimately supported the majority of a large department business needs.

This experience suggests that introduction of enterprise 2.0 tools be thought out thouroughly and with a vision, prior to launch