Book Review: New Age of Innovation; Prahalad & Krishnan

If you're interested in large scale change and innovation then you'll find this book fascinating. On the one hand it felt like there was nothing startlingly new to me yet on the other it was neatly put together in a readable way that made sense.

A key premise is the current trend of personalisation and how value is based on the unique experience we all want. The authors refer to this as N=1. Current technology drives this, social networking, web 2.0 etc. How can we co-create value with our users and consumers? What are the challenges with managing who owns the knowledge? All good questions. They also suggest we need to make the most of collaborative networks, electronic and face-to-face, be flexible and ensure scalability. I liked the section on scalability and in my mind there is more in here than what they covered. This is a key element and is also linked to their second premise.

The 2nd key premise is the one that resources need to be global and they use another little formaula: R=G. Here they suggest the issue is that access to resources is more importnat than providing products; namely it is the solutions that matter rather than the kit or pieces. I think I agree with this. Again, scalability comes up.

They mention social movements and how they figure in the process as well as organisational transformation. There was nothing much new in the organisational process other than the context of the infomrational technology infrastructure - well, that is rather new and for some people rather perplexing.

If you've not yet engaged with Web 2.0 and new technology then this is definitely worth a read.

Systematic Review of Communities of Practice in Healthcare

I love systematic reviews. They are hard work, major undertakings and make life much easier for the rest of us. Compliments to the authors of this new paper which can be accessed online.



How and why are communities of practice established in the healthcare sector?
A systematic review of the literature.

Geetha Ranmuthugala, Jennifer J Plumb, Frances C Cunningham, Andrew
Georgiou, Johanna I Westbrook, Jeffrey Braithwaite

Australian Institute of Health Innovation, University of New South Wales, Sydney,
NSW 2052, Australia.

Model 3: data, information, knowledge, wisdom

One of the QI refrains is "increase the capability and capacity of employees". While this is a great concept, easy to declare and impossible not to support, for me it lacks any concrete applicability. What exactly is meant by this? There is another one of our data-information-knowledge-wisdom models which may help pin down what might be meant. Next time you hear somebody say the capacity/capability thing then whip this model out and ask them to explain their intentions and expectations along the data to wisdom curve.

 The challenge here is to produce learning experiences that enable someone to move up the curve. In my experience, much of healthcare improvement work is focused on developing data based skills - how to measure change. Some people get to the information stage where they learn to look for patterns, say by using SPC charts. Can they port this knowledge to other projects in a predictable way? Can they make intelligent choices? To what extent do the participants on a QI project become "wise"?

The above curve comes from Designing Knowledge Eco-Systems for Communities of Practice.  The web resources are excellent - especially if you are developing CoP's as part of your QI strategy.

eLearning 1: 5 Resources for supporting online discussions

Creating and moderating an online discussion group requires more than sending out an email inviting people to join. In some cases it is not the cheap, quick fix you may be after. It's work. Treat it like a project - from strategy, planning, resource allocation through to evaluation.

Here are a few of my favourite resources on the topic:

1. Designing and Managing online discussions from Oxford Brookes University (PDF paper, with references - my favourite)
2. Teaching with online discussion forums - good introduction 
3. Online discussions: Tips for Instructors from the Centre of Teaching Excellence at the University of Waterloo. Web page with bullet hints
4. Using discussion boards to engage students 
5. How to avoid problems with online discussions - student guide. Short web page with more links on it. USeful because it is from the student/user perspective

Different types of practice; good, best, novel, emergent

The definition of good practice has always been contested and maybe the use of the phrase "spread good practice" is part of the problem as to why adoption of existing practice is so difficult.  The Synefin model provides us with four categories of practice:

1. Best Practice (simple systems where the idea is obvious to all and obvious to adopt)
2. Good Practice (complicated systems where the relationship between cause and effect is less obvious, some investigation is needed and usually adaptation in order to solve the problem
3. Emergent practice (this occurs in complex systems where you only figure out in hindsight how something happened, how the results occurred - and this analysis is not necessarily predictive.
4. Novel Practice from chaordic systems where there is no relationship between cause and effect

If the goal of a large scale program is to spread the use of methods or techniques that deliver improvement then I think it is important to be able to diagnose what type of practice is being touted. Often novel or emergent practices are praised as the solutions to problems, putting the pressure on other individuals, teams and organisations to do something similar - and when they don't they are castigated for not trying.

The devil in the diagnosis of type of practice. Do you have any examples of the different types of practice?

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Connection is key for innovation

A little luck and a lot of perspiration is no longer the prerequisite for innovation. Nowadays connections, relationships and networks are key.

Steven Johnson's next book is about Where Good Ideas Come From. You can watch him in action on this TED video (which starts with a picture and talk about the Grand Cafe in Oxford).



A couple of key points include:

1. Innovation is the result of the brain making new connections and these connections mirror workplace connectivity.  The better the networks and more complex the relationships then the more likely it will be that good ideas arise. His premise is that innovation is an interactive process.
2. The architecture of space is important if ideas are to be generated and spread - he has looked into what environments have contributed to innovation. If we want innovation we need to design spaces that enable connections.
3. Great ideas that appear to spark from nowhere are most likely the result of a long period of incubation which may not be obvious and are most likely cobbled together from a variety of existing ideas.. He argues that ideas are networks and the way of thinking about them as sparks, illumination etc is no longer relevant.

Online Clustered Networks Spread Behavior Change Faster

Online communities have different dynamics to face-to-face communities of practice. New research suggests that for online communities, behaviour spreads more quickly when the community is grouped into networks with overlapping connections than when left to develop more random and distant links.

If you are managing online communities then the research is worth a closer look as it may provide hints on how to design and support it so behaviour and influence can spread amongst the participants.

For communities of practice not online this clustering effect is not new. Research has been around since the 1970's which show the importance of bringing groups together geographically, thematically and/or by profession or person type. As humans we like to be with people similar to ourselves and are most influenced by those the same as us - if Joe can make the change then I will probably be able to as well.

There is a lot of buzz about social movements, mobilising and organising for change in healthcare. One of the success criteria for this work will be the depth to which those doing the organising as well as those participating understand network dynamics, and design accordingly.  Random networks are less influential.

NHS partnership working and improvement; we've been here before

A number of large scale programmes are running in the NHS in England where communities are getting together to improve health and social care services. The projects have a wide membership from mostly statutory public sector organisations but also some in the voluntary sector. As some of the strategies sounded familiar I checked the Department of Health website.

I was involved in partnership working in the NHS in the mid and late 1990's. At that time in England there were also Healthy Action Zones which seem very similar to many of the programs underway at present. It seems to topic is coming round again but with a new language and consequently a delay in making changes. There are many papers and documents available form around 2002 - 2004 which have self-assessments, methods, best practice examples, case studies and similar. I find it so disappointing that those who are responsible for the spread of good practice and large scale change feel the need to continue to reinvent wheels - thus not practising what they preach.

If you are interesting in learning what has gone on before and in adopting and adapting existing ideas for large scale change then try out these papers from the Department of Health:

Working in Partnership; developing a whole systems approach (notable because it covers productivity - and this was 2002...)

Governance in partnership checklist of good practice

If you only want what is new then try
Working with Stakeholders which is 2010

Crowdsourcing shifts us from what to how

"to improve" is a verb. A verb is a "doing word". Improvement is action. Collecting and storing examples of good practice is a displacement for action. Huge knowledge banks where the thing of the 1980's (yes, thirty years ago) and by the late 1990's were largely discredited as a mechanism for helping spread good practice. The few organisations that did manage to leverage the codified knowledge, did so because they institutionalised through clever IT systems, the search and sharing of knowledge. Note, this sharing was linked to the individuals with the ideas and not odd pieces of extracted information. The personal relationship mattered.

What does the modern day action to improve look like when we are aiming to avoid the reinvention of wheels?

a) We crowdsource. We call on the community for their ideas. However, asking for and then collating ideas is not crowd sourcing - it is a cheap way to create an ineffective database. Crowdsourcing works when participants rate ideas, decide which is best. Many organisational leaders fear crowdsourcing because the answers may not be what they want.

b) We get more active in presenting the problems and then asking people to provide answers - as an open call. The joy in this approach is it is not limiting the solution to the thinking and mindsets of employees. This has been around for at least a decade and the are many websites and systems to help make this happen. Some organisations even provide all their data so others, not part of the organisation, can use it to help solve the problem. The first step to making this happen s to give up control and to ask for help.

In the UK we are experiencing the crowdsourcing as the Government has set up systems to ask for ideas on solving problems. I like the way they are asking the citizens on ideas and not restricting it to Government employees only.

Crowdsourcing gives the vote to the hungry consumers and nto to the turkeys.

Some Crowdsourcing links and resources


1. Wikipedia: for starters

2. IdeaScale is where you can set up your own Q&A and ranking community for innovations. There are hundreds of existing web applications for crowdsourcing so if you are spending money creating your own then let's hope there is am excellent reason for doing so.

3. Fevote - place to make suggestions and get votes on them (great for research and tests of change)

4. Kluster: - stunning group decision-making tool

5. Good blog post on crowd sourcing resources

To share or not to share?

I've spotted a proliferation of new initiatives within the NHS in England attempting to encourage staff to share their knowledge online. While this sounds like a useful and pragmatic action to take I wonder what the implications might be.

The main exhortation is about encouraging staff to share what has worked well for them. I expect there will be many who would like to share, though inputting your information into a fairly anonymous database is at the higher end of the perceived risk continuum. Without knowing who (as in a person) will be editing or reading the information, many people will be hesitant to "share" in this way.

The proliferation of different places to share is also confusing. In their own way, each organisation requesting sharing is doing so for the right reasons. However, how do you choose - NHS Networks, NHS Institute, NICE, own organisation's database... random sharing with colleagues using other online networks, professional groups?? Each organisation requesting sharing is doing so for it's own reasons and these reasons may not be easily identifiable by those who are targetted.

For some healthcare staff and their organisations the incentive to share may feel like a perverse one. In a competitive market there may be a disincentive to provide information about how well or how innovative you have been. In my experience the best results are seldom shared because of this restriction. So what we do get shared is often the less innovative and more obvious results of projects and changes.

I think the issue is not "to share or not to share". Sharing is only part of the story. Sharing is only of value if there is someone listening and looking. If the main group looking at what is shared is the group who owns the database then the value of what is shared is quite limited. The real issue is in encouraging staff to look and listen, to be curious and to accept that in just about everything thing they do and every problem they have, someone, somewhere has already addressed it - and this information is already available.

So if you're developing databases to captured shared information then a few pointers to consider:
a) how much of your time, budget and strategy is devoted to encouraging the look and listen?
b) how unique is your database? How will it be found and why should those who are searching use your database?
c) In what way can you build on or link to existing databases so you build a wider knowledge base rather than divide up a crowed space?
d) How can you move from the transactional share and disseminate approach to one which is based on the concept of interaction, dialogue and learning?

More on the fallacy of the tipping point

Last time I wrote about the fallacy of the tipping point I received a host of comments asking me to defend my thoughts a bit more. I ended up in a number of email conversations, some of which have persisted over the last few months.

The debate is essentially a Gladwell (as "son-of-Rogers") versus Watts debate if you want the protagonists' version. I see it more about Taylorist approach versus the networked world. Gladwell, like Rogers, has pursued very eloquently the theory that messages spread through a hierarchical type of system. It is based on a number of key influencers who spread the word. This is what he calls the "Law of the Few" which posits there are a few specifically influential people who spread the word. While there is some social system consideration in this approach it is essentially, to me, one of control and organisations. Maybe this is why so many leaders and organisations have fallen in love with the theory of the tipping point - it gives them a handle on which to explain their process driven communication plans.

I have felt for a long time that Gladwell/Rogers is way out of date when it comes to communication. Much of the arguments Gladwell use come from the 1990's - and can you remember how you used to communicate on both a small and large scale back then? Much of Roger's research was done pre-internet.

So, on the other hand, we have Duncan Watts who is approaching the debate from a networking perspective. His work demonstrates we are as likely to get information form a fairly random contact as we are from a "key influencer". The Watts approach to creating a viral experience for a message is harnessing the power of ordinary people's networks and strategies. Sure, there may be some influentials who spread the word, however, what Watts is making us think about is this may not be the only reason message spread. Gladwell's theories and examples are presented as a hub and spoke model - whereas Watts uses a more networked model which to me seems to more accurately reflect my world and experience. The difficulty of course is that it is not as easy to design a message spreading program is we believe the spread is more random than controlled.

One example both have used is the famous 6 degrees of separation one. Each has taken his own perspective. Gladwell repeats Milgram's results. Watts tested the theory using email and found that only 5% of the messages spread through what might be called Influentials - the rest was down to ordinary and perhaps less connected people.

If I had to invest in a spread strategy I would be looking to create learning communities, to be harnessing existing online connections, finding ways to get the messages into the email systems, developing content that worked on an online format etc. I used to be sold on the Rogers then Gladwell format but my own action research has led me to lean more to Watts.

Presentations to watch; 2009 Quality & Safety in Healthcare - Berlin

Part of sharing good practice and enabling others is about just that - sharing. I was unable to attend the International Forum on Quality & Safety in Healthcare, run by the IHI and the BMJ, held in Berlin in March 2009. However, I can watch the plenaries and check out the posters. I can also contribute to ongoing discussion. It is really good to see what used to be "closed" and only for those who could afford to attend, is now more available and creative in the ways messages can be sent out and conversations continued.

Plenaries: http://www.axisto.com/webcasting/bmj/berlin-2009/
Plenary 1 — What patient-centered care really means
Plenary 2 — Medical success leads to medical error: how health professionals accept responsibility for safety
Plenary 3 — Transforming whole systems: in search of theory and method

For all poster details and other resources: http://internationalforum.bmj.com/multimedia/multimedia-resources

To discuss the plenaries and posters: http://doc2doc.bmj.com/forums.html?slPage=overview&slGroupKey=f1ee0d38-22c5-450d-9f33-40bf110975f7

Use blogs to develop communities of practice

Use blogs to help knowledge flow and communities of practice to develop One of the great ways to reduce email is to use collaborative systems that enable project teams to work together, to share all their files and choose how they wish to remain in contact.

Dave Snowden has written an article in KMWorld about how blogging can help communities of practice as well as this use of virtual teaming. His perspective is how these methods can help knowledge flow around an organisation and how communities of practice can develop, thus embedding knowledge and helping sharing.He has a number of tips of how blogging can be used http://www.kmworld.com/Articles/News/News-Analysis/%3CI%3EEverything-is-fragmented%3C-I%3E%E2%80%94Building-CoPs-for-knowledge-flow--49849.aspx