Why government health departments are spending millions on mobile gaming

Curated on Posted on by Stefaan Verhulst

James Trew in Engadget : “Today sees the release of The Walk, an iOS and Android game backed by the UK’s Department of Health. It’s the second release in a collection of apps funded as part of the UK’s Small Business Research Initiative (SBRI). The first — StepJockey, an app that lets you map, locate, rate and log the calorific expenditure of staircases around your city — came out on Monday. All five apps in the program encourage you to move more, or change negative habits. Can an app improve your life? At the very least, we’re guessing the Department of Health — having just spent £2 million on this round of investment — thinks so. This is part of a growing trend, that could see government agencies in the UK taking a leaf out of Silicon Valley’s book when it comes to solving (health) problems. Read past the break to find out why it’s putting so much money on third-party digital initiatives.
Your mission is simple, ensure safe transit of a package from Inverness, to Edinburgh — and in the process save the world. Only one problem: a terrorist attack has rendered all motorised transport unusable — you’ll have to go on foot. That’s the premise behind The Walk. The concept isn’t complicated — encourage players to preambulate in the real world as part of an apocalyptic game narrative. Your phone’s accelerometer tracks your movements, unlocking levels and hours of story-telling audio which drive the plot along. Simple, fun, effective. The game’s predecessor (Zombies, Run!) uses similar mechanics, and currently encourages over 750,000 would-be Shauns (or Eds) to escape pursuing Zombies whenever they go for a jog. By lowering the requirement to walking, it’s hoped almost everyone can benefit this time. The focus is on increasing general daily movement, rather than dedicated, prescribed and sometimes prohibitive training routines.
There’s no question the theory is simple: apps that encourage activity, or responsible drinking, could cut down on healthcare requirements through prevention, negating the need for cure. In turn, it could also take a bite out of the estimated £8 billion that obesity and alcohol related diseases cost the UK’s health service each year. More interesting, is that the Department of Health is funding external mobile start-ups and indie developers at all. We asked it why, and were told it’s just as much about nurturing innovative ideas (where they can compete with more conventional fitness apps such as Nike+, MapMyFitness and Adidas miCoach) as it is about encouraging lifestyle change.

The motivation might initially be the potential (and hard to quantify) savings through a healthier public. But using apps to achieve this is an idea the US government is curious about also. ..”

We must create a culture of “open data makers”

Curated on Posted on by Stefaan Verhulst

Rufus Pollock (@rufuspollock), Founder and Director of the Open Knowledge Foundation: “Open data and open knowledge are fundamentally about empowerment, about giving people – citizens, journalists, NGOs, companies and policy-makers – access to the information they need to understand and shape the world around them.

Through openness, we can ensure that technology and data improve science, governance, and society. Without it, we may see the increasing centralisation of knowledge – and therefore power – in the hands of the few, and a huge loss in our potential, individually and collectively, to innovate, understand, and improve the world around us.

Open data is data that can be freely accessed, used, built upon and shared by anyone, for any purpose. With digital technology – from mobiles to the internet – increasingly everywhere, we’re seeing a data revolution. Its a revolution both in the amount of data available and in our ability to use, and share, that data. And it’s changing everything we do – from how we travel home from work to how scientists do research, to how government set policy….

its about people, the people who use data, and the people who use the insights from that data to drive change. We need to create a culture of “open data makers”, people able and ready to make apps and insights with open data. We need to connect open data with those who have the best questions and the biggest needs – a healthcare worker in Zambia, the London commuter travelling home – and go beyond the data geeks and the tech savvy.”

Give People Choices, Not Edicts

Curated on Posted on by Stefaan Verhulst

Peter Orszag and Cass Sunstein in Bloomberg: “Over the past few years, many nations have adopted policies that promise to improve people’s lives while preserving their freedom of choice. These approaches, informed by behavioral economics, are sometimes called nudges.
Nudges include disclosure policies, as in the idea that borrowers should “know before they owe.” They include simplification, as in recent reductions in the paperwork requirements for the Free Application for Federal Student Aid.
Nudges include default rules, which establish what happens if people do nothing at all — as with automatic enrollment in a savings plan. They also include reminders, such as text messages informing people they are about to go over their monthly allowance of mobile-phone minutes.
When the two of us worked in the Obama administration, we were interested in approaches of this kind, because the evidence suggests they work. For example, the Credit Card Accountability Responsibility and Disclosure Act of 2009 imposes numerous disclosure requirements, which are helping to save consumers more than $20 billion in annual late fees and overuse charges.
In the U.S. and other nations, automatic enrollment has significantly increased participation in savings plans. A recent study found that in Denmark, automatic enrollment has had a larger impact than significant tax incentives in getting people to save. The study found that 99 percent of the retirement contributions made in response to tax incentives would have been saved anyway; by contrast, the bulk of the contributions made by people who were automatically enrolled in a retirement plan represented a net addition to saving.
Big Benefits
In an economically challenging time, the nudge approach can deliver major benefits without imposing big costs on the public or private sector. And, like a GPS, nudges still have the virtue of allowing people to go their own way. If informed consumers want to run a risk, they can do that. A nudge isn’t a shove. Yet this approach to government has stirred up objections from both the right and the left.
What makes it legitimate for public officials to nudge people they are supposed to serve? Whenever government acts, isn’t there a risk of error, bias and overreaching?
These are good questions, and some nudges should be avoided. But the whole point of the approach is to preserve freedom of choice, and being nudged is part of the human condition. Both private and public institutions are inevitably engaged in nudging, simply because they design the background against which people make choices, and no choice is ever made without a background.
Whenever the government is designing applications and forms, its choices affect people’s decisions. Complexity produces different results from simplicity. Many laws require disclosure from the government or the private sector, and this can occur in different ways. The architecture of disclosure (including which items are placed first, font size, color, readability) is likely to influence what people select.
Life would be impossible to navigate without default rules. Computers, mobile phones, health-care plans and mortgages come with defaults, which you can change if you wish. An employer might say that you must opt in to be enrolled in a savings plan, or alternatively that you must opt out if you don’t want to participate. In either case, a default rule is involved.
Some skeptics (especially on the left) object that nudges may be ineffective or even counterproductive. In their view, coercion is often both necessary and justified. The objections are most pointed, as New York University School of Law professors Ryan Bubb and Richard Pildes argue in a forthcoming article in the Harvard Law Review, when nudges are seen as affirmatively harmful.
Automatic Enrollment
An example involves automatic enrollment in savings plans, which both of us have supported. Critics point out that if employers choose a low contribution rate, automatic enrollment can decrease employees’ total savings — a perverse effect. That observation, however, is a reason for smarter nudging, not for coercion, and is thus not a persuasive critique of nudges in general. One smarter approach in this area is “automatic escalation,” a complement to automatic enrollment.
With automatic escalation, as time goes on and people earn more money, a higher share of their wages goes into savings — unless they opt out. The objection that nudges reduce retirement savings collapses.
And guess what? A survey from Towers Watson & Co. found that in 2012, 71 percent of plans with automatic enrollment included escalation. In 2009, 50 percent did. So much for the critique that contributions in these plans are fixed at their initial levels.
To be sure, coercion might turn out to be justified when the benefits clearly outweigh the costs. But behaviorally informed approaches, which maintain freedom of choice, have growing appeal. As we continue to learn what works, we will identify numerous ways to improve people’s lives while avoiding the costs and the rigidity of more heavy-handed alternatives”

Index: Measuring Impact with Evidence

Curated on Posted on by Shruti Sannon

The Living Library Index – inspired by the Harper’s Index – provides important statistics and highlights global trends in governance innovation. This installment focuses on measuring impact with evidence and was originally published in 2013.

United States

  • Amount per $100 of government spending that is backed by evidence that the money is being spent wisely: less than $1
  • Number of healthcare treatments delivered in the U.S. that lack evidence of effectiveness: more than half
  • How much of total U.S. healthcare expenditure is spent to determine what works: less than 0.1 percent
  • Number of major U.S. federal social programs evaluated since 1990 using randomized experiments and found to have “weak or no positive effects”: 9 out of 10
  • Year the Coalition for Evidence-Based Policy was set up to work with federal policymakers to advance evidence-based reforms in major U.S. social programs: 2001
  • Year the Program Assessment Rating Tool (PART) was introduced by President Bush’s Office of Management and Budget (OMB): 2002
    • Out of about 1,000 programs assessed, number found to be effective in 2008: 19%
    • Percentage of programs that could not be assessed due to insufficient data: 17%
    • Amount spent on the Even Start Family Literacy Program, rated ineffective by PART, over the life of the Bush administration: more than $1 billion
  •  Year Washington State legislature began using Washington State Institute for Public Policy’s estimates on how “a portfolio of evidence-based and economically sound programs . . . could affect the state’s crime rate, the need to build more prisons, and total criminal-justice spending”: 2007
    • Amount invested by legislature in these programs: $48 million
    • Amount saved by the legislature: $250 million
  • Number of U.S. States in a pilot group working to adapt The Pew-MacArthur Results First Initiative, based on the Washington State model, to make performance-based policy decisions: 14
  • Net savings in health care expenditure by using the Transitional Care Model, which meets the Congressionally-based Top Tier Evidence Standard: $4,000 per patient
  • Number of states that conducted “at least some studies that evaluated multiple program or policy options for making smarter investments of public dollars” between 2008-2011: 29
  • Number of states that reported that their cost-benefit analysis influenced policy decisions or debate: 36
  • Date the Office of Management and Budget issued a memorandum proposing new evaluations and advising agencies to include details on determining effectiveness of their programs, link disbursement to evidence, and support evidence-based initiatives: 2007
  • Percentage increase in resources for innovation funds that use a tiered model for evidence, according to the President’s FY14 budget: 44% increase
  • Amount President Obama proposed in his FY 2013 budget to allocate in existing funding to Performance Partnerships “in which states and localities would be given the flexibility to propose better ways to combine federal resources in exchange for greater accountability for results”:  $200 million
  • Amount of U.S. federal program funding that Harvard economist Jeffrey Liebman suggests be directed towards evaluations of outcomes: 1%
  • Amount of funding the City of New York has committed for evidence-based research and development initiatives through its Center for Economic Opportunity: $100 million a year

Internationally

  • How many of the 30 OECD countries in 2005-6 have a formal requirement by law that the benefits of regulation justify the costs: half
    • Number of 30 OECD member countries in 2008 that reported quantifying benefits to regulations: 16
    • Those who reported quantifying costs: 24
  • How many members make up the Alliance for Useful Evidence, a network that “champion[s]  evidence, the opening up of government data for interrogation and use, alongside the sophistication in research methods and their applications”: over 1,000
  • Date the UK government, the ESRC and the Big Lottery Fund announced plans to create a network of ‘What Works’ evidence centres: March 2013
  • Core funding for the What Works Centre for Local Economic Growth: £1m p.a. over an initial three year term
  • How many SOLACE Summit members in 2012 were “very satisfied” with how Research and Intelligence resources support evidence-based decision-making: 4%
    • Number of areas they identified for improving evidence-based decision-making: 5
    • Evaluation of the impact of past decisions: 46% of respondents
    • Benchmarking data with other areas: 39%
    • assessment of options available: 33% 
    • how evidence is presented: 29% 
    • Feedback on public engagement and consultation: 25%
  •  Number of areas for improvement for Research and Intelligence staff development identified at the SOLACE Summit: 6
    • Strengthening customer insight and data analysis: 49%
    • Impact evaluation: 48%
    • Strategic/corporate thinking/awareness: 48%
    • Political acumen: 46%
    • Raising profile/reputation of the council for evidence-based decisions: 37%
    • Guidance/mentoring on use of research for other officers: 25%

Sources

Selected Readings on Smart Disclosure

Curated on Posted on by Andrew Young

The Living Library’s Selected Readings series seeks to build a knowledge base on innovative approaches for improving the effectiveness and legitimacy of governance. This curated and annotated collection of recommended works on the topic of smart disclosure was originally published in 2013.

While much attention is paid to open data, data transparency need not be managed by a simple On/Off switch: It’s often desirable to make specific data available to the public or individuals in targeted ways. A prime example is the use of government data in Smart Disclosure, which provides consumers with data they need to make difficult marketplace choices in health care, financial services, and other important areas. Governments collect two kinds of data that can be used for Smart Disclosure: First, governments collect information on services of high interest to consumers, and are increasingly releasing this kind of data to the public. In the United States, for example, the Department of Health and Human Services collects and releases online data on health insurance options, while the Department of Education helps consumers understand the true cost (after financial aid) of different colleges. Second, state, local, or national governments hold information on consumers themselves that can be useful to them. In the U.S., for example, the Blue Button program was launched to help veterans easily access their own medical records.

Selected Reading List (in alphabetical order)

Annotated Selected Reading List (in alphabetical order)

Better Choices: Better Deals Report on Progress in the Consumer Empowerment Strategy. Progress Report. Consumer Empowerment Strategy. United Kingdom: Department for Business Innovation & Skills, December 2012. http://bit.ly/17MqnL3.

  • The report details the progress made through the United Kingdom’s consumer empowerment strategy, Better Choices: Better Deals. The plan seeks to mitigate knowledge imbalances through information disclosure programs and targeted nudges.
  • The empowerment strategy’s four sections demonstrate the potential benefits of Smart Disclosure: 1. The power of information; 2. The power of the crowd; 3. Helping the vulnerable; and 4. A new approach to Government working with business.
Braunstein, Mark L.,. “Empowering the Patient.” In Health Informatics in the Cloud, 67–79. Springer Briefs in Computer Science. Springer New York Heidelberg Dordrecht London, 2013. https://bit.ly/2UB4jTU.
  • This book discusses the application of computing to healthcare delivery, public health and community based clinical research.
  • Braunstein asks and seeks to answer critical questions such as: Who should make the case for smart disclosure when the needs of consumers are not being met? What role do non-profits play in the conversation on smart disclosure especially when existing systems (or lack thereof) of information provision do not work or are unsafe?

Brodi, Elisa. “Product-Attribute Information” and “Product-Use Information”: Smart Disclosure and New Policy Implications for Consumers’ Protection. SSRN Scholarly Paper. Rochester, NY: Social Science Research Network, September 4, 2012. http://bit.ly/17hssEK.

  • This paper from the Research Area of the Bank of Italy’s Law and Economics Department “surveys the literature on product use information and analyzes whether and to what extent Italian regulator is trying to ensure consumers’ awareness as to their use pattern.” Rather than focusing on the type of information governments can release to citizens, Brodi proposes that governments require private companies to provide valuable use pattern information to citizens to inform decision-making.
  • The form of regulation proposed by Brodi and other proponents “is based on a basic concept: consumers can be protected if companies are forced to disclose data on the customers’ consumption history through electronic files.”
National Science and Technology Council. Smart Disclosure and Consumer Decision Making: Report of the Task Force on Smart Disclosure. Task Force on Smart Disclosure: Information and Efficiency in Consumer Markets. Washington, DC: United States Government: Executive Office of the President, May 30, 2013. http://1.usa.gov/1aamyoT.
    • This inter-agency report is a comprehensive description of smart disclosure approaches being used across the Federal Government. The report not only highlights the importance of making data available to consumers but also to innovators to build better options for consumers.
  • In addition to providing context about government policies that guide smart disclosure initiatives, the report raises questions about what parties have influence in this space.

“Policies in Practice: The Download Capability.” Markle Connecting for Health Work Group on Consumer Engagement, August 2010. http://bit.ly/HhMJyc.

  • This report from the Markle Connecting for Health Work Group on Consumer Engagement — the creator of the Blue Button system for downloading personal health records — features a “set of privacy and security practices to help people download their electronic health records.”
  • To help make health information easily accessible for all citizens, the report lists a number of important steps:
    • Make the download capability a common practice
    • Implement sound policies and practices to protect individuals and their information
    • Collaborate on sample data sets
    • Support the download capability as part of Meaningful Use and qualified or certified health IT
    • Include the download capability in procurement requirements.
  • The report also describes the rationale for the development of the Blue Button — perhaps the best known example of Smart Disclosure currently in existence — and the targeted release of health information in general:
    • Individual access to information is rooted in fair information principles and law
    • Patients need and want the information
    • The download capability would encourage innovation
    • A download capability frees data sources from having to make many decisions about the user interface
    • A download capability would hasten the path to standards and interoperability.
Sayogo, Djoko Sigit, and Theresa A. Pardo. “Understanding Smart Data Disclosure Policy Success: The Case of Green Button.” In Proceedings of the 14th Annual International Conference on Digital Government Research, 72–81. New York: ACM New York, NY, USA, 2013. http://bit.ly/1aanf1A.
  • This paper from the Proceedings of the 14th Annual International Conference on Digital Government Research explores the implementation of the Green Button Initiative, analyzing qualitative data from interviews with experts involved in Green Button development and implementation.
  • Moving beyond the specifics of the Green Button initiative, the authors raise questions on the motivations and success factors facilitating successful collaboration between public and private organizations to support smart disclosure policy.

Thaler, Richard H., and Will Tucker. “Smarter Information, Smarter Consumers.” Harvard Business Review January – February 2013. The Big Idea. http://bit.ly/18gimxw.

  • In this article, Thaler and Tucker make three key observations regarding the challenges related to smart disclosure:
    • “We are constantly confronted with information that is highly important but extremely hard to navigate or understand.”
    • “Repeated attempts to improve disclosure, including efforts to translate complex contracts into “plain English,” have met with only modest success.”
    • “There is a fundamental difficulty of explaining anything complex in simple terms. Most people find it difficult to write instructions explaining how to tie a pair of shoelaces.

Power to the people: how open data is improving health service delivery

Curated on Posted on by Stefaan Verhulst

The Guardian: “…What’s really interesting is how this data can be utilised by citizens to enable them to make more informed choices and demand improved services in sectors such as health. A growing community of technologists and social activists is emerging across Africa, supported by a burgeoning network of technology innovation hubs. They’re beginning to explore the ways in which data can be utilised to improve health outcomes.
In Northern Uganda, the brutal Lord’s Resistance Army conflict displaced two million people, leaving the social infrastructure in tatters. In 2008, the government launched a Peace, Recovery and Development Plan, but progress has been limited. There are insufficient health centres to serve the population, a severe shortage of staff, drugs and equipment, and corruption is widespread.
Cipesa – an organisation that uses communication technologies to support poverty reduction and development – and Numec, a local media organisation, have launched the iParticipate project. A multimedia platform is being populated with baseline data outlining the current status of the health service across three districts….
In the same region, Wougnet is training women to use information technologies to tackle social challenges. Local officials and community members have formed voluntary social accountability committees and been trained in the use of an online platform to capture and store information relating to poor governance and corruption in the health sector, often via mobile phones.
The platform strengthened campaign efforts which resulted in the construction of a health centre in Aloni Parish. In Amuru district, five health workers were arrested following reports highlighting negligence.
In the village of Bagega in Nigeria, 400 children died and thousands suffered significant health problems as the result of lead poisoning caused by poor mining practices. The government pledged $5.3m (£3.23m) for remediation, but the funds never reached the affected region.
A local organisation, Follow the Money, created an infographic highlighting the government’s commitments and combined this with real life testimonies and photographs showing the actual situation on the ground. Within 48 hours of a targeted Twitter campaign, the president committed to releasing funds to the village and, in February this year, children started receiving long overdue medical attention.
All these initiatives depend on access to critical government data and an active citizens who feel empowered to effect change in their own lives and communities. At present, it’s often hard to access data which is sufficiently granular, particularly at district or local level. For citizens to be engaged with information from government, it also needs to be accessible in ways that are simple to understand and linked to campaigns that impact their daily lives.
Tracking expenditure can also operate across borders. Donors are beginning to open up aid data by publishing to the IATI registry. This transparency by donor governments should improve the effectiveness of aid spending and contribute towards improved health outcomes.
It’s hard to draw general conclusions about how technology can contribute towards improving health outcomes, particularly when context is so critical and the field is so new. Nonetheless, some themes are emerging which can maximise the chances of an intervention’s success.
It can at times be challenging to encourage citizens to report for an array of reasons, including a lack of belief in their ability to effect change, cultural norms, a lack of time and both perceived and real risks. Still, participation seems to increase when citizens receive feedback from reports submitted and when mechanisms are in place that enable citizens to take collective action. On-the-ground testimonies and evidence can also help shift public opinion and amplify critical messages.
Interventions are dramatically strengthened when integrated into wider programmes, implemented by organisations that have established a strong relationship with the communities in which they work. They need to be backed by at least one strong civil society organisation that can follow up on any reports, queries or challenges which may arise. Where possible, engagement from government and local leaders can make a real difference. Identifying champions within government can also significantly improve responsiveness.”

Social Media Can Boost Disease Outbreak Monitoring, Study Finds

Curated on Posted on by Stefaan Verhulst

IHealthBeat: “Monitoring social media websites like Twitter could help health officials and providers identify in real time severe medical outbreaks, allowing them to more efficiently direct resources and curb the spread of disease, according to a San Diego State University study published last month in the Journal of Medical Internet Research, Medical News Today reports…
For the study, lead researcher and San Diego State University geography professor Ming-Hsiang Tsou and his team used a program to monitor tweets that originated within a 17-mile radius of 11 cities. The program recorded details of tweets containing the words “flu” or “influenza,” including:

  • Origin;
  • Username;
  • Whether the tweet was an original or a retweet; and
  • Any links to websites in the tweet.

Researchers then compared their findings with regional data based on CDC’s definition of influenza-like illness….
The program recorded data on 161,821 tweets that included the word “flu” and 6,174 tweets that included the word “influenza” between June 2012 and the beginning of December 2012.
According to the study, nine of the 11 cities exhibited a statistically significant correlation between an uptick in the number of tweets mentioning the keywords and regional outbreak reports. In five of the cities — Denver, Fort Worth, Jacksonville, San Diego and Seattle — the algorithm noted the outbreaks sooner than regional reports.
Tsou in a release said that the social media monitoring program detected outbreaks daily, while “[t]raditional procedures” typically “take at least two weeks.”

Inside Avaaz – can online activism really change the world?

Curated on Posted on by Stefaan Verhulst

The Guardian: “With 30 million members, Avaaz is an organisation with ambitions to save us all through technology. Carole Cadwalladr meets its founder Ricken Patel to find out what it has achieved…But then, this is the reality of 21st century protest: it’s a beauty parade. A competition for the thing that we all seem to have less of: attention. The TV cameras do show up, though, and a young Rohingya woman from Burma’s Muslim minority gives moving interviews to journalists about the terrible human rights abuses her family have endured. And a dozen or so mostly fresh-faced young people show up to offer their support. The protest has been organised by Avaaz, an online activist organisation, and these are Avaazers. They may have just signed an online petition, or “liked” a cause on Facebook, or donated to a campaign – to save Europe’s bees from pesticides, or to defend Masai land rights in Tanzania, or to “stand by” Edward Snowden. And, depending on who you believe, they’re either inventing a new type of 21st-century protest or they’re a bunch of idle slacktivists who are about as likely to start a revolution as they are to renounce their iPhones and give up Facebook.
In just six years, Avaaz – which means “voice” in various languages – has become a global pressure group to be reckoned with. It’s a new kind of activism that isn’t issue-led, it’s issues-led. It’s human rights abuses in Burma, or it’s the Syrian civil war, or it’s threats against the Great Barrier Reef or it’s homophobia in Costa Rica. It’s whatever its supporters, guided by the Avaaz team, choose to click on most this month. And if you hadn’t heard of Avaaz before, it’s probably only a matter of time….
“We’re like a laboratory for virality. For every campaign we test perhaps 20 different versions of it to see what people want.” It tweaks and it tweaks and it tweaks, changing the wording, pictures, call for action, and only then does it send it out on public release. Sam Barratt, Avaaz’s head of press, shows me the previous versions of its email about the Burma campaign. “Changing the meme at the top, or the photograph, massively affects the number of clicks. Eighteen versions were tested. People think we just chuck it out there, but there’s a huge amount of data sophistry into how we design the campaigns.” And, just as Amazon and Google try to predict our behaviour, and adjust their offerings based on our past preferences, so does Avaaz. It uses algorithms to detect things we perhaps don’t even know about ourselves.
“It’s a tremendously evolving science, internet engagement,” says Patel. “But we develop a picture of someone from their previous engagements with us. So, for example, we can see that a certain set of people, based on their previous behaviour, might be interested in starting a campaign, and another set won’t be, but may be interested in signing something. We can tailor it to the individual.”
Everything is viral now, says Patel, “from financial crises to health epidemics to ideas”. And learning the lessons of that and of how to garner attention from some of the most attention-deficient people on the planet – young people with electronic devices – has been Avaaz’s masterstroke….
A crisistunity is another Avaaz-ism. “Though I think we originally got it from The Simpsons,” says Patel. “It’s a mixture of crisis and opportunity. We’re at this extraordinary moment in history. We have the power to wipe out our species. But at the same time, we’ve had tremendous progress in the past 30 years. We have more than halved global poverty. We’ve radically increased the status of women. There are tremendous reasons for hope and optimism.”
There is something very Avaazian about the crisistunity, I come to think, in that it’s borrowed something slick and witty from popular culture and re-purposed it for something which used to be called the Greater Good. And then given it a thick dollop of added earnestness.”

Healthcare.gov and the Gulf Between Planning and Reality

Curated on Posted on by Stefaan Verhulst

Clay Shirky: “This is not just a hiring problem, or a procurement problem. This is a management problem, and a cultural problem. The preferred method for implementing large technology projects in Washington is to write the plans up front, break them into increasingly detailed specifications, then build what the specifications call for. It’s often called the waterfall method, because on a timeline the project cascades from planning, at the top left of the chart, down to implementation, on the bottom right.
Like all organizational models, waterfall is mainly a theory of collaboration. By putting the most serious planning at the beginning, with subsequent work derived from the plan, the waterfall method amounts to a pledge by all parties not to learn anything while doing the actual work. Instead, waterfall insists that the participants will understand best how things should work before accumulating any real-world experience, and that planners will always know more than workers.
This is a perfect fit for a culture that communicates in the deontic language of legislation. It is also a dreadful way to make new technology. If there is no room for learning by doing, early mistakes will resist correction. If the people with real technical knowledge can’t deliver bad news up the chain, potential failures get embedded rather than uprooted as the work goes on….
Given examples of technological success from commercial firms, a common response is that the government has special constraints, and thus cannot develop projects piecemeal, test with citizens, or learn from its mistakes in public. I was up at the Kennedy School a month after the launch, talking about technical leadership and Healthcare.gov, when one of the audience members made just this point, proposing that the difficult launch was unavoidable, because the government simply couldn’t have tested bits of the project over time.
That observation illustrates the gulf between planning and reality in political circles. It is hard for policy people to imagine that Healthcare.gov could have had a phased rollout, even while it is having one.
At launch, on October 1, only a tiny fraction of potential users could actually try the service. They generated concrete errors. Those errors were handed to a team whose job was to improve the site, already public but only partially working. The resulting improvements are incremental, and put in place over a period of months. That is a phased rollout, just one conducted in the worst possible way.
The vision of “technology” as something you can buy according to a plan, then have delivered as if it were coming off a truck, flatters and relieves managers who have no idea and no interest in how this stuff works, but it’s also a breeding ground for disaster. The mismatch between technical competence and executive authority is at least as bad in government now as it was in media companies in the 1990s, but with much more at stake…
Now, and from now on, government will interact with its citizens via the internet, in increasingly important ways. This is a non-partisan issue; whichever party is in the White House will build and launch new forms of public service online. Unfortunately for us, the last new technology the government adopted for interacting with citizens was the fax; our senior political figures have little habit of talking to their own technically adept employees.
If I had to design a litmus test for whether our political class grasps the internet, I would look for just one signal: Can anyone with authority over a new project articulate the tradeoff between features, quality, and time?
When a project cannot meet all three goals—a situation Healthcare.gov was clearly in by March—something will give. If you want certain features at a certain level of quality, you’d better be able to move the deadline. If you want overall quality by a certain deadline, you’d better be able to delay or drop features. And if you have a fixed feature list and deadline, quality will suffer.
Intoning “Failure is not an option” will be at best useless, and at worst harmful. There is no “Suddenly Go Faster” button, no way you can throw in money or additional developers as a late-stage accelerant; money is not directly tradable for either quality or speed, and adding more programmers to a late project makes it later. You can slip deadlines, reduce features, or, as a last resort, just launch and see what breaks.
Denying this tradeoff doesn’t prevent it from happening. If no one with authority over the project understands that, the tradeoff is likely to mean sacrificing quality by default. That just happened to this administration’s signature policy goal. It will happen again, as long politicians can be allowed to imagine that if you just plan hard enough, you can ignore reality. It will happen again, as long as department heads imagine that complex technology can be procured like pencils. It will happen again as long as management regards listening to the people who understand the technology as a distasteful act.”

OECD: Government at a Glance 2013

Curated on Posted on by Stefaan Verhulst

OECD: “Government at a Glance 2013 provides readers with a dashboard of key indicators assembled with the goal of contributing to the analysis and international comparison of public sector performance. Indicators on government revenues, expenditures, and employment are provided alongside key output and outcome data in the sectors of education and health. Government at a Glance also includes indicators on key governance and public management issues, such as transparency in governance, regulatory governance, new ways in delivering public services and HRM and compensation practices in the public service. While measuring government performance has long been recognized as playing an important role in increasing the effectiveness and efficiency of the public administration, following the economic crisis and fiscal tightening in many member countries, good indicators are needed more than ever to help governments make informed decisions regarding tough choices and help restore confidence in government institutions.”