Tim Kelsey (NHS) on why patient and citizen participation is fundamental to high quality health and care services: “…But above all my priority is to improve the way in which health and care services listen to people – and can therefore act and change. The work of entrepreneurs and apps developers like Patients Like Me, Patient Opinion and iwantgreatcare confirms the benefits of real time patient and citizen participation. The challenge is to do this at scale: open the doors, invite the whole community into the job of improving our national health service. Share decision making. Everybody needs the opportunity – and should be encouraged – to participate.
In April, the NHS did something unprecedented – it launched the Friends and Family Test (FFT), the first time a health service has reported a single measure of patient satisfaction for every hospital. It asked people to say whether they would recommend local inpatient and A&E services; the results are published every month on NHS Choices. By October more than 1m people had participated and hundreds of thousands had volunteered additional real time comments and feedback to local hospitals. ‘Great news’, said David Cameron – who has championed FFT from the start – in a tweet to mark the milestone, ‘giving patients a stronger voice in the NHS’.
This is the boldest move yet to promote patient voice at volume in the NHS and to concentrate our collective focus on improvement in care. At Hillingdon Hospitals NHS Trust, patients reported they could not sleep at night so staff have launched a ‘comfort at night’ campaign and developed a protocol for patient experience ‘never events’. In Lewisham, patients complained about poor communication and staff attitudes. They now plan daily visits for each patient. In Hull, bereaved families complained they had to pay car parking fees; the Trust has now given free passes to relatives in mourning. Routine feedback enables a different kind of conversation between the patient and the clinician. It is a catalyst for change. Commissioners will have to demonstrate how they are improving FFT for local communities to qualify for Quality Premium incentives.
This kind of customer insight is fundamental to the way we make choices as consumers. The NHS is not a hotel chain, nor a city authority: but there are vital lessons it can learn from Amazon and Trip Adviser about the power of transparency and feedback. In New York, more than 90,000 people every day share their views by phone, email and tweet on rubbish collections, potholes and dangerous buildings – and the city has become safer and cleaner.
Friends and family has its critics: people worry about the potential for gaming, for example. But the evidence, after six months, is of overwhelming human benefit and that’s why every maternity unit started to offer FFT to patients in October and why every NHS service will do so from 2015. It’s also why we are now requiring that every local organisation should offer people the chance to comment on, as well as rate, services from next year (most already do).
Some people ask me how we are ensuring the focus on transparency and participation is inclusive. We have launched Care Connect, a pilot project to test how giving people access by telephone and social media could improve feedback and complaints. Recognising that digital exclusion is an issue in some of our communities, we have started a partnership with the Tinder Foundation to help 100,000 people learn how to go online for health benefit. None of these initiatives exist in isolation, nor do I see them as ‘silver bullets’. My aim is to work with and build on existing good practice to make people’s voices heard and help the NHS act on them.
In a characteristically thoughtful talk last week, MT Rainey, social activist and former marketing guru, issued this challenge to the NHS: ‘How will we make the wisdom of the crowd meet the kindness of strangers?’ How do the tools of our age – big data, the internet, the mobile phone – meet the values of our species: compassion and honesty and doing our best for others? Friends and family is a good start. We are witnessing the birth of a new knowledge economy and a new social movement. The future is open.”
The Decay of American Political Institutions
Francis Fukuyamain the American Interest: “Many political institutions in the United States are decaying. This is not the same thing as the broader phenomenon of societal or civilization decline, which has become a highly politicized topic in the discourse about America. Political decay in this instance simply means that a specific political process—sometimes an individual government agency—has become dysfunctional. This is the result of intellectual rigidity and the growing power of entrenched political actors that prevent reform and rebalancing. This doesn’t mean that America is set on a permanent course of decline, or that its power relative to other countries will necessarily diminish. Institutional reform is, however, an extremely difficult thing to bring about, and there is no guarantee that it can be accomplished without a major disruption of the political order. So while decay is not the same as decline, neither are the two discussions unrelated.
There are many diagnoses of America’s current woes. In my view, there is no single “silver bullet” cause of institutional decay, or of the more expansive notion of decline. In general, however, the historical context of American political development is all too often given short shrift in much analysis. If we look more closely at American history as compared to that of other liberal democracies, we notice three key structural characteristics of American political culture that, however they developed and however effective they have been in the past, have become problematic in the present.
The first is that, relative to other liberal democracies, the judiciary and the legislature (including the roles played by the two major political parties) continue to play outsized roles in American government at the expense of Executive Branch bureaucracies. Americans’ traditional distrust of government thus leads to judicial solutions for administrative problems. Over time this has become a very expensive and inefficient way to manage administrative requirements.
The second is that the accretion of interest group and lobbying influences has distorted democratic processes and eroded the ability of the government to operate effectively. What biologists label kin selection and reciprocal altruism (the favoring of family and friends with whom one has exchanged favors) are the two natural modes of human sociability. It is to these types of relationships that people revert when modern, impersonal government breaks down.
The third is that under conditions of ideological polarization in a federal governance structure, the American system of checks and balances, originally designed to prevent the emergence of too strong an executive authority, has become a vetocracy. The decision system has become too porous—too democratic—for its own good, giving too many actors the means to stifle adjustments in public policy. We need stronger mechanisms to force collective decisions but, because of the judicialization of government and the outsized role of interest groups, we are unlikely to acquire such mechanisms short of a systemic crisis. In that sense these three structural characteristics have become intertwined….
In short, the problems of American government flow from a structural imbalance between the strength and competence of the state, on the one hand, and the institutions that were originally designed to constrain the state, on the other. There is too much law and too much “democracy”, in the form of legislative intervention, relative to American state capacity. Some history can make this assertion clearer….
In well-functioning governance systems, moreover, a great deal of deliberation occurs not just in legislatures but within bureaucracies. This is not a matter of bureaucrats simply talking to one another, but rather a complex series of consultations between government officials and businesses, outside implementers and service providers, civil society groups, the media and other sources of information about societal interests and opinions. The Congress wisely mandated consultation in the landmark 1946 Administrative Procedures Act, which requires regulatory agencies to publicly post proposed rule changes and to solicit comment about them. But these consultative procedures have become highly routinized and pro forma, with actual decisions being the outcome not of genuine deliberation, but of political confrontations between well organized interest groups….”
Book Review: Three Harbingers of Change
Howard Rheingold reviews the following books in Strategy and Business:
Viktor Mayer-Schönberger and Kenneth Cukier
Big Data: A Revolution That Will Transform How We Live, Work, and Think
(Houghton Mifflin Harcourt, 2013)
Marina Gorbis
The Nature of the Future: Dispatches from the Socialstructed World
(Free Press, 2013)
Henry Jenkins, Sam Ford, and Joshua Green
Spreadable Media: Creating Value and Meaning in a Networked Culture
(New York University Press, 2013)
“Whether you invest, build, teach, research, regulate, investigate, heal, entertain, or sell, major changes in how you do what you do are looming. “Big data,” much in the media spotlight recently—particularly for the revelations of the National Security Agency’s (NSA’s) surveillance of “metadata”—is probably already changing how you do your work. But socialstructing and spreadable media, two new terms that signal similarly momentous shifts, may still be unfamiliar. This year’s best business books on digitization can equip you to better understand all three phenomena and the changes that they will enable and engender….”
Net Effects: The Past, Present & Future Impact of Our Networks – History, Challenges and Opportunities
Ebook by FCC Chairman Tom Wheeler: “Almost a month into my new job, the fact that I’ve always been a “network guy” and an intrepid history buff should come as no surprise. Reading history has reinforced the central importance networks play and revealed the common themes in successive periods of network-driven change. Now, at the FCC, I find myself joining my colleagues in a position of both responsibility and authority over how the public is affected by and interfaces with the networks that connect us.
We have the privilege of being present at a hinge moment in history to wrestle with the future of our networks and their effect on our commerce and our culture. If such a topic is of interest to you, I hope you’ll download this short eBook. Hopefully, it’s the beginning of a dialogue.
Download the book on the following platforms for free:
Scribd: http://www.scribd.com/doc/188692474/Net-Effects-The-Past-Present-Future-Impact-of-Our-Networks-%E2%80%93-History-Challenges-and-Opportunities-By-Tom-Wheeler-FCC-Chairman
FCC website: http://www.fcc.gov/page/net-effects-past-present-and-future-impact-our-networks
PDF: http://transition.fcc.gov/net-effects-2013/NET_EFFECTS_The-Past-Present-…”
Government Digital Service: the best startup in Europe we can't invest in
Saul Klein in the Guardian: “Everyone is rightly excited about the wall of amazing tech-enabled startups being born in Europe and Israel, disrupting massive industries including media, marketing, fashion, retail, travel, finance and transportation. However, there’s one incredibly disruptive startup based in London that is going after one of the biggest markets of all, and is so opaque it is largely unknown in the world of business – and, much to my chagrin, it’s also impossible to invest in.
It’s not a private company, it wasn’t started by “conventional” tech entrepreneurs and the market (though huge) is decidedly unsexy.
Its name is the Government Digital Service (GDS) and it is disrupting the British public sector in an energetic, creative and effective way. In less than two years GDS has hired over 200 staff (including some of the UK’s top digital talent), shipped an award-winning service, and begun the long and arduous journey of completely revolutionising the way that 62 million citizens interact with more than 700 services from 24 government departments and their 331 agencies.
It’s a strange world we live in when the government is pioneering the way that large complex corporations reinvent themselves to not just massively reduce cost and complexity, but to deliver better and more responsive services to their customers and suppliers.
So what is it that GDS knows that every chairman and chief executive of a FTSE100 should know? Open innovation.
1. Open data
• Leads to radical and remarkable transparency like the amazing Transactions Explorer designed by Richard Sargeant and his team. I challenge any FTSE100 to deliver the same by December 2014, or even start to show basic public performance data – if not to the internet, at least to their shareholders and analysts.
• Leads to incredible and unpredictable innovation where public data is shared and brought together in new ways. In fact, the Data.gov.uk project is one of the world’s largest data sources of public data with over 9,000 data sets for anyone to use.
2. Open standards
• Deliver interoperability across devices and suppliers
• Provide freedom from lock-in to any one vendor
• Enable innovation from a level playing field of many companies, including cutting-edge startups
• The Standards Hub from the Cabinet Office is an example of how the government aims to achieve open standards
3. Cloud and open source software and services
• Use of open source, cloud and software-as-a-service solutions radically reduces cost, improves delivery and enables innovation
4. Open procurement
• In March 2011, the UK government set a target to award 25% of spend with third-party suppliers to SMEs by March 2015.”
Social movements and their technologies. wiring social change
New book by Stefania Milan: “Social Movements and Their Technologies. Wiring Social Change explores the interplay between social movements and their “liberated technologies”. It analyzes the rise of low-power radio stations and radical internet projects (“emancipatory communication practices”) as a political subject, focusing on the sociological and cultural processes at play. It provides an overview of the relationship between social movements and technology and investigates what is behind the communication infrastructure that made possible the main protest events of the past 15 years. In doing so, Stefania Milan illustrates how contemporary social movements organize in order to create autonomous alternatives to communication systems and networks and how they contribute to change the way people communicate in daily life, as well as try to change communication policy from the grassroots….
Read an excerpt from the book
“The question of infrastructure might sound trivial in times of abundance of “free” social media, microblogging platforms and apps allowing people to voice their opinions and share pictures and videos at will, and at virtually no cost. But we often forget that these platforms are owned and controlled by media and telecoms corporations whose agenda focuses on profit and corporate interests rather than participation, empowerment, and social justice. With this in mind, in recent decades activist groups have increasingly challenged media corporations and state-owned broadcasters on their own terrain. They have created alternatives to existing communication infrastructure by setting up community radio and television stations, and alternative websites for self-produced information. Such grassroots media have allowed broader swathes of the citizenry to access media production and secure communication channels. They have become what DeeDee Halleck calls “infrastructures of resistance” (2002, p. 191) to the neoliberal order in the media realm.”
Power to the people: how open data is improving health service delivery
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.”
Owning the city: New media and citizen engagement in urban design
Paper by Michiel de Lange and Martijn de Waal in First Monday : “In today’s cities our everyday lives are shaped by digital media technologies such as smart cards, surveillance cameras, quasi–intelligent systems, smartphones, social media, location–based services, wireless networks, and so on. These technologies are inextricably bound up with the city’s material form, social patterns, and mental experiences. As a consequence, the city has become a hybrid of the physical and the digital. This is perhaps most evident in the global north, although in emerging countries, like Indonesia and China mobile phones, wireless networks and CCTV cameras have also become a dominant feature of urban life (Castells, et al., 2004; Qiu, 2007, 2009; de Lange, 2010). What does this mean for urban life and culture? And what are the implications for urban design, a discipline that has hitherto largely been concerned with the city’s built form?
In this contribution we do three things. First we take a closer look at the notion of ‘smart cities’ often invoked in policy and design discourses about the role of new media in the city. In this vision, the city is mainly understood as a series of infrastructures that must be managed as efficiently as possible. However, critics note that these technological imaginaries of a personalized, efficient and friction–free urbanism ignore some of the basic tenets of what it means to live in cities (Crang and Graham, 2007).
Second, we want to fertilize the debates and controversies about smart cities by forwarding the notion of ‘ownership’ as a lens to zoom in on what we believe is the key question largely ignored in smart city visions: how to engage and empower citizens to act on complex collective urban problems? As is explained in more detail below, we use ‘ownership’ not to refer to an exclusive proprietorship but to an inclusive form of engagement, responsibility and stewardship. At stake is the issue how digital technologies shape the ways in which people in cities manage coexistence with strangers who are different and who often have conflicting interests, and at the same time form new collectives or publics around shared issues of concern (see, for instance, Jacobs, 1992; Graham and Marvin, 2001; Latour, 2005). ‘Ownership’ teases out a number of shifts that take place in the urban public domain characterized by tensions between individuals and collectives, between differences and similarities, and between conflict and collaboration.
Third, we discuss a number of ways in which the rise of urban media technologies affects the city’s built form. Much has been said and written about changing spatial patterns and social behaviors in the media city. Yet as the editors of this special issue note, less attention has been paid to the question how urban new media shape the built form. The notion of ownership allows us to figure the connection between technology and the city as more intricate than direct links of causality or correlation. Therefore, ownership in our view provides a starting point for urban design professionals and citizens to reconsider their own role in city making.
Questions about the role of digital media technologies in shaping the social fabric and built form of urban life are all the more urgent in the context of challenges posed by rapid urbanization, a worldwide financial crisis that hits particularly hard on the architectural sector, socio–cultural shifts in the relationship between professional and amateur, the status of expert knowledge, societies that face increasingly complex ‘wicked’ problems, and governments retreating from public services. When grounds are shifting, urban design professionals as well as citizens need to reconsider their own role in city making.”
Policy making 2.0: From theory to practice
Paper by E. Ferro, EN Loukis, Y. Charalabidis, and M. Osella in Government Information Quarterly: “Government agencies are gradually moving from simpler towards more sophisticated and complex practices of social media use, which are characterized by important innovations at the technological, political and organizational level. This paper intends to provide two contributions to the current discourse about such advanced approaches to social media exploitation. The first is of practical nature and has to do with assessing the potential and the challenges of a centralized cross-platform approach to social media by government agencies in their policy making processes. The second contribution is of theoretical nature and consists in the development of a multi-dimensional framework for an integrated evaluation of such advanced practices of social media exploitation in public policy making from technological, political and organizational perspectives, drawing from theoretical constructs from different domains. The proposed framework is applied for the evaluation of a pilot consultation campaign conducted in Italy using multiple social media and concerning the large scale application of a telemedicine program.”
The Good Judgment Project: Harnessing the Wisdom of the Crowd to Forecast World Events
The Economist: “But then comes the challenge of generating real insight into forecasting accuracy. How can one compare forecasting ability?
The only reliable method is to conduct a forecasting tournament in which independent judges ask all participants to make the same forecasts in the same timeframes. And forecasts must be expressed numerically, so there can be no hiding behind vague verbiage. Words like “may” or “possible” can mean anything from probabilities as low as 0.001% to as high as 60% or 70%. But 80% always and only means 80%.
In the late 1980s one of us (Philip Tetlock) launched such a tournament. It involved 284 economists, political scientists, intelligence analysts and journalists and collected almost 28,000 predictions. The results were startling. The average expert did only slightly better than random guessing. Even more disconcerting, experts with the most inflated views of their own batting averages tended to attract the most media attention. Their more self-effacing colleagues, the ones we should be heeding, often don’t get on to our radar screens.
That project proved to be a pilot for a far more ambitious tournament currently sponsored by the Intelligence Advanced Research Projects Activity (IARPA), part of the American intelligence world. Over 5,000 forecasters have made more than 1m forecasts on more than 250 questions, from euro-zone exits to the Syrian civil war. Results are pouring in and they are revealing. We can discover who has better batting averages, not take it on faith; discover which methods of training promote accuracy, not just track the latest gurus and fads; and discover methods of distilling the wisdom of the crowd.
The big surprise has been the support for the unabashedly elitist “super-forecaster” hypothesis. The top 2% of forecasters in Year 1 showed that there is more than luck at play. If it were just luck, the “supers” would regress to the mean: yesterday’s champs would be today’s chumps. But they actually got better. When we randomly assigned “supers” into elite teams, they blew the lid off IARPA’s performance goals. They beat the unweighted average (wisdom-of-overall-crowd) by 65%; beat the best algorithms of four competitor institutions by 35-60%; and beat two prediction markets by 20-35%.
Over to you
To avoid slipping back to business as usual—believing we know things that we don’t—more tournaments in more fields are needed, and more forecasters. So we invite you, our readers, to join the 2014-15 round of the IARPA tournament. Current questions include: Will America and the EU reach a trade deal? Will Turkey get a new constitution? Will talks on North Korea’s nuclear programme resume? To volunteer, go to the tournament’s website at www.goodjudgmentproject.com. We predict with 80% confidence that at least 70% of you will enjoy it—and we are 90% confident that at least 50% of you will beat our dart-throwing chimps.”
See also https://web.archive.org/web/2013/http://www.iarpa.gov/Programs/ia/ACE/ace.html