As many of you know I've been a contributor to the Technology, Health & Development blog over the last few years. We've recently moved off WordPress to a more permanent home. This makes the old site obsolete, although it will stay up. The same set of folks talking about the same sets of issues - a collective of research scholars and practitioners examining global health solutions with a focus on innovation and technology.
As some of you have noticed the Technology, Health and Development blog (THD Blog) formerly hosted at http://thdblog.wordpress.com has moved and changed names to this current site - Global Health Ideas (http:/globalhealthideas.org). Partly because of increased attention and scope we decided it was time for a more permanent home that would also allow us to do more. We are still going to be blogging about global health solutions, innovative projects and the use of technology and you can continue to reach any of us at thdblog AT gmail DOT com. All of our old posts will remain on the old site and also can be found on this site. Please bear with us over the coming weeks as we sort through various bugs and coding errors.
Also note that we will be live blogging from the Global Health Council's annual conference in DC 26-30 May. On Twitter we'll be at: @jaspaldesign, #ghc36 (the hashtag that the Global Health Council has endorsed).
Had lunch yesterday with Gerelmaa Bataa of Asian Health Services and Street Level Health to talk about her outreach work with the Mongolian Bay Area community, a group concentrated in Oakland, Alameda, and Albany. One of the questions I had was how she was trying to keep the community informed about swine flu (aka H1N1 aka Gahain tomuu). In addition to posting on a website frequented by Mongolian immigrants, she's posting flyers in apartment buildings with high density of Mongolians, talking to people seeking health services, and handing out these info sheets - same info as the flyers just smaller. The title reads: "Let's prevent the spread of swine flu".
A couple weeks ago a friend invited us to help her with a take-home activity she was assigned in advance of a focus group that she was doing for some extra cash. A UK-based firm had been contracted by a company that makes one of the products pictured above to understand how they might reposition the product. [Hint: not the one that is useful for combating ring-around-the collar.] This photograph was my main contribution to the activity since the one reminded me of the other.
As design researchers we constantly focus on empathy, but during this exercise I began to wonder how much we really empathize with the customer/user/client in their role as study participant. During the hour on the roof, there was quite a bit of rich interaction and discussion about the product - some positive, some negative, some tangential, but probably all useful. Our friend had been given a thick packet of questions to guide us through the activity - she was supposed to write answers to the questions by hand and was "free" to take photographs. More than one person mentioned that the questions seemed repetitive. It seems much of that rich social interaction was lost in the process of burdensome transcription, in part because of the quantity and quality of the questions. How much would that hour with us (live or by video or audio recording) have been worth to the client?
I talked to that friend again yesterday about the focus group itself. The research firm used it as an opportunity to test out new product concepts. At one point they brought a bottle of something green and she said, in reference to the above photograph: "My friend doesn't want to drink anything that looks like dish soap". The bottle was quickly whisked away. Another one of her observations: the focus group - like other focus groups she has participated in previously - was dominated by 1-2 people. An observation that suggests we should be more careful about how we use focus groups. It would be unfair to generalize about focus groups based on this sample, but it does suggest that we need to ensure that we appreciate the importance of good facilitation.
The Global Downturn Lands With a Zud on Mongolia's Nomads, from the Wall Street Journal (thanks Sara for the pointer). The story is about herders defaulting on loans due to decreased demand for cashmere in the midst of the global economic crisis. The title is a reference to "financial zud", a rather stark metaphor that compares the current situation to an extremely harsh winter in which many livestock die: zud on Wikipedia,the 1999/2000 zud as covered by BBC. The article focuses on the story of an individual herder in Tsogt sum in Govi Altai who has lost his animals to the bank. The piece includes a video (embedded below) and a photo slideshow - much more coverage than Mongolia typically gets. The photo above is from the slideshow and shows a bagiin emch at work. Given my interest in bagiin emch, this is notable - certainly the first time a bagiin emch has gotten his or her photo in the Journal. To see the full version of the above, see photo 7 in the slideshow (some excellent images in this set). For even more, see the photographer Josh Chin's Mongolia set on Flickr.
An MPH student from the Health Sciences of University of Mongolia recently contacted me on the recommendation of one of her faculty from the Department of Social Sciences. The reason? She was doing research on bagiin emch - aka bag feldshers - and I was one of the few people who had done any research on this group. Exciting stuff for me. With Khostuya's permission, I am posting the English language abstract of her Master's thesis here, along with keywords in English and Mongolian:
WORKLOAD AND JOB SATISFACTION OF BAG FELDSHERS
B.Khostuya, Kh.Damdinjav School of Public Health, HSUM (Mongolia)
Purpose: To determine the workload and job satisfaction of Mongolian bag feldshers (bagiin baga emch), to summarize the results, and to develop recommendations for improvement.
Methods: The study involved in total 88 bag feldshers (2 soums from all 21 provinces for a total of 42 soums; 3 bag feldshers from 4 of these soums and 2 bag feldshers from the remaining 38). We conducted the research using both quantitative and qualitative methods. Collected data were analyzed using SPSS 12.0. We registered working hours and activity by direct observation. Upon analysis, we clarified basic and additional work structure through document analysis and interviews.
Conclusions: The workload of bag feldshers varies by season, week, and day. It is not possible to determine their workload and job satisfaction using timing methods. Medical services are limited because 40.9% of bag feldshers involved in our study live at the soum center. The workload of those bag feldshers living at the soum center is less than those living in the countryside. Although bag feldshers tend to be satisfied with their job, there are persistent issues with support for social services.
Keywords: Bagiin baga emch, work conditions, workload, satisfaction, working environment
Many global health disparities persist not from a lack of technical solutions, but from an inability to effectively implement existing measures. While financing and human resources are critical concerns, so too is the need to better understand and adapt to the people who execute and benefit from these solutions. There is a significant opportunity here for applied ethnographic methods from design (design research) to examine the norms, knowledge, and needs of these individuals and groups. Despite interest in such an approach by organizations such as PATH, The World Bank, and the Bill and Melinda Gates Foundation, we still have a limited understanding of design research methods in the context of global health and development.
This dissertation aims to improve our understanding of these methods. It is a case study of a design research project examining the information management practices of “bagiin emch”, nomadic health workers in rural Mongolia. The design research was conducted between June 2006 and August 2008 in Mongolia in cooperation with the Ministry of Health and the Asian Development Bank’s Second Health Sector Development Program (HSDP-2). Although study participants included bagiin emch who received handheld computers from HSDP-2, the emphasis of this research was not on technology, but on innovation - the development and adoption of new information management solutions.
The primary field method was serial hanging out: multi-day, design-oriented participant observation. Serial hanging out is a novel approach to design research well suited to global health, so the contextual examination of the method is a primary contribution of this dissertation. The dissertation also operationalizes theoretical saturation for participant observation, providing empirically-based guidance for sample sizes, as had only been done for semi-structured interviews (reproductive health research) and focus groups (market research) prior to this study. This dissertation demonstrates how these methods achieve a richer understanding of people and phenomena, and how that is relevant to improving population health. At the same time, the dissertation explores how to use these methods most effectively, including an examination of design research capacity-building.
Relevance to the theme of the blog? An innovative model of using new media to motivate the masses. Might sound like a stretch, but Dr. V from Aravind often talked about emulating the McDonald's model and when I was at Kaiser's Innovation Center last month, they discussed how they visited In-N-Out to learn from their operations model.
The California Management Review recently announced the winners of the 2009 Accenture Award: Sara Beckman of Berkeley's Haas School of Business and Michael Barry, founder of design consultancy Point Forward and Adjunct Professor at Stanford, for their article, Innovation as a Learning Process: Embedding Design Thinking (Fall 2007, Vol. 50, No. 1).
From the award website (which is still on the 2008 winner as I write this): "The Accenture Award is given each year to the author (or authors) of the article published in the preceding volume of the California Management Review that has made the most important contribution to improving the practice of management."
The paper makes a compelling argument that innovation can be achieved by management and provides a model for cross-functional, cross-disciplinary teams to engage in this process. The relevance to global health as I've discussed before (really what this entire blog is about) is that the process can help us improve health systems through innovation.
The challenge in coming years will be how to get organizations and institutions working in global health - foundations, Ministries of Health, NGOs, development programs, health research centers, etc. - treating innovation as a way of working, not simply an input or an output.
The abstract/lead-in isn't openly available online so I'm copying it here:
Companies throughout the world are seeking competitive advantage by leading through innovation, some — such as Apple, Toyota, Google, and Starbucks — with great success. Many countries - such as Singapore, China, Korea, and India — are investing in education systems that emphasize leading through innovation, some by investing specifically in design schools or programs, and others by embedding innovative thinking throughout the curriculum. Business, engineering, and design schools around the U.S. are expanding their efforts to teach students how to innovate, often through multi-disciplinary classes that give students a full experience of the innovation process. However, what does leading through innovation really mean? What does it mean to be a leader, and what does it mean to engage in innovation?
There is a vast literature on leadership covering a wide range of topics: the characteristics of a good leader, how leadership is best displayed in an organization, leadership and vision, authority, leadership styles, and so on. There is also a growing body of literature on innovation and its various facets, much of it focused by application of the innovation process. Hundreds of publications describe the process of innovation for products — both hardware and software — and a growing number of publications focus on innovation in services. Further, there are dozens of books on innovation in building and workplace design.
Here we examine a generic innovation process, grounded in models of how people learn, that can be applied across these sectors. It can be applied to the design and development of both hardware and software products, to the design of business models and services, to the design of organizations and how they work, and to the design of the buildings and spaces in which work takes place, or within which companies interact with their customers. The model has evolved through two streams of thought: design and learning.
This video, which seems to be unaffiliated to the authors, summarizes the article [correction - I just found out that Shealy did work with the authors on this video - Tues-24-Mar-2009 12:18PM PDT]:
Giving talks is not one of my strong suits, but it seems to be a part of the job requirement. Earlier this month, I had the opportunity (even though I'm no good, I do consider it an opportunity), to give a couple talks, one to the Interdisciplinary MPH Program at Berkeley and one to a group of undergraduate design students, also at Berkeley. Despite the difference in focus, age, and experience of the two groups, the topic was roughly the same: How do we effectively use design thinking as an approach in public health?
The first session was so-so, and I suspect that the few people who were excited about it were probably excited in spite of the talk. It started well, but about halfway through, something began to feel very wrong and that feeling didn't go away until some time later that evening. Afterwards, I received direct feedback from the instructor and from the students in the form of an evaluation. I recommend this if it is ever presented as an option. Like any "accident", this one was a "confluence of factors": lack of clarity and specificity, allowing the discussion to get sidetracked, poor posture, and a tone that conveyed a lack of excitement for the topic.
It's one thing to get feedback like this, another to act on it.
The second session went much better, gauging by the student feedback, the comments from the instructor, and my own observations. This in spite of a larger group (60 vs. 20) that would be harder to motivate (undergraduates with midterms vs. professionals working on applied problems in public health). I chalk it all up to preparation and planning. Certainly there are people that are capable of doing a great job without preparation - I just don't think I'm one of those people.
Most of that preparation by the way was not on slides. I did use slides, but only had five for an hour session and that still proved to be too many. Most of the time that I spent on slides, I spent developing a single custom visual to convey precisely the information that was relevant to the students during this session (see image). The rest of the preparation was spent understanding the audience needs by speaking to those running the class; developing a detailed plan for the hour, focusing on how to make the session a highly interactive learning experience; designing quality handouts to support the interactive exercise; and doing my necessary homework. For this last one, I spent 20 minutes on the phone with a surgeon friend, since the session was built around a case study discussing surgical complications and design.
Three resources I found really useful:
Why Bad Presentations Happen to Good Causes, Andy Goodman, 2006. This commissioned report was developed to help NGOs with their presentations, but I think there is value here for anyone whose work involves presentations. It is evidence-based and provides practical guidance on session design, delivery, slides (PowerPoint), and logistics. Most importantly, it is available as a free download. I was fortunate enough to pick up a used copy of the print edition for US$9 at my local bookstore, which was worth the investment for me because of the design of the physical book. It's out-of-print now and it looks like the online used copies are quite expensive - at least 3x what I paid - so I recommend the PDF.
Envisioning Information, Edward Tufte, 1990. I read this when I was writing my dissertation. Folks in design all know about Tufte, but I still recommend a periodic refresher. This is the sort of book that will stay on my shelf. Also potentially useful is The Visual Display of Quantitative Information. For those working in global health, don't forget how important the display of information can be: (a) Bill Gates and the NYTimes, (b) Hans Rosling at TED.
Software for creating quality graphics. The drawing tools built into typical office applications, though they have improved in recent years, are still limited in their capability and flexibility, especially if you're looking at #2 above. In the past 10 days, three people in my socio-professional network have solicited advice on such standalone tools, OmniGraffle (for Mac) and Visio (Windows): a graphic designer in New York, an energy research scientist in California, and a healthcare researcher in DC. Both are great options. I use OmniGraffle these days, though I used to use Visio a few years back. If cost is an issue, there are open-source alternatives available, though I'm not at all familiar with them (e.g., the Pencil plug-in for Firefox).
Forum 2009: Innovating for the Health of All is this year’s milestone event in research and innovation for health. Organized by the Global Forum for Health Research, it will take place from 16-20 November in Havana, Cuba, at the invitation of the Ministry of Public Health.
What exactly is “innovation”?* How can decision-makers and practitioners work together to foster innovation for health and health equity? What can we learn from innovation policies and initiatives around the world? These questions will be answered in Forum 2009‘s interwoven discussions of social innovation and technological innovation.
This event will bring together some 800 leaders and experts from around the world to share ideas and forge new partnerships. It will include a unique mix of stakeholders from health and science ministries, research agencies and institutions, development agencies, foundations, nongovernmental organizations, civil society, the private sector and media.
As you expand your networks, you will also be able to learn from discussions on social entrepreneurship for health, public-private product development for neglected diseases, eHealth, knowledge-translation platforms, national health innovation systems, donor-country harmonization and coherence, and innovative financing strategies.
With the theme “innovation,” we are challenged to be innovative in the programme itself including new session formats that are more interactive, new ways to network and share information, and new opportunities for inclusion.
So please join us. Registration is now open on www.globalforumhealth.org. We very much look forward to seeing you in Cuba.
Yours sincerely, Professor Stephen Matlin Executive Director Global Forum for Health Research
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