Improving Deliberation on Health Care

We wanted to share this thought-provoking commentary on a recent study on health care opinions conducted by our friends and partners at Public Agenda and the Kettering Foundation. As our nation continues to grapple with reforming our health care system, we in the engagement community have a special role to play in helping our communities decide how to tackle the big questions of reform. We hope you’ll take a moment to read the commentary below or find the original PA blog post here.


PublicAgenda-logoAs is evident in “Curbing Health Care Costs: Are Citizens Ready to Wrestle with Tough Choices?“, there are disconcerting contradictions and inconsistencies in Americans’ views on health care that indicate the need for continued public information and deliberation. Several of these contradictions are worth noting, as they may hold a key for developing successful approaches to engaging the public in policies and practices that enable quality care and controlled cost.

Disconcerting contradictions and inconsistencies in Americans’ views on health care indicate the need for continued public information and deliberation.

As the report notes in its introduction, the current cost crisis is certainly not new, yet public consciousness and a sense of urgency have begun emerging only in the past five years. The reasons are many: unlike all other consumer services, the majority of health-care costs are indirect, handled through a third-party payer. Out-of-pocket costs were historically an issue only for the poor, uninsured and underinsured. The rest of the nation remained fairly protected and blissfully unaware. But those days have passed.

Many of the findings in this study ring true with our own at the American Institutes for Research and our Center for Patient and Consumer Engagement. Recent deliberations across the country that we conducted for the Agency for Healthcare Research and Quality found similar public interest in information, a variety of perspectives and a desire for a place at the table as solutions are found and implemented. As in the deliberations we conducted, the study participants walked in with both misinformation and an individual, rather than a social, perspective on costs.

It is no wonder that health consumers, who are informed more by direct marketing than science or policy analysis about health care, indicate in this study their belief that specialists and renowned hospitals justifiably cost more. Our own 2010 study found that most consumers believed that more care, newer care, and more expensive care was better. However, this study also shows the extent to which patients understand that doctors may order too many tests and treatments because they are financially motivated to do so.

These results, along with other similar findings, need to bolster the efforts now underway to engage consumers and patients in cost payment reform at a variety of levels.

There are many encouraging signs from this study, however, that need additional fostering. Our own experience echoes the experience in this study of witnessing a shift in perspective as participants become informed, an eagerness to learn more about the issue of health-care costs, and a sense of duty in “wrestling” with the complexities of health-care costs.

These results, along with other similar findings, need to bolster the efforts now underway — funded by both federal agencies and private foundations — to engage consumers and patients in cost payment reform at a variety of levels, ranging from cost-effectiveness conversations when deciding treatment with a doctor to engagement at clinics and hospitals considering new forms of payment systems, such as bundled payments.

Critical to the effort is the need for consumers to demand that cost and quality remain on the table together. Accountable Care Organizations, Patient-Centered Medical Homes, and a variety of new models for care are seeking both reduced costs and increased quality, and many are committed to involving patients and consumers in their efforts as the ultimate end-users of their work. We can only hope that a similar spirit of engagement can be found in public policy settings. Our patients have much to add to those discussions.

Two Grant Opportunities

We recently heard from our friends at Everyday Democracy about two foundations that make engagement-related grants, and we wanted to make sure to share about them. Funding is almost always a challenge, and we know every bit counts, so we encourage you to check out what the Norman Foundation and the National Endowment for the Humanities have to offer.

Norman Logo

The opportunity from the Norman Foundation is oriented toward social change efforts and has an environmental slant:

Guidelines

Thomas Jefferson observed that “the ground of liberty is won by inches.” The Norman Foundation seeks to help win some of those precious inches.  We support efforts that strengthen the ability of communities to determine their own economic, environmental and social well-being, and that help people control those forces that affect their lives.  These efforts may:

  • promote economic justice and development through community organizing, coalition building and policy reform efforts;
  • work to prevent the disposal of toxics in communities, and to link environmental issues with economic and social justice;
  • link community-based economic and environmental justice organizing to national and international reform efforts.

We will consider the following in evaluating grant proposals:

  • Does the project arise from the hopes and efforts of those whose survival, well-being and liberation are directly at stake?
  • Does it further ethnic, gender and other forms of equity?
  • Is it rooted in organized, practical undertakings?
  • Is it likely to achieve systemic change?

In pursuing systemic change, we would hope that:

  • the proposed action may serve as a model;
  • the spread of the model may create institutions that can survive on their own;
  • their establishment and success may generate beneficial adaptations by other political, social and economic institutions and structures.

The Foundation provides grants for general support, projects, and collaborative efforts. We also welcome innovative proposals designed to build the capacity of social change organizations working in our areas of interest.   Priority is given to organizations with annual budgets of under $1 million.

To find out more about how to apply for a grant from the Norman Foundation, visit their How to Apply page.

NEH logo

Next, the opportunity from the National Endowment for the Humanities is oriented toward supporting museums, community institutions like libraries, and historic places:

Brief Summary

Museums, Libraries, and Cultural Organizations grants provide support for museums, libraries, historic places, and other organizations that produce public programs in the humanities.

Grants support the following formats:

  • exhibitions at museums, libraries, and other venues;
  • interpretations of historic places, sites, or regions;
  • book/film discussion programs; living history presentations; other face-to-face programs at libraries, community centers, and other public venues; and
  • interpretive websites and other digital formats.

Implementation grants support final scholarly research and consultation, design development, production, and installation of a project for presentation to the public.

For more information on applying for NEH grant, you can contact the staff of NEH’s Division of Public Programs at publicpgms@neh.gov, or visit their grants website for more information.

Good luck, and here’s hoping these opportunities can help us advance our work!

The Optimist and the Pessimist

I saw this written on a bathroom wall today:

Life can get better! 
Suck
Then              :-)
you
Die

I was struck by the art of these two statements, literally orthogonal to each other.

I wondered which came first.

Did it start with the “pessimistic” message, followed by the encouraging “…can get better!” or did it happen the other way around?

I wonder which person drew the smiley face.

I put pessimistic in quotations above because I imagine that’s how most people would classify a comment like, “Life suck[s] then you die.” But I’m not sure I would.

Perhaps because I’m a contrarian and the general conflagration of “optimism” with “good” and “pessimism” with “bad” just makes me root for the pessimists.

But part of what moves me about this wall art is that while the sentiments seems contradictory…they really don’t have to be.

I’ll take as a given that whatever the state of life, it is true that “then you die.” So for simplicity, the statements simply read: “Life can get better; life sucks.”

Those don’t seem mutually exclusive at all. In fact, both statements hold truth. And to see them together seems meaningful.

I’ve never been comfortable with the division of people into optimists and pessimists.As if everyone at all times should be either an energetic Tiger bouncing off the walls and never feeling sad, or a dull, depressed Eore moping through the hallways and never feeling anything.

But most of us are both of those things; reveling in some times and languishing in others.

They say the best thing about being happy is that you think you’ll never be unhappy again. And the converse is true as well: the worst thing about being unhappy is that you think you’ll never be happy again.

So we envision these stark divisions. The optimist and the pessimist. The happy and the sad. The light and the dark. Two states that can never mix.

I like to imagine that the same person wrote both comments. Life sucks, life can get better. Life can get better, life sucks.

Then one day, they added the smiley face, when at last they came to peace with a feeling that both states were true.

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horizon as a metaphor for culture

(Chicago) The philosophers Edmund Husserl, Hans-Georg Gadamer, and Jürgen Habermas use the metaphor of a horizon to describe the background or framework of experience. Without addressing thorny questions of interpretation involving these three disparate and difficult authors, I’d like to defend the metaphor in general terms:

Any person at any given moment has a unique visible horizon–the line that divides the objects on the earth from the sky. Yet if I stand right next to you, or stand where you were a minute ago, my horizon will closely resemble yours. Thus the metaphor captures the uniqueness of individual experience while making difference a matter of degree that is somewhat within our control.

It’s possible for two people to have entirely different horizons–they cannot see any of the same objects. Yet those two people could move until their horizons overlapped. A person could stand between two individuals whose horizons did not overlap and be seen by each. Or a whole chain of people could connect two remote individuals, allowing them to share vicarious experiences.

Your horizon is a function of the way the world is and how you see things. To a degree, you can change how you look and where you stand, but you must start from somewhere that you did not choose.

You have the capacity to see anything within your horizon. But you cannot see it all at once. You can describe and communicate anything within your horizon, but you cannot ever describe it all. You are aware of the horizon as a whole, but your attention focuses on objects within it.

I think if you replace “horizon” with “culture,” most of these sentences will ring true. At any rate, ever since my first book, I have been criticizing theories of culture that presume that everyone who belongs to Culture A shares the same structure of beliefs, which must be different from the structure that defines Culture B. That kind of model promotes unwarranted relativism and skepticism.

The post horizon as a metaphor for culture appeared first on Peter Levine.

The scandalous case of the cornerback who said too much

It seems like everywhere I turn, I see people responding to the now infamous “Richard Sherman outburst.”

I first caught this story on the morning news. I honestly wasn’t paying much attention since celebrity gossip is not quite my thing, but I got the distinct impression that something scandalous had happened. The cornerback for the Seahawks, apparently, said something with perhaps more enthusiasm than was seemly.

Since the Pats were out of the superbowl (what a terrible game!), it seemed hardly worth my while.

Then I started to see the Facebook posts. In my feed, at least, a lot of folks were rushing to defend Sherman from the apparent attacks against him.

But I still didn’t really know what was going on. I asked someone else what the hubbub was about. They* didn’t really know either.

“Something, something, something, unsportsmanlike, something,” they said (or perhaps I heard). “Yeah, I think it’s basically that he was unsportsmanlike.”

Well, at least that added some clarity. People tend to freak out over unsportsmanlike comments. Remember the blow back on Rickey Henderson after he declared that, “Today, I’m the greatest of all time” ?

He got into some mighty hot water over that. Though, frankly, I still think it was kinda funny. I mean, seriously, the man had just stolen his 939th base. That day, he was the greatest of all time.

It may not have been my style to announce it to the world, but…having never stolen a single base, I’m not in the best position to reflect on this. And, if you’re wondering, the language “greatest of all time” was intended to be an allusion to the inimitable Muhammad Ali.

So, I don’t really care if someone says something unsportsmanlike. I get that some people care – some thinking its okay and others finding it poor role modeling – but I don’t really care. It’s just not my thing.

But this story really caught my attention when yesterday Sherman commented that his biggest concern is that folks are “using the word ‘thug’ as a substitute for the n-word.”

Okay, well, now I’m concerned about that, too.

I started trying to figure out what actually happened. After the game, Sherman went over to 49ers wide receiver Michael Crabtree and said something. Crabtree hit Sherman in the face. Sherman did a TV interview and Sherman exuberantly told FOX correspondent Erin Andrews “Well, I’m the best corner in the game! When you try me with a sorry receiver like Crabtree, that’s the result you gonna get! Don’t you ever talk about me!”

In response, as CNN reports: The bile flowed almost immediately — tweets calling him a gorilla, an ape or a thug from the ghetto. “Richard Sherman deserves to get shot in the (expletive) head. Disrespectful (N-word),” said one, expressing a common refrain.

So, folks may indeed be using “thug” as a substitute for the n-word, but, from the quote above, people seem pretty open to using that word too.

I’m unclear on why no one’s talking about Crabtree hitting Sherman. From what I recall, that’s not how we’re supposed to deal with our emotions. But, irregardless, it seems clear that there is a definitive racial component to this backlash.

I’m sure there are people who would be offended by unsportmanlike conduct regardless of race, but my impression is that those are not the voices giving this story its edge.

So, let’s talk about that.

Let’s not debate, in this conversation, whether sports players need to be good role models. Let’s put aside for a moment the discussion of unsportsmanlike conduct. Let’s not make this a story about Richard Sherman or Michael Crabtree. Of who said what to whom or who was at fault.

Let’s talk about the fact that a not insignificant portion of Americans are appalled, upset, or disgusted to see a large black man showing, perhaps, a little too much exuberance.

I mean, really, let’s talk about that.

*While “they” is not appropriate here grammatically, I continue to use it as a gender-neutral term no matter how many times in my life I’ve been marked down or corrected. So there.

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Enhancing Engagement with Textizen

Are you looking for creative and effective ways to keep people engaged in your engagement projects? Then we have something you might want to look into.

textizen

We have been following the development of something called Textizen – an ingenious, text-based platform designed to help facilitate public engagement that emerged from a collaboration between Code for America and the City of Philadephia. The Textizen team is on the cusp of launching a new “campaigns” feature that we know that many of our NCDDers could find extremely useful.

Textizen Campaigns are a revolutionary way to turn lightweight action into long-term engagement. Once you’ve built an initial audience, it’s easy to stay connected through our automated text platform. Share project updates, collect additional input, or segment audiences based on past responses — it’s up to you.

The idea of using text messaging for public engagement is not new, but Textizen provides a unique and innovative way for engagement professionals to easily make use of texting to collect and organize input from multiple constituents through a simple web interface. The new campaigns feature is designed to help build a constituency for engagement projects and keep that constituency engaged and informed over time, in between meetings, and as projects change. Textizen has a suite of sophisticated tools that will help engagement professionals make the best use of the collective knowledge and capacity of their communities.

We encourage you to check out their website at www.Textizen.com, and if you’re interested in getting early access to Textizen Campaigns, you can sign up on their campaigns page. You can also stay up to date by keeping an eye on the Textizen Blog. We hope you find it useful!

big data comes to the social sciences

Gary King, director of Harvard’s Institute for Quantitative Social Science, has written a manifesto entitled Restructuring the Social Sciences. I have mixed feelings about it, but it’s a useful statement of influential trends in academia. King begins:

The social sciences are in the midst of an historic change, with large parts moving from the humanities to the sciences in terms of research style, infrastructural needs, data availability, empirical methods, substantive understanding, and the ability to make swift and dramatic progress.

King is highly enthusiastic about these trends, asserting that “the social sciences are undergoing a dramatic transformation from studying problems to solving them.” Solving problems certainly sounds like a good thing. One important reason is that social scientists are moving from statistical models based on samples (for instance, surveys) to the analysis of comprehensive datasets, such as all the job announcements posted in a set of newspapers over many years, or all the votes cast in the 2012 election. Social science thus merges with the kind of research conducted by firms like Google and Facebook, government agencies like the NSA, and political campaigns. Disciplinary boundaries are blurred, as some of the most interesting basic research on society now comes from computer science and business rather than the liberal arts.

In practical terms, King advocates the creation of centers like his own that can provide a shared infrastructure and a meeting place for diverse social scientists who use the new techniques. He claims that qualitative methods will retain an important role, because the masses of data that ethnographers and interviewers collect can also be mined by data analysts.

He suggests that centers for social science can become dramatically more efficient and effective if they apply their findings about organizational psychology to their own operations. For instance, they need lots of IT support, and they can provide that in ways that mimic the best-practices of IT firms. Finally, King would make a place for theorists, arguing that their insights can be helpful. “Moreover, theorists don’t cost anything! They require some seminars, maybe a pencil and pad, and some computer assistance.”

I am left with several questions:

  1. What does King mean by the humanities? He repeatedly describes the social sciences as moving away from the humanities, but what does he think they are leaving behind? Solo research? Unsystematic research? Unproductive research that doesn’t solve problems? (See my post on “What are the humanities? Basic points for non humanists” and also “Stop problematizing–say something“)
  2. How successful are these new techniques, really? In particular, are they generating new general knowledge and frameworks, or simply ad hoc answers to very particular problems? King cites a study that used massive data to demonstrate discrimination against people with stereotypically African American first names. I think that is an important finding. But does it tell us anything about the underlying reasons for racial prejudice or general strategies that we might use to defeat it? (Cf. “Bent Flyvbjerg’s radical alternative to applied social science” and my “critique of expertise, part 1″)
  3. What are the ethical pitfalls of increasing our power to track, predict, and influence human behavior? To put it another way, if the social sciences move from studying problems to solving them, are the “solutions” ethically acceptable in terms of their means, their ends, and the ways that they engage the affected populations? (See my “qualms about Behavioral Economics” and “the new manipulative politics: behavioral economics, microtargeting, and the choice confronting Organizing for Action.”) This, of course, is why the humanities remain so important in an era of big data.

The post big data comes to the social sciences appeared first on Peter Levine.

Group Decision Tip: My part

In principle, there are at least two pieces to every puzzle, at least two parts to every solution. No solution to a problem is entirely in the hands of just one person.

Group Decision Tips IconFor example, people at the back of a room might have a hard time hearing the speaker at the front. When this happens someone is apt to suggest to the speaker: “Speak up.” But another solution is in the hands of the listeners: “Move closer.”

If I have a problem with someone’s behavior, one solution is for them to change. Another solution is for me to change. I can change how I interact with them or I can change my attitude toward them.

When I assume my problem is entirely because of someone else, I am hiding an important part of the solution. When I deny my part, I am in the way of the group moving forward.

We can spend a lot of time and energy wishing our group was different, complaining about our group, questioning other group members about their ways. But there is only one question that leads to real change: “What am I going to do about it?”

Practical Tip: With every problem remember that there are multiple parts to the solution. Ask, “What’s my part?” If you want the problem solved, act in ways that will help solve the problem rather than talk about how others should solve it.

Be the change that you want for your group, for your world.

The Power of Tension

The Oxford English Dictionary has several definitions of  the word tension, but many are along the lines of “a straining, or strained condition, of the mind, feelings, or nerves.

That doesn’t sound too good.

Indeed, the word tension seems to conjure images that are arguably negative. “You could cut the tension with a knife,” or “My shoulders hurt from all the tension.”

Tension, it would seem, is a generally unfavorable condition.

Or is it?

A bow capitalizes on tension to project an arrow great distances. Bridges rely upon a careful balance between compression and tension. Tension can be found in mechanical devices and in all manner of every day objects.

Perhaps this difference in attitude arises simply from difference in usage. The “tension in a room” certainly seems quite different from tension in the physics sense.

But I’m intrigued by the connection in these seeming disparate settings. A word may just be a word, but if nothing else, it’s interesting that our language would evolve to use the same word – from, incidentally, the Latin “to stretch”.

In strength training, tension is critical. To lift especially heavy weights, tension is arguably more important than sheer strength. It’s not enough to just muscle it up there, you need tension, you need to feel it in your entire body and use every muscle to make it happen.

Tension is the baited breath before the long sigh.

It’s a moment of power, of strength. It’s a feeling that difficult and uncomfortable, but tap into that tension correctly and its as if there’s nothing you can’t do.

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