Rob's Thoughts

Welcome

Welcome to Rob's Thoughts. This site is linked to my current blogs and is designed to hold long articles. You may well have come here as a result of a link on one of my regulars sites such as Robert Paterson's Weblog or Our Kids Their Future.

Here you will find in depth articles that support ideas that I float in a more blog like style or you will find long articles from others whose ideas I like as well.

I hope that you find what you are looking for

Best wishes Rob

Vocabulary - the Trajectory of Development

The Big IdeaThe message of the Early Years is that we are most capable of learning until the age of 6. Underpinning this message is the idea of "plasticity". This is not news. What might become news is if we find out what to do with this knowledge.

For the problem is that we have not known what to do about this knowledge. We have not known how to move from concept to action? Until now.

We believe that the research has now come together to provide us with a clear direction and a clear focus. If we focus on the acquisition of vocab by the age of 2 and its drivers the amount and quality of conversation and the amount and timing of touch we believe that we will have resolved the gigantic complexity of the early years into a field narrow enough yet powerful enough to get movement. This series of articles will explore this proposition and link the separate areas of research into a coherent and self supporting whole.

The trajectory of vocab
Our brains and our world view are open to many choices at birth but by 3 many of the alternatives and the trajectory for our future development is largely set. By the age of 2 the size of our vocabulary will indicate how we will be able to learn all the way through school.

This slide shows us a dramatic picture. Vocab is a powerful and measurable predictive factor. If we measure an infant's ability to understand vocabulary at 2 we can get a strong sense of the development trajectory for life. Much of the research now informs us that by 4 the vocab trajectory is largely set. Infants with a vocab of 150 or less will normally develop on a very shallow trajectory reaching by grade 10 an ability of grade 5. At the other end of the scale, infants with a vocab of 300 words will be on track for an exponential trajectory leading to a vocab of a 2nd year university student in grade 10.

This revelation about the predictive power of vocab attainment raises the issue of the idea of Trajectories and when they are able to be influenced. Chaos theory tells us that "Initial Conditions" are the most powerful element in how systems unfold. It is likely that vocab attainment in the Early Years represents the measure of the Initial Conditions of human development.

The impact of this ideaThis insight has huge implications for how we as a society consider our current investment in the education system that begins age 6. We have enormous faith in schools - after all we all went to them and they have become the centrepiece of how we "see" education. But as we begin to understand the idea of trajectories for learning and for behaviour School Readiness takes on a new importance. Why is this so important? Because we are finding it very difficult to alter trajectories in school once they are set. US data suggest that even the application of extraordinary resources in school cannot change the shape of the development curve. The main work has to be done before our children arrive in school.

So we have quite a shock. We have thought that our schools were going to be the key to our children's future and we find that it is our job as parents.

Our development in the Early Years is not only confined to our ability to learn. Our world view is set then as well which sets up our norms for behaviour and the boundaries for our coping skills. Consequently, many of the drivers for our future health, such as the capacity of our immune system, are also laid down in this period as well. By 4 we will have acquired life-long eating preferences that will be hard to change throughout life. By 4 our athletic skills and our desire to take exercise will largely be set.

So we are beginning to understand that the Early Years encompass issues that extend beyond literacy to include obesity and activity: in fact for a health trajectory for life as well. As with schools, we currently pour most of our society's resources into a healthcare system that does its best to fix an ever expanding litany of chronic disease such as type 2 diabetes, complications from inactivity and poor diet etc. Many of our addictive behaviours such as smoking are also strongly influenced by world view and family culture. It is clear that the trajectory for much of the chronic illness we suffer from today is set in the Early Years. Fixing poor life time habits is an exceptionally challenging job for both the individual and for the healthcare system. The only time that we are plastic enough to set habits is when we are very young.

This is the responsibility of really understanding the meaning the Early Years. Our core experiences as humans that set up these trajectories occur inside the culture of our immediate family.

It's all about culture and how and when we transmit itHumans are cultural beings. All other animals use biology to adjust to shifting environments. Humans use culture. While humans are enormously en-cultured by their larger society, we are set up as individuals on a cultural path by the powerful interactions within the culture of of family when we are infants. So the best time to intervene is very early and the best people to make the difference are parents

This is scary news for parents. Scary because, until now, we did not know how powerful our interaction with our children would be. Scary because we thought that it was school that was going to make the big difference in learning. Scary because we thought that our doctor was going to keep us well. Scary because we don't know how to respond to this challenge. We thought that if we kept our children clean and safe and taught them how to behave that would be enough - society would teach our children and keep them well.

In this context, what then do we have to know as parents to best prepare our children in the first 4 years of life? What might be the 1-3 simple things a parent could do that would help the most? It surely cannot be the 100 things. These things must be simple as well.

If we can find out what are the 1-3 things that would make a large difference in how parents interacted with their children, how could society itself get behind parents to help in this work? Then what practical things could policy makers consider when seeking to improve overall societal development outcomes? And finally what could researchers focus on that would enable them to see if what we were all doing would be worthwhile?

The social and economic context for this workHow important is it to find these answers anyway? Maybe it is just a few poor Canadians that have the problem? Regretfully not. We now know that the largest group of Canadians whose children are having development problems are middle class.

The chart shows the relationship between understanding vocab and income. We see that there are many children from poor families that are doing well and that the majority of children that are not doing well come from middle class income brackets. The "bottom line" in the slide is that fact that poor development is not confined to welfare mums. We are all involved. Wilms' great insight which is supported by Hart and Risley is that family culture is the egg and family income is the chicken. It is the behaviour and attitude of the parents that en-cultures the infant and sets the infant up on a series of trajectories.

The stakes are high and time is short. In particular for Atlantic Canada where we do not have the benefit of high immigration rates and high birth rates. On PEI 42% of adults can only read at a level 3. 17% of Islanders cannot read. Consequently most Islanders cannot participate in the complexity of the modern economy. PEI and most of Atlantic Canada do not have enough high quality human capital to solve our social and economic problems.

PEI's future, in fact the future of Atlantic Canada is irrevocably linked to our being able to raise most of our children so that they have the best potential to learn and to cope. Finding ways to improve the developmental outcomes of all our children is therefore a strategic necessity. We have a generation to shift these challenging numbers or we risk missing the chance of being viable in the 21st century

Is there hope? Do we know what might be the 1-3 things that parents could know and act upon that would make a difference. The answers to these questions are yes and yes

To be continued in the "Keys to the Kingdom"

And then in Building the NetworkTBA

The Keys to the Kingdom - Words, Touch and Culture

What is the power of the Vocab Trajectory? It compresses all the huge complexity of all the interactions and gives us one measure that tells us in the right time frame where we are and what more we need to do.

When they were building the Confederation Bridge, the project manager and the funders demanded a set of measurements that would enable them to see if they had the full complexity of the project in hand and to let them know if they were on track to complete on time. They had the same problem as we do in measuring the impact of many complex factors and interactions on the Early Years. They chose one measure. The Foot Poured of Concrete per Day. Why? Because to pour a foot of concrete, everything prior to that had to have been completed. The full complexity of all the hundreds of interrelated steps had to have been pulled off well. Foot poured would also give the engineers and funders a clear view of the trajectory of the work. They could still change elements in the mix to get them back on track. This is the power of the Vocab measure.

What do we know about the key elements that give a high score on vocab at age 2? We know that it is largely determined by three factors. The most important is the number of words heard in conversation by the infant. The second is how much the infant was touched. The last was the quality of the interaction between the parent and the infant.

Hart and Risley - Meaningful Differences in the Every Day Experience of Young American Children has explored the words and culture aspect of this driver. Here is the core finding. The brain and outlook of infants is moulded by the experience of language itself. Like any moulding experience cumulative experience counts.

The amount of words heard and the Impact on the Brain and Consciousness
By 4 the children in the Professional Family group had heard an accumulation of 50 million words. The Welfare family children had heard only about 10 million. A 40 million word difference! By 4, the language pathway has almost closed and while a child that has heard only 10 million words can speak, it lives mainly in an instrumental world. Its ability to perceive the symbolic world, which is now the core of our society,  is very small and the opportunity to add back 40 million words is not possible. Many 4 year olds from a high talk family have a wider vocab than the parents of the welfare child! The last meaningful time to intervene is at 2. The best time to intervene is at birth.

Of all the developmental factors, H & R and Wilms feel that the amount of language heard in conversation is the single most important driver for opening learning pathways. I emphasize in conversation. The context for hearing is relationship. Humans connect with each other in two ways by touch and by conversation. Dunbar makes the case that language development itself was an extension of primate grooming over distance. Babies do not hear TV, they hear their mothers in a dance of intimacy.

There are some qualitative issue as well.

There is a very large cultural gap embedded in vocab which is the nature of the discourse. Wilms's research is clear. That Authoritative family culture - nice but firm is the most effective. This slide shows the significant difference between cultures in the positive aspects of discourse.

Families in an instrumental world tend to focus language on the does and don'ts - mainly on the don'ts with little or no context or interaction. They "see" their children as objects or instruments to be cleaned, fed and controlled. They themselves are often objects in the workplace whose destiny and welfare is objectively "managed" by a larger parental figure such as a boss or the government. No one consults them or asks their opinion. They are not trusted and have no public power.

Recent tragedies such as Columbine have been centred in middle class settings. What is going on there?  Many middle class parents both working full time are exhausted and feel guilt. While they have the symbolic verbal skills, they have lost the energy to form strong attachments. They too may have been captured by the instrumental world of a bureaucracy. They have become objects as well and risk being "corporate" at home which then becomes a task centred culture. They may react to their circumstances by being very permissive and not providing enough structure. They may have a nanny from the developing world who will seek the easy life and be permissive or be inattentive and allow TV to be the primary interactive agent. The nanny may herself come from an instrumental culture where the instrumental aspect of care overshadows the emotional and connective aspects of the underlying relationship and the need for conversation.

The issue of development in the early years at its deepest level appears to be framed in terms of the parent child relationship which is in turn framed by the culture of the parent. We pass on our culture to our children when they are most impressionable - when they are new born and until the age of 3-4.

In the context of the trajectory and words, touch and culture, what might be the big 3 items that would empower parents to ensure that their children have the best potential to learn and grow though life?

1. The power of having lots of the optimal conversation with our infants which includes lots of reading

2. The power of  high touch  especially in the first 6 months of life - which includes breast feeding and lots of reading

3. The Power of seeing these two pathways in the context of a deep attachment with the child where the parent develops an authoritative family culture for the family

How then could we help all parents obtain this insight and how could we help them obtain the skills?

We are recommending that we design and build a network system of knowledge that supports each family in a way that suits the unique needs of each family best. How might we do this?

See Building the Network for the final section of this paper.

 

Culture - Family Functioning - Wilms

“Culture is learned, not inherited. It derives from one’s social environment not from one’s genes”
Geert Hofstede[1]

School, Literacy, Employability and Children’s Behaviour "I have been given 28 Senior Kindergarten students who I dub "the class from hell". Every day consists of stealing, lying, hitting, throwing tantrums, throwing rocks, throwing up. I wake up at night having nightmares and get up in the mornings unrested and with butterflies in my stomach, worrying about going to work and facing these children. I am fearful for the adults they will become and the teenagers they will be in ten years. What is wrong with the world? "[2]

Conversations with many Kindergarten and Grade 1 teachers reveal that they are often the first witness of a growing wave of poor behaviour. Poor behaviour that inhibits children’s ability to learn at school. Teachers, and the school system as a whole, are finding it exceptionally difficult to shift behaviour and hence outcomes once the child is school age.

Research[3] backs up this anecdotal evidence.

“..approximately 212,000 children out of 900,000 in the 0-6 age group are at risk of not reaching their full potential when they enter the school system and are on a life course that could lead to learning, behaviour and health problems in later life. The majority of these children live in two parent, middle income families”

We are beginning to recognize that the battle for literacy, social cohesion and employability is best fought before a child enters school. The time of maximum opportunity is in the first 3 years. The optimal place is in the home.

What do we know now about home environments that will help us move upstream to where the root causes of learning problems occur?

Family Culture is the Driver for Behaviour and Hence Learning Outcomes
Until now, we have focused our limited resources available for supporting the Early Years on the poorest segment of families. We looked at the Socio Economic gradient as the best way of finding out where to focus our limited resources. We have made the assumption that poor learning outcomes are closely linked with poverty.

New research[4] suggests that how a family functions, or its “culture”, is more powerful than Socio Economic Status (SES) in affecting learning outcomes of children.

“These findings present a serious challenge to the “culture of poverty” thesis and the widespread belief that the children of poor families do not fare well because of the way that they are raised.

These findings show that positive parenting practices have important effects on childhood outcomes, but that both positive and negative parenting practices are found in rich and poor families alike. Thus good parenting is a concern for all parents………….

Because positive practices are only weakly associated with Socio Economic Status (SES), it is not feasible to identify parents with relatively poor skills on the basis of socioeconomic factors[5]”

Nor is family structure itself tightly coupled to learning outcomes:

“Parenting practices are not strongly related to SES or to family structure…both positive and negative practices are apparent in all types of families”

Willms’ team identify the three key family cultural groups as being:

“Authoritative” – Parents who establish a warm and nurturing relationship with their children but set firm limits for their behaviour

“Authoritarian” – Parents who are highly controlling, requiring their children to meet an absolute set of standards

“Permissive” – Parents who are overly nurturing and who provide few standards for behaviour and are extremely tolerant of misbehaviour.

The Willms research informs us that the poorest learning and development outcomes are found in families that have Authoritarian and Permissive cultures. The research team’s conclusion is:

“..Given that about a third of parents might be characterized as Authoritative, most parents could benefit from training programs that improved their skills. …The aim would be to provide parents with practical ways to monitor their children’s behaviour, engage with them positively and encourage their independence[6]”

We are beginning to understand that simply targeting the poorest of our society will not shift our total development deficit[7]. Wilms is making the point that the collective of family functioning, or culture, is a very productive place to look and work.

Geert Hofstede, the leading scientist looking at culture in the workplace reinforces this view:

“Every person carries within him or herself patterns of thinking; feeling; and potential acting which were learned throughout their lifetime. Much of it has been acquired in early childhood, because at that time a person is most susceptible to learning and assimilating. As soon as certain patterns of thinking; feeling and acting have established themselves within a person’s mind; (s)he must unlearn these before being able to learn something different; and unlearning is more difficult than learning for the first time. “[8]

If the close linkage is to be found in culture, how can we identify family culture and how can we affect family culture so that we can improve outcomes?

--------------------------------------------------------------------------------

[1] Cultures and Organizations – Software of the Mind – Intercultural Cooperation and its Importance for Survival. Geert Hofstede. McGraw Hill 1997

[2] A teacher in a private Kindergarten in Toronto – from a private email to the author October, 2002

[3] The Early years Study Three Years Later – McCain and Mustard August 2002

[4] Vulnerable Children– Findings from Canada’s National Longitudinal Survey of Children and Youth. – J Douglas Willms , Editor University of Alberta Press, Applied Research Branch HRDC 2002

[5] IBID Willms

[6] IBID

[7] “The greatest number of vulnerable children live in two parent, middle income families; targeting developmental resources to children living in poverty, although valuable, will have a relatively small impact on the overall population. Estimates suggest that if we could eliminate the negative impact of poverty, we would reduce the numbers of children who are vulnerable by 10%” Commenting on children in Ontario The Early Years Study – Three Years Later. McCain and Mustard August 2002

[8] Hofstede IBID

The Vocab Trajectory - Predictive Power

What do these trajectories look like and are there any gender issues that may help explain why boys are struggling today?

Here is Doug Wilms team's views on this chart taken from their recent proposal

Most children say their first few words at around 12 months of age. It is an exciting time, as it is soon followed with more words, and then an exponential growth in vocabulary. However, the pace of development differs among children, and depends on their environment. Huttenlocher et al. (1998) conducted detailed studies of children’s vocabulary development from 12 to 26 months of age. Their work demonstrates the importance of understanding children’s growth trajectories.

Figure 2 displays the trajectories for 26 of the children they observed. The solid black line represents the average growth trajectory, while the red and green lines depict the trajectories for girls and boys respectively. A multilevel analysis of these data revealed that these children varied significantly in their rates of vocabulary growth, and that about 20% of this variation was associated with the quantity of mothers’ speech. Also, the frequency with which mothers used particular words was strongly related to the age at which children acquired those words.

This research and similar work by Hart and Risley (1995) provide strong evidence of the importance of both the quantity and quality of parental speech.

The next slide comes directly from Hart and Risley's work and confirms the data that Wilms was looking at.

The final slide in this series comes from What's Going on in There - How the brain and mind develop in the first 5 years of life By Lise Eliot. The data set (p 380) comes from work by L Fenson et al in a monograph of the Society for Research in Child development 59 (5) 1994. It shows the same track now broken up by gender

Hart and Risley have tested the predictive power of this trajectory and have found a strong correlation between vocab at 2 and language skill at age 9-10 (p 160-168)

"We conclude that these variables are not simply marker variables denoting social class or subculture but are powerful characteristics of everyday parenting that cause important outcomes in children....everyday parenting in the individual family was predictive of the accomplishments of the child>"

Building the Network

So what do we do with the idea of helping parents prepare their children to have the largest possible vocab by 2? How do we use our knowledge that the best way to reach this goal is by having more interactive conversation and by using more touch to create more attachment?

The immediate response, drawn from our industrial conditioning, might be that we need to create new institutions to "help" parents. After all this is how we have organized schools and how we organize the support services for social services. We think that taking this route is a fundemental error.

We think that institutions as we "see" them today have had their day. They tend to evolve quickly into self serving monoliths. They accrue structural cost growth that exceeds their capacity to deliver the service well. So they bleed the customer interface. If you don't agree with me, then think of schools today with their huge "supporting" bureaucracies and a front-line that has become a battleground of stressed teachers and acting-out kids. Think of how we deliver healthcare where stressed-out healthcare workers hand out prescriptions but do not have the time to think about why we might be ill. Think about the service side of the private sector where you get the run around from the support folks such as when you last phoned the phone company for support and got the dreaded recorded voice telling you that we value your custom but all our people are on the line (or in meetings) and asking you to wait for someone in a cubicle in a call centre thousands of miles away. Conventional institutions have become authoritarian organizations that do not listen and have taken away the voice and the sense of control and hence worth of their employees. Everybody suffers including the customer.

A new model for organization is now evident and is destroying the traditional model. We can learn from this model and apply it in this work
Networks such as eBay are different. They involve the communities that they serve and set up the conditions where people can help each other. They listen intensely and they build trust by giving their employees and most importantly their customer significant control. They have exceptionally low direct costs in inventory because they don't push product out, they respond to client needs. They have exceptionally low indirect costs in that they have the internal responsiveness and flexibility to make good decisions very quickly when faced with changing circumstances or the advent of new ideas. This is the type of help and support I think parents find is attractive. This work is all about relationships and culture.

If we seek to shift parental relationships from authoritarian and permissive to Authoritative and Collegial, then the culture of the support mechanism has to be culturally aligned to also be Authoritative and Collegial. There is no compromise on this structural point.

So this then is the work that we are going to explore in the next few months.

1. Content - Words- What are the best methods that a parent can use to significantly increase the amount and the quality of their conversation with their babies in the first 3 years of life. How can we set up the habit of dialogue when the parent came from a family culture where their mother did not do this? How might reading help? What outside help for the parent works best? We know from the area of addictions, of weight loss of personal fitness that changing the habits of a lifetime on our own is impossible. What then might be the role of a personal coach? What might be the role of a local community support group of fellow parents?

2. Content - Touch. In our busy world where so many women work and where we have been conditioned to think that we are spoiling the child by holding them too much, how can we find practical ways of significantly increasing the amount of touch? How will seeing breast feeding in the context help? How might reading be seen in this context? What about co-sleeping with our infants - what are the real risks/benefits? How do you then make the break? What about the use of slings and pouches versus strollers and car seats in a busy world? What about mothers who have a year off for maternity leave?

3. Content - Attachment and Culture. What do we mean by Authoritative Parenting style? If a natural style is authoritarian or permissive - how can we make adjustments? How can we help parents notice and react instinctively to the cues that our infants send us - in effect, what is baby language? How do parents cope with the opposing cultural influences of their own parents and grandparents who may think that what they are doing is wrong?

4. Social Marketing There is no one message or one method that will fit every parent. The age of mass marketing is over. What then are the messages and the channels by which we will reach a wide range of parent cultures and families. How can we reach business and government so that they "see" what the stakes are and how they can best help. Can we use the lessons of the Tipping Point as a low cost high yield process? Who can help us here? How can we use technology, such as how eBay works, to connect parents in authentic community and to link parents to trusted coaches and information so that they can teach and help each other as peers and in communities of practice?

5. Training - Train the Trainers. Who will be the coaches and what will they have to know? How will they be Branded/certified? How will they remain current? How will their learning flow back into the larger knowledge pool so that we constantly build up the pool of Intellectual Capital that supports this work?

6. Research - Accelerating the interaction between action and research How will we link what we do in the field to the growing research effort on the Early Years? How do we do this without adding too much friction to the work? How can we get results that are meaningful quickly so that they can be fed back into the system and changes made?

7. Where do we start? We would like to start on PEI because we have the scale that enables us to see an entire society but where we are small enough to get something done. Because we have the foundation of infrastructure with community-based centres all across the Island. Where every new born's parents are already assessed as parents. Where research feeders are in place

8. How will we design and operate the network? Form follows function. We are fortunate in having some early exemplars of community based organizations such as eBay that are built on the platform of creating the right space for trusted relationships. If you want to know more please follow this link.

The New Organization - Based on Capturing the Value in the Relationship

The performance breakthrough has arrived

After more than a decade of fads and buzz words, the real new economy has arrived and is dismantling the pinnacle organizations of the traditional economy. Bookselling, general retailing, the airline industry are the early sectors where the real new economy has emerged. It’s not about the internet, though the internet is important. It’s not about knowledge, though knowledge is important. It’s not about learning, though learning is important. It is primarily about a new culture and a new operational doctrine that is the opposite of our prevailing culture and doctrine. This is why it is so difficult to “see”.

Over the last 30 years, expensive new technology has filled the modern workplace. The result? No breakthrough in performance. In fact, in spite of all this investment, there has been, in many cases, a significant increase in friction, stress and costs. Importantly, relationships between front line service providers and customers and citizens have degraded. This is especially evident in healthcare and in education. Workplace stress is now a major issue for the Public Sector (PS) and for the Canadian Forces (CF). Can we explain this paradox?

History tells us that prior to other performance breakthroughs, there is a lag as the technology arrives before the required shift in culture and in operational doctrine to implement the technology well.

A concrete example of this lag was the Victorian Royal Navy. Throughout the middle of the 19th century the Victorian navy added a series of new technologies such as steam, steel and breech loading guns onto their ships. By the 1880’s ships looked “modern”. But they weren’t. They were the Victory in disguise. Why?

Because, in spite of the new technology, the Navy held onto to the class and command culture of the age of sail and also to the core operational doctrine of close engagement. The Nelsonic class culture and the Nelsonic operational doctrine prevented the new technology from being optimized. Fisher’s breakthrough in Dreadnought was to include engineering into the command culture of the Navy and to revolutionize fighting doctrine from close engagement to long distance engagement. This was not an incremental move but a revolution.

All of this revolution in culture and doctrine converged in the design of one ship that had the power to sink the entire German Navy on its own. That was the magnitude of the performance breakthrough. Navies had no recourse but to scrap their existing fleet and to build a new fleet based on the Dreadnought model.

This is where we are now. The Public Service, and most organizations in both the public and private sector, have most of the new gear but we remain captured by the culture and the doctrine of our fathers. We have not made the leap to what is more important than the technology itself, the new culture and the new operational doctrine.

But it is 1906 all over again. A new Dreadnought has been launched. The difference in performance between the old and the new is as astounding as in 1906.

Our Nelsonic Culture and Doctrine
Our Nelsons were Henry Ford and Professor Taylor. When Henry Ford introduced mass production at the beginning of the 20th century, he not only changed how things were made, he changed the culture of the workplace. Taylor codified this approach. In this production culture, head office was the organization’s brain and it decided everything. Products were conceived, designed, produced and then marketed and sold. The enterprise pushed out from the centre. All work was routinized and essentially deskilled. The process became inviolate and no thinking or attacks on the process could be tolerated from its participants. Only a few at the top could make changes.

This model has taken over all aspects of organized life today. At its heart is a need to control the core process. Everything and everyone had to be “managed”. It was successful during a long period of relative stability. We are so imbued with this model that we mainly fail to see it for what it is – a model. Today, we have reached the design limits of this model. More efficiency cannot be squeezed out of it. The business, social and technology environments are now changing so fast that such a model cannot react fast enough. Trying to squeeze more out the old model only adds to the friction and to the stress.

The New Dreadnought
A new model has arrived. It is the reverse of the production model. Just as Dreadnought represented a shift in the relationship in warfare from close intimacy to a distant machine perspective, so the new organizational model shifts organization from a distant and machine relationship to a close and human relationship.

In the old model, value is captured is in the transaction. This is a zero sum game where the frontline linkage to the customer is adversarial. Customer choice and needs are relentlessly squeezed. Witness the Airline or Healthcare interface right now where frontline staff and passengers/patients are both miserable. Ever larger scale has enabled the distributor to limit choice and to increase “efficiency”. Until now, we all had to keep going to the hegemonic supplier. But no longer. New technology is enabling suppliers to disintermediate the hegemonic mega-scale suppliers who have built a cost structure based on their scale. With a dramatic shift in cost and choice, the customer is also experiencing a warm and not adversarial relationship

In this new model, which we can see in the actions of new adopters such as eBay, Amazon or Dell, the flow of energy is reversed and the full participation by not only the staff but the customer is desired. In this new model, the customer not the CEO sets the product agenda. It is the customer who decides what they want and who drives the production process back into, not simply into one organization, but into a network of suppliers organized by the host company. The new model works deliberately to eliminate, or significantly reduce, inventory or it carries inventory in a distributed form in the supporting federated system such as Wal*Mart and its suppliers. With very low or no inventory, they have a compelling cost advantage.

All have remarkably sensitive customer interfaces where, at best, individual customer profiles, preferences and accrued activity and trust are maintained in real time such as by Amazon, eBay and Dell. Or where community profiles are held in aggregate such as at Wal*Mart.

The New Rules
This is not simply a re-engineering of the process but a shift in culture. If an organization wishes to adopt this revolution in deployment and process, it involves working to radically change how everyone “sees” themselves and the organization. It demands a revolution in the very nature of relationships from an oligarchy to a democracy. No small change!

It involves the giving up of the idea that the market and the world can be controlled by head office. Head office in these organizations does not pretend to be able to predict customer behaviour, instead it works to have the best sensory system possible. It uses this acutely sensitive information system to track trends and to react immediately. As a result, the customer experience has been transformed from an outward push to an inward acceptance. Consequently the customer interface has become a good place to be for both the customer and for the staff. It is fun to fly Southwest as well as being inexpensive. Why/ Because the staff have a lot of control. Amazon provides a community of book reviewers that pulls the customer into the primary sales position in the firm. Wal*Mart greats each customer and so on. The customer gets what they want rather than only what the firm will give them.

Why has this shift occurred? In a world where most of have all that we need, in terms of things, this putting the customer into the driver’s seat give them the potential for the experience of control and participation that the old system prohibits. This is the key to understanding the new model. Its value is in the experience of control and participation given to the customer. For the first time, the customer is in control and not the corporation. Once customers have experienced this, they do not go back! Conversely, in the new organization, to give the customer control and participation, head office has had to give the front line control, and participation as well. Once employees have had a taste of this they too do not want to go back.

To pull this off, these organizations have pushed a remarkable amount of decision making power out to the front line. Floor clerks in Wal*Mart can move material around the store and each store has a computer assisted re-order model that enables the store to track orders to the unique preferences of its own community. At Dell your PC and you have a unique identifier enabling you to have the machine serviced throughout its life. At Amazon you have a personal webpage that reflects what you do and what you look at. You are a market of one. At eBay the buyers and sellers deal direct. The best practioners of the new model deliberately support the creation of customer communities. So at eBay the golfers run their part of the enterprise. At Amazon, the unpaid reviewers provide the marketing.

The result of this giving up of conventional control is a radical reduction of costs. The direct costs that are reduced are in inventory and in HR such as employee health, turnover and absenteeism costs. The indirect costs are in speed and effectiveness in making the right decisions and in reacting to changes in the environment. None of these structural advantages are available to the traditional organization. To reduce costs, they have to cut people and cut service delivery or be bought or buy another to increase scale even more. The outcome? A more unhappy workforce, a more cynical customer and more friction and drag. Thus making their service more vulnerable to those who can offer the new alternative.

If you are a competitor of one of these new model firms and you are still using the old model, you will fail. You cannot deliver the costs and you cannot deliver the customer experience. So we see the icons of the old model struggling or even moving into bankruptcy. United Airlines, AMR Air Canada; Kmart, Home Depot; and most small booksellers and Indigo and Chapters. eBay is on track to dominate the second hand car market. Dell can take on any competition and is moving into other sectors beyond PC’s.

In the old model, you could compete by applying a simple concept – more money. By gaining access to more resources, you could use increased scale to push prices and costs down and use your increased hegemony to have power over the consumer and over your staff. This is why the trend in the old model is for more scale. But now scale will not help United Airlines or Home Depot. The new model demands that you kill off your old culture, the culture that made you successful and which you know so well.

Just as all the benefits in the 20th century accrued to those organizations that adopted the Ford model well and early, so in our time, the advantages will accrue to those that understand and apply the new relationship model.

Fixing Agriculture

Can we fix Agriculture by a focus on how we do it or by seeing the system?

1. Its a system - in our role playing we can see that
trying to play one group off with another leads no where
but into blame. One of the key metaphors in TNS is the
idea of leaves versus the trunk of the tree. Avoid
working with the details and go to the heart of the
system. So what are the leaves? We focus on things like
rotation and buffer zones which all have to be done but
they don't get us to the core of the system. What is the
core of our system? That the food business is based a a
very very small group of distributors sitting in the
middle between all the farmers and all the consumers and
taking value for both sides. The result is that so long
as farmers are restricted to selling to 2 buyers, they
will be in a jam and will have to take it out on the
land.

Can you see what I am saying? It is not about farming
practice per se it is about the entire food system where
in potatoes there are only 2 processors for fries and 2
end buyers for fresh. They push back at the grower who
has to himself become more efficient and hence has to
use more capital equipment, get more land and hence have
more debt.

If you went organic and sold to Loblaws, you will end up
in the same pickle.

This is where we have got it all wrong from a policy
perspective. We focus on the "leaves" of the farm
practice. Farm practice will be vital but we won't get
a change in practice until we can change the economics
and the power issues for the farmer

2. What is the emerging new model? It is to grow,
process and sell food locally and for the grower to own
all three aspects of the process. It is in effect to
develop a direct relationship with the consumer. The
essence of the industrial model was to own the interface
- initially the production such as making steel or cars
- but more recently the real power has been in
distribution or in ideas. Think of this. A DVD player
can be bought for $50 now but a DVD film costs $20!
Production for all producers has been commoditized to
the point where no one can make money after a while as a
producer only. You can download music for free - soon
you will be able to download most movies as well.

3. What are the negative trends that will help the move
to the new model? Energy costs. Modern food systems
depend entirely on cheap energy. Fertilizer is made from
oil and gas. Farmers need lots of heavy equipment. Food
is transported a 1,000 miles before it is eaten. All the
cheap and easy oil has been found. The swing oil is
located in Saudi arabia. How hopeful are you that we
will have a stable middle east? For certain oil prices
will go up. This will push the cheap oil system to the
limit. Secondly there is the issue of food safety. Mass
produced food is inherently unsafe. Cows fed grain get
ill and have to use large amounts of antibiotics and
hormones. As we understand this we will back off. Cows
slaughtered in big factories are killed badly and
cruelly. Mistakes can contaminate thousands of tons of
hamburger or hot dogs. As these risks become more
apparent we will back off. Food additives for shelf life
like trans-fats are very bad for us. As we understand
this we will back off - and so on. In the next 3 years,
food health as driven by mass production and mass
processing will come to the fore.

The idea of growing a lot here and selling it a lot over
there - the export model - is dead. Why? because
everyone except the developing world now grows a lot.
The Americans and European farmers will fight Canadian
exports and will use any means - one sick cow, a few bad
spuds to close the border. Canada's whole food industry
is built on this model and as the idea of an open border
dies so will this business.

4. What are some trends that will help? The growth of
fully integrated local food systems such as Chudleigh's
as an example to others. Or Organic coops that also
grow, process and sell locally. The growth of the
understanding that we don't want to buy food that is
unsafe or to support companies that take advantage of
us. There will be in effect a consumer lead pull for the
new.

5. Leadership - there will be a crisis or a series of
crises. We have them here already. Wart, mad cow, lumber
etc. Poor leadership sees these as blips and hopes that
the good time will come back. Good leadership sees the
pattern and knows that we have to change. Like Ikea, the
good leader will react to the wake up call. In your
assignment be that leader. How would you get your
message across - what would you do?

6. A tip. People find it hard to grasp concepts alone.
My advice would be to build and in-cent an alternative
system on PEI and let farmers and consumers choose.

A post I used in my UPEI COurse on Business and the Natural Step

The Relationship Economy - UPEI Jan - March 2003

The Customer Revolution - The Relationship Based Business Model - Turning Our World Inside Out

We are so encultured by the traditional model for organization that we no longer think about it. It is just how things are. When anyone becomes unconsciously captured by an idea, they are vulnerable to a new and better one. The Ford production model was invented a 100 years ago this year. It has been so successful that it has taken over every aspect of how we organize to do work – not only in business but in government, education and healthcare.

But, in the last 5 years, many leading firms that use this model are being threatened with extinction. The discounters have overwhelmed the full service airlines. In retailing, Kmart is bankrupt and many of the past retail leaders such as Home Depot and the Gap are really struggling. In bookselling, Amazon has shaken the industry to the core. In PC’s there is only HP left to confront Dell. In food, McDonalds seems mortally wounded and cannot appear to help itself.

We are also seeing the public sector struggle. Our K/12 education system is not delivering. Drop out rates are close to 30%. Boys are seriously underachieving. Our healthcare system is becoming too expensive and risks being overwhelmed by the advent of the seniors’ demographic bulge. Those that try and improve things by applying the old model harder and faster seem to get even further behind. So what is going on? This course will help shed light on this turning point.

A new model for organizing for work both in business and in the public sector has arrived.

When applied well, it destroys those that still use the traditional model. It has enough practioners now that we can see how it works and we can extract the lessons so that we can apply it ourselves. Understanding both the old and the new model will become a survival issue. This course will look below the surface of the Ford Model and reveal how it really works. Why? Because we have taken it for granted and we no longer question it or even see its rules and how they work. We will put the traditional organization into the MRI and see why using the Ford model is a fatal condition. .

We will look at eBay, at Amazon, at Dell, at the Discount Airlines, at Wal*Mart and we will discern from their activities, a new model emerging that has a radical approach to costs and a radical approach to value. We will see that at its heart the new model has a radically different set of assumptions about power and about relationships. We will see what it means to make the shift from a transaction economy to a relationship economy. We will see how these firms have revolutionized costs. We will see how they have found value in emphasizing community. We will see why in most cases it is much more personally rewarding to work in this type of organization.

We will look at the demographic and cultural forces that underpin this new model and we will look at some of the new Social Software that is transforming the customer and workplace interface.

We will speculate what this new model means for business and all institutions in Atlantic Canada. We will explore the “Hick” effect – many of the new leading organizations have been born in small town cultures. We will also explore what this model means for education and healthcare delivery. Finally we will explore what this means for your personal choices and for your work life.

Context for the Course – The Core ideas
When Henry Ford introduced mass production at the beginning of the 20th century, he not only changed how things were made, he changed the culture of the workplace. In this production culture, head office was the organization’s brain and it decided everything. Products were conceived, designed, produced and then marketed and sold. The enterprise pushed out from the centre. This model has taken over all aspects of organized life today. At its heart is a need to control the core process. Everything and everyone had to be “managed”. It was successful during a long period of relative stability.

We are so imbued with this model that we mainly fail to see it for what it is – only a model which has had a life of about 100 years. Today, we have reached the design limits of this model. More efficiency cannot be squeezed out of it and the business, social and technology environments are now changing so fast that such a model cannot react fast enough.

A new model is emerging. It is the reverse of the production model. In this new model, which we can see in the actions of new adopters such as Wal*Mart, Amazon or Dell, the flow is reversed. The customer sets the product agenda. It is the customer who decides what they want and who drives the production process back into, not simply one organization, but into a network of suppliers organized by the host company. The new model works deliberately to eliminate, or significantly reduce, inventory, such as eBay, Dell or Southwest, or to carry inventory in a distributed form in the supporting federated system such as Wal*Mart and its suppliers. With very low or no inventory, they have a compelling cost advantage.

All have remarkably sensitive customer interfaces where, at best, individual customer profiles, preferences and accrued activity and trust are maintained in real time such as by Amazon, eBay and Dell. Or, profiles are held in aggregate, where community profiles are maintained such as at Wal*Mart.

This is not simply a re-engineering of the process but a shift in culture. It involves the giving up of the idea that the market can be controlled by head office. Head office in these organizations does not pretend to be able to predict customer behaviour, instead it works to have the best sensory system possible. It uses this acutely sensitive information system to track trends and to react immediately.

As a result, the customer experience has been transformed from an outward push to an inward acceptance. It is fun to fly Southwest as well as being inexpensive. Amazon provides a community of book reviewers that pulls the customer into the primary sales position in the firm. Wal*Mart greats each customer and so on. The customer gets what they want rather than only what the firm will give them.

In a world where most of have all that we need, in terms of things, this putting the customer into the driver’s seat give them the potential for the experience of control and participation that the old system prohibits.

This is the key to understanding the new model. Its value is in the experience of control and participation given to the customer. For the first time, the customer is in control and not the corporation. Once customers have experienced this, they do not go back! Conversely, in the new organization, to give the customer control and participation, head office has had to give the front line control, and participation as well. Once employees have had a taste of this they too do not want to go back.

To pull this off, these organizations have pushed a remarkable amount of decision making power out to the front line. Floor clerks in Wal*Mart can move material around the store and each store has a computer assisted re-order model that enables the store to track orders to the unique preferences of its own community. At Dell you speak to a real person who then tracks your order all the way to set up. At eBay the buyers and sellers deal direct.

If you are a competitor of one of these new model firms and you are still using the old model, you will fail. You cannot deliver the costs and you cannot deliver the customer experience.

So we see the icons of the old model struggling or even moving into bankruptcy. United Airlines, AMR Air Canada; Kmart, Home Depot; and most small booksellers and Indigo and Chapters. eBay is on track to dominate the second hand car market. Dell can take on any competition and is moving into other sectors beyond PC’s.

In the old model, you could compete by applying a simple concept – more money. By gaining access to more resources, you could use increased scale to push prices and costs down and use your increased hegemony to have power over the consumer. This is why the trend in the old model is for more scale. But now scale will not help United Airlines or Home Depot. The new model demands that you kill off your old culture, the culture that made you successful and which you know so well.

This is what competing by using culture really means. It means that an old model restaurant chain has to give up its identity to compete. McDonalds cannot stop itself from being a production based culture that drives from the centre out. It is so invested in the old model that it cannot change. This is what makes it and many like it so vulnerable to a new model competitor who competes by culture.

All new models supplant their predecessors. Henry Ford destroyed the idea of the automobile as a luxury item and invented a model that could be applied to any organization. This is the story of McDonalds and why it was successful and will now fail. For Ray Kroc was the “Henry Ford of Food”. He introduced a new production model to the diner. In the early years, if you were a family diner and were faced with a Production Model competitor, you inevitably failed. This is even the story for government services and for education and health care. They have become production line organizations.

Just as all the benefits in the 20th century accrued to those organizations that adopted the Ford model well and early, so in our time, the advantages will accrue to those that understand and apply the new relationship model.

Course Objectives
• To use a series of case studies on eBay, Amazon, Dell, Wal*Mart and Southwest & Ryan Air to develop an explicit understanding of the key features of the new model
• To understand the origin and the application of the Ford model in all sectors of organization
• To explore the new Darwinian process of how the small and the nimble destroy the large and the powerful
• To understand the cultural aspects of this shift and how they connect to a major cultural shift in society
• To speculate on how this model can be applied to business in Atlantic Canada
• To understand how the new model may be applied to parts of the public sector such as education and health
• To explore what this model means for each of us as individuals

Required text & Recommended Reading
We will be using three texts this semester. None of them are text books – all of them are leading works on various aspects of this issues. All are fun to read as well.

• Our core text is called “The Support Economy – Why Corporations are failing individuals and the next episode of capitalism” by Shoshana Zuboff and James Maxmin. Published by Viking Penguin ISBN 0-670-88736-6. ($39.99 Cdn)The book explores the reasons for the failure of the Ford model and presents a clear vision of how a model based on capturing the value in the relationship will work

• Our case book text is called “The Perfect Store – Inside eBay” by Adam Cohen. Published by Little Brown ISBN 0-316-15048-7. ($36.95 Cdn) This book explores the founding of eBay and picks up many of the ideas in the Support Economy and puts a human face on them. If there is a “How to Book” for the relationship economy this is it.

• Our process book is called “The Innovator’s Dilemma – When new technologies cause great firms to fail” by Clayton Christensen. Published by Harvard Business School Press ISBN 0-87584-585-1. This clever book reveals how good firms risk their future by ironically upgrading their service and hence costs to meet the needs of their existing clients – risking that they open up pools of opportunity for low cost innovators to come in below. Southwest Airlines’ rout of the conventional full service airlines or the Mini Steel Mill’s triumph over big steel come to mind as examples. Here we see how the application of new technology can be so disruptive.

Other Course Resources
My weblog, which is updated daily, has a great deal of other supporting material and links. It is an interactive site and allows for your comments. I would like you to start your own weblog as part of the experiential aspect of the course. Weblogs are part of the new very inexpensive tool kit that is reconnecting the world.

Have a look at “The Cultural Creatives- How 50 million people are changing the world” by Paul Ray and Sherry Anderson. This will give you a sense of the powerful cultural forces of individualism that are driving the shift in organizational model.

Have a look at “The Hidden Connections – Integrating the biological, cognitive and social dimensions of life into a science of sustainability” by Fritjof Capra. The first half of the book is a challenge but his second part where he takes the theories of living systems and applies them to organizational life is breathtaking and simple.

Have a look at “Free Agent Nation – the future of working for you self” by Daniel Pink to see how many individuals, millions of them in fact, are now working in the new model for themselves

Course requirements and structure
The course will be offered online using the webct platform at UPEI. The course will last for 12 weeks and will have 4 assignments – i.e. specific written papers. The key to the course is a “Learning Conversation” which takes place in the Bulletin Board. 40% of the marks will be for regular participation in the bulletin board. It is mandatory that you participate regularly in the bulletin board.

The assignments will be valued at 10% for the first 3 and 30% for the final paper. The assignments will be set from a menu of topics – the course is very broad. I want to offer you enough choice to enable you to find topics that especially interest you.

Evaluation plan

• Participation 40% of the total mark
o The bulletin board is at the heart of the course. Dive in and have fun.
o I am looking for Quality and Quantity.

 Quality is defined by introducing novel insights and by building well on the ideas of other.
 Quantity is defined by participating 3-6 times a week
 If you participate less than 3 times a week without just cause, you will fail the course immediately

• Assignments 60% of the total mark.

o Papers that simply deal with the question and repeat the class thinking will be marked in the 60-75% range
o Papers that show original thought as well as having the covered the material will be marked in the 75-85% range
o Exceptional Papers that should be published will be marked in the 85-95% range

Course Schedule

Please note that some of the schedule may change. Please see this as an outline. Check my weblog under UPEI for the current schedule and for supporting material for all the key points of the course.

It is important to have read the set books early.
Week Topic Assignment

Part 1 – Conceptual Overview – What is the new Model in action

1. Jan 8 Intro - EBay and Amazon The Perfect Store by Jan 18

2. Jan 17 Dell, Southwest and Wal*Mart

3. Jan 22 What are the new lessons? Assignment 1 due Jan 22

Part 2 – What is the Ford Model? What is the new model as a theory? Why Culture?

4. Jan 29 Explore the Ford Model Support Economy by Feb 12

5. Feb 5 What is the new model?

6. Feb 12 What are the cultural issues ? Assignment 2 due Feb 12
Part 3 – The power of disruptive technology – Why great companies are failing

7. Feb 19 The Innovator’s Dilemma Dilemma by Feb 26

8. Feb 26 Social Software and Community

9. March 3 Costs and Inventory Assignment 3 due March 3

Part 4 – the power of experience and competing by culture

10. March 5 Applying the “Experience” concept

11. March 17 The internal changes to culture

12. March 19 The public sector – Education and Health?

13. March 24 What it means for you? Assignment 4 due March 26

The essence of peer to peer

Great article
The best paper yet on the essence of the relationship economy

Moving from Alchemy to Chemistry - The workplace today Part 1

Why is the workplace becoming more stressful? This is the question that Brian Chambers and I have been struggling with for more than three years. We think that we have stumbled upon some insights that might help you if you share this question.

Brian was the Chair of the Veterans Appeal Board. He was witnessing an ever larger parade of young soldiers who had become disabled in their work asking to be pensioned off. Brian wanted to find out what was the real pressure that was causing this? Why did the obvious fix of providing more medical intervention to soldiers not seem to help? He asked this question about the military just as the Public Service itself had put the issue of the workplace near the top of its agenda as well. Surveys had revealed a growing morale problem based on what seemed to be workload and non supportive management. Plans for significant interventions were put in motion. These plans were largely based on introducing more flexibility into the workplace and in helping staff become more healthy

I had been the SVP for HR for CIBC. Back in 1991, in response to our own perception of growing stress in our workplace I too had brought in the "Mother of all Workplace Programs". We had flex, leaves of all sorts, part time benefits, fitness support. We brought in a brilliant young occupational health doctor, David Brown to help and to coach the senior executives. We had all the fixes that the Public Service were now espousing.

My problem in 2000 was that I knew something that many in the public service did not. I knew that I had failed to halt the slide by using these conventional fixes.

By 1993, we knew that we were not only not making headway but we were sliding into a pit. I knew this because we looked the real numbers - the banker in me. We found that our total cost for everything related to workplace stress, illness, absence, back fills and drugs was then $200 million a year. We ran the numbers out into 2000 and found that unless we did something that worked our stress-related costs would be in the region of $500 million. This got the Chairman's attention. His instruction to us was to find the real reasons why people were breaking down and to find a real fix.

I left shortly after to join Dr Fraser Mustard at the Canadian Institute for Advanced Research and it was David Brown who carried the CIBC torch and who subsequently had much of the breakthroughs that shifted our understanding of this problem from a dependence of beliefs with no science behind them, Alchemy, to a set of principles deeply rooted in 30 years of scientific research, Chemistry.

But before I review with you what we learned from David, and then from the US Army, BP and New York City, we want to add our own view of the context for action. At CIBC we introduced these programs in 1991 because we thought that somehow it would help us look good. After all, who likes the Banks? It was only in 1993 that CIBC woke up to the numbers involved and CIBC got really serious from a core business perspective.

So we asked, was this a nice to have issue or was it more serious than that. For a year, we tried to get the numbers but we failed in that. The task was too complex for the accounting system of the Public Service. At least from our end of it. So we did the next best thing and looked into the future. There was already a intuitive sense in the PS that the current workplace and hiring was going to be an issue. There is the famous, maybe apocryphal, story of the Clerk being told at the dinner table by his own children that they would never consider working for the PS.

Brian and I had arguably a more extreme context for action. We could see a near future that meant that having a more responsive workplace was not a nice to have but a survival issue. We could see a "vice" of powerful forces that were going to intersect in 10 years that would possibly cause the collapse of traditional organizations. By 2003 in the areas of airlines, book-selling, retailing we can see the first effects of the radically new organization confronting the traditional.

1. Who would we hire after the boomers retired? In 2016, Canada will have fewer young than all G8 countries. Not only fewer in number but fewer in quality as our education system is also in tatters with up to 40% of kids either not graduating or leaving school with very poor literacy and social skills.

2. A shift in values that reject the corporate world We have observed a radical shift in values by most of the best of the young who cannot find the freedom and self-expression that they demand in conventional workplaces. Consequently they drift, work for themselves or work for non-conventional employers.

3. The impact of new technology There is a disruptive power emerging in many technology sectors. In essence the need to have a large organization to own major tools is becoming passé. A band can make a CD, mix and edit it and distribute it without the need for a record label. This technology dis-intermediation is taking place all over the economy.

4. The acceleration of the pace and power of change. It is hard to believe that the internet has only been a presence since 1994. It is now ubiquitous. This process took 70 years for the telephone. Moore's law is still working. We can anticipate computing power costing $1000 to include most what is totally available today in 20 years. It is impossible to comprehend what this will mean.

Maybe, we asked, it was the inability of the rigid structures and the culture of the traditional command and control organization to cope and respond effectively to these forces that was the deeper issue. Maybe we have been working on the symptoms. We could see greenfield organizations thriving at the expense of traditional organizations. Could we find any evidence of some traditional organizations that were adapting?

This question lead us back to David Brown and to my old friends at CIBC

Moving from Alchemy to Chemistry - The workplace today Part 2

A myth in science is that great insights occur as a result of linear application of effort and experiment. Most of the great insights have occurred serendipitously in the bath, Archimedes, or after a long walk with a friend, Einstein. It seems that the preconditions are having an open mind and having thought about a problem for a long time.

Brian and I make no claims to be original. We happen to be wide eyed observers. We went looking for answers and for insight. We spent the next year meeting with people much more thoughtful than us and reading about those that were making a real difference. Taken together we saw a pattern.

Changing to the new state that fits the turbulent world that we now live versus the relatively stable world of the 20th and 19th century requires a two step process. We have found that you have to change the workplace culture first and then you have to change the way that you organize. Culture first. What culture you may ask. Please read on and we will explore this map in detail.

Our first call was to David Brown and his partner Dr. Andrew Clarke to catch up with what was happening with their practice and at CIBC. I had heard that they had made progress but I knew none of the details. What we learned got us excited. After 3 or 4 years of frustration and failure in applying the conventional wisdom - much of it by trying to intervene medically earlier and with more power, David and Andrew broke through their own acculturation as physicians. Their insight was that workplace illness is not an illness in itself. It is a symptom. Workplace illness is a symptom of a stress in the relationship between the manager and the managed. While the illness manifest itself in medical terms or in disability, it cannot be "cured" unless the underlying cause - stress in the relationship is dealt with.

David and Andrew took this insight and built a measurement tool an intervention tool based on the managerial relationship and persuaded John Hunkin, the then new Chairman, to give it a try. John was embarking on a massive restructuring and had to take $500 million of costs out of the bank and to shift the culture in the retail operation with 35,000 employees, mainly middle-aged women, to sales. He wanted to find something that would work in providing some stability in a very turbulent time. In simple terms they used a simple tool to track the frequency and duration of absence and illness. In this new context of managerial relationship, regular absence is the first smoke that tells you that fire is brewing. Very few employees are inherently slackers. When an employee is regularly ill, these are the flames. The "cure" was to bring in an outside and neutral Facilitator who worked with the manager and the employee face to face until the real issues were on the table and were resolved. The cure was to broker a real conversation where both sides could be heard. In this short paper there is not space to provide you with a full description of what tis process really involves. The main point is that the cure is in the conversation. A conversation that cannot take place with out a neutral facilitator.

John Hunkin's priority was not science but results. He got them. $8,000,000 was saved in the first 9 months and the disability rate was cut by 40%. In two years, in the midst of the restructuring, CIBC was rated on of th top 35 companies to work for in Canada and the savings rate had continued to build.

So an important insight was gained by reconnecting to David and Andrew.We piled back into the research that supported the idea that the core issue in workplace illness and stress was relational. Michael Marmot's Whitehall Studies are critically helpful in this regard. His study of the British Civil Service shows that workplace illness is found on a gradient in the hierarchy. Those at the bottom with no voice or control had 4 times the amount of illness and even accidents than those at the top. His insight, there will always be hierarchies. The issue is the culture in them. Is it closed or open? Linda Duxbury is close to seeing this as well. She has deduced that the issue that drives most illness, absence and acting out is behaviour of the manager. She is also clear that all the conventional cures such as flex etc do not work in the unreformed organization. A valuable find was the Institute for Work and Health. Their work in the automotive industry shows conclusively that most of the back injuries in factories were related to the amount of control and voice that employees had and were only loosely connected to ergonomics. There is a mass of similar research supporting the issue that stress at work is a product of the managerial culture. An additional aha for us was more research in an entirely different field. Dr Doug Wilms at UNB, and a fellow of the CIAR, has been working on why so many of our children are vulnerable. The conventional wisdom is that poverty is the main driver for poor attainment. Wilms contradicts this. He has found that it is parenting culture not income that is the main driver. The most damaging parental culture? Very authoritarian culture. The same pattern.

So if culture, managerial culture was the key to workplace stress and illness, why did the facilitator seem to work so well to fix it and was this the holy grail or did we need to learn more?

Because we wanted to try this out in the Canadian Forces, we thought we should find a military testbed. So we turned to the work of General Gordon Sullivan (Retired Chief of the Army) and Colonel Mike Harper. To our surprise we found an entirely different route to the same destination. David and Andrew's insight at CIBC is well understood in the US Army and a different process, but with the same DNA, has been in play for over a decade. But we found a new issue. That you can be successful in changing a culture but if you don't also change the main operational doctrine, you are still stuck.

Moving from Alchemy to Chemistry - The workplace today Part 3

It's a paradox that the organization that gave us Command and Control is an organization that has done so much to find a new way of doing things. What was General Sullivan's context for understanding that Command and Control had to go?

As we have witnessed in the last decade, the modern battlefield is now incredibly complex. There is simply no way that all the information can be fed back to the command, understood and then relayed back to units. Everyone has to be in the loop at the same time and those at the front have to have the maximum liberty to take action with no call back for orders or more information. The issue for distributing all this information and power of command is not directly technology. It is culture. If you have a culture of command and control you can't use the new technology.

This is actually every "General's" context whether she runs Hewlett Packard or he is the Clerk of the House. The complexity of our world is increasing exponentially.

The principal tool in the Army's portfolio for culture change is a deceptively simple process called the After Action Review. The AAR works like this. After any task those involved time out and WITH A FACILITATOR, have a discussion about what really happened and what they should learn from this. Does the AAR work? The US Army may not be the exemplars of peacekeeping but their tactical performance in the Middle East was breathtaking. The AAR is recognized as the most important tool in unlocking the culture and enabling this type of tactical flexibility. Brigadier General W (Scott) Wallace, formerly in command of the NTC, has observed that the AARs have "instilled a discipline of relentlessly questioning everything we do.
Above all, it has re-socialised three generations of officers to move away from a command-and-control style of leadership to one that takes advantage of distributed intelligence. It has enabled us to learn that we can never become too wedded to our script for combat and that we have to remain versatile enough to exploit the 'broken plays' that inevitably develop in the confusion of battle.“

Let's play with this for a moment. Do you have real and frank discussions about what is really going on? Do you have junior folks speak in front of you telling you what you did wrong? Do you have junior folks acting as the thought leaders in the group? I doubt it. The key? The Facilitator. Here is where the pattern started to become clear to us.

Culture is embodied in voice. At the heart of the managerial relationship is the issue of voice. Stress as Marmot says visits those of us most that have no voice or who feel that we have no voice. Having a voice does not mean that everyone is in charge. The US Army is still firmly attached to the chain of command. Having a voice means that our opinion is taking seriously. Having a voice as a leader means that we speak the truth.

How we speak to each other is the culture in action. If we have a habitual way of speaking we cannot change this on our own. If you are the DM, or the general, you have a certain type of dialogue with junior folks and they expect this and also speak their side of the deal. To speak differently demands that there is a neutral broker, as in the CIBC or the AAR, to level the playing field. Both the CIBC process and the AAR in their DNA open up the conversation between the leader and the led. They have to use a neutral facilitator to pull this off because we have all be trained too well to play the old conversation.

The central figure in the development and deployment of the AAR is a remarkable man. Col (RTD) Ed Guthrie. Ed was not only the staff man for Sullivan on this file but has since his second retirement, Sullivan called him back to be the AAR guy for 13 years after he had retired, has gone on to make a substantive difference at BP. It was in speaking directly to Ed that we began to see that finding ways to shift the culture were not enough. There was another step that we had missed. Unless you then change the main operational doctrine, you are still bridging two worlds - you are not in the new yet.

Moving from Alchemy to Chemistry - The workplace today Part 4

Our conversations with Ed took place in the context of the political war going on between Secretary Rumsfeld and the Army just prior to the second shooting war wit Iraq. Ed gave us a deep insight as to the blind spot in the Army. They were hanging onto the structure required for the cold War - the Armored division and the "Big 5 Weapon Set" developed for the European theatre and for the Soviets. As Rumsfeld and the Army fought, Ed was providing us with the meaning.

Rumsfeld is deeply influenced by the thoughts of the military genius of the late 20th century the late Col John Boyd USAF Rtd. Boyd is a huge topic himself. One of Boyd's main ideas is that speed itself is the competitive issue. His great thinking tool is called OODA. In layman's terms is is about how fast you can "see" what is really going, understand it, decide what to do and then act. Applying OODA well in today's complex world where we don't see or understand a lot is the difference in whether you win or lose in any competitive situation whether in war, business or in government.

Rumsfeld's problem was that the Army doctrine was wedded to an organization that was by design too slow and too ponderous for the political issues confronting the US. He needed a quick and successful war. But the way that the Army was organized was in the way.

In the US Army operational culture, real generals drive armoured divisions with a huge tail. While the Army had made great progress in changing the command and control internal culture, they still saw gigantism and the Armored Division as how they did things. So the 1st Armored Division could not deploy in Kosovo, the roads and bridges could not fit them. Nor could they deploy the Blackhawk either as it was too expensive to lose and too vulnerable to a sophisticated enemy. Rumsfeld's frustration with the Army in Iraq is that they wanted to take another 6 months in bringing up the stuff. So he forced the issue and got his way. While the political aftermath is a mess and the Army's lack of suitability of peacekeeping is self evident. Their tactical achievement is outstanding. They surprised themselves!

Shock and Awe a Boyd concept where you defeat your enemy in his mind by your speed and flexibility was proved out in the field. Rumsfeld's latest attack on the Armor Generals is the appointment of a new new Chief of the Army who is a retired Special Forces General.

So our study of the US Army had shown us that it was not enough to find a way to change the internal culture. If a large traditional organization was going to make the shift, it would have to change its core operational doctrine as well. The history of technical change and its proper deployment in the military has become a field of study itself. Each new development is introduced in the operational context of a previous era. Long Bows had been in action for a century before they were deployed properly at Crecy. It took 3 years for leaders in the US Civil war to acknowledge that you cannot deploy men in line as you did with muskets in front of rifles. It took until late 1917 to acknowledge that courage was not enough when confronted with a machine gun. The history of arms is only an illustration of the point that when a disruptive new technology emerges, our only context for its deployment is how we used to do things. Hence the Dot com bubble.

Ed lead us to another large organization that had tackled both its internal culture and its operational discipline. BP.

Moving from Alchemy to Chemistry - The workplace today Part 5

BP's story is well documented in Chris Collinson excellent book Learning to Fly. Beyond learning much from the book, it was a thrill for us to have direct contact with Ed Guthrie who played such a key role in the first steps of the transformation that Lord Browne is pulling off at BP.

Understanding what BP, a 100,000 strong organization of mainly male engineers many of whom are Scots, is doing gives us some hope that a traditional bureaucracy can transform. We do not believe that all traditional organizations can transform. Look at the airlines' response to discounters or Kmart's response to Wal*Mart. We are saying that with the right leadership, transformation may be possible.

So what was Lord Browne's context for change? He and his team recognized that they were in the "End Game" for oil. All the easy oil had been found. All the oil in cheap geological structures, in easy political environments, in easy environmental areas has been found. Only the tough oil was left. He and the team recognized that it would take all of BP's energy and intellectual capital to stay in the game and to be close to winning it. What a daunting challenge! But then someone pointed out "What if we win the end game for oil and miss the point - that the future may be hydrogen, wind or something that we don't see '

Well they thought they had a problem but now they had a crisis. How were they going to do their day job in oil and be competitive in the alternative game? The alternative game was a real game. the stakes were survival. BP had to become a leader in the alternative game while still be a contender in the End game for Oil. Who could teach them all these new skills? How could they crank out enough earnings in the oil game to pay for the early days in the new game?

The only answer that they could come up with was that they were going to have to rely only on themselves. There was no one out there that could help. How could they learn enough quickly enough? All the jargon about being a learning Organization now made sense. being a learning organization had nothing to do with credentials, it was all about reacting appropriately to changes in the environment. Being a Learning (OODA)?Organization is a an evolutionary concept. Observe, learn and adapt or perish. (OODA) BP had two strikes against them. They had an exceptionally male engineering culture where not knowing something was not acceptable and asking for help an impossibility. How can you learn if you cannot accept that you don't know? How can you learn if you cannot ask for help? They also were organized by departments and by geography. They were a silo-based organization where crossing departmental or geographic boundaries was in effect impossible. How could you learn if you could not access the full knowledge embedded in the global organization?

They overcame all these barriers and then some. BP did three things well. Browne helped everyone understand what the context was for their future. He had mainly got the job as CEO because if his demonstrated skills as a communicator.as a division leader. A shared context is the opening move in playing the evolutionary game well. Secondly he brought in a world class teacher, Ed Guthrie to work on the culture with the introduction of the AAR. Ed's job was to make it OK to ask for help and to capture the learning. Browne recognized that he had to break down the barriers for conversation before he invested in any technology that may broaden the conversation beyond face to face and hence to tap into the full distributed intelligence of all of BP. Thirdly BP created a new sub organization - the Community of Practice. BP still has the organization that we all recognize in org charts. But BP has a second organization that it is intensely stable. That is global and which even lasts after retirement. It is based on the reality that shared interests are more stable that conventional structures. If you are a driller, drilling is your real organization. being located in the North Sea or in South east Asia does not matter if you are connected to all the drillers. if you are retired you are still a driller and you may know stuff that the younger drillers may find valuable. You are still a player. The mundane gas station COI saved $700 million in 3 years by applying all their learning repeatedly to each new station construction.

The key to effective COI's? A FACILITATOR!. BP found that groups need to be brokered to ensure that the right type of conversation takes place. To work well COI's have to have the right type of conversation. Again voice emerges as a key. Underlying voice is the human relationship that voice establishes. A conversation is essentially human. being human it is attractive and it drives enquiry, challenge and response. It gives the speaker a place in the tribe and status that no official organization can give. The authoritarian voice dos not allow conversation. It is essentially a one way deal. it shuts down the receiver. It closes down the child. It impoverishes the organization

So what does all of this mean? Is there a silver bullet? Is there a Red Pill that we can take that will reveal the Matrix. No but there are perhaps a few principles which any organization could use to transform itself.

Moving from Alchemy to Chemistry - The workplace today Part 6

So what do we know? Could it help you?

1. We think we know a few things about the context of our time. By 2010, tomorrow, we will live through the convergence of a powerful series of vectors that will make staying as we are impossible. While we have mentioned 4 vectors in the Vice that we are sure of, we have not added any environmental or extraordinary factor such as war, a financial bifurcation or an energy crisis. Our point is that we do not have to be right in any detail about these vectors to know that we live in times that are so complex as to be beyond the prediction of mortal man. Only organizations and individuals that are exceptional at reading the times and reacting to them will survive.

2. We are prisoners of our mindsets Our mindsets affect two critical paths. They affect our relational culture or how we as individuals fit into an organization or into society. Currently we are locked into a parental command and control pattern which is evidenced by the corporate voice. This voice is not human and most people know that it is not real. At one end it is the voice of spin and the other the voice of dependency. Only organizations and individuals that speak with a human voice, that have conversations, will learn enough to keep up and to attract the best of the best. We know that the only way to change these voices is to use a facilitator. We are too embedded to do this on our own. We know that only if we can change our voice can we "see" enough to consider changing our operational doctrine.

3. Only a change in operational doctrine will complete the transformation. It was when Fisher did both in Dreadnought that 60 years of technical development in the Victorian Navy bore fruit. eBay would be our Dreadnought today.

4. There are no silver bullets. There are a number of good tools. What is needed above all is an understanding of the context and great leadership. We found many good tools at CIBC, in the US Army and at BP, But the key is not tools per se but intellectual and moral leadership. We are still bemused that most of the research that tells us that command and control is the problem, is not widely know. We suspect that it is easier to act using the conventional wisdom than to do the work to find out what science has to offer. Our greatest risk is to confuse action with understanding and acting for the sake of acting with courage.

Which brings us back to our beginning. Like the medieval world, we seem attracted to a set of beliefs that have no foundation except that they are conventional wisdom. We continue to discuss the issue of "workload" as if this is the accepted definition of the problem. We mandate managers to be supportive, without seeing the irony. We continue to see health as a product of physical issues which only require the application of medicine to be cured. We see being competitive in the future as about the application of technology alone. We think that knowledge is a thing. This is "Alchemy". None of these beliefs have any basis in observation, science or reality.

Science tells us that stress in the workplace is directly related to lack of voice and powerlessness. Science tells us that hierarchy is an essential part of nature and cannot be replaced but that its character can be changed. Science tells us that we cannot change ingrained behaviour by fiat but only by the gentle modelling of a peer or a facilitator. Science tells us that health is driven by our immune system which in in turn is driven by our coping ability which in turn is driven by how supportive our social environment is. Science tells us that to competitive a species or a group or an individual has to be able to observe, learn and adapt to changes in their environment. This is the chemistry of human relations. They are based in rigour and in observation and have been established for many years.

So maybe there is a silver bullet. You can choose to stick with Alchemy or you can choose Chemistry.

How do Virtual Teams work?

Note to me follow this link For the Wikipedia case study referenced by Ross

Graffiti

Here is an article from Land of Six Peoples

The Meaning of Graffiti
Before his transformation into New York's symbol of recovery from the terrror attacks, Rudolph Giuliani earned a special mention in that city's history as the mayor who halved the number of crimes committed in the city and cut the murder rate by nearly two-thirds. Before Giuliani, crime had reached "epidemic" proportions in some parts of New York. The drug trade and its attendant violence turned certain areas into no-go zones each night and violent crime had become so commonplace that a fatalistic acceptance of the city's new character was emerging.

The famous "zero tolerance" policy worked from the premise that small crimes encourage larger ones. So, while the police could not directly control the rate of murders, rapes and other violent crime, they could alter the context or "culture" in which these took place by suppressing the petty crimes which framed them. This theory was based on the work of two criminologists who said that indifference to small deviations from a desirable norm (such as broken windows that were left unrepaired) encouraged larger transgressions such as street crime and drug dealing. One of them wrote: "[m]uggers and robbers, whether opportunistic or professional, believe they reduce their chances of being caught or even identified if they operate on streets where potential victims are already intimidated by prevailing conditions. If the neighbourhood cannot keep a bothersome panhandler from annoying passersby, the thief may reason, it is even less likely to call the police to identify a potential mugger or to interfere if the mugging actually takes place."

Writing about the success of this approach in a wonderful little book called The Tipping Point, the New Yorker journalist Malcolm Gladwell traced the evolution of "zero-tolerance" from the city's subway system which decided to eliminate grafitti from its cars and then to crack down on fare-beating (an estimated 170, 000 people avoided paying a token each day). Police had avoided arresting fare-beaters because of the amount of time they wasted doing it (the paperwork usually took a whole day to complete). After thinking hard about the problem, Transit Police chief William Bratton improved his staff's facilities, reducing this time to an hour. Then he chose several high-profile stations and made a large number of arrests as publicly as possible.

One in seven fare-beaters had outstanding warrants for previous offences and one in twenty was carrying some kind of weapon. Fewer armed men meant fewer violent confrontations and eventually, the likelihood of being stopped and searched discouraged many potential felons from walking around with any kind of weapon. The fare-beating arrests therefore had a significant knock-on effect on other crimes. Transit Police arrests quintupled between 1990 and 1994 (the year Giuliani was elected) and Bratton became head of the New York Police Department which then implemented the subway strategies on a much wider scale. The policy was a great success, but it was not done with a wave of a wand. Incremental changes in the subway "culture" combined with improved policing and long term administrative support to produce the sharp drop in crime rates.

Since then "zero tolerance" has been touted as a quick fix for any city with a crime problem. Mexico City, for example, recently signed a US$ 4.3 million contract with Giuliani's consulting firm for advice on how to lessen the city's chaos and carry out similar law enforcement reforms. Whether Mexico's very different economy and public culture will be able to underwrite the kind of change Giuliani is being asked to deliver is anyone's guess, but some locals are doubtful. The Christian Science Monitor reports: "Only 3 percent of Mexicans have confidence in the police. 'The difference is, in the US, people aspire to be law-abiding citizens,' says Mario Arroyo, a researcher at the International Center for Safety Studies in Mexico City. 'Here in Mexico, respect goes to those who evade the law.'"

Could "zero tolerance" work in Guyana? Maybe, but probably not as it ought to. How much radical change is possible given the erosion of our civic norms? Blocked drains and unweeded parapets, potholes, decrepit public buildings, people urinating in public, speeding minibuses, overloud music, traffic lights that don't always work, casual littering, spitting and obscenity - these create "streets in which potential victims are already intimidated by prevailing conditions." Our society has defaulted to "full tolerance" - and easy cures are a fantasy. Giving policemen bigger guns or faster cars is not the only way to tackle a crime problem. We must also consider their salaries and training, and the wider public context of our many "broken windows". We should not blame them for our failure to address the poverty and despair which underlie so much of the recent violence. The recent shutdown of businesses showed that crime cannot occur in a vacuum. Neither can solutions.

The Power of Online Health Communities (Source: Sapient Health Network)

The Power of Peer to Peer Groups in Health 
E-Patients Prefer eGroups to Doctors for 10 of 12 Aspects of Health Care Don't like the news? Go out and make some of your own. Bill Kelly, vice president of Sapient Health Network (SHN) and I decided to do exactly that. We were having breakfast at a Portland restaurant when Bill invited me to compose a survey for members of SHN's online support communities. I sketched out a rough draft on a paper napkin. Bill sent our completed questionnaire to 1,000 members of SHN's online service for people with chronic and serious illnesses. We asked these online self-helpers which of three health resources--their online support groups, their specialist physicians, or their primary care docs--they found most useful in 12 dimensions of health care. The 191 self-helpers who responded rated online support communities as more helpful than either specialists or primary care docs in ten of the twelve areas. Specialist physicians received highest ratings in two areas. Primary care docs received no top ratings. When both types of physicians were combined into a single group, self-helpers rated their support networks ahead of their doctors in eight of the 12 categories. The Most Useful Resource for 12 Dimensions of Medical Care--As Rated by the Members of an Online Support Community. Most Cost Effective
Online Groups--82.68 percent
Specialist MD--8.38
Primary Care MD--8.94 Best In-depth Information on My Condition
Online Groups--76.92
Specialist MD--20.88
Primary Care MD--2.20 Best Help with Emotional Issues
Online Groups--74.73
Specialist MD--9.89
Primary Care MD--15.38 Most Convenient
Online Groups--72.68
Specialist MD--14.21
Primary Care MD--13.11 Best for Helping Me Find Other Medical Resources
Online Groups--68.68
Specialist MD--14.29
Primary Care MD--17.03 Best Practical Knowledge of My Condition
Online Groups--68.48
Specialist MD--23.37
Primary Care MD--8.15 Best Help with Issues of Death and Dying
Online Groups--57.50
Specialist MD--15.00
Primary Care MD--27.50 Most Compassion and Empathy
Online Groups--52.46
Specialist MD--17.49
Primary Care MD--30.05 Most Likely to be There for Me in the Long Run
Online Groups--49.43
Specialist MD--21.02
Primary Care MD--29.55 Best Technical Knowledge of My Condition
Online Groups--47.54
Specialist MD--44.81
Primary Care MD--7.65 Best Help and Advice on Management After Diagnosis
Online Groups--34.59
Specialist MD--42.70
Primary Care MD--22.70 Best Help to Diagnose My Problem Correctly
Online Groups--11.35
Specialist MD--73.51
Primary Care MD--15.14 E-GROUPS PROVIDE "INFORMATION IN THE CONTEXT OF COMMUNITY" Online groups ranked significantly higher than either generalists or specialists for convenience, cost-effectiveness, emotional support, compassion/empathy, help in dealing with death and dying, medical referrals, practical coping tips, in-depth information and "most likely to be there for me in the long run." By a narrow margin, online health communities were also rated as the best source of technical medical knowledge. Specialist physicians were rated highest for help in diagnosing a condition correctly and for help in managing a condition after diagnosis. The results surprised us. We had expected the support groups to rate highest for support and the clinicians for diagnosing and treating. But we had expected that the rankings for our information-related categories would have been more evenly divided. The biggest surprises were the high ratings the online groups received for providing technical medical information, "in-depth information about my condition," and referrals to other medical professionals, It was clear that most of our respondents consider ed their online support groups their primary sources of medical information. Many of the online community members made it clear that as they were dealing with serious medical problems and often felt overwhelmed, isolated, and discouraged, their online community served as an important and treasured haven--a place where they feel welcomed, valued and understood. Comments from study participants provide a fascinating picture of the many ways online support communities can empower, support, and inform their members: #107-"[My] bulletin board is the best therapy possible. I check the boards at least twice a day and it has gotten me through some rough times... I recommend SHN to every breast cancer patient I come in contact with." #109-"I had looked up "fibromyalgia" about 18 months ago but found mostly hard, cold facts, most of which I already knew. I'd been to a [face-to-face] support group and [had] left depressed each time as everyone was so utterly self-absorbed. When I stumbled into SHN I began reading the personal accounts [and realized that] the only people who could honesty understand my life now were those who were walking the walk right along with me. Dealing with fibromyalgia is a challenge, but... every day is a joy in spite of my pain. [This online community] is full of real people, sharing real problems, looking for real answers, and knowing that we all walk in the same moccasins." #33-"I truly do feel more empathy and support from the online communities [than from my doctors]. One time while talking with my doctor, he made me feel like I was beginning to annoy him with all my questions.... I asked him about a supposed "cure" [described in an] article from ABCNEWS.com and he knew nothing about it. He asked me to send it to him and he would comment... I sent it to him [some time ago] but he has yet to comment. A GOOD SOURCE OF INFORMATION NOT AVAILABLE FROM DOCTORS Several of our respondents commented that they had been able to find information via their online support communities that they had not been able to obtain from their own doctors: #119-"I just really appreciate SHN and the community. I would never have found out about the clinical trials at Scripps without them." #134-"When my questions are not answered by my family doctor, I almost always find the answer (or at least someone else with same question) on SHN... it's a comfort to know where to go online to find quick reliable answers. Helping us sort it out and help ing us to deal with chronic pain are not areas most doctors handle very well." #53-"[SHN is a useful] source of information from patients or family members of patients who have experienced the same problems and questions--such as whether it is reasonable to undergo a liver transplant considering the cost, my age, and the lack of don ors. When I asked my primary care physician this, he ignored my question." Some respondents noted that they especially valued the speed and convenience of medical information available from their online communities: #184--I recently had an abdominal/lumbar strain and needed information to explain the unusual swelling inside. I had answers from SHN before the lab tests and x-rays could tell me. #146--It was important to me to be able to do research [on my breast cancer] at the moment without having to go to a library or even talk to someone. The help was there immediately, that evening, not the next day. ONLINE COMMUNITIES CAN HELP TO CREATE SMARTER PATIENTS Several comments emphasized that online communities can help patients become extremely knowledgeable about their medical conditions, and that this allows the patient to play a more active role in the doctor-patient relationship: #166--When I see the doctor it is usually me that has the answers rather than the doctor giving me the information. [When you have hepatitis-C] blind faith [in] the medical community just does not work. #88--I do like SHN and feel it benefits me greatly. I research my Fibromyalgia and then partner up with my primary care doc. He is quite open to this type of management for my condition. It is important to note that our survey subjects were highly experienced users of online health information and online health support. Such highly-experienced online self-helpers still comprise a relatively small part of our population. But their numbers are increasing at a rapid rate. If existing trends continue, millions of people with chronic and serious illnesses will soon become regular members of online support communities. LIMITATIONS OF THIS SURVEY Our low response rate (nineteen percent) may have biased the sample. Individuals with a more favorable opinion of online self-help groups may have been more likely to respond. People with more time to spend online may have responded differently than those under more limiting time pressures. And self-helpers who were doing well may have been more likely to respond than those dealing with a crisis. Nearly all of our respondents had very positive things to say about the survey. But there were a few critical observations as well. One self-helper argued that the term "online support community" did not adequately discriminate among (a) the user's primary online support group on SHN, (b) the other information and people-to-people resources on SHN, and (c) the other online support resources employed by each user. Another suggested that the issues we asked about could not adequately be approached with a multiple-choice questionnaire. A third commented as follows: #35--The real answer is a blend of online information, the primary care, and the specialist physicians, as well as any other possible resources (books, magazines, friends, etc.). Online health communities are a good resource, but I don't think anyone should make decisions based on one resource alone. ONLINE GROUPS AND DOCTORS COMPLIMENT EACH OTHER Condition-specific electronic support communities appear to be best at what doctors are worst at and worst at what doctors are best at. Even the most experienced users of online support prefer to rely on their doctors for help in diagnosing their illnesses and recommending a treatment plan. And many of the types of information and support which online groups provide are those that many doctors are unable or unwilling to supply. Online support groups are not about to put doctors out of business. But doctors would be well-advised to ask their patients about their involvement with online groups and to learn about these groups that are becoming such important medical resources for t heir patients. Perhaps the most important take-home lesson from the survey is that good physicians plus good online communities will mean better health care for all of those dealing with a medical condition. Published in The Ferguson Report, Number 1, March 1999

Gay Marriage - The Church has been here before

I heard the Bishop of PEI opine tonight - unkown terrors will befall us if we allow Gay marriage.

I am reminded of the same fears that the church held when confronted by Galileo. If you are intersted have a look at the follow on where I post the excellent article on the Church and Galileo produced by Wikipedia. History repeats itself