Putting Patient Engagement To Work, No. 4

I've had a few-decades-long fascination with management frameworks, comprehensive approaches, and attempts to codify what does or doesn't work in-and-for organizations. It keeps me continually wanting to keep up with what the ABCs (see previous post) have cookin'.

About a year ago, The Bridgespan Group, a leading consultancy serving nonprofits exclusively, came out with a report entitled From Input to Ownership: How Nonprofits Can Engage with the People They Serve to Carry Out Their Missions. I've since read and referred to it many times. What really interests me are the authors' attempts to (1.) categorize the different ways nonprofits are engaging their constituents, and (2.) locate those on a straight-line continuum based on the "depth of intensity" they represent.

Per their framework, less intensive forms of engagement are put on the far left. Those have to do with efforts to elicit and gather timely data, i.e., input, from constituents. Input such as? Basic demographic info. Answers to poll questions. Survey responses. The juicier stuff that focus groups and /or ethnographic research can often unearth. 

Remember the docs and clinicians at Boston Children's Hospital, the ones I intro'd in post No. 2? They want input. Third-party observations about their patients' health-states are highly valuable, so they're engaging teachers, family members, etc. to obtain them.

By comparison, staffers at PCORI envision additional roles for patients to play. All research projects, for example, go through planning phases. Why couldn't and shouldn't patient partners help to: identify the topics? develop the research questions? create the interventions? identify comparators? define the characteristics of the studies' participants? You end up with better plans when they chip in, believeth PCORI. Garbage in...garbage out.

Relating this back to the report -- 

PCORI is promoting and pushing for more intensive forms of engagement, what Bridgespan calls co-creation. "Some organizations have chosen to take constituent engagement further into what we call co-creation -- developing solutions with constituents." These the authors peg as middle-of-the-continuum activities.

Interesting, hunh? Both Boston Children's' and PCORI's conceptions of patient engagement seem more or less to fit Bridgespan's schema. No doubt you can see why I applaud the efforts. 

Is it entirely helpful, though? Is it logically consistent? 

Well...

I believe every patient-partner contribution counts. It all matters. I don't believe you're doing less, or lesser, work the farther right on some dreamed-up scale you go. Offering input in the form of answering "yes" or "no" to a poll question, for example, isn't inherently shallower than co-creating. If it helps further an organization's mission, it's valuable. No matter how much sweat, synapsing, or soul searching is required. 

So I guess I don't know what "intensity of engagement" really means. Can you reliably measure it? I don't believe so.

Drawing lines between constituent (patient) contributions that are valued as input vs. contributions used for developing solutions can get dicey, too. But I do believe categorizing different engagement activities by type could prove to be helpful. Maybe we can say what Bridgespan gives us in this regard is a start. I hope to return to it in future posts.

For now --

All the various things engaged patient partners do lead to checklists getting marked off, to dents being made in workloads, to getting things done. For a trained manager, different forms of engagement equal different forms of execution. For the untrained rest of us, it's just plain ol' work. And it's on to looking at patient engagement as work where I'll head next.

Putting Patient Engagement To Work, No. 3

The budding patient engagement "movement" is mainly about improving clinical and economical outcomes. It's about quality and efficiency, being more effective. D' you s'pose our leading management thinkers and practitioners might have a worthwhile thing or two to add along those lines?

I do. 

In the sub-sections below, I want to touch on one management process and another practice that I find germane to the subject. I'll describe some of the work being done around each, who's doing it, the tools and techniques they're using, etc.

Voice of the customer (VOC) (#notVolatileOrganicCompound)

The customer is king. And the "fact" -- debatable -- that he's always right (in reference to the famous Marshall Field quote) has been the case for as long as I can remember.

Recent studies are backing this up. From IBM's The Customer-activated Enterprise, for example, "Outperforming organizations are much more likely than underperforming ones to be collaborating with customers." Plus, "We found that companies that are receptive to customer input tend to have longer and more profitable relationships with their customers than companies that keep customers at arm's length."

Two companies that stand out in my mind for being ahead of the curve are Toyota (with its Toyota Way) and Procter & Gamble. Both have long "known it in their bones" that contexts matter. You simply can't do a great job of satisfying customers without partnering with them, and without absorbing and incorporating their very particular, i.e., local, knowledge. 

Now other companies, in their efforts to catch up, are looking to their own customers for feedback and insight. They're commissioning Chief Customer Officers*. And they're leaning for help on management consultancies that specialize in things like VOC.

VOC -- voice of the customer -- is a term used in business to describe the in-depth process of capturing a customer's preferences, expectations and aversions. I think of it as nearly synonymous (a near-o-nym? an almost-o-nym?) with patient engagement.

Vision Critical is one such consultancy. It specializes in building and supporting cloud-based customer intelligence platforms -- insight communities -- that provide companies with ways to deeply engage their customers. The goal in every case is to deliver meaningful insights that companies can use to make better decisions. Companies...

And other organization-types, as well. Nonprofits in the healthcare arena, for example, are using insight communities to understand and develop new patient journeys, explore and obtain feedback on new treatments, and more. Take Cleveland Clinic: it's been using one to listen to its patients. And reaping the rewards. Its "Patient Panel" has helped the Clinic improve internally in areas from marketing to operations to HR. Check out Do better for your customers: 5 business lessons from patient communities for more.

Delegation

Patient engagement = getting things done through other people = delegating

If you've been following along and clicking through my links, you know about PCORI’s, Boston Children's', and Cleveland Clinic's conceptions of the kinds of things that are delegable to patient partners. There are a lot o' things, aren't there? So many, in fact, that one might begin to wonder what's not potentially delegable. (Isn't every thing on every employee's to-do list at least a candidate? I mean, once someone commits to completing a task, he or she has three options: do it right away, do it later, or delegate it to someone else...) 

Alison Green and Jerry Hauser, authors of Managing to Change the World (2009), believe it's a nonprofit leader's duty to delegate. "If you can delegate it, you should delegate it, ” they write. Delegating should enable you to make the most of your limited** human resources and thereby maximize the effectiveness of your organization in pursuing its mission. 

Stop for a second. How many nonprofit leaders, for the sake of the mission, try to hand off every task they can? How many equate patient engagement with delegation?

When you delegate well, you put people in positions to do what they're dramatically well-suited to do. But it doesn't just happen. To the contrary, there are practices to be practiced, step-by-steps to follow. Green and Hauser offer easy-to-implement tools, for example, for determining what to delegate, assigning roles and responsibilities, and successfully guiding off-loaded work to completion. Bain and Company (one of Earth’s largest and oldest consultancies; Consultasaurus rex?) has compelling things to say about the decision making that goes into delegating. (“One key to successful delegation is to coach team members on making and executing critical decisions.” See How to be a Better Boss)

The bottom line here? 

Those who would engage patients should learn the ABCs of delegating from the ABCs -- thanks for the acronym to David K. Hurst, one of the “C”s -- of management: Academics, Business people, and Consultants.

*  *  *  *  *

Now, generalizing and summarizing:

There’s no need to completely reinvent the wheel if you’re an executive in the healthcare world who's considering a patient engagement initiative. You can look to what’s working in the business world…and apply liberally. I know in the cerebral palsy (CP) /neurological disorders arena we’re not drawing upon that knowledge nearly as much as we could. 

*Essentially, the CCO is expected to form deep personal relationships with the company’s customers to truly understand them. 

**I’ll call into question how limited those human resources really are later.

ROUND SEVEN: Follow The Bridgespan

Here's something a little different stemming from our Parents to Projects (P2P) program. An opportunity -- not for parents to help an organization that's working on their behalf, but -- for leaders of disability organizations to help another organization that's working on their behalf. 

Confusing? 

Follow me: 

The Bridgespan Group is a management consultancy that serves nonprofits. It regularly conducts polls and surveys. The reason being? Bridgespan believes the more insights it can gather about its constituents or customers, the better it should be able to increase its own impact. By "increase its impact" I mean help organizations (like the many nonprofits that make up our community) become more effective. 

Their unstated proposition: If you nonprofit leaders will tell us about yourselves and your organizations by voting in our polls -- if you'll go to work for us, in other words -- we'll do our best to repay you down the road. How? With tools and advice: better ways of doing things; better ways of running your operation; better ways of trying to fulfill your mission. That's the inducement.

I'll throw in two more -- one that's hypothetical-theoretical and another that's more immediately practical:

• I doubt if Bridgespan has a clue about our community. What if, however, it were suddenly deluged with survey and poll responses from us? Maybe it would then pay us some attention, keep us in mind, or make concerted efforts to serve us? 

• If you as an organization leader were to take a few minutes to share your opinions here, at Bridgespan's site, you might well learn something valuable about gathering constituent input. (which you could then conceivably apply within your organization)

Either way, in my opinion our nonprofits would do well -- very well -- to follow their lead.

ROUND THREE: What CP Parents Are For (Part D.2)

We left off talking about the possibility of breaking work -- even something like a writing assignment -- down into smaller bits and inviting other people to help chip away at it. This'd be an example of using collective intelligence: the pooling of small and incremental contributions into coherent, useful bodies of knowledge. Surely it's an execution approach CP-facing orgs could use to get more stuff done.

Ever hear of Amazon's Mechanical Turk? It enables, in the words of David Weinberger*, "vast numbers of people to work on small, distributed tasks" in exchange for small amounts of money. What kinds of tasks? Getting images labeled, finding duplications in yellow-pages listings, rating the relevancy of search engines' results...

We have tons of communicating to do. Could any of it be run through Mechanical Turk or something similar? What about researching? I think about UCP's close to 100 affiliates and all the data they must generate. Could it somehow be worked on in small increments and parsed?

I really don't know much about this "microwork" business, but it does seem to represent a relatively shallower form of worker engagement. Little or no training or expertise are required. The contributors probably aren't deeply commited or emotionally involved. Much of what they have, potentially, to offer never enters the equation.

It may actually be helpful to look at the use of collective intelligence in terms of how relatively engaged the worker is -- with "fully dis-engaged" at one end and "fully engaged" at the other of a spectrum -- and to ask: What are the next, more-engaged kinds of work (after microwork) on the continuum? More to the heart of our matter: What additional kinds of work could organizations pull from the collective of CP parents out there?

As The Bridgespan Group sees it, the next, slightly deeper form of engagement involves getting constituent -- think CP parent -- input. The more insights an organization has about its constituents or customers, the better it should be able to increase its impact. You accomplish something, in other words, when you're able to engage constituents in doing the work of telling you about themselves. (Who are you? What do you think?) Gathering demographic info. Taking surveys. Conducting focus groups. Employing human-centered design processes. Making real-time and comparative feedback systems available. These are all ways of seeking input, of eliciting constituent voice. 

How many of these approaches are any of our CP orgs taking? Not many, I'm willing to bet.  We could be doing a lot more. Outfits that may be able to help nonprofits in particular in their quests to elicit customer voice? Keystone Accountability. Great Nonprofits.

The quality and quantity of information an organization is able to draw out via surveys, focus groups, and the like depends on how it frames questions and otherwise manages its interactions with constituents. Those things set the limits as they relate to depth of engagement.

The next level of engagement is where the org actually gets its constituents thinking creatively, developing programs and solutions together with your organization. On the same page and fully partnering with you, in other words, in furthering your mission. This is the deepest level, really, because lots of fully engaged people give you: multiple perspectives; ongoing relationships; surprises /unexpected better ways of thinking and acting...

The Net makes this sort of co-creation possible. And it holds out this promise: The more smart people you can deeply engage, the bigger the dent you can make in whatever problem it is you're trying to solve. This is where collaborative communities coming together at forums, wikis, mindmaps, etc. come into play. And where we'll head next.

*author of Too Big To Know (2012)