Monday, May 26, 2008

Taking Community Engagement Seriously: How to Find Good Ideas and Make Them Stick

By Neil Seeman

IN THE LAST TWO YEARS, “community engagement” was mentioned more than 5,400 times in international newspapers and government and corporate press releases. Compare that to 1998-2000 when “community engagement” came up 111 times. What’s behind the new fashion in community engagement (a.k.a. “stakeholder engagement”), and does it work?

Community engagement (in my view) means developing and enhancing public participation in change: the more vigorously you engage stakeholders, the more you will understand their legitimate issues, misconceptions and potential resistance to change. Your solution will not only therefore be more effective, you will enjoy better “buy-in” for implementing new initiatives.

“Community engagement” is a concept that William E. Connolly, the Johns Hopkins political theorist, might consider an “essentially contested concept” : wide agreement exists on the virtues of the notion, but argument arises about what it means or what it aims to achieve. In some organizational contexts, extensive community engagement can reflect a culture of risk aversion (a.k.a. “buck-passing”) to the community; or political posturing (“hearing out the stakeholders,” with no follow-through). The exercise of consulting the community can be meaningless. Lacking intelligent oversight, the final result of expensive and time-consuming public engagement sessions is often a long list of complaints, unanswered questions, and unfulfilled wishes. The ensuing report makes it seem that everything (and, therefore, nothing) is a “priority”.

But sometimes – and let’s not kid ourselves, this is rarely done well – community engagement can bring about real, lasting innovation (though this “suitcase” word , too, needs definition). Why do some experiences in community engagement achieve greatness result while others remain an exercise in futility?

Before embarking on the engagement exercise, many fail to ask fundamental questions: Do community members offer better insights than those who have studied the issue; or are the “experts” themselves bound by conflicts (e.g., wanting research funds to evaluate new, untested programs rather than being keen on implementing proven solutions)? In some situations – e.g., improving access for the community – stakeholders offer profound insight and are in the ideal position to design solutions. When the solution needs to be adopted by the community to be effective (e.g., the use of walking trails or bike lanes to support increased physical activity), community engagement is critical. In other situations, community “stakeholders” come to the table with their stakes dug in. The concern may not be the bias itself, but leaving it undeclared.

To help illustrate the appropriate role for stakeholders, my IBM colleague, John Soloninka, has identified the following taxonomy of problems, and their related engagement goals :

Problem | Goal of Engagement

Complex problem needing expert solution
Engage stakeholders for input on what the problem is and possible solution elements, but do not ask them for the entire solution

Complex problem that only those on the front line know how to solve
Engage front line in designing the solution

Problem for which there is wide variation in opinion, and no “objectively” right solution (i.e., one based on values)
Engage in societal values definition

Problem for which there is poor general understanding of the facts among the general public, and many special interests legitimately or illegitimately driving misperception
Engage for education, and how to manage perceptions (this may be misinterpreted as paternalistic, and communications must therefore be managed delicately)

Once the right scope for community engagement is defined, there are two errors in logic that can trip up the initiative. These errors badly disrupt the progress of innovation.

First, it is a fallacy that all new ideas are of equal merit; secondly, more voices do not necessarily lead to better ideas. Ideas have to be sifted and weighed, and that takes serious effort.

The trouble with innovation in health care (or in any other sector) is that it’s not tangible; it cannot be measured easily – and its success cannot be easily predicted. When thinking about innovation, people often make an “attribution error,” welcoming an idea that is familiar because it fits well with traditional values of the culture or the organization. True novelty at first feels “foreign” and, therefore, is frequently rejected.

Gary Hamel of the London Business School finds this problem widespread among corporate executives today, and has compared the current state of business innovation unfavourably to the early 20th century era of Fredrick Winslow Taylor, who pioneered new ways of managing business, or to later 20th century examples such as the Toyota Production System or total quality management. In my view, this attribution error is exaggerated in healthcare, an expert-driven industry where there is a high degree of deference to yesterday’s opinion as the best model for tomorrow’s.

It is for these reasons that community engagement gatherings sometimes keep re-inviting the very same people who came to the previous session, usually the most outspoken and best mobilized groups, and measure the supposed success of the enterprise by the number, rather than the quality, of ideas generated.

Just as corporations generally tap into the creative potential of a very small proportion of their talent pool, health care leaders run the risk of enlisting only a small segment of their stakeholders when they try to generate innovative ideas. Insufficient resources are invested in marketing and recruitment efforts to get the right people to the table. More intelligence needs to be harvested to identify and quantify the good ideas – the ideas that have real promise of improving quality of life or another outcome of interest.

The problems of group idea-generation have been well-documented in the organizational context. Amy Edmondson of the Harvard Business School finds that corporate teaming exercises – often designed in good faith to be representative of a diversity of skill-sets and knowledge, typically break down in three ways. First, depending on who else is there, people may be too afraid to share information. Second, some people may be naïve about others’ self-interests, eliciting argument rather than generating ideas. Third, some people, all too aware of competing interests, withhold information. These problems can be overcome by an effective moderator and by group exercises such as role play where, for instance, the group is divided into fact-providers and Devil’s Advocates, and then roles are exchanged.

A greater challenge – especially in a tight funding environment – is inviting the right people (rather than just more people) to the sessions, and then synthesizing the best ideas.

Social networking tools online are instructive here. IBM, which launched its open “Innovation Jam” process in 2006 , posted White Papers and internal strategy documents online, inviting public comment using blogs. Customers, suppliers, and family members of employees provided input into IBM’s corporate strategy. Wired magazine has dubbed this approach “crowdsourcing.” The message here is to take risks and invite “competitors” and customers to the table; in the health care context, this might mean involving representatives from neighbouring hospitals, regions, private industry, and from government.

Once the ideas are generated, how are the best ones selected? Remember that idea generation and mobilization – the focus of any communication engagement – is just the first stage. In Crafting Organizational Innovation Processes, Kevin Desouza and colleagues dub the second stage “advocacy and screening”. They observe that corporations have more success when this process is transparent and standardized. The third stage is experimentation; this stage assesses the sustainability of ideas for a particular organization at a particular time. The fourth stage is commercialization or market testing – in a public health care context, this might mean “client feedback” – to analyze the costs and benefits of rolling out the innovation. Finally, the last stage is diffusion and implementation: gaining company-wide buy-in. In health care, this last stage means championing the idea internally and externally.

All this is to say that successful community engagement is more than just a cocktail party bringing together the usual suspects. It requires significant effort to find the right people – i.e., targeted message campaigns to historically unrepresented voices. It requires transparent analytics – such as statistical forecasting tools and correlation analyses to assess the anticipated impact of new ideas on outcomes of interest to corporate strategy. It then requires piloting; returning to the community to gain feedback on the ideas selected; and, finally, pursuing a corporate strategy in order to “own” the idea publicly.

Innovation is like a glow-worm, easier to see from far away, long after someone else has thought of it. If it weren’t hard, it wouldn’t be worth it.

Neil Seeman, JD, MPH is a Managing Consultant and Researcher at IBM Healthcare and IBM Global Business Services in Toronto. He is a writer and adjunct professor of health services management at Ryerson University. His research focuses on governance and social networking tools in healthcare. He is currently writing a book about obesity and community. He may be reached at:

1 comment:

Marcus said...

Excellent points. Active engagement is a critical key to success - encompassing the pertinent, yet also relevant, stakeholders to help guide their own destiny. In an often challenging healthcare environment, innovative thinking frequently loses out to the status-quo. Perhaps examples of successful campaigns can lead to more frequent incorporation of "outside the box" ideas that improve community benefits as well as corporate agendas.