Over the past year, I have had the pleasure of advising the non-profit organization Lybba. Lybba’s vision is closely aligned with the work we’ve been doing at New Media Medicine. This month I accepted a one year Research Fellowship with Lybba; the objective is to complete and apply my PhD research in the context of Lybba’s ongoing projects. Chief among these projects is the Collaborative Clinical Care Network (C3N) which I wrote about a few weeks ago.
I’ve been extremely impressed with the scope of their ambition, the quality and breadth of their team and partners, and the concrete projects they’ve chosen to invest time in. As someone trained at the Media Lab, I particularly appreciate the design and communications focus they bring to the Health 2.0 landscape. Technologists (including myself) are too easily excited by the prospect of applying new technologies and media to enable novel social interactions. In reality, it is social processes that determine technology adoption and success. The ecology model that Lybba uses to guide their technology strategy encompasses both people and technology. They identify points of strategic intervention in social processes that will influence outcomes, then work backwards to design technology that supports those interventions. For example, a hospital system that reminds a nurse to call a patient caretaker each quarter may have more impact on reducing flare-ups of a chronic condition than a hospital portal chock-full of social networking features.
Over the past two years, they’ve partnered with organizations that engage in systemic process improvement driven by empirical measurement of outcomes. For decades we’ve applied mathematical optimization to improve performance in military systems, industrial production, medicine, software engineer, and in some businesses, but to my knowledge it has not been effectively applied at scale to complex public-private problems such as healthcare communities. Lybba is engaged in practical projects that seek to identify the design principles of organizations that can systematically adapt and improve to optimize their targeted outcomes. In many respects my PhD work is modeled on this: a community that optimizes individual and collective outcomes through repeated experimentation and adaptation.
This is an extremely important area that has implications far beyond healthcare; namely, I believe that the two main philosophies of driving systemic change in this country are ineffective. Grossly simplified, the liberal’s solution is to work to achieve better outcomes by legislative design, but more often than not, fail because the systems we govern are simply too complex to be anticipated. Conservatives emphasize market forces despite endless demonstrations that competitive marketplaces continually fail to improve areas of critical concern to society such as healthcare, education and poverty. Markets fail because the costs and outcomes of interest to society are simply not well-reflected in the incentive structure of the market. We have to stop trying to legislate solutions, or expecting an invisible hand to do it for us.
Of course I’m throwing rocks when I don’t have a strong alternative to offer, but I do believe that Lybba, and others of similar intent, are trying to uncover something new which may dramatically influence the future of democratic governance. In a world that grows more complicated by the day, learning to manage and improve systems that we can’t decompose or explain, is the only way we can hope to consciously evolve our way into a better future.