We’re hoping to build something awesome across the UK, although we’re struggling to name it and don’t know if it’ll get funded. Even if it does get funded, we think we’ll get enough for the first 6-9 months. Not more.
What a mess, eh?
Here’s the deal. Over the last few months, I’ve spoken to some amazingly innovative practitioners looking to understand - and solve - why systems struggle to connect with people most in need. I’ve got 96 pages of notes and I’m going to do them all a disservice by distilling them down to two key challenges (I wrote about this work when it started here).
The first is that they’re lonely. They’re thinking way out of the box, questioning everything about how things are currently done, and imagining new ways of working. But their work is out of the comfort zone of the majority so they’re often lone voices. This leads them to doubt their work, and sometimes their sanity, even though, paradoxically, they’re absolutely convinced of it (or at least the general direction of it). This makes them feel alone, sometimes desperately so.
The second is that the moment they make contact with established systems they rarely survive. Systems have a way of exerting - mercilessly - their world view, which is often the wrong lens to use on innovative work. For instance, a housing innovator may have more traction with a community when he frames his work around them thriving collectively but the system just asks how many people were housed - completely missing the broader value being created. A similar thing happens in health all the time; engaged communities start asking for the things that matter to them but the health system just asks, “So, did the rate of diabetes go down?”. Ugh.
The awesome thing we want to build is, err, a space. It’s a space where, in the short-term, we hope to help them overcome their loneliness and fend off their impending insanity. The great thing about these practitioners, however, is that they also want to learn. So, we’ll be looking to overcome their loneliness by helping them to learn from each other.
We’re calling this a ‘learning environment’.
In the medium term, however, we need to increase their chances of survival when they make contact with established systems. This requires the innovators being ready for the questions ahead but also the people of the systems being open to seeing things differently. To be frank, not everyone is going to be capable of this, and some may actively resist it. I’ve experienced - and have grown very tired of - doctors that say they care about communities only to render all of their problems down to diet, exercise and education (to be honest, I’m often left embarrassed by the idea that we’re of the same profession; were they really smart enough to get into medical school?!). So, the challenge is going to be to find the people within systems willing to think - and do - differently, and to bring them together in some kind of highly curated environment.
We’re calling this an ‘enabling environment’.
How do we create these environments? We’re not sure but we see two immediate needs: holding the narrative; and getting the innovative practitioners to help shape what they need.
The narrative here is pretty simple. Systems are failing many of the people they were designed to help and yet are not relinquishing their power to enable new thinking and doing. People outside of these systems have to realise that they have power and then be encouraged to step into it.
Of course, the people I’m working with are way more diplomatic than me, and, together, we’ll find more inclusive and welcoming ways to share the above narrative. I’m ok with that - it’s part of what we need to do - but I’m disinclined to let my profession off the hook for its utter failure to respond to communities in need.
A challenge in getting the innovative practitioners to help shape what they need is that it’s hard to have too many cooks. We need to hear what they’re saying and then make choices around what we build, and how. I’m sure that we won’t please everyone and also that pleasing the majority may not be right either. All in all, it’s going to be tough but, as a great innovator once said to me, if it was easy it would not be worth doing. Indeed.
I hope we can get the first part funded. I’m convinced that once we have momentum we’ll be able to bring other funders to the table. In fact, that’s going to be a big part of my involvement in the work.
I guess we’ll need to find a name for it too.
Pritpal S Tamber
I’m the CEO & Co-Founder of Bridging Health & Community (BH&C) and the Founder of the Creating Health Collaborative. Before all this, I was the Physician Editor of TEDMED, Medical Director of Map of Medicine, Editorial Director for Medicine at BioMed Central, the company that pioneered open access publishing, and an editor at the BMJ. I have an MBChB (a UK equivalent to an MD) from the University of Birmingham, UK. This is my personal blog. If you're interested in BH&C or the Collaborative, check out the BH&C website, including the updates, which you can receive by email. My speaking agent in the US is Executive Speakers Bureau; elsewhere I'm represented by London Speaker Bureau.
I had a nice croissant and coffee during the writing of this article... (just saying)