imagesDaniel Henninger, the author of the Wonder Land column in the WSJ, wrote today (10-29-2009) about “Obama and the Old Hat People.”  Today’s column is about the current health care reform proposals making their way through the US Congress, and the current emphasis on dramatically expanding Medicaid alongside the much-debated “public option.”  Henninger places the thinking behind these proposals squarely in the “old hat” category, calling them “pre-iphone” proposals.

Leaving aside the politics or the persuasiveness of his argument, his use of “old hat” thinking and “pre-iphone” proposals got me thinking about old hat, pre-iphone proposals in human services.  In this field we are all too familiar with the Medicaid model and its myriad rules, regulations, complexities, compliance pitfalls, and frustrations.  15 minute billing increments, arcane rounding rules, encounter forms, eligibility change management, concurrent auditing, and much much more are part of the daily lives of human services delivery systems and the people we support.  They are also a part of the infrastructure –human and technological–that human services organizations must have to survive.  We all have software designed to manage the minutia of the rules.

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It just doesn’t get much more old hat than that.  

Most human services organizations are moving to service models based fundamentally on the individual being served.  We call it person-centered-planning, self-determination, or any number of other names, but we are often stymied by old hat bureaucratic thinking.  In this time of technological innovation and social movements based on an increasing ability for individuals to belong to disparate de-centralized groups (social media being a very important example) AND an industry movement toward personal choice, we still haven’t been able to be very new hat, have we?

New hat would be a service delivery and funding model based on individually developed service plans.  New hat would be an iphone app that removes the bloat and just delivers the information relevant to that person in that moment.  I’m circling back, I think, to an earlier post about the need for innovation in human services.

 I want us to be post-iphone.  

We need to be new hat.

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By now you’ve heard about the White House’s new Social Innovation Fund.  It should be just what I was wishing for, since, after all, I’ve been using much of this space to lament the lack of innovation in human services.  

It all reminds me of the time I spoke at a large gathering about the progress of a particular nonprofit.  They were very proud of their progress and accomplishments of the preceding year, and asked me to speak about their plan to increase creativity and cooperation across the enterprise.  At first I was very skeptical.  The very idea of “planned creativity” caused a little chill to run up my spine.  But I was too quick to judge. 

What the organization had done was to thoughtfully plan to get out of people’s way so they could be creative on their own.  The organization brought no canned expectations or creativity outcome requirements to the exercise.  They simply got out of the way and let people create hundreds of small creative innovations that each changed lives.  

It was wonderful.

Perhaps I am too quick to judge here, too.  I would be more encouraged though, if it seemed that the federal government was going to get out of the way so nonprofits could innovate.  While the language the White House is using seems to be proposing a top-down approach, complete with all the innovation-strangling bureaucracy that only the government can impose, let us hope that there is still time to provide input and guidance.  Let us hope and encourage the White House not to prejudge the innovation, but to unleash the pent-up creativity of a vibrant nonprofit community.  We have so much to offer.

Allison Fine, whose blog I’m adding to my daily reading, seems to agree.  Let’s hope we can all make this work.

I had the good fortune to attend the Clinton Global Initiative Exchange in New York last week.  In contrast to the rest of the CGI gathering, which is by invitation and membership only, the Exchange portion is more open.  It is intended as an opportunity for the NGOs, Foundations, and social entrepreneurs to meet, exchange ideas, and connect resources to needs.  It was exciting and daunting to be in a room surrounded by people who are doing such amazing things.

There were people working on clean water and climate change issues.  The Global Fund for Children, Little Star, Going to School, Global Water Challenge, and The Alliance to End Hunger, among many others, were there.  Curriki, You Tube, Flip, and TechSoup  were there.  It was energizing to be around so many good ideas at one time.  Especially encouraging was seeing the technology companies showing up asking what they could do to help.

Going to work every day should be more like that.  At Keystone Human Services, every day there are literally thousands of people going to work to make a difference in someone individual’s life, and by extension, all our lives.  One difference is that we don’t celebrate it enough, we don’t encourage its celebration enough.  

You may have discerned by now that I am going back to my innovation theme.  At CGI the air was crackling with innovative ideas.  While it would admittedly be tiring to face that every day, I know that the people I work with are no less smart and no less committed, both on the technology side and the service delivery/operations side.  Today we can begin to re-create that spirit within our own agencies.  I’m going to start by proposing our own version of CGI—pulling together in one room people with good ideas, people with resources, and people who know how to connect.  Sure, it will be on a much smaller scale, but it will still be energizing and humbling.

Other ideas, anyone?

Earlier this week I had dinner with George Pashel, the CEO of Esteam,  a Pittsburgh technology company focused on human services.  I was talking about the need for innovation in human services and the need to think in new ways about technology and information, when he challenged my premise.  Imagine!

He asserted that what the industry needs is less innovation and more standardization. 

Interesting.  I think he deliberately narrowed my use of the word “innovate” to make his point, but his point was worth making, nonetheless.  What he sees is an industry, a market sector, a “vertical” that is very un-self-aware (even the technology people in this field are frustrated therapists) with practitioners who don’t even have a common language to describe what they do. 

For example, if he responds to an RFP from an early intervention provider, that provider could have a very different “line of business” depending on the Country, State, County etc they are operating in.  That is unheard of in health care.  Neurosurgery is not different in California than it is in New York or in London.  Health care has HL7.  Human Services has a tower of babel controlled by competing funders and regulators.

His point is well taken.  It goes right back to the argument that Human Services needs to move to evidence-based practices.  That would then lead to more standardization.  He’s right to point out that the current situation makes for very challenging terrain for software companies, and vastly increases the liklihood that vendors and customers will completely misunderstand each other.

Ironically, though, I think it still points to the need for innovation.  We are increasingly strangled by conflicting regulatory requirements, unfunded mandates, unreasonable expectations, and outdated service delivery models.  I think we will need quite a bit of innovation and leadership before we can get to standardization.

Do we value innovation in Human Services?  I’m not sure we do, so I’ve started another page on this blog just for that.  I think I’m timely on this one, since the Stanford Social Innovation Review is also talking about it this month, and so are others.  

If we don’t value it and promote innovation in our own organizations and our own field, is it too much to expect from our technology vendors?   They, after all, try to match our organizational cultures as much as possible.  Have we met the enemy?

something to think about.

 

Jeanine