Pioneering Ideas

Talking About Philanthropic Failure

In a new Communications Network diavlog (no, that isn't a misprint, it is an awkward attempt to combine dialog, video, and blog), Pittsburgh Foundation President Grant Oliphant talks about failure. It is good to see more attention to this topic. Paul Brest of the Hewlett Foundation and Jim Canales of the Irvine Foundation have been outspoken about the need to be more forthcoming about programs that don't work, and Robert Giloth and Susan Gewirtz from Annie E. Casey Foundation document the potential value of foundation mistakes in the Winter 2009 issue of Foundation Review. So the issue is beginning to get traction. The Robert Wood Johnson Foundation's recently released Anthology (Volume XIII) adds to the mix with four chapters on foundation failures.

In his remarks, Oliphant comments about good and bad reasons for talking about failure. Good reasons include not wanting to hurt grantees or the cause intended to be helped - i.e., do no harm. Bad reasons include foundation embarrassment.

I’d offer two more – one good reason to talk about failure and one bad reason.  The bad reason is fear – fear of being held accountable for using tax-protected dollars in ways that don’t lead to results.  That fear is understandable, but it undercuts the very role that foundations are in the best position to take: reasonable risks on potentially high-impact activities that are less likely to attract support in the business or public sector.

 

The good reason starts with asking the question: why does the topic of failure even come up in the first place?  After all, the performance of most organizations is the constant subject of many outside observers. But that is the point - foundations are not the subject of systemic observation, in part because they occupy a relatively powerful and independent status in our society. As I argue in the RWJF Anthology, it is this very independence that drives the need for foundations to themselves generate the honest, critical assessment of their performance that is so important to their missions.

 

Finally, do you know of foundations that expect failure? RWJF's attention to failure is tied to different levels of risk intended to be taken by different grant portfolios in the Foundation. As my colleague Paul Tarini, Team Director of the Pioneer Portfolio, noted here, Pioneer expects more failure than other RWJF portfolios because it aims to support highly innovative, high-risk projects. If you are aware of other funding efforts designed to be high risk, and expect more failure, please let us know so we can learn from each other.

This Is a Brainstorm

There is no such thing as a blank check — particularly in this economic climate. Resources are not endless; parameters exist. But the Pioneer Portfolio is dedicated to powering ideas that have the ability to truly transform health and health care and — to do so — we need to encourage people to THINK BIG.

From October 27-30, members of the Pioneer team will be in San Diego to participate in TEDMED2009. While we are there, we will ask other participants — if someone was to hand them a blank check — what they would do to transform the future of health and health care? What kind of problems do they see as being “stuck” and that, if solved, could bring about significant improvements 5, 10, 15 or more years down the road?  Where are the breakthrough opportunities?

But we don’t want to limit the conversation to the group at TEDMED; we want to take the conversation to Twitter and ask a broader audience for their ideas. Like you.
 
There is no blank check.
 
This is not a call for proposals.
 
This is a brainstorm.
 
We want to hear your ideas because they inspire us and because we hope you might inspire each other.
 
If you would like to participate in the conversation and let us know how you would transform the future of health and health care, please tag your “tweets” with the #blankcheck hashtag. We’ll “retweet” them to share with those who follow Pioneer on Twitter and we’ll share them with everyone at TED MED through a live feed we’ll have playing throughout the event. If you don’t want to share your own ideas, but want to see what other people are thinking, you can follow the conversation here. And please consider telling others about the #blankcheck conversation.

Better Informed Managers of Our Health

Most of what I read and almost all of what I believe is that we, as individuals, must assume primary responsibility for managing our health. I'm also told that I need to become a more informed consumer when making health and health care decisions. As a person who's spent a good part of my career doing research I think that I'm more ready than most to investigate, consider and make informed decision. However, no matter how ready I am, no matter how skilled I am at analytic reasoning, I can not make an informed decision if the information is not available to me.

I know that some of the data is hard to acquire and may be harder to analyze. It is difficult even for hospitals to predict the total cost to the patient of a hospital stay. For drugs used to treat many conditions it can be hard to understand the cost versus the benefit, especially where there are competing choices. The prescription drug situation is further complicated by the fact that there is so much direct to consumer advertising of patent medicines that almost never reveal enough data to make an informed decision.

The perspective article in the recent New England Journal of Medicine discusses the fact that, although the FDA collects and makes available what may be extremely important information about prescription drugs, it does so in a relatively haphazard way. The authors, Lisa M. Schwartz, M.D., and Steven Woloshin, M.D. have developed a format for a "Prescription Drug Facts Box" that has been shown to provide clearer, more actionable information to consumers. We funded an FDA pilot of the Facts Box and, most recently, the FDA's Risk Advisory Committee recommended that the FDA adopt these boxes as the standard for their communications. It seems to me that this is one relatively straight forward way that we can become better informed managers of our health.

Fun Behavior.

Earlier this month, Volkswagen launched a competition for ideas to help change people's behavior. The premise is that the best way to change behavior is to make things fun. They call it The Fun Theory: http://thefuntheory.com/.  One example: get people to switch from the escalator to the stairs by changing the steps into a working piano. There are three videos that will make you smile. The competition closes Nov. 15; first prize is 2,500 euros.

Are questionable dosing practices fueling antibiotic resistance?

This post comes to us from Patricia Geli Rolfhamre over at Extending the Cure.  More in-depth conversation about antibiotic resistance and the future of our nation's supply of antibiotics is happening on the ETC blog.

Are there ways in which we can reduce the spread of antibiotic resistance by treating patients more strategically? The dosing and duration of antibiotic treatment have been shown to be critical determinants of the likelihood of curing an infection and of the emergence of resistance.   Adjusting these factors to a patient’s individual condition instead of treating every patient with the same antibiotic regimen may be an easy step toward fighting resistance.

Research reports from the American College of Emergency Physicians annual meeting in Boston earlier this week revealed that doctors who work in hospital emergency rooms rarely adjust antibiotic doses for obese patients. The consequences are an increased risk of treatment failure and resistance development. Yet it is unclear how much this will spur the growing resistance epidemic. Given the fact that more than a third of the US population is obese - this trend is worrying. But solving the obesity problem or adjusting the doses for obese patients is only a part of the answer. The other important parameter for successful treatment and for which a one-size-fits-all approach has generally been applied is the duration of treatment.

The H1N1 Flu Prediction Market

As kids across the country are starting to go back to school this month, parents, health officials and school administrators are wondering whether or not we will see a resurgence of H1N1. While no one can forecast the future, we asked Phil Polgreen and Forrest Nelson, the directors of the Iowa Electronic Health Markets, to explain what they’ve learned so far from their H1N1 market, a pilot prediction tool, and discuss what their expert traders believe will happen in the fall. The Iowa team has been running prediction markets for avian influenza (bird flu) and for seasonal influenza for several years.

On Friday, April 24, some of the first news reports about a frightening new influenza virus surfaced here in the United States. That news prompted us to re-tool our prediction market for the bird flu in order to develop a market for this new strain. We immediately started working on the questions for the new market and recruiting traders.

We had already assembled a group of microbiologists, doctors, public health officials, epidemiologists and others that had inside information about influenza, including trends in seasonal and bird flu. We gave those experts $100 in virtual money (makeshift dollars that can be used to buy and sell shares on the market) and asked them to start trading. By April 28, the H1N1 market was up and running.

Right off the bat, most of our traders predicted that by the end of May, there would be more than 1,101 cases across the U.S., with a low the mortality rate. As it turned out, they were right: As of June 1, the Centers for Disease Control and Prevention had reported 10,053 cases of swine flu in all 50 states and the District of Columbia with 17 deaths at that time.

What’s remarkable about the forecast is that in late April, news reports played up the danger factor, reporting that the virus was killing young, relatively healthy people in Mexico. The fear was that H1N1 would spread rapidly in the U.S. too and be a formidable killer. Our expert traders didn’t buy into the hype, betting instead on a future that resembles the course actually played out by H1N1. In fact, the market predicted that H1N1 would spread widely and quickly but the mortality rate would be less than 1 percent during the first few weeks of the outbreak.

Can Green Cleaning Products Prevent and Control HAIs?

We’ve written several times on Pioneering Ideas about the impact of hospital acquired infections (HAIs) on lives and hospitals as well as the costly drain HAIs have on the health care system.  Simply increasing the use of cleaning and disinfecting products to tackle HAIs can create a host of other health hazards for both health care facility workers and patients – not to mention significant harm to the environment.

This conundrum has led to the development of wide range of green cleaning methods, but at this point there remains a need for more evidence of about the extent to which these programs meet infection control and prevention goals. In a recent white paper, Health Care Without Harm(HCWH), in collaboration with the Global Health and Safety Initiative(GHSI), explores whether there are cleaning strategies for the health care sector could effectively prevent and control infection in a way that would be both healthier and friendlier to the environment.

The paper, which was produced with support from Pioneer, does not present any final answers, but it does lay out some out compelling recommendations for “closing the knowledge gap.”  Please take a look and let us know your thoughts.

Now that’s Progress

1899

 

2009

 

My family dog, Chance, testing the latest prototype. 

Credit to my wife, Naomi, for the idea.

The back story: Chance is about seven months old. He learned to swim in a local creek the other day. Then, in his excitement, he jumped off a bridge and landed on ground 10 feet below. I think he figured if he could swim, then he could also fly. We spent a good five hours at the emergency room, most of it waiting. The vet on call wanted a specialist to see him. The specialist, a doggie ortho surgeon, thought they would need to operate—to the tune of $4,000.  Additional x-rays showed no broken bones, but some torn tendons. It was just like a visit to a human ER, only with a lot more fur. Chance should be ok in three or four weeks.  In the mean time, he claims to be receiving podcasts from New Zealand.

Can a Reduction in Hospital Acquired Infections Cut Health Care Costs?

There is no denying that hospital acquired infections (HAIs) are an expensive drain on the system and impact the lives of an estimated 1.7 million hospital patients a year – killing nearly 99,000 annually. Is it possible that simply instituting best practices in infection control can substantially reduce these infections and save the nation’s healthcare system billions of dollars a year?  Yes, according to an article in last week’s Roll Call by Ramanan Laxminarayan of the Extending the Cure initiative, a Pioneer grantee, and Ed Septimus from HCA Healthcare System.  Laxminarayan and Septimus propose several ideas and incentives, which they believe will reduce the rate of resistant HAIs and control the rise of antibiotic resistance. 

Are hospital acquired infections really the low hanging fruit that will benefit patients and cut health care costs?  Check out the article and then come back here and let us know what you think.   

 

Using Games to Support Children's Healthy Development: Opportunities & Challenges

We welcome Ann My Thai to our guest blogger series.

Ann My Thai is the Assistant Director of the Joan Ganz Cooney Center at Sesame Workshop and the co-author of Game Changer: Investing in Digital Play to Advance Children’s Learning and Health. Ann leads the Center's strategic partnership efforts with high tech and gaming industries, and oversees organizational growth and strategy. Before joining the Center, she served as a consultant for Education for Development, Vietnam, a nonprofit organization that develops informal educational programming for disadvantaged children in Ho Chi Minh City, Vietnam. Thai received her bachelor's degree in Political Science from Yale University and a master's degree in Business Administration from the Ross School of Business at the University of Michigan.

Readers of the Joan Ganz Cooney Center’s latest report, Game Changer: Investing in Digital Play to Advance Children's Learning and Health might be asking why we chose to discuss how digital games could advance both children’s learning and health in the same paper. Named for its founder, the Center’s roots lie in Sesame Street’s “whole child” approach, which encourages learning that supports many different aspects of a child’s healthy development—from literacy skills, to social and emotional development, to practicing healthy habits.  A solid base of research tells us that children who eat healthfully and are more physically active are also able to learn more easily.  It also tells us that children who suffer from health threats such as obesity do worse in school and are less successful later in life.  Given the inextricable ties between learning and health, and the parallel efforts in each field to harness the power of games, we wanted to address the potential role they might play in health and education reform together.

The idea that digital games might actually help improve children's learning and health is, in some quarters, a radical one, but for authors of the report, it is also a pragmatic one. The medium has a high penetration, with 97% of American teens playing computer or video games.  Furthermore, digital games are reaching children at younger and younger ages for longer periods of time.  The average child begins playing games at age 6, down from 8 years old a few years ago, and the amount of time a child plays on average more than doubles between age 6 and 9.  This level of play shows that it is no longer a question of whether we should enlist games in our learning and health efforts but how we may do so.  Game Changer aims to spark a productive dialogue about the opportunities and challenges of using games to support children’s healthy development.

To kick off this dialogue, we unveiled the report on Tuesday with the Woodrow Wilson Center for International Scholars at an event in Washington, DC.  It featured a panel of experts from industry, research, and policy and hosted nearly 100 participants and a web audience from these key sectors. 

A key insight raised at the event was the lack of training available to health researchers to engage in the type of multi-disciplinary game R&D requires. Dr. David Abrams, Executive Director of the Schroeder Institute at the American Legacy Foundation, which focuses on accelerating the reduction in tobacco use, especially for young people in the U.S. population, said that the health care sector has “not looked beyond itself” to consider the whole child in advancing children’s health. The current generation of health researchers is too often isolated from the broader perspectives or tangible incentives to engage in a multi-disciplinary approach.  

Some of the biggest challenges of the day—such as childhood obesity or the fourth grade reading slump—are too broad and complex to be addressed by the expertise of any one discipline.   These are problems couched in layers of social, economic and other environmental factors, as well as developmental factors distinct to each child.  Responding to these issues from a whole child perspective will demand greater investment toward funding and collaboration models and infrastructure that support multi-disciplinary collaboration.  Such investment is essential if we are to tap into the digital media that surrounds today’s children in a purposeful way.