Flexible Futures

I: A Brief Tour of the Future

During my first visit to Sydney, in 1997, I made arrangements to catch up with some friends living in Drummoyne.  I was staying at the Novotel Darling Harbour, so we agreed to meet in front of the IMAX theatre before heading off to drinks and dinner.  I arrived at the appointed time, as did a few of my friends.  We waited a bit more, but saw no sign of the missing members of our party.  What to do?  Should we wait there – for goodness knows how long – or simply go on without them?

As I debated our choices – neither particularly palatable – one of my friends took a mobile out of his pocket, dialed our missing friends, and told them to meet us at an Oxford Street pub.  Crisis resolved.

Nothing about this incident seems at all unusual today – except for my reaction to the dilemma of the missing friends.  When someone’s not where they should be, where they said they would be, we simply ring them.  It’s automatic.

In Los Angeles, where I lived at the time, mobile ownership rates had barely cracked twenty percent.  America was slow on the uptake to mobiles; by the time of my visit, Australia had already passed fifty percent.  When half of the population can be reached instantaneously and continuously, people begin to behave differently.  Our social patterns change.  My Sydneysider friends had crossed a conceptual divide into hyperconnectivity, while I was mired in an old, discrete and disconnected conception of human relationships.

We rarely recall how different things were before everyone carried a mobile.  The mobile has become such an essential part of our kit that on those rare occasions when we leave it at home or lose track of it, we feel a constant tug, like the phantom pain of a missing limb.  Although we are loath to admit it, we need our mobiles to bring order to our lives.

We can take comfort in the fact that all of us feel this way.  Mobile subscription rates in Australia are greater than one hundred and twenty percent – more than one mobile per person, one of the highest rates in the world.  We have voted with our feet, with our wallets and with our attention.  The default social posture in Australia – and New Zealand and the UK and the USA – is face down, absorbed in the mobile.  We stare at it, toy with it, play on it, but more than anything else, we reach through it to others, whether via voice calls, text messages, Facebook, Twitter, or any of an constantly-increasing number of ways.

The mobile takes the vast, anonymous and unknowable world, and makes it pocket-sized, friendly and personal.  If we ever run into a spot of bother, we can bring resources to hand – family, friends, colleagues, even professional fixers like lawyers and doctors – with the press of ten digits.  We give mobiles to our children and parents so they can call us – and so we can track them.  The mobile is the always-on lifeline, a different kind of 000, for a different class of needs.

Because everyone is connected, we can connect to anyone we wish.  These connections needn’t follow the well-trodden paths of family, friends, neighbors and colleagues.  We can ignore protocol and reach directly into an organization, or between silos, or from bottom to top, without obeying any of the niceties described on org charts or contact sheets.  People might choose to connect in an orderly fashion – when it suits them.  Generally, they will connect to their greatest advantage, whether or not that suits your purposes, protocols, or needs.  When people need a lifeline, they will turn over heaven and earth to find it, and once they’ve found it, they will share it with others.

Connecting is an end in itself – smoothing our social interactions, clearing the barriers to commerce and community – but connection also provides a platform for new kinds of activities.  Connectivity is like mains power: once everywhere, it becomes possible to imagine a world where people own refrigerators and televisions.

When people connect, their first, immediate and natural response is to share.  People share what interests them with people they believe share those interests.  In early days that sharing can feel very unfocused.  We all know relatives or friends who have gone online, gotten overexcited, and suddenly start to forward us every bad joke, cute kitten or chain letter that comes their way.  (Perhaps we did these things too.)  Someone eventually tells the overeager sharer to think before they share.  They learn the etiquette of sharing.  Life gets easier (and more interesting) for everyone.

As we learn who wants to know what, we integrate ourselves into a very powerful network for the dissemination of knowledge.  If it’s important to us, the things we need to know will filter their way through our connections, shared from person to person, delivered via multiple connections.  In the 21st century, news comes and finds us.  Our process of learning about the world has become multifocal; some of it comes from what we see and those we meet, some from what we read or watch, and the rest from those we connect with.

The connected world, with its dense networks, has become an incredibly efficient platform for the distribution of any bit of knowledge – honest truth, rumor, and outright lies.  Anything, however trivial, finds its way to us, if we consider it important.   Hyperconnectivity provides a platform for a breadth of ‘situational awareness’ beyond even the wildest imaginings of MI6 or ASIO.

In a practical sense, sharing means every employee, no matter their position on the org chart, can now possess a detailed awareness your organization.  When an employee trains their attention on something important to them, they see how to connect to others sharing similar important information.

We begin by sharing everything, but as that becomes noisy (and boring), we focus on sharing those things which interest us most.  We forge bonds with others interested in the same things.  These networks of sharing provide an opportunity for everyone to involve themselves fully within any domain deemed important – or at least interesting.  Each sharing network becomes a classroom of sorts, where anyone expert in any area, however peculiar, becomes recognized, promoted, and well-connected.  If you know something that others want to know, they will find you.

In addition to everything else, we are each a unique set of knowledge, experience and capabilities which, in the right situation, proves uniquely valuable.  By sharing what we know, we advertise our expertise.  It follows us where ever we go.   Because this expertise is mostly hidden from view, it is impossible for us to look at one another and see the depth that each of us carries within us.

Every time we share, we reveal the secret expert within ourselves.  Because we constantly share ourselves with our friends, family and co-workers, they come to rely on what we know.  But what of our colleagues?  We work in organizations with little sense of the expertise that surrounds us.

Before hyperconnectivity, it was difficult to share expertise.  You could reach a few people – those closest to you – but unless your skills were particularly renowned or valuable, that’s where it stopped.  For good or ill, our experience and knowledge now  extend far beyond the circle of those familiar to you, throughout the entire organization.  Everyone in it can now have some awareness of the talents that pulse through your organizations – with the right tools in place.

 

II: Mobility & Flexibility

Everyone now goes everywhere with a mobile in hand.  This means everyone is continually connected to the organization.  That has given us an office that has no walls, one which has expanded to fill every moment of our lives.  We need to manage that relationship and the tension between connectivity and capability.  People can not always be available, people can not always be ‘on’.  Instead, we must be able to establish boundaries, rules, conventions and practices which allow us to separate work from the rest of our lives, because we can no longer do so based on time or location.

We also need some way to be able to track the times and places we do work.  We’re long past the days of punching a timeclock.  In a sense, the mobile has become the work-whistle, timeclock and overseer, because it is the monitor.  This creates another tension, because people will not be comfortable if they believe their own devices are spying on them. Can organizations walk a middle path, which allows the mobile to enable more employee choice and greater freedom, without eternally tethering the employee to the organization?

This is a policy matter, not a technology matter, but technology is forcing the hand of policy.  How can technology come to the aid of that policy?  How can I know when it might be appropriate to contact an employee within my organization, and when it would be right out?  This requires more than a quick glance at an employee schedule.  The employee, mobile in hand, has the capacity to be able to ‘check in’ and ‘check out’ of availability, and will do so if it’s relatively effortless.  Employees can manage their own time more effectively than any manager, given the opportunity.

It’s interesting to note that this kind of employee-driven ‘flextime’ has been approaching for nearly thirty years, but hasn’t yet arrived.  Flextime has proven curiously inflexible.  That’s a result of the restricted communication between employee and organization, mostly happening within the office and within office hours.  Now that communication is continuous and pervasive, now that the office is everywhere, flextime policies must be adjusted to accommodate the continuously-evolving needs of the organization’s employees.  The technology can support this – and we’re certainly flexible enough.  So these practices must come into line with our capabilities.

As practice catches up with technology, we need to provide employees with access to the tools which they can use to manage their own work lives.  This is the key innovation, because empowering employees in this way creates greater job satisfaction, and a sense of ownership and participation within the organization.  Just as we can schedule time with our friends or pursuing our hobbies, we should be able to manage our work lives.

Because we rely so heavily on mobiles, we lead very well-choreographed lives.  Were we to peek at a schedule, our time might look free, but our lives have a habit of forming themselves on-the-fly, sometimes only a few minutes in advance of whatever might be happening.   We hear our mobile chime, then read the latest text message telling us where we should be – picking up the kids, going to the shops, heading to a client.  Our mobiles are already in the driver’s seat.  Fourteen years ago, when I sat at Darling Harbour, waiting for my late friends, we had no sense that we could use pervasive mobile connectivity to manage our schedules and our friends’ schedules so precisely.  Now, it’s just the way things are.

Do we have back office practices which reflect this new reality?  Can an employee poke at their mobile and know where they’re expected, when, and why?  By this, I don’t mean calendaring software (which is important), but rather the rest of the equation, which allows employee and employer to come to a moment-by-moment agreement about the focus of that employment.

This is where we’re going.  The same processes at work in our private lives are grinding away relentlessly within our organizations.  Why should our businesses be fundamentally more restrictive than our family or friends, all of whom have learned how to adapt to the flexibility that the mobile has wrought?  This isn’t a big ask.  It’s not as though our organizations will tip into chaos as employees gain the technical capacity to manage their own time.  This is why policy is important.  Just because anything is possible doesn’t mean it’s a good idea.  Hand-in-hand with the release of tools must come training on how these tools should be used to strengthen an organization, and some warnings on how these same tools could undermine an organization whose employees put their own needs consistently ahead of their employer.

Once everyone has been freed to manage their own time, you have a schedule that looks more like Swiss cheese than the well-ordered blocks of time we once expected from the workforce.  Every day will be special, a unique arrangement of hours worked.  Very messy.  You need excellent tracking and reporting tools to tell you who did what, when, and for how long.  Those tools are the other side of the technology equation; give employees control, and you create the demand for a deeper and more comprehensive awareness of employee activities.

Managers can’t spend their days tracking employee comings and goings.  As our schedules become more flexible and more responsive to both employee and organizational needs, the amount of information a manager needs to absorb becomes prohibitive.  Managers need tools which boil down the raw data into easily digestible and immediately apprehensible summaries.

Not long ago, I did quite a bit of IT consulting for a local council, and one thing I heard from the heads of each of the council’s departments, was how much the managers at the top needed a ‘dashboard’, which could give them a quick overview of the status of their departments, employee deployment, and the like.  A senior executive needs to be able to glance at something – either on their desktop computer, or with a few pokes on their mobile – and know what’s going on.

Something necessary for the senior management has utility throughout the organization.  The kind of real-time information that makes a better manager also makes a better organization, because employees who have access to real-time updates can change their own activities to meet rising demands.  The same flexibility which allows employees to schedule themselves also creates the opportunity for a thoroughly responsive and reconfigurable workforce, able to turn on a dime, because it is plugged in and well-aware of the overall status of the organization.

That’s the real win here; employees want flexibility to manage their own lives, and organizations need that flexibility to able to respond quickly to both crises and opportunities.  The mobile empowers both employee and organization to meet these demands, provided there is sufficient institutional support to make these moment-to-moment changes effortless.

This is a key point.   Where there is friction in making a change, in updating a schedule, or in keeping others well-informed, those points of friction become the pressure points within the organization.  An organization might believe that it can respond quickly and flexibly to a crisis, only to find – in the midst of that crisis – that there is too much resistance to support the organizational demand for an instant change of focus.  An organization with too much friction divides its capabilities, becoming less effective through time, while an organization which has smoothed away those frictions multiplies its capabilities, because it can redeploy its human resources at the speed of light.

Within a generation, that’s the kind of flexibility we will all expect from every organization.  With the right tools in hand, it’s easy to imagine how we can create organizations that flow like water while remaining internally coherent.  We’re not there yet, but the pieces are now in place for a revolution which will reshape the organization.

 

III: Exposing Expertise

It’s all well and good to have a flexible organization, able to reconfigure itself as the situation demands, but that capability is useless unless supported by the appropriate business intelligence.  When a business pivots, it must be well-executed, lest it fly apart as all of the pieces fall into the wrong places, hundreds of square pegs trying to fill round holes.

Every employee in an organization has a specific set of talents, but these talents are not evenly distributed.  Someone knows more about sales, someone else knows more about marketing, or customer service, or accounting.  That’s why people have roles within an organization; they are the standard-bearers for the organization’s expertise.

Yet an employee’s expertise may lie across several domains.  Someone in accounting may also provide excellent customer service.  Someone in manufacturing might be gifted with sales support.  A salesman might be an accomplished manager.  People come into your organization with a wide range of skills, and even if they don’t have an opportunity to share them as part of their normal activities, those skills represent resources of immense value.

If only we knew where to find them.

You see, it isn’t always clear who knows what, who’s had experience where, or who’s been through this before.  We do not wear our employment histories on our sleeves.  Although we may enter an organization with our c.v. in hand, once hired it gets tucked away until we start scouting around for another job.  What we know and what we’ve done remains invisible.  Our professional lives look a lot like icebergs, with just a paltry bit of our true capabilities exposed to view.

One of the functions of a human resources department is to track these employee capabilities.  Historically, these capabilities have been strictly defined, with an appropriately circumscribed set of potentials.  Those slots in the organization are filled by these skills.  This model fit well well organizations treasured stability and order over flexibility and responsiveness.  But an organization that needs to pivot and reorient itself as conditions arise will ask employees to be ready to assume a range of roles as required.

How does an organization become aware of the potential hidden away within its employees?

I look out this afternoon and see an audience, about whom I know next to nothing.  There are deep reservoirs of knowledge and experience in this room, reservoirs that extend well beyond your core skills in payroll and human resources.  But I can’t see any of it.  I have no idea what we could do together, if we had the need.  We probably have enough skills here to create half a dozen world-class organizations.  But I’m flying blind.

You’re not.  Human resources is more than hiring and compliance.  It is an organizational asset, because HR is the keeper of the human inventory of skills and experiences.   As an employee interviews for a position and is hired, do you translate their c.v. into a database of expertise?  Do you sit them down for an in-depth interview which would uncover any other strengths they bring into the organization?  Or is this information simply lying dormant, like a c.v. stashed away in a drawer?

The technology to capture organizational skills is already widely deployed.  In many cases you don’t need much more than your normal HR tools.  This isn’t a question of tools, but rather, how those tools get used.  Every HR department everywhere is like a bank vault loaded up with cash and precious metals.  You could just close the vault, leaving the contents to moulder unused.  Or you can take that value and lend it out, making it work for you and your organization.

That’s the power of an HR department which recognizes that business intelligence about the intelligence and expertise within your organization acts like a force multiplier.  A small organization with a strong awareness of its expertise punches far above its weight.  A large organization with no such awareness consistently misses opportunities to benefit from its unique excellence.

You hold the keys to the kingdom, able to unlock a revolution in productivity which can take your organizations to a whole new level of capability.  When anyone in the organization can quickly learn who can help them with a given problem, then reach that person immediately – which they now can, given everyone has a mobile – you have effectively swept away much of the friction which keeps organizations from reaching their full potential.

Consider the tools you already employ.  How can they be opened up to give employees an awareness of the depth of talent within your organization?  How can HR become a switchboard of capabilities, connecting those with needs to those who have proven able to meet those needs?  How can a manager gain a quick understanding of all of the human resources available throughout the organization, so that a pivot becomes an effortless moment of transition, not a chaotic chasm of confusion.

This is the challenge for the organizations of the 21st century.  We have to learn how to become flexible, fluid, responsive and mobile.  We have to move from ignorance into awareness.  We have to understand that the organization as a whole benefits from an expanded awareness of itself.  We have to do these things because newer, more nimble competitors will force these changes on us.   Organizations that do not adapt to the workforce and organizational movements toward flexibility and fluidity will be battered, dazed and confused, staggering from crisis to crisis.  Better by far to be on the front foot, walking into the future with a plan to unleash the power within our organizations.

People Power

Introduction: Magic Pudding

To effect change within governmental institutions, you need to be conscious of two important limits.  First, resources are always at a premium; you need to work within the means provided.  Second, regulatory change is difficult and takes time.  When these limitations are put together, you realize that you’ve been asked to cook up a ‘magic pudding’.  How do you work this magic?  How do you deliver more for less without sacrificing quality?

In any situation where you are being asked to economize, the first and most necessary step is to conduct an inventory of existing assets.  Once you know what you’ve got, you gain an insight into how these resources could be redeployed.  On some occasions, that inventory returns surprising results.

There’s a famous example, from thirty years ago, involving Disney.  At that time, Disney was a nearly-bankrupt family entertainment company.  Few went to see their films; the firm’s only substantial income came from its theme parks and character licensing.  In desperation, Disney’s directors brought on Michael J. Eisner as CEO.  Would Eisner need to sell Disney at a rock-bottom price to another entertainment company, or could it survive as an independent firm? First things first: Eisner sent his right-hand man, Frank Wells, off to do an inventory of the company’s assets.  There’s a vault at Disney, where they keep the master prints of all of the studio’s landmark films: Snow White and the Seven Dwarves, Pinocchio, Peter Pan, Bambi, A Hundred and One Dalmatians, The Jungle Book, and so on.  When Wells walked into the Vault, he couldn’t believe his eyes.  Every few minutes he called Eisner at his desk to report, “I’ve just found another hundred million dollars.”

Disney had the best library of family films created by any studio – but kept them locked away, releasing them theatrically at multi-year intervals designed to keep them fresh for another generation of children.  That worked for forty years, but by the mid-1980s, with the VCR moving into American homes, Eisner knew more money could be made by taking these prize assets and selling them to every family in the nation – then the world.  That rediscovery of locked-away assets was the beginning of the modern Disney, today the most powerful entertainment brand on the planet.

When I began to draft this essay, I felt as constrained as Disney, pre-Eisner.  How do you bake a magic pudding?  Eventually, I realized that we actually have incredible assets at our disposal, ones which didn’t exist just a few years ago. Let’s go on a tour of this hidden vault.  What we now have available to us, once we learn how to use it, will change everything about the way we work, and the effectiveness of our work.

 

I: What’s Your Number?

The latest surveys put the mobile subscription rate in Australia between 110-115%.  Clearly, this figure is a bit misleading: we don’t give children mobiles until they’re around eight years old, nor the most senior of seniors own them in overwhelming numbers.  The vast middle, from eight to eighty, do have mobiles.  Many of us have more than one mobile – or some other device, like an iPad, which uses a mobile connection for wireless data.  This all adds up.  Perhaps one adult in fifty refuses to carry a mobile around with them most of the time, so out of a population of nearly 23 million, we have about 24 million mobile subscribers.

This all happened in an instant; mobile ownership was below 10% in 1993, but by 1997 Australia had passed 50% saturation.  We never looked back.  Today, everyone has a number – at least one number – where they can be reached, all the time.  Although Australia has had telephones for well over a hundred years, a mobile is a completely different sort of device.

A landline connects you to a place: you ring a number to a specific telephone in a specific location.  A mobile connects you to a person. On those rare occasions when someone other than a mobile’s owner answers it, we experience a moment of great confusion.  Something is deeply disturbing about this, a bit like body-snatching.  The mobile is the person; the person is the mobile. When we forget the mobile at home – rushed or tired or temporarily misplaced – we feel considerably more vulnerable.

The mobile is the lifeline which connects us into our community: our family, our friends, our co-workers.  This lifeline is pervasive and continuous.  All of us are ‘on call’ these days, although nearly all of the time this feels more like a relief than a burden.  When the phone rings at odd hours, it’s not the boss, but a friend or family member who needs some help.  Because we’re continuously connected, that help is always there, just ten digits away. We’ve become very attached to our mobiles, not in themselves, but because they represent assistance in its purest form.

As a consequence, we are away from our mobiles less and less; they spend the night charging on our bedstands, and the days in our pockets or purses.

Last year, a young woman approached me after a talk, and said that she couldn’t wait until she could have her mobile implanted beneath her skin, becoming a part of her.  I asked her how that would be any different than the world we live in today.

This is life in modern Australia, and we’re not given to think about it much, except when we ponder whether we should be texting while we drive, or feel guilty about checking emails when we should really be listening to our partner.  This constant connectivity forms a huge feature of the landscape, a gravitational body which gently lures us toward it.

This connectivity creates a platform – just like a computer’s operating system – for running applications.  These applications aren’t software, they’re ‘peopleware’.  For example, fishermen off of India’s Kerala coast call around before they head into port, looking for the markets most in need of their catch.  Farmers in Kenya make inquiries to their local markets, looking for the best price for their vegetables. Barbers in Pakistan post a sign with their mobile number, buy a bicycle, and go clipper their clients in their homes.  The developing world has latched onto the mobile because it makes commerce fluid, efficient, and much more profitable.

If the mobile does that in India and Kenya and Pakistan, why wouldn’t it do the same thing for us, here in Australia?  It does lubricate our social interactions: no one is late anymore, just delayed.  But we haven’t used the platform to build any applications to leverage the brand-new fact of our constant connectivity.  We can give ourselves a pass, because we’ve only just gotten here.  But now that we are here, we need to think hard about how to use what we’ve got.  This is our hundred-million dollar moment.

 

II: Sharing is Daring

A few years ago, while I waited at the gate for a delayed flight out of San Francisco International Airport, I grew captivated with the information screens mounted above the check-in desks.  They provided a wealth of information that wasn’t available from airline personnel; as my flight changed gates and aircraft, I learned of this by watching the screen.  At one point, I took my mobile out of my pocket and snapped a photo of the screen, sharing the photo with my friends, so they could know all about my flying troubles.  After I’d shot a second photo, a woman approached me, and carefully explained that she was talking to another passenger on our delayed flight, a woman who worked for the US Government, and that this government employee thought my actions looked very suspicious.

Taking photos in an airport is cause for alarm in some quarters.

After I got over my consternation and surprise, I realized that this paranoid bureaucrat had a point. With my mobile, I was breaching the security cordon carefully strung around America’s airports.  It pierced the veil of security which hid the airport from the view of all except those who had been carefully screened.  We see this same sensitivity at the Immigration and Customs facilities at any Australian airport – numerous signs inform you that you’re not allowed to use your mobile.  Communication is dangerous.  Connecting is forbidden.

We tend to forget that sharing information is a powerful act, because it’s so much a part of our essential nature as human beings.

In November, Wikileaks shared a massive store of information previously held by the US State Department; just one among a quarter million cables touched off a revolt in Tunisia, leading to revolutions in Egypt, Bahrain, Yemen, Libya, Syria and Jordan.  Sharing changes the world.  Actually, sharing is the foundation of the human world.  From the moment we are born, we learn about the world because everyone around us shares with us what they know.

Suddenly, there are no boundaries on our sharing.  All of us, everywhere – nearly six billion of us – are only a string of numbers away.  Type them in, wait for an answer, then share anything at all.  And we do this.  We call our family to tell them we’re ok, our friends to share a joke, and our co-workers to keep coordinated.  We’ve achieved a tremendously expanded awareness and flexibility that’s almost entirely independent of distance.  That’s the truth at the core of this hundred-million dollar moment.

All of your clients, all of your patients, all of your stakeholders – and all of you – are all unbelievably well connected.  By the standards of just a generation ago, we are all continuously available.  Yet we still organize our departments and deliver our services as if everyone were impossibly far-flung, hardly ever in contact.

Still, the world is already busy, reorganizing itself to take advantage of all this hyperconnectivity.

I’ve already mentioned the fishermen and the farmers, but as I write this, I’ve just read an article titled “US Senators call for takedown of iPhone apps that locate DUI (RBT) checkpoints.”  You can buy a smartphone app which allows you to report on a checkpoint, posting that report to a map which others can access through the app.  You could conceivably evade the long arm of the law with such an app, drink driving around every checkpoint with ease.

Banning an app like this simply won’t work. There are too many ways to do this, from text messages to voice mail to Google Maps to smartphone apps.  There’s no way to shut them all down.  If the Senate passes a law to prevent this sort of thing – and they certainly will try – they’ll find that they’ve simply moved all of this connectivity underground, into ‘darknets’ which invisibly evade detection.

This is how potent sharing can be.  We all want to share.  We have a universal platform for sharing.  We must decide what we will share.  When people get onto email for the first time, they tend to bombard their friends and family with an endless stream of bad jokes and cute photographs of kittens and horribly dramatic chain letters.  Eventually they’ll back off a bit – either because they’ve learned some etiquette, or because a loved one has told them to buzz off.

You also witness that exuberant sharing in teenagers, who send and receive five hundred text messages a day.  When this phenomenon was spotted, in Tokyo, a decade ago, many thought it was simply a feature peculiar to the Japanese.  Today, everywhere in the developed world, young people send a constant stream of messages which generally say very little at all.  For them, it’s not important what you share; what is important is that you share it.  You are the connections, you are the sharing.

That’s great for the young – some have suggested that it’s an analogue to the ‘grooming’ behavior we see in chimpanzees – but we can wish for more than a steady stream of ‘hey’ and ‘where r u?’  We can share something substantial and meaningful, something salient.

That salience could be news of the nearest RBT checkpoint, or, rather more helpfully, it might be a daily audio recording of the breathing of someone suffering with Chronic Obstructive Pulmonary Disease.  It turns out that just a few minutes listening to the sufferer – at home, in front of a computer, or, presumably their smartphone – will cut their hospitalizations in half, because smaller problems can be diagnosed and treated before they become life-threatening.  A trial in Tasmania demonstrated this conclusively; it’s clear that using this connection to listen to the patient can save lives, dollars, and precious time.

This is the magic pudding, the endless something from nothing.  But nothing is ever truly free.  There is a price to be paid to realize the bounty of connectivity.  Our organizations and relations are not structured to advantage themselves in this new environment, and although it costs no money and requires no changes to the law, transforming our expectations of our institutions – and of one another – will not be easy.

 

III:  Practice Makes Perfect

To recap: Everyone is connected, everyone has a mobile, everyone uses them to maintain continuous connections with the people in their lives.  This brand-new hyperconnectivity provides a platform for applications.

The first and most natural application of connectivity is sharing, an activity beginning with the broad and unfocused, but moves to the specific and salient as we mature in our use of the medium.  This maturation is both individual and institutional, though at the present time individuals greatly outpace any institution in both their agility with and understanding of these new tools.

Our lives online are divided into two separate but unequal spheres; this is a fundamental dissonance of our era.  Teenagers send hundreds of text messages a day, aping their parents, who furiously respond to emails sent to their mobiles while posting Twitter updates.  But all of this is happening outside the institution,  or, in a best practice scenario, serves to reinforce the existing functionality of the institution.  We have not rethought the institution – how it works, how it faces its stakeholders and serves its clients – in the light of hyperconnectivity.

This seems too alien to contemplate – even though we are now the aliens.  We live in a world of continuous connection; it’s only when we enter the office that we temper this connection, constraining it to meet the needs of organizational process.

If we can develop techniques to bring hyperconnectivity into the organization, to harness it institutionally, we can bake that magic pudding.  Hyperconnectivity provides vastly greater capability at no additional cost.  It’s an answer to the problem.  It requires no deployment, no hardware, no budgeting or legislative mandates.  It only requires that we more fully utilize everything we’ve already got.

To do that, we must rethink everything we do.

Service delivery in health is something that is notoriously not scalable.  You must throw more people at a service to get more results.  All the technology and process management in the world won’t get you very far.  You can make systems more efficient, but you can’t make them radically more effective.  This has become such a truism in the health care sector that technology has become almost an ironic punchline within the field.  So much was promised, and so much of it consistently under-delivered, that most have become somewhat cynical.

There are no magic wands to wave around, to make your technology investments more effective.  This isn’t a technology-led revolution, although it does require some technology.  This is a revolution in relationship, a transformation from clients and customers into partners and participants. It’s a revolution in empowerment, led by highly connected people sharing information of vital importance to them.

How does this work in practice?  The COPD ‘Pathways‘ project in Tasmania points the way toward one set of services, which aim at using connectivity to monitor progress and wellness. Could this be extended to individuals with chronic asthma, diabetes, high blood pressure, or severe arthritis?  If one is connected, rather than separate, if one is in constant communication, rather than touching base for widely-spaced check-ins, then there will be a broad awareness of patient health within a community of carers.

The relationship is no longer one way, pointing the patient only to the health services provider.  It becomes multilateral, multifocal, and multiparticpatory.  This relationship becomes the meeting of two networks: the patient’s network of family, friends and co-afflicted, meeting the health network of doctors and nurses, generalists and specialists, clinicians and therapists.  The meeting of these two continuous always-on networks forms another continuity, another always-on network, focused around the continuity of care.

If we tried to do something like this today, with our present organizational techniques, the health service providers would quickly collapse under the burden of the additional demands on their time and connectivity required to offer such continuity in patient care.  Everything currently points toward the doctor, who is already overworked and impossibly time-poor.  Amplifying the connection burden for the doctor is a recipe for disaster.

We must build upon what works, while restructuring these relationships to reflect the enhanced connectivity of all the parties within the healthcare system.  Instead of amplifying the burden, we must use the platform of connectivity to share the load, to spread it out across many shoulders.

For example, consider the hundreds of thousands of carers looking after Australians with chronic illnesses and disabilities.  These carers are the front line.  They understand the people in their care better than anyone else – better even than the clinicians who treat them.  They know when something isn’t quite right, even though they may not have the language for it.

At the moment Australia’s carers live in a world apart from the various state health care systems, and this means that an important connection between the patient and that system is lacking.  If the carer were connected to the health care system – via a service that might be called CarerConnection – there would be better systemic awareness of the patient, and a much greater chance to catch emerging problems before they require drastic interventions or hospitalizations.

These carers, like the rest of Australia, already have mobiles.  Within a few years, all those mobiles will be ‘smart’, capable of snapping a picture of a growing rash, or a video of someone’s unsteady gait, ready to upload it to anyone prepared to listen.  That’s the difficult part of this equation, because at present the health care system can’t handle inquiries from hundreds of thousands of carers, even if it frees up doctor’s surgeries and hospital beds.

Perhaps we can employ nurses on their way to a gradual retirement – in the years beyond age 65 – to connect with the carers, using them to triage and elevate or reassure as necessary.  In this way Australia empowers its population of carers, creating a better quality of life for those they care for, and moves some of the burden for chronic care out of the health care system.

That kind of innovative thinking – which came from workshops in Bendigo and Ballarat – which shows the real value of connectivity in practice.  But that’s just the beginning.  This type of innovation would apply equally effectively to substance abuse recovery programs or mesothelioma or cystic fibrosis.  Beyond health care, it applies to education and city management as well as health service delivery.

This is good old-fashioned ‘people power’ as practiced in every small town in Australia, where everyone knows everyone else, looks out for everyone else, and is generally aware of everyone else.  What’s new is that the small town is now everywhere, whether in Camperdown or Bendigo or Brunswick, because the close connectivity of the small town has come to us all.

The aging of the Australian population will soon force changes in service delivery.  Some will see this as a clarion call for cutbacks, a ‘shock doctrine‘, rather than an opportunity to re-invent the relationships between service providers and the community.   This slowly unfolding crisis provides our generation’s best chance to transform practices to reflect the new connectivity.

It’s not necessary to go the whole distance overnight.  This is all very new, and examples on how to make connectivity work within healthcare are still thin on the ground.  Experimentation and sharing are the orders of the day.  If each regional area in Victoria started up one experiment – a project like CasConnect - then shared the results of that experiment with the other regions, there’d soon be a virtual laboratory of different sorts of approaches, with the possibility of some big successes, and, equally, the chance of some embarrassing failures.  Yet the rewards greatly outweigh any risks.

If this is all done openly, with patients and their community fully involved and fully informed, even the embarrassments will not sting – very much.

In order to achieve more with less, we must ask more of ourselves, approaching our careers with the knowledge that our roles will be rewritten.  We must also ask more of those who come forward for care.  They grew up in the expectation of one sort of relationship with their health services providers, but they’re going to live their lives in another sort of arrangement, which blurs boundaries and which will feel very different – sometimes, more invasive.  Privacy is important, but to be cared for means to surrender, so we must come to expect that we will negotiate our need for privacy in line with the help we seek.

The magic pudding isn’t really that magic. The recipe calls for a lot of hard work, a healthy dash of risk taking, a sprinkle of experiments, and even a few mistakes.  What comes out of the oven of innovation (to stretch a metaphor beyond its breaking point) will be something that can be served up across Victoria, and perhaps across the nation.  The solution lies in people connected, transformed into people power.