How To Cover Social Innovation: Start Small, Build Big
This article is the latest in a series that dissects news stories to make the case for high-quality “solution journalism.”
Last Wednesday, our founder David Bornstein gave a talk about Solution Journalism to Studio20, a graduate program at NYU studying the future of journalism (from which I’m about to graduate.) They seemed to get it. But their overwhelming reaction – which mirrors most journalists’ responses – was “Wow, this is really big. Where do you even begin?”
A good and perfectly valid question. Solutions to problems as complex as healthcare costs, the financial crisis or broken democracies are often ambiguous and multifactorial. They’re more like ecosystems than process maps. And choosing one angle of attack can be overwhelming, not to mention feel like an endorsement.
But, done well, this doesn’t have to be the case.
A perfect example is the other half of the story to The Atlantic Senior Editor Derek Thompson’s blog post, “Who Really Robbed the Middle Class? Maybe It Was Healthcare.”
The piece expands upon a slideshow by Business Insider’s Henry Blodget, which attempted to pinpoint the root cause of the Occupy Wall Street movement with charts and graphs. It’s a complicated argument. But, as Blodget summarized on one slide, “the one overarching reason the Wall Street protesters are so upset…Wages as a percent of the economy [are] basically the lowest ever.”
And here, Thompson did something quite awesome. Blodget’s slide lead you to believe that people are angry because companies don’t shell out enough cash to keep up with cost of living.
But what Blodget omits, and Thompson explains, is that while wages have fallen as a percentage of GDP, overall compensation–which includes wages and benefits, like health insurance–has stayed the same: (italics mine)
“As it turns out, [health care, pension benefits, and employer contributions to Social Security, Medicare and other government programs] have increased from about 4.5 percent of the economy in 1960 to about 11 percent of the economy is 2009…Blodget is making the argument that corporate profits stole your raise. But it’s more likely that health care stole your raise. Health care and other benefit costs have more than doubled as a share of GDP since 1960. Corporate profits have not.”
Here-in lies the beauty. Thompson has taken a really big, complex problem proposed by Blodget (“Wages are the lowest ever”) and deconstructed the system of compensation to pinpoint one potential root cause for your lack of wages: healthcare is really f’ing expensive.
Once you’ve identified a root cause, it’s a bit easier to investigate potential solutions people are already working on.
I took a preliminary stab at it by searching Dowser’s Innovation Database for the word “healthcare,” and restricting my results to organizations in the United States. And then I read. A lot. Six overarching strategies emerged for lowering costs while maintaining quality of care:
- Improve Process Efficiency The Institute for Healthcare Improvement, a sort of watchdog group for health care innovation, is a good place to start for an overview of the newest models in improvements in process efficiency in healthcare. (They also devote a potion of their practice to motivating practitioners to change– a whole other problem, with its own set of solution strategies.)
- Disseminate best practices. Organizations like Evidentista US, and online forums such as Patients Like Me, highlight best practices, so that even the busiest of doctors, and patients, will be up to date on treatments and health management.
- Improve Doctor Communication Skills. Some medical schools have started screening their applicants for people skills. Poor communication results in unnecessary patient errors, which pushes up insurance premiums and results in higher costs for you. Plus, doctors with better communication skills often result in more effective coordinated care, which leads us to…
- Innovative Coordinated Care. This is a form of health care delivery that looks at the patient holistically–from medical compliance to the situation at home to ensuring adequate finances, food stamps and transportation are available. It’s kind of become a buzzword within the medical community, but Kaiser Permanente and the Mayo Clinic are the two largest examples of coordinated care centers in the United States. For more variations on the theme, see this strategy, or this initiative, or this, this or this one.
- Hotspot Needy Patients. This is a strategy borrowed from the world of crime fighting. When police notice rising crime rates, they identify the areas with the highest incidences and direct their resources toward those neighborhoods. Similarly, in healthcare, a small percentage of patients quite often command the bulk of annual healthcare costs. The idea, outlined in a January 2011 New Yorker article by Atul Gawande, is that targeting the neediest patients will reduce costs for everyone.
- Charge A Per-Patient Flat Fee. In several organizations linked to above, the move that allowed them to implement innovative, effective change was to switch from a fee-for-service model, to a flat fee. It’s explored in more depth here and here.
The most effective initiatives that cut cost while maintaining quality of care employ a combination of the strategies above. In my few hours of research, the frontrunner seemed to be an amalgam of hotspotting, innovative coordinated care and flat fees. Gawande’s article examined these strategies in action in-depth, as did The Quiet Healthcare Revolution, a feature article in this week’s The Atlantic Magazine that explores how an organization called CareMore uses coordinated care to hotspot the elderly.
Of course, it’s not as simple as the research above. Confirming my observation would require more investigation. Not to mention that each of these strategies has their own complications. For example, it can be quite expensive to recruit nurses and peripheral professionals to monitor a patient as part of a coordinated care system. (Which, in turn, has sparked its own branch of solution strategies, like using volunteers to ensure compliance with non-medical doctor’s orders.)
The data analysis sometimes associated with hotspotting can also increase costs. (Although, as one physician told Gawande, the corresponding solution to that may be to just ask doctors to identify their worst patients.)
There’s also liability to consider. Joelle Karlik, a friend of mine and a fourth-year medical student at Brown University, supports non-medical elements of coordinated care. However, she pointed out that if a non-certified mentor says a patient shouldn’t worry about a mild fever, and it ends up being a sign of something worse, serious consequences could follow for both the doctor and the center.
A problem as complex as healthcare costs – which could, in turn, mitigate some of the financial crisis – doesn’t have one answer. A journalist’s job is to examine the problem from all angles, in a thoughtful and credible way, and then synthesize the information in a way that makes sense.
Because someone, somewhere, might be able to combine those elements into an elegant solution. Think about Steve Jobs. He didn’t invent the mouse; he took it from Xerox. In fact, most of the pieces that make Apple computers, like the one I’m typing on right now, run so smoothly, Jobs did not invent. But he had the acumen to piece them together.
My last point here: choosing a solution angle to cover is, in no way, an endorsement of that solution (unless you do bad reporting). People often say to me they support Dowser proposing solutions – but that’s not what we’re doing at all. We’re reporting on and investigating what already exists. If I covered an art installation in Soho, would people assume I supported it as the best installation in the world? No need for any other installations, ever! Probably not.
It’s the same with solutions. Isolate a piece and examine it from all angles – including its criticisms – so that society can work on a system that works.
And – goes without saying – this is a piece of how to cover social innovation effectively. Start small and build, people.
Solution Journalism Roundup.
Some good examples of Solution Journalism that emerged over the last couple weeks.