Expertise beyond the silo in areas of public interest

There’s some interesting discussion going on in the LinkedIn Dundee IHP-HELP UNESCO Centre Group just now.
The Dundee UNESCO Centre is concerned with professional fields such as water law, and some of us have been discussing the role of the ‘Expert’ in bringing this critical issue more into the public eye.

'Judgement extremism'?

The New York Times / International Herald Tribune has today (30 July 2010) carried an article entitled entitled ‘Greece and the power of negative thinking‘. Taking as an example the often-stated view that Greece is at the epicentre of the current European economic crisis, the authors, Thierry Malleret and Olivier Oullier, argue that ‘Neuroscience has much to teach us about ‘judgement extremism’ and our economic outlook’.

Overstatement usually pays off
In the view of these authors, ‘judgment extremism’ pays dividends. They note that:

“The neural system used when anticipating rewards is active long before the one in charge of evaluating risks and losses. Most academics and opinion-makers know that the rate of return on postulating extreme outcomes is far greater than that of simply establishing facts: A columnist is much better off predicting a dire outcome than being caught up with the facts that lead to a complex and uncertain one.

“Therefore, an outlandish prediction (albeit, perhaps, inadequately grounded) of a euro zone implosion is likely to be rewarded by editorial success and intellectual kudos; and by the time it may be proven wrong, it might well go unnoticed.”

Joining the dots
Further, Malleret and Oullier suggest, the increasing specialization of expertise means that people often think only within their own ‘silos’, rather than across the spectrum of the situation as a whole – with the outcome that, for instance, they see only the economic and not the political situation:

“… before May 2, when the Greek authorities finally signed an agreement with the European Union and the International Monetary Fund, the markets became convinced that a Greek default was both imminent and inevitable by refusing to consider that the political imperative would trump the economic reality. Put simply, they did not connect the dots between politics and economics.”

Nuance is out?
The suggestion here is that ‘it depends‘ is rarely a response which grabs the headlines or fires the imagination – the immediate rewards for commentators of a dramatic judgement (e.g. that Greece will fail, taking the Euro zone with it) usually outweigh alternative nuanced responses which incorporate more aspects of the situation and probably reflect overall realities more accurately.

But if the big picture lacks nuance, how can we really understand it?
How can careful analysis and insight be rewarded, to accommodate a subtlety which offers potential for resolution of complex scenarios and avoids the possible perils of dramatic silo thinking?

The professor and the policeman: what went wrong?

The ‘Gatesgate’ report (Missed Opportunities: Shared Responsibilities, 15 June 2010) is finally out.

The USA City of Cambridge, Mass. has produced 64 pages of commentary on the investigation of a suspected break-in at a professor’s home, when the home-owner ended up himself being arrested.

$100,000 and a year down the line, we now learn that it should have been possible to avoid the incident in which the black Harvard professor of African-American studies, Henry Louis Gates, was arrested in Prof Gates’ own home on 16 July 2009 by police sergeant James Crowley.

All these two men would have had to do, was talk to each other more in a more mutually civil way at the onset of the incident. The report identifies ‘….. missed opportunities to lower the temperature of their encounter and communicate clearly with each other, and the results were unfortunate for all concerned. They [therefore] share responsibility for the outcome.’

Not ‘profiling’, just personal
The personal stakes for the two men were high – presumably, being accused of no arrest of a suspect when there should have been one, or alternatively failing to challenge racism when one’s professional reputation is partly centred on this subject – but these stakes could have been managed if civility had been maintained.

So it seems there wasn’t really much basis on this occasion for the conflicting claims about police racial profiling. It might all have ended more quickly with a shared chat in Prof Gates’ garden, not over a beer on President Barack Obama’s patio.

Edgy individuals but perennial issues
But – and it’s a big but – people often do get edgy in difficult situations (as a black person at unfair risk of arrest, or as a law enforcement officer concerned about burglars); and the media love these sorts of stories.

To its credit, the City of Cambridge in its report on this incident addresses perennially challenging issues around community policing. The wider general question however remains for us all to consider: how can common sense prevail when sensitivities are acute?

What sort of advice or protocol, we might wonder, can help opposing parties to have the thoughtful exchange of views first, when the potential for being accused later of inappropriate inaction is so high?

Vaccination: Understand at individual level, debate at group level…

Sir Leszek Borysiewicz, chief executive of the Medical Research Council, is reported in The Times (10 June 2010) as saying doctors and nurses must take greater responsibility both for educating the public about vaccine benefits and for exploring any objections. In his view public health strategists rely too heavily when responding to concerns on ‘big sign solutions’ such as comprehensive studies and analyses.

“We need to train a whole cadre of health professionals to be able to address at an individual level people’s concerns and fears …. It’s about getting to that point where you are asking: ‘What is it that you are really worried about? Let me try to understand where you are coming from as an individual’…. For most people it goes back to the primeval: ‘Well my mother had measles, I had measles, so why do I need to take the risk [of vaccinating my child]?’ What they are really saying is, ‘Can I live with myself if something went wrong?’ ”

Indeed – though one might also ponder here whether sometimes people simply seek a rationale to avoid the unpleasantness of having the jab?

And the messages are mixed even amongst those professionals who we expected understand the arguments. Apparently in the winter of 2009/10 around 40% of midwives advised pregnant women (known to be at high risk if not immunised) against having the swine flu vaccine; and – incredibly? – fewer than 1 in 7 front-line NHS staff themselves have the seasonal flu vaccine.

Prof Borysiewicz said that medicine had been caught flatfooted repeatedly by a failure to prepare for opposition to vaccination, from swine flu and MMR now, back as far as smallpox in the 1860s.

“With every vaccine story we go through, we act as if we are surprised that somebody is actually opposed to it….. You don’t address [concerns] by trying to rubbish the people who are coming up with these views. You have to try to understand them at an individual level and then be prepared to debate them at a wider group level.”

So here’s a compelling case for the million small conversations. Who then will the proposed ‘cadre of health professionals able to address at an individual level people’s concerns and fears’ be?
And how / by whom will they be trained, in what contexts and in what specific skills?

The importance of 'tiny, apparently meaningless' conversations

What follows is a commentary by The Guardian Society Daily blog editor, Patrick Butler (to whom thanks) on The importance of tiny conversations

Sometimes it’s tiny, apparently meaningless conversations and formalities that matter when it comes to forming an opinion about whether a public service is “good” or not. Sometimes it’s not the words but the tone and the manner in which they are delivered that tells you something profound about the nature of your relationship with the service you are using, particularly if it is a ‘care’ service.

So even if it’s a good, efficient service, you might go away nursing ambivalent feelings about your overall experience. A relative of mine, in his 80s, who recently had to spend two days in hospital came away incensed by the way the nurses referred to him by his first name, rather than the “Mister + surname” formula. He was sure they thought they were being breezily cheerful: to him it felt disrespectful and patronising, as though they were treating him as a helpless child.

Here’s a couple of other examples of “tiny conversations” that I’ve come across online recently.

First, a typically thoughtful reflection [on Ethnic Origin ] from social worker blogger Fighting Monsters describing one such “little conversation” during a recent hospital visit. And second, this posting on the excellent Patient Opinion website, from a hospital patient utterly dismayed and confused by the assumptions of a doctor at North Durham University hospital. I’ll reprint it in full:

“I was admitted to hospital with sickness, dizziness and low blood pressure.
I was examined and put on the medical admission ward. I was put on a drip and antibiotics for a few days. I was seen by a few doctors whom I felt none explained to me what could be wrong with me as I was very poorly.
Then a doctor came to me and said, “I have read your file and realised that you are gay and so I have arranged for you to have a HIV test tomorrow.”
I was deeply offended about this as she did not even ask anything about me or my very long-term partner of 22 years and consequent marriage.
Before I had a chance to say anything further to her, she walked away and so I ask three different nurses to ask her to come and see me again but she never did. I think this is outrageous and unfair.
Does anyone know whom I can make a formal complaint to?”

Now, that’s one side of the story, obviously, and the hospital hasn’t yet responded to the post (and that’s the beauty of Patient Opinion and web 2.0, that the hospital can not only be held accountable but can fulfil its duty of accountability, personally and in public, and in more-or-less real time). But you can see why the patient is angry.

By the way, it’s well worth a trawl through the posts on Patient Opinion: it’s not, as some may fear, a whingers’ charter, but full of accounts of good experiences. A not uncommon sentiment is:

“I can’t praise the staff highly enough.”

These are all real-life small conversations, assisted as Patrick Butler says by the latest in web technology.

What can we learn from these conversations, and how can they best become part of the move towards bigger sustainable change?