An Unhappy Healthcare System

November 19, 2019 By David Griesing Leave a Comment

It came as no surprise.

After writing about the growing challenges and responsibilities facing medical professionals and patients last week, I happened upon two posts about the burnout rates for the professionals who are charged with promoting health and healing in the rest of us.

The first was a PBS Newshour segment about the extent of the problem and, more recently, some possible cures. It cited studies from recent years that doctors commit suicide at twice the rate of the general population, that 86 percent of the nurses at one hospital met the criteria for burnout syndrome, that 22 percent had symptoms for post-traumatic stress disorder, and that the PTSD numbers for critical care nurses were comparable to those of war veterans returning from Afghanistan and Iraq. The reporter described what is happening as “a public health crisis.” In a small ray of hope, providers have also begun to create outlets—like arts programs—so healthcare workers can “process some of the trauma” they are experiencing on a daily basis and begin to recover.

The second post, in Fast Company, discussed the most stressful jobs that are being done by women today, including the category “nurses, psychiatric healthcare provides and home health aides.” It noted that registered nurses are 14-16% more likely to have poor cardiovascular health than the rest of the workforce, “a surprising result” because the job is so physically active and nurses are more knowledgeable about the risk factors for cardiovascular disease than the workforce in general.

Several of you who work in the health care industry wrote to me this week about your experiences at work, which (sadly) mirror these discouraging reports.

The other follow-up development relates to the data that is being gathered from patients by the health care industry. Earlier this week, the Wall Street Journal reported hat Google had struck “a secret deal” with Ascension, one of the nation’s largest hospital systems, to gather and analyze patient data including lab results, doctor diagnoses and hospital records. Called Project Nightingale by Google and “Project Nightmare” by others, the data extraction and analysis “amounts to a complete health history, including patient names and dates of birth.” Having all of our medical information instantly available for analysis in one place is clearly a game changer.

The first alarm bells sounded about Project Nightingale involved the privacy of patient data. (Indeed, the day after its initial report, the Journal reported that the government had launched an investigation into Google’s medical data gathering on the basis of these concerns.) Among the privacy-related questions: will access to a patient’s data be restricted to practitioners who are involved in improving that patient’s outcomes? If this data can be used by others, how will it be used and how is the hospital system ensuring that those uses are consistent with that provider’s privacy policies? The governing statute, the Health Insurance Portability and Accountability Act of 1996, provides only the loosest of restrictions today. (Hospitals can share data with business partners without telling patients as long as the information is used “only to help the covered entity carry out its health care functions.”)

On the positive side, the aggregation of patient data can facilitate more accurate diagnoses and more effective patient treatment.

Google in this case is using the data in part to design new software, underpinned by advanced artificial intelligence and machine learning that zeroes in on individual patients to suggest changes to their care.

More troubling, given Medicine’s continued drift from “profession” to “business,” is how providers can realize more profits from their patients by prescribing more medications, tests and procedures. How can patients distinguish between what they truly need to promote their healing and what is profit-making by the health care provider? As the Journal story also reports:

Ascension, the second-largest health system in the U.S., aims in part to improve patient care. It also hopes to mine data to identify additional tests that could be necessary or other ways in which the system could generate more revenue from patients, documents show.

How will patients be protected from unnecessary interventions and expense, or, unlike today, be enabled by industry reporting about medical outcomes to protect themselves? As I argued last week, the ethical responsibilities for everyone in healthcare–including for patients–are shifting in real time.

Earlier this year, I posted (here, here and here) on a similar Google initiative regarding smart cities. In places like Toronto, the company is helping government to gather and “crunch” data that will allow their cities to operate “smarter” and provide greater benefits for their citizens from the efficiencies that are achieved. As with Project Nightingale, there are privacy concerns that Google is attempting to address. But there are also key differences between this tech giant’s plans for monetizing citizen data in smart cities and its plans for monetizing patient data in the medical system.

In healthcare, your most personal information is being taken and used. This data is far more vital to your personal integrity and survival than information about your local traffic patterns or energy usage.

Moreover, in smart cities there are governments and long-established regulatory bodies that can channel citizen concerns back to government and its tech consultants, like Google. Because these interfaces are largely absent in health care, monitoring and enforcement is up to individual patients or hospital-sponsored patients’ rights committees. In other words, if you (as a patient) aren’t “watching the store,” almost no one will be doing so on your behalf.

To this sort of concern, Google responds both early and often, “Trust us. We’ve got your interests at heart,” but there are many reasons to be skeptical. Another Fast Company article that was posted yesterday documented (with a series of links) some of Google’s recent history mishandling user data.

Google has gotten in trouble with European lawmakers for failing to disclose how it collects data and U.S. regulators for sucking up information on children and then advertising to them. The company has exposed the data of some 52 million users thanks to a bug in its Google+ API, a platform that has been shutdown. Even in the field of health, it has already made missteps. In 2017, the U.K.’s Information Commissioner’s Office found the way patient data was shared between the Royal Free Hospital of London and [Google affiliate] DeepMind for a health project to be unlawful. The app involved…has since controversially been moved under the Google Health umbrella. More recently, a lawsuit accused Google, the University of Chicago Medical Center, and the University of Chicago of gross misconduct in handling patient records.

Much of moving forward here depends on trust.

Will health care providers, that suddenly have the profit-making potential of big data, protect us as patients or see us only as revenue generators?

Can these providers “master the learning curve” quickly enough to prevent sophisticated consultants like Google from exploiting us, or will the fox effectively be running the chicken coop going forward?

What will Google and the other data-gatherers do to recover trust that seems to be damaged almost daily wherever their revenues depend upon selling our data to advertisers and others who want to influence us?

Is Google’s business model simply incompatible with the business model that is evolving today in health care?

As the future of medicine gets debated, we all have a say in the matter.

This post was adapted from my November 17, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

The Next Crisis Will Be a Terrible Thing to Waste

September 30, 2019 By David Griesing Leave a Comment

(photo by Markus Spiske temporausch.com @pixels)

We are moving into less settled times both here and in the rest of the world. Several different storms are gathering along the waterfront today:

– in politics, with gridlock both breaking down and intensifying over impeachment and the future course for America, in the UK over its relationship with the rest of Europe and what it wants for itself, in the battles between populists and traditionalists elsewhere;

– in economics, with weakening global prosperity and the likelihood of a financial pullback that will affect almost all of us as the fundamentals weaken;

– in the environment, with increasing alarm over the current effects of global warming, the longer-term outlook for the health of the planet, and state actors’ halting efforts to respond to the challenge;

– in the world order, with a rising China, a demoralized and divided West, and a handful of nations around the edges that are both willing and able to take advantage of the uncertainty; and

– in the prevailing spirit, perhaps the most impressionistic of these storms but potentially the most powerful, as pessimism, alarm, hysteria, backlash and hostility get reduced into urgency in their boiling cauldron—a drive to do something, anything to move off the dime.

The silver lining is that chaos, confusion and uncertainty also provide opportunities. When you’re clear about the priorities behind your work, your chances to advance them are always greatest when the storms finally break as long as you’re ready to rebuild the storm-tossed world in the ways that you want. Now is the time for getting ready, because the chances to address our most pressing problems–and the rewards for us and others that can flow from that–may never be greater.

When the work we do helps us realize our priorities, it becomes more purposeful and satisfying.  As I argued here last week, in many of our jobs it is both possible and desirable to align our priorities with that job’s broader objectives. Improved health. Greater fairness. A more sustainable way to live.

In other words, it’s tying what you want yourself to almost every job’s higher purposes. Not only does the alignment reduce friction between you and those impacted by your work, it can also produce an esprit de corps with your bosses, co-workers, customers, suppliers and members of the broader community as they support your efforts. You’re experiencing the shared benefits of a productive community while taking home both the pride and satisfaction that comes with it.

Of course, another essential of “good work” is its future focus: anticipating circumstances that might enable you to take bigger-than-usual strides towards realizing common priorities. It is being aware of the obstacles and opportunities today so you are ready to act when the storms break and the lay-of-the-land shifts, weakening those obstacles and providing those with a vision of the future a path for realizing it. That’s because everyone who has weathered the storm wants to put the pieces back together and is unusually receptive to putting it all back together in some better way.

Realizing your particular work ethic in times of crisis has almost nothing to do with luck but everything to do with your mindset and plans. It’s having a vision of the better future that you want, keeping your eye on that goal line as the game degenerates into chaos, and, when everyone is finally able to listen, inviting your fellow survivors to help in rebuilding something that you’re convinced will be more durable and sustainable than all of you had before. At such times, aligning your personal priorities with a higher, common purpose will not only be satisfying for you, it can also make changes that seem impossible today, possible tomorrow.

My priorities (in search of this broader resonance) would include the following:

Thriving workers, families and communities.  Most of us have jobs as citizens of democratic countries with capitalist economies. We regularly make our preferences known by choosing leaders who share our priorities. As citizens during unsettled times, what kinds of change would we support and priorities would we pursue?

In large part because “thriving workers” are the foundation for other kinds of positive change (such as reducing income inequality, gaining affordable health-care and safeguarding the environment in our communities), I’ll be looking for leaders with the courage to say they are foregoing other “hot button” reforms to invest in retraining today’s workforce for a more automated world; to support trade buffers so that workers here don’t lose their jobs to cheap foreign labor when they’re compensated more fairly or work under safer conditions; and to support new public policies like bolstering the economic security of low-wage workers by supplementing their incomes through payroll deposits, thereby encouraging their continued work and improving their chances to start building wealth for their families and communities.

We don’t hear politicians making hard choices between costly alternatives.  Or willing to make the engines of capitalism more democratically-driven by ensuring that working men and women have a larger seat at the table with business owners. In the wake of the economic storm that’s coming, there will be many citizen-driven opportunities to support leaders who are eager to rebuild the future on the backs of thriving workers, while admitting that to realize that goal means putting many other goals on a back burner. It should also be a bi-partisan issue. As citizens, our focus and support can help them to accomplish this one important thing as the political process bottoms out and it struggles to identify new, common goals.

Environmental stewardship. As Alain de Botton argues persuasively (and often amusingly) in The Pleasures & Sorrows of Work it can be difficult to understand the wide-ranging impacts of your paying job given the global supply chains that feed it and the distribution networks that bring your “goods or services” to consumers. Difficult yes, but hardly impossible.  Among many other things, De Botton invites us to learn more about the consequences of our work, both for better and for worse. I’d argue that when we do, we’ll be able to see “how we can work better in the future” in a common light that includes “greater environmental stewardship.”

Is the product I’m selling or helping to sell, is the service I’m providing and the ways I’m providing it, improving the health of the planet or reducing it? Raising consciousness in the workplace about an issue like environmental stewardship provides opportunities for alignment with others–including bosses and even owners—who may share your concerns. The accelerating storm of today’s climate debate and the quest to find our way out of it will likely present many opportunities to change business practices (and even nudge them in groundbreaking directions) where we work.

Righting the balance between people and profits. Connecting your paid work to its wider-world impacts is not just limited to environmental stewardship. As global economies get roiled and we begin to look beyond these upheavals, we can be thinking now about how our jobs can provide greater benefits to us and our communities and not simply about how we can assist business owners in becoming profitable again. To ensure that you and I are not merely helping to restore the profit-dominated status quo after the next recession, we could be learning now how to connect our labor to “more of its fruits” than higher corporate dividends.

As I argued last March, administrators of a global education test are using that test to assess independent thinking, collaborative problem-solving and building better communities. On the theory that we “treasure what we measure,” students globally are now building these aptitudes in their classrooms because they will ultimately be tested on them.

By the same token, employers could assess (and reward) their employees–and be assessed themselves–for “aptitudes” beyond profit-making, including their success at tying company productivity to greater community benefits. For example, workers could push their companies to retain them (even with reduced hours) instead of firing them during economic downturns because policies like this maintain stable communities, or to take less profit from a product or service if it will keep a job here instead of losing it to a foreign worker. Moreover, employees who can demonstrate that they have strengthened the company-community bond would be rewarded for doing so.

The groundswell for this broader focus needs to come from forward-looking employees as well as executives and owners, and the time to be thinking about more community-oriented work assessments and broader exercises of corporate responsibility is now.

After we’ve weathered the next downturn, are looking for better ways forward and desiring greater corporate accountability for common problems—that’s when you can stand up with your new way to determine economic success.

That’s when you can argue that what’s good for the company needs to be good for the community too, and that the economic fallout might be reduced next time if the broader community were part of the equation from the start.

That’s when you can gain even more pride and satisfaction than is usually available when you help to solve common, work-related problems, because now you’re helping to humanize the foundations of democratic capitialism itself.

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We are far enough today from the economic recession that began in 2008 to gain at least a measure of historical perspective. Two new books are arguing that Barrack Obama was so eager to restore economic stability and the health of the American banking industry that he failed to “use” this crisis (as FDR had used the Depression) to seek fundamental—and to these authors—necessary changes to the country’s economic policies.

For example, in the course of re-building America’s way out of the last recession, they observe that Obama (like Clinton before him) never challenged the economic imbalance between the corporations and ordinary working people that had been a hallmark of the Democratic Party from the 1930s through the 1980s. When it came to punishing wrongdoing, Obama refused to insist that the bankers who had profited from the bubble they had created in the housing market be held accountable. When it came to economic initiatives like the Affordable Care Act, he favored market solutions over government policies and direct interventions (unlike the alphabet soup of initiatives during the Thirties or The Great Society programs of the Sixties).

According to Reed Hundt’s Crisis Wasted (out last April) and Matt Stoller’s Goliath: The 100 Year War Between Monopoly Power and Democracy (coming in mid-October), Obama sought to preserve the pro-business status quo rather than rectify the economic imbalance that disadvantaged workers, families and communities while benefiting the American business owners who held (and continue to hold) a disproportionate share of the country’s wealth.

I agree with them that a crisis is a terrible thing to waste, and that the last one was a string of opportunities neither taken nor pursued. None of us should be willing to waste the next one.

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I’m defining a “crisis” here as a ground-deep unsettling of prior certainties. A political/economic/environmental/moral crisis tends to prove that “the ways we used to do it” are no longer working and, for a brief window of attention and opportunity, regular people are willing to explore (and even support) both different and better ways forward. It’s why from the perspective of our work, we need to be ready with arguments, data, plans, hope and visions for the better world that each of us wants when that window finally opens.

We don’t need to agree on the changes. (The bold-faced objectives above just happen to be some of mine). But I’d argue that all of us need to be active parts of the conversation, even when it’s full of anxiety and has a fevered pitch. Because it’s when your work really can “change the world” and when the personal satisfactions and sense of purpose that come with it can be similarly transformative.

In 2016, a group of forward thinkers who were clustered around the University of Sussex in the UK created educational materials for anyone who is interested in seizing the opportunities of a world in flux. Those materials begin with powerful examples from history where:

– radical changes occurred in disruptive times that would not have been possible otherwise;

– to nearly everyone’s surprise, immediate changes were accepted by the public fairly rapidly; and

– longer-term improvements followed, with some expected and others exceeding expectations.

The Sussex materials also describe how, in a host of practical ways, change-agents can capitalize on the opportunities crisis presents and maintain forward momentum.

There is a broader discussion of their approach and a link to additional materials here. If you’re interested in readying yourself to take full advantage of the opportunities after our gathering storms break and the re-building begins, I think you’ll find their approach empowering.

Our work can always be aligned with deep motivations and high purposes, but the rewards are never more satisfying than when you’re helping to build a better world out of one that may be ending.

This post was adapted from my September 29, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Making Our Jobs as Big (or as Small) as Possible

September 24, 2019 By David Griesing Leave a Comment

We bring our priorities into our work–making it more purposeful and satisfying–by using our capabilities more deliberately and by demonstrating our values when we do our jobs.

Our basic “capabilities” include our personal autonomy (or the drive to realize our gifts) and our generosity (or encouraging the autonomy of others who are touched by our work, from co-workers to bosses, customers, suppliers and the broader community that supports our efforts).

Our “values” are moral intuitions (or feelings) that frame our experiences and help us decide how we should respond to them. Examples include freedom, fairness, equality, personal security, an ordered life or the sanctity of living things. For each one of us, some values more than others provide quick, intuitive signals that guide us as we try to figure out how to interact with the world around us.

Work is more satisfying when it engages our capabilities and serves our values, because they are among our most basic priorities.

When talking about these ideas, people often ask me: “On a practical level, how do I align my priorities with the work that I do everyday?” It’s often followed by a second question: “What if my employer’s priorities are different from mine—won’t this put us at odds with one another?” My quick answers are as follows.

Alignment of personal priorities with job priorities usually comes down to your mindset: how you see yourself in that job. Is it doing the bare minimum, “staying within your lines” and keeping your eye on the clock so you can leave for home after you’ve put in your time OR do you pour yourself into that job, finding opportunities for your priorities either within or right along side the priorities of whomever you’re working for? In other words, how hard are you trying to find more satisfaction in every job that you do?

Sometimes these alignments are nearly impossible, as in my recent post about gig-economy workers at Uber and Amazon. At each of these companies, the capabilities of their ride-hailing and delivery drivers are being exploited instead of respected. Uber’s and similar companies’ business models depend on offloading as much risk and cost onto their workers as possible. These workers’ recourse? They have to look to governments (like California’s) to safeguard their basic priorities on the job, leave those jobs altogether, or tamp down these basic drives because their economic necessities override the personal costs.

On the other hand, in many jobs it is both possible and desirable to align your priorities with those of your employers and others who benefit from your work. It is what organizational psychologists have called “job-crafting.” When you bring a suitable mindset to your job—when you ask, “how much instead of how little can I make out of it?”—many jobs become opportunities to build more satisfaction, and even fulfillment, into your hours spent working.

After elaborating on job-crafting and my own take on it, I’ll share some fateful testimony from two practitioners of “this highly practical art” from an interview I overheard while on the road earlier this week.

The Opportunity to Job-Craft More Rewards Into Your Work

Amy Wrzesniewski, a psychologist at Yale’s School of Management was talking about job crafting on a terrific podcast called Hidden Brain this week. I hadn’t heard this episode, but a regular reader wrote me about it (thanks Joe!) and listening reminded me of how long so-called industrial psychologists (who study our behaviors and expectations around work) have been tinkering with the boundaries of our jobs and the perceptions we bring into them.

Take (as Wrzesniewski did) a janitorial job cleaning a hospital. Let’s also assume two different men filling that job: I’ll call them J and B. Both were hired to show up at regular times and keep the floors and available surfaces in their parts of the hospital clean. With the tools and working hours available, they can clean everything they’re responsible for in their 5-day workweeks. The following Monday, J and B each start the same circuit over again.

Let’s assume that J always does what’s expected of him without complaint, but rarely does more than is required. Viewing his job as a paycheck, he’s hardly fulfilled by it. Instead of satisfaction at the end of a workday, he’s more likely to feel a tinge of resentment, that it’s beneath him to clean up after other people, but he needs the income so he puts up with the indignity and has done so for twenty years. J rarely interacts with the hospital staff or patients, although he understands that keeping the place clean contributes to the overall mission of the hospital, which is to help people to stay alive and hopefully get well.

B couldn’t see his job more differently. Feeling that he’s part of a team improving patient outcomes, B regularly makes a point to give a cheerful word to patients he’s noticed have few visitors, will go the extra mile to clean parts of his area that no one else seems to be getting to, and gives staff members he’s known for much of his working life words of encouragement when he senses that they’re feeling down. Unlike J, B connects his job to something bigger than himself—promoting the health of everyone who is around him everyday—and goes home with both satisfaction and pride that he’s contributed to the hospital’s mission along with a paycheck from it.

B accomplished this by “job-crafting” the way he sees his work and the importance of it in the broader scheme of things. From my perspective on work, he has also engaged both his capabilities and his values when it comes to service and community in order to gain additional rewards from it. As podcast host Shankar Vedantum put it, there are people who quit their jobs when they win the lottery and others who still want to work. B might keep working because the rewards he brings home aren’t just monetary ones.

After 25 years of studies in the psychology journals—from scholars like Arnold Bakker, Maria Tims and Justin Berg as well as Wrzesniewski—there seem to be three different approaches that workers take when “crafting their jobs.” Sometimes they rearrange how they characterize their job responsibilities, emphasizing certain aspects over others. Is a chef simply cooking a meal that her customers will keep paying for or is it far more important to her that she’s creating plates that are pleasing to the eye and producing delightful experiences for friends who keep coming back? One is a successful economic exchange while the others are more than just that.

A second approach focuses not on the end product but the interactions that help to produce it along the way. Instead of B deriving meaning from making the floors shine, he finds it in those interactions with patients, visitors and staff along the way.

The last approach is how you see yourself on the job. J would say, “I am a janitor” or define himself apart from this job altogether if asked “what do you do?” B on the other hand might say proudly, “I am an ambassador for the university health system, creating an environment that promotes the healing process,” and really mean it.

In a post from last February, I made an argument that uses terminology from economics and ethics instead of psychology to try and prove a similar point. When you take responsibility for your job satisfaction and don’t expect somebody else to provide it, you act like a stakeholder instead of an employee. Because job satisfaction is important to you, you collaborate to solve work-related problems that involve everyone (co-workers, suppliers etc.) and everything (like the communities and environments) that your work impacts. The compensations that follow are always more than the paycheck attached to your job description, because you’re consistently investing your effort into yielding a more satisfying job experience by addressing what’s important to you and to others.

I’m Bringing You More Than Tomorrow’s Weather

In a week that was dominated by students demanding that older generations take bolder steps to ensure that they have a livable planet in their future, it’s worth noting that most people still fail to recognize that rapid global warming is one of the most important problems confronting them. Until a proper majority engages with this problem politically, policy makers will simply avoid taking the necessary actions. Perhaps no American workers see the need to engage more of the public—while also having the ability to engage people effectively–than the men and women who bring tomorrow’s weather to millions of people who have little scientific background or knowledge in their communities.

When I overheard on the radio a conversation with two meteorologists a couple of days ago, it was clear that these weather reporters (along with increasing numbers of their colleagues) are engaging the public on the imperatives of climate change by grounding their daily reports or 5-day forecasts in statistical evidence that goes back (or extends forward) 20 or even 100 years where they and their viewers live.

They might ask: how many unusually hot days did we use to have in July or unusually destructive storms in September, and how many are we having now–before providing the relevant numbers. These men and women are accustomed to explaining climate-related information to non-scientists—so they’ve already developed more skills and gained more trust than perhaps anyone, in any other line of work, when it comes to placing the recent developments involving weather and climate in a meaningful, scientific context. Moreover, by sticking to hard data and avoiding political “calls to arms,” they are building audience knowledge and engagement while maintaining their impartiality.

When these meteorologists make the deliberate effort to locate today’s weather in a much larger story (instead of just sticking with whether their listeners need to bring umbrellas to work tomorrow), they are “job crafting” or “taking responsibility for common, work-related problems” far beyond the media contracts that they’ve negotiated. In other words, they could easily “get by with less” but refuse to do so. Both interviewees made clear how much providing a broader context for their weather reports was enhancing their job satisfaction. It was also clear how much of an impact they and a growing number of their colleagues are having when they engage the public with a problem that has long been too difficult for most non-scientists to understand.

Mike Nelson, the chief meteorologist at ABC 7 in Denver, and Amber Sullins, in the same role at ABC 15 in Phoenix, both see themselves as providing this bridge. Each realized that they needed to locate their weather reports in a climate-change context when they were confronted with new generations (Sullins having a daughter and Nelson a grand child). Nelson explained that even with only a few minutes on air, telling a broader or deeper story than tomorrow’s weather “is not as difficult as you might think.” If he knows in advance that his producer has a story about the fire season or current drought, he can work in an “explainer” about the 2-degree increase in temperatures in Rocky Mountain National Park over the past century or how ,at this rate of increase, the “climate in Denver in the next 50 to 70 years will be more like Albuquerque, New Mexico.” Sullin does much the same for her viewers when she explains the 115 degree day today by noting that prior to 1960, there were only 7 days this hot every 20 years, while in the current 20-year period, there have been 42 of them. They’re providing viewers with some relevant facts and leaving it to them to figure out what to do about the picture they paint.

Nelson says there is occasional blowback even though he sticks “to physical science instead of political science.” But he adds that for every complaint or attempt “to bully him,” there are 20 audience members expressing their gratitude. Since people are inviting him into their living rooms, he feels it’s “his responsibility” to tell them the whole story. Sullins also feels she is building an additional level of trust with her audience, explaining how the positive feedback she gets from emails and Facebook posts are continuing and broadening the conversation. As viewer’s grapple with the issues, she sees “more wheels spinning in their heads” and their pursuit of even more information. Both Nelson and Sullins are actively working with new meteorologists too so they can learn how to provide this broader context in their weather reports and avoid having their new careers derailed by a political backlash. More than “weather reporters,” Nelson and Sullin see themselves as “educators” of both their audiences and their younger colleagues.

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In a post of mine last May called “How to Engage Hearts and Change Minds in the Global Warming Debate,” much of the answer seemed to depend on how much those hearts and minds trusted the messenger who brought them the information. According to one poll I cited, that need for trust comes from the fact that only 60% of Americans think that global warming will affect the US, only 40% believe that it will affect them personally and 2/3rds never talk with anyone else about what lies ahead. Addressing climate change is still not on most people’s list of priorities, but letting trusted people “in their living rooms” to talk about it could change that.

As long as a group trusts you enough to ‘give you the floor and listen to what you have to say,’ you’ll likely engage them in your argument when it’s grounded in your values, demonstrates your care about where the group is headed, and provides a glimpse of a better future for all of you if you succeed in persuading them.

Meteorologists are “job crafting” their weather reporting and “taking responsibility” for educating their viewers who have found “what’s at stake” and “what can be done about it” difficult to understand until now. They are bringing their already trusted voices to a broader definition of their current jobs because it’s filling them with pride and they know that by doing so they could be making all the difference in the world.

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Notes: I just started publishing some of my weekly posts on Medium, an on-line opinion network, and my recent post on Uber drivers and Amazon packages was featured by its Business and Economy editors this week. Stories on Medium are usually available behind a paywall, but it you want to see my post or check out the site, here is a link that will get you there for free. (Of course, it would be much appreciated if you give it a quick read and check out the new pictures when you visit!)

This post was adapted from my September 22, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

We Find Where We Stand in the Space Between Differing Perspectives

September 16, 2019 By David Griesing 1 Comment

When you hear an argument on Tuesday and its opposing argument on Thursday, it’s always a challenge to arrange a further date where you can line them up at opposite sides of the room while you sit in the middle to figure out what you think and feel about the issue. Rescheduling your attention like this always seems to get lost in the shuffle.

On the other hand, the opportunity to listen, process and react almost immediately to opposing points of view is what can make live debate and virtual encounters with discordant perspectives both clarifying and satisfying.

They may also be ways to move beyond the polarizing shouting matches that characterize much of American democracy today.

When an issue “gets joined” you can figure out where you stand either on the spot or while continuing the conversation with yourself and others immediately thereafter. All you have to do is build this new information and its subtleties into your own perspective once you’ve had the chance to sleep on it.

When it comes to processlng opposing views, time compression seems critical. Being part of a live audience interacting with live “actors” or encountering real people in a virtual world is too. Another factor is your decision “to make yourself available to their persuasion” by the physical act of showing up, something you rarely do when you’re watching people testify on the other side of a screen. On each of these “live” or “almost alive” occasions, you’ve chosen to immerse yourself in a world of different perspectives where you’re open to changing your mind.

A final factor is also critical. Theater that is built on counterpoint stories and virtual worlds that make us confront our own preconceptions are jarring experiences. Both demand that your thoughts and feelings connect across a broader waterfront than you recognized before. They challenge moral certainties and provide building blocks you can use immediately to construct a more nuanced point of view. Their wake-up calls can often make you behave differently too—impacting the jobs you do as community members or citizens. They offer highy engaging ways to figure out where you stand and what to do next.

All of these dynamics were apparent in a recent theater production in Portland Oregon, where actors playing members of the community and its local police force held the stage in front of an audience from that same community, told their distinctive stories and changed some minds.

Similar changes in perception became evident when people put on the virtual reality (VR) headsets that were recently developed by a California company. VR technology can take you places and put you among people you may think you know about until you are literally walking among them at Rikers Island prison, on the US-Mexico border, or in a Syrian refugee camp.

What used to seem black and white and came cloaked in moral certainties can be shaken into reconsideration by these “live” or “virtually alive” experiences. Abstraction and over-simplification are no longer quite as possible when issues that we thought we understood have faces. Once we’ve learned more and have the experience to know better, we may no longer wish to view ourselves (or be viewed by others) as being so cold in our certainties or so removed from the blood, sweat and tears of most people’s lives.

Do these kinds of experiences offer a way to move past the knee-jerk polarities that undermine our collective purpose?

Are they vehicles for helping at least some of the undecided and disengaged in this country to make up their minds and help build a future that they want instead of leaving their prospects to others?

Finding Shared Human Perspectives While Looking At and Listening To One Another

The chasms between diverse communities and the police who are charged with protecting them yawn widely across America. In Portland, some creatives in the performing arts and forward-thinkers in law enforcement came together to try and reduce them. Their approach: a stage adaptation of the dueling perspectives, only this time with several rarely heard points of view along the stark divide—including the witness provided by minority police officers who, in more ways than one, have come to embody it.

Much of this story about perspective building in the community, and all but one of the quotes here, come from a PBS NewsHour segment that ran on the same day in August that New York City police officer Daniel Pantaleo was fired for his involvement in subduing Eric Garner, an arrest that ended in Garner’s death.

Kevin Jones and Lesli Mones founded the August Wilson Red Door Project, a theater company, to provide a platform for addressing issues of importance to the City’s African American residents. The other driving force in this story is Robert Day, the former deputy chief of the Portland Police Bureau. Jones and Mones asked him to gather perspectives from policemen who serve in minority neighborhoods like theirs and he pursued their invitation with relish.

What ultimately came together in one performance were a series of monologues from two different plays. “Hands Up” was written by African Americans about their experiences being racially profiled by police. “Cop Out” tells the stories of individual police officers when they are wearing their uniforms as well as the lingering effects after they take them off.

Jones and Mones each described the intent behind bringing witnesses from both perspectives onto a single stage. Said Jones:

We’re not dividing the story into two sides, right, the good guys and bad guys. On both sides, we have a group of people who feel that their stories are not being told, that they’re being vilified, that they’re being shunned, that — and nobody wants to really hear their story.

For her part, Mones addressed early criticism she’d heard from the African-American community in an earlier interview with the Portland Mercury:

From a social power perspective, you can’t compare the experiences of the two groups of people. But from a shared human perspective, the feeling of being unseen, depersonalized, and stereotyped is something both groups can relate to. It’s in the DNA of Red Door to honor a multiplicity of viewpoints, because we know it’s imperative in producing a healthy racial ecology for the community.

Four excerpts from the monologues suggest the power of this “shared” and “deeply human” approach.

– Community member: ‘They slammed me to the ground. One of the officers had his foot on the back of my neck. Another officer pointed a gun to the back of my head and said, ‘Move one inch and I will blow your head off.’ Oh, I went into survival mode. I tried to convince them I was one of the good ones.’

` Policeman: ‘I used to think nothing about being a cop would shake me up. But when you arrive on scene and watch your partner pull an infant out of a microwave because his meth head father couldn’t stop the kid from crying, your lens gets colored.’

– [A community member asks everyone in the audience to raise their arms in the air]:

A voice representing the police: ‘Hands up.’

Members of the community: ‘Don’t shoot.’

A voice representing the police: ‘Hands up.’

Members of the community: ‘Don’t shoot.’

-Policewoman: ‘The only reason I carry a gun if for protection, primarily mine, sometimes yours, sometimes, in highly specific circumstances, like an active shooter, or –no, that’s about it.’

The theater company is hoping to take performances of these combined monologues across the country, starting later this year. However, the fundraising and logistical hurdles that need to be surmounted before the show can hit the road are daunting. But no one provides a better reason for persevering than former deputy police chief Day:

We’re touching on sort of the third rail conversations of race and policing. And I think they are conversations that are happening in African-American families in homes and communities, and I know they’re happening in police communities, because I have heard them, been a part of them, I have seen them.

But they’re not happening publicly, and they’re not happening generally across from each other, because of the sort of high-voltage nature of them. So, the theater allows us to put it all out there. We can speak what has been left unsaid.

Only when “it’s all out there” and being processed by the folks in the audience who are most impacted by it can there be any hope of actually “seeing the other,” identifying shared objectives, and pursing them together.

The Issues Are No Longer Vague. They Feel Like Lived Experiences

With VR or virtual reality, the divides aren’t personified on a stage and the processing doesn’t begin when you’re seated in front of it. Everything you need for your views to be jarred into a broader perspective is brought into the perceptual space “between your ears” by this advanced technology.

Emblematic is a VR studio that was founded by Nonny de la Pena and is based in Santa Monica. De la Pena was profiled as one of 2018’s top innovators by the Wall Street Journal, both for developing groundbreaking VR technology that enables you to feel like you’re moving through a real space (instead of just standing in it) and for the rationale behind her inventiveness.

The author of the profile explained her intentions this way:

The idea is to put people in places they wouldn’t normally find themselves, experiencing situations they would not normally experience. Often, these are related to urgent issues, issues that are, in their sprawling complexity, seemingly difficult to grasp or even care about. But suddenly, there you are, standing in a cell in solitary confinement, or at the foot of a melting glacier, or before a protest line outside an abortion clinic. When you are in these places—hearing the anguish of a prisoner, the calving of a glacier, the vitriol of the protesters—the issues no longer seem like issues, with vague names attached, like prison reform or global warming or women’s health. Rather, they seem like lived experience, like people you’ve met and places you’ve been—like memory.

Within Emblematic’s VR headsets, the perspective you’ve brought with you is jarred by the unfamiliar in “real” time and you’re invited to start responding immediately to the flood of new information that’s washing over you. Particularly when you enter environments with other people in them, it feels like you are entering a reality as it’s being lived by someone else, providing unprecedented opportunities for connection and empathy.

Before you put the headset on, you also know where you’re going and have made yourself available to broaden and deepen your point of view. You find a new place to stand in the neurological mindspace between your thoughts and feelings about this issue before and the virtual experience that you’re having now. As long as it’s programmed as an exercise of free will, this technology can help you to make up your mind or intensify your most important commitments.

Unlike the challenges of putting the “Hands Up/Cop Out” show on the road, the financial and logistical challenges for de la Pena and Emblematic are likely making their technology cheap enough and portable enough that it can someday travel on its own to wherever people are undecided or simply want to know more. They (and other monitors) will also need to mind the gap between its use for illuminating an increasingly complex world and simply manipulating our reactions to it.

Sometimes, groundbreaking innovations like de la Pena’s have their roots in childhood, and so it is with the story of how she first learned the value of differing perspectives–even when one of them is hers. The Journal’s profile of her actually begins with it:

When Nonny de la Peña was in junior high, in West Los Angeles, her math teacher wrote a note home to her parents. ‘It was about something I’d rebelliously done,’ she says. ‘It was something minor, like speaking up, or speaking too loudly.’ Her father read the note, then turned the paper over and looked at her. ‘This is what she says you do, he said to me,’ de la Peña recalls. ‘Tell me about her. What does she do?’ De la Peña listed some of her own unflattering observations about the teacher, and her father wrote them down on the back of the note, so that now the piece of paper contained two notes, two different perspectives. Then her father signed it. ‘So what does that make you do? Of course [says de la Pena], it makes you think about the structure of things…. Of how situations are multidimensional.’

Her father knew, and early on it seems that she came to know too, that the truth can usually be found somewhere in the space between perspectives.

+ + +

I’ve written before about the space “where we can make up our reasonable minds” because I’m concerned (and sometimes alarmed) about how our demonizing of those we disagree with has disabled us from building anything of consequence in America today. It also comes from how others’ “not caring enough to have points of view” further undermines “what those who do care enough” hold in common. These sentiments were behind my post on the remarkable public exchange between two academic friends, the left-leaning Cornel West and the right-leaning Robert George, and what we all gain (but seldom enjoy today) from politically charged conversations, as well as another about the clarifying nature of dissent.

These arguments (and the one today) feel personal to me.

When I abandon my reasoned points of view, or don’t bother to come up with them anymore, I cede control of my future and my family’s future to somebody who may know less and care less. As long as I hold this right and it has not been taken away from me by those who want to control my mind, I’d be a fool not to exercise it.

Where I decide to stand and what I decide to do about it in the work I do and the way I live are among the most valuable contributions that I can make to myself and others. As long as it’s mine, I’ll continue to find the space for evolving my perspectives because it’s part of feeling alive.

This post was adapted from my September 15, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

Citizens Will Decide What’s Important in Smart Cities

July 8, 2019 By David Griesing Leave a Comment

The norms that dictate the acceptable use of artificial intelligence in technology are in flux. That’s partly because the AI-enabled, personal data gathering by companies like Google, Facebook and Amazon has caused a spirited debate about the right of privacy that individuals have over their personal information. With your “behavioral” data, the tech giants can target you with specific products, influence your political views, manipulate you into spending more time on their platforms, and weaken the control that you have over your own decision-making.

In most of the debate about the harms of these platforms thus far, our privacy rights have been poorly understood. In fact, our anything-but-clear commitments to the integrity of our personal information have enabled these tech giants to overwhelm our initial, instinctive caution as they seduced us into believing that “free” searches, social networks or next day deliveries might be worth giving them our personal data in return. Moreover, what alternatives did we have to the exchange they were offering?

Where were the privacy-protecting search engines, social networks and on-line shopping hubs?
Moreover, once we got hooked on to these data-sucking platforms, wasn’t it already too late to “put the ketchup back in the bottle” where our private information was concerned? Don’t these companies (and the data brokers that enrich them) already have everything that they need to know about us?

Overwhelmed by the draw of  “free” services from these tech giants, we never bothered to define the scope of the privacy rights that we relinquished when we accepted their “terms of service.”  Now, several years into this brave new world of surveillance and manipulation, many feel that it’s already too late to do anything, and even if it weren’t, we are hardly willing to relinquish the advantages of these platforms when they are unavailable elsewhere.

So is there really “no way out”?

A rising crescendo of voices is gradually finding a way, and they are coming at it from several different directions.

In places like Toronto (London, Helsinki, Chicago and Barcelona) policy makers and citizens alike are defining the norms around personal data privacy at the same time that they’re grappling with the potential fallout of similar data-tracking, analyzing and decision-making technologies in smart-city initiatives.

Our first stop today is to eavesdrop on how these cities are grappling with both the advantages and harms of smart-city technologies, and how we’re all learning—from the host of scenarios they’re considering—why it makes sense to shield our personal data from those who seek to profit from it. The rising debate around smart-city initiatives is giving us new perspectives on how surveillance-based technologies are likely to impact our daily lives and work. As the risks to our privacy are played out in new, easy-to-imagine contexts, more of us will become more willing to protect our personal information from those who could turn it against us in the future.

How and why norms change (and even explode) during civic conversations like this is a topic that Cass Sunstein explores in his new book How Change Happens. Sunstein considers the personal impacts when norms involving issues like data privacy are in flux, and the role that understanding other people’s priorities always seems to play. Some of his conclusions are also discussed below. As “dataveillance” is increasingly challenged and we contextualize our privacy interests even further, the smart-city debate is likely to usher in a more durable norm regarding data privacy while, at the same time, allowing us to realize the benefits of AI-driven technologies that can improve urban efficiency, convenience and quality of life.

With the growing certainty that our personal privacy rights are worth protecting, it is perhaps no coincidence that there are new companies on the horizon that promise to provide access to the on-line services we’ve come to expect without our having to pay an unacceptable price for them.  Next week, I’ll be sharing perhaps the most promising of these new business models with you as we begin to imagine a future that safeguards instead of exploits our personal information.

1. Smart-City Debates Are Telling Us Why Our Personal Data Needs Protecting

Over the past 6 months, I’ve talked repeatedly about smart-city technologies and one of you reached out to me this week wondering: “What (exactly) are these new “technologies”?” (Thanks for your question, George!).

As a general matter, smart-city technologies gather and analyze information about how a city functions, while improving urban decision-making around that new information. Throughout, these data-gathering, analyzing, and decision-making processes rely on artificial intelligence. In his recent article “What Would It Take to Help Cities Innovate Responsibly With AI?” Eddie Copeland begins by describing the many useful things that AI enables us to do in this context:

AI can codify [a] best practice and roll it out at scale, remove human bias, enable evidence-based decision making in the field, spot patterns that humans can’t see, optimise systems too complex for humans to model, quickly digest and interpret vast quantities of data and automate demanding cognitive activities.

In other words, in a broad range of urban contexts, a smart-city system with AI capabilities can make progressively better decisions about nearly every aspect of a city’s operations by gaining an increasingly refined understanding of how its citizens use the city and are, in turn, served by its managers.

Of course, the potential benefits of greater or more equitable access to city services as well as their optimized delivery are enormous. Despite some of the current hew and cry, a smart-cities future does not have to resemble Big Brother. Instead, it could liberate time and money that’s currently being wasted, permitting their reinvestment into areas that produce a wider variety of benefits to citizens at every level of government.

Over the past weeks and months, I’ve been extolling the optimism that drove Toronto to launch its smart-cities initiative called Quayside and how its debate has entered a stormy patch more recently. Amidst the finger pointing among Google affiliate Sidewalk Labs, government leaders and civil rights advocates, Sidewalk (which is providing the AI-driven tech interface) has consistently stated that no citizen-specific data it collects will be sold, but the devil (as they say) remains in the as-yet to be disclosed details. This is from a statement the company issued in April:

Sidewalk Labs is strongly committed to the protection and privacy of urban data. In fact, we’ve been clear in our belief that decisions about the collection and use of urban data should be up to an independent data trust, which we are proposing for the Quayside project. This organization would be run by an independent third party in partnership with the government and ensure urban data is only used in ways that benefit the community, protect privacy, and spur innovation and investment. This independent body would have full oversight over Quayside. Sidewalk Labs fully supports a robust and healthy discussion regarding privacy, data ownership, and governance. But this debate must be rooted in fact, not fiction and fear-mongering.

As a result of experiences like Toronto’s (and many others, where a new technology is introduced to unsuspecting users), I argued in last week’s post for longer “public ventilation periods” to understand the risks as well as rewards before potentially transformative products are launched and actually used by the public.

In the meantime, other cities have also been engaging their citizens in just this kind of information-sharing and debate. Last week, a piece in the New York Times elaborated on citizen-oriented initiatives in Chicago and Barcelona after noting that:

[t]he way to create cities that everyone can traverse without fear of surveillance and exploitation is to democratize the development and control of smart city technology.

While Chicago was developing a project to install hundreds of sensors throughout the city to track air quality, traffic and temperature, it also held public meetings and released policy drafts to promote a City-wide discussion on how to protect personal privacy. According to the Times, this exchange shaped policies that reduced, among other things, the amount of footage that monitoring cameras retained. For its part, Barcelona has modified its municipal procurement contracts with smart cities technology vendors to announce its intentions up front about the public’s ownership and control of personal data.

Earlier this year, London and Helsinki announced a collaboration that would enable them to share “best practices and expertise” as they develop their own smart-city systems. A statement by one driver of this collaboration, Smart London, provides the rationale for a robust public exchange:

The successful application of AI in cities relies on the confidence of the citizens it serves.

Decisions made by city governments will often be weightier than those in the consumer sphere, and the consequences of those decisions will often have a deep impact on citizens’ lives.

Fundamentally, cities operate under a democratic mandate, so the use of technology in public services should operate under the same principles of accountability, transparency and citizens’ rights and safety — just as in other work we do.

To create “an ethical framework for public servants and [a] line-of-sight for the city leaders,” Smart London proposed that citizens, subject matter experts, and civic leaders should all ask and vigorously debate the answers to the following 10 questions:

Objective– why is the AI needed and what outcomes is it intended to enable?
Use– in what processes and circumstances is the AI appropriate to be used?
Impacts– what impacts, good and bad, could the use of AI have on people?
Assumptions– what assumptions is the AI based on, and what are their iterations and potential biases?
Data– what data is/was the AI trained on and what are their iterations and potential biases?
Inputs– what new data does the AI use when making decisions?
Mitigation– what actions have been taken to regulate the negative impacts that could result from the AI’s limitations and potential biases?
Ethics– what assessment has been made of the ethics of using this AI? In other words, does the AI serve important, citizen-driven needs as we currently understand those priorities?
Oversight– what human judgment is needed before acting on the AI’s output and who is responsible for ensuring its proper use?
Evaluation– how and by what criteria will the effectiveness of the AI in this smart-city system be assessed and by whom?

As stakeholders debate these questions and answers, smart-city technologies with broad-based support will be implemented while citizens gain a greater appreciation of the privacy boundaries they are protecting.

Eddie Copeland, who described the advantages of smart-city technology above, also urges that steps beyond a city-wide Q&A be undertaken to increase the awareness of what’s at stake and enlist the public’s engagement in the monitoring of these systems. He argues that democratic methods or processes need to be established to determine whether AI-related approaches are likely to solve a specific problem a city faces; that the right people need to be assembled and involved in the decision-making regarding all smart-city systems; and that this group needs to develop and apply new skills, attitudes and mind-sets to ensure that these technologies maintain their citizen-oriented focus.

As I argued last week, the initial ventilation process takes a long, hard time. Moreover, it is difficult (and maybe impossible) to conduct if negotiations with the technology vendor are on-going or that vendor is “on the clock.”

Democracy should have the space and time to be a proactive instead of reactive whenever transformational tech-driven opportunities are presented to the public.

2. A Community’s Conversation Helps Norms to Evolve, One Citizen at a Time

I started this post with the observation that many (if not most) of us initially felt that it was acceptable to trade access to our personal data if the companies that wanted it were providing platforms that offered new kinds of enjoyment or convenience. Many still think it’s an acceptable trade. But over the past several years, as privacy advocates have become more vocal, leading jurisdictions have begun to enact data-privacy laws, and Facebook has been criticized for enabling Russian interference in the 2016 election and the genocide in Myanmar, how we view this trade-off has begun to change.

In a chapter of his new book How Change Happens, legal scholar Cass Sunstein argues that these kinds of widely-seen developments:

can have a crucial and even transformative signaling effect, offering people information about what others think. If people hear the signal, norms may shift, because people are influenced by what they think other people think.

Sunstein describes what happens next as an “unleashing” process where people who never formed a full-blown preference on an issue like “personal data privacy (or were simply reluctant to express it because the trade-offs for “free” platforms seemed acceptable to everybody else), now become more comfortable giving voice to their original qualms. In support, he cites a remarkable study about how a norm that gave Saudi Arabian husbands decision-making power over their wives’ work-lives suddenly began to change when actual preferences became more widely known.

In that country, there remains a custom of “guardianship,” by which husbands are allowed to have the final word on whether their wives work outside the home. The overwhelming majority of young married men are privately in favor of female labor force participation. But those men are profoundly mistaken about the social norm; they think that other, similar men do not want women to join the labor force. When researchers randomly corrected those young men’s beliefs about what other young men believed, they became far more willing to let their wives work. The result was a significant impact on what women actually did. A full four months after the intervention, the wives of men in the experiment were more likely to have applied and interviewed for a job.

When more people either speak up about their preferences or are told that others’ inclinations are similar to theirs, the prevailing norm begins to change.

A robust, democratic process that debates the advantages and risks of AI-driven, smart city technologies will likely have the same change-inducing effect. The prevailing norm that finds it acceptable to exchange our behavioral data for “free” tech platforms will no longer be as acceptable as it once was. The more we ask the right questions about smart-city technologies and the longer we grapple as communities with the acceptable answers, the faster the prevailing norm governing personal data privacy will evolve.

Our good work of citizens is to become more knowledgeable about the issues and to champion what is important to us in dialogue with the people who live and work along side of us. More grounds for protecting our personal information are coming out of the smart-cities debate and we are already deciding where new privacy lines should be drawn around us.

This post was adapted from my July 7, 2019 newsletter. When you subscribe, a new newsletter/post will be delivered to your inbox every Sunday morning.

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