From the Bottom Up

From the Bottom Up


In 2003, the Minister of Health for the country of Eritrea, World Bank staff and other experts were reviewing the progress of their efforts to combat the spread of HIV/AIDS. They were disappointed at their lack of results. Despite several years of intensive efforts on many fronts, the rate of infection continued to climb and threatened to turn into a full-scale epidemic.

Two years later, Eritrea became one of the only African countries in which infection rates had begun to decrease – and was hailed as a model country by the United Nations. 

Eritrea achieved these transformational results only after it took a different – and counter-cultural—approach: it turned to the people closest to the problem for innovative ideas and effective action. As a start, the Minister of Health convened l00 commercial sex workers in a two-day work session modeled on GE’s famous “WorkOut” process, led by a few of our colleagues. Their perspectives not only challenged the assumptions of experts and officials about “what worked,” they transformed the focus of this country-wide effort. Success ensued.

For example, one of the initiatives aimed at a 25 percent increase in voluntary counseling and testing services (VCT) participation, with user satisfaction above 80 percent. One hundred days later, the weekly number of clients had ramped up by 80 percent. Moreover, exit questionnaires showed a consistent 95 percent level of satisfaction with the quality of VCT service.

This kind of impact is not limited to one sector or industry.  For example, some years ago, the mental health hospitals run by the state of Connecticut faced an unsustainable level of staff injuries. In the words of one staff person, “When we would talk at coffee breaks, we would compare concussions and the double vision that often accompanied them.” As a result of these injuries, costs were soaring, patient care was difficult and the lives of staff were severely affected, often permanently.

Like the country of Eritrea, the state of Connecticut had tried “everything” – incentives, training, new equipment and more. So widespread was the issue that it even tried punitive measures to discourage staff from claiming injuries without proper certification, as many thought their claims must be part of a massive fraud. But injuries and their impact continued to mount.

Ultimately, management of a single hospital in the Department of Mental Health, as well as leaders of the labor union, decided to take a different approach – a “Rapid Results” approach. Rapid Results projects mobilize people at all levels to achieve tangible short-term goals very quickly – within 100 days or less – and develop enthusiasm, confidence and capability along the way so the short-term results can be scaled to achieve more far-reaching goals.

At this single hospital, the geriatric ward set an aggressive but achievable goal to reduce patient-related injuries to 50 percent of the previous year’s monthly average within one month. Now focused, the team created patient profiles and patient alert reports to understand specific behavior patterns and how they changed from shift to shift, allowing staff members to predict the key causes of incidents. This opened the door to tackle the causes. The Geriatric team put posters at key locations to remind employees of safety concerns and also produced a videotape demonstrating proper use of mechanical equipment for lifting and bathing patients.

The results? A dramatic reduction in incidents, injuries and costs, as well as a huge boost in morale. More importantly, the project keyed in on critical insights that were used to scale the results to the larger hospital system.

Perhaps it is the nature of hierarchies and organizations – corporate, public and not-for-profit – that they focus idea-generation and innovation on experts, or on the most senior people. Corporate idea labs, R&D centers and people with deep experience do often discover and develop tremendous ideas, after all. But the hidden secret to promoting human progress in many instances lies in learning how to tap into the insights and innovations of the people closest to the issue, and empowering them to take part in the solution.

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Matthew McCreight’s blog post on The Economist Blog: The Ideas Economy.

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