Health

How to influence your field? Be shaped like a “T”

The Letter T
The Letter T

If your organization wants to have broad impact on its field, consider this: Success often comes when an organization can use direct program experience to inform its position of thought leadership.

Here’s a case in point. Consider the Brazelton Touchpoints Center that helps improve care for very young children. They had a question: Should they continue to deliver in-person training and consulting to health care workers and parents, or should they focus on disseminating their ideas broadly to influence such people all over the country?

As we worked with the Center, it became clear they needed both. The direct interaction with those engaged with young children provided concrete experiences and a fertile ground for testing new ideas, which in turn informed the organization’s disseminations to the field. Moreover, such experience added credibility to their message.

You can picture this combination of direct service with broad ideas dissemination as the letter “T.”  The stem of the T represents in-depth direct-service work conducted in specific locations, going narrow and deep. Here the organization provides direct service to people, delivers training, conducts programs, or provides coaching and consulting. The organization can use these “laboratories” to develop innovative approaches, and evaluate its results.

We have seen a number of organizations use this T-shaped structure to advantage, including Frank Porter Graham Child Development Institute, a university think tank bringing innovative approaches to early child care, Garrison Institute, bringing the wisdom of meditation to social change efforts, Glynwood Center, a land-use organization helping to preserve farmland, and the Child Health and Development Institute, an advocate for high-quality children’s health care. In each case, the organization engages in direct-service program work, training health care practitioners, running a grass-fed beef operation, or hosting meditation retreats. These in turn strengthen the organization’s ability to develop and disseminate really useful ideas that others can employ.The cap of the T is the dissemination that brings proven ideas to the field, going broad and wide through publications, social media, or public presentations.

So, if you want to influence your field through well-founded, practical ideas that others will use, one good way is to be shaped like a T.

Experts, step aside

Centering II w text
Centering II w text

In the social services and healthcare fields, two experiments are underway that share a similar (and counter-intuitive) approach: Get the experts out of the way so that people can help each other. An anti-poverty organization called the Family Independence Initiative (FII) forbids its staff from offering help or advice to participating families – even when the families are making costly mistakes. Despite this, the organization's results in Oakland and San Francisco show an increase in earnings and savings of 23% and 240% respectively, with 17% of participating families buying homes and 70% of children improving their grades.

The way the Family Independence Initiative sees it, families will not stay out of poverty if they rely on a program or paid social worker for support. FII works to nurture robust social networks -- neighbors who help each other find jobs, buy homes, or with childcare. FII thinks that social workers, however well-intentioned, often get in the way and absorb resources that could go directly to poor families.

Likewise, the CenteringPregnancy model for prenatal healthcare teaches doctors and midwives to take off their white coats, sit in a circle with a group of their patients, and talk as little as possible. When the experts take a facilitative, rather than didactic approach to delivering healthcare, the women themselves share their own fears and experiences about pregnancy and childbirth with one another. They go from being passive recipients of expert advice to being active, powerful participants in the process.

It turns out, prenatal care delivered in this way simply gets better health outcomes. In a multi-site randomized control trial, CenteringPregnancy was shown to reduce the preterm birth rate among participants by 33%. That means for every two CenteringPregnancy groups, one baby is spared the trauma and risk associated with a preterm birth, and society saves an average of $52,000 in expenses.

For those of us who sometimes wonder whether we have too many experts and not enough community, these are welcome data points.