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Exploring the BC Health System: 10 Years of GP Data

For Open Data day, my mission has been to explore data related to General Practitioners in British Columbia, Canada. My data source has been Medical Services Plan payment data from Data BC.

What follows is really a scratch pad as I try out using Google Fusion Tables to understand the data posted to the site.

Usefully, in a few cases there are data sets that show a decade's worth of change for GPs. I created a slice of the above referenced data that focuses solely on General Practitioners. 

To start, it's interesting to know how many GPs there have been over the last 10 years.  What you can is that over the last 10 years, BC has added about 800 GPs. As of last fiscal year, we have over 5000 docs.

We also can see that our GPs are getting older. Their median age (the exact age where half the population is older and half is younger) is increasing. 

We also have data that shows the average number of patients each GP has managed over the last 10 years.  What you can see is a wide variation in numbers. I'm also surprised by how many patients each GP carries. A high of 1820 patients per doc, but a rough average of around 1780. That's a lot of customers!

Finallly, one last surprising chart shows how the number of days billed by GPs has declined by about 20 days over the last 10 years.  Good for docs, for sure. But it's strange that as the number of patients have fluctuated, there haven't been similar peaks and valleys in days billed. Could it be that investments in technology and new kinds of staff (e.g. nurse practitioners and services like 811, for example) have taken some of the pressure off of GPs?

As usual, more questions than answers. But I'll keep looking at the data to see what sort of stories may emerge.

 

 

 

What should a BC government data catalogue do?

In my day job, I’m part of a team of people who are working to bring the BC Government into the global open data movement. It is very fun, exciting work.


In  Citizens @ the Centre: BC Government 2.0, our public service has committed that people from British Columbia and around the world can access our provincial government data to improve research and decision making, and foster innovation in  information services through things like web and mobile apps.

 

A key element of this shift will be to create a data catalogue that allows people to access BC’s data. And so the question of ‘what should a data catalogue do?’ becomes pretty relevant.

 

Let’s pause there and say that what follows is a set of ruminations and thinking, and not an official representation of the BC government’s position, and that it could be subject to radical change. If anything, it’s an official representation of me trying to do my job (my official title is Executive Director, Citizen Engagement in BC's Ministry of Citizens' Services) by engaging people who are smarter and more experienced in a discussion about  what would be ideal for BC to be doing, and where we might have blind spots as our team goes about our work.  Really, this is risk management—I don’t want to miss some great opportunities and I don’t want to do anything dumb either. That said,  I hope you’re keen to dig in alongside us. Many thanks in advance.

 

Looking around at what’s been done with data catalogues to date, you see most of them working with a basic concept of data provision.  Toronto, Vancouver, Australia and New Zealand fall pretty squarely into this category, with Edmonton’s catalogue being among the most sophisticated. Other sites like http://www.data.gov also encourage data conversations by not only providing data, but also seeking some dialogue around the data through blogs and discussion forums. More interesting to me are data catalogues like http://data.gov.uk that put an emphasis on data action by trying to connect ideas about using datasets to a development or analysis project. Equally interesting are sites like http://data.worldbank.org that seem to focus on data understanding by focusing a lot on visualizations of data sets, making them more understandable to researchers, policy types and other people who aren’t necessarily skilled in data manipulation.

 

We can sum these up as a series of intents or purposes for data catalogues: provision, conversation, action, and understanding. In my mind, while these overlap and build on one another, what you choose as your most important intent will have a big impact on the function and design of your catalogue.

 

So here’a  good time to stop and check—is this typology right? Is there another intent that’s missing that could extend what data catalogues can accomplish?

 

One thought that occurs is what I’ll label data relevance. Data relevance would try and personalize how data sets are presented, especially using locations. So you could imagine searching for an issue, seeing a location of an office that deals with that issue (so, search for health, see a hospital or a clinic or a local nursing school), and then present data that is relevant to that issue (see performance data or research data or enrolment data). Ideally, these data sets might even link to the specific place itself, so you could see the data produced at that location. This, I think, is what Tim Berners-Lee is talking about when he’s going on about ‘linked data’ or ‘web 3.0’—where data can find other data. We see this on the UK data catalogue, but the explanation about what it’s supposed to do is pretty fuzzy. I might be wildly off base in making this connection,  but the feel of where I’m going seems to be following Sir Tim’s line of thinking.

 

Looking at these opportunities, then, where should BC’s emphasis lie?

 

While understanding that provision is fundamental—if our data is no good or impossible to find, everything else is a non-starter—I don’t think that it should be BC’s emphasis. What I think I’d like is to prioritize our intents this way:

1.       Action—BC’s catalogue’s success will be primarily  measured by how many projects it sparks that make use of provincial data sets. As such, the site should be designed with focused calls to action that move people from exploring data into using the data in productive ways. It will use the social networking capacity of the internet to help  ideas connect with skills and other necessary resources to make things happen.

2.       Conversation—BC is in its infancy in providing data to the public in this manner. Having rich feedback loops that allow the province to sense demand for data, how it can be improved, and how it is being used will help BC get better at providing data. Luke Closs’s rough-in work for a new data catalogue for our Apps 4 Climate Action contest is a big inspiration—especially his ideas about how to triage a data set: http://demo.socialtext.net/a4cadata/index.cgi?how_to_triage_a_dataset

3.       Understanding –those skilled at manipulating data—software and web developers, economists, statisticians and researchers—are not the only people we want to learn about the data. Telling stories that place the data in context can help all kinds of people understand issues that are important to them, and help build understanding of the issues facing BC, and maybe what we can do about them. A great inspiration for this kind of approach would the Guardian newspaper’s http://www.guardian.co.uk/news/datablog.

4.       Relevance—that we build on GeoBC’s geospatial strengths to start connecting data sets to places as early as possible. The resulting map interfaces could be incredibly powerful.

5.       Provision—that we get the basics right, meaning: a) anything we call open data is in a format that is machine readable; b) that there is robust metadata that explains the data's provenance etc; c) that the data is structured through standards in such a way that it is usable; d) that it is findable through a strong search function; and e) that data, over time, becomes automated in terms of updates and publishing, using xml feeds and APIs. In my experience these basics aren't necessarily that easy, and really getting these right will be an ongoing process rather than something that gets done right off the bat.

 

What do you think? Is this the right order? Something missing? Am I off my rocker?

 

Depending on the answer, the next step will be to start to imagine some functionality that could support these intents, in this (or whatever) order. I’ll take that up in a subsequent post.

7 things I've learned the hard way

So for the last year and a half or so, I've been busily trying  bring some new ideas into the organization where I work.  My colleagues and I have helped to create some really interesting projects that have moved the dial in terms of how public engagement tools get used in our provincial government. We've taken lots of risks and gotten some tangible, positive results. I'm really proud of what we've accomplished.

A big part of what I see as our success has to do with how we've come at our work. Inspired by folks who design products and systems for a living like the UK's Design Council , we made the assumption that in the launch of new ideas, highly detailed planning and extensive business cases can be unhelpful. Instead, ideas stand or fall based on how they perform when tested. So, if you have an idea, create a 'prototype', test it, get feedback and improve. Eventually you'll figure out it won't get you where you need to go, or it will show you you are downright visionary (or somewhere in between). Bonus: you won't have wasted piles of time and bucks in coming up with something that may or may not work, or is simply too big to fail. 

As a theory, this seemed wildly practical. Then I had the amazing opportunity to actually do it.

Practice is Painful

Some lessons I've learned along the way:

1) Prototypes aren't as easy as they sound

A designer colleague has this saying that I love: "quick and dirty is okay, but sometimes the dirty tends to hang around." We've had to get stuff up very cheaply and very fast. On the one hand, this wasn't so much prototyping as it was having to execute really quickly. On the other hand, it also meant that our first cuts were live, and we could try and improve on the fly.

The challenge here was that sometimes our users thought we were offering our final draft, not our first or second. Moreover, incentives within our organization to keep projects relatively secret meant that trying out early iterations was a no go.

As a result we endured some reasonable criticism. Happily, from an organizational change perspective, getting criticized can often be just the thing to break down resistance and catalyze the details of innovative projects (read: some of the 'dirty' gets cleaned up).

2) Ego is the enemy

Taking ownership of projects can be a real plus. It helps motivate you to put in the hard work, extra hours and push the envelope. It catalyzes creativity and a team. So ownership can be a boon for productivity.

But when ego starts getting in the way, there's a problem. Signs your ego is a problem? You're more interested in speaking opportunities than in getting your projects done. At night you imagine yourself as the great savior of your organization, a historical  visionary that will lead the way to innovation grace and wind up in a documentary somewhere. You are totally frustrated by the organization's inability to listen to you. You are completely overwhelmed by work because you believe you are the only one who can do the work well. If you're not doing it all, you hoard all the really juicy and interesting tasks for yourself.

This is will cause trouble because: 1) It means nobody else is learning except you; 2) You will burn out when your self-inflated expectations aren't met, and your project and change agenda will fall over; 3)When projects become closely associated with an individual rather than the organization, they are easily dismissed by decision makers, which will also hurt your change agenda.

I've been guilty of some or all of the ego behaviors above, and probably will be again. But what I've found out is that while having a vision of where to go with a project makes you strong, having an ego just makes you brittle. Fight ego off as much as you can.


3)  Something bosses need to hear: "Good, fast or cheap--now pick two."

Real enthusiasm for an idea from the executive ranks can be an amazing thing for a project. But said buy-in can lead to unrealistic expectations from execs. The discussion can turn into: "Great, we'll get a super duper project launched by the end of the week for free!" And depending on the project, you may be able to pull that off.

But if you find yourself in the realm of doing something complex that can't be done by the end of the week, I've found that using a trick taught to me by a systems guy I worked with in New Zealand works wonders. Ask the enthusiastic exec whether they have ever done any renovations to their house (the answer tends to be yes). Then introduce the renovation triangle, which has good, fast and cheap at the three points (this principle often applies to building stuff generally). You then elaborate on how you can pick two of the three--good and fast, but not cheap; cheap and fast, but not good; cheap and good but not fast. This tends to bring some discipline to the conversation.

4) Ideas are 10% or less. Everything else is fast talk and hard work.

I've found that when it comes to innovation, most folks want to be ideas people. And I understand why: it's fun to be brilliant and to be seen as brilliant (see point two).

But innovation isn't anything without action. This is the strength of the design led, prototyping approach, I think. But to keep organizations moving means taking on work people don't want to do, and keeping teams motivated through the inevitable rise and decline of enthusiasm around a project.

So reminding people of purpose and of already achieved awesomeness will help them stay motivated. Simultaneously being unafraid of grunt work helps send the signal that you are serious about making things happen, no matter what.

5) Taking on innovative projects means being regularly terrified and/or depressed. This is normal.

One thing I've learned about in spades is the emotional life of projects. The ramp up stage is full of excitement. Approval elicits elation. Launch is exhausting. Maintenance is full of uncertainty and/or boredom. And conclusions are full of nightmares of the whole thing falling over, ruined careers and general shaming by the higher ups. Sleepless nights can happen the whole way through.

If you don't anticipate or recognize this volatility it can really do a number on you. I've known lots of innovators who hamstring themselves because they are emotionally drained by trying to get things done. But this innovation stuff requires a thick skin and lots of patience. Otherwise, you'll be done before you even get started. Recognize what's happening, and pace yourself.

6) Getting a project out the door means choosing the imperfect. Sometimes the wildly imperfect.

The projects I've been involved with have not be as beautiful as I imagined them to be at the outset. Strange as it sounds, I'd like to make art with the work that I do. But being mature about constraints means understanding that isn't always feasible. It's more important that the project exists than be perfect. Because the next time, maybe you can be gorgeous.

7) Fire. Ready. Aim. It actually does create change.

The last thing I've learned is that this design inspired approach works. It really does. It's laid the foundations for a bunch of change that's helped benefit other parts of our organization. It's also help spark and draw together a community of people that want to do more work on similar themes. And it's starting to get our organization recognition as a leader in a rapidly advancing field.

The next phase will be about consolidating what's been created and building it out so that more people can do more work. We've learned a lot, and we can't lose that. Hopefully it will help make small innovations scale up to make a big difference.



Is 'public policy' an out of date discipline?

Sometimes I wonder whether my chosen field, public policy, is actually running out of steam as a discipline.

Here's my line of thought:

1. Public policy can be understood as the process by which decisions by public institutions (mainly government) are made for the benefit of the public. Policy is enacted through government programs and services implemented by public administrations.

2. Increasingly, though, government is not in charge of the issues that it wants to address. Homelessness, climate change, spiraling health care costs--all of these are critical issues of our political conversation, but government cannot 'fix' them, despite pretensions otherwise. Progress in these areas demands the efforts and resources of many different players. No one organization is going to save the world by itself.

3. This means public policies are a lot less important than they used to be. To be clear: it's not that they're unimportant. But they are only really powerful if they can be well coordinated with the action of other organizations, communities and individuals.

4. So the value of public policy isn't the policy. It's the ability to build relationships, trust and manage interests in such a way that leads networks of individuals, communities, businesses and NGOs towards a shared goal.

There are lots of examples of areas where 'policy' as it's classically understood  still has tons of sway. Tax policy and economic forecasting come to mind. But even those are simply tools in a toolbox that government has to achieve goals and influence change. Good tax policy is useful when it aligns with (or funds) programs and services that make a difference.

If I'm right about this, I think the most interesting implication is the shift it will demand from the public servants formerly known as 'policy wonks'.

Policy wonks are the privileged experts of the government world. They are impartial advisors to elected decision makers, and handle some of the most sensitive and secret of materials for their political masters. They know issues deeply, and through analysis and research, come up with the options that land on Cabinet tables. It's heady, influential and addictive stuff.

The argument I'm making is that in the future, wonkish expertise is going to be of lower value than the ability to leverage networks, cut deals, and align ideas, people and action behind the goals Ministers want to achieve. Policy analysts won't be doing much analysis. Instead, they'll be using collaborative tools like the web in tandem with well honed powers of communication, facilitation and imagination to do the work the public needs.

I'm curious what you think. Am I saying something obvious? Or is there a real shift occurring that means 'policy' isn't that relevant any more?


RIght on Canada, but what about Norway?

With all the marvelous and deserved flag waving and back patting that's happened after the Olympics, it occurred to me (after a conversation with my Dad, actually) that there is a story that deserves to be told that hasn't.

Norway.

In the final medal count, they were fourth with 23, just behind our fair country's 26. But wait, compare some simple demographics:

According to Wikipedia, Norway has a population of 4.8 milliion. Whereas Canada's population comes in at roughly 33 million.

In fact, Norway was a top five Olympic finisher with a population roughly the same size as we have here in British Columbia.

This is remarkable, is it not? That a country that small could achieve so much?

Dear world press: please celebrate the achievement of the Norwegians. They might not win at hockey, but boy did they clean up everywhere else.


Yahoo! Canada Toolbar : Search from anywhere on the web and bookmark your favourite sites. Download it now!

Conan and Generational Change

So I'm on #teamconan.

I've watched him, on and off, since university (UVic Grad 2001). And he's been great. Pimpbot; Triumph the Insult Comic Dog, the Masturbating Bear are all hilarious. More interesting still was how he came from being a behind the scenes writer-guy to getting out in front of the camera, growing into the role as he got experience. And now, as we know, he's been pushed out of his 'dream job' so that Jay Leno can return to the Tonight Show.

I don't have a real beef with Leno--he's  funny for an audience that likes its humor safe, and is apparently a ratings winner in his traditional time slot.

But I'm squarely with Team Conan because of the important subtext of this story: generational change.

Conan is youngish (47), has played by the rules, and done everything he can to position himself to inherit Johnny Carson's chair on the Tonight Show, just like Jay did almost two decades ago.

But the old guy won't budge. And the old guys at NBC, looking desperately at their wallets, won't budge either.

My worry is that this is a portent of things to come.

In every sector of our society, from commerce to public service, teaching to trades, it's anticipated that retirements are going to hugely impact available skills. Young people have been told this for years, and many are ready or are getting ready to lead.

As these shortages begin to really make themselves felt, will organizations follow NBC's lead and bet on the old war horse? Or will new blood get a chance to take the reins of the big show? 

Working out a way to avoid a constant, internecine,  society wide clash between a tried and tested Baby Boom generation and the group of young people who make up Generation X and onwards, who think their vision of the world is best positioned to lead humanity out of the trouble it finds itself in, is going to be a major challenge. And to be frank, I'm not sure what to do.

In an ideal world, organizations allow young leadership to step in, but evolve a more knowledge focused mentoring role for its vital but older leadership--something like an Emeritus position. It'd be great to know who, if anyone, is trying new inter-generational organizational models on, hopefully with some real benefits to performance.

I love Micah's stuff, but he's mistaken

 

Micah Sifry is a very smart guy who is doing great stuff for the culture and practice of web enabled politics and government.

He is one of the convenors of the Personal Democracy Forum conference and website, an incredible source of news and ideas about how democracy and politics is changing in the digital age.

At the end of the year he posted a piece outlining his analysis of why the Obama administration's participatory style hasn't had much steam once it came into government. He followed it up with another talking about his alternative.

His basic analysis was that Obama was never as grass roots driven as he made out to be, and that the leadership of the campaign never really seriously committed to involving the network they had created in decisions once they came into office.

I've encountered this view before, especially among online activists and campaigners. And while Micah titled his posts, 'the Obama Disconnect', I think (and I say this with deep respect) the disconnect is really his.  I'd like to weigh in to offer a different direction.

The problem with the Obama campaign after it won was not about whether it would commit to keeping the momentum going, as Micah says. I think the deeper, and more real problem was that there was no model for a massive participatory approach to governance, despite expectations to the contrary. There was nothing to commit to because it doesn't exist.

Once in office, the Obama administration did move forward rapidly with a series of experiments, including 'Open for Questions', the OSTP blog, crowdsource advertising, open data and many more. This was useful, good stuff, that also had its share of problems. But I would say they've made some real progress.

It's curious  why Micah doesn't address these moves in his post about Obama. His mistake, it seems to me, is that he's gotten political campaigning and governing confused.

Campaigns are single minded, binary, winner take all propositions. A movement matters in that equation.

But governing is a different activity. Issues are more dispersed over lots of interests, decisions require trade offs. This seems especially true in the American congressional system, where individual senators and congressmen can have an incredible impact.

The single-mindedness of a campaign has to give way to deal making. And once the deal is made, it has to be doable, since the President's and his other party member's electability will to a large degree hinge on whether they get results.

So I can imagine the Obama team saying to itself--how are we ever going to make the heavily centralized power and discretion of the office of the President of the United States work with such a wide team?  They simply weren't sure how a network of campaigners could become effective at doing the business of the President.  Managing that set of widely dispersed partisan interest into getting behind the President's more singular interest to effect a whole bunch of the widely dispersed interests of Congress and others is a huge job. And it probably appeared too hard to do. Moreover, in their first year, they needed to show they could get some stuff done--that they could govern. So keeping the momentum of the campaign would reasonably be seen as less of a priority.

I agree with Micah that we need some more imagination applied to the situation. But I don't think it was commitment that was the problem. It's just they didn't have the model. And I think Micah needs to give them more room to invent it, and credit for the imagination they have applied to date.