Breakdowns to Breakthroughs #2

A Series of Reflections on the Way to Wellville

When you’re working with communities, as we are, you know you’re doing your job when you uncover the unexpected. That’s when the real work begins.

We come to our communities from a leadership position in technology and with extensive experience in health. Esther Dyson’s tech bona fides are well known and Marvin Avilez has worked for Apple and Oracle; Rick Brush and Jeff Doemland spearheaded the large health insurer Cigna’s foray into the social determinants of health.

As our involvements with our communities evolve we’re learning how progress can sometimes be a winding road. It’s not just outcomes that are important; it’s what’s learned along the way that’s most valuable.

Based on our leadership in the tech sector alone, the easy assumption is that we think every problem has a tech solution. Yes, we advise our communities on technologies with a potential for doing good. And that means we deal with the effects of what’s come to be called the “substitution myth” – the blind faith in technology to solve problems and make work easier and life better.

The experience with a technology implementation in one of our communities is a cautionary case study. In Spartanburg, SC the implementation of a text-messaging platform caused an unexpected performance decline for an organization working with the county’s uninsured. Initially rolled out to two case managers, the platform had the potential to improve both their performance and client experience. But it was having opposite result.


Because we’re outside the organizations we work with, we’re able to resist the appeal of the quick fix. So instead of going back to the vendor with complaints about the performance decline, we talked candidly with the case managers experiencing the problem first hand. (Workplace dynamics had precluded management from having such a conversation with the case managers).

What we discovered was not a problem with the technology per se but a problem with its implementation. Prior to installation of the new platform, the case managers had done their jobs by following an established workflow. What no one had taken into account were all the subtle ways the new technology disrupted – rather than integrated with – this workflow. With this information we had a concrete and actionable request for the vendor: a more comprehensive, responsive training engagement.

The result? According to management, performance declines have been reversed and the platform has been rolled out to all six case managers. And we think it’s a great story about dealing with the inevitable, unanticipated and inescapable realities that accompany any effort to effect change in a community setting.

These realities – so easy to ignore when crafting a vision and a plan for realizing it – will continue to crop up. They’re the course materials for our master class in learning. You can read an earlier edition of our class notes here.