{"id":35606,"date":"2015-11-04T12:12:33","date_gmt":"2015-11-04T11:12:33","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=35606"},"modified":"2015-11-06T10:57:43","modified_gmt":"2015-11-06T09:57:43","slug":"pritpal-s-tamber-on-agency-exploring-the-evidence","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2015\/11\/04\/pritpal-s-tamber-on-agency-exploring-the-evidence\/","title":{"rendered":"Pritpal S Tamber on agency: exploring the evidence"},"content":{"rendered":"

\"pritpal_tamber_2014\"<\/a>In a departure from my usual interview format, today I am sharing a conversation with Ollie Smith, Director of Strategy and Innovation at Guy\u2019s and St Thomas\u2019 Charity. The charity describes itself as an innovation catalyst and recently put out an invitation to tender looking for organisations to help them test the hypothesis that a solution to the health challenges facing their part of the world is to increase individual agency in the local population. I was lucky enough to win the work<\/a> and, currently halfway through it, we thought we\u2019d share a little on the background and where we\u2019ve got to.<\/p>\n

Pritpal S Tamber:<\/strong> You better start by telling folks what an innovation catalyst is.<\/p>\n

Ollie Smith:<\/strong> It\u2019s all about taking risks. We are an independent charitable foundation with an endowment of almost \u00a3600m (US$920m) which enables us to spend \u00a320m (US$30.5m) a year to tackle the major health and care challenges facing the London boroughs of Lambeth and Southwark. We were established over 500 years ago, and our endowment means we are able to take a long term perspective and consider radical new approaches, the ones that we hope will have the greatest potential to improve the health of the local population. By funding others we enable them to take big risks, bigger than commercial capital usually tolerates. We have a long and close relationship with Guy\u2019s and St Thomas\u2019 NHS Foundation Trust, one of the major local health care providers, but we support anyone who has ideas to improve people\u2019s health in Lambeth and Southwark.<\/p>\n

PST:<\/strong> You mention “radical.” “Agency” seems to be quite a radical idea. What is it?<\/p>\n

OS:<\/strong> At its heart it\u2019s about control. If I have agency then I\u2019m able to take control of my life.<\/p>\n

PST:<\/strong> And why is the charity talking about it?<\/p>\n

OS:<\/strong> Because we think it has the potential to solve some deep rooted problems. Lambeth and Southwark are two of the most deprived areas in the UK and that strongly correlates with poor health. This is despite the presence of well-regarded health and care institutions. To get under the skin of this, last year we undertook some research into how people think about health in the context of their lives. This revealed that “health” is often seen as more than just the avoidance or treatment of illness. What people want is a fulfilling life, financially secure, with nourishing relationships. This broader definition of health is often termed “wellbeing.” Often the institutions we work with struggle to respond to what people really want or need, rather focussing on the “system.” Our working theory is that if we can catalyse people to have more control\u2014or agency\u2014in their lives it will improve their, and others\u2019, wellbeing.<\/p>\n

PST:<\/strong> How do you know if greater “agency” in a community will lead to better health outcomes?<\/p>\n

OS:<\/strong> The short answer is that we don\u2019t but I need to unpack your question a little. First of all, we are aware of some evidence that suggests it is important but we wanted to go beyond this, hence the exploratory work that we\u2019ve asked you to lead. Secondly, we understand that it\u2019s not so much that agency will lead to better health, but that having agency is an important part of feeling well. Being in control of your life is an important part of “wellbeing.” Perhaps you could say a few words about the work you\u2019re doing on our behalf.<\/p>\n

PST:<\/strong> Yeah, sure. As regular readers likely know I\u2019ve spent the last few years exploring the future of health and it has brought me to the idea that it\u2019s about starting where people are, as opposed to where experts and systems think they should be. It\u2019s led to the Creating Health Collaborative, an international collective exploring the idea of health beyond the lens of health care\u2014very much the kind of stuff you unearthed in your local research.<\/p>\n

OS:<\/strong> Yes, that\u2019s why we asked you to lead this work.<\/p>\n

PST:<\/strong> To date, my work has been about following clues and speaking with good, entrepreneurial people. What you\u2019ve asked me to do is more systematically examine the “evidence” that\u2019s out there so we have a consolidated sense of the space. We\u2019re looking at the indexed literature for examples of projects that have been defined and led by communities, while also speaking with some of the leading doers at the vanguard of this space. We\u2019re hoping to leverage published and experiential knowledge to glean the design principles for a truly community-led piece of work that the Charity might fund. Back to you; are there any examples out there that resonate with your thinking?<\/p>\n

OS:<\/strong> The California Endowment\u2019s Building Healthy Communities programme is a hugely important example. They are half way through a US$1bn, 10-year programme to improve the health of 14 low-income communities across California. What excites me about their work is how they have really taken the time to understand the local context, prioritise the issues that are important to each community, and to invest in local capabilities. I know that it has not all been smooth sailing and that they\u2019ve learnt a lot on the way. I\u2019m hoping that we can benefit from their experience. Back to you; do you have a sense yet of what a Charity-funded programme for Lambeth and Southwark might look like?<\/p>\n

PST:<\/strong> As you know, we\u2019re only half-way through the work but we\u2019ve started to get a strong sense of it. I think there are three fundamental ideas that need to be embraced. Firstly, communities are complex environments in which events are hard to predict. One needs to design a programme that can handle unexpected events. Secondly, it\u2019s hard to know when a community is exerting agency. It\u2019s easier to know when individuals are, but there is a need to invest in and nurture the idea of community-level agency. And thirdly, we\u2019re of the view that whatever you do it has to seek and test new business models for health as they\u2019re fundamentally different to the business model of health care, which is organised around sickness or its prevention.<\/p>\n

OS:<\/strong> Sounds good. I\u2019m looking forward to seeing the fruits of your labour. I know it will be important to the Charity but I\u2019m sure others will be interested too so I plan to share the results as soon as we can.<\/p>\n

PST:<\/strong> Excellent. This “space” will only grow through open collaboration.<\/p>\n

By the end of this work<\/a> we\u2019ll have honed a set of design principles for a community-based programme to build agency. We firmly believe that no two communities are the same, no matter what the demographic or epidemiologic data says, which is why we think what matters most are the fundamentals of programme design.<\/p>\n

Pritpal S Tamber<\/strong>\u00a0is an explorer of the future of health and an adviser on transformative innovation in healthcare. His work<\/a> is informed by his experience as the physician editor of TEDMED; the medical director of Map of Medicine, a company that helps clinicians improve the quality of care; and numerous roles in medical publishing, including at BioMed Central, the company that proved open access publishing was commercially sustainable. Pritpal honed his ideas through a movement called Wellthcare<\/a>, in which he explored the idea of creating health through community. This work has led to the Creating Health Collaborative<\/a>. Follow him on Twitter<\/a>.<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"

In a departure from my usual interview format, today I am sharing a conversation with Ollie Smith, Director of Strategy and Innovation at Guy\u2019s and St Thomas\u2019 Charity. The charity […]<\/p>\n

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