In Guwande’s New Yorker article comparison of the historical uptake of anesthesia and antiseptics, he asks, why did one take off rapidly while the other languished? “First, one combatted a visible and immediate problem (pain); the other combatted an invisible problem (germs) whose effects wouldn’t be manifest until well after the operation. Second, although both made life better for patients, only one made life better for doctors. Anesthesia changed surgery from a brutal, time-pressured assault on a shrieking patient to a quiet, considered procedure. Listerism, by contrast, required the operator to work in a shower of carbolic acid. Even low dilutions burned the surgeons’ hands. You can imagine why Lister’s crusade might have been a tough sell.”
Guwande could have been contrasting randomised control trials (RCTs) and Constituent Voice! RCTs and CV have much in common. They are each useful measurement tools. They both cost something, though RCTs are far more expensive. They both require technical skill, though RCTs require more specialized skill associated with advanced social science research degrees. They both provide reliable evidence of outcomes, though the RCT model for evidence quality is more widely understood and fiercely defended by its priesthood. Constituent Voice does not have a priesthood (yet).
There are two important differences. First, RCTs address a strongly felt pain point of the most powerful actor on stage, the funder, who quite reasonably wants to know what difference his funding made. The experience of those meant to benefit from social change is, in terms of power, what Guwande called “an invisible problem”. In fact, the lack of voice for those meant to benefit is frequently part of the cause of the problem being addressed by the intervention. Second, and this may be the bigger deal, for funders and implementers, dealing with feedback and being held accountable can be a “shower of carbolic acid” – at best inconvenient and often threatening.
This analysis helps to explain a conundrum we have wrestled with in promoting Constituent Voice. We see very little uptake through our free do it yourself tools. On the other hand, we see good absorption when we act as advisors, walk with organizations, share their experience, norms and culture. We are there to make the connection, step by step, to the values that they hold dearest but which are getting overwhelmed by competing day-to-day work pressures. Through consulting we can demonstrate how easy and even fun it is to do Constituent Voice. And once managers experience CV, the resulting benefits seal the deal.
Conundrum solved. Constituent Voice is more like antiseptics than like anesthesia. Thank you Dr. Guwande.