Disruptive Innovation for Social Change

2006-12-10T22:22:00.000-08:00

"Disruptive Innovation for Social Change" is the title of a feature article in the December '06 Harvard Business Review. Source. Its argument in one sentence is this:

"In the social sector, too much attention is devoted to providing more of the same to narrow populations that are already served. It's time for a fundamentally different approach."

I couldn't agree more, and I recommend this article to LifeRing convenors for study. The lead author is Prof. Clayton Christensen at Harvard Business School. The three other authors are executives of investment and consulting firms specializing in innovation. They open the argument by pointing out that the U.S. spends more per capita on health care and education than many other countries, but gets results that lag behind, sometimes far behind.

What accounts for this poor showing? It’s not a lack of solutions but rather misdirected investment. Too much of the money available to address social needs is used to maintain the status quo, because it is given to organizations that are wedded to their current solutions, delivery models, and recipients. Many provide relatively specific, sometimes sophisticated offerings to a narrow range of people. While they may do a good and important job serving those people, and while their services may steadily improve, these organizations are unlikely ever to reach the far broader populations that are in need—and that would be satisfied by simpler offerings if only they were available.

This description perfectly fits the picture in the American chemical dependency recovery business. Virtually all the money available is used to maintain the status quo; it goes to fund treatment programs and indirectly to fund mutual aid organizations that are welded -- not wedded -- to their time-encrusted solutions and delivery models. They provide highly complex offerings based on the Twelve Steps, Twelve Traditions, and Twelve Promises to the narrow range of people who are amenable to religious or quasi-religious healing approaches. These organizations have an enormous attrition rate -- 95 per cent after one year is the most often quoted figure. Source. The effectiveness of the groups and of the treatment paradigm based on them is often asserted as an article of faith, but has never stood the test of scientific examination. Source. The concepts underlying the predominant treatment model are those for which there is the least evidentiary support. Source. The percentage of persons needing treatment who elect to be treated by this model is in the single digits. Source. Most Americans reject this treatment model; they have to be forced to go there. Source. A solid 60 per cent of those who succeed in long-term recovery from alcoholism avoid these groups. Source. The twelve-step paradigm has had 70 years to adapt and to demonstrate the capacity to make an impact on public health; yet the paradigm remains virtually unchanged, and the dimensions of the alcoholism and other addiction problem in the U.S. are, if anything, broader and more ominous than ever. Nevertheless, investments continue to flow into this paradigm, if only because nobody ever gets fired for recommending the status quo (whether it works or not).

Dr. Christensen, the lead author, has a theoretical model that explains how social change nevertheless occurs in some instances, despite the apparently overwhelming inertia of the status quo. He identifies what he calls "catalytic innovators" who bring about social change through "disruptive innovation."

1. They create systemic social change through scaling and
replication.
2. They meet a need that is either overserved (because the existing
solution is more complex than many people require) or not served at all.
3. They offer products and services that are simpler and less costly than
existing alternatives and may be perceived as having a lower level of
performance, but users consider them to be good enough.
4. They generate resources, such as donations, grants, volunteer manpower,
or intellectual capital, in ways that are initially unattractive to incumbent
competitors.
5. They are often ignored, disparaged, or even discouraged by existing
players for whom the business model is unprofitable or otherwise unattractive
and who therefore avoid or retreat from the market segment.

By "scaling and replication," the authors have in mind ventures like the "Minute Clinics" that offer elementary health care services according to a precise software-based protocol. The DNA of these ventures is clear and easily replicated, and the number of providers can easily be scaled up to meet demand. How does LifeRing rate on this issue? Any reader of How Was Your Week? knows that the format of the basic LifeRing meeting is similarly clear and can easily be replicated without special training by anyone with basic social skills and the requisite months of sobriety. The number of meetings is limited only by the supply of convenors (meeting leaders), rooms, and referrals. LifeRing is a mutual aid group solution that is eminently scalable and replicable.

How does LifeRing fare on the second point? The existing twelve-step solution may have appeared simple when it was first proposed, but today it is more heavily overlaid and burdened with doctrine than the medieval Catholic church. Abstinence from alcohol and drugs, instead of being addressed directly, is believed to come as a secondary byproduct of the successful completion of a circuitous twelve-stage obstacle course that somehow -- by psychological and/or theological mechanisms that remain mysterious at their core -- extinguishes, it is hoped, the desire to drink. Twelve Traditions and Twelve Promises confront the patient with additional challenges to surmount. There is an enormous secondary literature, far more than any human being could scan in a lifetime. Even if the basic programmatic concepts were straightforward, which is far from the case, the historic development today is one of overwhelming complexity. Along comes LifeRing: Don't drink or use, no matter what! Make sobriety your priority in life! The central task that people who have issues with alcohol and other drugs need to accomplish -- to stop drinking/using -- is finally moved into the foreground, not as a byproduct or a secondary goal, but as the direct objective of participation in the organization, and the guiding principle for all further individual progress.

The third quality of Prof. Christensen's catalytic innovators is particularly intriguing. Such ventures, he writes, offer services that are simpler, and may be perceived as having a lower level of performance, but users consider them good enough. There is no question that LifeRing is simpler than the twelve-step approach. (Whether it is also easier, or more difficult, is a different issue.) There is no doubt also that some consider the LifeRing approach as having "a lower level of performance," because we do not pretend to address the theological needs of our participants, preferring to refer our members instead to the established religious/spiritual providers such as the churches, synagogues, mosques, etc. For theorists who believe that addiction has a core "spiritual" dimension, and who think they have a cure for that malaise, LifeRing clearly offers a reduced level of services. It is true that LifeRing tends to be rich in psychological qualities such as empathy, support, positive reinforcement, caring, and love -- qualities that some authorities subsume under the "spiritual" heading -- but because we see human synergy and human choice as the engine of transformation, rather than the intervention of a "higher power," we always get failing marks in the "spirituality" examination. One example that Prof. Christensen gives of a catalytic innovator is Southwest Airlines, whose low-cost no-frills flights disrupted much of the commercial passenger business. You could say that LifeRing's "no higher power" approach is similar to Southwest's "no airplane food" business model. Note that Southwest succeeded nevertheless because people considered it "good enough." It gets you from A to B. Similarly, if you fly LifeRing, you will get from A to S -- from addiction to sobriety. You will not necessarily have the Meaning of Life revealed to you, you may not discover the Theory of Everything, but you will recover your native clean and sober endowment, your life, to do with what you choose.

Prof. Christensen's fourth point, for us, still needs much more development. He speaks of generating resources such as donations, grants, volunteer manpower, or intellectual capital. We are only at the beginning of exploring financial support such as donations and grants. We operate entirely on volunteer manpower. We do have some intellectual capital -- I'm thinking of the Recovery by Choice workbook and some other items -- that is attracting an ever-broader readership.

The fifth point -- "they are often ignored, disparaged, or even discouraged by existing players" -- is one that will resonate with every LifeRing convenor who has worked to get a new meeting started. We encounter not only basic psychological inertia, the fear of anything new, but a formidable array of vested interests. There is big money being made from the Twelve-Step paradigm. Privately owned treatment programs charge major fees for dispensing what you can get free at any AA meeting (minus board and lodging). Even the humblest of steps -- reaching out to peers who are still suffering, as described in the twelfth step -- can be lucrative: an AA-based organization called The Other Bar in California collects $372,000 a year from the California State Bar (an agency of the state government) for doing 300 hours a month of peer support services, which comes to $103.33 per hour. Building the LifeRing support network is almost everywhere an uphill struggle.

The authors of this Harvard Business Review article observe that "disruptive innovation for social change" operates most quickly in areas with a relatively free market, but much more slowly in realms "that are controlled by politics and other forces outside the market." Chemical dependency is to a great extent controlled by politics, both of the ingrained institutional and the expressly partisan variety. Nevertheless, say the authors, no sector is impervious.

LifeRing is well on its way to becoming one of the "catalytic innovators" that Prof. Christensen describes. If there are "social investors who are frustrated with current solutions" -- the authors' phrase -- I invite them to seek us out. In the closing words of the article,

Not only will this have an immediate social impact, but it will also help
establish the model and inspire more social entrepreneurs to think
catalytically.

Well said.