Ashoka

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Ashoka and the Robert Wood Johnson Foundation have announced the winners of the Designing for Better Health competition, which asked innovators around the world to come up with nudges for health and health care. The contest’s judges picked three winners, each of whom will receive $5,000 for their idea:

1) Healthy amazon. A program for turning waste in the largest Amazonian community in Peru into compost for vegetable gardens. The organization that came up with the program, San Francisco Saludable, gives compost away freely to anyone who contributes their recyclables, garbage, and trash, which is a serious problem in the area. The Spanish/English web site is here.

2) Just a cloth piece? A small, affordable piece of cloth that is meant to improve menstrual hygiene and spark conversations about an otherwise taboo topic. In India, where the project is based, women commonly use sand, wood ash, old rags, newspapers, and plastic bags as a substitute for sanitary pads. The organization responsible for the idea, GOONJ, is partnering with grassroots groups, NGOs, the Indian Army, and others to distribute the cloth pieces.

3) Child promoters on oral health. A Venezuelan program to help children, not nagging adults, teach other children about the importance of clean, healthy teeth. Poor dental care is common in Venezeula, and the program Fundación BOCA SANA is intended to reach 20,000 kids between ages 3 and 12 each year. A project web site (in Spanish) is here.

Find out more about Ashoka’s contest and read the full entries here.

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Changemakers, an initiative of the social entrepreneurship non-profit Ashoka, has partnered with the Robert Wood Johnson Foundation to look for great nudges in medicine. Got an idea for the next medical checklist? The next smart pillbox?

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The contest is officially open, and will remain that way until May 8, 2009. It has been designed with transparency in mind. All of the submissions will be available online for others to read and discuss. A panel of judges will select a group of 10-15 finalists. The competition’s community of readers will then vote (American Idol style) in late May for three winners, each of whom will receive $5,000 in seed money to put their nudge into practice. So far, the judges include Cornell’s Food and Brand Lab Director Brian Wansink, University of California-San Francisco Medical School pediatrics professor H. Carrie Chen, and the Robert Wood Johnson Foundation’s Pioneer Portfolio leader, Paul Tarini. Others may join later.

All the information you’ll need to enter is here.

*Fame and fortune not guaranteed, of course.

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In the field of medicine, there is perhaps no better nudge than Peter Provonost’s medical checklist. Adapted from pre-flight preparations by airline crews, the medical checklist is a six-step set of routine actions for preventing Intensive Care Unit line infections that doctors may otherwise forget to do because of time constraints, stress, or distractions. The success of this checklist in Michigan hospitals has been well documented. After two years the checklist had prevented 43 infections and eight deaths, saving $2m dollars in costs. (The graph below comes from a lecture by former Congressional Budget Office Director Peter Orszag.)

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Changemakers, an initiative by the non-profit social entrepreneurship group Ashoka, is preparing to launch a competition to generate medical nudges (more on that in a later post), and the contest organizers have selected the checklist as one of their case study examples. They remind us why the checklist is such a brilliant idea. It’s not the six simple steps. It’s the observing nurses who provide instant feedback ensuring that the medical checklist is followed.

Pronovost’s masterstroke came next: asking ICU nurses to observe doctors’ behaviors after the lists were posted. If they didn’t follow the list, nurses should intervene. Nurses were also to ask doctors daily whether lines ought to be removed, so as not to leave them in longer than necessary.

“When we first said it, the nurses said, ‘Hey, I’m gonna get my head bit off’,” recalls Pronovost. “And docs said, ‘You can’t have nurses second-guessing me in public’. So I pulled all the teams together and said, ‘Is it acceptable that we can harm patients here in this country?’ And everyone said, ‘No’.”…

(Provonost) made the nudge public – involving nurses and reframing the issue as one about harming patients, not authority, Provonost created a cultural shift, empowering everyone in ICU to nudge each other toward right choices to preventing infections.

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