Big behavior change from the outside: Triangulate around the truth

If you’re an outsider who is trying to solve a big institutional problem or create a big shift in behavior, you first need to deeply understand the status quo. Despite how things might look from the outside, behaviors that seem totally illogical actually have pretty good reasons behind them. Before trying to change anything, you first have to figure out why things are the way they are.

If you’re running a startup, or you’re working on a new project, this becomes a lot harder. You’re either commercializing a new technology, porting a business model from one context to another, expanding into a new vertical/customer base, or some combination of all three. This means what you think you know, you probably don’t really know for sure.

Does my product really have value in [new market]? Does [target customer] really want to pay for this or is the problem not big enough? One way of figuring this out is to just get out there and try. Conventional Silicon Valley wisdom encourages us to talk to customers aggressively, because chances are high that we’ll learn pretty quickly. This works particularly well for consumer-facing businesses. But for projects that target big or complex institutions (enterprise sales, government lobbying, M&A, private equity, etc), the number of possible target customers is low. You don’t have that many shots, and asking the wrong question in a meeting will kill your credibility fast.

I’ve learned to first ask dumb questions early, and to ask them of other outsiders. This means not going straight to an executive or their staff. It means waiting on those meetings and getting as close to the truth as possible by learning from people with experience. In the world of government relations, it means talking to NGOs and multilateral institutions with a local presence, chatting with researchers at in-country think tanks, and grabbing dinner at embassies with diplomats.

The goal is to find people who are deeply familiar with the problem you are trying to solve. Who else has tried to solve it? Surely you aren’t the first one. Who else is working with the organization you’re targeting, and what are their insights? What do they say about the incentives, competing priorities, and challenges within that organization? In the case of health, there are so many non-profit experts with both in-country and broad global experience who are happy to offer amazing perspective into the challenges of last mile and rural healthcare, and the ways of working with government institutions that manage these areas.

I’ve also learned to ask the same questions often, and to ask them of many different people. If you’re asking the right questions, they probably won’t have a single answer, and 10 people might give you 15 different opinions. But being a good listener, probing a lot, having an open mind, and having a genuine interest in the problem you’re trying to solve can all go a long way in getting close to the truth.

Big behavior change from the outside: Finding an early adopter

Selling an enterprise service. Lobbying for new legislation. Acquiring a company. They all might seem very different, but they share at least one thing in common: they each require an outsider to get a lot of people to commit to a shift in behavior. 

When a salesperson tries to get a company to buy her service, she probably doesn’t just need to convince one person; she needs to convince a group of users and a few decision makers that paying for something new is worth the effort. When a lobbyist needs to get something signed into law, she doesn’t just need to convince a single politician; that lobbyist needs to build consensus among a big group of lawmakers to prioritize her policy above their current set of goals. When a CEO wants to acquire a new business, she needs to convince her C-level team, her Board, and the target company’s shareholders that merging will create better results than the status quo.

Of course some of these examples are more complex than others, but they are all big lifts in one way or another. How do you get a bunch of people inside an organization to care about something that you care about, particularly if you are sitting on the outside? More importantly, how do you get them to care so much that they spend the time and energy to try something totally different?

This is what we have to figure out at Zipline. We have this crazy technology that can make instant deliveries to rural and remote areas that would otherwise be impossible to reach in hours or even days. We want governments to use our technology to have a big impact on health outcomes. It seems like a no brainer until you think about all the things that have to change in order for our technology to start saving lives. Civil airspace needs to accommodate the traffic that comes with a new class of autonomous flying robots. The public health system needs to shift its entire supply chain to adjust for the new possibilities of automated delivery. The government needs to allocate budget because any new technology comes at a cost. And before all this happens, key stakeholders need to spend money and resources on determining whether these big changes are even worth their effort, or whether their time is better spent on something else. 

I’ve been thinking a lot about this, and have tried to break the process into steps.

The first step is getting a foot in the door with an early adopter. Not everyone within an organization will immediately get excited about an innovation. In fact, many people will absolutely hate it. To many, the word innovation means uncertainty, it means cost, and it usually means more work (at least at the beginning).

Who are the kinds of people who get excited about an innovation before everyone else? It’s usually the people who are closest to the problem that’s being solved. In Zipline’s case, the problem we are solving is helping governments increase access to medical supplies. That usually means the people who get excited are stakeholders within Ministries of Health who understand the challenges of healthcare logistics. But if Zipline were creating accounting software for Ministries of Health, we would of course be approaching a different set of people within that organization.

These early adopters provide a really amazing perspective on what is currently working and what isn’t. If they are close the problem you are trying to solve and don’t immediately love what you’re doing, there’s probably something wrong with it. But once they are bought in, they can act as thought partners, they can help you tweak and improve what you’re trying to do, and can help you craft a message that will resonate with others. They can even give you a peek behind the curtain and give you a sense of who the movers and shakers are, who has decision-making power, and who the right people are to convince. And you know when your early adopters are truly excited when they become advocates inside their organization to help accelerate what you’re trying to accomplish.

What does universal health coverage mean for Africa?

I was asked this question while speaking at Harvard Business School a few weeks ago. I don’t like the question for a lot of reasons, but I figured it’s worth exploring because people seem to ask it a lot. I’ve visited hospitals and clinics in a few African contexts (Rwanda, Ghana, Ethiopia, Senegal, Cote d’Ivoire, Togo) and here’s what I’ve learned.

Let’s start with this: universal health coverage (“UHC”) means different things to different people, and it definitely means different things in different places. Before diving into the topic of UHC, we have to first remember that Africa is an enormous place. Questions like this fall into the intellectual trap of giving all of Africa’s nations, cultures, and economies a monolithic and unproductive label. There is an incredible amount of diversity between countries, and even within a single country we can observe widening resource and lifestyle gaps between rich and poor, urban and rural, tribal divisions, and so on. Africa is diversifying and diverging rapidly, with some standout countries experiencing accelerated economic growth like Ghana and Rwanda, while plenty more countries are still stuck where they were decades ago.

In short, UHC will mean one thing for Nigeria, and an entirely different thing for Niger.

But having said that, there are definitely productive ways to think about healthcare for the continent and beyond. First, any country’s benchmark for universal health coverage should be the quality of healthcare its poorest and most vulnerable people. Metrics like number of hospital beds and doctors trained might be useful for some planning and policy purposes, but it doesn’t have an impact on UHC if only a small slice of a country’s population actually has access.

Second, geography really matters. In the US, 30M rural Americans live more than one hour from a hospital. That’s almost 10% of the population that doesn’t live anywhere near medical care. Has America achieved universal health coverage? By higher standards befitting the country’s GDP, absolutely not. This geographic issue is a bigger struggle in African contexts where the majority of populations continue to live outside of major metropolitan areas. Universal access to hospitals and doctors is deeply obstructed simply by geography alone.

Third, quality is the name of the UHC game in Africa (and in Asia as well). Many countries across the continent are aggressively extending and improving their supply chains, building more last mile health clinics, and training more health staff. But as public health systems expand, the central and administrative resources to monitor and control them spread thin. Are doctors effectively treating patients? Are facility budgets managed properly by administrators? Are medicines and supplies arriving on a regular basis and stored in correct conditions? The problem is now ensuring that growing health systems are delivering high quality care even at the margins.

Quality control example: storage of medicines

Quality control example: storage of medicines

So what does UHC mean for Africa? It depends on the country, but from what I’ve seen it should involve a combination of optimizing for the most vulnerable citizens, geographic disparities, and service quality.

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Say it like you meme it

Right now more of our country’s attention is focused on dissecting tweets than policy white papers, and Democrats find themselves more ineffective than ever at crafting messages that resonate. It’s about time we acknowledge why we are failing to energize voters, and fix it in time for the midterm elections in November.

Let’s revisit the presidential election for a quick moment. It’s easy to remember Trump’s presidential campaign slogans: “Make America great again,” “Build the wall,” “Drain the swamp,” and the classic “Lock her up.” Can you remember any of Hillary Clinton’s campaign slogans?

Me neither.

Since Democrats lost the election, there have been plenty of rationalizations that avoid accepting blame for our embarrassing political failure. For a while we faulted social media platforms that reinforce partisan extremism. Lately we’ve decided that “the Russians” hacked the election – even though nobody has any clue what that really means.

Progressives hate to admit that Trump’s campaign won him 2 million more votes than Mitt Romney received in 2012. Let’s be honest. Trump’s election was mostly the result of a remarkable effort by his campaign and his supporters to rile each other up enough to show up at the ballot – and this was achieved in large part through creating simple, shareable content on social media that sparked conversation.

That brings us to an exploration of the simplest, most shareable content that exists on the internet: memes. We’ve all seen them, but it’s hard to explain them. It’s even harder to understand the massive role they are beginning to play as a vehicle for political discourse, particularly among people below the age of 30.