I think part of the conversation is that what we call evidence of outcomes for old questions is still based on old questions. Old questions often intrinsically do not have the power to lead us to new results. New questions have this power, and the conundrum with new questions is that they provide new signals, new kinds of feedback. For example, in the form of stories or metrics that diverge from old stories and metrics from old questions.
This is why we invite people to turn all of their assumptions into as many questions as possible and improve their questions so that they can form new actionable questions that make the difference. That manifests as what we call evidence.
Some of the things we care most about, trust, belonging, courage, friendship and hope, may not simply require new questions and new metrics. They may require us to accept that some aspects of human flourishing exceed our capacity to evidence them fully.
The challenge may not be finding better measures in response to better questions alone, but learning when measurement itself has reached its limits.
Perhaps the question becomes: how do we remain accountable for what matters without reducing what matters to only those things we can count?
Mike lovely piece and been thinking down the same lines - and saw this in Brighton Dialysis unit the other day. Again not rewarded under todays economic system.
When a patient's peritoneal dialysis begins to fail, they enter a classic soft transition. The decline is gradual, continuous, and multi-signal. In a traditional, fractionated system, the soft drift goes uncoordinated and the system misses the accumulating signals of decline until a catastrophic hard event occurs.
The Sussex Kidney Unit counteracted this category error by merging their PD and Home Haemodialysis services into an integrated home unit. This structural redesign allowed the care team to pool warm data and engage in a continuous probe–sense–respond mode. By routinely tracking early soft signals — and proactively asking long-horizon screening questions such as "Would you be surprised if this patient transferred to HHD in six months?" — they created a protective buffer around the patient's physiological reserve.
The operational results are unambiguous. Patients demonstrating early, subclinical signs of inadequate clearance were identified early enough to allow planned vascular access placement (AVF/AVG). This bypassed the need for emergency CVC lines entirely, reduced modality-transition hospitalisations to zero in compliant tracks, and improved long-term patient survival. By dissolving administrative boundaries between distinct therapies, the Sussex model transformed a chaotic, emergency-driven event cascade into an organised, continuous, and deeply relational navigation of a complex illness path.
Great post. When we are required in our ABCD community cultivation efforts to track outcomes we focus on 5 indicators of community resilience - Social trust, collective efficacy, civic investment, the emergence of community leaders (not paid professionals)and the a co-created community vision and plan. These seem to cause the least harm and fit our objective of cultivating connection and shifting power to the community. However, I think story is the best way to capture impact.
Thanks Wendy. I think at the heart of this piece is a belief that no matter the questions we ask or the stories we listen to and tell we can never truly know our impact. We are always working inside a mystery. The clues we pick up are helpful but they do not offer us easy answers…
I was having exactly this discussion with a Freedom to Speak Up guardian -but you have articulated it so much better than I could. How do you measure impact? How do you proove your worth?
And what if the worth of these things cannot be proven, because they have qualities that are beyond measure? Beyond description? Beyond comprehension? Why must they be reduced to what is measurable?
I think part of the conversation is that what we call evidence of outcomes for old questions is still based on old questions. Old questions often intrinsically do not have the power to lead us to new results. New questions have this power, and the conundrum with new questions is that they provide new signals, new kinds of feedback. For example, in the form of stories or metrics that diverge from old stories and metrics from old questions.
This is why we invite people to turn all of their assumptions into as many questions as possible and improve their questions so that they can form new actionable questions that make the difference. That manifests as what we call evidence.
Some of the things we care most about, trust, belonging, courage, friendship and hope, may not simply require new questions and new metrics. They may require us to accept that some aspects of human flourishing exceed our capacity to evidence them fully.
The challenge may not be finding better measures in response to better questions alone, but learning when measurement itself has reached its limits.
Perhaps the question becomes: how do we remain accountable for what matters without reducing what matters to only those things we can count?
Mike lovely piece and been thinking down the same lines - and saw this in Brighton Dialysis unit the other day. Again not rewarded under todays economic system.
When a patient's peritoneal dialysis begins to fail, they enter a classic soft transition. The decline is gradual, continuous, and multi-signal. In a traditional, fractionated system, the soft drift goes uncoordinated and the system misses the accumulating signals of decline until a catastrophic hard event occurs.
The Sussex Kidney Unit counteracted this category error by merging their PD and Home Haemodialysis services into an integrated home unit. This structural redesign allowed the care team to pool warm data and engage in a continuous probe–sense–respond mode. By routinely tracking early soft signals — and proactively asking long-horizon screening questions such as "Would you be surprised if this patient transferred to HHD in six months?" — they created a protective buffer around the patient's physiological reserve.
The operational results are unambiguous. Patients demonstrating early, subclinical signs of inadequate clearance were identified early enough to allow planned vascular access placement (AVF/AVG). This bypassed the need for emergency CVC lines entirely, reduced modality-transition hospitalisations to zero in compliant tracks, and improved long-term patient survival. By dissolving administrative boundaries between distinct therapies, the Sussex model transformed a chaotic, emergency-driven event cascade into an organised, continuous, and deeply relational navigation of a complex illness path.
Wow! Wonderful to hear this sort of discernment finding practical expression…
Great post. When we are required in our ABCD community cultivation efforts to track outcomes we focus on 5 indicators of community resilience - Social trust, collective efficacy, civic investment, the emergence of community leaders (not paid professionals)and the a co-created community vision and plan. These seem to cause the least harm and fit our objective of cultivating connection and shifting power to the community. However, I think story is the best way to capture impact.
Thanks Wendy. I think at the heart of this piece is a belief that no matter the questions we ask or the stories we listen to and tell we can never truly know our impact. We are always working inside a mystery. The clues we pick up are helpful but they do not offer us easy answers…
I was having exactly this discussion with a Freedom to Speak Up guardian -but you have articulated it so much better than I could. How do you measure impact? How do you proove your worth?
And what if the worth of these things cannot be proven, because they have qualities that are beyond measure? Beyond description? Beyond comprehension? Why must they be reduced to what is measurable?