Eli MacLaren

Citizens In Charge

I spent last week working in Dallas, standing up BIF’s experiments in family well-being. This is part of an 8-month project to design and test new models that will move a pediatric system to a model that serves the whole family, that will move a sick care system to a model that delivers family well being.

I’ve worked with this client, on variations of this project for three years. I believe we delivered excellent insights about the patient experience and important areas for exploration. It is good to see the prototyped versions of these models. It is great to see families organizing to deliver a nutritional education and shopping experience in the Lake Highland community. But as I watch families engage, it is clear:

It is not about the elegance of the new models. What matters is that we put citizens in charge — triggering agency, personal power, and positive networks.


#family #wellbeing test - families setting up the #eduahoppe experience #bifpxl

A photo posted by @elithechef on


This is an important principle across all of BIF’s real world experience labs. We know that:

  • Communities are stronger, safer, and more prosperous when citizens feel accountable and able to act in service of these outcomes.
  • Kids engage differently in the classroom when they are given permission to design their own education experiences.
  • Patients take ownership for their health when we shift the center of expertise from the doctor to patients themselves through their own personal stories and narratives.

There are a variety of mindsets, however, that make it difficult for system leaders to embrace this principle and put it into play:

“Social systems are designed to serve citizens; not the other way around.”

This is an underlying mental model that constrains service design within social systems. When we believe it is our job to take care of a population, it can cause the system to organize in ways that can disempower individuals, who then, overtime, experience a positive feedback loop of learned helplessness.

In our foundational research in Dallas, we heard a handful of powerful stories of how lives changed when patients took agency for their health. For example, we met sixteen year old boy who realized he could improve his own nutrition and physicality, which led to changes across his entire family. Juxtapose this to a more common narrative: patients feeling helpless within the health care system— using the emergency department because they felt out of control, lacking trusted sources of information, failing to engage in the critical thinking that enables them to make meaning of well care and sick care visits.

“Citizens in charge? Are you crazy? They can’t handle that responsibility!”

I heard this first many years ago while working at Ashoka. While distilling the underlying principles that guided social entrepreneurs pioneering new education models, we discovered “children in charge” was a common theme. It is also one that is met with significant resistance — in part because it instills system leaders with a sense of terror. Children in charge, or even citizens in charge, translates to disorder and chaos. Politicians imagine rowdy town hall meetings, with angry citizens telling them what to do.

It also brings into question the “expert” model that governs much of our culture. Doctors imagine their expertise and authority — which they worked years to hone — being questioned by patients. It shakes the sacred role they have established for themselves.

In this mindset, it becomes about what the system leader needs, when it needs to be about what the individual needs. The job of systems leaders should be to unleash people’s greatest potential. Instead, however, we tend to categorize and constrain people — telling them what they are and are not capable of. The truth is people often need to have their potential reflected back to them, which is best done by giving them increasing responsibility.

“Systems are intended to serve the masses. How does citizens in charge work at scale?”

This is the industrial era mindset in which systems need to be rigid for delivering standardized production at scale. Complex adaptive systems give us a different model of scale to consider.

At BIF, we believe in purposeful networks — individuals organizing together in meaningful ways to create value. Not unlike what we see in Dallas right now:

I believe that purposeful networks serve as the basis for complex adaptive systems. To some extent, this notion of purposeful networks is a simplified business model wherein the key capabilities are community assets and people. If a business model is a network of capabilities (people, processes, and technologies) organized to deliver and capture value, a system is a network of business models organized to do this at scale. The same concept applies to purposeful networks.

More interestingly is the value created by a system comprised of purposeful networks. Imagine how dynamic it is when the system is real people interacting with other real people, gathering feedback, learning, and adapting. Imagine how flexible it is because it is decentralized and more capable of changing on demand and in real time. Imagine how customized it is, each node capable of responding to diverse and unique needs.

System leaders understand that personal agency is the keystone to positive outcomes in health, education, and civic engagement. But, as my favorite proverb goes:

To know and not to act is not to know.

In order to deliver on the promise of agency, system leaders need to think, and act, differently. They need to organize differently, giving citizens leading roles in service design and delivery. Not only will the system benefit from their elegant solutions, it will benefit from the new found agency, personal power, and networks catalyzed by citizens in charge.

Originally published on BIF Speak, a Medium.com publication. 

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