education

A McKinsey report on nonprofits states that not-for-profit organizations have a special need for a vision as a means to guide their actions and evaluate outcomes. A “compelling, easy-to-understand description of how the nonprofit would like the world to change in the next three-to-five years, what role the organization will play in that change, and how the nonprofit will measure the success of its role” (Kilpatrick & Silverman, 2004, p. 3), the vision should pervade the organization’s activities: an ultimate guide for making decisions and setting goals in alignment with collective values and aspirations.

A vision should express values, purpose, and progress toward a better future. It should be neither too specific nor too general. Detailed goals, though necessary, do not belong in the vision itself; they easily become outdated, either once they are attained or when unforeseen opportunities and unexpected consequences occur. On the other hand, noble sentiments and statements of principle do not always easily translate into action under complex circumstances.

A shared vision should be clear and compelling, aspirational for a better world in the future, and describable in simple terms. It should be capable of being understood as a common purpose, and of acting as a guideline for evaluating decisions and outcomes on a continuing basis. Nanus (1992) recommends that a vision be challenging but realistic, and developed by people throughout the organization.

The content of a shared vision is less important than the life it brings to the organization. Peter Senge quotes Robert Fritz that "It's not what the vision is, it's what the vision does." (Scharmer, 1996, para. 30). A shared vision comes from the individual visions of group members; it becomes a force for action through the process of becoming shared. The difference between the shared vision and current reality should generate energy for change. Through its use, a shared vision should ensure that strategic decisions and specific goals are aligned with the organization’s values.

To provide both accountability and allegiance to collective values and goals, a vision must be successfully put into practice. According to Etienne Wenger, "One can design visions, but one cannot design the allegiance necessary to align energies behind those visions." (1998, p. 229); members’ allegiance can, however, be encouraged in the way a group or organization enacts a shared vision—how its members live out their accountability to collective values and goals. One way to promote allegiance to a vision is to use and communicate it constantly; another is to promote behavior, both inside and outside the organization, which is consistent with the vision.

A shared vision lives constantly in tension with fast-changing and unpredictable circumstances. To pursue a vision while ignoring what is practical and relevant cannot sustain an organization, yet the vision is an essential guide to action through a succession of new circumstances and possibilities. Brinckerhoff (2003) believes that not-for-profit organizations should respond flexibly to external demands, while remaining in alignment with the collective purpose. By maintaining the shared vision, an organization learns not only how to do better, but also what better to do; “The world changes, and so must the vision.” (Nanus, 1992, p. 20).

A shared vision helps to guide an individual project with specific tasks and finite lifespan (Christenson & Walker, 2004). Developed in conjunction with stakeholders both within and outside the project members (for example, developers, funders, and the community at large), it helps people make sense of the project plan and their contributions to it. An easily understood, inspiring, credible and challenging vision can create and sustain the alignment of members’ energies, their enthusiasm and allegiance to the group, and their accountability to shared values and specific goals.

When a community or civic project first begins, participants may be highly enthusiastic, each with a strong conception of what the project should be. It is tempting to jump right in and assume that everybody shares the same vision. Proceeding from this ambiguous and contradictory beginning may lead to division and hard feelings within the group, and to unsound early decisions that become "built-in" to the system.

Developing a shared vision may be the single most important task for the group to accomplish at the outset. Developing shared perspectives on both the vision and the process for enacting it are indispensable for success. Good communication is essential; face-to-face group meetings, brainstorming and other methods of envisioning a collective future provide a forum for dialogue which e-mail, for example, can not address adequately.

Steve Cisler suggests the use of a spoked circle as a graphical decision aid to fine-tuning the vision. The circle represents the "space" of decisions and goals, and the endpoints of the spokes represent the two possible extremes of each decision. Cisler (1994) shows an example of the spoked-circle used by the Silicon Valley Public Access Link (SV-PAL) Project. The upright spoke, for example, might be labeled "architecture" and the location of the small circle on the spoke near the "distributed" endpoint depicts the decision to use a distributed architecture instead of a centralized one. A point on the middle of a spoke would indicate an intermediate position between the views represented by the endpoints.

There are no stringent requirements as to how to use the tool. Simply identifying the spokes can be an important first step, as the spokes clearly show which decisions are to be made. It may not be critical to determine the exact location of the spot indicating a decision. In some cases, a group may decide to postpone a decision, but it is a group decision, nevertheless, that ultimately must be made with others in the group. If it hadn't been resolved, for example, whether the network should be free to use or whether there should be fees, the organizers could say, "We're still trying to resolve this. Which approach do you think is best?" The tool can be used as a way to explain compromises or transitional circumstances by showing the current point in relation to the direction along which the developers plan to proceed. For example, when the system is launched it might be deemed necessary to charge users a small fee, but ultimately the system would be expected to be free to use.

A sustainability model was originally constructed, as an analytic abstraction for research purposes, to model the suggestion that three main factors, each with sub-factors, might explain sustainability or its absence in non-profit ICT.
The top-level factors were inspired by the triple bottom line in sustainable development (Henriques & Richardson, 2004) combined with information systems theory. They are associated with longevity (technical factors which affect IT quality and life expectancy), success (management factors which affect the overall impact of ICT use on the organisation) and autonomy (empowerment factors which affect the extent of appropriate relationships with outside expertise). A three-segment graphical representation was created to summarise and integrate these factors visually.

A method of appraising sustainability operationally in any given non-profit was derived from the theoretical model. A questionnaire asks respondents to agree or disagree with assertions associated with sustainability in each of the three main areas, using a five-point Likert scale. Drawing on Bell and Morse's (1999; 2003) approach to sustainability indicators, these qualitative responses are plotted on a three-segment diagram similar to the theoretical model. This results in a visual impression of sustainability, as subjectively interpreted by the organisational stakeholder(s) taking part.

A full "Information Systems Healthcheck" service was then designed (Plant, 2001). The consultant first gathers and preliminarily analyses sustainability appraisal data from completed questionnaires. A face-to-face meeting then takes place, at which feedback is offered, and the situational diagnosis is discussed with client representative(s). The consultation then moves towards initial action planning and change. Possible areas for improvement are drawn directly from the graphical sustainability appraisal "plot" and respondents’ annotations.

Specific action-plans that might bring about change and improvement are identified, focusing on segments where sustainability appears to be weakest. The follow-up to this part of the process involves a wider cross-section of the client organisation's staff being canvassed if possible in order to confirm, enrich or challenge the situational diagnosis and the action-planning steps emerging.

Evaluation of the healthcheck service suggests that it leads to new insight for client organisations. Key phrases appearing on evaluation questionnaires emphasise the strengths of a “completely outside perspective” that “forces the issue” to give participants an “understanding of context” and “make recommendations” from an “unbiased viewpoint” following “critical review”.

Insight appeared to be based largely on bringing to the surface ideas that were already latent within the organisation, newly articulated and legitimised as a result of the engagement. It was therefore argued that internal capacity can be unlocked by employing the external facilitator in the role of a ‘sounding board’. Drawing out multiple perspectives through this participative approach appeared particularly important.

The crucial requirement for the client to take ownership of the process cannot yet be taken for granted. For this reason and others, further action research is needed to confirm or challenge the findings. Follow-up work is time-consuming and demanding for clients, particularly if, as suggested during the healthcheck, the consultant’s definitions of ‘health’ and ‘sustainability’ are to be challenged, reviewed and appropriated to suit local conditions and culture.

The qualitative basis of this work also leads to its own challenges. The most effective sustainability appraisals have been those involving questionnaire responses from multiple stakeholders that express divergent views. Productive outcomes have resulted from the debate and discussion over the multiple subjective interpretations of sustainability that have emerged. Focusing on disagreement as well as agreement can of course generate conflict instead of consensus, so requires sensitive facilitation and careful management.

Furthermore, given that as follow-up clients are encouraged to engage organisational stakeholders at all levels (a move that could generally be considered ‘healthy’), such conflict can be problematic for those in less powerful positions. More generally, the process may influence the existing power balance; this could either be positive or negative in any given organisation. As a minimum, this possibility must be taken into account.

Conflict can affect a group of people positively or negatively; it can be functional or dysfunctional. Some level of conflict can lead to creativity, responsiveness to change, and learning from experience. Conflict becomes dysfunctional when it produces feelings of hostility, interferes with honest communication, and distracts from the shared goal. People become frustrated when conflict prevents them from achieving what they want to achieve. They may react through aggression, compromise or avoidance; each of these makes the situation worse than it was. The result is a diversion of the group’s attention to perceived problems with the collective enterprise: a language of deficit in which not merely the shared goal, but the group itself becomes a problem to be solved.

Geoffrey Bellman writes of the commitment, passion, and “aspiration for a larger life” (2000, p. 68) which energize people who seek to change the world for the better. If we can see the beauty in our collaborations, we can release the creativity that comes from a compelling vision of a future worth working for.

Human beings, the groups and organizations we work in, and the world we inhabit all contain the potential for this larger life. Through consistent attention to what is alive, and to what can be alive in the future, we can become more alive. The belief that that people are good and that they respond positively to being treated accordingly is well-grounded in research on the Pygmalion effect (Cooperrider, 1990). We respond to positive images of ourselves by regarding others more positively: by noticing their successes, remembering their strengths, and seeing challenges from a positive aspect.

An appreciative approach adopts a fourfold cycle of discovery, dreaming, design and destiny (Cooperrider & Whitney, 1999). It starts not by identifying a need or deficit, but by discovering the best of the current situation. It dreams or envisions what a better future might be, rather than analyzing what caused the deficit. In place of planning how to redress a deficit, it collectively constructs a design for a better future. Instead of acting to resolve a problem, this approach enacts a better future as its destiny.

To enact a better future suggests that a life-affirming end is a natural outcome of life-affirming means; we aspire to larger life in the world through larger life in ourselves and in our collaborations. If we learn to be drawn together by a positive image of each other, our collective effort “enhances the potential for creative, fresh human action toward a life-enhancing purpose” (Srivastva & Barrett, in Srivastva & Cooperrider, 1990, p. 386).

This can succeed if we continually revise our expectations of what we can achieve: to open new possibilities for ourselves, for those we collaborate with, and for the world we hope to improve. This requires that we continually learn by developing and revising “the norms, strategies and assumptions which specify what work gets done and what work is important to do” (Dixon, 1999, p. 48). We need to maintain a dialogue, with ourselves and others, about our individual and shared assumptions.

To better understand the value of others, we must suspend our own assumptions. People are seldom malicious or idiotic, but they often work from different assumptions; once we can understand these assumptions we can appreciate their value. For this reason, appreciating differences is critical to collaboration. Once we appreciate others’ concerns (Spinosa et al., 1997), we can embark on a dialogue about how to work together.

Appreciative collaboration assumes that differences are valuable, and focuses attention on what is positive in any situation; in place of a vocabulary of deficit, it offers a forward-looking language of hope. Combined with a clear shared vision, appreciative collaboration allows us to achieve life-affirming goals through life-affirming means.

In a variety of settings from the workplace to village level development initiatives, informal learning through group interactions and individual self-teaching can be an effective tool for developing new skill sets, alternative ideas and even new approaches to advancing livelihoods.

What is informal learning? There is a hot debate among many educators as to what it really is, especially since its practice has become more common place within developed countries as businesses and employees attempt to stay abreast with the latest developments in technologies, and management practices so that they can collectively and individually remain competitive in a market driven environment.

Definition:

• Informal work-related adult education activities that take place without an instructor. Examples of such activities include on-the-job demonstrations by a supervisor or coworker; on-the-job mentoring or supervised training; self-paced study using books, videos, or computer-based software; attendance at brown-bag or informal presentations; and attendance at conferences, trade shows, or conventions related to one’s work or career (nces.ed.gov/programs/coe/glossary/i.asp).
• Occurs in everyday life and may not even be recognized as learning by the individual. For example, using a television guide may not be equated by an individual as having learned how to use a table. Related concepts/terms include: incidental learning (www.nald.ca/adultlearningcourse/glossary.htm).

To better illustrate, here is a visual aid used to describe informal learning processes based upon information need.

In the developing country, informal learning has gained a reputation as a tool for meeting a number of goals that not only include skills training, but also civic and health related education that can be acquired through individual inquiry, as well as through group interactions. Similarly, adult literacy projects that utilize an informal education approach (predominately among women populations) have gained increasing prevalence. In fact, women participants of local self-help groups often support one another through imparting knowledge to one another, they can help to tutor each other in their homes for building up literacy and educating each other on personal finance.

When done in a group context an informal learning project can consist of a number of group led demonstrations that relate to managing one’s personal finances, to starting a business, as well as how to use a computer for e-mail and even how to access your political representatives. The learning spaces are as dynamic and varied as the topics and the people often involved in them. Sometimes these groups are started through simple conversations among neighbors, or the group is seeded with support by an outside agency that brings some structure to the initial group development but after time allows the groups to be autonomous and define its own interests and pursuits.

Similarly, online learning groups can assist its members in learning new software, or computer programming. Take for instance the number of user forums dedicated to asking and answer technology related questions. This exchange among participants constitutes an informal learning group in which information is shared that ultimately builds upon the skills of the participants. In this online dialogue, individuals bring to the group their own experiences and expertise to share with other members of the group to help support a mutual sharing of knowledge. Even those not openly communicating with the group can benefit from finding answers to their own questions. As new doors are opened through this process new levels of curiosity emerge that can aid in the further participation in the group.

While these types of learning communities are contingent upon access to information technology; in other contexts these groups can meet within their geographical proximity. Community animator can act as a facilitator by asking participants questions that help them ask new questions or find answers to question that they may have not known how to answer before.

Regardless of how a group is organized the informal learning group serves two basic functions to provide access to information and knowledge creation as well as evoking a deeper level of individual curiosity among participants and to prompt them towards greater levels of self-enrichment, whether that be for financial gains or merely inner personal gains.

Though informal learning has gained greater focus over the years within development related education and beyond, technologies and access to information resources can make this pattern difficult to effectively utilize. While usage of these groups in development initiatives is high its difficult to ascertain whether or not they have had the level of benefit being represented through the increased effectiveness among employees with the corporations of more highly developed countries. While, this does not mean that informal learning groups are inadequate but it perhaps highlights the acceleration of learning possessed by those who have greater access to information on a larger scale. For this reason this pattern could be made more effective within a development related context through the linking with other patterns that emphasize technology infrastructure an alternative access to information for groups.

There are many ways of speaking to this family of problems/issues/concerns: face-to-face get-togethers, from conversations to conferences; email/discussion lists, blogs, web sites and bulletin boards; books and articles; faxes and radio—are all useful approaches. Tying into all of these, regular publications have come to serve a key role in movement-development and community-building. Tom Paine's Common Sense at the beginning of the American Revolution, arousing the colonists in a radically new "common sense" way, and The Federalist Papers, the country's first major newspaper op-ed series, designed to convince people to support the newly drawn up Constitution—these crucial works of popular journalism that helped set our country's founding are indicative of what can be found in any social and political movement, large or small, specialized or general. Regular publications that cover the events and developments of a movement are indicative of the depth of thought and commitment that people have to their work and their interest in sharing it and learning from one another. Movement/community-building journalism and their publications are most often written and produced by the actors and participants in the movement and provide reflections on the roots and meanings of specific contributions to the field; they tie particular events and achievements, programs, institutions, and actors to a wider field of interconnected activities that together point toward renewed possibilities for people creating a healthier and more democratic common world. Consider professional academic disciplines, how they all have their many journals (international, national, regional) and their growing on-line availability and distribution, and their importance to developing cohesion and direction in their respective communities of practice. Consider the situation among artists, social workers, leftists, conservatives, citizens of any size viable community. In American political life, consider the longevity of key political journals and how they have not only reflected trends and movements but helped define the movements themselves and provided an arena for its participants to learn about and from one another—that strand of radical liberalism that has characterized The Nation from its inception as a vocal anti-slavery voice, the descent from progressive liberalism to neoconservatism represented by The New Republic, the development and fracturing of the radical political culture and politics of eastern European Jewish immigrants as found in The Partisan Review, Dissent, and Commentary.

In the field of community media and technology, the Community Technology Review (www.comtechreview.org) reflects several useful pattern features of current community-building journalism:

• CTR has served as the formal and informal publication of both the Community Technology Centers' Network, www.ctcnet.org, the country's oldest and largest association of nonprofit and community organizations dedicated to providing emerging technology resources for those who don't ordinarily have effective access, and of the Association for Community Networking (www.afcn.org), the affiliation of institutions and individuals interested in developing community-wide information resources and tools. CTR has covered key directions and issues of its two prime organizational partners by placing them within the developments of the wider field of community media and technology. Thus, for example, the fall 1999 issue was a joint production of CTCNet, AFCN, and the Alliance for Community Media (ACM, www.alliancecm.org), the national association of community cable public, education, and governmental (PEG) access centers; ACM and community cable access center development receive on-going coverage. CTR has maintained close relations with the Community Media Review, ACM's official publication; with the fairly-recently established Journal of Community Informatics (http://ci-journal.net), the international journal of what is emerging as the emerging academic discipline of the field, especially outside the United States; with the Digital Divide Network, the online communication environment (at www.digitaldividenetwork.org) that has done so much to address issues involving the problem identified in its name; and with the Nonprofit Technology Enterprise Network (www.nten.org), the association of nonprofit technology assistance providers, and has offered ongoing coverage of NTEN, Circuit Riders, CompuMentor/TechSoup and other organizations/developments in this part of the field. To the degree it is a model, CTR suggests that coverage of key organizations in a field provide a useful map that can be of assistance to both the experienced actor and the new participant looking for information and guidance.

• CTR is published simultaneously on-line and in hard copy, using state-of-the-art tools most appropriate to each environment. The developing on-line environment has been designed with open source publishing tools (Movable Type/Drupal) that provide a large number of embedded hyperlinks for readers to easily explore special areas and references in depth, extensive searching capacity throughout the archives (www.comtechreview.org/issue.php), interactive options for reader comments/additions and communication with authors and editors. Desktop publishing is tied to appropriate printer and print-on demand options for hard copy production and distribution, providing a tangible publication for those readers and occasions where hard copy availability is especially appropriate and useful. With the growing number of links to community-produced audios and videos, CTR provides an integrated multi-media platform that models a variety of approaches that can be used.

• Articles are written by a combination of recognized leaders in the field and first-time authors who have worked on innovative projects and new resources. With first-time authors, editorial staff have expended substantial time in providing writing and editorial assistance. Overall, the tone and approach towards the reader is one that assumes an interest and some familiarity with the field but one that seeks to provide explanations and meanings when technical or field "jargon" or acronyms are used; in general the CTR seeks to welcome the reader into an on-going conversation among some of the major practitioners and leaders in the field (hence the inclusion and important role of photos of authors and individuals who are participants in the events covered). In contrast to so-called "objective" or "neutral" journalism and reportage, movement building journalism engages both the producers and readers in a way that builds and strengthens their communities.

Citizenship Schools originated in South Carolina in 1959, and quickly spread throughout the South through the Highlander Folk School in Tennessee. In the late 1950s many Southern states had literacy tests, that required people to be able to read and write, and sometimes answer "citizenship" questions (generally designed to exclude blacks from voting). Teaching large numbers of African-Americans in the South to read, write, and learn about citizenship was critical in the larger struggle for civil rights, including the right to vote. According to Andrew Young and Ella Baker, movement leaders, the Citizenship education program was the "foundation on which the entire movement was built." (1) But communities with Citizenship Schools had few ways to make connections with other communities that lasted over time. Eventually, as the early fights for civil rights were won, the schools faded.

The spirit of the schools lived on through the decades that followed in hundreds of civic training programs conducted by organizations and local communities. Faith-based community organizations like the Industrial Areas Foundation train local clergy and lay organizers who learn to conduct campaigns and forums to build consensus on issue agendas like housing, school reform or job training. Environmental watershed, forestry, eco-system restoration and justice movements and others, teach citizens and youth to collect data and monitor environmental quality while building skills of civic trust and cooperation. And new civic movements to build a new model of the public and civic university are growing, like the Council on Public Engagement at the University of Minnesota .

Citizenship Schools have also beeen tried online. In 1994, the American Civic Forum met to try to address a widely perceived crisis in political life and civic culture in the U.S. The Citizenship Schools were an imoprtant model and a Civic Practices Network (CPN) was built, to use the newly emerging technology of the Internet to build skills of citizenship. CPN, launched that year, sought to facilitate broad and multimedia sharing of best cases, civic stories, mutual evaluations, and mentoring opportunities. Other independent civic networks also emerged around this time, including LibertyNet in Philadelphia, and Civic Net. Despite the growth of the Internet, however, no broad network connected and nurtured these activities.

As the web matured beginning around 2000 finding information on many topics of civic interest-public deliberation, the environment, youth, education, health care, communication-became relatively easier for individuals. But the new problem was how to link these groups together to not only provide information in their own specialized subfields, but to create an active environment for teaching, learning, and collaboration while also building a larger sense of solidarity in citizenship. National civic portals to aggregate the growing number of civic sites and discussions on the Net were one proposed answer. But by 2003 or so with the emergence of the blogosphere, the topology of the web itself suggested that distributed links among widely dispersed civic sites might lead to new kinds of collaboration in which a great deal of the work of gathering and connecting is done by sites in the mid-range. This is the level most appropriate for new citizenship schools on the web.

Therefore to build Citizenship Schools in local communities and institutions it is necessary to build a framework that can support many local organizing efforts with curricula and training routines that are distributed, shared, inexpensive, flexible, and sustainable. These can be done in local communities, through institutions like schools and universities, and on the web.

Local citizenship schools would necessarily be the result of pooled efforts among many active local civic organizations across different areas. Many could benefit from local government support. In Seattle, for example, the Department of Neighborhoods provides leadership and skills training to many neighborhood, environmental, and other civic groups.

Citizenship Schools through university extension and outreach could train new expert practitioners rooted in local communities. For example at the University of Minnesota, the Council on Public Engagement reaches out to both scholars and academic staff to redefine the teaching and research mission of the publci university. Potentially, certificates and university credit through university extension services and community colleges could provide individuals valuable learning resources that also support and reinforce the extended investment of time, attention, and civic commitment.

New Citizenship Schools on the web could allow collective learning in a distributed, asynchronous environment; help frame a broad civic agenda collaboratively through distributed discussion; and form a mid-range network of portals to focus attention without the intial high costs of building national space. Schools on the web could support and integrate both local and statewide efforts. The CPN is one online model indicating that there is significant demand online for serious learning material about civic practice. Deliberative-Democracy.net demonstrates how key blogger-editors can be recruited for a civic site and distribute the labor of a serious, ongoing conversation. The Liberating Voices Project [check best name] is also a key example of a distributed learning collaborative.

For the pattern to be realized online, moderate-sized hubs with committed editors will need to be seeded and a few models created. Possibly, Citizenship Schools on the web could ally with university partners, particularly in civically oriented extension programs, to provide credentials and a modest flow of support. Their life-cycle is potentially renewable. If a network of citizenship schools succeeds, it could become self sustaining, using commons models with relatively little ongoing external support.

The biggest challenge in building Citizenship Schools on a commons model is sustaining energy and collaboration, and maintaining a high quality of information. As noted, a commons model requires moderate levels of commitment from a wide core. Many of the contributers will be citizens, academics, policy makers and administrators with other jobs and commitments. Rewards will be instrinsic. A second challenge is to get citizens to commit time to learning, not to just "graze" for information.

The main critics of the concept might say that Citizenship Schools are an anachronism and depend on communities of face-to-face solidarity that are less relevant by the year. Learning doesn't take place this way anymore, despite the fact that the Citizenship Schools would be on the web. Further, getting individuals to make long-term commitments at adequate levels will be nearly impossible.

As healthcare in developed countries becomes more complex, more sophisticated and expensive systems are being put in place, with no proof that delivery of care is improving. Inasmuch as these systems succeed in reducing costs, they tend to benefit the large public and private healthcare providers who sponsor them. They constitute ever more effective electronic filing systems for information about patients, but which those patients neither see nor use.

We live in a world of choice, and if there is little access to information about patients there is plenty of other information for them. More and more, the public seeks information so as to choose among their options for treatment. At the same time, more and more is available on the Internet (e.g. www.nhsdirect.nhs.uk) for those who want high quality information about health and well-being.

Simply providing information is a job half-done. Until patients can work with their own health indices, such as blood pressure, blood sugar, cholesterol and diabetes status, for example, they will find it difficult to relate information they find on websites to their own health. Secure systems already exist for patients to add blood pressure and blood sugar data to their records (“UK Doctors”, 2003). Clinicians welcome such information when determining a patient’s treatment management plan, especially if it can be easily found in one place. Clinicians who have experienced patient-maintained personal health records in become enthusiastic about the practice (Protti, 2005).

Traditionally, the medical practitioner has provided a bridge between medical knowledge and the patients themselves. If a treatment plan did not perfectly match the patient’s needs, or if the patient was challenged by changes or crises, then the practitioner would take responsibility. Nowadays, there is seldom a single clinician involved in any patient’s care; no single person is in a position to mediate between the complexities of medical technology and the real-world experience of the patient. Patients themselves are willing to contribute to this role; they are clamoring for access to their full electronic health records so as to see for themselves what clinicians have written about their individual consultations, the results of tests they have undergone, letters that have come back from specialists, and what medications they have been prescribed both in the present as well as in the past.

Fulfilling the goal of active patient involvement in healthcare through access to medical records offers many opportunities and challenges. Patients could verify the accuracy of their medical records (Cross, 2005), and access their medical records wherever in the world they travel. Given proper controls for privacy and confidentiality, patients could share their information with others if they so wish. Given professional protocols between medical practices (the lack of which has led to bad outcomes for patients in the past), availability of information on patients should be protected at all points of healthcare service delivery. Some patients may find some information in their records upsetting, while equivalent information may help in the treatment of other patients or other conditions. Patients may need protection from seeing some information about themselves before a clinician has discussed it with them, and this may limit a patient's choice to access to full information. Information about a patient gleaned from a third party requires careful treatment before it is entered into the record.

The clinician’s role as mediator between medical expertise and the patient’s experience will never go away, but it will change. Some of the opportunities of patient access to medical records may save clinician time, and others may not. Some patients will thrive on the ability to combine health information on the Internet and elsewhere with information about themselves from their medical records; others will not. With the right of online access to medical records comes the responsibility to deal with the information presented on a computer screen. The informed and responsible patient, comfortable with interpretive tools for making sense of medical data, has greater trust and confidence in the medical profession. Such changes in health behavior cannot be left to the technology and the information; they may require emotional support that depends upon some degree of human intervention.

Online recording of medical information by patients is already being done (www.ihealthrecord.org; www.healthspace.nhs.uk). Online patient access to medical records is beginning (www.paers.net; Bos, Fitton & Fisher, 2006), and it presents a cutting-edge challenge for practical trust between patient and clinician, and amongst medical providers. Medical records are being put online anyway, and over time they will become increasingly interoperable; the challenge is to make record access not merely a cost reduction measure for administrators and providers, but a tool for patients and their families to participate in their own healthcare.

The world of mirrors — and, hence, any discussion of them in a metaphorical way — leads to reflections and reflections of reflections and reflections of reflections of reflections and so on. So be it.

Mirrors reflect, but not perfectly. At the very least they reverse the image that they're reflecting. We're only using mirrors, however, as a metaphor for reflection or replication.

Due to the size and complexity of most of these mirroring endeavors, formal or informal organizations are established to tackle the job. For many reasons organizations that mirror to some degree the area within the overall environment that they are focused on are likely to have more success than those who don't. An institution is society's attempt to make a "machine" whose output is of a desired type. It reflects (however imperfectly) the desires of its creators and maintainers and its "products" are "mirror images" of each other (or at least have the same "family resemblance.") "Mirror Institutions" are those institutions that reflect or reflect upon other institutions or other realities. As such this pattern covers a very wide range. To cover this wide range we've identified four important facets: the reflective mirror institution, the critical mirror institution, the alternative / generative mirror institution, and the flattering mirror institution. The boundaries between these different institutional mirror types aren't clear. It's hard in other words, to know where one ends and another begins. And the "mirror" itself (at least the metaphorical mirror we're talking about) is a constructed object whose object is implicitly or explicitly what it's set up to be and what it has come to be (while realizing, of course, that the characteristics are not completely knowable either but are subject to interpretation themselves — via another mirror. And, like all mirrors, the reflections can be seen from many angles.

The reflective mirror institution is used to help us understand without bias some aspects of the "real world." This institution needs to reflect the most salient aspects of its object back to the people who need to understand the object. Scientists ideally employ this type of mirror institution when they endeavor to understand the complex and intricate relationships within the physical environment.

James A. Wilson in his essay "Matching Social and Ecological Systems in Complex Ocean Fisheries" states that the "mismatch of ecological and management scale makes it difficult to address the fine-scale aspects of ocean ecosystems, and leads to fishing rights and strategies that tend to erode the underlying structure of populations and the system itself." He goes on to state that "This is likely to be achieved by multiscale institutions whose organization mirrors the spatial organization of the ecosystem and whose communications occur through a polycentric network."

Problems can result arise if people believe that they're using a reflection that has perfect fidelity or if they're work is overly influenced by ideology.

The critical mirror institution is used to uncover, analyze and expose the failings of another institution. Using the explicit philosophy, goals, and practices of the institution itself to show the stark contrast between their often noble rhetoric and what they're actually doing is a common approach. In the U.S., for example, the OMB Watch organization performs a "watchdog" function on the Office of Management and Budget (OMB) within the U.S. government. The Bretton Woods project uses the decisions made by global economic powers at the 19__ Bretton Woods meeting as the basis for its critique of international capital and its institutional handmaidens.

The alternative / generative mirror institution is used to develop — and propagate — alternatives to existing institutions. Governments in exile are one use of this pattern, as are community banks, whether they're in Venezuela or other countries. Sometimes the alternative is then mirrored into multiple versions of itself. Federated institutions that are loosely connected to each other and more-or-less the same type of species represent a good way to develop strength globally while maintaining local control. This was used in the realm of independent, non-commercial communication, including community access television, community networks and the Independent Media Centers movements.

The World Social Forum is a blend of two mirror institution facets: the critical and the alternative / generative; it established itself as a counter-forum to the World Economic Forum which promotes alternative ideas and visions. The World Social Forum is also being mirrored in the form of regional and thematic forums.

The flattering mirror institution is an existing mirror, sometimes called an infinite mirror that is self-referential, often self-indulgent, self-deceiving, self-reinforcing, and sycophantic. That is, to a large degree, the state of the media today, endlessly reflecting upon itself like an echo chamber.

[Note that media reflects society — however incompletely — back to itself. As Israeli journalist Gideon Levy of the Haaretz newspaper pointed out "The Palestinians know what the Israelis are doing."]

There are several ways by which to look at any mirror institutions — especially when setting one up.
   The object or environment — What is standing in front of the mirror?
   The reflection — What is being reflected?
   Reflecting on the reflection — What are you seeing in the reflection? Should you be looking for other things?
   The audience — Who is (or should be) peering into the mirror institution?

Does relying exclusively on "reflections" mean that wholly new institutions can't be devised? Although brand new institutions can be created through a series of partial changes, this argues for more of an intelligent (or pragmatic, efficient or opportunistic) design, rather than creation. Decentralized Intelligence Agency?!

Challenges: Adopting and realigning when necessary. Maintaining a network with like-minded organizations — mirror or not. The "mirror" approach is ecological — but who's doing the "higher level" work?? Governments exists to (or should exist to) sort out (or at least assist with the sorting out process) issues related to rights and responsibilities — who (and what) can do something and who (and what) should do something. Associated with this is the task of developing (and exercising) incentives to encourage people to do the right thing and penalties for those who don't.

This is a pattern for conscious adaptation. A pattern transformation, since culture is propagated by its institutions. This is very much an analogy to basic evolutionary theory. Mirroring implies copying -- but generally copying with changes made to one or more aspects of the original in the process. Liberating Voices is a mirror of A Pattern Language.

The use of the concept of "citizen diplomacy" was apparently first applied when US citizens journeyed to the former Soviet Union in the 1980s and met with activists, educators, scientists, health professionals and "ordinary" citizens. These citizens — and their Soviet counterparts — did not want to accept the "inevitability"of war, either hot or cold, and sought to find common ground on which to build a more peaceful future for everybody. Citizen diplomacy offers the promise of (world?) peace by building on actual, hopeful and optimistic face-to-face encounters by citizens of the designated enemy states.

The idea for this pattern, like others in the language, arose in a specific historical context, namely in the late 1980's during the protracted "cold war" between the Warsaw Pact nations (most notably the Soviet Union) and the NATO countries (most notably the USA). Although the information reported here is based on experiences from that time, it is expected that this pattern will be applicable in a great variety of situations in which two (or more) states or other large groups are enemies. Several antagonistic dyads come to mind — India and Pakistan; Israel and the Arab States; the US and Cuba or Venezuela — and each situation contains its own unique opportunities and risks.

People who engage in projects along these lines certainly fit Richard Falk's description of a "citizen pilgrim" who is willing to go on a quixotic journey for a seemingly improbable goal.

Interestingly, especially in a pre-Internet era, many of the collaborative efforts (described in Citizen Diplomacy: Progress Report 1989: USSR) were related to the use of information and communication. Some of the projects include Children’s Art Exhibit and Book, US-USSR State Bridge Citizen Diplomacy, Moscow-DC Live Broadcast: Soviet Citizen’s Summit, Peace Lines: Computer Supported Net-working, US Kids to Siberian Computer Camp, Electronic Peace Mail Project, Video Conference: Doing Business with USSR, and World Civilization and Education Centers.

The collaborative projects themselves are subject to enormous challenges. Simply meeting with people from "the other side" presents great obstacles (including financial costs, legal restrictions on travel to — and within — the other country, privacy of communications, and access to people). Furthermore, any collaborative project, unless it is done clandestinely, will exist "at the pleasure" of the powers-that-be. In fact, one of the ultimate risks inherent in a project like this is that individuals being used or manipulated by the powers-that-be (such as the media, state power, think-tanks, political parties, or religious institutions) in ways that simply overwhelm the hopes and energy of the citizen-diplomat.

Since the unraveling of the Soviet Union in the early 1990's, the global situation as noted above has changed considerably. The rough parity of power (exemplified to some degree by the size of their nuclear weapon stockpiles) between the Warsaw Pact countries and the NATO countries and the promise of "Mutually Assured Destruction" (or MAD) helped prevent direct confrontation and led to numerous "proxy conflicts" which were sponsored in part by the combatant's respective superpower allies. The military parity has now largely dissolved and the arms race between the US and the USSR has given way to a one-sided arms race where the US appears now to be competing with the rest of the world; its military expenditures (including several new nuclear weapons) now amounts to nearly half of the world's military expenditures.

Finally it must be said that it's not obvious that collaborative projects like these will yield any long-lasting benefits. An interesting example is that when the US media entered the Soviet Union after Glasnost, they followed the routes that the citizen diplomats has established. While it's true that relations were finally normalized between the two countries, the citizen-diplomat may be well-advised that setbacks may outnumber the gains.

The projection of a three-dimensional, multimodality, co-located, synchronous deliberation experience (i.e., communicating face-to-face in a non-virtual place) onto a two-dimensional, primarily visual, distributed asynchronous interaction requires essential aspects of face-to-face deliberation to be remapped onto a screen interface. The needed mappings can be judged according to two broad goals:

• Visible relationships. Relationships between comments and the texts they reference, between different comments, and between group members and the document and discussion should be as visible as possible.
• Distinguishable boundaries. Separations between contextually related and unrelated text and comments and between individual authors of documents and comments should be as distinguishable as possible.

We first consider visible relationships. Exhibiting relationships between the components of document-centered deliberation (document, comments, and participants) implies a number of refinements of this goal. First, the document text that is the target of deliberation should be covisible (displayed simultaneously) with comments around it, and the identities of comment authors and document text, when relevant, should also be covisible with their output. Second, the referencing relationship between a comment and its target text should be visible, that is, the interface should incorporate ostensive pointing (meaning that a pointing relationship is displayed on the screen rather than being enacted through a peripheral device) and in-text placement of comments. Third, response relationships between comments should be visible through threading. And fourth, the reactions of deliberation participants should be visible through polling and decision features.

The other goal is distinguishable boundaries. Visible relationships can be inadequate, as anyone would know who has used a map with ambiguous place labelings. The interface should also mark boundaries between text that is and is not the reference target of a comment, for example, though text highlighting. Text authored by different people at different times should be distinguishable through textual boundaries. The topic of a text should be able to be viewed separately from its main body through headers. And obsolete comments (those made on a previous version) should be recognizable through pertinence markers which indicate which versions a comment pertains to, as well as those to which it does not apply, for example, because it has been addressed in the revision process.

The Deme environment for online deliberation is a tool for document-centered discussion, polling, and decision making that incorporates all of the elements derived above in a dynamically updating (no-page-reload) interface. The introductory image above shows the most recent design of the meeting area viewer in Deme. The shaded-in header of a comment in the discussion view pane on the right points to a shaded-in comment reference in the text of a document shown in the item view pane on the left. Deme provides covisibility between document and comments through an optional split-screen view. In-text comment references are transiently pointed to (the dotted-line arrow goes away as soon as the user scrolls) when clicked on, and comments are displayed in the context of hierarchical threads. Members can vote on documents under a variety of decision rules. Boundaries are provided through highlighting, text boundaries, headers, and a versioning system that remembers when comments become obsolete and marks them as such. The design takes advantage of no-page-reload web server calls to provide dynamic relationship visibility and boundary distinguishability.