s2e15: What Twitter Should Do; CXO vs CUO; Shilling 

by danhon

0.0 Sitrep


12:20pm on Tuesday 4th August 2015, lunchtime at the Code for America office in San Francisco. I was walking back from lunch and thought I might do a What Dan Would Do kind of collection of things today. I’m still a bit buzzing from Foo and this whole concept of just going out and actually doing/delivering the things (ha, the strategy is *delivery*, you see. The strategy is pointedly *not* delivering newsletters) instead of reckoning about them. So, today, a bit of Alternate Timeline where these are some of the things I’m doing. Maybe.


1.0 What Twitter Should Do


Let’s try and do this quickly, in bullet points.


* The Ev Williams era of Twitter back in mumble mumble (it doesn’t matter, just that it was pre-iPhone and SMS texting was a thing) as a microblogging service. Twitter was a *bit* mobile, but not *very* mobile.


* This is Twitter as in democratization of publishing – a way to talk to the world and to have conversation. Tweeter shall tweet unto tweeter. This has done some undeniably amazing things, because networks because lowering barriers to communication and also, eventually, because mobile.


* Then, after a while, post Mobile Explosion That’s Still Happening Or In Other Ways Has Happened Enough, you get a valid Jack Dorsey view, of Twitter as a genuinely useful window onto the world[0]. In other words, Twitter-the-platform has gotten big enough to now do two things for two different types of users: be useful enough for a) people who want to have a conversation, and b) people who want to know what’s going on.


* This is pretty much two products. It’s the conversational Twitter that a whole bunch of hardcore users are on about where they don’t want their timeline fucked up. These people are, arguably, producing the work-for-free value and contributing content to the network. They’re doing it because people like feedback.


* Then there’s everyone else: and if we just take as read that the rough 1:9:90[1] rule of participation continues to hold even when networks scale to unprecedented rates (e.g. Facebook sizes, and I suspect it does), then there’s *way more* people who just want to look at Twitter – the lurkers – than want to to use it as a microphone.


* So: your conversational product that’s optimized toward making the best, clearest, simplest, fastest microphone as possible, with a little bit of listening to help those users find the conversations that they want to take part in. That’s probably Twitter.app that already exists. You’ve just got a clearer direction and vision for it now.


* And then the new one. I have no idea whether it’s anything like Project Lightning[2] is going to be anything like this, but it’s already weird that it’s being billed as a new “feature” of Twitter that’s going to be in the Twitter app, as opposed to a separate thing that really clearly and simply does the separate thing of helping people find out about what’s happening.


* *This* product – not the existing Twitter.app – should be totally optimized toward finding stuff that’s happening – and in that respect it makes some of the profile page product decision (ie: no longer being a simple reverse-chronological list) make sense (if you’re trying to tell a story as to why Twitter might have done that). Reverse-chronological *might not be* the best way to help someone figure out the most important thing that is happening.


* In other words, don’t try to make a weird microphone-window hybrid. Make a great microphone and make a great window.


[0] The Case for Jack Dorsey, Twitter CEO – Stratechery by Ben Thompson

[1] 1% rule (Internet culture) – Wikipedia, the free encyclopedia

[2] This Is Twitter’s Top Secret Project Lightning – BuzzFeed News


2.0 CXO vs CUO


I tweeted earlier in the day that, during a conversation with Rebecca Coelius, our literally awesome Director of Health at Code for America (seriously: she’s an MD, a Fulbright Fellow and before Code for America was Medical Officer for Innovation at the Department of Health and Human Services), I’d had to inevitably explain what I thought was the distinction between a Chief Patient Officer and a Chief Experience Officer.


I was making my case for why I thought healthcare groups should have a Chief Patient Officer – someone with the responsibility to improve the end-to-end patient, er, “experience”, as it were, and therefore remit to cut across silos in order to meet that responsibility. Because there are some Chief Experience Officers in hospitals and medical systems and practices already, and I think the point that I made (and I should stress that this wasn’t an argument – it was just a request for clarification) was that, if you’re just looking at the terminology of the job title, the problem with a title like Chief Experience Officer is that – well – whose experience? What for? I mean, we’re all having experiences all the time, right?


For me, the distinction is in the purpose, and I might just be primed because I’ve been thinking about the idea for the last few months. But the point of a Chief Patient Officer is a bit like a Reader’s Editor, or an Ombudsman – someone who’s looking out for the customer or the audience or, as is being emphasised (to pretty good effect), the user.


I suppose the analogy to draw would be how the UK Government’s Digital Service successfully created the role of Chief Digital Officers – whose responsibility is to focus on digital service delivery to users – as opposed to Innovation Officers or User Experience because there’s more of a focus on the “so that”. Part of this, I suppose, is an attempt to carve out a sort of space or end run to explicitly make user needs (or, in this case, a specific class of user’s needs) important. You could also make the argument that having a Chief Patient Officer means focussing on patients-as-users to the detriment of Every Other Damn User In The Hospital, of which there are Seriously, A Whole Damn Load, in which case I’d counter with the fact that concentrating on the Patient User has the second-order effect of making it service-providers-as-users needs important, so they can actually do a good job of meeting the patient’s user needs.


So, that’s what I’d do: I’d look at the stupendous amount of money being spent in the American healthcare system and I’d go to either Sand Hill Road or private equity with a long-term gameplan and say: hey, see Kaiser and those other integrated healthcare systems? Would be an awful shame if someone came along and did a substantially better job for less money and out-competed them. Because the thing is, Kaiser, one of the better-performing healthcare systems, is doing well because it’s (from what I understand, at least), pretty well vertically integrated. They get to do things like preventative care well because they’re an insurer and a provider and they do everything: because preventative care saves them money. But one place where they’re not doing well is in software because they’re stuck with the same options as Every Other Damn Healthcare System In The Entire World right now, which is that you get to choose between shitty option (a), which is Epic, or shitty option (b) which is Cerner. So Kaiser has to spend about a billion dollars (really), buying a new software system, and the DOD has to spend around *nine* billion dollars, over the project’s lifetime, buying a new software system. Both of which are bits of legacy software that date back to the 70s and grew to include workflow and electronic health records out of the most important bit of American healthcare, which was billing. And this isn’t even coming anywhere near the fact that most of the hardware and medical devices in healthcare systems are still pretty shittily designed! So yeah, that’s what other me would do: build a brand new integrated healthcare system with technologists because software can eat the provision of medical care, too.


Of course, this is one of those stupid plans that is too stupid and too naive for me to understand all the numerous holes that can be shot into it, which is precisely why someone should do it. And part of the plan relies instead of just being a software shop that sells in software to go for the even stupider bigger part of the pie, which is the whole. damn. hospital. system.


Oh, and it doesn’t even matter if there’s more than one competitor in the market! The American healthcare market is too big and too insane anyway! There’s lots of room at the top of American healthcare.


Part of this is a sort of irrational exuberance that is still in my system post Foo Camp which is that this shit needs to be built and it doesn’t look like there are enough people doing it. So you can either complain about it or get off your damn ass and stop writing newsletters.

How much does it cost to build a hospital system anyway?

(I think I might have buried the lede in the title for this section. It probably should’ve just been called Insanely And Naively Disrupt The Hospital System)


3.0 Shilling


So I’m doing the closing keynote at the HOW Interactive Design Conference in Chicago later this year. This is terrifying because there are a whole bunch of other people who are speaking who are super smart and actually know things. You probably want to listen to them talk about the UK’s Government Digital Service, how Buzzfeed, NPR and Lynda do design and some new startup called Slack that’s all weird because it’s got liberal arts majors in it or something. And then there’s me right at the end, so people can leave early. If you want to listen to all the smart people, then you can get $50 off the registration fee by using the code HON50 which is my last name with the number 50 and not MYLASTNAME50 and definitely not HON50’); DROP TABLE USERS.


So. Come see people smarter than me (like that chap Russell Davies I keep going on about) talk about awesome things they’ve done and save $50 bucks[0].


[0] http://www.howinteractiveconference.com/index.php/register – use HON50



9:45pm and we’re wheels down in PDX.


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