Author: Renee Ho
We often talk about how information is power: provide people information and it will change the world.
As an example, in Information is Power, the authors find that providing Ugandan citizens— in local community-driven development programs— with information “report cards” about their health clinic’s staff performance resulted in significant improvements in health care delivery and health outcomes.
But in our simplified assertion that information is power, we are implicitly suggesting that information is in the hands of regular people— citizens or project “beneficiaries”.
The problem with simplification is that things are rarely so simple: information, in itself, is not power but a tool.
Perhaps, much like technology, its real power depends on
- Who is using the information
- How this information is used
When information is released into the ether, it may not just go to the intended beneficiaries. It can be used, manipulated, and controlled by other constituents and stakeholders.
Information is powerful, but for whom?
In the recent article, Giving Doctors Grades, we learn how a well-intentioned information program not only flopped but had perverse effects.
In the early 1990s, New York State developed a system of surgical “report cards” as part of a quality-improvement program. The information on the report cards was shared with hospitals and the public; surgeons who weren’t doing well would get a poor rating and, in theory, be forced to improve.
Instead surgeons veered away from very sick patients that would be difficult to help– the patients that needed help the most. This rating system created risk-adverse surgeons more focused on maintaining a good rating than caring for the sick.
Information, in this case, was powerful but for surgeons– not the patients and hospitals for whom the information was intended. A survey found that only 6% of patients used this report card information in making medical decisions.
Why did the report card in Uganda work in improving health services and outcomes? But not the report card in New York State?
We don’t know the answer to this question, nor do we really purport to. It goes without saying that the report card programs in Uganda and New York State are very different in design, content, and implementation context. There are many reasons why information was powerful for different constituents in each case.
We only note a few glaring differences:
In Uganda, the information was first collected through baseline surveys and then provided as report cards directly to the intended beneficiaries of basic government health services in the neighborhood. The beneficiaries were also organized in a community-driven development program so they received the information in a facilitated way.
In New York, the information was dynamic, provided more generally to the public, and for specialized services from individual surgeons that were not particularly tied to a community.
Another more subtle but key difference leads us to this hypothesis:
The utility of information— at least in the form of a report card— may depend on its purpose.
Is the information for accountability or learning and improvement?
If information is meant to be for accountability (as in the case of Uganda) maybe it’s okay to present it publicly as a report card. But if information is meant to be for learning and improvement (as in the case of New York), public report cards are not the solution and can even be harmful.
When school districts or local newspapers decide to create and publicly publish individual teacher ratings, we have to ask ourselves, are we doing this for accountability? Are we doing this for learning and improvement? For either objective, are the detailed parameters and conditions in place to make it work? Does it make more sense to have accountability be the goal of institutions and learning be the goal of individuals?
If we think that teacher ratings will change the behavior of teachers (and that the teachers are the problem with student learning, and not other factors), have we thought through how the teacher ratings will change the behavior of other constituents and stakeholders in this vast ecosystem that we call public education?
For whom will information really be powerful?