Why do so many promising solutions — in education, medicine, criminal justice, etc. — fail to scale up into great policy? And can a new breed of “implementation scientists” crack the code?
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more about how there is shaping the future of agriculture. Visit crop science, dot bear dot, com. Usually, when children are born deaf, they cause nerve deafness, but really not the actual nerve, its little tiny here, cells in the cochlea Venus us, is a physician scientist at the University of Chicago and more dramatic We, she is a pediatric surgeon who specializes in cochlear implant my job. To implant. This incredible piece of technology, which bypasses these Active here cells and takes this on from the environment. The acoustic, sound and transport said into electrical energy, which then stimulates the nerve in somebody who is severe to completely profoundly deaf after
implantation can have normal levels of hearing, and it is pretty phenomenon. It is pretty fast If you ever need a good cry, happy cry just type in cochlear implant activation. On Youtube, you'll, see little kids, during sound for the first time in their parents, slipping out with joy She smiled even worse, the cochlear implant is a remarkable piece of technology, but really it just one of many remarkable advances in medicine and elsewhere, created by devoted researchers and technologists sundry, smart people
but even more remarkable. How often we fail to take advantage of these advances, one of the most compelling samples is the issue of hypertension Bear a third of all Americans high blood pressure? First of the awareness rate is about only eighty percent of those. Only fifty percent actually are controlled. Have great drugs frame, but you can see that ask aid of issue when to disseminate you have to hear etc, and the public health ramifications of that prescription adherents is a very difficult not to crack its job lists he's an economist at the University of Chicago. They actually have to go and get the medicines which a lot of people have a very hard time,
doing, even though its sitting next to your bed every night people don't take it and they don't take it because they forget that don't take it because the society fact is a lot worse than the benefit they think they're. Getting. These types of problems as humans, including myself, we do a real a bad job in trying to solve all of us, Our lives get busy, we forget, You didn't think you'd have an inherent issue with something like the cochlear implant. It has such an obvious upside, and yet, when I put internal device in it stays there, but it actually the fires and external portion is well sort of like, hearing aid, and that is the part where you see issues related to it, just because I put the Internal part: does it mean that it all or a child, will be wearing external part in ones.
But he only half of the participants wore their device full time I mean we have figure through randomized control tries to understand causation, real impact small scale by the next step is understanding. The science of how to use this science, because you know how you do it on the small scale in perfect conditions is very different than the messy real world in that it very real issue today, Humphrey radio what to do about that very real issue, because you see that something not just in medicine, but in education and economic policy and elsewhere, solutions that look foolproof in the research stage or failing to scale up. People said: let's just put it out there, and then we quickly realized that are more complicated. There might be something that you think would be but it's never going be able to be implemented in the real world. We need to know what is the matter. Jack saws.
Who go in search of that magic. Sauce read after this from stature and Gunnar productions. This is frequently radio broadcasts and explores the inside of everything. Here's your home Stephen governor. John list is a pioneer in the relatively recent movement to give economic research more credibility, in the real world if you turn back the clock to ninety nine days. There was a credibility evolution in economics, focusing on what data
in modeling assumptions, are necessary to go from correlation to causality list responded by running dozens and dozens of field experiments no MIKE and tradition in the credibility. Revolution was instead of working, secondary data. I actually went to the world and use a world is my lab in generating new data to test theories and estimate programme effects. Ok, so you who and others moved experiments out of the lab and to the real world. But have you been able successfully translate those eggs criminal findings into, let's say, good policy our work in two parts, making circles in having a very strong impact, has just not been there, and I think, one of the most important questions is how are we going to make that natural progression of field experiments within the social Sciences? Two more keenly talk to
policymakers abroad or public, and actually the scientific community as a whole. The way this season, academics, like him work hard to come up with evidence Some intervention, that's supposed to help alleviate poverty, Eeyore or improve education. Tell people quit smoking were their blood pressure, medicine. The academic then rates up their paper for an incredibly impressive. Looking academic journal impressed at least two fellow academics in the rest of us. It's jargon Ian indecipherable, but then with paper in hand, the academic goes out proselytizing to policymakers, you might say You politicians always talk about making evidence based policy. Well, here's some new evidence for an effective and cost effective way of addressing that problem. You say you care so much about The policy maker may say well the last time, listen to an academic like you, we did just where they told us, but it didn't work and
it costs three times what they said. It would end. We got hammered in the press and here's the thing the politician and the academic may both be John List has seen this from both sides. Now past life I worked in the White House advising president on environmental and resource issues within economics. This was in the early two. Thousands under George W Bush a harsh lesson that I learned was. You have to evaluate the effects of public policy is opposed to its intentions because the entire genes are obviously good, for instance, improving literacy for great schoolers or helping low income high schoolers get to college. When you step back look at the amount of policies that we put in place that don't work. It's just a travesty list. Has first hand experience with the failure to scale so
down in Chicago height. I ran a series of interventions in one of the more powerful interventions. Called the parent academy. That was a problem and that brought in parents every few weeks and we taught them what are the best MAC his arms and approaches that they can use with their three four and five year old children to push both their cognitive skills and their executive function, skills things like self control. What we found was with and three to six months, we can move a child in very short order, too. Very strong cognitive test scores in very strong executive functions skills. So, of course, we're very domestic after getting this type a result, and we want the whole world to now do parent academies. The UK approach the sauce and said we want to roll it out across blonde
in the Berlin around London. What we found is that it failed miserably. It wasn't that the programme was bad, it failed miserably because no pair it's actually signed up. So if you want your problem M to work at higher levels. You have to figure out how to get the right people and all the people, of course, into the programme wow, if you ask me to guess all the ways at a program like that could fail, it would have taken me a while to guess at you simply didn't get parental uptake. The main problem is we just don't understand the science of scale in, if you do it, I shall now turn to what this is scalability blank. Is it a price, is it a dilemma? Is it a crisis? I do think it's a cry. It is in that, if we don't take, of it as scientists. I think everything
it do can be undermined in the eyes of the policy in the broader public. We don't understand How do you use our own science to make better policies so John List and Dana Susskind and some other researchers are on a quest to address this scalability crisis. They ve been writing a series of papers, for instance the science of using science, towards an understanding of the threats to scaling experiments, allow their folk is on early education, since that is a particular passion of Susskind. I guess You could say I'm a surgeon by day and so the scientists by night. My clinical work is about taken care of one child at the time. My research really comes out of the fact that not all children do as well as others after surgery and trying to figure out the best ways to allow all my patience and really children born into low income backgrounds to reach their end,
occasional potentials. It is kind of like a superhero in reverse during day, you're doing the big dramatic stuff and at night you're going home to analyze the date and figure out what's happening. I think that really, the hard part is night part. I love doing surgery. I adore my patience, but it's actually not as high As for many of the complex issues in this world and with other cognition, some kids after the surgery sort of zoomed up there, patient ladder and others didn't yeah. That's simply about here it's, because language is the food, the developing brain before surgery. They all looked like they have the same potential to it say: zoom up the educational ladder after surgery there are very different outcomes and too often that difference a long socio economic lines, dad made me start searching outside the operating room for understanding. Why, in what I could do about it, and it has to
me on a journey so day. I met back and twenty twelve and we were introduced by a mutual friend in we did the usual ignore each other for a few years, because we're too busy and push came shoved in and I started to work on early childhood research and after that research turned to love, I always do. That I was wooed with spreadsheets, and has this? Is that true? Yes, so in fact the reasoning decided to marry. Him was because I wanted this area scaling be robust area research, perhaps because it really is a major issue so concerned. In what was then called the thirty million Words initiative, thirty mill
and being an estimate of how many fewer words a child from a low income home will have heard than an affluent child by the time they turn for, but these days the project called the tea mw center. We have action moved away from the term thirty million words, because it such a hub button issue hot button, because it so hard to believe that the numbers, well, no emanate some people say: look its deficit mentality, you're talking about, what's not there and then do replication. Somebody did another study. That said, oh, it's only four million, and it really is an actually even the point, because this matter about words about the interaction. So I just made the decision. I'd rather be for hissing on developing the research hidden fighting a naming battle, so you didn't make teamed up. You stand for something else. Well, that's where everybody gives me trouble for stands for thirty million words, but only I know that, ok,
now. You all know it too. Anyway, they started the centre with this idea with this idea that you know we need to take a public health or a popular level approach during the early years to optimize early foundational brain development, because the research is pretty clear that parent TA Interaction in the first three years of life are the catalyst for brain development and so that's basically our work. Ok, so far, so good, the researchers clear that heavy exposure to language is good for developing brain. But how do you turn that research finding into action- and scale it up, flee, we started with an intensive home visiting programme, but understanding the two reach population level impact you need to develop programmes both with it. I for scale as well as an eye for understanding where parents go I gladly because healthcare
the education system. The first three years of life really dont have any infrastructure in which to disseminate programmes, so we actually expanded our model. We have this multi faceted grim that reached parents where they were from turning words into pediatrics offices into the homes as well as group sessions, those programme, that are most vulnerable to the issues of scale. Are the complex sort of service delivery? vengeance. You know anything that takes human service delivery killing isn't an end is really just continuation You know it's a hard one. That's petty chamberlain, science during of the organs Social learning centre, and I oh research, an emblem taken of evidence based practices.
In child welfare, juvenile justice, mental health and education systems, Chamberlain, also looks at scaling as a process. So it's like their stages that you have to go through and if the first stage is research that involves and merci t. Randomize controlled trial is already an important choice to make your farming her off to situate your our see tee in a real world setting than in university clinic so that you're learning from the beginning what's feasible and what's not feasible. There might be something that you think would be great, but it's never gonna be able to be implemented in the real world. I've been asked this now fur o, probably twenty Five years- and I learned sort of through failing one
Ok, I'm Chamberlain, founded, is called treatment, Foster care, Oregon, kids tend to commit crimes together. It's a team sport, but then, oddly, the way that we are set up to deal with It's who you know reached the level where they are really being on if two themselves into the community is we put them in group homes together or putting kids a situation where there are more likely to commit crimes. So we decided what if we placed a child singly and a family that was completely devoted to using but in space parenting skills to help that child do well with pier in school and in the family, setting what if we gave the since the biological parents, of that kid, the same
and skills that the treatment Foster CARE family had what if we gave the kid individual therapy, the biological family was getting family therapy where giving the kids support at school. So we were basically, wrapping all these services around and individual child in a family home. What we found was TAT yeah, the kids. Do lot better. They have a lot fewer arrests, they spend less days in institutions, they use fewer drugs and guess what it costs a lot less as well as you do not have a facility, you do not have to for seven staff that your pain and shifts you do not have you know all of this stuff that it takes to run an institution. You have a family successive Chamberlains Programme caught the eye of researchers who were working on a programme for a federal agency called the office of Juvenile just and delinquency prevention as well.
We got this car saying you know we want you to implement your programme and fifteen sites. If the programme was successful at one site, how hard can it be to make it work at fifteen I went in thinking that it wouldn't be that hard, because we had good out We showed that we could save money, and yet we were absolutely not ready. It wasn't me we didn't have enough data. We had at that point plenty a data, but we didn't have the know how of her. I put this thing down in the real world and it blew up one reason: systemic complication, the three systems our welfare, juvenile justice and mental health. All put some money in the past to fund this implementation. I was completely delighted I thought this is gonna be great because we have all there
Levin systems buying into this, or what happened was when we tried to implement. We ran to the tremendous barriers because if we set, five, the policies and procedures of one system. We were at odds with policies and procedures and the other system, petty Chamberlain, had run up against something that Dana Susskind had come to see as an inherent disconnect. When you try, scale up a research finding theirs. The implementation, everybody focusing on adherence, but there is also a sort of the infrastructure D. Free mechanism, which I think is issue, whether its government or health care that they are just not set up for interventions which are sort of like innovation, so you ve got these researchers who think of themselves. As you know, scientific entrepreneurs developing the next best thing. You don't think You know you build it and they will come and then you ve got organism
since that are built for efficiency, rather than effectiveness that can't uptake it. If only there were another science, a science, to help these scientific entrepreneurs and institutions come together to implement this new research, maybe something that could be called limitations. I implementation science implementation, science, implementation, science; ok, let's define mutations science. It's the study of how grams get implemented in practice and how the quality of that implementation may affect. How well that programme works or doesn't work that is low principally she's the deputy chief operating officer of a nonprofit called child trends, which promotes evidence based policy to improve children's lives before that supply worked for years, evaluating programmes within the federal government, mostly at health, inhuman services. This whole science is maybe ten or fifteen years old, it's really coming out
This movement of evidence based policy and programmes where People said well, we have this programme, it appears to change important outcomes, let's just put it out there and then we quickly realized There are a lot of issues, and actually that put it out, there is her more complicated. A lot of the evidence based programmes. We have were designed by academic mergers who were testing sting it any, maybe more ideal circumstances that they had available to them that might have included ground. Students, it might I've been a school district that was very amenable to research, and then you take the results of that and trying put that into another location is where the challenge happened. So coming up after the break an implementation. Science really helped. You know I want policy, I am not to be an oxymoron you're, listening to
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actual intervention does in a particular population. In a particular context, it doesn't mean that is generalised ball back again is susskind from the University of Chicago bag. You have taken. You the science, so you can understand how it's gonna work in a different place in a different context, with different population and have the same fact in that part of the scheme science scaling science. That is what Susskind and her economist collaborator. John list is also her husband and other researchers have been working on. They ve been system. Clay examining why interventions that work well in experimental or research settings often fail to scale up. You can why this is an important puzzle to solve scaling up. You. Intervention like a medical procedure or teaching method, has the potential to help thousands millions, maybe billions of people, but what, if it simply fails at scale what
ends up costing way more than anticipated or serious unintended consequences that will make it that much harder for the net set of researchers to persuade the next set of policymakers to listen to them so list and Susskind I've been looking at scaling failures from the past in trying to categorize what went wrong. You can kind of put what we ve learned into three general buckets that seem to encompass the failures pocket number one is that the evidence was just not there to justify scale in the programme and the first the Department of Education did this broad survey on prevention programmes, attempting to attenuate youth,
substance, say and crime in in aspects like that in what they found is that only eight percent of those programmes were actually backed by research evidence. Many programmes that we put in place really don't have the research findings to support them, and this is what a scientist would call a false positive. So are we talking about bad researcher? We took him at cherry picking. Are we talking about publication bias? So here we are talking about. None of those were talking about a small scale, research finding. That was the truth in that finding, but because of the mechanics of statistical inference, It just won't be right. What you were getting into is what I would call the second pocket of why things fell, and that's what I call the wrong people were studied You know these are studies that have a particular.
Sample of people that shows really large programme effect sizes. But when you programme is gone who general populations that effect disappears. Essentially, we were looking at the wrong people in scale into the wrong people and when you say the wrong people, the people that are being studied then are to what they are. The people who are the fraction or the group of people Who received the largest programme benefits. So I think of something governments that are done on college campuses rate, where there's a professor, whose looking to find out something about. Let's say out tourism and the expense Reynolds setting is a classroom route. Twenty college, so come in and there are pretty homogeneous population and their pretty.
Motivated, maybe the very disciplined and that may not represent what the world actually is. Is that what you're talking about that's one piece of it, another piece, is who will sign their kids up for headstart or for a programme? in a neighborhood that advances the reading skills of the child, it who's gonna be first in line the people who really care about education and the people who thing their child will receive the most benefits from the programme. Now the way to get it is of along the lines that you talked about. It could be the recent Sure knows something about the population that other people don't know like I I give my programme its best shot of working, ok and what's in your third bucket of scaling failures, the third bucket is something that we call
all the wrong situation was used, and what I mean by that is that certain aspects of the situation change when you go from there. General research to the scaled research programme. We don't understand what properties of the situation or features of the environment will matter there. A really large group of implementation scientists who have explored this question for years now. What they emphasise in focus on is something called voltage drop And voltage drop essentially means. I found a really good result in my original research study, but then, when they do it at scale that voltage drop ends up in, for example,
a tenth of the original result or a quarter of the original result. In example, of this, is when you look at headstart Tom Visiting services, what they do there This is an early childhood intervention that found huge improvements in both child and parent comes in the original study, except when they try to scale that up in do home visits at a much larger scale. What they found is that, for example, home visits for at risk families involved more distractions in the house. I know there is less time on child focused DEC, Evidence of this is sort of the wrong doses.
Or the wrong programme is given at scale. There are many factors that contribute to this voltage drop, including the admirably high standards set by the original researchers. When the researcher starts his or her experiment, the inclination I'm going get the best tool in the world, so I want to be able to show how effective my intervention is. Dana Susskind again We need a ten math tutors and you happen to get the Phd students from the University of Chicago and then what happens? If you show this tremendous effect size and the scaling all of US you need a hundred or a thousand, and you no longer have that access to those individuals, and you go either down this hi chain with individuals were not quite as while trade or you end up having to pay a whole lot more money to maintain the trained our programme and one where the other either the impacts.
The intervention go down or your costs go up significantly. Another problem in this third bucket, it's a big bucket is when the person who designed the intervention and masterminded the initial trial can know could be so involved once the programme scales up to multiple locations. Imagine if, instead of without an educational or medical programme. We were talking about a successful restaurant and the original chef when you think about the chef. If a restaurant succeeds because of the magical work of the chef and you think about scaling that if you can't scale the match, back in the chef. That's not scalable. Now, if the magic is because of the mix of ingredients and he could sauce like dominoes, for example, good, sauce or Papa Johns is the act. Ingredients
that will be scalable. Now, if you are the kind of pizza eater who doesn't think dominoes or Papa Johns is good pizza. Well welcome to the scaling dilemma going big means you have to many things to many people going big means. You will face a lot of trade offs going big means. You'll have a lot of people asking you. Do you want this done fast? You want it done right. Once appear inside these failure. Buckets listen, Susskind describe it's not so surprising that so many good ideas fail to scale up. So what did they prefer? those that could help now our proposal is We do not believe that we should. Scale a programme until you're. Ninety five percent, certain the result is true, so and she what that means is. We need
original research in then three or four well powered independent replication of the rich. No findings, and how often is that already happening in the real world of let's say education, reform research, I can't name one Well, how about in the realm of medical compliance research, my intuition is that they're, probably not far away from three or four well powered independent applications in the Hard Sciences in many cases you not only have the original research, but you have a first replication, also published in science, in all. The current credibility crisis in science is a serious one that major Dolls are not replicating The reason why is because
We weren't serious about replication in the first place, so this sort of puts the onus on Paul. Two makers and funding agencies and a sense of saying we need to change the equilibrium. So that suggests that policy Where is your decision makers? They are being what over eager premature in x, being a finding that looks good to them and want to rush it into play, or is it that there Researchers are overconfident themselves or may be pushing this research too hard. Where is this failure really happening like it sort of a mixed? They think it's fair to say that's some policy makers, are out looking for evidence to base their preferred programme on what this will do is slow that down. If you have a pet project that you want to get through Find the replication and that's make sure the science is correct. We think we should actually be real.
Ordained scholars for attempting to replicate you know right now in my community. If I try to replicate someone else, guess what I have just made. I have just made a mortal enemy for life if you find a punishable result. What result is that you're, refuting previous or he's hurt now have doubled down on my enemy. So that's like a first, step in terms of rewarding scholars, who are attempting to replicate now to compliment that We should also reward scholars who have produced results that are in Penitently replicated in autumn talking about time. Ten year decisions grant money. In the like to people who have given us credible research that replicates
but replication is just one component of the scaling revolution that list is proposing. He also wants to make sure the original research is more robust, say I'm doing an experiment in Chicago Heights. On early childhood- and I find a great result, how confident should I be that when we take that result to all of Illinois or all of the MID West or all of Amerika, is that result still going to find that important benefit cost profile that we found in Chicago height. We need to know what is the magic sauce. Was it the twenty teachers you hired down in Chicago Heights? air. If we go nationally, we need twenty thousand, so it should behoove me is, Regional researcher to say? Look if this scales up we're gonna need many more teachers, I know tee
measures are an important input. Is the average teacher in that twenty thousand- The same is the average teacher in the twenty. This is the dreaded voltage drop that implementation scientists talk about, and the implementation scientists have focused on fidelity is a core component hide, the voltage drop, fidelity, meaning that the scaled up programme reflects the integrity of the original programme, measures of fidelity. That's a really critical part of the implementation process. That again, is petty chamberlain. Founder of treatment, foster care organ. You ve gotta be able to measure. Is this thing That's down in the real world the same yeah. Does it have the same components that produce the outcomes in the our cities? Remember it was chamberlains good outcomes with young people and foster care
the maid federal officials want to scale up her programme in the first place. We got this call saying we want you to implement your programme and fifteen sites. She found the scaling up initially very challenging, but wasn't the come by our moment that we thought I was gonna be, but in time treatment foster care, organ became a very well regarded programme has been around. Roughly twenty five years now and the model has spread well beyond organ to more than a hundred sites throughout the U S and abroad, one to this success has been developing fidelity standards so that that we do it as we have people upload all of their sessions onto a hip, a secure website and though he called those and if there now meeting the fidelity standards, then we offer fidelity recovery plan. You know we haven't had to drop aside, but you have had to have some of the people in the site retrained or not continue being able to
measure, fidelity well from afar, provides another benefit. Two scaling up. It allows the people who developed the original programme to ultimately stepped back, say, don't become bottleneck, which is a common failing problem. There can be sort of an orderly process whereby you step back in increments, as people become more and more. Then doing what they're doing and that's what you want, because you don't want to have this tied to the developer forever. Otherwise, you can't get any kind of reasonable reach. That said, you also need to have some humility when you're scaling up you shouldn't assume. Your original programme was perfect, that it won't need adjustment and need to be willing to make adjustments for Paul. We recognised that when we were in real world communities, kid needed something that wasn't therapy per se say they needed skills because the kids,
often been excluded from normal socializing yeah, no sort of things like sports teams and clubs and and so We needed what we call skills coach to help those kids learn the moves that they need to be able to participate in his pro social activities that that our normal kind of things, so you have research, you have a theory and then you have the implementation and that feeds into more research. More theory, more implementation, everybody's motivation at the end of the day, is about trying to do good for the people they serve Dana Susskind again there are many children have there and There are a lot of injustices, so we need to move, but there I don't know, science is slower than you'd like people have wanted things before I they were ready and finding a way to deal with that dance of people were, getting information, but also one
to continue to build the evidence? I think we can figure out how to do it. Now you got exactly and John List again they think too many times whether its public policy, whether it's a for profit or a not for profit. We tend to only focus on one side the market? When we have problems and you really need to take account of both sides, is your optimal solutions? The best solutions are only gonna come when you look at both sides of the market and probably getting the straw or at least being way too reductive. But to me it sounds like the chief barrier to scaling up programmes to help. People is people the people, the problem. Yes, I do think inherently. It is about people. That said this is not a fatal flaw their causes.
To throw up our arms and say well, this isn't physics and chemistry. We have to deal with people, so we You science, I think, that's wrong, because there very very neat advantages of scaling. Think about on the key side- economists always talk about you know when things bigger and bigger guess what happens? The per unit costs goes down its cod. Increasing returns to scale the problem that the kind of work thinking about, is let's make sure that those policymakers who really want to do the right thing in new science, let's make sure that they have the right programmes to implement. So what are your papers include? This quote from bill. Clinton early, something that couldn't may have said, which is essentially that nearly every problem has been solved by someone somewhere, but we just can't seem to replicate those solutions anywhere else
So what makes you think that you ve got the keys to success here where others may not have been able to do it. You know, I view what we Don is put forward, tat of modest proposals is only a start to tackle what I think is a most vet, in problem in evidence based policy may. In which a scale in I think we're just taking sums all steps, theoretically, particularly, but I do think that this first set of steps are important because If you go in the right direction, what I've got and is it? Literature will follow that direction if you in the wrong direction. Sometimes a literature follows that wrong direct for several years- and we really don't have the time right now- the opportunity cost of time is very
I you know in the end, I want policy science not to be an oxymoron erratic. That's what this research agenda is about. The way that I would view it is that the world is imperfect, because we haven't used science in policy making and if we add science to it, we have a chance to make an imperfect world a little bit more perfect, if you want read the papers, John List and data. The second and their collaborators have been working on you'll, find links on our website as well as links Chimu, petty chamberlains work with treatment, foster care organ and much more, including, as always, a complete transcript of this episode. Coming up next time on economics, radio so how many chinese language robot calls. Am I supposed to get everyday? I'm not
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Transcript generated on 2020-04-03.