Too often our analysis is skewed before we’ve even begun, because the burden of proof is going the wrong way.
I’d assumed that a trip to the hospital is good health-care, until I hear of a patient receiving poor care. Even then, I figure it’s an anamoly. Right? Wrong, says Dr. Jeffrey Brenner, who’s quoted in Dr. Atul Gawande’s recent New Yorker article:
“Emergency-room visits and hospital admissions should be considered failures of health-care system until proven otherwise,” he told me–failures of prevention and of timely, effective care.
What a difference that 180-degree turn in perspective makes. It’s not good until proven bad, it’s bad until proven adequate.
It reshapes the whole approach.
We assume the same about nonprofits: they’re doing good, unless a scandal shows otherwise. And even then, that’s just an anomaly.
What if the burden of proof was the other way around: The work of nonprofits and philanthropy should be assumed to be mediocre at best, harmful at worst, unless demonstrated to actually improve society.
It reshapes the whole approach.
Suddenly it makes sense to spend money on evaluation and causation and “overhead.” It makes sense to focus on how the recipients are changed by the donation, rather than how the givers feel about their donation. We are no longer complacent in do-goodism. We are rigorous in impactism.
Change the burden of proof, and we change what’s acceptable, what’s extraordinary, and what we in philanthropy can truly achieve.
Tweets that mention Burden of Proof -- Topsy.com // Jan 21, 2011 at 9:22 am
[...] This post was mentioned on Twitter by Pablo Rodriguez B., Roxanne Alvarez and Saundra, Good Intentions. Good Intentions said: Burden of Proof – Nonprofit work should be considered mediocre or harmful until proven otherwise – from @BrigidSlipka http://ow.ly/3HY93 [...]
Michael Keizer // Jan 21, 2011 at 7:43 pm
I think you misunderstand (or misrepresent) the point Brenner is trying to bring across. What he says is not the hospital needs to prove that what they do is right, but that the visit to the emergency room/hospital by itself is a signal that something went wrong in the entire health system (because it is supposed to ensure our health and hence make the visit unnecessary) — and that this signal leads to a reversal of the burden of proof for the system.
The equivalent would not be that everything non-profits do should be proven effective; instead, it would be that the system of which they are a part (and let’s not forget that this includes for-profit and government organisations) should prove its effectiveness if and when there is a signal of failure.
Note that I don’t disagree with your suggestion that we should prove our effectiveness; it just doesn’t follow in any way from the quote.
Michael Keizer // Jan 21, 2011 at 7:44 pm
Apologies for the italics — something went wrong there with a closing tag.
Brigid // Jan 22, 2011 at 7:45 am
Michael, thanks so much for your thoughtful feedback. When I read the article, I was startled that, as a patient, I’d always thought of this backwards. It made me realize that, as a donor, I’ve done the same thing. You’re thoughts about the systematic indications are well put – I was considering it only from my role as an individual player (first as a patient, then as a donor).
Perhaps the larger takeaway for me is that I shouldn’t write about whatever gives me an idea for a post, I should just get right to the meat of it
Thanks again (and you go with your fancy italics!)