READ ON TO DISCOVER:
- What pediatrician Nadine Burke Harris is doing to change integrative medicine for the better
- How Google is influencing the nonprofit sector
- The role of powerful storytelling in successful organizations, from IDEO.org to small nonprofits
Pediatrician Nadine Burke Harris is transforming how we respond to both childhood adversity and the resulting toxic stress that dramatically impacts health and longevity. Her TED Talk on the subject has been viewed over four million times, and her organization, the Center for Youth Wellness, has brought her new approach to the Mayo Clinic, the American Academy of Pediatrics, and Google Zeitgeist. She recently sat down with Kathleen Kelly Janus—social entrepreneur, lecturer at Stanford University’s Program on Social Entrepreneurship, and author of Social Startup Success—for a captivating conversation on how to buckle down and make the world a better place.
This conversation has been edited and condensed. To view Nadine and Kathleen’s full conversation, click the video below.
Nadine: When I see a problem in the world, I immediately envision how it should be different. As a pediatrician, when I was seeing patients in my clinic and seeing the effect that [social and economic] adversity was having on their health, immediately I asked myself, “Why isn’t every doctor screening for this?”
I really believe that we can improve the health of patients if every doctor in America were screening for adverse childhood experiences. I didn’t know at the time how much that was to take on and what would be necessary to put all the pieces in place. With that belief as our north star, [we can] bring people on the team who can help get us to that place.
Kathleen: I love that you start with the problem—so many of the organizations that I interview for my book, Social Startup Success, started because they face a problem. What I often see in my students at Stanford is the tendency to have a solution without spending a lot of time really understanding the problem.
One of the most important things early-stage organizations can learn is how to assess what the problem is, not only from the beginning—when you’re developing a pilot and trying to understand—but also as you grow. Think about how you can create a feedback loop in your work so that you are connected with the community that you’re serving. The nonprofit sector differs from the for-profit sector in that the customers, or the beneficiaries, are different from the people that are paying for the services. In the for-profit world, if you’re in business and your product isn’t working, then people stop buying it and you go out of business.
“Think about how you can create a feedback loop in your work so that you are connected with the community that you’re serving.”
Nadine: You get real-time feedback.
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Kathleen: Exactly. You see it on your balance sheet. Not true in the nonprofit sector. You have to be thinking about how to improve your project and get feedback from the beneficiaries as you grow.
Nadine: It’s about efficacy, [asking] “What is going to allow us to be more effective?” As a nonprofit leader, you have to recognize that you have two different target audiences. You have the families that you’re serving, and then you also have the folks that are funding and supporting the work. To tell the story to funders, you have to show your effectiveness, and in order to be effective, you have to be incorporating the voices of the people that you’re serving.
Kathleen: Actually, that’s something that I saw in my research—the organizations that began measuring their impact from day one tended to scale much more quickly than the organizations that did not. That makes sense, because those are the organizations that are not only able to show that they are making an impact for their donors, but they’re also able to use that impact metric to improve their programming.
I think that’s the biggest problem in the nonprofit sector—so often, nonprofits use metrics to prove what they’re doing is right, not improve.
Nadine: At the Center for Youth Wellness, the minute we could cobble together the money, one of the early positions that we brought on was a Director of Organizational Learning and Data. The purpose of getting this information for us was really to understand how good of a job we are doing. Are we effective in doing what we want to do? Where do we need to course correct?
Kathleen: Tell me about the early stage of developing this survey for doctors. You were a young doctor, you had identified this problem, you wanted every pediatrician to shout it from the mountains. You also wanted this survey to diagnose ACE [Adverse Childhood Experience], to be the best possible diagnostic tool for doctors in the field. I know that you balance that with trying to also engage doctors in the learning process.
Nadine: In medicine, the standard is a randomized controlled trial. It’s rigorous, extensive, deep research, which takes a long time and costs a lot of money. At the same time, we were talking about the fact that children who are exposed to adversity have much greater health risks. And there really wasn’t any routine way for doctors to screen for this.
I really felt like we were facing a public health emergency. It was important for us to be able to identify this and act sooner rather than later. One of the most fortunate things that happened for our organization is that one of our early supporters, Google.org, not only supported us with dollars but also with expertise from their teams.
We were sitting around the table with a team of folks from Google, and I said, “We have this tool for doctors to be screening for adverse childhood experiences, and we’d like to test it, but we also don’t want to release it until we feel like it’s perfect.”
One woman said, “Listen, we’re Google. If we were Apple, we would wait until the tool is absolutely perfect down to the last detail, and then release it. But we’re Google, and we beta test.” She said, “If Google made a car, we’d put it out on the road with three wheels and ask users what the fourth wheel should look like.”
That really resonated, and there were two things that were important about it. One was that there is more than one approach, and the second was thinking about the right approach for what we’re trying to accomplish. What that allowed me to recognize is that in order for doctors around the country to use this tool, I felt like it was really important to have some sense of co-creation. That distinctly informed our strategy at the Center for Youth Wellness to pilot our tool, by making it available for free online and putting a disclosure at the bottom for doctors that are downloading that said, “This hasn’t been validated, we haven’t had the randomized control trial, but if you’re interested in using this and looking for a tool to use, please give us your feedback.” That has been incredibly powerful.
“If Google made a car, we’d put it out on the road with three wheels and ask users what the fourth wheel should look like.”
Kathleen: That not only made it more effective, but also you have all the doctors as champions and advocates of the cause, and they become part of the movement for change. I also love that you talk about the randomized control trial because I think that this has become such a trend in the nonprofit sector, for better or for worse. On the one hand, we’re seeing nonprofits being so much more metrics-driven, and they want the gold standard for testing whether their programs are actually having an impact, but [on the other hand,] randomized control trials cost hundreds of thousands if not millions of dollars, and small organizations simply cannot afford that.
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I’ve seen some really creative ideas of how to be more rigorous using the influence of the randomized control trial in my research, [while also being more frugal]. For example, there’s an organization Aimée Eubanks Davis founded called Braven, which supports low-income kids in college to help them graduate at a faster rate and to get better jobs. She started the organization when the kids were freshmen. so she wasn’t gonna see impact for four years, but she still needed to get funded in those four years. She was trying to think, “Okay, how can I get a sense of whether my programs are working?”
Again, getting back to not just proving but improving, she didn’t just look at the test scores of her students and say, “Okay, they’re going up, that means we’re being effective.” She really, really tested the counterfactual, and she wanted to figure out, “Can we find a control group of students who couldn’t participate in Braven programming for whatever reason, and give them 25-dollar Amazon gift cards to participate in trials?” They follow up with them every few months to see how they’re doing versus the students who are participating in their programs. It has the effect of being rigorous without costing millions of dollars. That’s the kind of rigor and creativity that we need to see in the nonprofit sector more.
Nadine: I’ve read your book—it’s amazing and incredibly valuable. I wish it was around six years ago, when I was starting [my organization]. What was it that motivated you to write this book?
Kathleen: I wrote this book for that reason—it was the playbook that I wish I had when I co-founded my organization in San Francisco, which engages millennials in gender equality issues and philanthropy. We were a small organization, but we were mighty. We had so much buzz in the beginning, and we were doubling our revenue every few months and then, just as we hit our stride, we hit a wall. We couldn’t get the capital that we needed to get past this wall of 500,000 dollars in revenue to scale to the next level.
I was a young 25-year-old new nonprofit professional and got really curious about, “Who are all these organizations that are scaling around me?” Kiva was just starting right about the same time, and [their founders] were on Oprah and raised 11 million dollars overnight. I was asking, “Wait a second, what are we doing wrong?”
It led me down this path to research organizations. I surveyed over 250 social entrepreneurs in the country and found that the organizations that are scaling past this two million dollar revenue hump are doing very similar things. They have very similar strategies, whether it’s testing their ideas and using innovation, or measuring their impact very early.
What’s really exciting about the findings in Social Startup Success is that the organizations that are implementing these strategies are not doing so by hiring multi-thousand-dollar consultants. We all have the capacity within our organizations to be more effective. The social problems that we’re facing—whether it’s homelessness or global poverty or climate change—are huge, and require all hands on deck to help us solve them.
“The social problems that we’re facing—whether it’s homelessness or global poverty or climate change—are huge, and require all hands on deck to help us solve them.”
Nadine: One of my favorite parts of your book was your chapter on storytelling, and how important it is to engage in resonant storytelling as part of getting this word out. As founders, as social entrepreneurs, although we tend to end up being very focused about raising money, we didn’t get into this work to raise money. We got into this work to change the world.
The more that we can get that message across in a way that resonates and galvanizes folks towards change, then the greater an impact we’ll ultimately have in the world.
Kathleen: I would love to hear how you think about storytelling as a vehicle for movement building. How do you spread the word, and how do you think about your role as an individual?
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Nadine: Most of the population still [doesn’t know] that childhood adversity doubles your risk for heart disease and cancer. One of the things that we look at, at the Center for Youth Wellness, is understanding how to get the message out. How do we make this important enough and build enough public goodwill that we’re able to effectuate true societal change?
That has been a core piece of this work. I just bring my whole self to it. I show up with who I am—my background and my expertise as a doctor, but also the fact that I’m incredibly passionate. It was really important for me to be authentic about that because there is a tremendous amount of suffering that is happening in the world, and we can do something about it.
“The more that we can get that message across in a way that resonates and galvanizes folks towards change, then the greater an impact we’ll ultimately have in the world.”
Kathleen: One of the things I saw in the organizations that I interviewed is that they prioritize storytelling, not only at the executive director or CEO level, but at every single level of the organization. Everyone within the organization can be a brand ambassador for the cause, whether it’s a staff member who happens to be at a cocktail party and comes across a donor, or whether it’s a beneficiary talking to a funder about the effectiveness of the work.
Some of the organizations that I interviewed actually did storytelling practice in their staff meetings. IDEO.org does this storytelling roulette where they spin a wheel, and on the spot, a staff member has to tell a story about a project that they worked on. It’s that repetitive practice that really helps build storytelling skills.
Nadine: One of the great benefits of doing that is that within the organization, it builds cohesion and alignment around the messaging and the brand. It’s really a powerful internal development tool, as well as an external development tool.
“In the organizations that I interviewed, they prioritize storytelling, not only at the executive director or CEO level, but at every single level of the organization.”
Kathleen: Since we’re both moms of multiple children, we should talk a little bit about what it’s like to be a female entrepreneur. I admire you because you take into consideration things like self-care—how do you find balance or take care of yourself?
Nadine: As a female founder and CEO, one of the things that’s been very fulfilling for me is the opportunity to model for my team. “Integration” of work and life—”balance” [isn’t] the right word. There’s also the opportunity to model self-care in terms of managing our own stress response within our organizations, whether it’s going for a walk or taking a moment to do a meditation. In fact, my team at the Center for Youth Wellness will actually see me go into one of our treatment rooms for 20 minutes and do a mediation in the middle of the day.
Kathleen: I love that you’re talking about modeling, because I think about this a lot as a parent with my kids. My daughter was sitting on my lap the other day while I was trying to send emails. She said to me, “Mommy, why are you working so much?” And I closed the computer and said, “You know, I really care about making this world a better place, and I work hard to do everything I can to give back. And I hope that one day, you’ll do the same.” It’s what my parents taught me, and it’s the value that I hope to pass on to my children.
Nadine: Yeah, that’s absolutely right. In order for us to change the world and make it a better place, we have to be walking along that path. We have to be doing it for ourselves as well.
