to change the world
role of the social entreprenuer
ideas are to take root and spread, therefore, they need champions
obsessive people who have the skill, motivation, energy,
and bullheadedness to do whatever is necessary to move them forwards
to persuade, inspire, seduce, cajole, enlighten, touch hearts, alleviate
fears, shift perceptions, articulate meanings and artfully maneuver
them through systems. (From a book by David Bornstein).
origin of the modern postal system is a classic example.
system was introduced in England in 1840 by Rowland Hill, a then-unknown
British school-master and inventor whose ideas initially met with
hostile opposition and ridicule. Hill had noticed that postal revenues
in England failed to increase between 1815 and 1835 although the
countrys economy had grown considerably.
the time, the average price to mail a letter in England was 12 cents,
which put the service out of reach for most of the population. The
price was a function of handling costs. Because postal clerks priced
letters according to their weight, enclosures, origin and destination,
each letter had to be studied individually: Clerks would hold letters
up to lamplight to count the number of enclosures before consulting
price tables and recording each transaction in a log. Additionally,
letters were paid for at the time of receipt; if the intended recipients
rejected them, no money was collected.
his analysis, Hill demonstrated that the costs for conveyance of
mail were actually minor in comparison with handling and administrative
costs. He began thinking about ways to simplify the system and came
up with the idea of charging a uniform price for all mail in Great
Britain (initially a penny for a half ounce) and a prepayment system:
an adhesive postage stamp.
proposal met with virulent opposition from the postal bureaucracy.
Senior postal officials condemned it as prep0sterous
and a wild and visionary scheme. But his call for a
Penny Post struck a populist chord and eventually won
the endorsement of leading newspapers, which stood to benefit from
reduced postal fees. After a protracted political battle, the government
authorized Hill to implement his system.
then embarked on a two-decade battle within the postal authority
to reorganize the collection and delivery of mail so that the service
could handle a dramatic increase in volume and justify the trust
that prepayment implies. It took several years for the systems
merits to be demonstrated. However, by 1843 the idea had already
spread to Switzerland and Brazil. From 1838 to 1863 annual mail
delivery to England rose from 76 million to 642 million letters.
To cite one example of the impact of the Penny Post on commerce,
in 1839 the annual amount transmitted via money orders in England
was Stg L.313,000. By 1863 the amount was StgL 16.5 million , more
than a 5,000 percent increase. Among those for whom Hills
system was a godsend was Florence Nightingale, author of 12,000
behind-the-scenes innovator was John Woolman, an eighteenth-century
American Quaker whose impact on American society remains largely
unrecognized. Among those most active in the campaign to end the
slave trade in the United States were the American Society of Friends,
or Quakers, who voluntarily emancipated all their slaves between
1758 and 1800. Although individual Quakers had been preaching against
the evils of slavery since 1680, Quakers did not actually abandon
the practice of slaveholding in large numbers until Woolman, a tailor
and part-time preacher living in Mount Holly, New Jersey, took it
upon himself to travel the country talking them out of it.
another, more hidden, healthcare innovation in the United States:
improvements in the administration of anesthesia. Between the 1960s
and 1980s, a death due to anesthesia error occurred once or twice
in every 10,000 operations. With anesthesia administered 35 million
times a year in the United States, that translated to 3,500 to 7,000
avoidable deaths each year many of them during minor procedures.
In a New Yorker article entitled When Doctors Make Mistakes,
medical reporter Atul Gawande chronicled how Ellison C. Pierse,
an anesthesiologist, changed the standards in his field.
grew up in North Carolina and attended Duke Medical School in the
early 1950s. He began documenting deadly anesthetic mishaps in the
1960s, but his focus on patient safety intensified after friends
took their eighteen-year-old daughter to the hospital to have her
wisdom teeth pulled and the young woman died while under general
anesthesia because the anesthesiologist mistakenly inserted the
breathing tube into her esophagus instead of her trachea, a common
error that is usually quickly corrected.
1973 Massachusetts General Hospital hired a man named Jeffrey Cooper
to develop machines for anesthesiologist researchers. Cooper spent
hours observing anesthesiologists and noticed a lack of standardization
in the machines: in half of them, a clockwise rotation of a dial
decreased the concentration of anesthetics; in the other half, it
increased the concentration. He interviewed anesthesiologists to
search for patterns in how mistakes were made and, using a technique
developed by aviation experts called critical incident analysis,
studied 359 errors. He published his findings in a 1978 paper entitled
Preventing Anesthesia Mishaps: A Study of Human Factors.
Gawande reported: The study provoked widespread debate among
anesthesiologists, but there was no concerted effort to solve the
problem In 1983 Ellison Pierce was elected vice-president
of the American Society of Anesthesiologists. After ABC Televisions
20/20 aired a segment on the dangers of general anesthesia, Pierce
seized the opportunity to move his field in a new direction. He
established a committee on patient safety and pulled in respected
colleagues. Then he teamed up with Cooper and persuaded the Food
and Drug Administration to produce a preanesthesia machine checklist
and a series of patient safety videos for anesthesiologists and
persuaded pharmaceutical companies to pay to distribute the videos
to every anesthetic department in the United States. Then he and
Cooper brought fifty anesthesiologists from around the world to
Boston for the first international symposium to focus exclusively
on anesthetic patient safety, a meeting now held biannually.
then established the Anesthesia Patient Safety Foundation (APSF),
raising money and embarking on an extended tour of meetings with
surgeons, nurse anesthetists, anesthesia equipment manufacturers,
insurance companies, pharmaceutical companies, government officials
and senior figures in the American Medical Association every
group that had a role to play in the solution. Through APSF,
we were able to work without restricts and hierarchy, Pierce
told me. It was much better than trying to work changes through
existing organizations, which were so staid and rigid. APSF
launched a newsletter, which today has 60,000 sub-scribers, and
began channeling grants to researchers focusing on patient safety.
would operate like a franchise, with decentralized management, but
with a uniform brand, operating procedures, and standards. It would
remain a free, national twenty-four-hour service. The word Childline
would always be written both in English and translated phonetically
into regional languages. (India has eighteen officially recognized
languages). The logo and the phone number would remain the same
city would select organizations based on local needs but conform
to a uniform structure: A nodal organization, a noted
academic institution like TISS, would facilitate operations, training,
documentation, and advocacy. Collaborating organizations,
like YUVA, the shelter where I met Ravi, Samir and Rupesh, would
respond directly to calls. Support organizations would
handle follow ;up, and resource organizations would
assist with long-term needs.
city would have one Childline coordinator. The government would
make grants to Childline partners to pay salaries for Childline
social workers and team members placed in them. Each organization
also would have to raise its own funds for Chidline. Franchisees
would receive training and promotional materials, a call-tracking
database (in development), and, initially , one years funding
for out-of-hospital medical assistance to children.
the structure was defined, the phones were activated and the DOT
communicated with pay phone operators across the city. Then, after
locals had had two weeks experience handling calls, a staffer
from the national office came to conduct a ten-day training. Two
or three months later, if all went well, the local franchise called
a press conference and launched an awareness campaign. The national
office monitored franchises closely for several months and, thereafter,
through spot checks.
were always problems. One of the most common was when a local organization
claimed full credit for Childline. In the NGO sector, a lot
of people, especially senior people, dont like partnering,
explains Jeroo. My biggest task is making everyone feel that
they own Childline>
the spring of 1999, Childline had launched 1098 in Calcutta and
Madras and was preparing to start up in Patna. Groundwork had begun
in Bhopal, Bhubaneshwar, Calicut, Combatatore, Guwahati, Gwalior,
Jaipur, Lucknow, Panjim, Pune, Trivandrum and Varanasi. (In one
year Jeroo and her colleagues visited nineteen cities).
ChildNet database system was an unusual computer program: It had
been designed for users who were easily distracted and often semiliterate.
It guided team members with picture and voice commands in English,
Hindi, and regional languages. Street kids really dont
like to document things, Meghana Sawant explained. And
even when they do document them, there are often important elements
new system, which addressed the problems, proved extraordinarily
useful for analyzing call patterns. For example, it enabled Childline
to track specific hot points within cities. If a high number of
health-related calls were coming from a particular railway station,
Childline could advocate for a medical booth to be installed in
Childline expanded to new cities, the call-tracking system also
emerged as an important source of child protection information.
National data showed that the biggest killer of street children
was tuberculosis, but regional call patterns revealed a variety
of local problems. In Jaipur, for example, childline received reports
of abuse in the garment and jewelry industries. In Varanasi, there
were reports of children being abducted to work in the sari industry.
In Delhi, many calls came from middle-class children. In Nagpur,
a transit hub, there were frequent reports of children abandoned
in train stations. In Goa, a beach resort, a major problem was the
sexual abuse of children by foreign tourists.
many high-level pledges of cooperation, Childline found that police,
health, and railway officials across India remained largely ignorant
about and indifferent to 1098. So Childline designed a series of
training workshops, and, in June 2000, in conjunction with the governments
National institute of Social Defense and seventy-eight partner organizations,
launched a National Initiative for Child Protection.
goal was to make police stations, hospitals, schools, and train
stations more child friendly by educating officials
about the law, introducing them to street children, and teaching
them about Childline. One of the features of the campaign was the
presentation of awards by children to child-friendly police stations
empathy begins with understanding, the training began with children
explaining to officials what their lives were like. They role-played
encounters with police and hospital employees. The interactions
were followed by discussions about childrens rights and Indian
much fanfare, the government came through with little funding for
the National Initiative for Child Protection. As they had done before,
Childines partners drew on their own resources, conducting
more than 700 training programs with officials across the country.
majority of participants in these programs reported to Childline
that, in the future, when they encountered children in distress
they would call 1098. Many of them regularly had experiences like
that of a policeman in Calcutta who one day came across a young
girl wandering naked alone in the streets. The policeman admitted
to Childine that, if he hadnt completed the training course,
he might have ignored the problem not knowing how to help
the child and not wanting to take an action that might create significant
paperwork for himself. Instead, he simply dialed 1098 and was immediately
referred to a shelter with social workers and an educational program.
He took the girl there. He even bought her crayons and a coloring
the fall of 2002, Childine had spread to forty-two cities, with
preparatory work under way in another twelve. Mature franchises
were now directly paired with start-ups to speed training. In addition,
preparatory activities had become more sophisticated. We do
much more training with the police, health departments, Department
of Telecommunications, and the chair of the Childline Advisory Board,
Jeroo said. And we dont launch formally until the service
has been in operation for at least six months.
network had more than 120 organizations directly implementing the
Childline service and over 2,000 providing assistance. By October
2002, Childline had fielded 2.7 million calls. The Ministry of Justice
and Social Empowerment had consulted with Childline during the drafting
of its most recent Five Year Plan. The government also had incorporated
several Childline recommendations in revisions of Indias Juvenile
Justice Act and mandated Childline as a lead child protection agency.
2001, Jeroo received international recognition for her work from
the Schwab Foundation for Social Entrepreneurship. Later that year
she made the decision to step down as Childlines executive
director. She remained on board until May 2002, easing back from
her 100-hour workweek and watching how things progressed without
her. Some of Childlines board members felt her decision was
premature. But she believed that Childlines expansion had
become a technical challenge and felt her energy could be better
capacity to cause change grows in an individual over time as small-scale
efforts lead gradually to larger ones. But the process needs a beginnings
a story, an example, an early taste of success something
along the way that helps a person form the belief that it is possible
to make the world a better place. Those who act on that belief spread
it to others. They are highly contagious. These stories must be