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Trust in public health systems: frames and
experienced paths in Emilia-Romagna
Workshop: Social Participation:
Communication Challenges
and Good Practices
Budapest, NUPS
12-17-2014
P. Lalli
Master in Public and Corporate Communication
Department of Political and Social Sciences
University of Bologna
P. Lalli
1: Shifting citizens…
Networked relationships and individualism
Our “world is oriented around looser, more fragmented
networks that provide on-demand succor”
It creates new affordances but requires new social skills 




Pew Center’s and University of Toronto Net Lab hypothesis (2012)
People “need to develop new strategies for handling challenges
as they arise. (…) They must actively network to leverage the
human resources”
Meanwhile… Crisis of confidence in public organizations
P. Lalli
1: Shifting citizens…
Networked relationships and individualism
•  The priority of skills is or not antidemocratic?
•  The multitude is not the masses….
•  The social organization appears as a multipolar living body
êêêê
New elites appear, basing their legitimacy on several dimensions
êêêê
Bloggers can hold against journalists, collectives develop Linux,
Wikipedia, or OpenStreetMap, new influencers on the social web allow
for a new agenda of information
There are a multitude of skills…
(Verdier 2014)
P. Lalli
2: Shifting from government to “governance”
At least two definitions of "governance":
a) decentralization and ”subsidiarity" based on
common "utility" among some actors
è market adjustment by private interests
(stakeholders as "interests bearing")
b) decentralization and " subsidiarity" in a social
process building shared meanings of actions
and mutual involvement
è "community" based on trust
(stakeholders as subjects committed in collective goals)
P. Lalli
2: Shifting from government to “governance”
Anyway, if the so-called “subsidiarity” is connected to
new forms of Welfare State as the administrative
decentralization and the engagement of citizens to
participate in public decisions
êêê
Could communication and information be
essential to enable the governance’s
process?
P. Lalli
3: Communication, innovation, democracy
ü  The innovation in a democratic context comes from
normative frameworks that set out principles or values
ü  Ongoing process that concerns:
Transparency - Open Data
Visibility
Information
Communication
Accountability
P. Lalli
Transparency and accountability
Transparency is coupled
with the duties of the
visibility and accountability
regarding public opinion
è The citizens’ right to
scrutinize the government
action
The purposes of body
control of visibility may
represent:
a)  A fair distribution of
public knowledge
b)  A marketing strategy
influencing both media
and citizens
P. Lalli
Participation vs. propaganda?
Development of activities and actors
devoted to publicity of the action of
government
Disappearance of the "propaganda" and the
emergence of “communication”
In a representative democracy “propaganda”
is discredited because it is connected to an
explicit goal of manipulation and consensus
(Ollivier-Yaniv 2009)
P. Lalli
INFORMATION and DATA = STRATEGIC RESOURCE
ê
NEED CONTROL, FRAMES AND MANAGEMENT FOR
DECISION PROCESSES AND EVALUATION
ê
a) TECHNOCRATIC VISION = PROFESSIONALS AS
VISIBILITY EXPERTS in the “multipolar society”
VERSUS
b) REFLEXIVE VISION = PROFESSIONALS AS
MORAL ENTREPRENEURS in the “multipolar society”
The perspective of a
“fair distribution of social knowledge”
P. Lalli
The new functions of information
è Public bodies provide data decisions-makers as a
basis for decision, and journalists or
“communicators” to ensure good frames of
information to citizens for public evaluation
è  Public bodies directly provide data using new
media channels to ensure the transparency of the
decision making process for well informed
participating citizens
Transparency, frames, data
P. Lalli
è Quality of data
è  Frames of data
è Required skills in understanding and handling data
è Competition in data use (private, instrumental…)
è Over-saturation of data (BIG DATA)
Difficulties
P. Lalli
è  Absolute transparency is an illusion: governments
always choose what they want to communicate
è  Transparency does not build confidence, but mistrust
è  Open Data promises a more direct rapport with power,
but in fact creates a new technocracy (those that can
understand data)
è  Close attention be paid to document the data itself (who
created it, when, why, etc.) in order to allow citizens to
criticize
(i.e. Rupert 2014)
Transparency and open data an illusion?
P. Lalli
è  Data can been used to hurt us
è  We cannot see or control all data
è  Most people just want to be asked nicely, explained the rules,
simply and clearly and be given control
è  Essentially, they want to trust
è  TRUST IS THE NEW OIL
è  Trust is produced by a promise made and kept over
è  There seems to be a shortage of trust now, so its value is
soaring, particularly at the start of each day’s news cycle
(Aiken 2014)
Are data the new oil?
P. Lalli
May be opening data does not rely
on a value granted to "transparency”
The core concept can be
responsibility or accountability,
recognizing the dignity of the subject
that exercises its responsibilities
OPENING DATA & DEMOCRACY
“Society has the right to require of every public agent an account
of his administration”
P. Lalli
Many actors
potential
players(Verdier 2014)
P. Lalli
è The data are intellectual constructions
è The more accountability on the choices regarding
the construction of data, the more precision on the
implicit hypotheses are in order
è One just has to ask the right questions on the data
è  Open Data appears to be more capable of
asking these right questions than other social
worlds (i.e. mass media)
Which questions to data?
(Verdier 2014)
P. Lalli
The Open Definition
The Open Definition sets out
principles that define “openness” in
relation to data and content
It makes precise the meaning of
“open” in the terms “open data”
and “open content” and ensures
q u a l i t y a n d e n c o u r a g e s
compatibility among different pools
of open material
“Open means anyone can freely
access, use, modify, and share for
any purpose”
(http://opendefinition.org/)
participation

participation
P. Lalli
1.  Transparency as total access of information regarding the
organization and the action of public bodies, in order to
promote forms of control on the institutional functions and of
the use of public resources
2.  The transparency (…) contribute to implement the democratic
principle and the constitutional principles of equality,
impartiality, good course, responsibility, efficacity and
efficiency in public resources, integrity and loyalty (…). It is a
guarantee condition of the individual and collective freedom
(…)
3.  Art. 41: Obligation to publish in the internet site the “waiting
lists for health-care”
Italian Law n. 33 (2013) on publicity, transparency and diffusion
of information by the public administrative bodies
P. Lalli
A case study
(in coll. with V. Bazzarin)
The Department of Health-
care of Emilia Romagna
Region has a portal with 3
access options
-  news
-  services for citizens
-  h e a l t h - c a r e g i v e r s
institutional area
http://www.saluter.it/
This Region has been one of the most efficient for its Regional Health-Care
System and one of the most participative among citizens and voters → 2014
political crisis of the Council, many inquiries carried by the Courts, and new
anticipated regional election → trust crisis → only 37,7% go to vote
P. Lalli
SISEPS and REPORTER
The 3 channels allows
to access the
information with
different levels inside
the information system
as well as the Open Data
area, called ReportER
http://www.saluter.it/siseps/reporter
Italian Law n. 33 (2013) on publicity, transparency and diffusion of information
by the public administrative bodies
P. Lalli
P. Lalli
The organizational framework
3 teams are involved in this
action that started in May
2014
Ø  communication team
Ø  statistical team
Ø  @sanimov (innovation
team)
Since the beginning of
december 2014 when people
are operating joint they are
called the Open data staff
P. Lalli
Activities
The different teams of the open data staff would have to
-  set up the “open data frame and agenda” (the release of new
data set)*
-  connect to an international and national network
-  promote the open knowledge, the use of this service and the
professional and civic participation
-  talk with newsmakers and policy makers on how this data can
improve “transparency” or accountability as well as the
quality and the reliability of informations
* Meeting and debate with the leadership of the Department
P. Lalli
Observation of meetings
Through participant observation of
meetings and public events we can define 3
phases of this process:
-  fear of the unknown → solved with a
set of common rules but not with a
common vision
-  conflict to define roles → solved by the
intervention of the decision maker
-  collaboration with caution → output is a
program of activities for the 2015
P. Lalli
Observations of meetings
Difficulty to publish a regional set of data
about the waiting lists → contingency of
anticipated regional council election and fear
of political use (communication office more
spokesman than citizen oriented)
Low participation in the site “Io partecipo”
after the Open Health Day
Double mistrust about open data becoming
more work for statisticians and more rating
lists for journalists
Through participant observation of meetings and public events we
identify 3 main issues
P. Lalli
Open questions
-  How can the data become information?
Framing data for citizens can improve the quality of
data for the decision makers?
Are the actual rules able to ensure quality of data?
How can be promoted the participation in order
to involve many actors and new watchdog’s
roles?
Are there some groups who have the priority to
be informed and trained to use open data?
How can be identified the gatekeeper’s role in
this opening process?
P. Lalli
More: what’s about trust?
Think of trust as a brand → Organizations should ensure
consistency, competence and conscience of their everyday action
Efforts to promote ACCOUNTABILITY to improve citizen access to
reliable information and perceived satisfaction with care have to
be effective
P. Lalli
è  To challenge the present crisis of confidence:
è Active listening
è Multipolar Access to information
è Integrated models of participation
è New forms of alliances
è New forms of accountability
Conclusions
Governance, competence and openness
P. Lalli
pina.lalli@unibo.it
Thank you - Köszönom
«Tell the truth and trust in the
people»
(Joseph	
  N.	
  Pew	
  	
  Jr.)	
  

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in public health systems: frames and experienced paths in Emilia-Romagna

  • 1. Trust in public health systems: frames and experienced paths in Emilia-Romagna Workshop: Social Participation: Communication Challenges and Good Practices Budapest, NUPS 12-17-2014 P. Lalli Master in Public and Corporate Communication Department of Political and Social Sciences University of Bologna
  • 2. P. Lalli 1: Shifting citizens… Networked relationships and individualism Our “world is oriented around looser, more fragmented networks that provide on-demand succor” It creates new affordances but requires new social skills Pew Center’s and University of Toronto Net Lab hypothesis (2012) People “need to develop new strategies for handling challenges as they arise. (…) They must actively network to leverage the human resources” Meanwhile… Crisis of confidence in public organizations
  • 3. P. Lalli 1: Shifting citizens… Networked relationships and individualism •  The priority of skills is or not antidemocratic? •  The multitude is not the masses…. •  The social organization appears as a multipolar living body êêêê New elites appear, basing their legitimacy on several dimensions êêêê Bloggers can hold against journalists, collectives develop Linux, Wikipedia, or OpenStreetMap, new influencers on the social web allow for a new agenda of information There are a multitude of skills… (Verdier 2014)
  • 4. P. Lalli 2: Shifting from government to “governance” At least two definitions of "governance": a) decentralization and ”subsidiarity" based on common "utility" among some actors è market adjustment by private interests (stakeholders as "interests bearing") b) decentralization and " subsidiarity" in a social process building shared meanings of actions and mutual involvement è "community" based on trust (stakeholders as subjects committed in collective goals)
  • 5. P. Lalli 2: Shifting from government to “governance” Anyway, if the so-called “subsidiarity” is connected to new forms of Welfare State as the administrative decentralization and the engagement of citizens to participate in public decisions êêê Could communication and information be essential to enable the governance’s process?
  • 6. P. Lalli 3: Communication, innovation, democracy ü  The innovation in a democratic context comes from normative frameworks that set out principles or values ü  Ongoing process that concerns: Transparency - Open Data Visibility Information Communication Accountability
  • 7. P. Lalli Transparency and accountability Transparency is coupled with the duties of the visibility and accountability regarding public opinion è The citizens’ right to scrutinize the government action The purposes of body control of visibility may represent: a)  A fair distribution of public knowledge b)  A marketing strategy influencing both media and citizens
  • 8. P. Lalli Participation vs. propaganda? Development of activities and actors devoted to publicity of the action of government Disappearance of the "propaganda" and the emergence of “communication” In a representative democracy “propaganda” is discredited because it is connected to an explicit goal of manipulation and consensus (Ollivier-Yaniv 2009)
  • 9. P. Lalli INFORMATION and DATA = STRATEGIC RESOURCE ê NEED CONTROL, FRAMES AND MANAGEMENT FOR DECISION PROCESSES AND EVALUATION ê a) TECHNOCRATIC VISION = PROFESSIONALS AS VISIBILITY EXPERTS in the “multipolar society” VERSUS b) REFLEXIVE VISION = PROFESSIONALS AS MORAL ENTREPRENEURS in the “multipolar society” The perspective of a “fair distribution of social knowledge”
  • 10. P. Lalli The new functions of information è Public bodies provide data decisions-makers as a basis for decision, and journalists or “communicators” to ensure good frames of information to citizens for public evaluation è  Public bodies directly provide data using new media channels to ensure the transparency of the decision making process for well informed participating citizens Transparency, frames, data
  • 11. P. Lalli è Quality of data è  Frames of data è Required skills in understanding and handling data è Competition in data use (private, instrumental…) è Over-saturation of data (BIG DATA) Difficulties
  • 12. P. Lalli è  Absolute transparency is an illusion: governments always choose what they want to communicate è  Transparency does not build confidence, but mistrust è  Open Data promises a more direct rapport with power, but in fact creates a new technocracy (those that can understand data) è  Close attention be paid to document the data itself (who created it, when, why, etc.) in order to allow citizens to criticize (i.e. Rupert 2014) Transparency and open data an illusion?
  • 13. P. Lalli è  Data can been used to hurt us è  We cannot see or control all data è  Most people just want to be asked nicely, explained the rules, simply and clearly and be given control è  Essentially, they want to trust è  TRUST IS THE NEW OIL è  Trust is produced by a promise made and kept over è  There seems to be a shortage of trust now, so its value is soaring, particularly at the start of each day’s news cycle (Aiken 2014) Are data the new oil?
  • 14. P. Lalli May be opening data does not rely on a value granted to "transparency” The core concept can be responsibility or accountability, recognizing the dignity of the subject that exercises its responsibilities OPENING DATA & DEMOCRACY “Society has the right to require of every public agent an account of his administration”
  • 16. P. Lalli è The data are intellectual constructions è The more accountability on the choices regarding the construction of data, the more precision on the implicit hypotheses are in order è One just has to ask the right questions on the data è  Open Data appears to be more capable of asking these right questions than other social worlds (i.e. mass media) Which questions to data? (Verdier 2014)
  • 17. P. Lalli The Open Definition The Open Definition sets out principles that define “openness” in relation to data and content It makes precise the meaning of “open” in the terms “open data” and “open content” and ensures q u a l i t y a n d e n c o u r a g e s compatibility among different pools of open material “Open means anyone can freely access, use, modify, and share for any purpose” (http://opendefinition.org/) participation participation
  • 18. P. Lalli 1.  Transparency as total access of information regarding the organization and the action of public bodies, in order to promote forms of control on the institutional functions and of the use of public resources 2.  The transparency (…) contribute to implement the democratic principle and the constitutional principles of equality, impartiality, good course, responsibility, efficacity and efficiency in public resources, integrity and loyalty (…). It is a guarantee condition of the individual and collective freedom (…) 3.  Art. 41: Obligation to publish in the internet site the “waiting lists for health-care” Italian Law n. 33 (2013) on publicity, transparency and diffusion of information by the public administrative bodies
  • 19. P. Lalli A case study (in coll. with V. Bazzarin) The Department of Health- care of Emilia Romagna Region has a portal with 3 access options -  news -  services for citizens -  h e a l t h - c a r e g i v e r s institutional area http://www.saluter.it/ This Region has been one of the most efficient for its Regional Health-Care System and one of the most participative among citizens and voters → 2014 political crisis of the Council, many inquiries carried by the Courts, and new anticipated regional election → trust crisis → only 37,7% go to vote
  • 20. P. Lalli SISEPS and REPORTER The 3 channels allows to access the information with different levels inside the information system as well as the Open Data area, called ReportER http://www.saluter.it/siseps/reporter Italian Law n. 33 (2013) on publicity, transparency and diffusion of information by the public administrative bodies
  • 22. P. Lalli The organizational framework 3 teams are involved in this action that started in May 2014 Ø  communication team Ø  statistical team Ø  @sanimov (innovation team) Since the beginning of december 2014 when people are operating joint they are called the Open data staff
  • 23. P. Lalli Activities The different teams of the open data staff would have to -  set up the “open data frame and agenda” (the release of new data set)* -  connect to an international and national network -  promote the open knowledge, the use of this service and the professional and civic participation -  talk with newsmakers and policy makers on how this data can improve “transparency” or accountability as well as the quality and the reliability of informations * Meeting and debate with the leadership of the Department
  • 24. P. Lalli Observation of meetings Through participant observation of meetings and public events we can define 3 phases of this process: -  fear of the unknown → solved with a set of common rules but not with a common vision -  conflict to define roles → solved by the intervention of the decision maker -  collaboration with caution → output is a program of activities for the 2015
  • 25. P. Lalli Observations of meetings Difficulty to publish a regional set of data about the waiting lists → contingency of anticipated regional council election and fear of political use (communication office more spokesman than citizen oriented) Low participation in the site “Io partecipo” after the Open Health Day Double mistrust about open data becoming more work for statisticians and more rating lists for journalists Through participant observation of meetings and public events we identify 3 main issues
  • 26. P. Lalli Open questions -  How can the data become information? Framing data for citizens can improve the quality of data for the decision makers? Are the actual rules able to ensure quality of data? How can be promoted the participation in order to involve many actors and new watchdog’s roles? Are there some groups who have the priority to be informed and trained to use open data? How can be identified the gatekeeper’s role in this opening process?
  • 27. P. Lalli More: what’s about trust? Think of trust as a brand → Organizations should ensure consistency, competence and conscience of their everyday action Efforts to promote ACCOUNTABILITY to improve citizen access to reliable information and perceived satisfaction with care have to be effective
  • 28. P. Lalli è  To challenge the present crisis of confidence: è Active listening è Multipolar Access to information è Integrated models of participation è New forms of alliances è New forms of accountability Conclusions Governance, competence and openness
  • 29. P. Lalli pina.lalli@unibo.it Thank you - Köszönom «Tell the truth and trust in the people» (Joseph  N.  Pew    Jr.)