I’m capturing notes at the MyPublicServices event from PatientOpinion.  This session is lead by Paul Hodgkin from PatientOpinion .  Use the tag #MPS09 to follow conversations and highlights from others at the event.

What is it about the health community that’s different? It’s about death.  Why do we tell stories? Because it helps us deal with panic or impulses, it’s a gift.  The amazing thing about the web is what we can do with those impulses, stories, and gifts.

PatientOpinion was created as a gift economy.  Gift economies all have:

  • Gifts are always free – If you go to someone’s house for dinner, have a great time, and at the end of the evening you say, “wow, can I write you a check for $56 because I think is about what it was worth,” you’ve just breached the principle of the gift economy.
  • people are judged by how much they give, not how much they have
  • the gift always tarvels/what does around comes around

We don’t own the stories, we are stewards of the stories.  And that’s true with health, too.  Research shows that if you give stuff every day you are less likely to be depressed.

Why now?

  • the web creates visible real-time reputations
  • the web collapses distance and set up costs
  • information goods can be shared forever
  • networks offer increaing returns to scale

Are gift economies undermined by the thought that someone, somewhere is making money off it? Absolutely. Once people start getting paid for things at different parts of the cycle or so on, the gift economy falls apart.  For example, PatientOpinion’s community could operate very different if it was a for-profit company instead of a nonprofit organization.

Decreasing returns to scale, aka ‘one more heave’ and ‘lessons must be learnt’ – As the number of people involved in the system increases, the returns diminish.  Decreasing return systems are tightly coupled:

  • Prize consistency and coordination
  • averse to variation and risk
  • hierarchical, mechanistic
  • extrinsically motivated, enforced

When you move to the web, you have increasing returns to scale, but the number of people involved to affect the increasing returns are at a much larger scale (many more people, etc.).  Examples: YouTube, eBay, Wikipedia, Google.  Increasing return systems are:

  • digital
  • loosely coupled
  • intrinsically motivated
  • network, horizontal
  • variable, uncontrolled


  • Wikipedia
  • MyObama
  • PledgeBank

Why not just turn up and eat the food? Digital gift economies turn free loaders into “audience.”

A gift economy for the public sector?

  • identify the thoughtfully passionate
  • provide easy, incremental steps to involvement
  • strength-based, internal motivation
  • use the platform to increase local impact
  • use the platform to drive local social movement
  • abstract the learning plus improvements and data
  • future users certify improvements are real
  • rate the providers
  • repeat x 1,000 groups per year
  • business model that supports the gifts

Feedback to presentation:

would want to involve staff and services in the offline local events to share their experiences, too.  but that coul emean imposing a structure.  – don’t know if that’s true necessarily, could be determined by the partners putting on and participating in the event what kind of structure and context the event has.

there a high degree of facilitation that’s involved; there’s a natural fear from the service side of fear from the outside, so there has to be real facilitation to get sustainable change and not just reaction.  the patientopinion platform has tools that anyone can use, ie you are going to go out and do something, you tell us what you want, we build it and you pay for it, then we give it to you and you can go do what you want.

seems like people who had a bad experience would be more inclined to get involved with this…is that bad? it’s more of coming from a place of “we all want to be better and do things as good as possible” so it negates just being negative.

if you have a one size fits all solution then it’s a danger, you need to try to get feedback combined with other inputs and so on. it’s important that if someone has a bad experience that they get supporter but also that your solution to that bad experience doesn’t make it worse for other people.

Learn more at http://patientopinion.org.uk

GIft Economies at MPS09
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