Friday, April 4, 2008

Do No Harm and Mistakes

" Mark Twain reminds us that "if your only tool is a hammer, all problems look like nails." While the human service tool has undoubted efficacy in particular situations, like the hammer, it can also do great harm when used inappropriately."

"(E)valuation usually focuses on whether an intervention "made a difference." The intervention is presumed to help if it has any effect at all, and if it has no measurable effect, it is assumed not to have hurt."

John McKnight, The Careless Society: Community and its Counterfeits

Remember the admonition: Do No Harm? I received this oracular warning shortly after taking a job at a foundation from an old community development sage. There is even a DO NO HARM Initiative related to humanitarian interventions in world crisis situations. In my thinking about mistakes, I now have four categories in mind: 1) trial and error prototypes or innovations; 2) non constructive failures that comprise the range of human and organizational frailties; 3) constructive mistakes which occur despite our best efforts; and 4) the iatrogenic harms and collateral damage that result from our helpful interventions and programs. Think of the harms done when we encourage the proliferation of CDCs without hope of long-term sustainability, or the launching of sometimes doomed social enterprises in the hope of generating revenues for self-sufficiency. What about when our social investment dollars fuel hyper competition among nonprofits or the flawed replications of model projects? What damage is done to the already stressed civic fabric? Do our good intentions feed the cynicism that nothing works? We rarely account for these harms if we even are conscious of their existence.

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