Hits and clicks are the steroids of the web. Got ‘em and you’ve got growth, revenue and eyeballs. Without ‘em your dead in the water – or at least that’s the conventional wisdom. But whose interest do clicks and hits really serve? Well sometimes it’s useful to know that lots of other people liked an item – it’s a great way to get a sense of a field that you know nothing about. But thereafter hits and clicks mostly serve advertisers and shareholders. They are important because they reflect the ability of the site to raise revenue. But what if your site isn’t interested in selling things? What if you’re site is about changing the world?

Of course if your site is about campaigning or growing a political movement, then getting the message out is important and size still matters. But there is a new game in town, sites that are about generating hyper-local change. Patient Opinion for example is about making ward 15 in Solihull General less noisy at night, or about working with staff at Rotherham to improve how relatives are cared for. Here the motivation comes from the citizen - people are often strongly motivated to stop others going through some particular aspect of  care that has been poorly delivered at some specific site in the NHS.

No point in thinking that this posting will or should garner thousands of hits. What is much more important than size is that just the right 3 or 5 or 15 people who can do something practical about the problem see it and act on it. If we could find a currency and a business model that drove such micro changes, then we would be looking at a way to release the energies of citizens to improve the world in hundreds or thousands of small but significant ways. We might also be looking at the next YouTube. 

Four economic aspects of the web make such a system possible: cheap voice enables everyone to have a public say; RSS feeds increase the signal to noise ratio and enable your message to get to just the right people; the web makes it easy to find ‘people like me’ cheaply and quickly – people who are driven by the same passion or problems as your self; and finally the web makes it easy for people to coordinate action from email to PledgeBank to MeetUp new tools are helping people get organised.  All these tools are currently citizen-centric not organisation centric. For the first time in history it’s easier and cheaper for citizens to put together an effective response than it is for organisations. The problem is that such citizen campaigns can undermine collective solidarity. Such effects can be seen with both Al Quada and the ability of particular patient groups to (understandably) pursue their own with the effect of reducing benefits to others.

So what we need are tools and a web currency that rewards citizens for their efforts and passion about some hyper-local aspect of a service whilst incentivising busy staff so that they no longer see patient comments as blemishes but as the starting point for getting professional and organisational rewards.

Hyper-local tools are what Patient Opinion is now working on. How can we exploit the new economics of the web to enable citizens and front line staff to change thousands of micro-aspects of care?

Last week I talked about Patient Opinion at Alex Stobart's very excellent ScotWeb2 unconference. Lots of very interesting, knowledgeable and motivated people there, so it was a great day.

One or two people wanted the slides, so I've put them on SlideShare and embedded them here:

We're keen to provide a proper Patient Opinion service for patients and carers in Scotland who want to offer feedback about their health care (and we already get stories). One challenging issue, which we are already bumping into elsewhere too, is that there are many, many small hospitals located in very sparsely populated areas.

Why is this a challenge? Because we aim to maintain the confidentiality of those posting on Patient Opinion, and because we don't want to inadvertently defame a member of staff. Suppose we receive a posting about the Royal Isolated Hospital which says: "I was seen at this hospital last week with my genital warts. The nurse I saw was clearly incompetent." So far so good: the patient and staff member are not identified - unless you happen to live locally. In which case you and everyone else round about will know that the only patient seen there in the last month was Iain, and the only nurse at the Royal Isolated Hospital is Margaret.

This doesn't seem desirable - but neither does the option of publishing feedback without saying which service it is about.

We have a few ideas on how we might tackle this - but we're looking for more. Suggestions, please!