"Scale" vs. "Diffusion"

One of the most interesting conversations that came up during last week's Global Engagement Summit was a conversation about our understanding of how you "scale" social sector innovation, and the question of whether "diffusion" might be a more useful mental framework?

FrontlineSMS: Medic co-founder and GES delegate Josh Nesbit opened a conversation at our closing open-space style unconference session on Sunday about how to effectively scale. The question for Josh is about horizontal scale. FrontlineSMS: Medic is software that makes it easier for rural clinics to communicate with their community health workers via SMS and without the internet even at great distances. This improves quality and coverage of care. His pilot in Malawi went extremely well, and now he's working with others to integrate photographs, electronic medical records, and more.

Josh is thinking a lot about scale, because his goal is not just to expand to a few hundred clinics a year, but to make it easy for any rural clinic in the world to know about and use FrontlineSMS:Medic if they find it useful. He has no allegiance to the brand or the software itself except insofar as it seems to him to be the best option currently available for enabling individual clinics to take better charge and better support their community health workers.

What he's really looking for is not a "scale" that provides new benefits for ownership because of reduced costs, but the diffusion of a tool and an approach to supporting rural health care. I wonder how many innovations in the social sector are under-leveraged or face too-limited distribution because our conception of scale is rooted in a private sector ownership conecption of scale? Is the process of diffusing an idea different than the process of manufacturing a good or service at higher volume?

Does our conception of social entrepreneur - which generally involves an social innovator looking to scale their model to a point where they can achieve systemic change - focus too much on the scale of the organization rather than the scale of the innovative approach? Does Paul Farmer care more about Partners in Health becoming huge or is what he's really after a broad based affirmation of things like the necessity of paying community health workers and creating complex and coordinated health systems? Does Eboo Patel care more about the scale of the Interfaith Youth Core or is he cooking it to build a generation of pluralist thinkers and faith leaders?

And here's the kicker: if the answer is that what we're really after is diffusion of approaches and ways of seeing, are the structures through which we support social entrepreneurship flawed, or at least fundamentally incomplete? Instead of making him an awardee, should the Skoll Foundation be hiring Weiden+Kennedy to create targeted advertising campaigns to make sure clinics around the world know about FrontlineSMS, for example? Even if it's not Skoll, should someone be doing this?

It seems to me it's worth remembering that when it comes to social entrepreneurship, the field is so young that there are really no rules, and how we support and help foster the diffusion of innovation outside a traditional institutional model seems to be a wildly important conversation.