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Transformation Through A Shared Vision Partnership for Health and Wholeness Benjamin V. Lozare, Ph.D Johns Hopkins University May 26-2007.

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Presentation on theme: "Transformation Through A Shared Vision Partnership for Health and Wholeness Benjamin V. Lozare, Ph.D Johns Hopkins University May 26-2007."— Presentation transcript:

1 Transformation Through A Shared Vision Partnership for Health and Wholeness Benjamin V. Lozare, Ph.D Johns Hopkins University May

2 Session objectives 1. Appreciate how “self-limiting” mental models weaken creativity and thinking processes. 2. Appreciate an alternative way to defining health problems. 3. Understand the concept of shared vision and its importance

3 Life From Many Angles Is there only one way to see things? Is there only one TRUTH? How can we develop multiple perspectives? From Zoom, an illustrated book (1995) by Istvan Banyai, Hungarian artist

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35 Where do leaders operate? Beyond Imagination That’s Impossible Looks Difficult Easy to do

36 Insert Believe Theme

37 Key Idea How can you make a difference if you think you can’t?

38 Somewhere in the future Kobie and Ajoba represent the resourceful couple. He is a driver; she is a street vendor. Health is a priority in their lives and like their friends, they invest time and money to ensure that they remain healthy.

39 Somewhere in the future Kobie and Ajoba plan to have only two children so they can provide them with love and care and ensure their health, education and welfare. They saved enough money before they had their first child.

40 Somewhere in the future They sought information on pregnancy and child birth and learned the danger signs of pregnancy. They knew what to do in case problems occurred. It did not matter to them whether their child was a boy or girl. They agreed to raise their children so that they too would value their health and sexuality.

41 Somewhere in the future Kobie and Ajoba understand the risks of HIV/AIDS and have shared their knowledge with friends and family. Both are deeply concerned about the political and economic future of their country. They vote intelligently and always encourage their friends to do the same.

42 Somewhere now Ebo and Abena are living together. Ebo is a mechanic who works when he wants to. Abena would like to earn some money but Ebo refuses to let her work. They do not know about modern contraception and have not been to a health clinic in five years.

43 Somewhere now They have six children, all unplanned. Four are seriously malnourished. Because Ebo’s income is meager and irregular, their children often go hungry. When there is food, the boys get the largest portions and eat first.

44 Somewhere now Ebo and Abena do not talk about their condition or the future. Ebo drinks heavily and often beats Abena when drunk. He was surprised one time when Abena fought back. This made him so furious that he beat her severely.

45 Somewhere now Abena ended up in the hospital. The police jailed Ebo briefly but he did not have any remorse when released. Both Ebo and Abena are HIV positive but they do not know their condition. They don’t care about politics and have never voted.

46 Why is there a difference? Our challenge is to think deeply and then act.

47 Our present health system is “perfectly” designed to produce our present results! If we want the same results, let us keep the system.

48 If we want new results, we may need to redesign our health system.

49 We may need to change our mental models of cancer and public health. Cancer

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51 On eyesight and vision “There is nothing more pathetic than a man with eyesight but has no vision”. Helen Keller

52 Session objectives 1. Appreciate how “self-limiting” mental models weaken creativity and thinking processes. 2. Appreciate an alternative way to defining health problems. 3. Understand the concept of shared vision and its importance

53 What are self-limiting mental models? How do they influence our thinking processes? Self-limiting mental models are assumptions or beliefs that “define” what is “easy to do, “possible”, “realistic” or “achievable” and restrict what people aspire for.

54 “ I will be happy with just one more cow! From the book Behind Mud Walls

55 On introduction of sound for film “Who the hell wants to hear actors talk? Harry Warner, Warner Brothers, 1927

56 “There is no likelihood that man can ever tap the power of the atom.” Robert Andrews Millikan, Nobel Prize winner for physics, 1923

57 “I think there is a world market for about five computers.” Thomas Watson Jr. Founder and Chairman of IBM, 1943

58 “Everything that can be invented has been invented.” Charles H. Duell, Commissioner, US Office of Patents, urging President William McKinley to abolish the patents office, 1903.

59 “Horses are here to stay. The automobile is only a novelty, a fad.” President, Michigan Savings Bank, advising Henry Ford’s lawyer not to invest in Ford Motor. Disregarding the advice, the lawyer invested $5,000 which he later sold for $12.5 million.

60 “There is no reason for any individual to have a computer in his home.” Ken Olsen, President, Digital Equipment, 1977 Compaq now owns Digital Equipment

61 Leadership starts with vision.

62 Leadership starts with a vision. Erik Weihenmayer climbed Mt. Everest in 2001 He is completely blind!

63 Insight from a blind woman “There is nothing more pathetic than a man with eyesight but has no vision.” Helen Keller

64 Who dares wins! “It is not that things are difficult that we do not dare, it is because we do not dare that things are difficult!” Seneca Roman Philosopher 16 BC

65 Where do leaders operate? Beyond Imagination That’s Impossible Looks Difficult Easy to do

66 Evidence-based thinking and science of the day Science Problems Solutions X Y

67 What happens when the problem lies outside of the science of the day? Science Problems Solutions ? YY X

68 What happens when the problem lies outside of the science of the day? Science Problems Solutions ? YY X That’s difficult! That’s impossible! That’s beyond imagination!

69 Our best thinking got us here. The problems that we face cannot be solved by the same level of thinking that created them. Albert Einstein

70 We need to find solutions outside of the science of the day! Science Problems Solutions Y X

71 Science values intuition and imagination too! “Imagination is more important than knowledge.” Albert Einstein

72 Where do leaders operate? Science ten years from now Tomorrow’s science Today’s science Yesterday’s Science Problems Solutions XY

73 What is difficult? Impossible? Beyond imagination?

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76 We do not reach visions, we create them. “The future is not a result of a choice among alternative paths offered by the present, but a place that we create, first in the mind, next in will, then in action. The future is not some place where are going, but a place we are creating. We do not discover the paths but make them, and the action of making the future changes both the maker and destination.” John Schaar

77 How much can a person achieve? Unlikely more than his or her vision. We can turn things around and say, a vision limits what we can do!

78 The only true limits are the ones that the mind accepts. Thomas Edison failed 10,000 times before he perfected the light bulb! Abraham Lincoln lost 8 elections (local) before he became President of the United States!

79 “There are no rules here, we are trying to achieve something!” Thomas Edison

80 Session objectives 1. Appreciate how “self-limiting” mental models weaken creativity and thinking processes. 2. Appreciate an alternative way to defining health problems. 3. Understand the concept of shared vision and its importance

81 How do we usually define “health problems”? 1. “Deviation from a norm” or “indicator chasing” 2. Existing “solutions” in tool box - Ideology - Training 3. Knee-jerk “lack of resources”

82 Deviation from the “norm” 1. Who determines the “norm”? MDG? 2. What if “norm” is the source of the problem? 3. Restoration of “norm” is system maintenance not improvement

83 Use existing solutions - When we have a hammer, everything looks like a nail! 1. Trainer - everything is a training problem. 2. Manager - everything is a management problem. 3. Community mobilizer - everything is a community mobilization problem. 4. Medical doctor -everything is a medical problem.

84 Lack of resources 1. Resources are universal constraints - when will we ever have enough? 2. Are we using existing resources effectively and efficiently? 3. How resourceful are we?

85 What is an alternative way to defining problems? Define problems in terms of why there is a difference between what we want (shared vision) and what is happening (current situation) and how to bridge this difference.

86 Our choices in defining health problems 1. Deviation from a norm 2. Tools in our tool box 3. “Lack resources” 4. Ask why is there a difference between our shared vision and the current situation? 5. Other ways?

87 Approach requires two things 1. We need to know clearly what we want. 2. We need to know clearly what is happening now.

88 Session objectives 1. Appreciate how “self-limiting” mental models weaken creativity and thinking processes. 2. Appreciate an alternative way to defining health problems. 3. Understand the concept of shared vision and its importance 4. Discriminate between a good shared vision and poor one. 5. Know the steps in nurturing a good shared vision

89 Leadership Principle Effective leaders inspire a shared vision. A shared vision is a picture of a desired future that all stakeholders want to create. The emphasis is on shared, not on vision.

90 Let us think like architects, not like mechanics. Problem solving mind set is different from that of creating something new!

91 A few questions 1. Do you have a shared vision in your organization? 2. Do you have a national shared vision for development? For health? 3. Can everyone describe what the shared vision is? 4. If you don’t have a shared vision, what is the reason?

92 Military strategy concepts Four levels of strategy 1. Grand strategy 2. Strategy 3. Operational strategy 4. Tactics

93 Grand strategy defines everything Should we go to war? Who is our enemy? Who are our allies? What price do we want for peace?

94 Declaring war may take time! WWII - Roosevelt, Stalin, Churchill It took the US two years after Nazi Germany invaded parts of Europe before it declared war!

95 Strategy level How will we conduct the war overall? What forces will we mobilize? How will we deploy them?

96 Strategy level WWII - Gen. Marshall, Sir Allan Brooke 5 million men, Europe before Pacific, Invade Germany not blockade

97 Operational level How will we achieve the strategic ends with our military resources? What combination or mix of resources is best?

98 Operational level WWII - Gen. Eisenhower, MacArthur and Admiral Nimitz. Army and Air Force were combined. Capture every island or skip some on the way to Japan.

99 Tactical level Where opposing forces meet. How to achieve specific or concrete objectives. WWII - Capture a bridge or hill. Occupy a crossroad.

100 The “war” on HIV/AIDS It took more than 20 years since HIV/AIDS appeared before Kofi Anan declared “war” on HIV/AIDs in Abuja, Nigeria. He declared that the UN will raise $10 billion a year and will mobilize all the resources of the UN system to fight HIV/AIDS.

101 How do health strategy concepts compare with military concepts? Grand strategy Strategic level Operational level Tactical level Shared vision Policy Program strategy Campaign strategy

102 How do health strategy concepts compare with military concepts? Grand strategy Strategic level Operational level Tactical level Shared vision Policy Program strategy Campaign strategy

103 How do health strategy concepts compare with military concepts? Grand strategy Strategic level Operational level Tactical level Shared vision Policy Program strategy Campaign strategy

104 How do health strategy concepts compare with military concepts? Grand strategy Strategic level Operational level Tactical level Shared vision Policy Program strategy Campaign strategy

105 2. What is shared vision? A clear description or picture of the future that all stakeholders want to create. It is a future that people are willing to pay the price for.

106 “I have a dream!” “I have a dream that one day little black boys and black girls will join hands with little white boys and white girls as sisters and brothers. I have a dream that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character. I have a dream today!

107 He did not say….“I have a “strategic plan!”

108 What is shared vision? Emphasis is on shared not on vision. Description is in the present tense. Draws a picture and avoids use of indicators or numbers.

109 Key purpose of a vision Generate new levels of inspiration and energy to change the current situation and create a new future.

110 RDS Should a vision be achievable under present conditions?

111 Types of visions Personal - What do I want to happen or create? Shared -What do we want to happen or create?

112 Personal and shared vision Shared visions emerge from personal visions. Shared visions emerge from personal visions. Personal visions come from an individual’s deep caring. Personal visions come from an individual’s deep caring. Shared visions come from a common caring. Shared visions come from a common caring.

113 Government Households Community Vision shared by whom?

114 Government Households Community Vision shared by whom? Everyone!

115 Key question Do families, the primary producers of health, participate in shaping the national health vision in your country?

116 Vision shared by whom? Government - Reduce MMR by 5%

117 Let’s ask a pregnant woman’s husband. “How much maternal mortality would you like? ”

118 Vision shared by whom? Government - Reduce MMR by 5% Household - Zero MMR

119 Let’s ask the community. How much maternal mortality would you like?

120 Vision shared by whom? Government - Reduce MMR by 5% Household - Zero MMR Community - Zero MMR

121 Can the community participate here? Strategic objective - Reduce MMR by 5% points (300/100,000 to 285/100,000) in one year.

122 Can the community participate here? Vision - No mother dies from child birth in this community. Should we do it alone? Or with communities and households?

123 How do develop visions and strategies? 1. Conventional way - Start with situational analysis. 2. An alternative way - Start with defining a shared vision.

124 Conventional approach to “strategy development” 1. Where are we now? 2. Where do we want to go? 3. How do we get there? 1. Situation analysis 2. Strategic objectives 3. Strategy

125 Disadvantages of common practice 1. Situation analysis is often more descriptive (indicators list) and less analytical. 2. “Visions” are set lower because reference point is the current situation (often depressing). 3. Encourages only incremental changes, not fundamental ones.

126 Should visions be based on situation analysis? Should we want only what we can have given the current situation? Should we aim for what we truly want and change the current situation?

127 An alternative way 1. Where do we want to go? 2. Where are we now? 3. Why is there a difference? 4. What needs to change? 5. How do we get there?

128 An alternative way - different wording 1. What do we want to happen? 2. What is happening now? 3. Why is there a difference? 4. What needs to change? 5. How do we nurture change and accountability?

129 Comparison Current practice Situationanalysis Strategic objectives Strategy Alternative way Shared vision Situation statement Root cause analysis Strategic objectives Strategy

130 Advantages of the new way 1. Shared vision clarifies what is important and empowers people to important and empowers people to take initiative. take initiative. 2. Nurtures analytical thinking. 3. Encourages focus and creativity. 4. Highlights the need for change. 5. Forces confrontation of the “dragons”.

131 What do you want to happen? Vision

132 Are you avoiding the dragons? Smart objectives

133 SMART strategic objectives Specific Measurable Action-oriented Realistic Time bound

134 Are we focused on milestones and ignoring the dragons? Smart objectives

135 To improve your score, you have to keep your eye on the ball! Are people engaged in “indicator chasing”? A “health indicator” is not the ball. It is the score!

136 Are we focused on milestones and ignoring the dragons? Smart objectives

137 Maternal mortality example Indonesia 350 per 100,000 birthsGOI 650 per 100,000 births WHO Is maternal mortality important enough to measure accurately?

138 Perceptions 3% reduction/year is “easy to do.” 10% reduction/year is “difficult!” 25% reduction/year is “impossible!” Elimination of MMR is “beyond imagination!

139 Shared vision? GOI - reduce MMR by 3% every year! Community - Zero MMR! Household - Zero MMR!

140 The facts What is the MMR range of possibilities in a household with mother giving birth? Answer - 0 or 1

141 If we accept GOI figures MMR = 350 /100,000 births How many households with births has zero MM? 99% How did we come to believe that MMR = 0 is “beyond imagination”?

142 How many mothers die in Indonesia from birth related causes? Each year = 24,000 deaths (1990) How many villages in Indonesia? More than 58,000 villages! At least half of the villages have zero MMR if MMR is equally distributed!

143 Some contextual facts 99% of the more than 500,000 maternal deaths each year is from the developing world. Greatest discrepancy of all indicators Most of this loss and suffering is preventable

144 Shared vision asks: What do we want to happen? Or What do we want to create? NOT What is feasible given present conditions?

145 Have we tamed our dragons? Have we tamed our dragons? Smart objectives

146 Have we tamed our dragons? Have we tamed our dragons? Smart objectives

147 How “big” should your vision be? The answer is how deeply do you care? How much are you willing to change? Every vision has a price. If stakeholders really want something, they must be willing to pay the price.

148 How “big” should your vision be? 1. “Floor setting” - “At least” we should….. 2. “Go for broke or ceiling” - What we truly want “no matter what”.

149 At least to move closer to the castle so I can visit my family in prison.

150 To rescue our families, no matter what! Shared Vision

151 Key question What would you do if you were not afraid?

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153 Mother Theresa Vision “Care for the dying” Initial reaction “You will die yourself” Price paid Life of sacrifice

154 Gandhi Vision “An independent India” Initial reaction “But that will never happen!” Price paid His life.

155 Founder of Pakistan - Jinnah Vision - A new country - Pakistan Initial reaction - “ But that is impossible!” Price - Struggle and much suffering

156 Abraham Lincoln Vision “No man should be a slave. Everyone man is created equal. ” Initial reactions “You are going to break the nation apart!” Price paid His life

157 Nelson Mandela Vision A democratic South Africa free of apartheid Initial reactions You’re crazy! Price paid 27 years in prison

158 Some things have to stop!

159 Common response I’m scared!

160 Old language patterns “That’s ideal, we live in the real world!” “That is impossible!”

161 Old language patterns “Do that and you will become a bus driver!” “You are throwing your career away!” “Are you crazy?”

162 A leader’s response - New language patterns If not now, then when? If not me, then who?


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