15 May 2024

How to liberate structures

Fostering inclusivity, enhanced collaboration, and driving innovation in health.

A set of 33 innovative methodologies that foster inclusivity, enhance collaboration, and drive innovation.

This session is being facilitated by Matthew Keks, a Technical Officer Innovation, currently at the World Health Organization.

He will provide insights into how applying structured, human-centric tools can empower conversations within teams and across diverse stakeholders with real-life examples drawing on his work in public health, international policy and development, and the chance to try one or two of the "tools"

Matthew has shared some links to some of the references he made in his webinar:

Expert: Matthew Keks, Technical Officer Innovation, World Health Organization

Transcription:

Good morning, good afternoon, or good evening, depending on where you're joining us from, and a warm welcome to today's webinar. Ciarán Walsh is my name, I'm clinical director at BMJ, and I'm chairing today's session. The topic for today is how to liberate structures, fostering inclusivity, enhanced collaboration, and driving innovation in health.

And we're delighted to be joined by our expert speaker, Matthew Cacks. BMJ Future Health is a new community we've created. It consists of a webinar series, podcasts, and a live event planned for November of this year. It's all about innovation in digital solutions, creating thriving health systems, a supported workforce, ultimately leading to better patient outcomes and healthier populations.

At the end of this presentation, we'll be having a few minutes of Q& A where you can submit your questions. Please do add them to the Q& A box and any general comments to the chat box. Just a reminder that this session is being recorded and will be made available to watch afterwards. It's my pleasure. to welcome Matthew Kecks, Technical Officer of Innovation at the World Health Organization.

And Matthew is going to be speaking on a set of innovative methodologies that foster inclusivity, enhance collaboration, and drive innovation. And he will also provide insights on how applying structured, human centric tools can empower conversations within teams and across diverse stakeholders with real life examples drawn on his work in public health, international policy and development, and also the chance to try one of the tools.

So welcome, Matthew. Thank you very much for taking this session today and over to yourself.

Here and thank you very, very much for that introduction and thanks to BMJ Future Health for the opportunity to, present to all of you today and to have a Well, what I'm hoping to be a very interactive session.

Actually, yeah. Thank you. Also for introducing sort of my background. Full context. I've been with W. H. O. in headquarters within the digital health and innovation department for 3 to 4 years now, and before that, in the Australian federal government context, applying innovative practices across different public sector areas.

So I'm really just to fight my practice, I guess, of, using and implementing innovation has really been In that policy environment in that strategic environment, but then also within teams and being able to coach and develop teams in that way. Another key aspect of some that I use and apply these sort of methodologies and tools is across the work we do at the innovation hub at W.

H. O. In particular, where we manage intrapreneurship programs for staff, where we look to actually engage directly with member states and countries about how to leverage both innovative practices as well as the science of scale up. I was really, had a great conversation with the BMJ team about well, what actually would be interesting to this particular group.

And so we settled actually on something a little bit divergent, perhaps from kind of a classic conversation around how do we innovate in public health. And as you started talking about, well, there's all of this, I guess, interface or glue where we sort of maybe don't prioritize it enough. We know technically this is the conversation we need to have.

But perhaps we don't know how to have that conversation necessarily or to have the right structures or tools to enable all voices to be heard. The most cynical of us have heard of that phrase for stipulation. We definitely don't want to fall down by going down that path, but then if you don't know, perhaps other ways to approach these conversations, particularly we start thinking about the nature of communities with civil society, bringing academia, public sector, et cetera, together.

So now just to give you a little bit of context for that now again, I promised or I'm warning you that this is going to be very interactive for the first 30 minutes. So I'm just going to share my screen now. We're looking to use or at least I'll be using Slido, as part of this conversation. So continuing to sort of see from the chat as well, but I might actually call upon, several people.

As, possible. So we'd love it if you, again, joining here, if you could scan the QR code with your phone, or if you're watching this on a laptop, again, you can just go to Slido. com and then with the hashtag BMJLS. So I wonder, yeah, I can see everyone as attendees, so I'm just going to assume that we have the chance or you've had a chance to log in, and I'm just going to start the first poll.

So one of the things that is, interesting or one of the things to really discuss around how do we bring different stories together and how do we create different conversations, again, stratified either at a team level, at a meeting level, at an organisational level or beyond is success. And actually reflecting on where things have worked really, really well.

Trying to unpack and understand that. So, we'd love it if, again, got a smaller group here today, if those of you who are online, if you could jump on, I can see there's one participant already starting to share. I'll give everyone maybe two minutes to quietly, think of, a success in their work.

And to just be able to share that via the slider. That would be great. Thank you.

Fantastic. I think we've got four people responding. Six, five.

Okay, so we have our first one. Cloth face masks in times of COVID 19. Changing the medical supplies inventory management with digital transformation that reduces the expiry and pilferage. Really great. Innovative digital tool on managing patients with comorbidities. Okay, would be very interested to hear about that one.

Someone might have been testing their keyboard unless there's an acronym that I don't know myself. Self administered injectable contraception. Fantastic and again, sort of thinking about the nature of being a successful innovation. So not necessarily a prospective, like, I hope this innovation will be successful, but I hope it's grounded.

And again, if you'd like to share an additional example, please do of something that is, is, is that you can actually say, yes, this was a success. Thanks. I'll go into more detail of what that is shortly. Using AI to predict and prevent DNA in DNAs in outpatients, exposing children to epidemiology in elementary school, early introduction to evidence based medicine, that's fantastic.

Introduction of a digital feedback tool for conditions working along an emergency pathway and patient triage for primary care access with digital solutions. I want to ask, so here's solutions, plural. I wonder if the, if the person who shared that one. We'd love to hear a little bit more about this particular success story, or if anyone else would like to actually share in a little bit more detail, I'm guessing if you can raise your hand, we could also put you off mute, so you can actually share back.

If anyone would like to hop on mute, or hop off mute, should I say, and actually share maybe one of their stories,

you might have to raise your hand and then we can allow you to speak.

Not getting on anyone just yet. I don't know, Kieran, can I steal you for a moment? I wonder, which one did you put down as a success? Oh, we've got Julian? Maybe Julian and then Kieran.

Julian, over to you. I think the, I think you can go off mute. Or if you are speaking, we can't hear you, unfortunately.

Alright, we might have lost

Ah, yes, I can. Fantastic. Please, Julian, love to, if you could share or, or elaborate on your, the success that you shared, via the slider.

Yeah, no, we, we developed a digital tool to, for the emergency laparotomy pathway, where, provided individual patient level feedback to those clinicians who worked along that pathway on a case by case basis to sort of supplement traditional clinical audit, which, obviously looks back over summative care and retrospectively, often long after, episodes of care have been delivered.

Whereas this was provided, on the individual patient journey, a qualitative sort of mini case review, shortly after that journey had completed.

Okay, fantastic. And you said supplemented. So how did it work sort of working with almost those two systems?

Well, I mean, the, the original system is the traditional clinical audit model whereby, you know, clinicians will, periodically, review data for, epochs of time, often quite quickly.

Away in the past, and, that is used to develop, for professional development and develop quality improvement work, but it, what it tends to, to lack in some ways is the immediacy of the individual patient journeys. Stories so that clinical often clinical audit has failed to sort of deliver some of the hopeful benefits and in some ways that can be related to not having those real near real time descriptions of of a patient journey where you see what works really well day in day out as well as this, the sort of.

The, the occasional occurrence of where care isn't as expected, but you're actually learning from what you're doing well every day and you get a chance to review and reflect that, and that's what I mean by supplementing traditional audit, which is more anonymous retrospective and, you know, larger cohorts of patients.

So I think also maybe the traditional model, you can lead to, to, limited improvements, but where there's, you know, 80 percent of a quality standard is being met. We all, to some extent may believe that, when it isn't met, it's, it's not us, it's somebody else. But when, when you're getting individualized feedback, the patient level, there's that little nudge that, you know, occasionally.

We all may not actually reach a quality standard that we believe we practice to every day.

Yeah, Julian, thank you for sharing. I think that's, it touches on a few different aspects, right? It's not just the solution, but what you're almost talking about is how people interact with this question, with these, these issues.

And then how does that actually affect the outcome? I don't want to, go into any more detail just yet, because I'd love to, we'll explore that a little bit more as well. So Julian, but thank you for sharing that. Yes. If I could call on you as well.

So I'm the one who put down about the patient triage in primary care as a GP. So we've developed probably s of Covid a, using a, a company already set up. We've sending out text messaging services, but we've used that and used that as a total triage system where everything runs through that basis.

But then we've also then used a steam deck to macro code one click. allocation of patients according to clinical need or referral to the services. So it's a way of trying to speed up the process by which we, it's almost like the, the time it takes to send that person off to the next person that needs to be dealt with digitally.

But we use a, the sort of steam deck macro coding to sort of do that all for us. So it's very intuitive and very quick. And we do that with the company as well in terms of trying to make it. Far more, you know, less latency, less buggy, and my colleague who sort of run that project has sort of presented that elsewhere as well.

So it's been quite successful for our practice.

Fantastic. Thanks for sharing that one as well. I as, I'd love to hear a steam deck used in this context. I guess what I'm hearing from both of you is there's a, there's an aspect of being just in time, but also meeting clinicians, I guess, where they are and what they need.

And I guess that level of responsiveness is kind of an aspect of, I guess, the success of this, these particular innovations you've shared and just looking at some of the other ones that just were coming through as well. Really, really great. I'll do now is actually, so this is a, an activity. It's called Success, evidence and strategy.

And I'm gonna go to number two. Now. This, this particular tool basically says, well look, let's think about success. Let's share stories of success and give a, give each other an opportunity to sort of actually talk about, not just problems. 'cause I think we can have a, sometimes a pro, a problem bias at times.

Like, this is a problem, this, that's a problem. Let's talk about something which has worked well retrospectively. But then let's also reflect to identify. So I'm going to give everyone a explain why that was a success with what kinds of evidence can we draw on that actually speak to that success. So in the same way, I'll give everyone another minute or two to sort of respond to that question again.

Quantity over quality as many kind of data points as you want to use, and my background is in qualitative research, so I always love a good story as much as I love a good number, but I'll give everyone again another minute or two to respond.

Okay, very clear number there. So reduce expiring pilferage by 9 million. That's great. And maybe as much as anything. So reduction of 50 percent in DNAs. So that's a, that's a kind of outcome success, a piece of evidence, but also maybe, and I was sort of touching on this in the last one, if you can unpack some of the aspects that spoke to, the success.

So like I was talking with Julian and I has this idea of, you know, maybe this just in time kind of responsiveness. Is that a. And then the story of actually perhaps how clinicians were able to where they otherwise might not have been able to treat it as successfully or be able to respond to successfully were, that's also my extra nudge is to reflect on those kinds of evidence as well as the sort of outcome, output outcome.

So this is at the national level. We've got that

there. So I think that I'm assuming that's scaled at the national level.

That's great.

I'll give you around a little bit longer.

Engagement from clinicians improved that entry socializing and shorter pathway times. All lead clinicians supported wider rollout after the initial pilot key that staff support innovation. Okay, I'd love to explore that one a little bit more. If the person who wrote that one, particularly this idea that the staff support innovation, what kind of evidence did you see that sort of supported that statement?

If you'd like to raise your hand, we'd love to hear from you or anyone else actually as well. If you're still typing, that's great. Or otherwise, if you'd like to go off mute, you can also just share not necessarily through the slider, but just even just coming off mute. Yeah, would be amazing as well.

Got a hand. Yana, Jenna, make sure I pronounce your name correctly. Over to you.

Yes. Yeah. Hi. I wrote that about, staff supporting the innovation. So for most of our innovation project, it's standard that afterwards we have a staff survey to see whether they are happy with the approach, whether it works better for them, and whether they would support it going forward.

Okay, so you've got the surveys and then you sort of actually hearing that sort of responses in the inverse. Do you ever get times where they reject the innovation through the surveys? And how do you sort of respond to that? Just out of curiosity?

Yes, I would say that has happened in the past. Maybe sometimes the benefits it's with one staff group, but it has a knock on effect on another staff group who have done more work, or it just shifts or it is.

a pain to use and costs them more time, even though there is a benefit in the end. So I think it's probably varied how we address that if we believe there's still overall a benefit. Then we try to support staff nevertheless by maybe shifting something else or making more time available or more resources available.

But in most instances, we try to, in a smaller scale, identify first whether staff actually see this as a valuable innovation.

Yeah, sure. No, that's, that's really great to hear and really great. You've got that mechanism to catch that as well. I want to see some of the others that came out. So all the clinicians supported wider rollout after the initial pilot.

Sorry, that was your one. And then we've got one more here. We used feedback from patients and clinic clinician experience AB testing to improve responsiveness, measured number of calls reduced in reception by 60 percent as directed through the triage system. All right, that's great. I wonder if Julian, sorry, if I could call on you again.

What were your some, what were some of your reflections on, on actually, The things that made it successful, basically, we'll be trying to understand that for a few years as well.

Yeah, please, Gillian, go.

Yes. So the feedback I put there was about the engagement from clinicians, improved data entry, socializing of patient stories and short pathway times. So, we had clinicians wanting to use. the tool and using it in their practice, whether that was with trainees during handover to look back specifically at individual patient journeys and what went well, in that and how to reinforce that.

improved data entry, we found that historically the data entry was done by people who may, by trainee staff who may well have left the hospital before the audits were conformed, but in this way they could actually see a benefit from the effort and the burden of data entry. And it was to do, it was on an emergency surgical pathway and There have been significant improvements on the times from decision to operate to operate, but not on the arrival to decision.

We saw shortenings of those pathway times from arrival to reaching the decision to, to operate.

Yeah. Okay.

And so how did you collect that? I guess that that data or evidence to use the language of this particular activity? Was it through observation? Was it through staff engagement,

the actual data that sits behind the tool or just in

terms of that learning, for example, as you said about the trainees, the data entry and whatnot.

Yeah. So, so that, that, that's the, the, the, the, the data, the source data from it is from a national clinic model. So, the improved data entry, we can see very well from that, that the data entry is more timely and more comprehensive. The engagement from clinicians is, is, is talking to users of it and how they, how they've used it inside their teams.

And, things like M and M meetings, and just talking with colleagues, about it, about the cases, between, different specialties who work along the pathway. And the shorter pathway times is from the national clinical audit itself. We can actually retrospectively review what's happened to those time points on the journey, since introducing the tool.

Now that's, that's really, really great to hear that you're able to collect that level of, granularity to be able to compare over time as well in terms of that, that efficiency of the pathway too. So really glad I'm really glad you're able to capture that. And then thank you also for sharing, putting you on the spot again.

Great. So I hope again and where we're going with this, and I'll open up the third poll. Like I said, it's interactive and maybe it's a bit more work than you might have been expecting from a midday women up is to. Think prospectively now. So we've been thinking a bit retrospectively, right? We've been reflecting on a success and kind of really trying to unpack why it was success.

What sort of factors, what sort of aspects, were a success. Now, have you had to synthesize that information to sort of say, well, look prospectively for a new project, a new innovation, what are some of the critical strategies that could actually help to achieve a future success? What might you like to share with others and say, well, look, if I had to sum up three learnings, it would be A, B and C.

And again, please share your A, B and C. Don't feel like you just need to share your A, but, it'd be great. And I'll give everyone again a minute or two quietly. And then let's have a bit of a conversation around strategies

off the mark. Thank you. So phase one generated analytics from available data. Phase two implementation of the AI based WIMS system.

Hmm, my call on, sorry, I know you were great coming in first, but I actually would like to understand that a little bit more. How, how does it transition from phase one to phase two? Excuse my ignorance, perhaps in this space. But whoever's shared that very first one, we'd love to hear from you.

You can put your hand up if you'd like to share.

Aaron.

Yeah, go ahead, please. Hi, Aaron. I'm from Barron. So we are currently engaged in a PPP project, private public partnership project, where the Supreme Council of Health and Barron has initiated a private company to implement the warehouse inventory management system for the entire public sector, which comprises of eight hospitals and 27 primary health care centers.

And the total value of medical supplies that was dealt is around A hundred and, $240 million. So, they wanted to transform the entire operations. And, this has got various elements, such as the digital transformation, the infrastructure transformation, the human resource transformation, and also the, the technology part, transformation, which is the digitization and, and automation of the building.

So, when I mentioned phase one and phase two. When we took over the project, there was an existing legacy system, software system, that was used to, map the entire medical supplies. That was a legacy system. And, the, the data was available, but there was no analytics generated from the data.

So we used the buy tools to generate, data analytics and, have, meaningful insights to make the changes initially. And in the second phase, we have implemented a full flesh. Warehouse inventory management system, from Portugal, that was implemented in Portugal 30 years back. So we have, implemented that system to generate further advantage, on the control of expiry and pilferage.

So these are the two phases that, we went through. The second phase is not completed and, this is rolled out throughout the entire public healthcare system in Bahrain.

Okay. Fantastic. So in essence, but still the strategy even further, it's, capture the current state in order to design for the future state.

That's right. That's right. And we have also identified the as is, situation and also to be situation so that, we captured the entire existing process and how this can be transformed into, more, analytical way and using data and more generative analytics, which is a predictive analytics way of managing the whole operation.

So that's how we are moving forward and more benefits will be re, reaped as we go along.

Now, that's really great to hear. I've been a part of enough sort of business transformation processes where, the inverse of responsiveness is, just moving really, really quickly. And, thinking that that will respond to the problem rather than actually taking the time to, to understand.

What for key factors you need to bring into the question. I think that's also an Albert Einstein quote. I'll remember it in a second. I might just have a look just briefly with some of the others as well coming through. So, it's hard persistence. Yeah, I'll speak to that one, too. In terms of innovation, synthesizing the problem or potential issue.

Consider the current context and how this can be approved upon. Is this a new way of thinking, data collection and proposed ideas and solutions? Testing, testing, testing, land, quick review and analysis of solutions, and their potential to succeed. Yeah, I love the reference in particular to a new way of thinking, too.

I think it's as part of any kind of innovation, we have to appreciate that innovating does create opportunities. Inactive transformation process, right? So in essence, we are asking people who are going to be implementing those innovations to think or do differently. So if we don't engage with that, that's a risk in terms of implementation.

So understanding of your problem, the data around the baseline sponsorship. Yeah, evaluation criteria clear from the start, including staff and patient views. I really love that. And then considering also the up and downstream effects yet taking almost a slightly more system me. So view or even a macro view of your particular intervention and a multi secular approach and scale of innovation.

Local community buy in. That's kind of our modus at the innovation hub. In Geneva is really how do we focus on that? How do we bridge that gap? All right, guys. You've been absolutely fantastic. I've got one last prompt. I promise. So now if you go really, really small and we refer to this as the 15 percent solution, so I heard a lot of great things there, which are kind of really quite expansive as a strategy.

So like, again, bringing in, you know, community voices. That sounds fantastic. But if you had no extra money, no extra resources, no extra time, and you had to say, Look, how do we do this just tomorrow? Or how can I do this right now in my work or take that away? What might that be? How might you do that?

So again, generative analytics. So starting with the dashboard.

One other writing. I think, Kieran, I called on you well, well from the start. I don't know if you're still there. I don't know if there's any sort of reflections on your journey thus far of the success, evidence and strategy.

Yeah, thanks, Matthew. I'd like to, to, to speak to this point in particular, and my, suggestion earlier was about the digital tool to help manage patients with comorbidities, which is a digital tool. But one thing that I think we need, still need to do more of, is to find more about the humans. We're using the digital tool where they are, but what devices in what context, how much time they have, how they're going to put it into practice, how they're going to tell patients about it.

And those are lots of different things which can find out from just from digital analytics, but only through talking to people that I find that we could do always do more of that each time we do get so many insights. Thanks.

Thank you, Kieran. And yeah, sometimes it is just literally as a 15 percent solution to that.

It's just talking to someone or at least making that effort to at least have a conversation, particularly with an end user or someone in that value chain and having some sort of way to maybe capture that information and hopefully collect it and then start to synthesize. My full background is in human centered design in particular.

And quite often I used to describe sort of that mixed methodology as, the data can really tell you what is happening, but doesn't always tell you why. And that's where actually, you know, drawing from ethnography, drawing from those different sort of skills and tool sets, allow you to, capture that why, which will actually maybe get you more closer to the right path.

Lots of things we could do, but only a few of them we can fund. Prioritization. That's a really, really important one in terms of even just thinking about what our next solution could be. I might just pause the polls there, and I'll go and, stop sharing my screen for a moment. So this, this particular tool is called Success Evidence Strategy, as you've probably gathered from the prompts.

Where it actually comes from is from a development team that operated primarily in the Pacific Islands. They operated primarily in communities. So as a tool in the method to again, liberate the standard structures of how we might engage with an end user and end user community. They started by saying, well, look, what is actually working close to home?

What is working for you and your community in your context? Tell us what's happening there. Unpack why it's working and then what kind of strategies could we then think about in terms of their employee? I know some of the teams we've been working with over in that space have been a lot around digital records.

And when you start to have that conversation around what's working, quite often they're not even using written records, right? And we know the difficulty in terms of the data in this space. So then how do you how do you bridge that gap? And so that's again, trying to think about particularly what are the kind of indigenous solutions that are occurring, but then what sort of sitting underneath them?

And then how can we accelerate that through potentially a digital transformation rather than starting the other way around and saying, Hey, this is what you should do. And here's ABC step to do that. And then finding that perhaps the implementation doesn't go as well as you might hope. And this broadly, and I'll go share my screen again now, Sort of speaks to the liberating structures that, you were promised and you got to engage with actually just one.

So SES or Success Evidence Strategy does not sit within, the grouping of liberating structures. I'll share in the chat, perhaps during the question Q& A, an actual link to these structures. But in essence, they it is a toolkit amongst many toolkits. And this is my probably my favourite toolkit to actually think about how to bring people together.

You'll see there's 15 percent solution there. Normally we're a smaller group actually. So we probably could have done a one, two, four, all where you kind of did that where I asked you to think individually, quietly, and then to actually come together as in this case, a plenary, but also if you come together as a small group and discuss and to share.

What it's ultimately trying to do is trying to speak to this idea, and this goes again from the way you might do meetings, the way you might do coordinate with others, is the extent to which people are included in shaping actions and the extent to which people control the content. So again, the classic sort of presentation, right, or a managed discussion, the stipulation, phrase that I was referring to before.

The extent to which, you know, a status update, yes, it allows a bit more of a critique. But it's still very, very controlled, and that even extends to when we sort of think traditional brainstorm or even open discussions. Which require a specific facilitator to drive perhaps the discussion or maybe to shape the discussion and bias the discussion.

A lot of these liberating structures really do allow sort of a, an open engagement. But what is a liberating structure in essence? So, again, it's this idea of creating self discovery in groups. So particularly where you want to create an environment where it's not just sharing, but it's actually learning.

So again, the difference between a status update and actually talking through kind of the next phase of work with potentially a very mixed group of stakeholders. It's, down up inside out. I know that's a little bit of an awkward phrase, but it's basically saying that we want to start from individuals or we want to start from these small groups and then expand out to learn.

And the other one I probably sort of drawing in particular is a question of buy in. So the nature of these liberate structures is because everyone gets to be heard, whether it's literally you come off mute or you again, I'm using Slido in this instance to be able to capture more data and information from you.

It allows all of us to go through a shared sort of mental process as we sort of unpack a problem or think about a solution.

So a big, big part of the liberating structures and why I find it very, very important to think about, whether again, a meeting or a workshop or, you know, a very structured engagement. Is think about those different factors that that actually all the, strategies as it was to to a successful engagement.

So it's about how you structure the invitation, how you invite people into the space, and how and the kinds of, ways that you can allow for that. So a very simple example might be some of those liberating structures that I've shared very active. They, they require quite a extroverted personality at times, but there's ways to allow people to perhaps, particularly those who are a little bit more introverted to engage as well.

So it could be providing the instructions as part of an email attachment and saying, look, if you'd like to be spontaneous in your, ideation or in your sharing. Just don't read these instructions. So being very, very deliberate about how you craft the invitation, how you craft the space. So here we're, we're obviously operating digitally.

So how do I allow you to easily participate? I've used Slido in this instance, but I could use the chat function. There's What I'm using here to present these slides in Miro. So there's a lot of different tools we can use, then also how we shape the spaces as well. You know, the difference between a boardroom and, you know, that's a circle versus a long table.

You know, all of these little things matter. Participation, I think I flagged before the nature of how, how you craft, the right groups of people. The nature of these kind of liberating structures to is it can at times actually work to democratize the conversation. So you can have a series of experts and some might be technical experts, but some might be experts in terms of context again, going back to community or user voices on the structure.

These liberating structures tools treat everyone basically on the same level. So they can make it much, you're more invited to be able to speak and to allow yourself to, to share, I guess, authentically, where you're coming from and what you have, to add to the conversation. The last two configuration sequence, it's just kind of really speaking to, you, if you're facilitating a liberating structure, how do you actually Control the flow.

So again, I sort of would stop and start if you observed in the success evidence strategy, allowing some sort of, reflection, some speakers, and then otherwise sort of capturing your thoughts through the slider.

Yeah. So again, we'll share all of these. They, work really well when they work together. So again, I sort of put two together in terms of a, or a different tool in this instance with success evidence strategy, and then applying a 15 percent solution. Again, I told you about the one, two, four, all.

The three W's, third from the top, really, really interesting way to sort of unpack the what, so what, and the now what, particularly if you want to start thinking about how you drive towards actions, we could have actually done another loop there and spent another 15 minutes just reflecting on, okay, that was a great exercise or that wasn't a great exercise, what worked and what didn't.

But then also, what were we hearing? So again, I'm sort of reflecting on the room here now so that we have a lot of people who are focusing on on digital transformation, clinical experience. Who else could be interesting to be in this room? And then as an action, how might we, maybe increase participation from other groups to create, you know, different voices, share different stories.

So there's little things like that, that, make this really, really powerful, particularly, again, as you're thinking about the particular context that you might be operating in, the kinds of conversations you want to invite. And I think in the Q and I would love to hear from from you if this tool resonated or other tools resonate or what you're sort of being challenged with.

And if one of these things might be able to respond to that, maybe just a little bit. And I just thought I'd just share just before finishing just around kind of why this is important to us at W. H. O. Innovation is not something which hasn't been happening just because suddenly WHO is explicitly talking about innovation.

Innovation happens across all of the different thematics and disciplines within our organisation, but obviously in all the work that you are all doing. I guess the differences over the last few years is kind of really, WHO sort of saying, well, what is our role in innovation in particular? And where can we, help to accelerate the impact of innovation in order to achieve the SDGs and the outcomes we otherwise are looking to achieve?

So again, within the within the African region and just most recently within the Western Pacific region, there's been some active work to, to actually have indoor strategies that really speak to not only if you look at the Western Pacific one as an example, but also, the question of how do we exploit health innovations?

But how do we build good governance? How do we have that level of capacity building, measurement and then also finance? So thinking about a more broader, holistic understanding of innovation and in the UN 2. 0 most recently, too, with this quintet of change about learning to scale new solutions. So across all of this, you can see there, like I referred to at the start, what is the interface?

How do we ensure that these conversations are happening in the way? And how do we how are we liberating perhaps existing structures, which might be impinging upon, the achievement of what would otherwise be a successful innovation and specifically to our team. That's that's a big, big focus. I think I talked a little bit before before about this idea of scale up of solutions and saying, well, we don't really play in the early stage space.

And again, the nature of what scale up of solutions looks very, very different, right? Depending on which health area. But it's more so saying that if, as government as being a key engine of scaling, how do we work with them to sort of break down some of their particular, we, we coined this phrase wall of frustration.

So how do we, how do we help them to pierce these frustrations or to navigate these frustrations effectively? And something that's really come up in our sort of practice over the last few years is this idea of multi stakeholder engagement to get the right voices in the room, the right experts, both experts in context and technical experts together.

To be able to co design or co develop these, these suite of solutions, whether they're both policy solutions as well as actual, you know, the, the digital or the actual implementation solutions as well. And all this sort of speaks within this idea of, building a system capacity to respond to and to, activate, I guess, a well functioning sort of health system that can actually adapt, collaborate.

Which draws on evidence and is well aligned to achieve population health outcomes.

I'll, I'll finish on this slide because I think it's, it's a, it's something which we use as kind of a framework and a maxim and it kind of speaks to, again, the, the role almost of the facilitator, why would you do liberating structures and who is going to do it in essence. And it's, it's really how do we connect people who want to do something with people who can help them do it.

While staying grounded in real world context, real need in context to ensure it works. So basically if, if you, and this is, this is a design thinking, method, but if you reflect on this idea of the voice of design, it's almost, it's the voice of the broker, the voice of the facilitator, the voice of the person who can coordinate.

And the key thing is there to how they can connect diverse communities. And then again, as I was saying about the expert, right, the voice of perhaps capability in this, this one, or the, the traditional thinking of what we consider an expert. And then how we bring that voice of experience, but never forgetting, maybe perhaps who is funding, or who is driving the particular mandate and authority.

And it's this ecosystem for change, which is really built on people and networks rather than processes and things. And so recognizing how that, that, again, that interface, and that's why I really love. Some of the, sharing back before and Julian as well, in particular, in terms of some of the things that you were sharing around your innovation success for me, it was sort of triggering a lot of these kind of thoughts about how these different voices interacted in order to achieve the success as well as also in others who shared back as well.

But anyway, I realize that's all I had in terms of a presentation. Would love to see what resonated. You know. What's great, what's not, take all sort of remarks, sarcastic, inclusive. So, but otherwise, yeah.

Fantastic. Thank you very much, Matthew. Sorry, losing my voice. Yeah, please do add any questions you might have to the Q& A, and we'll get through as many of them as we can. And while people are thinking of their question or typing it out, Matthew, I want to take chair's prerogative and ask you a question myself, which is about meetings.

I know you've kind of. Touched on how meetings work should work, but sometimes they don't always work as well as they should one issue that I've seen is sometimes the chair of a meeting when discussing a problem will kind of state their preferred solution or solutions. And say kind of off you go. Let's decide on one of these.

How do we prevent that happening?

Sure. So I think it was that maybe I'll just share my screen while I sort of to respond to that one. Again, it goes to that, that question of invitation, space, participation, configuration and sequence. And maybe just to, to use an acronym or one of my favourite acronyms, it's, familiar with the HIPPO.

In this context. No,

It, stands for highest paid person's opinion. It's a small I. And in essence, they are the hippo in the room. right. They're the ones who traditionally would drive the conversation. And so that's why I mentioned that phrase deliberately. This idea of how you democratize the conversation.

It's almost like, how do you nullify the hippo? So we do have structures and configuration, right? Where you have a chair who will initiate the conversation and who will then initiate the way and flow. And then so instead, you can perhaps supply, perhaps, and I appreciate too that particularly very hierarchical organizations, cultures that are very used to, operating in a very formal way, it can be very, very difficult to implement.

And I can, I'm very happy to respond to particular scenarios, where you might only have to tweak at the edges, but even that tweaking of the edges may be applying a tool not to start with. You have to let them sort of. Drive some of that conversation, but then to almost say, well, look, how might we validate some of these initial insights or these initial thinking through, say, a, deconstructive process.

So let's go and actually go and think individually together, think collectively, and then bring that all, back in plenary. So I use that in practice, actually, in the context of climate change. So not in health. Actually, but where we did have a situation where, you know, there was a very strong hippo.

And so how we responded to that was again, was actually using this, using post it notes. So there we go. Another sort of, fantastic innovation tool. And in a room of 30 people, we asked everyone to respond to that particular question. Again, quantity over quality, let's get all these different post it notes.

What ended up happening was when they were responding to the question, we used a, it's referred to as an affinity map where basically everyone sort of sticks up their post it notes in rough groupings. And you start to identify that actually the hippo was, was isolated. There was maybe only one or two or three post it notes that actually aligned with the, again, the chair in this instance.

And actually everyone else had a different view. And that was really, helpful. Because what you, what we learned was it wasn't a case of they just wanted to push their opinion, but that was just what they thought was, Was right. And actually, this this process, validated what others were thinking in terms of being able to say, Okay, in this room, most people are thinking this way.

But also was able to nullify that conversation. So we could have gone to a very different path. It was to do with oceans, plastic in particular. So, yeah, I hope that responds to your your question here.

Yes, thank you. Thanks. A great, great acronym. Thank you. Highest paid person in the room. Matthew, there is a question in the chat.

You might be able to see it yourself, but if not, I'll read it out. Of all the innovation and health disparities, there are still gaps in access, quality, and affordability of medical care that's still there. Why?

Well, that's a big question now, isn't it? Yeah. And I think it speaks to and maybe again, going forward back to that other framework, you'll find I'm a bit of a frameworks kind of guy.

Sometimes, and sometimes that is the fallacy of frameworks, right? Because every box is, is shown equally. It kind of feels like the voice of experience or the voice of capability as the same level of voice as the voice of intent. I think when we start talking about inequity, we start talking about the extent to which certain voices are maybe being heard over others.

And so I think that's kind of recognizing that aspect. And I said, there's a lot of different ways to take that question as well. And I'll leave it to some of my other colleagues in particular, where, as we lead to World Health Assembly coming up soon with all those different negotiations, to bridge the gap with equity.

I know that's been a big, big focus. Of our new work program for W. H. O. is the nature of equity and in particular, leveraging primary health care as a as a vehicle to achieve greater equity, but I think it's always been and I'm going to speak now just at kind of a practical team based level, sometimes even reflecting on how.

each of us maybe are being an oversized voice or an undersized voice. And again, this, this idea of liberating structures is sort of speaking to what kind of tools can we, you know, again, what kind of configurations, what kind of sequences can we design and be very deliberate about that in conversation in order to achieve a different outcome.

If we can design these, these incredible solutions that respond to particular health challenges. We can also respond to human challenges across our stakeholder group, as an example, so that's my invitation to everyone to reflect on if it's not working, then there probably is a way that you could make it work a little bit better and see if you get the chance to try it.

Thanks, Matthew. Great. Please do come up with more questions, feed them into the Q& A or the chat, whichever is easiest. I think I've got another question in the meantime, once again, related to meetings and sometimes meetings. Go on and seem to discuss things endlessly. And the only conclusion is to have another meeting at the end.

We do to prevent that happening.

Yeah. So that I think is, is, not even needing a liberating structure. In that instance, this might be. I've heard this phrase used before meeting hygiene. So, again, if we use the analogous example of hygiene, right? And if we're telling everyone to wash our hands for a certain amount of minutes and do it in a certain kind of way, well, in the very least, we can say, well, look, each meeting has to have an agenda, right?

Each meeting has to have, time to reflect, has to have maybe have someone who's a timekeeper. So actually say, well, look, this is a really great conversation. But we're going down a rabbit hole. Let's put this in a parking lot. Let's let's not not lose that conversation because it's very relevant, but it's not relevant to the agenda.

Let's put that on pause for a second and actually, move to reflecting on what potential action items there might be. So I think that's this. That's just kind of classic meeting hygiene and then. Once you start feeling confident with that, that's when you can start to employ the liberating structures methodology.

Again, configuration, sequence, invitation, participation, and space, and reflecting on how all of those things are either contributing to your poor meeting hygiene or how those things are enabling. Good meeting hygiene.

Fantastic. Thank you, Matthew. All participants, please do add further questions to the Q and a chat box. So we'll try and get through them in the meantime, like Matthew, another question for me, you mentioned innovation, obviously quite a lot. And I wonder what are the incentives for doctors and healthcare professionals to get involved in innovation?

It's massively hard work. There's no guarantee that your innovation will work in the end, on balance. It's probably less than 50 50, it's risky. What incentives would you say should drive people to get involved, attract people to innovation?

I think it does require a certain mindset. There's a, there's a particular model, so that the car institutes to loop model that sort of says that there's always an, a dominant system.

There's always an emergent system. And so within that dominant system, there's always people who look to stabilize that dominant system. And then there's always people in that, that, emergent system that are kind of always driving towards change. Sometimes it's almost again a reflective opportunity to think about the extent to which are you stabilizing the current system or are you looking to actually, build towards this emergent system, whatever that might be.

So almost firstly sort of reflecting on kind of you and in terms of your mindset and your values. And then it's kind of that question then. Yes, you're right. There's, a diagram for the, the emotional journey of doing anything great. And it's kind of got this. I might actually still have it here.

This pit of despair. We're basically, and I don't know if people use this, it's used in a sort of more Brené Brown sort of context, but I love it to actually use before I kick off any sort of project with the team. So it'll sort of say, look, this is going to be the best idea ever, to the point where this sucks and I have no idea what I'm doing.

I really, really hope we don't get to a point where it's like, quick, let's call it a day and say we learned something. But actually try to get towards that that achievement, and I think that's you know, there's a lot of different definitions to innovation. One of the ones and we have a technical definition, obviously, but the one that kind of resonates with me quite often.

It's it's change that outpaces the norm, right? So if that really resonates with you, it's almost like you're driven to go and attempt and to work in that in that way and in that space to continue to try to innovate in your work. And that's where it. Deliberating structure. 15 percent solutions can be very helpful because it says again, how do I, how do I do this change?

How do I make this innovation work that has no extra time? No extra resources, right? So that's that's starting from zero. And you can still do 50. You can still make a 15 percent improvement. It's kind of the heuristic. Now, if you want to make a 30 percent improvement, and let's say you do have a small amount of resources, so you see, you can always try to right size that change and know that you're contributing towards that that broader impact.

I would hope again this whole idea of you. We're all here to to improve the health and well being of the people we serve. And so I think innovation again is a big part of that, whether that's an innovative practice or there's an implementation.

Thanks, Matthew. Great. We've got a whole two minutes left.

There's one last comment in the Q& A. Thanks, Arundhati Govind. Determination and dedication from the leadership versus liberating structure. So I'm guessing that's about balancing the two. Great. So. Matthew, a whole, 30 seconds answer to that, if you can. Yeah. Of course.

Fantastic. So I think it's, what you've got to do is really find alignment in terms of that, that, senior executive, incentives.

If you can sort of see where there's an opportunity where your values and what you bring to the table in terms of your innovation can align with that sort of senior level mandate appreciating that they the voice of of intent is a voice as part of that of any sort of network of implementation when they don't align.

That's a challenge. And so, in essence, that's how one of the ways we prioritize which interventions in which places we play in. Is to sort of identify. Well, where do we see sort of strong alignment and synchronicity because there's so many challenges everywhere, so we might as well prioritize the ones where we can see a high degree of success.

So I would say it's challenging if you don't have that alignment, but try and find that alignment. Thanks here.

And thanks, Aaron, as well. Yeah, no, fantastic. Thank you, Matthew. And I think that's a probably a good point to wind things up for the content perspective. So thank you very much, Matthew, once again for the interactive presentation and detailed discussion at the end.

I'm just going to wind things up, by speaking on behalf of BMJ Future Health, that we're delighted to announce that the registration for our event on the 19th and 20th of November is now open. I'd be grateful if one of the team could share screen, so that then, potential delegates will be able to scan the QR code, or if not, just visit our own website.

For further information, just Google BMJ future health, our next webinar in this series will be on Tuesday, the 22nd of May, 5 to 6pm with the Shuri Network, how to develop the next generation of leaders. And finally, I'd like to thank you all for, for taking part and for participating actively and adding to the chat box and adding to the discussion and, and Q and A.

We really hope you found it valuable. We hope that you'd be able to put what you've learned into action to improve healthcare for, and outcomes for patients. Thank you once again.

Thank you, everyone. Really appreciate the time.

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