Terms of what makes our approach unique. I think that part of what we're looking at is really this holistic, integrated model that acknowledges that you need things to operate simultaneously in a way that balances each other. What I mean is that, if you're going to be asking people to learn and take risks, whether it's professional risks or psychological risks, you need to simultaneously be providing them with forms of security and stabilization that allowed them to feel secure in ways that are important to them but might not be critical to solving the problem. So it's this dynamic model that doesn't necessarily call for one thing or the other, but recognizes the two things in relationship are what allow them to sustain each other. Yeah, and I think one of the things that's unique about this model is that we are identifying the behaviors that people need to follow, but then we're saying, it's not enough to say people do this and behave this way, because what we see in reality is that for people to behave in those ways, it requires almost heroic courage and people who are willing to go against all this structural factors that prevent people from behaving that way in the first place. So this notion of like, well, what are the behaviors that we need people to engage in? and as a result, what are the risks that they're taking? What are the structural components that we need to build to support them in those risks? I think is what's unique. As an example, structural support that you need to create that doesn't have to be very formal. Actually what we have found is that it's not formal, it's flexible, and it's adaptive, but it's still structural and still somebody needs to provide it. Is for example, something as simple as there is a convening space where we can come together and we can meet, and while we're there, it's recognized by everybody that we are jointly working on this problem and we're protected from our organizations in our day-to-day jobs, in our incentives. But also we're provided with the structural support of a project manager, who's going to help us keep track of what we're doing so that we can be in the work, and stay connected to our day jobs, and we are supported by some financing that has the ability to adapt as we're learning. So somebody has to do that, somebody has to raise that money and frame it in the process of this collective learning enterprise, and somebody has to be providing each of us with the security that, this project is going to generate something that you can then take back to your organization and is going to be seen as valuable, and we see you, and we see what you need, and we're going to make sure that the process generates something that is a value to you. These are small structures that provide enough security for people to feel free to take the risks and extend their behaviors in ways that wouldn't be natural. One other element is this notion of a participatory design process that recognizes the vastness of complexity that might be before you, and that you don't need to understand all that complexity at once. If we can establish what we've called learning pitches, these are incremental questions that allow us to tackle sequential pieces of the puzzle. Then eventually we might get to this broader understanding, but we don't need to have it all figured out at once. Again, that's part of this dynamic of providing and of psychological security where you can, while pushing people to take risks in a measured way where it's actually going to be productive. It's about breaking down the problem into its smaller pieces and say like, here's all that we don't know. We don't really even know what's going to work for the midwife at the micro level, and so we need to start there. Let's figure out what would work in order to bring this insight into her daily work? We need to identify that as our first learning pitch. That's one type of knowledge that you generate through one set of interventions or experiments, but then there's a second thing that we may or may not know, which is, if we know what works for the individual, then what would it mean to replicate that for a whole team of individuals who are going to be working in a particular region, and that's a different challenge that operates at a different scale and that requires a different type of expertise. If we have discovered that, then what does it mean to actually create a policy that can replicate this across cities or across areas? That is a different question that requires a different design challenge and where the most relevant expertise is going to be different. Notice that the expertise of the midwife and the supervisor, is still really relevant for the question of regional escalation, but they're not going to be the experts anymore. They're going to be really important voices, but now the expert is the policymaker or the implementer of policies who can tell you, no, the administrative complexity and the budgetary needs for this to work are these. So this idea of breaking up the problem into these nested levels depending on where we are, and our knowledge can be very helpful because it reduces uncertainty. One thing that I want to make sure that is conveyed, and we touched upon it, is how critical it is to have an actual convener who is seen as a trustworthy actor. Who has the convening power to bring everybody to the table, but who's seen as neutral enough. Meaning, everybody recognizes that this actor doesn't have an agenda other than to help us all collectively succeed. It is critical to have that actor. Ideally, that actor will be able to translate across perspectives. So that actor will have either an expertise that has allowed that person to know the different roles with some intimacy. That actor will know that they need to bring in an intermediary who can translate across perspectives. Because without that space, and that convener who can then mediate, who can then help translate, who can then help people negotiate, and find a balance in the trade-offs that are going to emerge, it can be very difficult, because different actors are going to have different agendas. Other stakeholders are going to know that there's an agenda, and they're usually going to misrepresent what that agenda looks like. You really need that convening force that provides a space of neutrality where disagreements can be processed. Another thing I think that comes to mind is reframing this question around what works and how something functions and what's true, especially when you're going into a global context where you're coming up against potentially non-Western belief systems, and recognizing that whether something is true or not, from a Western perspective, is not necessarily relevant to how it's going to function in a community, and how it's going to function in a woman's body, in that. These psycho-emotional, spiritual, cultural factors can have real efficacy and impact. It's not really about whether we agree that these are real or not, but it's really about just honoring how they function in a community, and so basing your design process attention to that chain of events. Is to something that I think has been really important. My own personal experience with my moms have health issues in recognizing the psycho-emotional process of health is as critical as if it's a physical component. Two issues that come up for me are trust as well as motivation. I think you have to establish both of those things together, because they reinforce each other simultaneously. For one, I think you need to put in certain structural factors in place, whether it's an actual convening space that brings people together and makes them feel included in the issue. I also think having some type of neutral intermediary is really critical, who can rise above different agendas or perspectives. Then, through those two elements, as well as others, there is various transformative processes that you can engage in that help to establish a sense of trust, but also understanding of the problem that will drive actors over a long period of time. As you're talking about that, I agree with you. One of the things that we saw in our research is, what are the threads that can then be woven together to generate that trust and to generate that joint motivation? What we have found is that, stakeholders that are all necessary to converge in a particular problem space, inevitably see the problem from the perspective of their issues and their interests. That is a view that very often is it odds with or doesn't truly understand the views of the other stakeholders. Is one of the things that we find over and over again, as you mentioned is that, when you create a convening space that allows people to come together, and you establish a process that helps them agree on what definition of the problem they can all agree on. Rather than thinking about what's my issue, and what do I want to get out of this, and what are my interests, if you can help them to first establish, what is the problem that we're trying to solve here? What can we agree upon as a problem space that we all care about? Once that is constructed, the second thing that emerges from that, and that can be actually facilitated, is what are a set of values that we can all agree we share? Because once you have those things, once you have a shared problem and a shared set of values, then you can begin to have the conversations and the relationships that allow for trust to emerge. Trust is not something that can be thought of as a precondition. Trust is something that is built through relationships. What we have seen that actors do when they follow a successful process, is they first build the convening space where people can come together, realize that they have an interest in a shared problem, identify what are the values that connect them to each other, and then through that process, begin to develop a relationship where they can begin to trust each other, and they can begin to see the value in the perspective and in the knowledge that the other party can bring to the table for the problem that they all care about. I think it's also just important to recognize that, as much as you're trying to establish common ground, you're not trying to ignore divergent interests, and it's a bit of a dynamic process, and there's periods in which people have to come together to look at what is shared and what can we move towards, and then also periods that we have to say, "Okay, but this is what I need to get out of this in order for me to feel safe and feel also professionally secure." So I think that trust is also established through reinforcing somebody's outside divergent interests that might not be immediately pertinent to the shared problem that you establish. Yeah. To bring what you're saying down to a more practical level, if you have a policymaker who needs to be part of the conversation, it's critical to have that policymaker be bought into the problem that we all agree upon. But we also need to recognize that that policymaker has a boss, and that boss probably is worried about the electoral cycle and political pressures. If we neglect those political realities that, that policymaker has, then we are putting at risk the ability of that individual to remain engaged with us, and also for that individual to feel like he or she can trust us. So acknowledging how each of these individuals is inserted into an organization, a community of practice that has its own needs, its own values, and seeing how we can make sure that the joint work that we're doing is going to help you advance in your own personal needs, as we jointly solve a problem that we all care about, as you say, it's really an important balance to find.
