transformation through a shared vision partnership for health and wholeness benjamin v. lozare, ph.d...

Transformation Through A Shared Transformation Through A Shared VisionVision

Partnership for Health and WholenessPartnership for Health and WholenessBenjamin V. Lozare, Ph.DBenjamin V. Lozare, Ph.DJohns Hopkins UniversityJohns Hopkins University

May 26-2007May 26-2007

Session objectivesSession objectives

1.1. Appreciate how “self-limiting” mental Appreciate how “self-limiting” mental models weaken creativity and thinking models weaken creativity and thinking processes.processes.

2.2. Appreciate an alternative way to defining Appreciate an alternative way to defining health problems.health problems.

3.3. Understand the concept of shared vision Understand the concept of shared vision and its importanceand its importance

Life From Many AnglesLife From Many Angles

Is there only one way to see things?Is there only one way to see things?

Is there only one TRUTH?Is there only one TRUTH?

How can we develop multiple How can we develop multiple perspectives?perspectives?

From From ZoomZoom, an illustrated book (1995) by Istvan Banyai, , an illustrated book (1995) by Istvan Banyai, Hungarian artistHungarian artist

Where do leaders operate?Where do leaders operate?

Beyond Imagination

That’s Impossible

Looks Difficult

Easy to do

Insert Believe ThemeInsert Believe Theme

Key IdeaKey Idea

How can you make a How can you make a difference if you think difference if you think you can’t? you can’t?

Somewhere in the futureSomewhere in the future

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

Somewhere in the futureSomewhere in the future

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

Somewhere in the futureSomewhere in the future

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

Somewhere in the futureSomewhere in the future

Kobie and Ajoba understand the Kobie and Ajoba understand the risks of HIV/AIDS and have shared risks of HIV/AIDS and have shared their knowledge with friends and their knowledge with friends and family.family.

Both are deeply concerned about Both are deeply concerned about the political and economic future the political and economic future of their country. They vote of their country. They vote intelligently and always encourage intelligently and always encourage their friends to do the same.their friends to do the same.

Somewhere nowSomewhere now

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

Somewhere nowSomewhere now

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

Somewhere nowSomewhere now

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

Somewhere nowSomewhere now

Abena ended up in the Abena ended up in the hospital. The police jailed Ebo hospital. The police jailed Ebo briefly but he did not have briefly but he did not have any remorse when released. any remorse when released.

Both Ebo and Abena are HIV Both Ebo and Abena are HIV positive but they do not positive but they do not know their condition. know their condition.

They don’t care about politics They don’t care about politics and have never voted.and have never voted.

Why is there a difference?Why is there a difference?

Our challenge is to Our challenge is to think deeply and then think deeply and then act.act.

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

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

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

Cancer

Cancer

On eyesight and visionOn eyesight and vision

““There is nothing There is nothing more pathetic than a more pathetic than a man with eyesight but man with eyesight but has no vision”.has no vision”.

Helen KellerHelen Keller

Session objectivesSession objectives

1.1. Appreciate how “self-limiting” mental Appreciate how “self-limiting” mental models weaken creativity and thinking models weaken creativity and thinking processes.processes.

2.2. Appreciate an alternative way to defining Appreciate an alternative way to defining health problems. health problems.

3.3. Understand the concept of shared vision Understand the concept of shared vision and its importanceand its importance

What are self-limiting mental models? What are self-limiting mental models? How do they influence our thinking How do they influence our thinking processes?processes?

Self-limiting mental models are assumptions Self-limiting mental models are assumptions or beliefs that “define” what is “easy to or beliefs that “define” what is “easy to do, “possible”, “realistic” or “achievable” do, “possible”, “realistic” or “achievable” and restrict what people aspire for. and restrict what people aspire for.

“ “ I will be happy with just one I will be happy with just one more cow!more cow!

From the book Behind Mud Walls

On introduction of sound for On introduction of sound for filmfilm

““Who the hell wants to hear actors talk?Who the hell wants to hear actors talk?

Harry Warner, Warner Brothers, 1927Harry Warner, Warner Brothers, 1927

““There is no likelihood that man can There is no likelihood that man can

ever tap the power of the atom.”ever tap the power of the atom.”

Robert Andrews Millikan, Nobel Prize winner for physics, Robert Andrews Millikan, Nobel Prize winner for physics, 1923 1923

““I think there is a world market I think there is a world market for about five computers.”for about five computers.”

Thomas Watson Jr. Founder and Chairman of IBM, 1943Thomas Watson Jr. Founder and Chairman of IBM, 1943

““Everything that can be Everything that can be invented has been invented.”invented has been invented.”

Charles H. Duell, Commissioner, US Office of Patents, Charles H. Duell, Commissioner, US Office of Patents, urging President William McKinley to abolish the patents urging President William McKinley to abolish the patents office, 1903.office, 1903.

““Horses are here to stay. The automobile is Horses are here to stay. The automobile is only a novelty, a fad.”only a novelty, a fad.”

President, Michigan Savings Bank, advising Henry President, Michigan Savings Bank, advising Henry Ford’s lawyer not to invest in Ford Motor. Ford’s lawyer not to invest in Ford Motor. Disregarding the advice, the lawyer invested $5,000 Disregarding the advice, the lawyer invested $5,000 which he later sold for $12.5 million.which he later sold for $12.5 million.

““There is no reason for any individual to There is no reason for any individual to have a computer in his home.”have a computer in his home.”

Ken Olsen, President, Digital Equipment, 1977Ken Olsen, President, Digital Equipment, 1977

Compaq now owns Digital EquipmentCompaq now owns Digital Equipment

Leadership starts with vision.Leadership starts with vision.

Leadership starts with a vision. Leadership starts with a vision.

Erik Weihenmayer climbed Mt. Everest in 2001Erik Weihenmayer climbed Mt. Everest in 2001He is completely blind!He is completely blind!

Insight from a blind womanInsight from a blind woman

““There is nothing There is nothing more pathetic than a more pathetic than a man with eyesight but man with eyesight but has no vision.”has no vision.”

Helen KellerHelen Keller

Who dares wins!Who dares wins!

““It is not that things are difficult that we do not It is not that things are difficult that we do not dare, it is because we do not dare that things dare, it is because we do not dare that things are difficult!” are difficult!”

SenecaSenecaRoman PhilosopherRoman Philosopher

16 BC16 BC

Where do leaders operate?Where do leaders operate?

Beyond Imagination

That’s Impossible

Looks Difficult

Easy to do

Evidence-based thinking and science of Evidence-based thinking and science of the daythe day

Science

ProblemsSolutions

X Y

What happens when the problem lies What happens when the problem lies outside of the science of the day?outside of the science of the day?

ScienceProblems

Solutions ?

YY

X

What happens when the problem lies What happens when the problem lies outside of the science of the day?outside of the science of the day?

ScienceProblems

Solutions ?

YY

X

That’s difficult!

That’s impossible!

That’s beyond imagination!

Our best thinking got us here.Our best thinking got us here.

The problems that we face cannot be The problems that we face cannot be solved by the same level of thinking solved by the same level of thinking that created them.that created them.

Albert EinsteinAlbert Einstein

We need to find solutions outside of the We need to find solutions outside of the science of the day!science of the day!

ScienceProblems

Solutions

YX

Science values intuition and Science values intuition and imagination too!imagination too!

““Imagination is more important than Imagination is more important than knowledge.”knowledge.”

Albert EinsteinAlbert Einstein

Where do leaders operate?Where do leaders operate?

Science ten years from now

Tomorrow’s science

Today’s science

Yesterday’s Science

Problems

Solutions X Y

What is difficult? Impossible? What is difficult? Impossible? Beyond imagination?Beyond imagination?

What is difficult? Impossible? What is difficult? Impossible? Beyond imagination?Beyond imagination?

What is difficult? Impossible? What is difficult? Impossible? Beyond imagination?Beyond imagination?

?

We do not reach visions, we create We do not reach visions, we create them.them.

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

John SchaarJohn Schaar

How much can a person How much can a person achieve?achieve?

Unlikely more than his or her vision. Unlikely more than his or her vision.

We can turn things around and say, a We can turn things around and say, a vision limits what we can do!vision limits what we can do!

The only true limits are the The only true limits are the ones that the mind accepts.ones that the mind accepts.

Thomas Edison failed 10,000 times before he Thomas Edison failed 10,000 times before he perfected the light bulb!perfected the light bulb!

Abraham Lincoln lost 8 elections (local) Abraham Lincoln lost 8 elections (local) before he became President of the United before he became President of the United States!States!

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

Thomas EdisonThomas Edison

Session objectivesSession objectives

1.1. Appreciate how “self-limiting” mental Appreciate how “self-limiting” mental models weaken creativity and thinking models weaken creativity and thinking processes.processes.

2.2. Appreciate an alternative way to defining Appreciate an alternative way to defining health problems.health problems.

3.3. Understand the concept of shared vision Understand the concept of shared vision and its importanceand its importance

How do we usually define “health How do we usually define “health problems”?problems”?

1. “Deviation from a norm” or “indicator 1. “Deviation from a norm” or “indicator chasing” chasing”

2. Existing “solutions” in tool box2. Existing “solutions” in tool box

- Ideology- Ideology

- Training - Training

3. Knee-jerk “lack of resources”3. Knee-jerk “lack of resources”

Deviation from the “norm”Deviation from the “norm”

1. Who determines the “norm”? MDG?1. Who determines the “norm”? MDG?

2. What if “norm” is the source of the 2. What if “norm” is the source of the problem?problem?

3. Restoration of “norm” is system 3. Restoration of “norm” is system maintenance not improvementmaintenance not improvement

Use existing solutions - When we Use existing solutions - When we have a hammer, everything looks have a hammer, everything looks like a nail!like a nail!

1. Trainer - everything is a training problem.1. Trainer - everything is a training problem.

2. Manager - everything is a management 2. Manager - everything is a management problem.problem.

3. Community mobilizer - everything is a 3. Community mobilizer - everything is a community mobilization problem.community mobilization problem.

4. Medical doctor -everything is a medical 4. Medical doctor -everything is a medical problem.problem.

Lack of resourcesLack of resources

1. Resources are universal constraints - 1. Resources are universal constraints - when will we ever have enough?when will we ever have enough?

2. Are we using existing resources 2. Are we using existing resources effectively and efficiently?effectively and efficiently?

3. How resourceful are we?3. How resourceful are we?

What is an alternative way to What is an alternative way to defining problems? defining problems?

Define problems in terms of why there is Define problems in terms of why there is a difference between what we want a difference between what we want (shared vision) and what is happening (shared vision) and what is happening (current situation) and how to bridge (current situation) and how to bridge this difference.this difference.

Our choices in defining health Our choices in defining health problemsproblems

1.1. Deviation from a Deviation from a normnorm

2.2. Tools in our tool Tools in our tool boxbox

3.3. ““Lack resources”Lack resources”

4. Ask why is there a 4. Ask why is there a difference between our difference between our shared vision and the shared vision and the current situation?current situation?

5. Other ways?5. Other ways?

Approach requires two thingsApproach requires two things

1. We need to know clearly what we want.1. We need to know clearly what we want.

2. We need to know clearly what is 2. We need to know clearly what is happening now.happening now.

Session objectivesSession objectives1.1. Appreciate how “self-limiting” mental models Appreciate how “self-limiting” mental models

weaken creativity and thinking processes.weaken creativity and thinking processes.2.2. Appreciate an alternative way to defining health Appreciate an alternative way to defining health

problems.problems. 3.3. Understand the concept of shared vision and its Understand the concept of shared vision and its

importanceimportance4.4. Discriminate between a good shared vision and Discriminate between a good shared vision and

poor one.poor one.5.5. Know the steps in nurturing a good shared Know the steps in nurturing a good shared

visionvision

Leadership Principle Leadership Principle

Effective leaders inspire a shared vision.Effective leaders inspire a shared vision.

A shared vision is a picture of a desired A shared vision is a picture of a desired future that future that all stakeholders want to all stakeholders want to create. create. The emphasis is on The emphasis is on sharedshared, not , not on vision.on vision.

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

A few questionsA few questions

1. Do you have a shared vision in your 1. Do you have a shared vision in your organization?organization?

2. Do you have a national shared vision for 2. Do you have a national shared vision for development? For health?development? For health?

3. Can everyone describe what the shared 3. Can everyone describe what the shared vision is?vision is?

4. If you don’t have a shared vision, what is the 4. If you don’t have a shared vision, what is the reason?reason?

Military strategy concepts Military strategy concepts

Four levels of strategyFour levels of strategy

1. Grand strategy1. Grand strategy

2. Strategy2. Strategy

3. Operational strategy3. Operational strategy

4. Tactics4. Tactics

Grand strategy defines everythingGrand strategy defines everything

Should we go to war? Should we go to war?

Who is our enemy? Who is our enemy?

Who are our allies? Who are our allies?

What price do we want for peace?What price do we want for peace?

Declaring war may take time!Declaring war may take time!

WWII - Roosevelt, Stalin, ChurchillWWII - Roosevelt, Stalin, Churchill

It took the US two years after Nazi It took the US two years after Nazi Germany invaded parts of Europe Germany invaded parts of Europe before it declared war!before it declared war!

Strategy levelStrategy level

How will we conduct the war overall? How will we conduct the war overall?

What forces will we mobilize? What forces will we mobilize?

How will we deploy them? How will we deploy them?

Strategy level Strategy level

WWII - Gen. Marshall, Sir Allan BrookeWWII - Gen. Marshall, Sir Allan Brooke

5 million men, Europe before Pacific, 5 million men, Europe before Pacific, Invade Germany not blockadeInvade Germany not blockade

Operational levelOperational level

How will we achieve the strategic How will we achieve the strategic ends with our military resources? ends with our military resources?

What combination or mix of What combination or mix of resources is best?resources is best?

Operational levelOperational level

WWII - Gen. Eisenhower, WWII - Gen. Eisenhower,

MacArthur and Admiral MacArthur and Admiral

Nimitz.Nimitz.

Army and Air Force Army and Air Force

were combined. were combined.

Capture every island Capture every island

or skip some on the way to or skip some on the way to

JapanJapan..

Tactical level Tactical level

Where opposing forces meet. Where opposing forces meet.

How to achieve specific or concrete How to achieve specific or concrete objectives.objectives.

WWII - Capture a bridge or hill. Occupy a WWII - Capture a bridge or hill. Occupy a crossroad.crossroad.

The “war” on HIV/AIDSThe “war” on HIV/AIDS

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

How do health strategy concepts compare How do health strategy concepts compare with military concepts?with military concepts?

Grand strategyGrand strategy

Strategic levelStrategic level

Operational levelOperational level

Tactical levelTactical level

Shared visionShared vision

PolicyPolicy

Program strategyProgram strategy

Campaign strategyCampaign strategy

How do health strategy concepts compare How do health strategy concepts compare with military concepts?with military concepts?

Grand strategyGrand strategy

Strategic levelStrategic level

Operational levelOperational level

Tactical levelTactical level

Shared visionShared vision

PolicyPolicy

Program strategyProgram strategy

Campaign strategyCampaign strategy

How do health strategy concepts compare How do health strategy concepts compare with military concepts?with military concepts?

Grand strategyGrand strategy

Strategic levelStrategic level

Operational levelOperational level

Tactical levelTactical level

Shared visionShared vision

PolicyPolicy

Program strategyProgram strategy

Campaign strategyCampaign strategy

How do health strategy concepts compare How do health strategy concepts compare with military concepts?with military concepts?

Grand strategyGrand strategy

Strategic levelStrategic level

Operational levelOperational level

Tactical levelTactical level

Shared visionShared vision

PolicyPolicy

Program strategyProgram strategy

Campaign strategyCampaign strategy

2. What is shared vision?2. What is shared vision?

A clear description or picture of the A clear description or picture of the future that future that all stakeholders all stakeholders want to want to createcreate. .

It is a future that people are willing to pay It is a future that people are willing to pay the the price price for.for.

““I have a dream!”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!

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

What is shared vision?What is shared vision?

Emphasis is on Emphasis is on sharedshared not on vision. not on vision.

Description is in the Description is in the present tensepresent tense..

Draws a picture and Draws a picture and avoids use ofavoids use of indicatorsindicators or numbers. or numbers.

Key purpose of a visionKey purpose of a vision

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

RDSRDS

Should a vision be achievable under Should a vision be achievable under present conditions?present conditions?

Types of visionsTypes of visions

Personal - Personal - What do What do II want to want to happen or create?happen or create?

Shared -Shared - What do What do wewe want to want to happen or create?happen or create?

Personal and shared visionPersonal and shared vision

• Shared visions emerge from personal Shared visions emerge from personal visions.visions.

• Personal visions come from an Personal visions come from an individual’sindividual’s deep caring. deep caring.

• Shared visions come from a Shared visions come from a common common caring.caring.

GovernmentGovernment

HouseholdsHouseholds

CommunityCommunity

Vision shared by whom? Vision shared by whom?

GovernmentGovernment

HouseholdsHouseholds

CommunityCommunity

Vision shared by whom? Vision shared by whom? Everyone! Everyone!

Key questionKey question

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

Vision shared by whom?Vision shared by whom?

Government - Reduce MMR by 5%Government - Reduce MMR by 5%

Let’s ask a pregnantwoman’s husband.

“How much maternal mortalitywould you like? ”

Vision shared by whom?Vision shared by whom?

Government - Reduce MMR by 5%Government - Reduce MMR by 5%

Household - Zero MMRHousehold - Zero MMR

Let’s ask the community.

How much maternal mortality would you like?

Vision shared by whom?Vision shared by whom?

Government - Reduce MMR by 5%Government - Reduce MMR by 5%

Household - Zero MMRHousehold - Zero MMR

Community - Zero MMRCommunity - Zero MMR

Can the community participate Can the community participate here? here?

Strategic objective - Reduce MMR by 5% Strategic objective - Reduce MMR by 5% points (300/100,000 to 285/100,000) in points (300/100,000 to 285/100,000) in one year.one year.

Can the community participate Can the community participate here? here?

VisionVision - No mother dies from child birth - No mother dies from child birth in this community.in this community.

Should we do it alone?Should we do it alone?

Or with communitiesOr with communities

and households? and households?

How do develop visions and How do develop visions and strategies? strategies?

1. 1. Conventional wayConventional way - Start with - Start with situational analysis.situational analysis.

2. 2. An alternative way An alternative way - Start with defining - Start with defining a shared vision.a shared vision.

Conventional approach to Conventional approach to “strategy development”“strategy development”

1. Where are we now? 1. Where are we now?

2. Where do we want 2. Where do we want to go?to go?

3. How do we get 3. How do we get there?there?

1. Situation analysis1. Situation analysis

2. Strategic objectives2. Strategic objectives

3. Strategy3. Strategy

Disadvantages of common Disadvantages of common practicepractice

1. Situation analysis is often more descriptive 1. Situation analysis is often more descriptive (indicators list) and less analytical.(indicators list) and less analytical.

2. “Visions” are set lower because reference point is 2. “Visions” are set lower because reference point is the current situation (often depressing). the current situation (often depressing).

3. Encourages only incremental changes, not 3. Encourages only incremental changes, not fundamental ones. fundamental ones.

Should visions be based on Should visions be based on situation analysis? situation analysis?

Should we want only what we can have Should we want only what we can have given the current situation?given the current situation?

Should we aim for what we truly want Should we aim for what we truly want and changeand change the current situation? the current situation?

An alternative wayAn alternative way

1. Where do we want to go?1. Where do we want to go?

2. Where are we now?2. Where are we now?

3. Why is there a difference?3. Why is there a difference?

4. What needs to change?4. What needs to change?

5. How do we get there?5. How do we get there?

An alternative way - different An alternative way - different wordingwording

1. What do we want to happen? 1. What do we want to happen?

2. What is happening now?2. What is happening now?

3. Why is there a difference?3. Why is there a difference?

4. What needs to change?4. What needs to change?

5. How do we nurture change and 5. How do we nurture change and accountability?accountability?

ComparisonComparison

Current practiceCurrent practice

Situation Situation

analysisanalysis

Strategic objectivesStrategic objectives

StrategyStrategy

Alternative wayAlternative way

Shared visionShared vision

Situation statementSituation statementRoot cause analysisRoot cause analysis

Strategic objectivesStrategic objectives

StrategyStrategy

Advantages of the new wayAdvantages of the new way

1. Shared vision clarifies what is1. Shared vision clarifies what is

important and empowers people to important and empowers people to

take initiative.take initiative.

2. Nurtures analytical thinking.2. Nurtures analytical thinking.

3. Encourages focus and creativity.3. Encourages focus and creativity.

4. Highlights the need for change.4. Highlights the need for change.

5. Forces confrontation of the “dragons”.5. Forces confrontation of the “dragons”.

What do you want to happen?What do you want to happen?

Vision

Are you avoiding the dragons? Are you avoiding the dragons?

Smartobjectives

SMART strategic objectivesSMART strategic objectives

SSpecificpecific

MMeasurableeasurable

AAction-orientedction-oriented

RRealisticealistic

TTime boundime bound

Are we focused on milestonesAre we focused on milestonesand ignoring the dragons? and ignoring the dragons?

Smartobjectives

To improve your score, you have to To improve your score, you have to keep your eye on the ball!keep your eye on the ball!

Are people engaged in “indicator Are people engaged in “indicator chasing”?chasing”?

A “health indicator” is not the ball. It is A “health indicator” is not the ball. It is the score! the score!

Are we focused on milestonesAre we focused on milestonesand ignoring the dragons? and ignoring the dragons?

Smartobjectives

Maternal mortality exampleMaternal mortality example

IndonesiaIndonesia

350 per 100,000 births350 per 100,000 births GOIGOI

650 per 100,000 births 650 per 100,000 births WHOWHO

Is maternal mortality important enough Is maternal mortality important enough to measure accurately?to measure accurately?

PerceptionsPerceptions

3% reduction/year is “easy to do.”3% reduction/year is “easy to do.”

10% reduction/year is “difficult!”10% reduction/year is “difficult!”

25% reduction/year is “impossible!”25% reduction/year is “impossible!”

Elimination of MMR is “beyond Elimination of MMR is “beyond imagination!imagination!

Shared vision?Shared vision?

GOI - reduce MMR by 3% every year!GOI - reduce MMR by 3% every year!

Community - Zero MMR!Community - Zero MMR!

Household - Zero MMR!Household - Zero MMR!

The factsThe facts

What is the MMR range of possibilities in What is the MMR range of possibilities in a household with mother giving birth?a household with mother giving birth?

Answer - 0 or 1Answer - 0 or 1

If we accept GOI figures If we accept GOI figures

MMR = 350 /100,000 birthsMMR = 350 /100,000 births

How many households with births has How many households with births has zero MM? 99%zero MM? 99%

How did we come to believe that MMR = 0 How did we come to believe that MMR = 0 is “beyond imagination”?is “beyond imagination”?

How many mothers die in Indonesia from birth How many mothers die in Indonesia from birth related causes?related causes?

Each year = 24,000 deaths (1990)Each year = 24,000 deaths (1990)

How many villages in Indonesia?How many villages in Indonesia?

More than 58,000 villages!More than 58,000 villages!

At least half of the villages have zero At least half of the villages have zero MMR if MMR is equally distributed!MMR if MMR is equally distributed!

Some contextual factsSome contextual facts

99% of the more than 500,000 maternal 99% of the more than 500,000 maternal deaths each year is from the deaths each year is from the developing world.developing world.

Greatest discrepancy of all indicatorsGreatest discrepancy of all indicatorsMost of this loss and suffering is Most of this loss and suffering is

preventablepreventable

Shared vision asks:Shared vision asks:

What do we want to happen? Or What do What do we want to happen? Or What do we want to create?we want to create?

NOTNOT

What is feasible given present What is feasible given present conditions?conditions?

Have we tamed our dragons?Have we tamed our dragons?

Smart objectives

Have Have wewe tamed our dragons?tamed our dragons?

Smart objectives

How “big” should your vision How “big” should your vision be?be?

The answer is how deeply do you care? The answer is how deeply do you care? How much are you willing to change?How much are you willing to change?

Every vision has a price. Every vision has a price.

If stakeholders really want something, If stakeholders really want something, they must be willing to pay the price.they must be willing to pay the price.

How “big” should your vision How “big” should your vision be?be?

1. 1. “Floor setting”“Floor setting” - “At least” we - “At least” we should…..should…..

2. 2. “Go for broke or ceiling”“Go for broke or ceiling” - What we - What we truly want “no matter what”.truly want “no matter what”.

At leastAt least to move closer to the castle to move closer to the castle

so I can visit my family in prisonso I can visit my family in prison. .

To rescue To rescue ourour families, families, nonomatter what!matter what!

SharedVision

Key questionKey question

What would you do if you were not What would you do if you were not afraid?afraid?

Mother TheresaMother Theresa

VisionVision

““Care for the dying”Care for the dying”

Initial reactionInitial reaction

““You will die yourself”You will die yourself”

Price paidPrice paid

Life of sacrificeLife of sacrifice

GandhiGandhi

VisionVision

““An independent India”An independent India”

Initial reactionInitial reaction

““But that will never happen!”But that will never happen!”

Price paidPrice paid

His life.His life.

Founder of Pakistan - JinnahFounder of Pakistan - Jinnah

VisionVision - A new country - - A new country -PakistanPakistan

Initial reactionInitial reaction - -

“ “ But that is impossible!”But that is impossible!”

PricePrice - Struggle and much - Struggle and much sufferingsuffering

Abraham LincolnAbraham Lincoln

VisionVision

““No man should be a slave. No man should be a slave. Everyone man is created Everyone man is created equal. ”equal. ”

Initial reactionsInitial reactions

““You are going to break the You are going to break the nation apart!”nation apart!”

Price paidPrice paid

His lifeHis life

Nelson MandelaNelson Mandela

VisionVision

A democratic South Africa A democratic South Africa free of apartheidfree of apartheid

Initial reactionsInitial reactions

You’re crazy!You’re crazy!

Price paidPrice paid

27 years in prison27 years in prison

Some things have to stop!Some things have to stop!

Common Common responseresponse

I’m scared!

Old language patternsOld language patterns

““That’s ideal, we live That’s ideal, we live in the real world!”in the real world!”

““That is impossible!”That is impossible!”

Old language patternsOld language patterns

““Do that and you will Do that and you will become a bus driver!”become a bus driver!”

““You are throwing You are throwing your career away!”your career away!”

““Are you crazy?”Are you crazy?”

A leader’s response -A leader’s response -New language patternsNew language patterns

If not now, then when?If not now, then when?

If not me, then who?If not me, then who?