Building the Boat While You Sail It

Lessons learned from rapid scale up of a global health program at UW

Setting SailJust sit right back and you'll hear a tale, A tale of a fateful trip That started from this Northwest port Aboard a tiny ship…

Aboard a tiny ship…

Map

I-TECH Projects Worldwide

I-TECHInternational Education

and Training Center for

Health

Institute for Health

Metrics and Evaluation

(IHME)

International Clinical

Research Center (ICRC)

Health Alliance

International(HAI)

Vision

I-TECH envisions a world in which all people have access to high quality, compassionate, and equitable health care.

What if you gave a training . . . and nobody came?

“We continue to go to nice trainings, get new forms to use that are designed to improve patient quality of care, but everything is impossible to implement.

My clinic is understaffed, there are no machines to copy forms, and it is unclear who to send them to.”

We learned a lot scaling up our own capacity here at UW in order to work well with local partners, and I think that many of the lessons we learned are relevant to other public universities in the US. While we were very accustomed to managing large research projects both within and outside the US, we were less prepared for the type of work required under PEPFAR funding- that of providing technical assistance to indigenous local partners and governments for the purpose of strengthening health systems. [rw1]

Adizes, I. (1996) The Pursuit of Prime: Maximize Your Company’s Success with the Adizes Program. New York: Knowledge Exchange.

Key Learning Early in Curve

Inspire a shared vision.

Hire the right people.

Enable them to act.

11Inspire a sharedvision.

“I have an egalitarian, inclusive, informal approach (to leadership), as do many Americans.

It took awhile for staff to get used to this in each country where I worked- and to trust it. Many did come to appreciate the opportunity to give real input on programs and issues and to feel empowered to make decisions and to grow professionally . . .

. . . however, people still wanted their leader to ‘act like a leader’ in the ways they were used to, especially in public, and I had a hard time with this —sitting at the leader table, having people do things for me that I could do myself, etc. It was sometimes offensive and insulting to others if I did not act in the leader role as expected.”

Hire the right people.

22

“Our US culture is very future-oriented and task-driven, and many of the places we work are more present-oriented and relationship-driven. We need to learn how to share the best of our culture, but understand when it is not welcome and also be comfortable operating in different ways—the ways of our host country.”

33Enable them to act.

Adizes, I. (1996) The Pursuit of Prime: Maximize Your Company’s Success with the Adizes Program. New York: Knowledge Exchange.

Key Learning Later in Curve

Challenge the process.

Navigate complex environments.

Reduce complexity.

44Challenge the process.

University of Washington

UWorldRegistered Sites

Current Challenge

“There are serious limitations to how large a global health organization can scale within a public university when funded entirely on federal dollars, especially in a state undergoing a budget crisis. The larger the organization grows, the greater the risks.”

5Navigate complex environments.

Walking the Talk

Building capacity vs. doing the work yourself

“Sometimes it means you work yourself out of a job, and that’s not easy.”

Walking the Tightrope

Decentralization vs. centralization

66Reduce complexity.

“Any intelligent fool can make things bigger and more complex. It takes a touch of genius- and a lot of courage- to move in the opposite direction.” Albert Einstein

Summary Inspire a shared vision.

Hire the right people.

Enable them to act.

Challenge the process.

Navigate complex environments.

Reduce complexity.

Thank you.