International Cooperation

Dr Peter R Mansfield OAM BMBS

GP

Director, Healthy Skepticism Inc

2

“What is simple is false, but what is not is useless.”

- Paul Valery

A system problem

“Put a good person in a bad system, and the system wins, no contest.” - W. Edward Demings

3

Complain or walk away

Barlow J, Møller C. A complaint is a gift. Using customer feedback as a strategic tool. Berrett-Koehler Publishers. San Francisco 1996

• “When customers feel dissatisfied with products and services, they have two options: they can say something or they can walk away. If they walk away, they give organizations virtually no opportunity to fix their dissatisfaction.

A complaint is a gift

• Complaining customers are still talking with us, giving us an opportunity to return them to a state of satisfaction so they will be more likely to buy from us again. So as much as we might not like to receive negative feedback, customers who complain are giving us a gift.”

Global problems require global cooperation

Healthy Skepticism Inc

• Main aim: To improve health by reducing harm from misleading health information

• Everyone who supports our aims is welcome to become a HS member

Selling vs. marketing

Kotler P, Armstrong G. Principles of Marketing 8th Edn. Prentice Hall NJ 1999

If you want to go fast go alone, if you want to go far go together

Diffusion of innovation

Barriers to cooperation between nations

• Language

• Culture

• Time zone

• Unequal wealth

Barriers to cooperation between people

• World view / tolerance levels

• Externalities

• Unquestioned assumptions

– illusion of control

• Communication preferences

• Under/Over-confidence, Optimism/Pessimism

Barriers to cooperation between people

• Oversimplification of others’ views

• Acceptance of responsibility

• Expectation levels

• Width of focus

The blind people and the elephant

Balance information and actionPaulo Freire

• Forming

• Storming

• Norming

• Performing

• Telling

• Selling

• Participating

• Delegating

Group stages

Situational leadership

Tuckman – Hersey and Blanchard

Actor-Network Theory

• Translation = innovators try to create a forum

• Stages:

– Problematisation

– Interessement

– Enrolment

– Mobilization of allies

Effectiveness

• “effectiveness at enrolling others to one’s projects is a more important determinant of the effective exercise of power than resources possessed. Those who exercise the greatest power are those who enrol many others with more resources and authority than themselves, and, more importantly, those who enrol others who are even better at enrolling others than themselves.”

• Braithwaite J, Drahos P. Global business regulation. Cambridge University Press 2000

How to achieve cooperation re hotel keys

21

Regulatory pyramid

Modified from Braithwaite J. Restorative Justice and Responsive

regulation. Oxford: Oxford University Press 2002

Cause of non-compliance Regulatory response

Unable

Profit seeking

Lacks knowledge but virtuous

Lacks understanding

Notification

Education /

Restorative justice

Costs

Remove

Win - Lose

Dr Alfredo Bengzon, former Minister of Health for the Philippines, First International Conference on Improving the Use of Medicines, Chiang Mai 1997

• “Considering the wide variety of stakeholders involved and the wide variety of their interests, it seems inevitable that there will be winners and losers. Yet that is exactly what we must avoid, because, like the systems of the human body, the systems of the body politic remain deeply connected, even as their interests appear to be at cross-purposes.

Win - Win

• What we must instead strive for is therefore a win-win situation, one where all positions are advanced, not necessarily equally so, but certainly equitably so. Through open, honest, thoughtful and productive development dialogue, we must direct our efforts at reconciling private gain with public good, professional pride with patient welfare, science with value. Only this objective will sustain the interest of the whole.”

Guardian vs. Trader ethics

• Jane Jacobs. Systems of Survival: A Dialogue on the Moral Foundations of Commerce and Politics 1992

Guardian

1 Shun trading

2 Exert prowess

3 Be obedient and disciplined

4 Adhere to tradition

5 Respect hierarchy

6 Be loyal

7 Take vengeance

8 Deceive for the sake of the task

Trader

1 Shun force

2 Compete

3 Be efficient

4 Be open to inventiveness and novelty

5 Use initiative and enterprise

6 Come to voluntary agreements

7 Respect contracts

8 Dissent for the sake of the task

Guardian

9 Make rich use of leisure

10 Be ostentatious

11 Dispense largesse

12 Be exclusive

13 Show fortitude

14 Be fatalistic

15 Treasure honor

Trader

9 Be industrious

10 Be thrifty

11 Invest for productive purposes

12 Collaborate easily with strangers and aliens

13 Promote comfort and convenience

14 Be optimistic

15 Be honest

Groupthink

Daniel Goleman. Vital Lies Simple Truths. The psychology of self-deception. 1985 Bloomsbury London 1997

• The impulse to obscure dark facts, we have seen, comes from the need to preserve the integrity of the self, whether individual or shared. A group may implicitly demand of its members that they sacrifice the truth to preserve an illusion.

Strangers are a threat

• Thus the stranger stands as a potential threat to the members of a group, even though he may threaten them only with the truth. For if that truth is of the sort that undermines shared illusions, to speak it is to betray the group.

Strangers are an opportunity

• Still the truth-teller may fill the quintessential modern need. We live in an age when information has taken on an import unparalleled in history; sound information have become the most prized of commodities. In the realm of information, truth is the best of goods.

32

• Conclusion: International cooperation is difficult and slow but is achievable and necessary.

• Recommendation: Further development of cooperative global forums to debate, design and promote reforms addressing the causes of misleading health information.