Dialogue with ACE Fellows and Interns

Mushin- the beginner’s mind

Types of questions

Single systemSingle system Values systemValues system Multi-minded Multi-minded systemsystem

Evidence and Evidence and reasoning within reasoning within systemsystem

Subjective Subjective preferencepreference

Evidence and Evidence and reasoning within reasoning within multiple systemsmultiple systems

Correct or wrong Correct or wrong answeranswer

Subjective Subjective opinionopinion

Better or worse Better or worse answersanswers

KnowledgeKnowledge Hard to assessHard to assess JudgmentJudgment

Elements of Thought

Point of viewPurposeQuestion at issueInformationInterpretation and inferenceConceptsAssumptionsImplications and Consequences

Intellectual Traits

HumilityIntegrity AutonomyCouragePerseveranceConfidence in ReasonEmpathyFairmindedness

Standards

ClarityAccuracyRelevanceLogicBreadthPrecisionSignificanceCompletenessFairnessDepth

Egocentric and socio-centric thinking

“It’s true because I believe it” – Innate egocentrism“It’s true because we believe it” – innate socio-

centrism“It’s true because I want to believe it”-innate wish

fulfillment“It’s true because I have always believed it”- Innate

self-validation“It’s true because it is in my selfish interest to believe

it –Innate selfishness

Ends drive means

Through the lens of your shared vision, find the key constraint and the “tipping point” in a system.

Ends

Means

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?

Science

Problems

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?

Science

Problems

Solutions ?

YY

X

That’s difficult!

That’s impossible!

That’s beyond imagination!

Our best thinking got us here.

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

Albert 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!

Science

Problems

Solutions

YX

Science values intuition and imagination too!

“Imagination is more important than knowledge.”

Albert 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

Evolution in “evidence-based thinking”

Evidence-based

Evidence informed

Evidence nurturing

Our learning can have the following results

• Maintain your present levels of uncertainty

• Lower your present levels of uncertainty

• Increase your present levels of uncertainty

• Generate information space

Karl Popper

We cannot “prove” a theory to be true. We can only show that it is false.

All swans are white. There are no black swans!

There are black swans in Australia and Tasmania!

UnderlyingConditions

Domains ofCommunication

Initial Outcomes

En

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Ser

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BehavioralOutcomes

SustainableHealth Outcomes

Context

Disease Burden

Social

Cultural

Economic

Communication

Technology

Political

Legal

Reduction in:

Unintended/mistimed

pregnancies

Morbidity/mortalityfrom pregnancy/

childbirth

Infant/child morbidity/mortality

HIV transmission

Threat of infectious diseases

Resources

Human and Financial

Resources

Strategic Plan/Health

Priorities

Other Development

Programs

Policies

SupportiveEnvironment

•Multi-sectoralpartnerships

•Public opinion•Institutionalperformance

•Resource access•Media support•Activity level

Service Performance

•Access•Quality•Client volume•Client satisfaction

Client Behaviors

Community•Sanitation•Hospice/PLWA•Other actions

Individual•Timely service use•Contraception•Abstinence/partner reduction

•Condom use•Safe delivery•BF/nutrition•Child care/immuniz.•Bednet use• Hand washing

•Political will•Resource allocation•Policy changes•Institutional capacitybuilding

•National coalition•National comm strategy

•Availability•Technical competence•Information to client•Interpersonalcommunication

•Follow-up of clients•Integration of services

•Leadership•Participation equity•Information equity•Priority consensus•Network cohesion•Ownership•Social norms•Collective efficacy•Social capital

•Message recall•Perceived socialsupport/stigma

•Emotion and values•Beliefs and attitudes•Perceived risk•Self-efficacy•Health literacy

Pathways Conceptual Framework -- Full version

Social PoliticalEnvironment

•Community action groups

•Media advocacy•Opinion leader advocacy

•Organizational development

•Coalition building

Service DeliverySystem

• Norms & standards• Rewards & incentives• Job/peer feedback• Job aides• Training in CPI• Supportive settings• Community outreach• Internet portals• Distance learning

Community &Individual

• Participation in social change efforts

• Strengthening social networks

• Peer support groups• Multimedia programs• Enter-education• Social marketing• Household care• Interactive media & internet