Dear colleagues,

The discussion that Wendy and Val have instigated around around
transformative change is thought provoking - thanks guys.  I have really
enjoyed the richness of David's stories around change management cases in
Nepal and the Indian sub-continent, and appreciated the insights, thoughts
and questions that have been shared by James, Lizzie, Chrys, Ashwani, Louise
and Christina.

I often think the problem we are talking about is less a lack of knowledge
around tools and practices that support (transformative) change, than it is
around having a language that enables funders, policy makers and
researchers/practitioners to be clear about the type of system, and level of
system change we/they are trying to support. As Canadian health researchers
Sholom Glouberman and Brenda Zimmerman have often pointed out, it makes a
difference if a problem is viewed as "complicated" or "complex" when
developing and applying remedies. In their writing they argue that health
care systems are complex, and that repairing or improving them is a complex
problem. However, they also go on to point out that most attempts to
intervene in Medicare (and in many other health care systems) treat health
systems as if they were merely complicated.

Complicated problems are like sending a rocket to the moon - formulae are
important, the system is predictable and repeatable, reductionist approaches
are useful, etc. Complex problems are like bringing up a child - every child
is unique, formulae aren't that good for management, children are self-aware
and adaptive, and you can't predict how they'll grow up. Moreover 50 percent
(at least) of the parent's well-planned interventions are doomed to failure
..... I took the kid to soccer, then cycling, then gumnastics, then swimming
.... when is this kid EVER going to find a sport that he/she likes !!!!

Communities - be they healthcare, farming, urban, indigenous, or whatever -
are more akin to the (complex) child metaphor, than the (complicated) rocket
metaphor!!!!  Every community is unique .....

The rocket - child analogy seems to resonate with many people ....
especially that the path to bringing up (supporting transformative change?)
children is littered wiuth failed interventions, and what works for one
child doesn't necessarily work for the next. It's as though the best support
comes from a veritable raft of interventions, aimed at a number of levels,
and provided from a range of different sources - parents, relatives,
friends, teachers and peers.

So it is an analogy that is easy to say - and it maybe even comes across
well when you say it quickly. But does it really translate into practice at
the policy level, and if so, does it imply a different approach to
mainstream policy making and/or change management?

If it is a useful concept, is it possible to take it further and develop
some terms for describing the range of problems that may lie at different
points on the continuum between complex and complicated problems?

best regards
Will


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