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«Chapter 13 Prototyping • Namibi • MITx Prototype Camp • Field Health Care Network • Principles of Prototyping • Field Notes Structure of ...»

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Chapter 13


• Namibi • MITx Prototype Camp • Field

Health Care Network

• Principles of Prototyping • Field Notes

Structure of Prototyping

aving established a connection to the source (presencing) and

having clarified a sense of the future that wants to emerge (crystallizing), the next stage in the U process is to explore the future

by doing (prototyping). Prototyping is the first step in exploring the future

through experimentation. David Kelley, founder and longtime CEO of the influential design firm IDEO, summarizes the design industry’s approach to prototyping succinctly: “Fail often to succeed sooner.”z Prototyping means to present a concept before it is perfected. Prototyping allows fast-cycle feedback learning and adaptation.

Health Care Network Dr. Schmidt and his colleagues left the dialogue forum with the intention of moving their system from levels z and 2 to levels 3 and 4, but they knew they needed different types of collaborative platforms to make it happen. So they |0z Th eory decided to start by holding regional conversations among the key institutional players about the practical issues they faced in their work. First, they defined the people who “own” the problems, the people who have the competence and responsibility to make decisions in their own institutional system. “We want to convene groups of practitioners who need one another in order to take effective action,” said Dr. Schmidt.

“We talk about all the issues and problems openly and focus on creating actionable solutions, and then we implement and review them quickly.

When an issue is dealt with, the group dissolves. Currently we have ten of these groups operating. And they all work much more effectively than our groups used to do earlier.” Schmidt said that when they visit their colleagues in adjacent regions, they are very aware of how far they’ve come. “They’re still worried about what the insurance companies will think and do. We’ve moved past that. Now we focus our time on where we can make the biggest difference.” One of Schmidt’s action groups focused on chronic diabetes. It convened key practitioners and diabetes patients and together developed a strategy for promoting new eating habits. In this way, they engage people to move beyond drugs and begin to live differently.

Other ad hoc action groups developed agreements for sharing specialized diagnostic equipment among medical groups; a new format for transferring information between hospitals and outside physicians; a jointly run office to coordinate care for patients moving between the two settings; and, last but not least, a new emergency control center. Now, in an emergency, patients have at least three networked options available. They can call a local physician, the center itself, or the emergency number to reach a centralized ambulance dispatcher.

Dr. Schmidt and his colleagues believed that by coordinating these three options across the region they would not only save money and time but also provide better patient care and make life easier for doctors. They have created an invisible connection to the area’s elderly and chronically ill people who live on their own but now feel “held” through the center. A physician hotline allows patients to consult a physician after hours and on weekends. This came about because research showed that 70 percent of all emergency calls P R O TO TYP I N weren’t really about emergencies at all; they were from people who were just seeking advice. Previously, an ambulance would routinely have been sent.

But now, with physicians working side by side with paramedics in the new joint control center, taking hotline calls, they have reduced the number of unnecessary ambulance trips, and the patients are satisfied with their care.

This change alone has saved the program four times its former costs.

The journey began with extensive and often frustrating negotiations among the key players—local hospitals, physicians, ambulance services, and insurance companies—each with its own interests, constraints, and turf allegiances. The breakthrough came when the practitioners began to speak about their own experiences, or those of loved ones, with the emergency system. The group soon reached a shared will and vision for more integrated, coherent patient service. That shared will allowed them to stay connected and to succeed in their negotiations.

The network of Dr. Schmidt and his colleagues emerged as one of the most successful among the dozens of similar networks started in Germany in the In 2000, the network instituted a new emergency control center that z990s.

includes a 24/7 physician hotline and provides higher-quality emergency service at lower overall cost. The project was unique in Germany in its use of cross-institutional collaboration. It operated very successfully for fourteen years, from 2000 to 20z4. In 20z4, however, a re-centralization of the federal system eliminated this once successful regional collaboration in favor of a more centralized and siloed structure. The regional network still exists, but with the generation of founders slowly moving out, its future is uncertain.

Namibia In the preface I talk about a different healthcare project that we facilitated in Namibia. The most interesting and successful prototype that emerged resulted in the idea for Regional Delivery Units (RDUs). A small cross-sector group of leaders, including nurses, doctors, and the regional director, began to hold weekly meetings as a way of learning by doing. Their objective was to significantly improve maternal health.

Th eory Each RDU meeting began with a review of the week’s data and events, allowing professionals of different ranks to communicate, question each other, and exchange views in a supportive and nonjudgmental environment.

At one RDU team meeting I attended, they discussed a situation of concern to the nurses. At one point in the discussion, a junior nurse, a young woman, turned to the most senior leader at the table (the director of the entire region), who had not participated in the discussion before. She said: “I gather from your body language that you do not agree with what is being said here.” And then it was the director’s turn to explain his reading of the situation. When I heard that junior nurse draw out the most senior person in the group, I knew that something was working—they had established a constructive communication and learning culture.

As of 20z2, these RDU team processes were being rolled out throughout Namibia’s thirteen regions. This work is being owned by and performed for Namibians, without any international partners. The RDU process helps the leaders in each region to focus on accountability for improved outcomes. The teams then drive policy implementation, coordinate service delivery, manage progress on goals, and solve problems to ensure the effectiveness of health interventions. Discovering what makes these groups effective is an ongoing process of learning by doing.

I took several observations away from my visits. The success of the RDR prototype seemed to depend on three enabling conditions: (z) the creation of an institutional infrastructure that could produce useful data: (2) the establishment of a group of key players from across institutional silos who commit to talk, learn, and adapt on a regular (weekly) schedule; and (3) the development of a learning culture, without which people just become defensive and blame each other.

MITx U.Lab Prototype Camp The key for successful prototypes lies in creating generative holding spaces.

At the u.lab, we wanted to experiment with that a little bit, so in 20z5 we invited a group of sixty MOOC participants who each submitted promising prototyping ideas to join us on the MIT campus for a four-day Prototype Camp. The purpose was to learn from each other and advance their initiatives.

P R O TO TYP I N The experience of the Prototype Camp felt like activating a generative container that keeps bubbling with lots of different entrepreneurial energies. As

one of the participants remembers:

The prototyping activities were powerful. As people became less attached to their ideas and had to create something quickly, they found themselves rapidly moving forward. Some even said that they had achieved more in ten minutes than they had through the last couple of months of working on the idea. They immediately put their ideas out to be tested, and within another couple of minutes they had already improved the idea.

Another of the participants remembers:

I went to the camp with so many doubts whether to proceed or not with the project. This was mainly because of my limited idea on how to move forward without, for example, financial resources. I was also questioning myself; why should I be worrying so much about the state of the planet while millions of people, businesses, and governments don’t? During the camp I learned about the power of people gathering together to make a difference in the World. I started low on the first day and ended very positive on the last because of people who helped me seeing other possibilities.

More important, I learned that my call is there, waiting to be put forward.

So I left MIT on Sunday with a feeling that I need to keep up. And I will.

The Field Structure of Prototyping Figure z3.z is a visual representation of the field structure of attention. It resembles the two earlier ones that illustrate presencing and crystallizing. But it takes the movement from presencing (connecting to source) and crystallizing (letting an image of the future emerge) to its next stage: the holding space (white outer sphere) is deepened, and the letting-come process in the center of the figure (the emerging white spiral) is expanded from envisioning to enacting.

To effectively prototype, we must integrate three types of intelligence: the intelligences of the head, of the heart, and of the hand. As Robert Redford’s Th eory character said in the movie The Legend of Bagger Vance, “The wisdom in your hand is greater than the wisdom in your head will ever be.” When we prototype living examples by integrating different types of intelligence, we always navigate the process between two major dangers and pitfalls: mindless action and actionless minds.

Principles of Prototyping Integrating these different intelligences effectively requires connecting to the source as well as to the whole, through fast-cycle feedback and infrastructures for reviewing and awakening.

Connecting to the Inspiration and Intention First and foremost, when moving into prototyping you need to stay connected to the inspirational spark of the future “that stands in need of you” (Buber).

“How do you do that?” I asked Joseph Jaworski, who is a master at establishing this kind of direct link.

F I G U R E 1 3. 1 : T H E F I E LD S T R U C T U R E P ROTOTYPING OF P R O TO TYP I N “First off,” he replied, “you need to do it on a daily basis.

As a matter of fact, it’s the first thing you do when you get up in the morning.” Joseph has a set of personal practices that he does when getting up before dawn. “So the first thing is about practice, practice, practice. You create that place of silence for yourself every day.” As Joseph was speaking, I thought of my parents. By five a.m., when my father started milking the cows, he and my mother had already finished reading a morning meditative text together. I also thought of several of my interviewees, who often practiced stillness during the first few hours before dawn.

“The second thing you focus on,” continued Joseph, “is staying true and connected with that deeper intention all the time, throughout the whole day or week or year, or even longer.” What does it take to stay committed? Simone Amber of Schlumberger, an innovator in the area of corporate social responsibility, once told me, “It took me many years to take the step from idea to moving into action. What’s important is that you don’t blame yourself for that. What’s important is that you stay true to your intention. But once I took that first step, doors opened;

helping hands began to show up. It was as if I had been put on a track.” “The third practice,” continued Joseph, is “to sense and seize opportunities as they arise. Whenever the real opportunities arise, it usually is not exactly where you expect it to happen. So you have to be really attentive. You have to pay attention to where that opportunity may arise that goes clunk with what your deeper intention tells you to do. When that happens, then you act in an instant. Then I operate from my highest self, which allows me to take risks that I normally would not have taken.

“For example, I got the feeling, in the middle of a workshop, that we were called to create a larger initiative. I grabbed the CEO of a large multinational corporation, whom I knew only a little, and said: ‘Wait here, we need to talk.’ Then I went around and grabbed three more people: the head of a foundation, a senior executive of the US National Park Service, as well as an NGO activist. I brought them back to the CEO, pulled five chairs into a small circle, and started the meeting. That moment actually was the beginning of the birth of an initiative that now is known as Synergos Multistakeholder Partnership Program.”| Th eory 0ø This little episode demonstrates several key aspects of acting from the future. First, the new shows up as a feeling, then as a vague sense of being drawn somewhere. It’s more a sense of what than a sense of why. You feel drawn to doing something, but you don’t know exactly why. And only then, after using the intelligence of your hands and your heart, does your head begin to figure out the why.

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