ACANGO: A global intervention network to reduce …ACANGO: A global intervention network to reduce...

Workbook for the Workshop to Launch the ACANGO Kenya Regional Network

ACANGO: A global intervention network to reduce health disparities in low-

income communities

A Workshop to Launch the ACANGO East African Regional Network

Panafric Hotel, Nairobi

January 6, 2005 Organized by AfriAfya and the ACANGO Global Hub Unit


Message of Welcome and Challenge from the Chair of AfriAfya’s Executive Board and the Managing Director On behalf of the Board and Staff of AfriAfya we welcome you all to this meeting. We also extend a very special welcome and thanks to Dr. Don Simpson and the ACANGO Global Hub team (with its base in Ottawa), who have provided much support to AfriAfya in making the necessary arrangements for this meeting. Last year, during a visit to Ottawa Caroline and I were invited by the Dean of the Medical School and the Director of the Centre for Global Health (at the University of Ottawa) – the “two Peters” – to join an international discussion group considering how to improve the link between academia and NGOs in efforts to promote improved health equity. The strengths and weaknesses of both types of organization, who were often facing the same challenges of reducing health disparities and poverty in low-income communities, were analysed. It was felt that while academia had the ability to undertake research, develop evidence and formulate policies, these were not always directed to the most pressing problems, and often failed to influence the decision makers. On the other hand many NGOs were closer to the real problems but often undertook interventions without adequate research as to their impact or commitment to sustainability. The discussions centred on ways to build on the strengths and reduce the weaknesses. Following an international on-line discussion representatives of universities, NGOs and international support organizations met for a workshop in Ottawa last June. At the workshop it was agreed that there was a need and scope for a new network, composed of representatives of both NGOs and Academia to further develop the concept of synergistic activities. This was called the ACANGO initiative. A Global Hub was established at the Centre for Global Health and plans were made for six regional hubs to be formed. AfriAfya was asked to provide the core for developing an East African Network. To this end you, as potential participants of the East African Network, have been invited to come and explore the strategy, core operating concepts, a possible action plan and challenges that such a network would face. AfriAfya, a relatively new Network for Health Knowledge Management and Communication, was established by a consortium of some of the major health NGOs in Kenya and the Ministry of Health to explore how ICTs could be harnessed for community health. AfriAfya’s vision is “to have universal and equitable access to quality health information to create informed, empowered and healthy communities contributing to social transformation”. In our early stages we have established Field Centres in seven existing community-oriented facilities belonging to our Partner Agencies*. We have equipped each of them with a computer, printer, and a WorldSpace receiver. In some we have added video equipment. We have trained three or four staff or community members from each Centre on how to use the equipment for receiving and transmitting information to and from our Hub in Nairobi. We have also provided training in documentation and community communication. Our target topic – to try out our communication system – was HIV/AIDS. We provide a limited amount of information to the centres and try to answer their questions. It is essentially a two-way communication system. Our stretch goal for 2008 is to have our Health Knowledge Management Service widely used and for AfriAfya to be recognized as a leading agency in Africa for connecting and helping Change Agents to share health knowledge in an interactive manner with community groups. We are now in the process of increasing the number of field centres and widening the range of topics covered. For this expansion we need to develop a more sophisticated system of managing our information – collecting, validating, synthesizing, storing and disseminating. We also need more reliable methods for measuring individual and community changes in behaviour to assess the impact of what is happening.


Through our early contact with ACANGO we are in touch with people with extensive experience in these fields, who are helping us. We, in turn, are providing practical field experience for students. It is because of these benefits to us, and potential benefits to you and others, that we seek your participation in the evolving East Africa Network for the ACANGO Initiative, which we believe will enable us to continue helping each other and to increase the impact of our efforts in the communities we serve. On January 5, 2005, the Executive Board and senior leadership in AfriAfya met to review our long term strategic plan (2003-2008) and to discuss our priority activities for 2005. 1Included in these priorities was a discussion on the Acango Initiative and AfriAfya’s role in it. We now look forward to exploring in more detail and with a wider group of potential participants the launch of an Acango East African Regional Nework. Thank you for taking the time to be here. I sincerely hope that you will be pleased with the discussions today and that you end up deciding that you wish to participate in and benefit from this new global network. Dr. Christopher Wood Chairman, AfriAfya Executive Board

1 AfriAfya Partner Agencies are: Aga Khan Health Services, Kenya; African Medical and Research Foundation (AMREF); CARE Kenya; Christian Health Association of Kenya (CHAK); HealthNet Kenya; the Ministry of Health, Kenya; Plan International, Kenya; and World Vision International, Kenya


ACANGO INITIATIVE WORKSHOP

(Organized by AfriAfya and the ACANGO Global Hub Unit)

Thursday, January 6

8:00 a.m. to 8:30 a.m.

Connecting Over Coffee

8:30 a.m. to 8:45 a.m.

Welcome and Presentation of a Challenge to the Group - Chris Wood – Chair, AfriAfya Executive Board - Caroline Nyamai-Kisia – Director, AfriAfya

8:45 a.m. 9:30 a.m.

Session 1 – Setting the Context for the Day including a Review of Expected outcomes

9:30 a.m. to 10:30 a.m.

Session 2 – Review Introductory Material on the ACANGO Initiative

10:30 a.m. to 10:45 a.m.

Break

10:45 a.m. to 11:45 a.m.

Session 3 – Three Fundamental Concepts Driving ACANGO’s Structure, Decision Making and Behaviours (Integration, Collaboration and Innovation)

11:45 a.m. to 12:00 p.m.

Reality Check • Review progress on achieving our Expected Outcomes for the workshop

and satisfying individual Expectations • Have we identified any additional priorities that we need to deal with in

the afternoon? 12:00 p.m. to 1:00 p.m.

Lunch

1:00 p.m. to 2:00 p.m.

Session 4 – A Draft Acango Operations Model

2:00 p.m. to 3:00 p.m.

Session 5 – How Can We Best Contribute to the Global ACANGO Network How Can the Global Network Best Support the Collaborative Flagship Initiatives of the Regional Network?

3:00 p.m. to 3:45 p.m.

Session 6 – Building an Initial Action Plan Regionally and Globally (January to April 2005 and May 2005 to October 31, 2006)

3:45 p.m. to 4:30 p.m.

Wrap Up Time


Session 1 – Setting the Context for the Day Purpose of Session 1 To set the context for the workshop including: • The Key Challenge to be addressed at the workshop • Introduction of participants invited to be initial members of the ACANGO East African Regional

Network • Review of the Vision of ACANGO • Expectations for the workshop • Profile of high performing organizations • “Rules of the Road” for this workshop

Background Documents • Ottawa Workshop Report: ACADEMIC NGO: A Global Network for Reducing Health Disparities

in Low Income Communities June 24 and 25, 2004, University of Ottawa (A copy of this report will be available)

• Information Brief on ACANGO A short introduction to the ACANGO Health Intervention Network (see Appendix 1)

• Overview Statements on AfriAfya (and the collaborative efforts of its 7 partner agencies) and on the Other Organizations Participating in the Workshop (Participating organizations are requested to bring this material to the workshop)

Notes for Session 1: Key Challenge for This Workshop The intent of the workshop is to: • engage participants in understanding fully the intentions and implications of collaborating with

AfriAfya in launching the ACANGO East African Network (with a focus on how individual organizations might contribute to and benefit from participation in the network)

• gain commitment from participating organizations to help build momentum for this East African Network and a Regional Hub Unit (Operations Team) which builds on AfriAfya’s Hub Unit, to oversee the initiation of flagship initiative(s) and interaction with the global Design and Development Team and the Global Hub Unit

• identify priority actions for the Regional Network and priority areas of desired support from the Global Hub Unit and from other ACANGO Regional Networks

• provide all participating organizations with ideas, processes and tools that might help them strengthen the performance of their own organization and their capacity to collaborative with others in innovative interventions aimed at addressing complex challenges


Vision of ACANGO The ACANGO Initiative intends to organize and operate a global knowledge network of networks to effectively produce and use relevant knowledge to support innovative interventions aimed at reducing health and social disparities in low income and marginalized communities. Value Proposition of the ACANGO Global Initiative The overarching intent of the ACANGO Global Network is to utilize innovative knowledge management systems to facilitate and support global collaboration among a self selected group of academic institutions, non governmental organizations, community groups and policy groups in order to support the successful application of health delivery models that make present health knowledge available in a manner that benefits the poor. Background Events Which Led to This Workshop (see Preface by Chris Wood and Appendix 1) • Expected Outcomes from This Workshop (as suggested by the Workshop Organizers)

All participants will have:

1. a clear understanding of the strategic intentions of the ACANGO Network of Networks and the way in which this global health intervention network intends to function

2. an increased understanding of the innovative intentions underway in the AfriAfya consortium to support the reduction of health disparities in low income communities AND the role AfriAfya has been asked to undertake in launching and ACANGO East African Regional Network.

3. a clearer sense of how the non AfriAfya organizations at the session (the academic institutions and other CBOs) are engaged in efforts to reduce health disparities in low income communities

4. determined how they might increase their collaboration with other organizations at the workshop and how they might benefit from and contribute to the evolving ACANGO network (regionally and globally)

5. helped to shape a “Next Steps” draft Action Plan to build on AfriAfya’s present involvement in ACANGO and to use the ACANGO global network to help leverage local collaboration and innovation as well as increased awareness and interest from funding agencies

Task for Participants Take a few minutes in your table groups to get to know your fellow participants by sharing your initial reactions (comments, questions, suggestions) on the following: • Key Challenge for this Workshop • Vision of ACANGO • Background Events Which Led to This Workshop (as described in Chris Woods

welcoming remarks and in the Appendix 1 Information Brief on the Acango Health Intervention Network)


6. been introduced to some concepts, processes and tools that might be used to help them strengthen the performance of their individual organizations

• Expectations of Individual Participants

Participants are invited to suggest what it would take to make this workshop worthwhile for them along with key questions they had on priority issues they wish to see addressed.

� Expectations

� Key Questions and/or Issues to Discuss

Task for Participants on Expected Outcomes In plenary session provide your reactions (questions, comments, suggestions) on the 6 Expected Outcomes for this workshop. Please raise any other personal expectations you have for the meeting and/or critical questions on issues you wish to see discussed.


• Profile of a High Performing Organization

The following 12 elements represent a synthesis of the characteristics usually found in high performing organizations in various sectors. In reviewing our strategy, our draft operations model and our initial Action Plan, we might want to take a moment to reflect on the extent to which we are embedding these 12 elements in our decisions, actions and behaviours regarding ACANGO. (You might find it useful to also reflect on the extent to which your individual organization is addressing these elements.) 1. We articulate a clear strategy (vision, mission, structure and operating principles). 2. In defining and communicating our clear strategic intentions we engage leaders from throughout

the organization in practicing systems thinking (seeing the whole pattern) and strategic thinking (setting long term stretch goals and using these goals to shape our short term priorities and our operating principles).

3. We have an informed and demanding group of stakeholders who are constantly expanding the

expectations they have of our organization. 4. We set significant challenges for ourselves and constantly work to achieve and exceed them. 5. We build powerful operations management processes for:

� Improving quality � Containing costs � Making decisions quickly � Practicing innovation - - with a focus on building a culture of innovation in our organization

in which everyone is challenged and supported in their efforts to extract social and economic value from knowledge and apply it in a manner that brings about a significant improvement performance

6. We acknowledge that the ability to nurture collaboration within our organization and with

suppliers, clients, and with other groups that we might have previously seen as competitors, is now a critical asset for improving performance.

7. We use effective and empowered teams widely. 8. We have a strong capability to collect, create, organize, integrate and apply new knowledge

and to efficiently and effectively share this knowledge. We function as a learning organization in which we challenge and support our people to function as agile learners and to apply the principles of a learning organization in gathering global intelligence.

9. We understand the importance of building practical, user-friendly knowledge management

systems that help us and our network members integrate global intelligence, strategic intentions, implementation processes, product development concepts and leadership skills with the appropriate information and communication technologies.

10. We recognize that the ability to attract, retain, and retrain high quality people (HQP) in our

organization is of critical importance for continuous improvement in performance (i.e. the challenges of building human capacity to support our work is seen as a high priority).


11. We place a strong emphasis on performance measurement and utilize tools such as balanced

scorecards and outcomes mapping (and other innovative assessment tools) with an appropriate tracking system to measure and document our outcomes and to assist team leaders to utilize these measures quickly in revamping their plans.

12. We focus on adding value and producing significant increases in satisfaction of our clients, our

investors, our delivery personnel and administrators, and our peers globally.

• Rules of the Road for Today’s Workshop

We should set ourselves some rules of behaviour to help ensure that in our workshop and our follow-up activities we model the type of collaborative, innovative, high performance behaviour we are advocating in ACANGO. In our work to date in ACANGO the core of our “Rules” flow from a commitment to apply the processes and tools of the Challenge Dialogue System™ (CDS) to strengthen our capacity to collaborate and innovate in order to accomplish complex tasks. (See Appendix 3 for a chart outlining distinctions between Dialogue and Debate. See Appendix 4 for a description of the tool of Alignment that is intended to help us make quick, quality team decisions.)

Suggested Rules of the Road for Today • Practice the keys to successful dialogue.

o Build on what’s been done to date o Document today’s discussions as we go (on flip charts) o Be conscious of “co-creating” and learn from what happens o Honour and seek to use the diversity in the room o Use our “expectations” as a touchstone for checking progress in the meeting

• Seek alignment rather than agreement, as a means of moving to action continually asking:

o Is there anyone not in alignment with this suggestion?

The question “Is anyone not in alignment?” eliminates time wasted (which would occur if everyone explains at great length why they are in alignment). Alignment means you can live with the suggestion as a way of moving us forward and will support it – it does not require 100% agreement on every detail of what’s been said.


Session 2 – Review the Introductory Material on the Acango Initiative Purpose of Session 2 The intention of Session 2 is to give participants an opportunity to: • review, discuss and react to the overarching strategy that emerged from the initial ACANGO

electronic Dialogue and the June 2004 workshop, including the value proposition and draft operation principles that are being presented to potential participants and supporters

• exchange ideas on key strategic issues and priorities that should drive the East African Network and thus influence the global strategy of ACANGO

• this session will also set the scene for: o a discussion on three fundamental concepts driving ACANGO (integration, collaboration, and

innovation) o a review of the draft operations model for launching Acango’s global and regional network.

Background Materials for Session 2 � Appendix 1 – Information Brief on the Acango Health Intervention Network � Appendix 5 – Value Proposition of the Acango Initiative � Draft operating Principles for Acango (a workshop handout) Session 3 – Three Fundamental Concepts Driving ACANGO’s Structure, Decision Making and Behaviours Purpose of Session 3 • To reflect on and examine the implications for the ACANGO Network of three fundamental concepts

(integration, collaboration, innovation) that are driving our decisions and behaviours • To focus our attention on the actions that will be required in order to position the Global Hub Unit

and the East African Network as a collaborative, innovative group with a capacity to deliver services that lead to significant breakthroughs in reducing health disparities

Task for Participants on Session 2 In your table groups share your overall reactions to these materials including the value proposition, structure, the anticipated benefits and core functions. Use your flip charts to capture your feedback. Please indicate: a) Do you have any red flags to raise (major concerns) about the vision, the operating

principle and potential value of the ACANGO Network? b) Is anything unclear or missing? c) How could we strengthen a description of the benefits to be obtained from interacting in

the network?


• To consider how involvement in the East African Network can assist participating organizations to improve the capacity of their organization to collaborate (internally and externally) and innovate to accomplish complex tasks

Notes on Session 3 Recognizing the Power of Our Personal Perceptions (Mind Maps) and How They Influence Our Actions Fundamental to our success is our ability to successfully challenge ourselves and others to become more conscious of how we view the world and what our expectations are regarding what it will take to implement the ACANGO East Africa Regional Network

Our View Of The World Influences The Actions We Take

“Said the father to the double seeing son “Son you are seeing double” “How can that be?” the son replied, “If it were true, then I would see four moons in the sky instead of two.” - - Suffi Proverb

The old advertising maxim says, “Perception is Reality”. This reminds us that the way in which we view the world determines our personal sense of reality and thus, shapes the way in which we react to the world. In turn, our world is determined by our upbringing and our experiences. What we see as “reality” may, in fact, be only one of many possible “realities” or indeed it may be a powerful illusion shaped by our mind’s limited view of what is possible. Another old maxim says, “I’ll believe it when I see it”. In a fast changing world where the possible realities keep expanding, it might be more accurate to say, “I’ll see it when I believe it”. Until our mind accepts that an innovative change which is outside our experience, is actually possible, the solution to our problem may be staring us in the face and yet we will not see it. The optical illusion rendered on this page, innovatively presents two architectural structures (round and square columns) as one and challenges our preconceived logic of “seeing” the third dimension in a two-dimensional diagram. The mind’s eye grapples with the creative tension of change, the eye’s mind eventually manages the change as it abandons hasty or single-minded conceptions.


In developing and implementing an innovative, collaborative strategy the personal challenge for most of us will be to help ourselves break out of the constraints imposed by our limited personal perceptions of what the new realities are and what innovations are possible. Current Mindsets are Often Limited Conventional mindsets of important leaders on current realities have over the years often proven to be incredibly inaccurate. Here are some examples: � “Heavier than air flying machines are impossible” - - - Lord Kelvin, President Royal Society 1882

� “The horse is here to stay, the automobile is a novelty” - - - Bank Manager to Henry Ford 1908

� “There is no likelihood man can ever tap the power of the atom” - - - Robert Milliken, Nobel

Prize in Physics 1923

� “Who the hell wants to hear actors talk?” - - - Henry Warner, Film Producer 1927

� “There is a world market for about five computers” - - - Thomas Watson IBM 1943

� “We don’t like their sound, and guitar music is on the way out” - - - President Decca Records, rejecting the Beatles 1962

Restating our Challenge We are challenging ourselves to practice “out-of-the-box” thinking and to use our imagination to avoid us limiting the success of ACANGO through a limited view of what is possible. Thus we are stressing that we are not another funding agency, nor a new research and development group nor a community based delivery agency. Rather we are creating a flexible, global network organization with a commitment to deliver innovative inputs aimed at helping diverse organizations to collaborate and innovate in order to dramatically improve their ability to reduce health disparities in low income and marginalized communities. Unless the efforts of the ACANGO Global Hub Unit can help the regional network members to achieve their intentions faster, at a higher level of performance and/or at a lower cost then there is no reason for the initiative to continue. Notes on Concept of Integration: A focus on systems as a critical concept for high performance in ACANGO. Definition of Systems Thinking - - Systems Thinking is the ability to see the whole picture rather than focusing on the individual parts. It describes the capacity to see the patterns of change rather than just individual events, and provides a framework for examining the inter-relationships among things in order to select those leverage points for action which have the potential for the greatest impact. Learning Challenge Presented to Us by Concept of Integration - - to increase our understanding of Systems Thinking and our capacity to function as a Systems Thinker.


SYSTEMS THINKING

Levels of Understanding

Level of Understanding Action Mode Time

Orientation Typical Questions

Shared Vision

Generative

Future What are the stated unstated visions which generate the structures?

Systemic Structure

Creative What are the mental organizational structures that create the patterns?

Pattern of Events

Adaptive What kinds of trends or patterns of events seem to be recurring?

Events

Reactive

Present

What is the fastest way to react to this event NOW?

The Organizing Principles We Use To View A System

(Our Mental Maps)

which influences

The way we think and the way we interact with others

which influences

The alternatives (the options) which we see as being possible which influences

The choices we make and the way in which we communicate those

decisions to others

which influences

The results we achieve

which influences


Sample Challenge How as a member of city council to deal with evidence that number of fires in the city is increasing dramatically? Seen at the level of individual events (the increased number of fires) the action tends to be reactive (build more fire stations, hire more fireman). Examining the patterns (increase is only in two wards or sections of the city) the action can be adaptive (increase fire fighting capacity in only two wards). Seen at a systems level (these wards have many slum landlords and their apartments are fire traps) the action can be more creative (stiffen regulations to force owners to improve the apartments). Seen at a vision level (the goal is to make every citizen a fire preventor) can lead to a generative or transforming response (massive public education, rewards for innovative ideas, reduced taxes for more fire proof buildings). In our day-to-day work we are constantly having to deal with events and nothing can make that reality disappear. However, at each level one can leverage the action which has the opportunity to have the greatest impact at that level. Also AWARENESS that we could view problems at 4 levels of understanding is critical to improved performance. One has little chance to be creative in our solutions if we only can think of the problems at the events level. The Operational Challenge Presented by the Concept of Integration We need to keep our minds focused on how to organize our efforts to best provide input into the social, political and knowledge systems in order to influence reductions in health disparities in low-income communities. In exploring interventions that influence the health delivery system we intend to isolate innovative Models, Key Content, Best Practices and Key Success Factors that may be shared widely. While focusing on the successful application of practical, fundamental knowledge of health practices we need also to constantly consider how other social and economic factors dramatically influence the health of individuals. Whenever feasible we will try to integrate our health system models into development work related to delivery systems for agriculture, job creation, social action and the nurturing of civil society.


Notes on the Concept of Collaboration (draw on the strengths of our network organization and our dialogue process to utilize diverse skills, global intelligence and the art of co-creation to produce innovative solutions) Learning Challenges Created by the Need to Collaborate It is important to understand the new realities that have led to a recognition that “Collaboration is no longer just a nice idea - - it has become a critical element in creating a high performing organization”. Some go as far as to day that “Collaboration has become the DNA (the critical element for success) in the knowledge economy”. The Operational Challenge Presented by the Concept of Collaboration a) The ability of the ACANGO Regional Network to practice appropriate collaborative behaviour

and to use the available processes and tools for supporting team work, will be influenced by the extent to which participants embrace the following assumptions about collaborative leadership.

• Leadership development is seen as one of the highest forms of leverage for an individual, an

organization, a province, or a nation.

• Leadership is first and foremost a way of thinking - - a mindset.

• Leadership attitudes and behaviours are increasingly expected of all people in an organization whether or not they are in a formal leadership position.

• In this global, knowledge-based economy leaders are faced with challenges that are increasingly complex, often ambiguous and which often stretch them beyond their previous level of training and experience.

• Leaders are regularly challenged to do more with fewer resources, to retain high quality outputs and to achieve results faster.

• We are living through a period of fundamental change in which the standard of performance in organizations has moved from certainty (rigidity) to flexibility

• It is not just a matter of learning some new rules, the rules of the game will continue to change

• Fewer decisions in an organization will be absolute and certain. There is an increasing need to regularly receive feedback from clients and to refine your actions based on their feedback.

• Leaders need a high tolerance for ambiguity and the need to make decisions based on

approximate knowledge will increase

• The complex challenges of our fast changing world have led most high performing organizations to pass authority and responsibility throughout their organization and to acknowledge the need to be able to quickly create and operate collaborative, cross functional teams that may form to deal with a specific task and then be disbanded.


• Quickness and flexibility will be increasingly important as will the capacity to practice the process of co-creation effectively in developing and implementing action plans.

• All of this means leaders have to learn to create collaborative teams quickly, make them high performers and help them develop a capacity to make quick, quality team decisions

(b) The ability of the ACANGO Regional Networks to practice collaboration will also be

influenced significantly by the collective ability of the Global and Regional Hub Units to efficiently develop and effectively utilize customized Knowledge Management Systems. These systems need to support easy, inexpensive and timely exchange of ideas, content, contacts, innovative models and processes and tools.

Developing an improved capacity of network members to choose and wisely use appropriate information and communication processes and technologies will be a major operational challenge for the ACANGO members as they strive to collaborate in achieving their big challenges. Notes on Concept of Innovation (Engage in Some Disciplined Thinking About Innovation and How to Support ACANGO Members to Strengthen Their Capacity to Innovate) The Learning Challenge Related to the Concept of Innovation

There is a need to engage in some disciplined thinking about innovation. There is a priority need to understand and be able to articulate the new imperative for innovation and what exactly we mean when we talk about innovation.

Task for Participants on Integration and Collaboration In your table groups reflect on the two concepts of Integration and Collaboration. Provide your feedback by noting on the flipcharts: • Key insights regarding the implications of trying to apply these to ACANGO • Questions you wish to raise on these concepts or additional support resources you would

like to request


We have a challenge to avoid being caught in the trap of many who use the term without any clear sense of what they mean by it or what strategies, structures, skills and behaviours are most likely to support innovation rather than impede it. We need to be clear that research is an important part of the innovation process, but the innovation process goes well beyond the research stage and includes all the efforts necessary to get a new idea and new knowledge utilized widely. The Operational Challenge Related to the Concept of Innovation The value proposition of ACANGO suggests that it will offer an innovative vehicle for helping the Regional Hub Units and their regional network members as well as individual network members to dramatically improve their capacity to reduce health disparities in low-income communities. To accomplish this ACANGO has to both help participants prepare to enthusiastically engage in the ongoing practice of innovation (i.e. the Learning Challenge) and to provide principles, processes and tools that will help groups apply the process of innovation in their everyday work and to eventually establish a culture of innovation in their organization. Part of the operational challenge to accomplish this with the regional networks and individual network members will be the need for the ACANGO Global Hub Unit to model the behaviour of an entrepreneurial, collaborative, innovative, high performing group. They need to be able to respond to requests for assistance with timely, high quality, inexpensive, innovative responses (see Appendix 5 for the detailed value proposition).


Notes on Innovation

Innovation – An intuitive art or a discipline?

“Me – creating a public nuisance? Gee, I never thought of myself as creative”

We need to acknowledge that although some people may be intuitively more creative than others, innovation is a discipline that can be taught and can be learned. Also the way one structures an organization can either nurture innovation or impede it. Defining Innovation Innovation involves the extraction of economic and social value from knowledge. It involves putting ideas, knowledge and technology to work in a manner that brings about a significant improvement in performance. It is not just an idea - - but rather an idea that has been made to work. Some Assumptions About Innovation Our ability to practice innovation will be influenced greatly by the extent to which we understand and embrace a number of assumptions about innovation. The old understanding of innovation largely as a specific event, a thing, or a mechanistic input is shifting to a view that innovation is more an integrating process for solving complex problems. This approach to innovation is enhanced through social exchange and is the result of ongoing exploring, learning, synthesis, integration, action and reflection. The new recognition of the important role of agile learning (involving out-of-the-box thinking) and collaboration in innovation and the sense that innovation systems are basically social systems has led us to conclude that “While innovation has many faces – its essence is best represented by the concept of a culture of innovation in which imaginative but disciplined experimentation is valued and practiced”.


There is a need to recognize the many faces of innovation including the following: • technological and social (organizational and behavioural) innovation • incremental and breakthrough innovation • innovations in strategy, structure, support systems, skills and shared values • innovation at the individual, organizational or inter-organizational level • innovations in products and services • process innovations (changing the way work is undertaken) • innovations in culture (changing the organizational structure and the operating principles including

changing attitudes and behaviours) An Innovation Equation to Support the Theory of a Culture of Innovation This theory perhaps is best represented by the following equation: I=(CIT)3 in which • I represents Innovation • C3 represents Courage, Commitment, Collaboration • I3 represents Imagination, Integration, Ingenuity • T3 represents Talent, Technology, Tolerance We are not using the above equation in the widely recognized conventional sense to mean that “I” is exactly equal to (CIT)³. We are using the equation in the manner that it has been used by scientists involved in exploring a whole new way of approaching a challenge. For these exploratory scientists a good equation is not simply a formula for making computations. Nor is it merely a confirmation that different items are exactly equal to each other. Since the beginning of the modern age scientists often have used equation and the equals symbol (=) as a device for directing thoughtful people’s attention to new ideas. Our intent is to engage ACANGO participants in thinking about this concept of a Culture of Innovation and exploring its importance in the ongoing success of their organization and of collaborative efforts such as the ACANGO Health Intervention Network. (See Appendix 6 for a Note on “What Does it Take to Create a Culture of Innovation?”) Setting Stretch Goals to Stimulate Innovation One way of looking at how these various elements required for innovation can be brought together in an organization is to look at the challenging goals an organization sets for its teams and individuals – i.e. its performance focus. Some call these challenging goals “big hairy audacious goals”, reflecting the challenging nature of such goals, while others have called them outrageous goals. The point is that organizations which see innovation as critical to their future, set a number of challenging goals which in themselves demand innovation because it is clear to everyone that if they continue to operate using the present strategy and behavior then these goals will never be reached. These stretch goals are intended to be achieved over a lengthy period and are intended to affect all in the organization. Examples of Stretch Goals For example, a goal at General Electric to achieve zero defects in all aspects of its work is a challenging goal. It means that error rates can be no more than 3.3 per million times a task is completed – whether it is a letter going out to a customer, a manufacturing process or a hiring of a new staff member. This is a very demanding and challenging goal. (It was achieved by using the process of Sigma Six)


Another company, the 3M Corporation, some years ago challenged all of its staff to do what they had done the previous year in one third less time – again, every individual in the corporation was asked to achieve a goal which focused on time – doing things faster without a loss of customer satisfaction. (3M has consistently used such stretch goals to position itself as a company that is clearly operating with a culture of innovation.) A school in Cwmbran, South Wales set itself the task of reducing truancy from 8% of the student population on any given day to 3% (within two years they achieved this result). A government department wanted to move all of its fee collection activity from individual visits, mail and collection centres to being entirely direct deposit or internet based transactions (this was achieved in twenty eight months). Each of these examples is of a challenging goal which is aligned with the strategy and vision of the organization and which required staff to be innovative if the goal was to be achieved. Such goals focus efforts on breakthroughs, are measurable, require creative and innovative skills and have a real impact on the performance of the organization. Effective innovation requires focus, which challenging goals provide. As long as such goals are linked to strategy and vision -- and teams and individuals are challenged, empowered, equipped and supported to respond to the goal, then such goals can provide a powerful starting point for making innovation happen, provided that the organization is ready for innovation. Innovation Stories One of the most powerful ways to help individuals increase their capacity to innovate is to present stories of successful innovations. Our intent is to make a major effort in capturing and sharing innovative stories presented by members of the ACANGO Network.

Task for Participants on Innovation In your table groups reflect on these comments on innovation and their implications for your individual organization and the new ACANGO East African Network. Provide your feedback by noting: • Key Insights and/or questions regarding the application of these ideas to the East Africa Network • Examples of innovations of various kinds undertaken by your organization that could be worth

sharing throughout the global network


Session 4 – A Draft ACANGO Operations Model The intent is to operate ACANGO as a flexible, nimble, global knowledge network to support health interventions in low-income communities - - using initially the following structure: A. A Global Design and Development Team (Steering Committee) B. Informal Regional Networks (built initially around one or two organizations who have demonstrated

(i) a commitment to reducing health disparities in low-income communities (ii) an ability to nurture collaboration among various groups in their region (NGOs, CBOs, Academic Institutions, Policy Groups)

These Regional Networks will have a Regional Hub Unit (operations team) and various delivery vehicles (hodes) to carry out community interventions, training programs and to educate and influence policy groups to build policy on the latest knowledge.

C. A Global Hub Unit (to support the Regional Networks Hub Unit in their efforts to support regional

network members. The Global Hub Unit is also expected to build awareness and credibility for the overall ACANGO Initiative and its global members)

D. Individual Network Members

These are individual innovators or leading organizations that have demonstrated a commitment to the strategic intentions expressed by the ACANGO initiative and who have expressed an interest in participating – even though they are not in a position to create or engage directly with an ACANGO Network in their region. This category could include funding agencies.


Draft Overall Structural Plan of ACANGO

Global Design and Development Team - to set policies and oversee growth of ACANGO

Global Hub Unit - to connect and support regional

intervention networks and other network members

- consists of a core team plus reps from the Hubs of the Regional Networks

East African Regional

Intervention Network (led by

AfriAfya)

Thailand Regional Intervention

Network (led by Institute of Health

Research –and College of Public

Health Chulalongkorn

University

Ottawa Regional Intervention Network (led by Institute of Population Health – University of Ottawa)

Next Self Organizing

Regional Intervention

Network - - likely Dignitas in Malawi

Individual Organization

Network Members

(Australia)


Network Members (Europe)


Network Members (Africa)


Network Members

(N America)


Network Members

(Latin America & Columbia)


Network Members

(Asia)


Notes on Various Structures of the ACANGO Network of Networks A. A Global Design and Development Team

The initial membership of this global Design and Development Team is expected to include:

Chairs: Dr. Peter Walker and Dr. Peter Tugwell Members at Large: Individuals from 3 NGOs, 4 Universities and 1 public sector health institute have been invited to be members of this Global Design Development Team. Caroline Nyamai-Kisia of AfriAfya is one of the initial invitees. Major Responsibilities: - continue work on the overall design of the Global Network of Networks, the Global Hub Unit and

the Regional Network - initiate memos of understanding with three founding regional networks and receive requests for

involvement by additional regional networks and individual organizational members - determine priority actions to build awareness, credibility and support for ACANGO initiative - find support for operation of the Global Hub Unit and approve operations plan for this unit to

support regional networks

B. Regional Networks

The regional networks are where the action takes place, be it community-level interventions in production of practical knowledge products, innovative training initiatives or policy-level changes. The regional networks will be self organizing. The 3 founding regional networks are expected to operate as some type of strategic alliance built initially around the work of one or two organizations. It is possible that some networks may wish to have a more formal arrangement for their collaboration. On the other hand it is possible that a regional network might consist simply of a cluster of projects in the same region without involving any formal structure. Each regional network will have some type of organizing team (or Regional Hub Unit) to facilitate the input of network members into the community-based flagship interventions. The Design Team proposes that a regional network include members from academia, NGOs (and other community-based organizations) and one or more client groups. Client is defined as the 5 “P”s: Public, Patients, Practitioners, Policy-makers, Private-sector. The clients participating in each network, and indeed in each project should have a strong commitment to the goal of reducing health disparities in low income countries.


Note: for a more detailed diagram see Appendix 8

General Criteria for Being Identified as an ACANGO Regional Network To initiate the initial regional networks, an organization in a region with a credible reputation for collaborative, innovative efforts to reduce health disparities in low-income communities will be recognized as the organizing group for nurturing the launch of the ACANGO Regional Network. • A regional group that has determined that it can benefit from and add value to the ACANGO

Global Network and that supports the vision, strategy and operating principles of ACANGO will request recognition by the Global Design and Development Team as an ACANGO Regional Health Intervention Network. The principles of self-organization, self-designation and self-attraction will guide the process of including new organizations into the regional network The structure of the regional network and the roles of its member organizations and the selection of its flagship initiatives will be defined by the regional network itself.

• A leadership group committed to the strategic initiative of ACANGO needs to demonstrate a commitment to engage with the 5 P’s of clients. 5P’s include: o Public (commonly) o Practitioners (formal health workers and local change agents) o Patients o Policy Makers o Private Sector

• Evidence that the group is successfully engaging academic institutions, non governmental organizations (NGO’s), other community based organizations (CBOs) and policy groups which are all committed to developing collaborative, innovative interventions to reduce health disparities in low-income and marginalized communities

• Some form of Regional Hub Unit (operating team) to facilitate regional collaboration and interaction with the Global Hub Unit

• A commitment by various members of this regional network to identify one or more specific regional flagship initiatives of significant importance in its potential for reducing health disparities and to commit to working collaboratively to ensure the success of this flagship initiative.

Academic Institutions

Clients

NGOs and

CBOs Regional Hub Unit (organizing team) facilitating collaboration and flagship initiatives


• A commitment by the network members to self fund the collaborative flagship initiatives at the regional level from the resources of the individual organizations. (Note: The Regional Networks can expect assistance from the Global Hub Unit to help them build awareness and credibility of their efforts with funding agencies)

• Acknowledgement of the growing complexity of many of the problems they face and a willingness to learn from others and to try innovative new approaches to strengthen their capacity to function as a high performing organization

• A readiness to interact regularly with the ACANGO Global Hub Unit to contribute to, and benefit from the Hub’s Knowledge Support System (KSS) and its contacts with Regional Networks and individual organizational members of the ACANGO Network throughout the world

Note: For more details see the list of Draft Operating Principles for Acango

C. Global Hub Unit

The Hub Unit should be seen as the great connector for the network – linking and supporting the innovators in the regional networks who are engaged in the creation and delivery of creative solutions for reducing health disparities in low-income communities. We might speak of the Global Hub Unit as “the concierge” for the ACANGO network. By that we mean it functions similar to a concierge in a hotel whose role is to help clients clarify their needs and then to provide appropriate responses - - directing them to the best source for meeting their needs whether or not this source is part of the hotel’s operations. The Global Hub Unit should adopt this “concierge culture” with its overarching commitment to serving the Regional Networks as well as the other individual members of the Network. Remember not only does a concierge tell you where to get what you want, and how to get there, they also ask you what is important and help you to clarify your priority needs before making any recommendations.

Task 1 – Serve as the Great Connector for the Regional Networks and Provide General Support for Them

• assist the Regional Hub Unit to strengthen their capacity to deliver a range of functions and

services to the various members of the regional networks • respond to calls for specific assistance from the regional networks by connecting them with the

appropriate sources of expertise and knowledge • providing regional networks with appropriate innovative best practices models, knowledge

content, and templates for organizing knowledge • providing operating processes and support tools for helping them engage diverse stakeholders in

their community to collaborate and innovate in accomplishing complex tasks


Task 2 – Organize and Implement a Select Group of Cross Cutting Initiatives Specifically Aimed at Addressing Big Picture Challenges Facing the Regional Networks

For example: • strategic communication initiatives • innovative initiatives related to capacity building and the implementation of creative learning

strategies (e.g. Action-Learning Forums on various themes e.g. measurement of impact) • demonstrating processes for engaging in global intelligence systems • evaluation initiatives for helping regional networks to efficiently and effectively measure their

performance against their stretch goals and for utilizing the results to adjust their plans • proven models for moving health evidence into action (knowledge translation)

Task 3 – Organize and Operate a Customized Knowledge Support System for the Network • this Knowledge Support System (KSS) will be enabled by a range of appropriate information and

communication technologies (ICTs) including the creative application of portal technologies to support the building of communities of practice concerned with reducing health disparities in low-income communities

• this KSS will be a flagship initiative of the Hub and will be positioned as a breakthrough innovation in its own right. The Hub Unit will employ the KSS as a critical resource for the task of collecting, creating, synthesizing, integrating, storing, sharing and utilizing of quality resources for reducing health disparities

• the Global Hub Unit will also use this KSS as a model for helping Regional Hub Units to develop and/or strengthen their own Knowledge Support System This may include an action learning forum linking and supporting key persons in each of the regional networks who are responsible for choosing and helping people use appropriate information and communication technologies.

Task 4 – Provide General Support for the Design and Development Team of ACANGO • in the transitional start-up phase of ACANGO the Hub serves as a general support group for the

Design and Development Team who are providing overall leadership • as the network begins to operate the Hub serves as the core secretariat (or core operations team)

for the global network (as a network of networks) Task 5 – Build and Strengthen Participation in the Network • initiate various efforts to engage individuals and organizations who could add high value to the

network and utilize its resources effectively, but who are not part of any regional ACANGO network

• provide support to the Design and Development Team of ACANGO in their efforts to identify and engage new regional networks

Task 6 – Promote the Network of Networks and the Individual Regional Networks • provide leadership for promoting and explaining the changing nature of networks and their

increasing importance, the nature of the ACANGO global network and the intentions behind it • attracting interest, involvement and support by articulating how this network of networks can

serve as a breakthrough initiative to dramatically improve performance in reducing health disparities in low income and marginalized communities

• assisting the regional networks to connect with potential funders and initiating efforts to build awareness and credibility of the work of the regional networks with funding agencies


Task 7 – Capture and Share Key Learnings and Evaluating Overall Performance of the Network • constantly engage Hub Unit members and others throughout the network in capturing key

learnings and in finding effective means for sharing the learnings and using them in future plans for the network

• building on the above efforts the Hub is responsible for initiating evaluations of the outcomes and impact of the overall network (utilizing some customized version of a balanced scorecard)

Note: The Global Hub Unit will stand ready to assist Regional Hub Units to strengthen their planning, evaluation and promotional efforts.

D. Individual Network Members

These are individual innovators or leading organizations that have demonstrated a commitment to the strategic intentions expressed by the ACANGO initiative and who have expressed an interest inn participating – even though they are not in a position to create or engage with an ACANGO Network in their region. This category could include funding agencies.

Task for Participants on the Operations Model In your table groups reflect on this structure and provide feedback by noting your reactions and questions about the structure as well as suggestions for best applying these operating principles to the establishment of the East African Regional Network.


Session 5 – What Can We Best Contribute to the Global ACANGO Network? How Can the Global Network Best Support the Flagship Initiatives of an East African Regional Network? Purpose of Session 5 • To identify how participating organizations in the East African Network might best add value to the

global ACANGO Network • To identify priority requests for assistance we would request of the ACANGO Global Hut Unit Background Reference Survey Template – See Appendix 7. Session 6 – Building an Initial Draft Plan to Launch the Regional Network Purpose of Session 6 • To determine some initial Next Step Actions to build some momentum for the ACANGO East African

Network

• Identify and discuss some priority initiatives and/or processes or tools from member organizations that might be usefully shared with global participants in the ACANGO Network

• Identify areas in which the individual organizations could most benefit from some inputs from the global Hub Unit

• Review and discuss some potential flagship initiatives that the East African Network might undertake on a collaborative basis

Task for Participants • On your flipchart start to list some priority actions for the East African Network • Start to draft a list of “Next Steps” for activating the network


Appendix 1

Information Brief on the ACANGO Health Intervention Network Brief Introduction to the ACANGO Initiative What is the ACANGO Initiative? The ACANGO Initiative intends to organize and operate a global network of networks to effectively produce and use relevant knowledge to support innovative interventions aimed at reducing health and social disparities in low income and marginalized communities How was the Initiative Begun? The Center for Global Health at the University of Ottawa (an Institute which involves most University disciplines) initiated in January 2003 an internal dialogue on the concept of the Academic NGO. This ACANGO concept was conceived as an attempt to move away from the tendency of the academic institutions to focus internally on research and training and to challenge themselves to include a more action oriented external focus for moving evidence to action. By the end of this internal dialogue the University of Ottawa team reached passionate alignment around a fundamental premise. If an effective way could be found to bring together the academic’s ability to produce sound scientific evidence and to organize strong teaching experiences, with the distinctive capacity of nongovernmental organizations, to initiate effective community based interventions to initiate change, then something of significant value would be created. Under the leadership of Dr. Peter Tugwell (Director of the Centre for Global Health) over 100 colleagues from around the world were then invited to join this exploratory dialogue on the ACANGO concept (which was carried on electronically) and culminated in a June 2004 workshop in Ottawa involving 80 participants representing eight different countries. The workshop resulted in a commitment by most of the participants to support the initiation of a two-year transition effort to test the pilot network concept and if successful, to establish a sustainable basis for a further five-year period. This two-year transition stage was launched November 1, 2004 with the University of Ottawa undertaking to finance the facilitating supportive Global Hub Unit for the first six months. What is the initial Organization Model for Testing the ACANGO Concept? • Design and Development Team (Steering Council)

o This group, led by Dr. Peter Walker and Dr. Peter Tugwell will include members from a minimum of six countries and will provide overall leadership for the network design, the operating principles and priority actions. They will approve the operating plans and the budget for the Global Hub Unit.

• Regional Networks

o These networks will build on the work of some present organizations and will represent a regional alliance among academic institutions, non governmental and policy groups who have a serious commitment to reducing health disparities in low income communities

o The Founding Regional Networks are:


a) East Africa - - building on the AfriAfya 7 Partner Consortium of non governmental organizations (NGOs) and the Ministry of Health by engaging academic institutions and some additional community-based organizations (CBOs)

b) Thailand - - building on the work of the Institute of Health Research and the College of Public Health at Chulalongkorn University in collaboration with the local public authority (Bangkok Metropolitan Administration), the Doung Prateep Foundation (NGO) and four types of community based organizations (CBOs) in the Klong Toey slum

c) Ottawa - - building on the work of the Centre for Global Health and the Institute for Population Health at the University of Ottawa and their direct involvement with a number of academic institutions, NGOs and CBOs in the Ottawa region and other parts of the world.

o Initial criteria for establishing Regional Networks have been developed. Included in the criteria is the commitment to initiate a collaborative regional flagship initiative

o The expectation is that some groups in other regions, stimulated by individual ACANGO members, will self organize into regional networks which will be added over the next two years. Some are already well on the way to position themselves as an ACANGO Regional Network

• Global Hub Unit

o The Hub Unit wishes to be seen as the great connector – linking and supporting innovators in the regional networks who are engaged in the creation and delivery of creative solutions for reducing health disparities - - as well as interacting with individual members of the global network.

o The Hub Unit intends to organize and implement a number of Cross Cutting Initiatives which respond to specific challenges presented by the Regional Networks (including the creation of an electronic Knowledge Support System, and the organization of online Action Learning Forums on topics of priority interest)

o The Hub Unit will be funded initially by the University of Ottawa and staffed by a small core team suggested by the Design Team as well as representatives from each of the Regional Networks

• Individual Network Members

o In addition to the founding regional networks, many other organizations (NGOs, CBOs, academic institutions, policy groups, funding agencies) and individuals have participated in the work to date and consider themselves members of the global ACANGO network.

o The Hub Unit is committed to helping these individual members contribute to and benefit from the global network.

o The Hub Unit will keep these members well informed about the initial collaborative flagship initiatives of the regional networks and will seek their supportive input of information and innovative practices.

o The assumption is that some of these organizations will serve to initiate additional regional networks

o Funding agencies who share a commitment to reducing health disparities in low income communities and who are interested in participation in the network are welcome

What are the Roots of the ACANGO East African Regional Network? Some members of the organizing Global Hub Unit Team have been interacting for some time with members of AfriAfya as the Kenyan-based group initiated efforts to develop collaborative vehicles (including electronic knowledge systems) to support community based health change agents. Two senior members of AfriAfya participated in the global electronic dialogue on ACANGO and attended the organizing workshop in Ottawa last June. AfriAfya was one of the six organizations invited to present a “Challenge Project” to this workshop. At the end of the session AfriAfya was invited to draw on its present consortium and collaborative activities as the core of an initial ACANGO East African Regional


Network and to invite participation from a number of academic institutions and other community based organizations. Global Hub Unit members have also had an opportunity to engage in some efforts of the African Health Research Forum and to work with some of the Forum’s Leadership at Kenya Methodist University and the University of Nairobi. Representatives of these organizations attended the ACANGO Ottawa workshop. Kenya Methodist University and TICH have both been engaged in building working relationships with the University of Ottawa. Their potential involvement in the ACANGO East African Network is another vehicle for nurturing this relationship. Following the Ottawa session the AfriAfya team was invited to play a catalytic, coordinating role in creating an East African Regional Network by inviting the participation of these and other academic institutions and additional community based organizations in an informal alliance. The intent was to identify some flagship initiatives emerging initially from the ongoing evolution of the AfriAfya consortium and from the health equity efforts of the academic institutions. This workshop on January 5, 2005 is an important step in launching this ACANGO Regional Network.


APPENDIX 2

ORGANIZATIONS INVITED TO ATTEND

• ACANGO GLOBAL HUB • UNIVERSITIES Methodist

Nairobi African Virtual Cape Town Tropical Institute of Community Health

• MINISTRY OF HEALTH • NGO's AKHS

AMREF Plan World Vision Care CHAK Healthnet Action Africa Help Community Capacity Building Initiative AfriAfya

• INTERNATIONAL ORGANIZATIONS

Rockefeller Foundation IDRC Exchange IICD OKN

• PRIVATE SECTOR Virtual City Community Representatives


Appendix 3

DISTINGUISHING BETWEEN DIALOGUE AND DEBATE While there is considerable recognition now of the importance of collaboration, network building and co-creation, too often our old instincts drive our action and turn our conversations into struggles over proving the position of others is wrong that we are right and that our approach should be embraced. To stimulate one’s thinking about the tools for nurturing high level, collaborative conversations aimed at developing breakthrough solutions to complex tasks we offer the following distinctions between Dialogue and Debate:

Dialogue Debate • Dialogue is collaborative: two or more sides

work together toward common understanding. • Debate is oppositional: two sides oppose each

other and attempt to prove each other wrong. • In dialogue, finding common ground is the

goal. • In debate, winning is the goal.

• In dialogue, one listens to the other side(s) in order to understand, find meaning, and find agreement.

• In debate, one listens to the other side in order to find flaws and to counter its arguments.

• Dialogue enlarges and possibly changes a participant's point of view.

• Debate affirms a participant's own point of view.

• Dialogue reveals assumptions in order to re-evaluate them.

• Debate defends assumptions as truth.

• Dialogue causes introspection on one's own position.

• Debate causes critique of the other position.

• Dialogue opens the possibility of reaching a better solution than any of the original solutions.

• Debate defends one's own positions as the best solution and excludes other solutions.

• Dialogue creates an open-minded attitude (openness to being wrong and an openness to changing one’s position).

• Debate creates a closed-minded attitude, a determination to be right.

• In dialogue, one submits one's best thinking, knowing that other people's reflections will help improve it rather than destroy it.

• In debate, one submits one's best thinking and defends it against challenge to show that it is right.

• Dialogue calls for temporarily suspending one's beliefs.

• Debate calls for investing wholeheartedly in one's beliefs.

• In dialogue, one searches for basic agreements • In debate, one searches for glaring differences. • In dialogue, one searches for strengths in the

other positions. • In debate, one searches for flaws and

weaknesses in the other positions. • Dialogue involves a real concern for the other

person and seeks to not alienate or offend. • Debate involves a countering of the other

position without focusing on feelings or relationship and often belittles or deprecates the other person

• Dialogue assumes that many people have pieces of the answer and that together they can put them into a workable solution.

• Debate assumes that there is a right answer and that someone has it.

The Challenge Dialogue System is a proven approach for helping diverse stakeholders use the approach and the tools of Dialogue to reach decisions that solve complex tasks.


Appendix 4

The Alignment Process For Quick, Quality Team Decision Making Purpose: To help people make quick, quality team decisions Alignment - What is it? • A tool for quick quality team decisions • Describes a state of group commitment in a specific context • Not necessarily complete agreement • If proposed action remains a priority, then all team members will support the action. The action is

seen as a high priority worth supporting though it may not have been their individual top priority

Utilizing the Tool: The ability to utilize new tools for teams to make quick, quality decisions depends upon acceptance of a few key assumptions about the realities of today’s world. Assumptions about the Global Knowledge-Based World: • It is a period of fundamental change • New realities of the global knowledge economy are provoking an organizational revolution • Leaders in all organizations are being pressed to do more, with less - - to do it at a high quality level

and to accomplish major tasks quickly • The standard of performance in organizations has moved from “certainty” to “flexibility” • It is not just a matter of learning some new rules, the rules of the “game” will continue to change • In this new “game,” new cross functional teams are regularly being formed to undertake specific tasks

for a short period of time • The pressure is on leaders to improve their ability to create new teams, get them working well together

in a short time and have them ready to quickly respond to changes in the “game” which will be on-going

If these assumptions are accepted, then we can also assume • Fewer decisions in an organization will be absolute and certain. • Leaders need a high tolerance for ambiguity and the need to make decisions based on approximate

knowledge will increase. • Quickness and flexibility will be increasingly important. • The ability to sensitively monitor the results of one’s decisions and make quick adjustments has

become critical. • All of this means leaders have to learn to create teams quickly, make them high performers and help

them make quick, quality team decisions. • Alignment is a powerful tool in any situation in which you have brought a team together to deal with a

particular task or project, and there is a need to use time efficiently to get some effective action started


How does the Alignment Approach operate? Individual suggests an action

Example: “I suggest that we make it a priority over the next six months to dramatically improve AfriAfya’s Knowledge Management System.

They then ask the question,” Is there anyone not in alignment?” NOTE – the reference is to disagreement. If everyone agrees, then no one speaks and a decision has been made, and the group moves on

People say, “I am not in alignment”, when they don’t understand the suggestion OR if they are absolutely in disagreement and could not live with this action

Then there can be a short 2-person discussion – without quick agreement the proposal is removed

2 person discussion only – 3rd man in gets thrown out to avoid “verbal brawl”

This process while rapid does not encourage casual acceptance of an idea

Alignment means team can expect your 100% support


Appendix 5 Value Proposition of the ACANGO Global Initiative The overarching intent of the ACANGO Global Network is to utilize innovative knowledge management systems to facilitate and support global collaboration among a self selected group of academic institutions, non governmental organizations and community groups in order to support the successful application of health delivery models that make present health knowledge available in a manner that benefits the poor. Other Elements of Value Proposition of ACANGO’s Global Hub Unit to the Regional Networks • Timely, efficient, effective responses to calls for specific assistance by connecting them with the

appropriate sources of expertise and knowledge • The requests might include requests for assistance in:

- developing or refining content and delivery models for community use or prevention and treatment of HIV/Aids, malaria, tuberculosis

- effective processes for community based planning initiatives and for effective assessment of impact

• A knowledge repository with key lessons learned, that actively captures and builds on both explicit (scientific) knowledge and “tacit” knowledge that comes from experience

• An effective Knowledge Support System for ensuring timely, efficient access by network members to the collective resources of ACANGO to help them respond successfully to client needs (This will include advice and assistance to help Regional Networks strengthen their own Knowledge Support System.)

• An action-learning forum that focuses on creative engagement of the diverse participants and focuses on developing innovative training programs to support efforts to reduce health disparities in low-income communities

• Ready-access to “best practice” models for translating knowledge into action that leads to improved health

• Assistance to Regional Networks in building awareness and credibility of their work with funding organization

• Provision of processes, tools and training to Regional Networks in strengthening their capacity to collaborate and innovate and operate a high performing organization


AAppppeennddiixx 66

What Does It Take To Create A Culture of Innovation?

Here are some key observations about the creation of a culture of innovation, derived from a review of the massive literature on innovation in organizations and from a decade long review of innovation practices in organizations conducted by the Innovation Expedition. These are included as a starting point for you to review what is happening in EnergyINet. As you read each one, ask yourself “does this apply to our organization?” Innovation requires a vision – innovation usually involves change, risk and upheaval. Innovation is not done for innovation's sake; there must be a driving motivator compelling the organization to develop the systems, resources and culture needed to support innovation. Thus, innovation is linked to an organizations vision, mission and goals. Such visions need to be powerful motivators, not just slogans or marketing statements – it is what the vision does here that matters, it should be driving change and development in the organization. Is our vision powerful, encouraging of innovation and motivating or is it just a slogan?

Innovation is customer or client-driven and bottom-line focused -- the purpose of innovation is to find better ways to delight customers or clients while meeting the needs of all other stakeholders and creating a financially viable organization. If customers or clients, including internal customers and clients as well as those who are the ultimate users of your goods or services, are not to benefit, then there needs to be a question “what or who is this innovation for?” If clients are to benefit, then it should have an impact on the bottom line – either in the short, medium or long term. Innovation is not an excuse for going over budget or losing money. It is the basis of providing better services, more effectively and at a better rate of return on investment. Innovation requires a foundation of ethics -- only in an environment of mutual trust and respect, not only within the organization but also within the surrounding community and its market, can an organization develop a truly innovative approach to problems and opportunities. When the culture is one of cliques, private intelligence and personal networks rather than open and honest dialogue then innovation becomes too much of a risk.

Innovation requires innovative thinking -- innovative thinking is a skill needed by every member of the organization. It is the ability to constantly look for new possibilities, generate ideas, think together productively, make sound decisions and gain the commitment needed for rapid and effective implementation. Innovation looks at the whole system -- creating solutions in one area that cause problems in another is not innovation; it's chaos. Innovation needs to be understood by all parts of the organization and needs to be linked to a careful and thoughtful understanding of its likely impacts on every aspect of the organization.


Innovation requires a diverse, information- and interaction-rich environment -- people with different perspectives, working together toward a common objective, with accurate, up-to-date information and the proper tools are the only source of innovation.

Innovation requires a risk-tolerant environment -- the creation of anything new involves risk and the possibility of failure. An innovative environment honors nice tries that didn't work (AKA failures) as learning experiences and part of the innovation process. Innovation involves and rewards every member of the organization -- there are no longer "thinkers" and "doers," "owners" and "workers." Innovation requires the very best thinking and doing from everyone and treats everyone as an "owner," equitably sharing the rewards generated by those best efforts. In turn the innovative organization is expecting leadership behaviours and the acceptance of responsibility from everyone in the organization regardless of whether they are in a formal leadership position.

Innovation is an on-going process -- innovation will never be a static state, which, once achieved, can be placed on a shelf and forgotten. It requires constant renewal, reinvention and dedication. Innovation requires a continuous scan of future trends -- just as the weather in Havana may be changed by the beat of a butterfly wing in Chile, the destiny of an organization may be determined by the efforts of an unknown team working in a basement laboratory of a small university. A great many of the things we now take for granted began as rejected ideas elsewhere – e.g. the 3M Post-It Note Pad, the digital watch, MS-DOS/Windows, Xerox machines for photocopying, Apple Computers, all of which were initially rejected by the companies who sponsored their development. Innovation requires a learning orientation -- only by creating an environment where every member of the organization is continuously learning more about its products, services, processes, customers, technologies, industry and environment can an organization successfully innovate year after year. Innovation requires a learning orientation -- only by creating an environment where every member of the organization is continuously learning more about its products, services, processes, customers, technologies, industry and environment can an organization successfully innovate year after year. Necessary Conditions for Innovation The following are some key conditions that need to be met, if our network organization is to be constantly innovative. Strategy: We have said Vision is key – without vision an organization will end up “lost” in the sea of opportunity. But in order to convert vision into something concrete and tangible, there is a need for a clear strategy that confirms the position the organization is seeking to occupy, the key elements of brand by which it wishes to be known and the “fit” of activities within the organization to these brand elements and strategic position. Without strategy, vision is rhetoric; without vision, strategy is detail. Together they shape the actions of the organization. Leadership: Vision and strategy provide a framework within which innovation needs to take place, but an equally powerful key is the nature of the leadership at all levels in the organization and their willingness to champion, sponsor and encourage innovation, out-of the box thinking and creativity. If leadership does not encourage innovation and, more significantly, does not reward it when it occurs then innovation will not take place. Leaders need to model innovative thinking and enable innovation at all levels in the organization.


Structure to Support Collaboration: structure shapes behaviour in organizations – there is therefore a need to ensure that the structure of the organization supports effective teamwork within a unit or division, between units and divisions and across different levels of people (i.e. executives can work with supervisors, front-line workers, customers and suppliers in the same team) so that ideas do not get stuck in the crevices of the organization. Organizational structure should be shaped to support innovation practices.

Implementation process: What happens when someone or a team suggests an innovation? What is the process for implementation? If this process is cumbersome, expensive and wasteful of energy, money and time then it will discourage innovation. In fast moving organizations innovative ideas are championed by a leader and decisions are made quickly and effectively so as to pilot and then implement ideas as they emerge. Measurement: effective innovation needs to have demonstrable results for the organization, which in turn requires measures to be in place to effectively measure the impact of changes and innovation on the organization. Without such measures, innovation is justified by anecdote, politics or ignorance. Data is the key to effective innovation over time. Tools: Innovation does not simply happen, it is a competence that can be nurtured and developed by helping teams and individuals master some skills – problem solving skills, creative thinking, process mapping and other skills. Investment in the development of skill is a pre-requisite for innovation being a part of the culture as opposed to something that only some people are able to do. Innovation is a discipline that can be taught and learned.


Appendix 7

ACANGO Health Intervention Network Survey for Regional Networks to Describe Their Priority

Interactions With the ACANGO Global Hub Unit

1. Coordinating Hub for ACANGO Regional Networks a) Organization (s) Note: Which organization(s) are taking responsibility for operating a Regional Hub Unit for coordinating the regional network (the various participating organization), ensuring communication between network participants, other regional networks and the global Hub Unit as well as ensuring that targets set by the network meetings are achieved? • who will be managing your Regional Hub Unit and be your representatives on the Global Hub

Unit Team?

b) Regional Steering Committee and Regional Hub Unit Note: Which individuals will play central roles within the regional hub team, and what are their roles? Who will be the key point of contact for the ACANGO Hub Unit and for Regional Network members • who will participate on the steering team for the regional network, who will chair this group, and

who will participate as member(s) of the global Design and Development Team (overall steering team for the global network, chaired by Peter Walker and Peter Tugwell)

2. Member Organizations (and contact person) participating in the Regional Network Note: Organizations involved in the informal regional ACANGO Network including a contact person and a brief description of the work of the organization.

3. Who are the “clients” of your regional network? Note: At the first ACANGO meeting, held June 24, 2004, we defined client as the 5 “P”s of: 1) Public; 2) Patients; 3) Providers; 4) Policy-makers and 5) Private-sector. Who are the primary clients of your regional network, and how will your network interact with them and engage some of their leaders in the network?

4. What type of support is desired from ACANGO Global Hub Unit by your network and its members? Note: Please specify the types of support that you would like from the ACANGO hub unit and from other regional networks. These may include quick and efficient access to appropriate knowledge tools and processes, access to people with skills and “soft” knowledge, proposal writing to obtain funding,


training/mentoring. Please specify for each item the specific knowledge or skill areas and topics requested to support your network, and for what purpose and context they are needed.

5. What contributions does your regional network plan to offer the ACANGO Global Network? Note: contributions may include resources for specific knowledge products and tools (please specify), contacts to people with knowledge and skills, information technology skills, experience and “soft” knowledge of network members (please specify), educational opportunities for students, etc). Please specify the types of contributions. For knowledge products, resources, tools, and “soft” or “tacit” knowledge, please specify general content areas that can be used to build a contact and resource repository.

6. What are critical questions your network would like answered? Note: Please specify any questions for the hub unit of the ACANGO Initiative that your network would like answered as to ACANGO’s long term strategies and expectations.

7. What initial plans does your network have for Flagship Initiatives aimed at reducing health disparities in low income communities? Note: Please describe initial targets for improving health in low-income communities, including the intended interventions (and “best practices”), as well as how these will be delivered to the community (what is the model for getting knowledge into action and translating knowledge into improved health?). In the long-term, what policy changes needed to ensure sustained delivery and scaling up of successful interventions?

8. How will your regional network evaluate the results of its involvement with the ACANGO Global Network? Note: What short and long-term outcomes need to be achieved for your regional network to be successful, in your opinion? What do you require from the ACANGO Global Hub Unit to demonstrate added-value to your Regional Hub Unit?

9. What does success look like? Note: What might the ACANGO Regional Network look like in three to five years if ACANGO is a success?

C:\Documents and Settings\vrobin\Local Settings\Temporary Internet Files\OLK14\011105 - Draft Workbook.doc

Appendix 8: Draft Structure of an ACANGO Regional Intervention Network

Academic Institutions (with focus on initiating action research, creating content and operate training programs i.e. the Knowledge Creation Process)

Non Government Organizations (NGOs) and Other Community Based Organizations

(CBOs) (with a focus on identifying needs and helping to engage local groups in the development and delivery of appropriate responses - - i.e. the community change process)

Clients of both the Academic Institutions and NGOs (5 P’s) • Public • Patients • Providers • Policy Makers • Private Sector (with focus on innovative interaction with the regional network to ensure that interventions lead to effective outcomes in reducing health disparities - - i.e. the health and social intervention process)

Some Type of Hub Unit (organizing team) for: - linking and supporting members

of the regional network - stimulating and supporting

Integrated Collaborative Innovative Interventions (flagship initiatives) involving academic institutions and NGOs working with one or more of the clients (5 P’s) to reduce health and social disparities

- interacting with the ACANGO Global Hub for sharing of ideas, contacts, knowledge products and innovative practices

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