I think in the case of a midwife having to advocate for her own expertise, I think it's very difficult for her to do it herself, and so I think this is a situation where bringing in some type of neutral, intermediary or stakeholder could be helpful, who could advocate for the midwives perspective but also help elevate the concerns of the community that she's operating in and recognize their expertise is also valid. And so I think it seems that in that type of situation, she's an interesting place where she's both having to think about these higher potential authorities such as physicians or institutions, as well as grounded experience of our patients and how she can mediate between those two things and find a way to build trust around her particular form of expertise in relationship to those stakeholders. >> Yeah, I would agree with that. Like this language of how do you assert or claim or find authority or recognition. I always find it tough because we're starting from a place where people don't understand exactly what it is that you do and why you're important. And so I agree with you that one of the things that we found in the research is the usefulness of the important of having a neutral convener that can be an intermediary that can help, yes, bring in the midwife in this case, but then identify who are other stakeholders that need to be a part of this conversation because there are parts of the picture of the midwife doesn't understand and doesn't see. And so who is it that we need to bring to the table? Who has the convening power to do that in a way that everybody feels like they can trust the process? Because this convenor is only convening with the sole intention of helping us solve a problem, like there's no agenda there. And then, a second thing that I hear in this question is that we can't solve for everything at the same time and we can solve for just all these issues and interest at this one stakeholder has, but rather, we need to think about what are the different problems that we're facing here that all of us care about. And how are midwives a critical component of the solution space, which they are, and then based on that then, how do we engage midwives in a more effective way? But I think it's kind of flipping the framing. If we frame it as like how do we get midwives to claim authority or to claim recognition, it's a nonstarter for the rest of the stakeholder space because there's a reason why they haven't been recognized and there's a reason why they haven't received it already. It might be that they just don't understand how that perspective is critical to solving a particular problem. And so this convener who can then create a space, where we can come together, identify a problem, and then through that identification identify who are the experts in the different pieces of this problem, then one of the experts is going to be the midwife because the midwife has a very particular expertise that is valuable and that is unique. But that has to be recognized by others as a result of a process, not the thing that you're trying to solve for, because if they saw the importance they would have solved it already. >> And another thing that comes to mind, we talk about framing is also how you're framing success, and I think establishing from the onset that child care and maternity is a very unstable, uncertain process, and that some kind of definite outcome is never going to be achievable, and that's not necessarily shouldn't be seen as a failure, but rather as part of an adaptive learning process. And some establishing this mutual understanding that we're here to learn and adapt together and build trust through one's capacity to learn and adapt, rather than build trust through one's capacity to execute on a particular outcome. And so I think from the onset of reorienting stakeholders around that learning based mentality is really critical as well. >> Right. So there's a project that I was involved in that was about trying to change sanitation habits in India, trying to generate large scale change. And they've followed a pretty thoughtful design process where you had a bunch of designers spending a lot of time in the communities and really understanding why community habits look that way, why people engage in the practice is that way they did. What we were trying to solve for was, how do you create a solution at scale? How do you design something that we can take and replicate across thousands of communities to affect millions of people across India? And the second you start talking in that language, you need government. It becomes about kind of the practices that allow government to do this at scale and to replicate this. And for the longest time in this process there was this real disconnect between what the designers were seeing on the ground and the connection they had with their communities. And the policymakers who are trying to figure out how to make this work. And there was this one moment in the process where somebody said, I am amazed at designers ability to empathize with individuals, but I'm equally amazed at the absolute lack of empathy that you have for these government officials were trying to figure it out. One of the reasons why designers are so good at their work is because they are so connected to the end user or whatever it is that they're designing. So they have this amazing ability to empathize with people by observing them and were being with him. Which is why midwives are so fantastic. Their job is to empathize with the woman that they're working with and really develop a connection. So they are the experts of that. But one of the things that makes them really good, is that they have a certain disdain for organization. Because they see that organized medicine has all these drawbacks when it comes to the personal relationship, and that happens to designers a lot. They're not only disdainful, but sometimes they actually dislike organizations, and they think it's kind of a bad thing. But if we want to truly scale things, if we want to truly bring down evidence or replicate evidence in a scalable and sustainable way, you need organization like just can't get rid of that. And it was truly a breaking point in the project when these designers decided to also look up and become curious about the government officials. Say like, well, tell me more like let me now turn my empathy towards you and figure out what you're solving for from. And that moment on, it completely changed the conversation and it allowed for a design process that was much more participative. And where designers were able to actually much more effectively, we've insights and priorities from the community into the design process of government officials because they now understood what government officials were trying to solve for. And they now understood that when they were bureaucratic, it's not that they were not caring is that bureaucracy is there for a reason. And one of the critical things that government has to solve for is for reliability, for lowering of risk, for standardization and for low budgets also, right? Part of the things in government you have to be super efficient and so that means you have to figure out a way to do this at the lowest budget possible. So it really was a turning point in that relationship. >> And I think that one of the key issues that comes up with scales, metrics and is recognition that these institutions or large organizations need metrics at the end of the day. And so as much as the midwife, however, the intermediary is canned can recognize that and translate these learning pitches, these questions, these resolutions into a form of metrics. That can satisfy organizational needs, all the better than they're playing that actual role of empathizing up and down and translating ultimately. >> And for each type of evidence, there's actually a different expert. And so yes, maybe on the abstract component of what type of medical procedures seem to have better statistical results. Yes, that is one component. But then there's a second layer which is like well, what does it mean to design A set of practices that incorporate that in real life in the context that we're in? And so the large scale design of practices that's going to be the purview on the expertise of somebody that may be more of an administrator or public health expert. Whereas the third part of that, which is like how does somebody actually enact these practices in their daily job, the expert there is going to be the midwife. And if you don't incorporate that expertise into the design process that is trying to bring down this abstract concept into the work, then you're going to end up designing something that just doesn't fit with the daily routines or the data realities of the people whose behavior trying to change. And kind of you need to identify that I am not the expert of you. You are the expert of you and if I need you then I need to take your expertise as like you are the decision maker for that part. Like you're the most relevant expert for that part of the puzzle. >> Do you think is so much more critical in the context of a woman's body, right where I think the patient herself is an expert on her own body and the midwife is potentially an advocate for her? So yeah, and I think your list of medical roam where things are becoming increasingly abstracted in some ways through the role of data and technology, recenterings of the woman's body in the womans intuition and knowledge of herself is really critical.
