[MUSIC] Now that we've used the five system questions, we're interested in how does this help us move forward? It does so in two ways. First of all, in addition to the impact our innovation is already having, we can use this to think about how to expand and deepen the potential impact of the innovation. If we try this in an example, or in an exercise now, Warren, if you were at mothers2mothers, how would you use this exercise to think about how you could deepen or expand impact? Well, I think the five system questions would help me really clarify what the core innovation was, that I was working on. And that was recognising the considerable expertise that was in the patients and was not being brought into or made part of the system. So there's a lot of experiential expertise there. A lot of actual technical knowledge about what it means to be a patient. Going through the kinds of treatment that they were talking about. And I did some role innovation there. I created this role of mentor mothers, right. And that actually had some impact on the authority, on decision making structures as well as the mentor mothers started to have some decision making power within the system. So I'd be thinking to myself could I do more of that, and what would that mean? Could I, for example, bring mentor mothers, or other kinds of patients, onto the board of the hospital? And that might have a real impact on power, and what kinds of information is making its way into the decision making process of the system. Or maybe, I bring them onto the board of mothers2mothers. Similarly, I guess we could think about using these questions to help Humanitas. Deepen their impact. So if you're at Humanitas what are you going to do? Well, if I joined the good people at Humanitas, I guess I would think that already the organization has challenged the group boundaries, intergenerational groups between students and senior citizens. And created really interesting spaces for interaction to reduce the loneliness of senior citizens. But to some degree, some of those interactions, I would be worried, might be reinforcing some of the roles that we put on young people and older people, and that the older people are the ones who need care and need help. And the younger people are the ones who have opportunities and learn. So the students are off-site, getting their education on a different campus. The senior citizens are in a care facility receiving care. What would happen if we perhaps took the university or university programmes and put it in the residential care facility where both senior citizens and young people could be co-learners, equal students alike, learning together on a programme. So I think in addition to this kind of deepening, what we're already doing, the other thing that the system questions can help us with, is to identify in the system where we're going to meet resistance and why. And that may give us some ideas about what to do about that resistance. So, I think it's very typical in social innovation, in the journey, especially when you've got a really great idea to expect the whole world to take that idea and run with it. And that's not usually what happens. And this is true, even when we've managed to demonstrate that idea. We've applied it into a particular corner of the world, into a community or an organization. And we've had an impact, but we can prove it. We could say, look, let's do this. And it still doesn't spread the way that we think it should, and it sort of dies out as we're trying to scale it. And this is because we're often disrupting many of these system elements in very powerful ways, and people are resisting it, mentally, physically. So one of the examples I love that illustrates this really well, it was written up by Atul Gawande, who was a physician and also a great writer. And he talks about in the 19th century, the relative simultaneous discovery of anaesthesia and of antisepsis, ie, how do we lower infection rates? So anesthesia of course they discovered compounds like ether that could take someone that used to be a wide awake patient who's getting surgery performed on him or her to someone that's asleep and not feeling the pain. And antisepsis, discovered things like how to wash your hands, how to sterilise instruments, how to maintain a clean operating operating environment. Because I think even today, one of the great dangers of surgery is the infection after the surgery, not the original condition that you're having the surgery for. And this was killing lots and lots of people in the 19th century to be sure. So the interesting thing is that and these seem like these are home runs. Everybody, all the physicians in the world are going to be like this is great. Anesthesia, perfect. Antisepsis, I'll have dramatically better results. Less pain, less death. That's not what happened. So anesthesia took off like wildfire. Within just a few years it became widespread practice in most surgeries in the world. Antisepsis, that wasn't the case and it took many. many years and even decades before it became finally adopted as a normal standard procedures in operating rooms. And Gawande says, well why is this? There are a couple reasons. One, anesthesia actually made life easier for the doctor immediately. So before I've got a screaming, squirming patient who's under a great deal of pain and now it's quiet. And I'm not hurting somebody and I can focus on what I'm trying to do. So that was a piece of why anesthesia, which was technically still rather complicated and needed some specializations to arise out of it could spread. Antisepsis, on the other hand, was not even that technically complicated. You needed to learn a how to wash hands and sterilise instruments. It didn't need a specialist to do that. And yet, the results weren't immediate for the doctors, so that was one thing. It took a little while down the road for you to see if actually the patient became infected or not. It didn't change the surgery itself. So, part of it is the feedback loop. But a bigger part of it I think was quite interesting. At the time in the 19th century the image, the belief, the why of surgery was kind of this heroic image, of the surgeon as a warrior. And, who wore kind of the frock coats and had the blood and guts of the patients they were operating on kind of spattered on them. And would move from one patient to the next, with the same blood from the last person on him, and this was, we're fighting, we're in drastic circumstances, and we're trying to work really quickly with this. And this is obviously not conducive to this other practice. Somewhere along the way in Germany, they started to kind of innovate around that image and say what if a surgeon is not a warrior, what if a surgeon is a scientist? That's a whole different metaphor, a whole different why underneath that, and if I'm a scientist then cleanliness is important, order is important, meticulousness not speed, not heroism, but reproducibility. As that image started to change and we started wearing white lab coats like scientists, it became easier for people to take in that I'm going to practice differently. I'm going to wash my hands. I'm going to change my clothes between surgeries. I'm going to make sure the instruments are sterilised. Not moving from one to the next. So a lot of it was just in a mindset, and in that mindset, resisted a very powerful social innovation for a long period of time. And I think that's often the case, maybe not quite so dramatically but in a lot of the social innovation work happening right now. And I think that one of the other things it helps us to do, is to become a little more patient. A little more empathetic. And to do a little more listening to the system as we go along to recognise that many of these innovations are going to take time. And they're going to take a lot of human to human contact. Sustained human to human relationship, in order for us to be able to really absorb these disruptions, these shifts, and to contextualize them in a variety of different places. So these questions and these reflections through these exercises have given us an opportunity to think about not only the new opportunities for where we might find impact. But also to be quite thoughtful about the setting in which we're going into, the system at play, the forces at play, often invisible, and the purpose and why of why some of the rules exist in the first place. And that will lead us to thinking more carefully about how we're going to go about implementing our social innovation, growing them and developing them to have wider scale impact. [MUSIC]
