CategorySystems

What is iatrogenics, why its important and how to avoid it for social change

Ethics and integrity should be measured primarily by the oath of the Greek physician Hippocrates. Primum Non Noncera — First, do no harm ~ Drucker

Image Courtest, edenpictures (8928257201) on Flickr

Image Courtesy, edenpictures (8928257201) on Flickr

In the field of social change this is the most important thing to remember – Good intentions does not always convert into good outcomes. The Drucker quote above is a great reminder for all of us.

So, what is Iatrogenics?

I always knew the concept but never had a word for it and then I found it in Anti-Fragile by Nassim Taleb through the fantastic blog Farnam Street.

Taleb says:

In the case of tonsillectomies, the harm to the children undergoing unnecessary treatment is coupled with the trumpeted gain for some others. The name for such net loss, the (usually bitten or delayed) damage from treatment in excess of the benefits, is iatrogenics, literally, “caused by the healer,” iatros being a healer in Greek.

[…]

Medicine has known about iatrogenics since at least the fourth century before our era-primum non nocere (“first do no harm”) is a first principle attributed to Hippocrates and integrated in the so called Hippocratic Oath taken by every medical doctor on his commencement day.

The very notion of iatrogenics is quite absent from the discourse outside medicine (which, to repeat, has been a rather slow learner.)

This is a powerful concept. Caused by the healer in our case is possible in many different ways.

  • Caused by the policy maker
  • Caused by the social worker
  • Caused by the manager
  • Caused by the minister
  • Caused by the psychologist
  • Caused by the funder
  • Caused by the ……..(your favourite example here)

This is a key concept that needs to be implemented by all the programs, services and enterprises that work in the space. It is not enough to focus on the right outcomes, it is important to decrease the possibility of the wrong outcomes from happening.

What does a bad outcome look like?

  • A couples therapy increasing domestic violence
  • State care of children creating drug addicts
  • Welfare payments creating intergenerational unemployment
  • Subsidised housing getting trashed

Some of them may be due to unintended consequences and some are genuinely due to the program design.

How do we solve it?

One of the best way to solve it is by using a technique called “theory of change” or sometimes called “program logic”. There are a variety of ways to implement this but the one I use works this way.

Every program is a theory incarnate. All the activities that are conducted in the program are towards a particular outcome. Each step in the program activity are based on a number of assumptions. These assumptions will determine whether the activity is the right one to do. And, most importantly, these assumptions can be tested and verified. If they fail, we need to change the activity and if they are validated, then we can go ahead. In time, the entire chain of activities are validated and the outcomes are reached.

In theory it is quite simple but in practice, like everything, its not.

However, there is great value in implementing this process.

Technically, this is how you can describe it.

A theory of change takes a wide view of a desired change, carefully probing the assumptions behind each step in what may be a long and complex process. Articulating a theory of change often entails thinking through all the steps along a path toward a desired change, identifying the preconditions that will enable (and possibly inhibit) each step, listing the activities that will produce those conditions, and explaining why those activities are likely to work. It is often, but not always, presented as a flowchart.

A logic model takes a more narrowly practical look at the relationship between inputs and results. It is often presented as a table listing the steps from inputs or resources through the achievement of a desired program goal. Some grant makers use separate logic models to chart the implementation components of theory of change.

Implementing like a designer

In our work at TACSI, we believe in making things easy to use and to create processes that enable individuals to use complex but important ideas to create better outcomes.

We have taken a visual process to theory of change by making it interactive, collaborative and explicit. Let’s look at it through the example of the famous health program An apple a day keeps the doctor away.

Apple a day program logic

What you need:

  • A large piece of butchers paper
  • Post its
  • A few hours
  • A team and a program
  • A facilitator would be good

We start with the problem at the left (the purple postit) and the goal is to create outcomes (orange on the right, both short term and long term). In between, the actions (blue) help determine the steps to be taken to achieve the outcomes. The assumptions (green) for each step are made explicit.

This process enables a team to clearly understand how their program runs and why it creates change? Both are important. In most of the teams this is possibly the first time they have detailed a process in this fashion. Even if the process is clear, the assumptions are never discussed. And this is the most useful part of the process.

By identifying the most critical assumptions, they can be tested and validated and in the process the entire process is improved. Most importantly, we can find out where it does not work and in the process creates more harm than good and thus avoiding iatrogenics.

This is the most powerful and useful way of testing and prototyping out your program.

Why are assumptions important?

Assumptions are important for a variety of a reasons. One major reason is that some of the fundamental assumptions will drive the whole program. For example, lets look at this idea to increase fitness.

Increase fitness program logic

If the problem as shown above is that there is too little physical activity and it could be totally true. The outcomes expected are increased fitness  and in the long term reduced health service usage. Both are good goals to have.

However, based on the assumptions behind the problem, whether the reduced physical activity is due to cost, being busy or spending time with loved ones the programs you would create will be entirely different. The initial assumptions you will make are fundamental to the engagement of people and the success of the program. Depending on the context, any one of the three assumptions behind the problem identified can be true and in some cases all three. However, unless the context is identified the solutions will be wrong.

The key is to remember the idea of first, do no harm and consciously use tools like theory of change to avoid creating more harm than good.

So, why would individuals do this?

Psychological Biases

Shane Parish lays out three possible biases that will make people do things even when the evidence says otherwise.

The first thing that goes through my mind is incentive caused bias. What is the incentive for action? Is there an agency gap where the outcome from person doing the intervention is disconnected from the outcome for the person experiencing it?

In my experience this is powerful stuff. If your job depends on it, if your beliefs depend it, if you are clouded because of the need to finish your work and reach targets and a myraid other reasons we will avoid it.

Another big reason I think this happens is a lack of clear feedback loops between action and outcome. It’s hard to know you’re causing harm if you can’t trace action to outcome.

This is more common in the case of social programs. Most are not funded to do evaluation, tools like theory of change are not common. Definitely they are not implemented like a designer to make the process easier.

Shorter and longer feedback loops are critical for success in these cases.

And the third major contributor, I’d say is our bias for action (especially what we consider positive action). This is also known as, to paraphrase Charlie Munger, do something syndrome. If you’re a policy advisor or politician, or heck, even a modern office worker, social norms make it hard for you to say “I don’t know.” You’re expected to have an answer for everything.

This is a biggy. We all have a bias for action. We are doing our work because we believe in the cause. That cause drives us and in the process we forget whether our actions create more harm than good because of the wrong belief that any action is better than no action.

What’s your theory of change?

System vs the Lifeworld

What happens when we forget the language of the people whose life we want to change?

LanguagePic by Ron Mader on Flickr

In the book Moment of Clarity, the authors discuss the work of the German philosopher, Jürgen Habermas, who developed extensive analysis to understand what happens when technical language outstrips the language of everyday life.

When technical language conquers simple language of the everyday, it is a sign that the system is gaining ground and everyday human reality, what he calls the lifeworld, is losing ground.

[…]

Such a shift leads to a far more systematic, rule-based, and technical idea of the world. It widens the gap between who we really are and the systems that we have become.

This is a very powerful and deep idea. In the social sector, I see this on a daily basis. The not-for-profits and the government  are rooted in their own jargon.

In a recent project, I asked the client and their stakeholders to discuss the “wants, needs & aspirations” of their primary customer – the individual or group whose life you want to improve. The client and the entire group were experienced individuals who have worked in this space for a long time. After a lot of discussion, I saw that they were using language which the primary customer would not identify with.

Then, I asked a simple question,

How would you describe this in the language of the primary customer?

That one question was enough to stop the discussion around the room. There was a lot of struggle to explain in the everyday language of the primary customer. For me, this is a clear sign that people do know enough about their primary customer. The technical language or the system language is very different from everyday reality and we can easily forget what it means to be an individual, a human being. This means it is tough to understand how a single individual experiences life?

Part of my work is to help innovators understand this challenge, to help them move away from the technical language and think about the individual: the things they see, do, hear and feel. One way of doing this is through the use ethnography techniques and problem interviews to get a sense of the individual, the language they use, the way they think about their “wants, needs & aspirations”. This is the starting phase of gaining deep insight.

A second but different challenge is for policymakers. Due to the nature of the system these individuals and teams are away from the on-the-ground experience where services and programs interact with the primary customer. The lack of interaction coupled with policy tools that are focussed on data, analysis, trends, large scale statistics miss the key insight needed to understand what is that an individual aspires for?

As Roger Martin suggests:

The greatest weakness of the quantitative approach is that it decontextualizes human behavior, removing an event from its real-world setting and ignoring the effects of variables not included in the model.

Understanding the real world setting, the context, is the key to the insight. I knew that language use is a good way to gauge the way an individual or team in terms of how they see the world. But now I know why this is important. The insight from the philosopher Jürgen Habermas, provides the context for why this powerful and the barriers it creates for innovation.

 

 

How to stay on track with your strategy?

 

Now that your strategy is ready to be implemented how do you know that it is being implemented as planned and you are not being distracted by the noise and busyness of work.

Clayton Christensen suggests to focus on tracking your resources (people, time etc). Because where resources go that becomes your strategy whether you planned it that way or not.

Peter Winick provides some practical advise:

We do certain things (meetings, projects, conference calls, etc.) for the distinct purpose of moving our strategy forward. We’ve given them the thought they require, allocated the right level of resources and insure they get done on time (and hopefully on budget). Where the gap exists is the other “stuff” that consistently seems to consume our time and energy. What I suggest you start to do is two things:

1) Before you commit to anything (meaning scheduling a call, a meeting, accept an invitation to speak at any event, participate in a webinar, contribute to an article, launch a social media initiative, etc.) ask if it is positive, neutral or negative relative to your strategy. Will it get you closer to your goals or is it a distraction?

[…]

2) Do a quick strategic audit of your calendar, Take a look at the last month or two and mark each item is positive, neutral or negative. I realize that there are many things we need to do that aren’t relative to the implementation of our strategy, but I also know that there are way too many things we commit to doing that we have control of.

 

Scaling Excellence: Interview with Sutton and Rao

I am waiting to read this book. Scaling is a critical aspect of our work. There is no point in innovating something new if you can’t scale it.

 

Who are your scaling heroes and why?

Bob: There are many, but three that stand out for me are Bonny Simi, vice president for talent at JetBlue Airlines, IDEO’s founder and chair David Kelley, and Dr. Louise Liang, who led Kaiser Permanente‘s computerized health records project. What’s compelling is that while they’re all wildly different, they all have something important in common.

All three created, and often discovered, pockets of excellence and then helped spread them to new places—that’s the meat and potatoes of scaling. All three started where they were with what they had. All three made wise early choices to get the ball rolling—to create one or a few early pockets of excellence. And all three never thought of scaling as an abstract or mechanical process.

Rather, they each viewed scaling as a fundamentally human undertaking, one that required constant attention to quirks, histories and motivations of the people they hoped would build and identify a bit of excellence and spread it to others.

– See more here

Can more money solve poverty?

Image Courtesy - Franco Folini on Flickr

Image Courtesy – Franco Folini on Flickr

Bill Gates wrote in his latest annual letter about the value of aid to developing countries. Bill Easterly, an economist who has done a lot to bust the myth of the value of aid writes in the FT about the challenge of attributing a lot of progress to aid. He is basically asking the question, “whether more money will solve poverty in developing countries?”

Yet the progress that Mr Gates celebrates began long before this club appointed itself troubleshooter of the world’s problems, and before the advent of organised foreign aid. Consider the case of public health. In the rich countries of today, life expectancy has been rising and infant mortality falling at least since 1900. Poor countries began seeing similar advances shortly after the second world war. While there is still great global inequality on health outcomes, sickness is declining in almost all countries, regardless of how they are governed and how much foreign aid they receive.

This revolution is a story of many actors rather than conspicuous heroes, as Angus Deaton explains in his superb book The Great Escape. The germ theory of disease led to more effective efforts to clear up the water supply, and spurred the invention of drugs such as penicillin. Improvements in transport spread knowledge, medicine and equipment more quickly. Educated parents practised better hygiene and knew how to get medicines for their sick children. Money was only a small part of the story. Ghana at the turn of the millennium was a far poorer country than the US at the beginning of the second world war. Yet it had reduced its infant mortality rate to a similar level.

The contribution made by philanthropists and politicians should not be overplayed. Yet, if aid is a feeble instrument of economic progress, it is nonetheless a powerful tool of self-aggrandisement for the western elite. “We” are important because we are the rich people giving aid, the political leaders of the poor countries that receive it and the experts who broker the exchange.

Easterly suggests that in the developing world more money, in this case; aid, is not the the answer. I think what Bill Gates is doing is quite important and worthwhile but that is not the total solution in my view.

I see the same challenge for Indigenous people in Australia. There are many policies announced, much money thrown at this problem however, the outcomes are nowhere to be seen.

The government in this case is more focused on dollar amounts, services and welfare payments. I do not see the leaders in this field think like that, I do not see that the indigenous people actually want that too. The solution is not that.

So, what is the solution?

What does freedom look like?

Image Courtesy – Kalyan Chakravarthy on Flickr

Easterly writes about freedom and individual rights as the answer in his new book, The Tyranny of Experts.

He gives the example of a block in New York as an example of freedom and development in this Fast Company article.

The block is Greene Street between Prince and Houston Streets, on the west side of Manhattan, not too far from NYU. Easterly notes that the street started as a residence for wealthy New Yorkers fleeing a yellow fever outbreak in 1782. But the street slowly declined, becoming known for its brothels. Later still, it became an industrial center and then–during New York’s decline in the 1970s, artists moved in to those abandoned industrial spaces. Now the cachet that those artists brought has taken the block full circle: It’s some of the most expensive real estate in the city, and home to an Apple Store.

“The story of that block shows how much development really is a spontaneous order full of surprises, and cannot be ‘intelligently designed’ by a ruler or a philanthropist,” Easterly explained.

So why is freedom important?

“In his 2013 annual letterBill Gates praised the government of Ethiopia for what it had accomplished in the fall in child mortality,” Easterly said. “That’s a real ‘intelligent design’ kind of view: that child mortality is under the control of this conscious designer that happens to be the ruler of Ethiopia and if it falls it’s because he wanted it to fall and he should be celebrated. And that winds up celebrating an authoritarian oppressor who puts peaceful bloggers in jail and violates human rights.”

Respect for human rights, Easterly argues, is what fuels spontaneous order and complex, adaptive, problem-solving systems in the messy, unpredictable, but wildly successful process that he calls “free development,” the process that he uses Greene Street in SoHo to illustrate.

A small clip from the launch of the book.

Measuring Outcomes

One of the most important part of any work is measuring whether we are doing the right thing. In general, social programs are notoriously bad at this.

Most funders do not ask for more than “activity or output” measures. For example, how many families visited the service? How many children did you see? Number of families who have completed the program? I have seen scenarios where measures like “number of children who visited the dentist” are used. That’s it. Nothing further is looked at as it is “hard” to measure and collect. How does this help anybody?. if my daughter visited the dentist, I will be interested in not only that she has visited but what is the outcome. Is her teeth healthy? Does she need anything else? What about her gums? When does she need to be back for another check up? Any suggestions and tips? However, for some programs the measure is whether there has been a visit.

In my view I see three kinds of measurements.

Improvement-Graph.png

The first kind are improvement measures. These are the “what happened after you visited the dentist” kind. What can we do with the information that is useful to improve the program? Does that information tell us something more about the issue at hand. In the dental example, do we know how the “teeth” is and in subsequent visits can we find what is the trajectory of the improvement. In these we can use other ratios like “teacher-student” ratio for example, if that makes a difference.

As the image suggests, it is as simple as that. What has happened in the past, what is happening now and where is this going? If we can predict the improvement and then track it then it helps us with working with our assumptions.

services outcomes

The second kind are evaluative measures. These are done infrequently and tell us whether a particular program is working or not. Randomised control trails fit here. Realist evaluation also works for this. If you are serious, cost benefit analysis follows. Sometimes these are done the first time a service is provided and not repeated again. These are generally expensive, are useful to know what happened and nobody funds them. In my estimation, millions of dollars are spent on social programs that are not evaluated. Go figure.

Lots of services are being provided to many people across Australia and in many parts of the world. Why have the outcomes not improved? In a lot of cases we can’t answer that question because we don’t even both to evaluate.

Society-and-Services.png

The third kind are well-being measures. The whole point of services and programs are whether people and the communities that they live in are better off. Mortality rate, life span, educational attainments, quality of water, etc. These are the point of doing anything. However, the challenge is to understand the cause and effect. Which programs create which outcomes and what are the environmental and social conditions for well being. In some cases, the programs are powerful and in other cases they do not matter much on their own. In most cases, well being is beyond any one program. And in a lot of cases, general economics, social and cultural aspects of life governs well being.

First, the most important thing is to understand your world view. Do you view society as something in which your programs and services are part of it and only one part? Or do you view your services as an overly important part of society? Is the service within society and or the services are the main thing which effect society. Understanding this world view is possibly the first step.

Second, how do you see the cause and effect? Do you see the services, programs, welfare money, government support as the key to improving lives? Do you see that as what has created the prosperity of Australia for example till today? Or do you see other players like business, community, family structures, people’s individual motivations and aspirations as more important?

Third, for which set of people do we need what?

We need to think about “performance” across all these levels and think about why and what we do in that space.

 

 

Keeping the DNA (or not forgetting who you are)

Horace Dediu and Ben Thompson discuss the challenge for organisations like Apple and Nokia to remember the reasons of their original success, the challenges they faced and to keep that history in the organisation.

The experience of Apple in the 1990s drives a lot of what it did in the 2000s. The challenge of closing down, losing marketshare, losing employees, forgetting that they have to win in the PC space and then continuing to look for the next big thing. This kind of thinking created the iPod, iPhone and iPad. The challenge is to continue to keep employees who have only seen success remember that.

The experience of Nokia to enable the GMS standard and using design to create usable cell phones was critical to its success of moving away from a lumber company to a world wide leader in mobile phones. Horace (who worked in Nokia) suggests that only 10 years later in 2000, most employees do not remember that. This ability to remember the corporate history is quite key.

One of the best tools I have seen for that is the idea of the Theory of the Business by Drucker. He suggests that every organisation has a theory about the environment, the challenges and the opportunities in them, the specific mission about how they want to create change in that environment and the core competencies required to achieve this. If we can document this, the assumptions behind these then they become the story that can be told, retold and guide strategic decision making.

Will this work? Is this the way to do this? What happens when the theory does not work and the assumptions break down? How do we go back to a previous theory?

Hard questions. History through people is still important.

Why Design Thinking Won’t Save You (or any other discipline)

Coming from a investment banking background, an MBA degree and a focus on social change, I easily saw the value of business thinking to create value in this space. At the same time, I have been using design thinking in combination with business thinking and the value has increased. To create social change through innovation we all need to be entrepreneurial. In that sense, lean startups and the entrepreneurial thinking is key. Ofcourse, social sciences are key to understanding the change you are creating. What about measurement and evaluation?

I am sure you get the drift. The point is not that design thinking or business thinking or any of the other disciplines – it the ability to work across and together that is the key. Our experience in The Australian Centre for Social Innovation (TACSI) and the people in TACSI coming these various backgrounds showcase this most vividly.

Why is this important? Imagine you are a leader with a social sciences background and you face a problem in child protection area. What do you do? You have “reference points” from your education and your experience. Using them you think about how to solve them. Your colleague comes from a business background. Her lens is different and so is the solution. The point is as Charlie Munger would say, It’s like the old saying, “To the man with only a hammer, every problem looks like a nail.” And we need to move away from this one hammer view of the world.

His suggestion: “And the models have to come from multiple disciplines—because all the wisdom of the world is not to be found in one little academic department.”

In Latticework of models for social innovation I discuss the thinking of Charlie Munger on Elementary Worldly Wisdom. We are a lot further from bringing this type of thinking to our work. But we are on the way.

What is elementary, worldly wisdom? Well, the first rule is that you can’t really know anything if you just remember isolated facts and try and bang ‘em back. If the facts don’t hang together on a latticework of theory, you don’t have them in a usable form.

You’ve got to have models in your head. And you’ve got to array your experience—both vicarious and direct—on this latticework of models. You may have noticed students who just try to remember and pound back what is remembered. Well, they fail in school and in life. You’ve got to hang experience on a latticework of models in your head.

What are the models? Well, the first rule is that you’ve got to have multiple models—because if you just have one or two that you’re using, the nature of human psychology is such that you’ll torture reality so that it fits your models, or at least you’ll think it does. You become the equivalent of a chiropractor who, of course, is the great boob in medicine.

It’s like the old saying, “To the man with only a hammer, every problem looks like a nail.” And of course, that’s the way the chiropractor goes about practicing medicine. But that’s a perfectly disastrous way to think and a perfectly disastrous way to operate in the world. So you’ve got to have multiple models.

And the models have to come from multiple disciplines—because all the wisdom of the world is not to be found in one little academic department. That’s why poetry professors, by and large, are so unwise in a worldly sense. They don’t have enough models in their heads. So you’ve got to have models across a fair array of disciplines.

You may say, “My God, this is already getting way too tough.” But, fortunately, it isn’t that tough—because 80 or 90 important models will carry about 90% of the freight in making you a worldly-wise person. And, of those, only a mere handful really carry very heavy freight.

This post is inspired by this HBR blog post by Peter Merhoiz

The Abandonment Question

In a series of questions that every organisation needs to ask itself, we looked at the purpose question. Now we look at Abandonment.

Brahma-Vishnu-Maheswara

In Hindu Philosophy there is the idea of Trimurti,

“in which the cosmic functions of creation, maintenance, and destruction are personified by the forms of Brahma the creator, Vishnu the maintainer or preserver and Shiva the destroyer or transformer.”

This is the same idea here. The idea that what is created,will need to be maintained for a while but there is a time when it has to end. This is important for new creation.

Jack Bergstrand asks,” What should we stop doing?”

There’s a natural tendency for company leaders to focus on what they should start doing immediately. But the harder question has to do with what you’re willing to eliminate. If you can’t answer that question, Bergstrand maintains, “it lessens your chances of being successful at what you want to do next–because you’ll be sucking up resources doing what’s no longer needed and taking those resources away from what should be a top priority.” Moreover, if you can’t figure out what you should stop doing, it might be an early warning sign that you don’t know what your strategy is.

I struggle to abandon stuff. Even simple things like clothes that have not been used for a long time. It is a natural human tendency to cling to “our past”. May be it will be useful in sometime. What if I need it for that occasion? This inertia is the same for organisations. There is organisational history and inertia that will force you to think about all the reasons something is valuable and cannot be eliminated. The first step towards innovation is abandonment.

In the Purpose Question, we looked at the Theory of the Business framework. This is the troika of environment, values/mission, and core competencies. The important thing to remember in this context is that this is only a set of assumptions.

Planned Abandonment

The question Drucker asks, What is our business?, will help us answer our current understanding and the theory of the business as it stands. However, this is based on a set of assumptions about the changing environment, the needs of the customer that will be different in the future and the market and technology is always moving. This requires that we are adaptive.

To this, Drucker adds a second question, What will our business be?. The idea behind this question is to question your assumptions and test them against reality. Do they still stand? Is there a need to change them? To what?

In order to tackle this change one of the first principles is “planned abandonment”.

Planned Abandonment is removing programs and activities that are decreasing in relevance or not producing adequate results. Drucker asks, “If we are not committed to this today, would we go into it?If the answer is no…how can we get our — fast?”

Planned abandonment fees up resources and talent. To consider and follow-through with planned abandonment requires courage and discipline.

When I ask this question, there is generally pin-drop silence in a room. Most people think about improvement, innovation – all the things you need to do. The to-do list. Abandonment is your stop-doing list and we are not good at that.

Creative Destruction

On a larger scale, this is true too. The economist, Joseph Schumpeter wrote about “creative destruction” in 1942.

The opening up of new markets, foreign or domestic, and the organizational development from the craft shop to such concerns as U.S. Steel illustrate the same process of industrial mutation—if I may use that biological term—that incessantly revolutionizes the economic structure from within, incessantly destroying the old one, incessantly creating a new one. This process of Creative Destruction is the essential fact about capitalism.

 

 

Is the Age of Efficiency over?

The new year always brings in new thoughts and new plans for me. What about you? What are you thinking about changing in this new year? And, Happy New Year to you.

Victor Hwang writes in Forbes about the underlying spirit behind the start up movement around the world.

The Startup Movement is like a reboot of the human spirit.  Gary Whitehill, who has launched a series of Entrepreneur Weeks around the world, calls the era we are leaving behind the “Age of Efficiency.”  I think he’s right.  We are moving from an economic model that treats individuals as replaceable cogs in an anonymous yet efficient system, to one that recognizes that individuals are the only ones who can make the system better through their innovations, inventions, and creations.

The truth is efficiency or doing things faster, cheaper, better in solving social problems can’t work. We have examples of that everywhere. In the developed world, the child protection challenges, indigenous people’s standard of life, ageing challenges are growing by the day. In the developing world, basic water, electricity, education, primary health are missing. These are challenges that cannot be solved by doing what we are doing faster, cheaper, better. To be effective, we need a different way of solving these problems. That is innovation.

The age of efficiency is clearly over. Part of the work for innovators like you is to sell the need for innovation, the need for effectiveness vs efficiency.

One challenge that you will clearly face straight away is the discussion around cost. One of the assumptions behind efficiency is about driving down costs. But, who says innovation is not about driving down cost? If you look at what IKEA, the global furniture company, includes in its scope for any new product – price of the final product on the shelf. The designer needs to think about raw materials, manufacturing, production, marketing and other costs when creating the product. Cost is a design constraint. That is the best way to think about it. It is part of the innovation output.

So, go ahead, lets make innovation the key focus in 2014 to make the world a better place.

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