At the recommendation of Bill & Melinda Gates Foundation CEO, Jeff Raikes, I recently read – actually devoured – an important new book, “How Will You Measure Your Life?” by Harvard Professor Clay Christensen. In this engaging read, Christensen draws key principles for success in business and applies them to our personal lives. In my case, I found that his lessons from business are directly relevant, not only to my personal life, but also to my work in global health and development.
We need to constantly experiment and test assumptions, iterate quickly, and empirically make our way toward achievement of our purpose and goals.
Christensen highlights a fundamental principle that resonates strongly with the scientist in me. We need to constantly experiment and test assumptions, iterate quickly, and empirically make our way toward achievement of our purpose and goals. Often, we lack the courage to fully apply this principle in our personal and professional lives. Inherent in this approach is a willingness to challenge our assumptions, take risks, admit mistakes and learn, and be open to a dynamic process of growth and personal and professional evolution. It strikes me that this is fundamental to being human, as well as to being a productive, valued, responsive partner, colleague, and employee.
Christensen stresses the importance of charting a course in life – a purpose – and developing a strategy to achieve, and measure progress toward fulfillment of that purpose. However, he distinguishes two elements or forms of strategy: deliberate strategy, in which one hypothesizes and charts a path to one’s aspirations and goals; and emergent strategy, which takes advantage of opportunities as they arise, and evolves only in the course of observation, experimentation, learning and course correction in alignment with one’s goals.
Monitoring systems are designed to provide early warning to the emergence of risks as well as to enable the recognition of unanticipated opportunities.Development of an emergent strategy requires measurement and assumes failure and learning from mistakes and changes in context or circumstance. Lack of foresight, courage, and dynamism to modify or forego a deliberate strategy in favor of an emergent strategy has been the downfall of many businesses. This, I believe, is a key factor holding us back collectively from achieving even greater advances in global health and development than seen to date. And this will be a critical determinant in “bending the curve” of achievement of impact through development aid.
One of the greatest shortcomings of global health and development programs, in my opinion, is neglect in clearly outlining and regularly challenging the assumptions that underlie our strategies for achieving our goals. What must be true in order for our goals to be realized, and how can we identify and mitigate risks to achievement of our goals as early as possible? Monitoring systems, then, are designed to provide early warning to the emergence of risks as well as to enable the recognition of unanticipated opportunities. A key function of management is to encourage the creation of an environment in which employees are free to experiment and learn how to navigate to the path that takes greatest advantage of the capabilities and resources available to an organization to achieve its goals in the emerging environment.
A theme that I have developed in a number of my blogs on this site is how to achieve impact in global health and development at scale. Again, Christensen draws from experience and learning in what determines success in business to offer wisdom that I believe is critical for accelerating our ability to achieve global health and development impact at scale. He observes that early in the development of a business venture, when success is still on the line, investors need to be “patient for growth and impatient for profit."
In other words, how to achieve success in business is best worked out while operations are small and monetary stakes are relatively low. To demand that a company become very big very fast, before profitability, or in public health terms, before “effectiveness” is demonstrated, is a recipe for disaster.
Once a successful strategy has been identified through rapid cycles of implementation, measurement, learning and adjustment, it is time to shift toward being “impatient for growth and patient for profit." While scaling up a successful model, it is important to monitor the process of implementation to optimize spread while learning how to maintain the impact of the intervention at scale, but recognizing that the intervention being implemented will need to be adapted based on the local context and effectiveness may be expected to waver during the scale up process. This is not cause for retreat, but rather for additional learning and adjustment in approach.
We have much to learn from business to improve our personal lives. We also have much to learn from business to improve our performance as public health and development professionals.Too often I believe we approach public health from the point of view that an intervention or delivery strategy is immutable once scale-up begins. In many cases the founder of an intervention holds on far too long to a personal conception of what fidelity to an intervention should look like when scaled up, and resists “letting go” and letting others iterate on modifications of the intervention that facilitate spread while preserving public health impact.
We also sometimes perseverate too long on perfecting an intervention and optimizing efficacy before releasing a proven intervention into the hands of partners who can effectively adapt the intervention for impact at scale. Moreover, we may mistakenly assume that compromises on effectiveness indicate the need to abandon scale-up rather than opportunities to make adjustments to implementation processes that are needed to ensure impact at scale.
As Christensen so skillfully demonstrates, we have much to learn from business to improve our personal lives. We also have much to learn from business to improve our performance as public health and development professionals.