In this final part of my conversation with Professor Anita McGahan, I asked about why inclusion requires transformations of our organizations, systems, and ways of doing business. Listen in particular for the importance of who is at the table, and how those people commit to work together to create transformations. Diversity means that everyone who is expected to contribute has a seat at the table. You have a diverse team when all stakeholder groups are represented. Like in the play pump example, the women from the community are participating in planning conversations. Inclusion is a lot harder. Inclusion means that everyone's views are valued and considered based on how they're going to engage with the project. That means you really have to listen to the women from the community. Remember, they don't know, for example, what the merry-go-round is going to be like. You have to figure out what they need without shutting them down or writing them off. It means putting their needs is paramount during the phase of the project where you're thinking about the way the play pump will be used. It's much more difficult to be inclusive than diverse. Transformation occurs when stakeholders find new ways of creating value together that are insightful, innovative, equitable, sustainable, whatever the community wants. Transformation is the work that arises from inclusivity. It's that listening thing that I was talking about. For example, when you get doctors and parents together looking at a car parts incubator, which is noisy and messy and calibrated for automotive use, not for the sensitivities of underweight newborn, then those doctors, and nurses, and parents, they can come up with the insight that educating mothers on kangaroo care is going to get you where you want to go. You need to know that for your purpose. The parents and doctors should be at that table working toward solutions, and the tech people who want to do something with car parts are important, but they can't drive the solution if it's not fit for purpose. That insight is about inclusivity. You have to realize that the car parts people are used to a way of doing work that gives way to designing, and implementing, and testing, and the local parents are not familiar with car parts or incubators. Making sure that the voices are valued of the people who really need this thing is the work of inclusion, and it can be transformational. Transformation is the work that arises from inclusivity. Now, you asked me about whether it's desirable. Transformation is not always desirable for everyone. There can be losers. Let's say that there's a retail bank branch that's set up in a village in Africa that has had a lot of success with savings clubs. If stakeholders get together and they threaten the bankers with shutting down the bank if the bank doesn't get with the savings clubs, then these people in the bank, they may have to agree that they're going to do it even if they make less money at savings clubs than they would by issuing credit cards, for example. They don't like it, they won't believe in it, but if the alternative is leaving the community, then maybe they'll do it. If this is going to be sustainable, then they really have to get with it. They have to do their best at it, and they have to do it well. That process of moving to that desire to do it well is transformation. It's not desired initially, but with luck, the bankers are going to get there. I also want to just say that transformation sometimes fails. I've been reading a lot lately about post-civil war reconstruction in the United States after slavery was abolished. That failed after privileged people, mostly white men, sabotaged black rights in various ways. There were terrible instrumental steps taken that crushed reconstruction, which was a failure, so the transformation didn't occur. Transformation is about creating as much value as possible for the community of stakeholders. You've got diverse stakeholders that trust each other, and they take on the hard work of trying to discern their common interests, what they have in common, their mutual concerns, their unique abilities to contribute to solutions. Then transformation happens because people internalize what others value, and then they represent that shared purpose better. It might be easiest if I give you an example of this. A while back, some physicians, friends of mine from the Massachusetts General Hospital, were working to develop some laminated cards to train midwives in South Sudan. These cards had pictures of various problems that can arise during childbirth, with pictures that instruct the midwives on what to do. For example, a child's turning blue, and then you turn them over to help them breathe, things like that. These cards are about half the size of a piece of paper folded the long way, with about a half dozen or so of them held together by a clip. They were each laminated and there were held together by a clip to make them easy to use. The head physician in the group, he came home from a session in South Sudan in which he and some of the others were distributing these cards to the head midwives and they were training them on how to train the other midwives, and he shows me this video in which the women had integrated these cards into traditional dances, they we're using them as musical instruments, like cast the nets in a way, and it was beautiful. These women loved these cards, and they'd given them a legitimacy by having fun with them and celebrating them in this way in their dances. The transformation that had happened through inclusion was, each stakeholder group, in this case, it was the head midwives, they truly took on as their own the goals of the community to learn from the doctors and to keep these babies and mothers safer at childbirth. Initially, they had all this pride in what they knew and they were skeptical and resistant that the doctors could teach them anything, but by the end of this session, the cards were a central part of this approach, and that transformation is what we're going for.
