Humanitarian Health Lessons Learned: Ebola

Why learning is key to the strategic shift in how the world manages health crises

Reda Sadki Global public health

This is the second in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

“Whereas health is considered the sovereign responsibility of countries, the means to fulfill this responsibility are increasingly global, and require international collective action and effective and efficient governance of the global health system.” (Stocking 2015:10)

“Effective crisis management for health”, writes the World Health Organization in its management response to the Stocking report, “requires a series of strategic shifts” (Chan 2015:5). Calls for substantial modernization of emergency management capacity and preparedness have focused on resources to ensure rapid mobilization for the provision of logistics, operational support, and community mobilization. Yet, “the primary lesson so far has not been about the need for new response methods, but about human resources and coordination”, wrote Anna Petherick in The Lancet in February 2015. “Building new treatment centres,” she concludes, “was an easy task [sic] next to training and supervising people to staff them” (Petherick 2015:592). In other words, how we learn is key to the strategic shift in how the world manages health crises.

Learning is the implicit process required to achieve the capacities sought. In-service training, the most prevalent form of formal learning, is only the tip of the iceberg. Every time we ask “how do we change the capacity of individuals and systems?”, we are asking about how we learn (pedagogy) and how we know what we know (epistemology). For example, learning, education and training (LET) are not mentioned at all in the 2005 International Health Regulations (IHR). Learning is the implicit process required to achieve the capacities described by the Regulations. And yet, we leave tacit the processes (the “how”) which enable the acquisition and sharing of knowledge, skills and behaviors (competencies) needed in order for the health workforce and affected communities to face a health crisis.

In Wednesday’s blog post, we’ll review online learning around Ebola so far – and examine whether such initiatives can contribute to the strategic shift in human resources and coordination.  

References

Chan, Margaret. “WHO Secretariat Response to the Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, August 2015.
Stocking, Barbara. “Report of the Ebola Interim Assessment Panel.” Geneva: World Health Organization, July 2015.
Petherick, Anna. “Ebola in West Africa: Learning the Lessons.” The Lancet 385, no. 9968 (February 2015): 591–92. doi:10.1016/S0140-6736(15)60075-7.

 

Humanitarian Health Lessons Learned: Ebola

Lessons learned from Ebola

Reda Sadki Global public health

This is the first in a series of five blog posts reflecting on what is at stake in how we learn lessons from the Ebola crisis that erupted in 2014 and continued in 2015. A new blog post will be published each morning this week (subscribe here).

The unprecedented complexity and scale of the current Ebola outbreak demonstrated that existing capacities of organizations with technical, normative culture, methods and approaches are not necessarily scalable or adaptable to novel or larger challenges. Large and complex public health emergencies are different each time. Each new event poses specific problems. Hence, traditional approaches to standardize “best practice” are unlikely to succeed. What are the appropriate mechanisms for learning from each of them? More broadly, how do we change the capacity of individuals and systems to learn?

“Huge praise is due to those who have responded to the Ebola outbreak in West Africa. At the same time, the retrospective analysis that is just beginning has already revealed several glaring lessons to be heeded next time” (Petherick 2015:591).

I believe that we can and should mobilize education and the affordances of technology that support it to tackle three questions:

  1. How do we ensure that lessons learned include the experience and expertise of communities on the frontline of the crisis?
  2. How can we ensure that lessons learned are retained, adapted and used by individuals, teams, and organizations?
  3. How close to the village can an online, distance learning initiative reach?

If we improve access, inclusion and retention of lessons learned, we can then help address the following questions:

  1. What humanitarian health standards and normative guidelines are needed and how can they be developed to stay relevant in the face of increasingly complex crises, when every outbreak is different?
  2. How do we foster an organizational culture of improved coordination, leadership, and preparedness in and between organizations, governments, and local communities?
  3. How do we develop a global workforce with the surge capacity to respond to crises?

These questions have an educational dimension that is not being addressed by current efforts. This is compounded by the fact that current humanitarian health education is mired by transmissive approaches that cannot allow for learners as knowledge producers – and that lessons must first be generated before they can be learned. This is why we urgently need a new education paradigm, supported by affordable, practical learning technologies and pedagogies, to strengthen humanitarian health response and preparedness.

Tuesday, I’ll explore why learning is the hidden key to the strategic shift – called for by the World Health Organization – in how the world manages health crises.

Reference: Petherick, Anna. “Ebola in West Africa: Learning the Lessons.” The Lancet 385, no. 9968 (February 2015): 591–92. doi:10.1016/S0140-6736(15)60075-7.

Skunk Works logo on Museum’s SR-71. Photo #2005-6014 by Dane Penland, Smithsonian National Air and Space Museum.

Skunk Works: 14 rules to live and die by

Reda Sadki Innovation, Quotes

Lockheed’s Skunk Works may be one of the earliest models for sustaining innovation inside an organization – never mind the nefarious mission of making flying machines to kill people. These are the basic operations rules enunciated by founder Kelly Johnson in 1954, as cited in his successor Ben Rich’s book:

  1. The Skunk Works program manager must be delegated practically complete control of his program in all aspects. He should have the authority to make quick decisions regarding technical, financial, or operational matters.
  2. Strong but small project offices must be provided both by the military and the industry.
  3. The number of people having any connection with the project must be restricted in an almost vicious manner. Use a small number of good people.
  4. Very simple drawing and drawing release system with great flexibility for making changes must be provided in order to make schedule recovery in the face of failures.
  5. There must be a minimum number of reports required, but important work must be recorded thoroughly.
  6. There must be a monthly cost review covering not only what has been spent and committed but also projected costs to the conclusion of the program. Don’t have the books ninety days late and don’t surprise the customer with sudden overruns.
  7. The contractor must be delegated and must assume more than normal responsibility to get good vendor bids for subcontract on the project. Commercial bid procedures are often better than military ones
  8. The inspection system as currently used by the Skunk Works, which has been approved by both the Air Force and the Navy, meets the intent of existing military requirements and should be used on new projects. Push basic inspection responsibility back to the subcontractors and vendors. Don’t duplicate so much inspection.
  9. The contractor must be delegated the authority to test his final product in flight. He can and must test it in the initial stages.
  10. The specifications applying to the hardware must be agreed to in advance of contracting.
  11. Funding a program must be timely so that the contractor doesn’t have to keep running to the bank to support government projects.
  12. There must be absolute trust between the military project organization and the contractor with very close cooperation and liaison on a day-to-day basis. This cuts down misunderstanding and correspondence to an absolute minimum.
  13. Access by outsiders to the project and its personnel must be strictly controlled.
  14. Because only a few people will be used in engineering and most other areas, ways must be provided to reward good performance by pay not based on the number of personnel supervised.

Source: Ben R. Rich and Leo Janos. Skunk Works: A Personal Memoir of My Years at Lockheed (1994). Kelly’s 14 Rules & Practices may also be found here.

Photo: Skunk Works logo on Museum’s SR-71. Photo #2005-6014 by Dane Penland, Smithsonian National Air and Space Museum.

Aerial view of Finney Chapel, Oberlin College, Oberlin, Ohio, United States (oberlin.edu)

The idea of a university (updated)

Reda Sadki Quotes

So I’m reading John Henry Newman’s The Idea of a University, which begins by asserting that the university “is a place of teaching universal knowledge”. I’m fascinated by the historical context (Catholicism in Protestant England), by the strength and substance of the ideas, and by the narrative style of carefully-constructed arguments. I’m also struck, however, by the centrality of learning as transmission, the line of demarcation between invention and teaching, and the belief that it is possible to know by disconnecting from society (although I acknowledge that concentration and flow tend to require quiet, in a pragmatic sense):

To discover and to teach are distinct functions; they are also distinct gifts, and are not commonly found united in the same person. […] He, too, who spends his day in dispensing his existing knowledge to all comers is unlikely to have either leisure or energy to acquire new. The common sense of mankind has associated the search after truth with seclusion and quiet. […] It must be allowed on the whole that, while teaching involves external engagements, the natural home for experiment and speculation is retirement.

If all three of these characteristics of institutionalized knowledge creation and production no longer align with the demands of the world we live in, what needs to change and how likely is the change to occur within organizations founded on very different ideas and assumptions?

Newman’s Idea is also crystal-clear with respect to the relationship between the university and the corporation (in his context, the Catholic Church):

Just as a commander wishes to have tall and well-formed and vigorous soldiers, not from any abstract devotion to the military standard of height or age, but for the purposes of war, and no one thinks it any thing but natural and praiseworthy in him to be contemplating, not abstract qualities, but his own living and breathing men; so, in like manner, when the Church founds a University, she is not cherishing talent, genius, or knowledge, for their own sake, but for the sake of her children.

Through the lens of organizational learning and the need for mission-driven organizations in a knowledge economy to invest in their people, this rationale stands, in my opinion.

Photo: Aerial view of Finney Chapel, Oberlin College, Oberlin, Ohio, United States (oberlin.edu)

Gilbert U-238 Atomic Energy Lab (1950-1951) (ORAU.com)

MOOCs for teachers, then and now

Reda Sadki Quotes

In February, Daniel Seaton and his colleagues shared data about the very high level of teacher participation (28% identified as past or present teachers) and engagement (over four times more active in discussion forums than non-teachers) in a series of MITx MOOCs.  Very interesting article when thinking of teachers as multipliers, mediators and facilitators of learning (and not just transmitters). Unlike earlier MOOC research that has been criticized for being ahistorical, Seaton shares the following example of pre-MOOC massive, open online education:

One of the earliest precursors to modern MOOCs targeted high school teachers in the United States. In 1958, a post-war interpretation of introductory physics called “Atomic-Age Physics” debuted at 6:30 a.m. on the National Broadcasting Company’s (NBC) Continental Classroom. Daily viewership was estimated at roughly 250,000 people, and over 300 institutions partnered to offer varying levels of accreditation for the course. Roughly 5,000 participants were certified in the first year. Teachers were estimated to be 1 in 8 of all certificate earners,  indicating reach beyond the target demographic of high school teachers. Through its expansion of courses between 1958 and 1963, the Continental Classroom represented a bold approach in using technology to address national needs in education reform. In contrast, the current MOOC era has largely focused on student-centric issues like democratizing access.

Source: Seaton, D.T., Coleman, C., Daries, J., Chuang, I., 2015. Enrollment in MITx MOOCs: Are We Educating Educators? EduCause Review.

Ho, A.D., Chuang, I., Reich, J., Coleman, C.A., Whitehill, J., Northcutt, C.G., Williams, J.J., Hansen, J.D., Lopez, G., Petersen, R., 2015. HarvardX and MITx: Two Years of Open Online Courses Fall 2012-Summer 2014. Social Science Research Network Working Paper Series.

Photo: Gilbert U-238 Atomic Energy Lab (1950-1951) (ORAU.com)

The last Saturn V launch carried the Skylab space station to low Earth orbit in place of the third stage (Wikipedia/public domain)

Education Moonshot Summit

Reda Sadki Events

This should be fun (and interesting). I’ll be heading to Amsterdam on July 21st for Google EDU’s Moonshot Summit. This event aims to bring “together top innovators from around the globe to design moonshot projects that will be launched in the Fall”. Attendees were selected, we are told, because of our “experience and belief that education can be improved for innovation”.

The moonshot co-exists with skunk works, DARPA, braintrust and many other terms that describe the conditions, process, or outcomes that foster and drive innovation. Google’s concept of a moonshot intersects innovation and scale, and posits that, in specific circumstances, scaling up can define innovation. “Instead of a mere 10% gain” Google’s Project X team explains, “a moonshot aims for a 10x improvement over what currently exists”:

The combination of a huge problem, a radical solution to that problem, and the breakthrough technology that just might make that solution possible, is the essence of a moonshot.

This event in Amsterdam is led by Esther Wojcicki, whose work  around moonshots in education (and specifically blended learning in the classroom) I’ve just discovered.

Photo: The last Saturn V launch carried the Skylab space station to low Earth orbit in place of the third stage (Wikipedia/public domain).

Wet Times Square (Kenny Louie/flickr.com)

Choose your own adventure

Reda Sadki Learning strategy, Presentations

This is my presentation at the Online Learning Summit in London on 16 June 2015. I asked participants to choose between a set of four questions: Question #1: Why are learning, education and training so impervious to change? Number two is the Extinction Event question: It’s 2025. Your organization ceased to exist in 2020.  What happened? What was your role, i.e. the role of the learning leader in what happened?  What are you doing now? Question #3 is about LSi’s capabilities: What problems can we help you solve? And, last but not least, Question #4: why does e-learning suck? I will let you guess which question(s) were chosen for the discussion and workshop…

Credit where credit is due: the Then-And-Now photo series is from a brilliant presentation by Michael T. Moe at the Global Leadership Congress held in Philadelphia a long time ago where I was a featured speaker. The Ferrari pit stop crew as a model for mission performance was first shown to me by Karen E. Watkins (University of Georgia) and Maya Drobnjak (Australian Army). Kermit Washington’s story (completely unknown to the London participants) is told by James Surowiecki in his New Yorker article Better All The Time.

All the way down (Amancay Maahs/flickr.com)

Can analysis and critical thinking be taught online in the humanitarian context?

Reda Sadki Events, Learning design, Presentations

This is my presentation at the First International Forum on Humanitarian Online Training (IFHOLT) organized by the University of Geneva on 12 June 2015.

I describe some early findings from research and practice that aim to go beyond “click-through” e-learning that stops at knowledge transmission. Such transmissive approaches replicate traditional training methods prevalent in the humanitarian context, but are both ineffective and irrelevant when it comes to teaching and learning the critical thinking skills that are needed to operate in volatile, uncertain, complex and ambiguous environments faced by humanitarian teams. Nor can such approaches foster collaborative leadership and team work.

Most people recognize this, but then invoke blended learning as the solution. Is it that – or is it just a cop-out to avoid deeper questioning and enquiry of our models for teaching and learning in the humanitarian (and development) space? If not, what is the alternative? This is what I explore in just under twenty minutes.

This presentation was first made as a Pecha Kucha at the University of Geneva’s First International Forum on Online Humanitarian Training (IFHOLT), on 12 June 2015. Its content is based in part on LSi’s first white paper written by Katia Muck with support from Bill Cope to document the learning process and outcomes of Scholar for the humanitarian contest. 

Photo: All the way down (Amancay Maahs/flickr.com)

Peter Paul Rubens. From 1577 to 1640. Antwerp. Medusa's head. KHM Vienna.

Experience and blended learning: two heads of the humanitarian training chimera

Reda Sadki Design, Events, Learning design, Learning strategy, Thinking aloud

Experience is the best teacher, we say. This is a testament to our lack of applicable quality standards for training and its professionalization, our inability to act on what has consequently become the fairly empty mantra of 70-20-10, and the blinders that keep the economics (low-volume, high-cost face-to-face training with no measurable outcomes pays the bills of many humanitarian workers, and per diem feeds many trainees…) of humanitarian education out of the picture.

We are still dropping people into the deep end of the pool (i.e., mission) and hoping that they somehow figure out how to swim. We are where the National Basketball Association in the United States was in 1976. However, if the Kermit Washingtons in our space were to call our Pete Newells (i.e., those of us who design, deliver, or manage humanitarian training), what do we have to offer?

The corollary to this question is why no one seems to care? How else could an independent impact review of DFID’s five-year £1.2 billion investment in research, evaluation and personnel development conclude that the British agency for international development “does not clearly identify how its investment in learning links to its performance and delivering better impact”… with barely anybody noticing?

Let us just use blended learning, we say. Yet the largest meta-analysis and review of online learning studies led by Barbara Means and her colleagues in 2010 found no positive effects associated with blended learning (other than the fact that learners typically do more work in such set-ups, once online and then again face-to-face). Rather, the call for blended learning is a symptom for two ills.

First, there is our lingering skepticism about the effectiveness of online learning (of which we make demands in terms of outcomes, efficacy, and results that we almost never make for face-to-face training), magnified by fear of machines taking away our training livelihoods.

Second, there is the failure of the prevailing transmissive model of e-learning which, paradoxically, is also responsible for its growing acceptance in the humanitarian sector. We have reproduced the worst kind of face-to-face training in the online space with our click-through PowerPoints that get a multiple-choice quiz tacked on at the end. This is unfair, if only because it only saves the trainer (saved from the drudgery of delivery by a machine) from boredom.

So the litany about blended learning is ultimately a failure of imagination: are we really incapable of creating new ways of teaching and learning that model the ways we work in volatile, uncertain, complex and ambiguous (VUCA) humanitarian contexts? We actually dialogue, try, fail, learn and iterate all the time – outside of training. How can humanitarians who share a profoundly creative problem-solving learning culture, who operate on the outer cusp of complexity and chaos… do so poorly when it comes to organizing how we teach and learn? How can organizations and donors that preach accountability and results continue to unquestioningly pour money into training with nothing but a fresh but thin coat of capacity-building paint splashed on?

Transmissive learning – whatever the medium – remains the dominant mode of formal learning in the humanitarian context, even though everyone knows patently that such an approach is both ineffective and irrelevant when it comes to teaching and learning the critical thinking skills that are needed to deliver results and, even more crucially, to see around the corner of the next challenge. Such approaches do not foster collaborative leadership and team work, do not provide experience, and do not confront the learner with complexity. In other words, they fail to do anything of relevance to improved preparedness and performance.

If you find yourself appalled at the polemical nature of the blanket statements above – that’s great! I believe that the sector should be ripe for such a debate. So please do share the nature of your disagreement and take me to task for getting it all wrong (here is why I don’t have a comments section). If you at least reluctantly acknowledge that there is something worryingly accurate about my observations, let’s talk. Finally, if you find this to be darkly depressing, then check back tomorrow (or subscribe) on this blog when I publish my presentation at the First International Forum on Online Humanitarian training. It is all about new learning and assessment practice that models the complexity and creativity of the work that humanitarians do in order to survive, deliver, and thrive.

Painting: Peter Paul Rubens. From 1577 to 1640. Antwerp. Medusa’s head. KHM Vienna.

Marble statue of the ancient greek philosopher Plato (Source: alienaxioms.com)

Blame it on Plato

Reda Sadki Quotes

Even as computer-mediated communication is now embedded into nearly every aspect of life, the sentiment persists that written and therefore distance communication is intrinsically inferior. Here is the very interesting introduction from Andrew Feenberg’s classic article – written in the late 1980s – calling into question the presumption of superiority in the face-to-face encounter:

In our culture the face-to-face encounter is the ideal paradigm of the meeting of minds. Communication seems most complete and successful where the person is physically present ‘in’ the message. This physical presence is supposed to be the guarantor of authenticity: you can look your interlocutor in the eye and search for tacit signs of truthfulness or falsehood, where context and tone permit a subtler interpretation of the spoken word.

Plato initiated our traditional negative view of the written word. He argued that writing was no more than an imitation of speech, while speech itself was an imitation of thought. Thus writing would be an imitation of an imitation and low indeed in the Platonic hierarchy of being, based on the superiority of the original over the copy. For Plato, writing detaches the message from its author and transforms it into a dead thing, a text.

Such a text, however, can cross time (written records) and space (mail), acquire objectivity and permanence, even while losing authenticity (Derrida, 1972a). That we still share Plato’s thinking about writing can be shown in how differently we respond to face-to-face, written, typed and printed forms of communication. These form a continuum, ranging from the most personal to the most public.

Feenberg, A. The written world: On the theory and practice of computer conferencing. Mindweave: Communication, computers, and distance education 22–39 (1989).

Photo: Marble statue of  the ancient greek philosopher Plato (Source: alienaxioms.com)