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The Architecture of Learning: Systems, Infrastructure, and Leadership for Health System Transformation Session Description Health care can improve as a system only if its parts are aligned around the shared purpose of better health for all. This talk will explore how learning health systems integrate science, data, and culture to enable continuous improvement and innovation. Through real-world examples from a single patient’s question to national learning networks, we will examine how...
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The growing interest in systems-change initiatives sits alongside increasing pressure to demonstrate value for money (VFM), which is challenging for emergent, interconnected and often intangible work. A new way to assess the VFM of systems-change work involves considering the value of changing system conditions and the creation of potential value for future systems transformation. This innovation combines the Water of Systems Change framework with the Cycles of Value Creation to create five...
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Track to Change homepage
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How practitioners navigate between systems and complexity thinking. Exploring structure and emergence in real-world collaboration and adaptive work.
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Calls for evaluating systems change and transformation in multiple fields present an opportunity to explore cross-field patterns. This article reports on part one of a critical, integrative review of academic and gray literature published between 2011 and 2021 (n = 102) within five areas: evaluation, health, organizational change, sustainability, and philanthropy. Questions address key definitions, how a systemic approach differs from traditional social problem-solving, leverage points to...
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The COVID-19 pandemic provided a stark reminder that societies will struggle to address global challenges unless they are able to change behaviour at scale. The widely adopted ‘nudge’ approach epitomizes an individualistic, deficit model of human cognition and motivation that leverages or overcomes people’s weaknesses and biases to get them to do things they would otherwise not. By contrast, we argue that tackling the challenges facing humanity requires a collective, capacity-building...
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Healthy Cities for Adolescents Phase II (HCA-II) is a multi-country programme that supports projects working to improve adolescent and young people’s health and wellbeing in intermediary cities. Guided by the principle of shifting the status quo, with adolescents at the centre of this, HCA-II aims to catalyse meaningful changes in how cities function for young people. This guide aims to help you influence the systems that shape adolescent and young people’s health and wellbeing in the...
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In a world where social, ecological, health, and other problems are influenced by multiple, intersecting systems, why do most interventions target single-factor solutions? Why does so much evaluation settle for incremental change, and how could it contribute instead to deeper, lasting, transformative change? Authors Emily F. Gates and Pablo Vidueira make two interconnected arguments in this book: they critique the "fixed" approach of traditional program evaluation and policy analysis, and...
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This paper shares an insider's perspective on the spread of Thinking and Working Politically (TWP) across the US Agency for International Development (USAID), highlighting lessons learned along the way that are relevant even beyond the dissolution of the Agency in 2025.
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While enthusiasm for systems change has grown steadily over the past decade, we find a significant gap persists between this enthusiasm and execution. Funders attempting to implement systems change consistently face 9 challenges, including unclear outcome attribution, long commitment horizons, and complex stakeholder coordination. When faced with these challenges, it is understandable why many funders find themselves defaulting to patching the system rather than changing it. The pressures...
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Critical summary – the single through‑line of the essay
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For about 15-20 years, a rather small-yet growing-community of designers started getting involved in public policy innovation and public problem solving activities. Those design activists (willing to work for the common good, public welfare and social justice) have decided to apply their design skills, tools and methods in order to help public authorities of all levels (from village, to city, metropolis, national governments, or EU commission, etc.) reset & solve public problems and/or fix...
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Today’s critical challenges are complex and require system level change. Issues like ending poverty, reversing biodiversity collapse, creating more equitable and sustainable food systems, or ending health inequalities, will not respond to neat siloed technical interventions. These are not problems we can tackle head on. Rather, we need to change the conditions (systems) that create these problems. Consequently, many of the most ambitious philanthropic foundations are adopting ‘systems...
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By Robert Ricigliano and Anna Muoio
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What it takes to create smart velocity
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The conventional paradigm in political economy routinely treats living, complex, adaptive social systems as machine-like objects. This treatment has driven political economists to oversimplify big, complex social processes using mechanical models, or to ignore them altogether. In development, this has led to theoretical dead ends, trivial agendas, or failed public policies. This article proposes an alternative paradigm: adaptive political economy. It recognizes that social systems are...
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Introduction Learning Health Systems (LHSs) offer potential for transforming healthcare through continuous learning and improvement. However, the current literature lacks a robust connection between theory and practice, limiting knowledge transferability across diverse healthcare environments. This article proposes a novel framework for integrating theorizing and continuous evaluation into LHSs, illustrated through the case of the Bipolar Action Network (The Network). Methods We use a...
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