TCI Global Toolkit: TCI Essentials
Pause & Reflect…and then Act- Home
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What Is It?
In today’s world, the only thing that is constant is change. As a result, it is imperative that governments and organizations leading health and development programs “manage adaptively through continuous learning.” Adaptive management is an intentional, iterative process for making decisions and adjustments by learning from outcomes of the decisions that were previously taken and changes that result. Adaptive management is not about changing goals during implementation; it is about changing the path being used to achieve the goals, in response to changes.
Most concretely, the aim of TCI’s Pause & Reflect (P&R) exercises are to improve how we do our work (to streamline and ‘right-size’, identify promising practices, learn from mistakes and avoid future pitfalls, etc.) – that is, to help us manage adaptively. TCI’s P&R exercises are internally focused and conducted by TCI’s regional hubs, at the global level and by some cities. On a quarterly basis, TCI uses a variety of learning techniques to reflect upon what is working well and what can be improved in operationalizing TCI’s business unusual model and to quickly alter strategies accordingly.
The P&R guidance provides TCI with a menu of approaches for facilitating its quarterly P&R exercise, including guidance for:
- Focus Group Discussions (based on use of the MSC questionnaire)
- After Action Reviews (AAR)
- Data Reviews: Coming Up with Headlines
- Fail Fairs/Failure Panels
- Learning Exchange Visits/Study Tours
- Peer Assists
What Are the Benefits of Conducting P&R Exercises?
- Ensure continuous questioning, introspection and progress towards better solutions/strategies
- Help TCI to stay focused on continuous improvement and meeting the cities’ ever-changing needs in a dynamic urban context
- Promote openness and honesty in facing challenges head-on and generating alternative solutions without blame or judgement
- Enable identification and development of recommendations to use to update work plans and improve program implementation
- Ultimately lead to better interactions between the various levels of TCI operations – city, hub and global – and a strengthened TCI model
As part of strengthening city managerial expertise and health systems management, hubs may also want to introduce P&R activities to their city partners. Cities that carry out P&R exercises can better use their data and human resources to reflect and learn from their experience implementing TCI high-impact best practices and cope with management challenges generally.
How to Implement
Since May 2017, TCI has employed a quarterly focus group discussion for its P&R sessions, using the MSC methodology to guide the discussion. Moving forward, TCI will continue to use this approach at least one quarter in the year. For the other three quarters, hubs are free to select among the other learning activities presented. The goal is to provide variety in activities to suit a variety of learning styles, to better integrate quantitative data into the reflection process, and to keep the reflection process and learning engaging.
To document learnings, a short (1-2 page) write-up on the exercise, noting the activity conducted, learnings gained and the resultant action steps planned, will be produced by global and each hub. Hub can share their results back through their quarterly reports and Gates Institute (GI) will do so through a quarterly emailed report, in which notable learnings and common themes across all P&R exercises will be distilled and shared.
Further, once or twice a year, GI will identify a broad topic area, such as AYSRH integration, sustainability, government accountability, etc., on which all hubs will conduct a P&R exercise and share their findings during a cross-hub webinar.
Options for Methodologies to Use in Conducting Quarterly P&R Exercises
Focus Group Discussions(drawing on the MSC methodology and questions)
Focus Group Discussion (drawing on the MSC methodology and questions)
What is it?
A facilitated group discussion that is intended to identify positive and negative changes as a result of TCI programming that will help to inform adjustments in programming strategies and decisions. This approach helped TCI to adapt its approach from light-touch, on-demand coaching to the Lead – Assist – Observe coaching model.
When to use it?
A focus group discussion is used when we want to learn more about the local context, gather general opinions from TCI hub and global staff, and identify key changes witnessed from their perspective. This data is helpful in putting into context the MSC stories collected at the TCI stakeholder/beneficiary level.
Instructions
- Requires 5-7 people, staff representing different levels and functions within the team
- Identify a facilitator (typically the KM staff person) and a notetaker
- Reserve 90-minutes for the discussion
- Use the MSC questionnaire/guide along with probes to sift out learnings
- All questions should be discussed to elicit significant learnings from the past quarter
- Paraphrase or summarize the responses back for extracting real and validated learnings
- Prepare a short PPT or share the notes from the discussion on key learnings, challenges and any resultant recommendations for action steps
Key questions
1. Looking back over the last quarter, what are some of the key changes – both positive and negative – that have taken place as a result of TCI?
Possible probes:
- What individual-level, community-level, and/or system-level changes have you noticed as a result of TCI’s high impact approaches (HIAs)?
- What changes in access and quality have you seen?
- What mindset shifts have we seen this quarter that are noteworthy – specifically from influential stakeholders?
- What changes in government ownership and financing of FP programs have occurred? Give specific examples from geographies.
2. Which is the most significant in helping us to achieve sustainable scale-up with impact? And why?
Possible probes:
- What’s moving the needle?
- What data exists to support the significance of this change?
3. As a result of all of the changes identified, what should TCI do differently or the same? And why?
Possible probes:
- What should we prioritize doing more of?
- What should we stop doing?
4. What other learnings have been noteworthy that will help you to improve the TCI model?
After Action Review (AAR)
After Action Review (AAR)
What it is?
A structured review process or debrief—usually a meeting— for project teams to reflect on an event or task they have just accomplished and analyze what happened and why, what worked well, and what can be done better or differently in the future.
AARs allow us to learn from our experience and apply the lessons learned into the next phase of the project or to accomplish the task more effectively the next time it is done. TCI Nigeria has used this approach after its first few 72-hour makeovers in Bauchi and Ogun states.
When to use it?
- After an event (e.g., training workshop, coordination meeting, share fair)
- Upon completion of an activity (e.g., baseline survey, systematic literature review)
- AARs are a useful follow-up activity for any significant team effort in our work plan
Instructions
- For optimal results, create and maintain an open and trusting environment so that participants can speak freely. Try to set a neutral tone.
- Use the below questions to guide the discussion. You do not need to use all of the questions, only those that are helpful. The questions are intended to establish a common understanding of the work item under review; generate reflection about the successes and failures during the course of the project, activity, event, or task; and help identify specific, actionable recommendations.
- Assign a notetaker to record all feedback so it can be accessed in the future.
- The AAR should primarily focus on process more than on people.
- Engage all team members in providing feedback and solutions.
- Save and share the findings wherever the rest of the project/activity materials are saved – for others to learn from who may conduct a similar project/activity.
- Produce a short (1-2 page) write-up on the peer AAR, describing the activity conducted, learnings gained, and any resultant action steps planned, and include in the quarterly Hub report.
Key questions
- What did we set out to do? What were the anticipated results?
- What did we actually do? What were the actual results?
- If there were differences, what caused them?
- What worked? Why?
- What didn’t? Why not? In other words, what could have been done differently?
- What will the team sustain or enhance?
- What would you do differently next time?
- What are some future opportunities to apply what was learned?
Data Review: Coming Up with Headlines
Data Review: Coming Up with Headlines
What it is?
There is a growing body of evidence suggesting that people struggle to actually use data and evidence to inform their decisions. While there are a number of reasons for this, one of the main reasons is that teams and organizations often fail to internalize the data and evidence they have. If people don’t interpret or reflect upon their data, they are much less likely to use it to inform their decisions.
The “Coming Up with Headlines” approach helps participants to digest data by developing the front page of a newspaper that highlights their key takeaways from the data.
When to use it?
Any time you have both qualitative and quantitative data and are planning to review them as part of a data review meeting.
Instructions
- Individual Reflection – ask each individual to take about 10-minutes to:
- Review the data
- Develop the cover of a newspaper by reflecting on these questions:
- What’s the lead story here?
- What are our key takeaways that need to be reinforced?
- Group work
- Divide into groups of 2-3
- Ask each group to take about 20 minutes to design one group newspaper cover on a piece of flipchart paper by synthesizing and identifying common themes across the individual work that was done
- Gallery walk
- Have each team post their flip charts on the wall and ask people to walk around and review the headlines. One member from the group can stay behind to explain the headlines. Provide post-it notes for participants to leave comments on each group’s flip chart. Make sure people rotate throughout the room. Approximately 10 minutes.
- Group share back for approximately 10-15 minutes
- Reflect:
- What’s the same?
- What’s different?
- Are there any contradictions in headlines?
- Any similarities rise to the top?
- Afterwards, produce a short (1-2 page) write-up on the Data Review: Headlines activity, describing the activity conducted, learnings gained, and any resultant action steps planned, and include in the quarterly report.
Other facilitation tips
- Give participants enough quiet individual time to digest data and ask clarifying questions before starting the activity. You might consider sharing the data via PPT before they do the headlines activity.
- For individual reflection, use 11 x 17 pieces of paper to give participants the space they need to capture key points (‘breaking news”) from the data.
- This activity is best for larger groups (7+) so multiple perspectives on the data can be shared.
- Encourage participants to have fun and be creative with their headlines, news stories, visualizations of the data etc.
- Give participants the opportunity to share with a partner or in small groups as well as the opportunity to share key points in a large group.
- After the activity, display the headlines somewhere in your office to reinforce the takeaways from the activity.
Fail Fair / Failure Panel
Fail Fair / Failure Panel
What it is?
Failure is quite possibly one of our greatest “missed” learning opportunities. The stigma around the term “failure” prevents many individuals from sharing what they deem “failures” with others, even their own staff. MobileActive, a nongovernmental organization (NGO) created to connect people, organizations, and resources using mobile technology for social change, invented this way to ease people into a conversation about failures.
Using a great deal of humor, and seven short rules listed under Instructions, share your story with fellow colleagues or complete strangers. The purpose, as borrowed from the World Bank, is “to draw lessons from experience and see how it may be useful for other colleagues who are working on similar projects and to foster more open dialogue among staff about how to identify and respond to project challenges of various sorts, in the hopes of making them more successful.”
When to use it?
A Fail Fair is most useful when the objectives of your meeting include sharing lessons learned. This can be used as the quarterly pause & reflect exercise, reserving 90-minutes for sharing and discussion or part of a meeting, such as a specific panel during a larger meeting. It helps to elicit questions and answers and is extremely helpful when onboarding new team members. TCI East Africa used this approach as part of their new staff orientation.
Instructions
- No names (i.e. you can’t talk about other people by name or directly name a project or organization).
- No blame (you can’t blame others).
- No recording (including no webcasting, no blogging, no live Tweeting of identifiable information, no archiving of presentations on the Intranet).
- You can only speak about projects you worked on.
- Information shared during a Fail Fair MUST NOT be used to the detriment of any person, place, or thing. Trust must be maintained.
- 7-minute time limit per participant – for either a panel discussion or a presentation.
- Audience participation required.
- Afterwards, produce a short (1-2 page) write-up on the Fail Fair, describing the activity conducted, learnings gained, and any resultant action steps planned, and include in the quarterly report.
Key questions
- What went wrong?
- What were some of the underlying factors that led to the failure?
- What would you do differently if you could?
- What advice would you give someone else facing similar challenges?
Learning Exchange Visits/Study Tours
Learning Exchange Visits/Study Tours
What it is?
A visit or series of visits — learning journey(s) — to one or more countries or sites by an individual or group with a specific-learning goal in mind; participants learn firsthand from the experience of their peers how a challenge was solved or solution implemented. TCI East Africa representatives from Uganda visited TCI Nigeria to learn more firsthand about how to implement the 72-Hour Clinic Makeover and adapt it for the Ugandan context. In anticipation of TCI East Africa’s visit, TCI Nigeria developed this Guidance Note for Documenting Learnings from the Study Tour.
When to use it?
- Gain new knowledge and/or learn directly from a project or program
- Establish direct contact with beneficiaries, community members, and/or key stakeholders
- Build networks and partnerships
- Customize, replicate, and scale up tried and tested development solutions
Instructions
- Assign a field visit lead from both the receiver and provider hub to finalize the logistics for the visit.
- Since many field visits include a team of visitors, it is important to make sure that all team members are prepared. Depending on the purpose and formality of the visit, it may be important to prepare a visitor’s guide that outlines roles and responsibilities and includes all relevant background information and documentation.
- Please review the questions in the left-hand column and provide written updates related to them in the right-hand.
Key Considerations | Planning Phase |
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Why? Define objectives; decide if exchange visit is the best choice. | |
Who? Team composition. How are they expected to benefit? Consider mix of backgrounds, seniority, gender, community members and agency staff, language skills, facilitation skills. *No more than 6-8 participants plus project staff who are organizing the event. |
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Where? How many sites to visit? Which sites and why? | |
When? Check travelers’ and host’s schedules, budget availability, major holidays, climate, lead time for permissions and travel documents. | |
What? Discuss plans with hosts. Mix activities to fit interests and learning styles. Allow enough time for informal discussions, reflection and rest as well as enough time between the different stops/facilities. Allow time for visiting teams to brainstorm on how they’d like to incorporate lessons learned into their programs. In the Caribbean exchanges, this was in the form of a “workplan” of several items/to-do’s that the visiting team prioritized to work on after the exchange. It’s also important to create a learning environment for the host as well. Consider providing some time to the visiting team to share something working well in their program. |
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Key Considerations | Implementation Phase |
Documents needed:
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Accommodation: Where should we stay? Are reservations made and where? | |
Transportation: Who will coordinate domestic travel? What’s the schedule in terms of locations to visit throughout the visit? | |
Meals: Will they be coordinated or will they be taken care of individually? | |
Document observations: Consider the questions below when taking notes. This will make compiling your written report after the visit easier. In addition, we ask that you consider writing a blog post on your experience.
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Key Considerations | Follow-Up Phase |
Send any materials promised to hosts | |
Send thank you emails/letters | |
Write report based on observations made during implementation of the actual visit | |
Follow-up survey 1-3 months after the visit to see how the visiting team incorporated any of the learnings into their work asking the following questions:
What suggestions do you have to make future visits better? |
- Afterwards, produce a short (1-2 page) write-up on the field visit, describing the activity conducted, learnings gained, and any resultant action steps planned, and include in the quarterly Hub report.
Peer Assist
Peer Assist
What it is?
A facilitated in-person or virtual event in which peers with relevant experience share their knowledge and experience, usually in the form of best practices and lessons learned, with a team that has requested help on a specific problem, project, or activity. TCI has used this technique virtually to brainstorm solutions and learn from each hub about how to incentivize local government commitment and release, which has been a common challenge across all hubs.
When to use it?
- Before doing a project or activity:
- When starting a new activity that would benefit from the advice of more experienced people;
- When faced with a problem that another group has overcome in the past;
- When you have not had to deal with a given situation for a long time;
- When you are no longer sure what new procedures to follow; or
- When you are planning a project that is similar to a project another group has completed.
Instructions
- Define the specific problem and be sure that your aim in calling a peer assist is to learn something (rather than seeking endorsement for a decision you have already made).
- Do some research to find out who else has already solved or tackled a similar problem. Also, share your peer assist plans with others, as there may be other teams who are currently tackling a similar problem who could also benefit from participating in the peer assist.
- Select participants who have diverse knowledge, skills, and experiences. Look “across” the organization rather than “up”– hierarchies can hamper the free exchange of knowledge whereas peers tend to be much more open with each other and can challenge without feeling threatened. Avoid the temptation to select “the usual suspects.” If the same experts are selected for peer assists again and again, you may be limiting the number of fresh ideas and perspectives available to you. Similarly, seek to select people who will challenge your ways of thinking and working and perhaps offer a different angle, rather than looking for people who will validate your current approach.
- Identify a facilitator. This should be someone outside of the host team who is seeking the assistance. The facilitator also may or may not record the event; be sure to agree on that before the meeting.
- Ensure that you plan a date for the peer assist that is early enough in your project to make use of the input you receive and to do something different on the basis of what you have learned.
Steps for conducting a peer assist
- Allow time in your agenda for the teams to get to know one another. It is important to build rapport so that the group can work openly together.
- The host team presents the context, history, and ideas regarding the task or issue at hand. This should occur in an open and flexible manner to allow its redefinition during the session.
- The resource team should ask questions and have a dialogue with the host team to develop a good understanding of the issues (background materials can be sent ahead of time to resource team).
- The resource team identifies options to solve the problem. The host team listens carefully and the facilitator records these options.
- The resource team presents their final feedback. The host team needs to take the recommendations from the resource team without interrupting or defending past efforts and decisions.
- Make sure to have a formal conclusion and feedback session at the end of the peer assist to summarize the outcomes. Generally, someone from the host team will do this.
- Produce a short (1-2 page) write-up on the peer assist, describing the activity conducted, learnings gained, and any resultant action steps planned, and include in the quarterly report.
Time Commitment
- The length of a peer assist depends on the complexity of the problem and the geographic range participants are coming from. Short sessions may last 90 minutes, while long sessions may be spread over several days (typically no more than 2 days).
Tips Applicable to All Six Approaches
- All of these approaches require there to be a level of trust and openness established among participants, so that they will speak and share freely.
- Make sure the facilitator sets a neutral tone and creates a safe space that focuses on continuous improvement instead of blame.
- Be open to capture unexpected changes and discoveries.
- Remember the goal of all of these approaches is first and foremost to elicit and capture learnings to improve TCI high-impact best practices and the model.