Fostering empathy, equity, and collaboration within the evidence ecosystem

Author: Zoe Jordan

The best way to predict the future is to create it.
– Abraham Lincoln

Empathy and equity are deeply ingrained in JBI and our global collaborative evidence network, the JBI Collaboration (JBIC). The JBIC is the network that drives our worldwide effort to promote and support the use of the best available evidence to inform decisions made at the point of care. The functions of the JBIC are directed towards the knowledge needs of local clinicians and consumers, with each Collaborating Entity leading evidence-based initiatives in their region, country, state or speciality. Core to our organisational values is ensuring that everyone across our global network is heard, understood and treated with respect.

The JBIC has existed since JBI’s inception in 1996 and has grown from a small group of seven Centres to more than 85 Collaborating Entities across 40+ countries. The JBIC consists of JBI Centres of Excellence and JBI Affiliated Groups that are driven by a united desire to contribute to improvements in the quality and outcomes of healthcare, globally, through the delivery of high-quality programs of evidence synthesis, transfer and implementation.

In 2015, with equity and sustainability firmly at the forefront of our minds, we conducted a review of the form and function of the JBIC. The existing framework had evolved organically over time and with minimal strategic oversight. Unfortunately, as the network expanded, we identified considerable inequity regarding output and support. What was also unearthed, however, was a critical imbalance for those situated in low- and middle-income countries where resources are scarce and English is not the primary language.

A new framework was required that was cognisant of the unique needs of all entities across the JBIC and sensitive to the diversity of their strengths and challenges. However, it was clear that we didn’t just require a new framework, but a new approach to how such a framework would be created. Traditional values of efficiency, effectiveness and economy might have been one way to tackle the challenges we were facing, but there was a persistent view that a paradigm shift was required if we were to truly reframe and reimagine our collaborative activities. While those more traditional pillars remained important, it was vital to shift our thinking if we were to achieve real, sustainable and meaningful change. Instead, we started from a value-based position of engagement and empathy, working transparently and openly without a predetermined plan.

Intentional meeting design
At the 2015 face-to-face meeting of our global network, everything changed, from the agenda to the way in which the room was set, to create a new way of working together. If we wanted dramatic change, we needed a dramatically different approach. We couldn’t afford to fall into old behaviours and practices. Those were not going to get us to where we needed to be.

Intentional meeting design responds to the need for shared purpose and to create an opportunity to identify a diversity of perspectives using exploratory dialogic methodologies that engage the entire group. Our goal was to have an open, transparent, authentic, collaborative, learning-oriented meeting. Establishing a meeting culture that would be productive and spark creativity required attention to preparation (room layout/pre-work), process (meeting structure/format) and products (reports/documentation/data).

Preparation
We wanted to design a collaborative space that spoke to the relationship we wanted to have with the Collaboration moving forward, radically rethinking the traditional hierarchical structure, and creating a space that allowed for discussion and dialogue. Not unlike a wedding, we paid attention to the seating plan, ensuring a diversity of perspectives on each table and a distribution of the JBI executives around the room.

Process
Our goal was to create a space for robust discussion to address complex challenges through generative change. With no fixed solutions, we employed both diagnostic and dialogic approaches to facilitate and enable transformation. Each session was different and included oral reporting, a world café, and a range of different strategies to engage a room full of academics from geographically dispersed and often culturally varied regions.

Products
The agenda had historically been heavily weighted with discussion papers and predetermined options for consideration, with very little opportunity for debate and open discussion and dialogue. On this occasion the agenda was dynamic, and the papers provided prior to the meeting presented objective financial and performance data as well as interview data for consideration, with a view to co-creating solutions.

The nature of an intentional design approach (in a similar vein to an approach suggested by Stanford University) meant we had increased opportunity to:

• Empathise: At the core of work related to equity is people and the knowledge we derived through this phase was critical to reframing the perceived challenges and gaining important insights into individual perspectives and experiences.
   
• Define: Together we identified common challenges and barriers to the existing framework, particularly as it related to those in low- and middle-income economies and those whose primary language was not English.
   
• Ideate: We attempted to intentionally invite and surface a broad range of different ideas and solutions to tap into the collective wisdom in the room.
   
• Generate: We then worked to synthesise and refine proposed solutions and collectively shape a new framework.
   
• Test: We were committed to working in an agile way with the network, to iterate over time as we learned what worked and what didn’t.

In her TED Talk titled ‘Daring to Disagree’, Margaret Heffernan spoke about the role of conflict as the catalyst for progress. While there is not a significant amount of conflict per se across our global network, the JBI Collaboration is not simply an ‘echo chamber’ for JBI. Sometimes we disagree. Sometimes we disagree deeply. That is something I am incredibly proud of. Our collaborators help us to think. They help us to think deeply. They challenge us; they question us; they look at what we are doing from a different perspective, offering constructive criticism and creative solutions (some of which we accommodate and some of which we don’t – or can't).

Equally important to this endeavour, I believe, is the role of empathy. The act of empathy in the development of transnational relationships that are diverse and inclusive is incredibly important. Empathy is an act of imagination that seeks to look at the world from different perspectives to better understand the complexities of other experiences, and respect that differences of ideas and perspectives exist and can be mutually accepted and sustained side by side. It is a critical skill that provides us with an opportunity to foster creative and positive solutions and has been vital to the success of our partnerships with entities across the globe.

As we work with such diverse groups and individuals, each with unique strengths and facts in their quivers, it is important that we have strategies in place to manage expectations and to work respectfully and equitably. Working with agility, responsiveness and a willingness to iterate as we discover new information and learn new approaches is vital to our success in this endeavour. It is, thus, a work in progress, but one that we are collectively committed to. We are ‘[co-]creating the future’ and it is one that I hope we will all be very proud of.

Conflict of interest
Prof Zoe Jordan is a member of the World EBHC Day Steering Committee

Disclaimer
The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.