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Book review: getting to maybe: how the world is changed.

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W. Anton Hart at Calvin College
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Getting to Maybe promises to make us effective agents of change by telling us how to improve the world by applying the science and process of social innovation.
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72
Getting to Maybe:
How the World Is Changed
By Frances Westley, Brenda Zimmerman and Michael Patton
New York: Random House, 2006
272 pages; US$34.95 cloth
Reviewed by Anton Hart
Publisher and CEO, Longwoods Publishing Corporation
Getting to Maybe promises to make us
effective agents of change by telling us
how to improve the world by apply-
ing the science and process of social
innovation.
The book begins with a brief
story about Bob Geldof ’s historic
response to the famine in Ethiopia.
Here is a little-known musician
who created a highly successful
global initiative – the Live Aid
Telethon – to raise awareness and
money. This venture was about
the power of one.
The authors then describe a movement of multiple interactions that took Brazil
from a very high infection rate for HIV/AIDS to a very low rate. No one leader
could be identified.
BOOK REVIEW
73
Getting to Maybe analyzes how such changes happen and tries to answer the ques-
tion, “How can the impossible become possible?” But the title of the book gives
the authors away: there isn’t an answer. The authors say that “there is no road map
for social innovation; it is not a route that can be mapped step by step.” Darned.
Yet, the book talks about vision, a sense of calling, developing possibilities and
the need for intense interactions, networking and information exchange. These
factors, mixed with talent and skill in identifying and removing barriers, the
authors say, will get you to “maybe.”
I am not so sure. For example, by reading about the post–World War II Dutch
emigration movement, I was shown a direct path of social innovation that was
repeated family after family and year after year. The book To All My Children, by
Albert Van der Mey (Paideia Press), demonstrates emigrants’ motivations, their
often uninhabitable beginnings, their resolve to build a better life, their commit-
ment to community and social fabric and their passion and resolve. These quali-
ties were the foundation of their economic and social success that evolved not
many years later. There was a clear path, one often repeated by subsequent waves
of immigrants. There was no maybe.
The authors get to “maybe” because that, it appears, is what they set out to do. If
they had developed these themes and taken some risks, they might have presented
a road map, a strategy and perhaps even a blueprint.
Yet, the many stories about social entrepreneurs are worth reading and serve to
inspire those who have the vision. If anything, the reader will understand the
importance of identifying roadblocks and reframing these as opportunities. This
approach, of course, is not unique to social innovation.
The book is worthwhile, if only to read and re-read a short section on the objec-
tive of introducing patient-centred care. It quotes Dr. Don Berwick – CEO of the
Institute of Healthcare Improvement and a Harvard professor – describing the
treatment of a patient who, he says, is no fool and has a lot to contribute to his
own care – if the system would let him. Find out how the patient is patronized,
kept in the dark, fed strange foods and pretty much ignored as his care providers
do everything to him and never with him. This situation is a problem that can be
restated as an opportunity, and so become the impetus to design much-improved
patient-centred care, with or without IT.
And if you do not know the story of Linda Lundström (and others like her), read
the book. Ms. Lundström designs and makes women’s clothing. She grew up in
a community that included many First Nation families. When as a youngster
Getting to Maybe: How the World Is Changed
74
Nursing Leadership Volume 21 Number 1 • 2008
she was faced by the reality of racism, she was moved to act. She returned to her
hometown and applied her knowledge, skill and drive to engage the women and
children, to offer hope and opportunity. This is the beginning of social transfor-
mation. As I write this, Ms. Lundström is facing her own challenges in dealing
with the globalization of the fashion industry. In some form, she will re-emerge;
just read the back of every price tag attached to her products: “I have a strong
belief in the power of positive energy that all women are capable of radiating
towards those we know, each other and the rest of the world.”
It is the stories in this book that work. The social entrepreneurs profiled provide
the learning and the motivation. They are inspiring.
A post-note: How to change the world
If you are interested in social entrepreneurs, find a copy of How to Change the
World: Social Entrepreneurs and the Power of New Ideas, by David Bornstein
(Oxford 2004). The author is a compelling writer who has travelled around the
globe to give readers a glimpse of individuals and movements that have changed
the world. The stories he has selected are captivating. For example, he describes
how Florence Nightingale was motivated by inexplicable obsession, action and
orientation for growth with an unwavering belief in the rightness of her ideas
– and so she was well suited to apply concentrated focus, practical creativity and
long-term energy to advance system change.
Bornstein also writes about child protection in India, assisted living in Hungary,
reforming healthcare in Brazil, care of AIDS patients in South Africa, micro credit
and the Grameen Bank and the Child Survival Revolution attributed to James
Grant, who headed UNICEF from 1980 to 1995.
At the end, Bornstein lists six qualities of successful social entrepreneurs, a blue-
print that does not explain why people become social entrepreneurs but does
make identifying them possible. And look, he says, at Changemakers.net, an initia-
tive of Ashoka: Innovators for the Public, which focuses on the rapidly growing
world of social innovation. It provides solutions and resources needed to help
everyone become a “changemaker” and presents compelling stories that explore
the fundamental principles of successful social innovation around the world.
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View
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Background Interest in how to implement evidence-based practices into routine health care has never been greater. Primary care faces challenges in managing the increasing burden of chronic disease in an ageing population. Reliable prescriptions for translating knowledge into practice, however, remain elusive, despite intense research and publication activity. This study seeks to explore this dilemma in general practice by challenging the current way of thinking about healthcare improvement and asking what can be learned by looking at change through a complexity lens. Methods This paper reports the local level of an embedded case study of organisational change for better chronic illness care over more than a decade. We used interviews, document review and direct observation to explore how improved chronic illness care developed in one practice. This formed a critical case to compare, using pattern matching logic, to the common prescription for local implementation of best evidence and a rival explanation drawn from complexity sciences interpreted through modern sociology and psychology. Results The practice changed continuously over more than a decade to deliver better chronic illness care in line with research findings and policy initiatives – re-designing care processes, developing community linkages, supporting patient self-management, using guidelines and clinical information systems, and integrating nurses into the practice team. None of these improvements was designed and implemented according to an explicit plan in response to a documented gap in chronic disease care. The process that led to high quality chronic illness care exhibited clear complexity elements of co-evolution, non-linearity, self-organisation, emergence and edge of chaos dynamics in a network of agents and relationships where a stable yet evolving way of organizing emerged from local level communicative interaction, power relating and values based choices. Conclusions The current discourse of implementation science as planned system change did not match organisational reality in this critical case of improvement in general practice. Complexity concepts translated in human terms as complex responsive processes of relating fit the pattern of change more accurately. They do not provide just another fashionable blueprint for change but inform how researchers, policymakers and providers participate in improving healthcare.
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