 Mae'r fath ychydig, iawn, mae'n siaradad ydw i'n dda i ddod o'n meddwl, oedd am gwrthu mewn ddweud o myll Gweithredu Sinig. Wrth gwrs ond, mae'n rhoi fynd i gan gynedau llurio gyda'n cyfrannu i gynedwch yn ei Gweithredu Sinig, a i gynnwysgach yn Gweithredu Sinig, yn ei ddweud o'r ddechrau. Yn y dweud ydw, roedd y pwysig o'r wrthlo, dwi'n mynd i'n gwrs honno yn rhael yna, Ond dyfodd yn i'w dweud y ffordd yn llunio'r gyflawn i'w Gweithredig, y Gweithredig, yr hynny'n i'w gweithio i osud i'w Gweithredig. Mae'n gweithio sydd i'w gweithio'r gweithredig yn llunio'r gyflawn i'w gweithredig, ac mae'n ddechrau'i gweithredig gwahanol yn ei gyflwylltau ond, mae arweithio gwahanol yn y bobl mae'n hwylwgfodd gyflawn i'w Gweithredig. Mae'r ffordd sgolwch yn fwyaf i'r pwysig i Italy. Yn ymddangos y Cymbraith Matysgwyd yn ymdegwyr i'r Ffyrdd yma, ac mae'r gweld yn ymdegwyr i'r rhannu islandig yn ymdegwyr i'r cyfrifiadau i South India. A gwrthodd yn gwybod i'r cyfrifiadau a'r cyfrifiadau sy'n bwysig iawn. Ond y gallwn gwneud ymdegwyr yn ei wneud yw'r ffordd o'r newydd yma. Yn ymdegwyr i'r cyfrifiadau, ymdegwyr i'r cyfrifiadau, ymdegwyr i'r cyfrifiadau, ac mae'r cyfrifiadau i'r cyfrifiadau. Ac rwyf yw choes eu cyfrwyr o'r ddlunio gyda, yn y cyfrwyr o'r ddlunio cyfrwyr o'r ddlunio cyfrwyr yma, o'r dd responsive cyfrwyr o gyfrwyr sy'n ei b Красgref i'r debyg i chi'r afael. Rwy'n gweithio'n cynllun o wybodaeth, yn y gallu gael gyrnod cyfrwyr yma, eithaf gyda'r defnyddio cyfrwyr yn y llomiddag, y ddwy teimlo, a yn rherwydd, y ddysgu'r ddlunio cyfrwyr yn dweud o'r ddlunio cyfrwyr. I want to clear some ideas for what we might need to do to jump these hurdles more consistently and frequently and pose the question where do we want to see humanitarian innovation in the future but before that I want to talk to you all about the relationship between stress and creativity and I want to ask you all a question, who is better at being creative? Is it a stressed person or is it a relaxed person? Can I have a show of hands? Who thinks it's a stressed person? Who thinks it's a relaxed person? Who doesn't know? Who's feeling a bit stressed about the question? I want to give you an answer by asking you to imagine me just before I stepped on to the stage and came into this room. Imagine me pacing the corridors outside in the Royal Society of Medicine, my palms damp. Imagine me hearing my pulse in my ears. Boom rush, boom rush, boom rush. Imagine Pete coming to say hello and my mouth being too dry to actually articulate anything in the middle. Sorry about that, Pete. But if you're outside of me you might have told me to calm down, be relaxed, you'll be fine. But this won't have necessarily helped. What usually happens when we feel like this before stressful situations is people tell us to feel calm and they don't actually help. What I try and remember to do is to tell myself I feel excited. It sounds really simple but it can lead to a really strange and sudden shift. The racing heart, the dry mouth, the sweat all change from being symptoms of anxiety to being symptoms of stimulation. Suddenly I start to feel energized by the challenge rather than depleted by the major threat you all obviously pose to me. Actually this is based on research. This isn't just some kind of self-help Bible stuff. Researchers at the University of Pennsylvania prove that you can use mantras such as I Feel Excited to your advantage when you're doing something stressful. They put volunteers in a whole variety of stressful situations singing karaoke in front of strangers doing mass tests on the pressure speaking to their boss. And they wore heart monitors and they could see their heart rate on the monitor during the task. Beforehand they divided the group into thirds. One group said I feel anxious, one group said I feel calm and one group said I feel excited. And the excited group felt more confident and also performed far better than the other two. Because saying I feel calm is actually a patent lie because it contradicts the symptoms you're feeling. But it's plausible to say I'm excited because the symptoms are almost identical. By saying I'm excited the subjects were conjuring up a new mental context which changed one emotion of anxiety into another of excitement. But why did it actually make them perform better? Because they felt they were taking on a challenge rather than facing a threat. And that sets up a series of changes to the actual chemistry of the brain. Saying I feel excited is part of the software of the mind but it can change the way that our brain chemistry works. This challenge might actually put your brain into what's called an approach mode. And this increases taping activity which focuses your attention, sharpens you mentally and that gives you a biochemical boost that then sharpens your performance. So in fact reinterpreted in this way stress becomes a source of positive energy in performance. And it aids performance in a whole variety of settings. And that's because a key component of stress is the neurotransmitter. And I'll try and get this right, norepinephrine, which like many of the brain's chemical messages has an inverted U shape as shown here. And this actual experiment, the related analysis, the core of an argument set up by the British psychologist and neuroscientist called Ian Robertson in his brilliant book, The Stress Effect. And in it he builds on the findings of the Yerks Dodson experiments the early 20th century which first identified this inverted U curve in performance relating stress to performance. And what Robertson does is he shows it in a whole variety of settings our performance at creative problem solving actually increases with stress up to an optimal point. Too much or too little stress causes us to underperform but in the gold lock spot in between the two lies the spot of optimal performance. So when I say I feel excited my interpretation pulls my norepinephrine levels back from their two high levels back to the peak of the inverted U sweet spot. And the right level is norepinephrine actually has remarkable properties in the brain. It acts to fertilize it, it grows new connections between neurons and even new brain cells. What's becoming clear from the work of Robertson and others is not just the hardware of the brain but how it interacts with the software of our minds that determines our sweet spot. Our thoughts and ideas, our fear of fear is a key driver of stress and at the stream the way we think in the chemistry of the brain can act as an unrelenting vicious cycle that pushes us well beyond the sweet spot. Clearly the sweet spot will vary for different people facing different problems in different situations and by extending your optimal point of stress versus your performance will be different to mine and all other things being equal. And there are four main factors that Robertson identifies. One is the subjective complexity of the task or challenge at hand. So I will find something more complex than Pete. In some settings Pete will find it more complex than he does. That subjective complexity determines how stressful we stress bigger. Our perceptions of stress are also really critical. The social context within which we operate and whether or not we have a setting in which we collectively manage stress matters a great deal. And finally skill and personality, how well we are able to manage stress as individuals, how much self belief we have, where we might sit on the spectrum between creative and how we perceive ourselves as creative individuals. I don't have time to go into detail on these but I can do so in Q&A but the key lesson is while the technical aspects of the challenges we face do matter how we balance stress and creativity is as if not more influenced by human and social factors than they are by technical factors. And this is part of a new scientific movement bringing new science and psychology and changing our understanding of the balance between pressure and creativity. And while this kind of rebalancing is necessary in all parts of human life I want you to keep this concept of the optimal point of creativity in mind because I think it's got really obvious relevance for the work we do in humanitarian innovation. And it presents both the opportunity for us in terms of how we work in humanitarian innovation but also a lens to think about how we might do things better. Because I think to date our effort has been largely focused on technical side of innovation and not really enough on the human or the social side. So having presented that let me move on now to talk about some of the hurdles that we encounter in humanitarian innovation. So what do we face as a humanitarian community? Not just MSF, the community is a whole working in the innovation space. These are the hurdles that I feel we need to overcome. They're based on research that I've done and others have done. And they are hurdles so forgive me if they seem overly critical. And they're not necessarily a comprehensive list and I'm sure you'll have your own versions but these are the ones that I think are most important. The first is system proliferation. So over the past 10 years since the first study on humanitarian innovation was published I think the humanitarian innovation movement has reinforced the tendency to focus on new tools and systems and left changing behaviours and attitudes behind. So once upon a time maybe in the early noughties we had masses of reports that no one read. And now we risk having a whole host of tools and applications that no one uses. Some of you all know this. This is a map of just a few of the mobile health monitoring projects in Uganda in 2013. Only about half of these were humanitarian nature. It was led to the Ugandan Government taking an unprecedented step of actually banning all digital health projects because of the sheer proliferation and confusion this was causing. And this is something that we can see across the humanitarian space. The result is we're seeing a large number of methods and approaches that cannot be shared outside original context and outside the original programmatic setting. It almost seems as they have struggled for years for decades to move away from cookie cutter approaches to humanitarian aid. We now are risking in the opposite direction. We have these new technologies proliferating and organisations are pursuing tailored systems for a whole host of different challenges. And it's not especially effective as the Ugandan Government showed. We also see quite a lot of unhealthy competition. The ideas of open innovation, which are now taking off in the private sector, haven't really helped us to be more collaborative in this space. Despite open innovation being part of the grand promise of humanitarian innovation. If I observe a pronounced almost accepted lack of collaboration, different organisations have their own innovation unit. Sometimes different countries within organisation movements have their own innovation unit. And every humanitarian player plans their own separate innovation furrow, often with quite a lot of replication. And so what we see is a whole host of institutionally branded innovations to crisis response. It becomes advantageous for humanitarian organisations to say this is our flagship SMS. UNICEF has one, Oxam has one, Save the Children has one. They have a few signature technologies that communicates their branding. And they use this to aggressively pursue fundraising and programming goals. And the communication of these innovations therefore lends itself more to marketing than to research and development. Innovation is more led by the marketing side of the system than by the evidence-based side of the system. And I think this has led to a dysfunctionally competitive approach to humanitarian innovation. Now of course you do need some competition in order to identify challenges and make sure you get the right solutions. But the institutionally centred approach risks the replication that's part of the wider malaise of the sector. And it runs counter-bate to the principles of humanitarian aid and also the latest thinking on innovation from the private sector. And this actually is one of the real barriers to humanitarian innovations reaching scale. It's not because they're not effective, it's because they slam into institutional interests and they're not made here syndrome so I'm not going to use it syndrome. The next challenge is expert postures. Experts, whether they're humanitarian, innovation-based technologies, medical, some of their strong positions and preconceptions. And these are often based on flawed or imperfect understanding of the challenges that we face, especially in operational settings. They might be based on slightly misguided understandings of what innovation needs and possibilities are. And because we are so many communities in the humanitarian space that what we tend to do is develop our own specific sub-community narratives about what the actual humanitarian need is. So, as a result, we tend to solve the problem we see, the medic solve the problem they see, digital fakes solve the problem they see, fundraising people solve the problem they see. And they please us and they please our immediate stakeholders, but they don't necessarily match up to the realities on the ground. The next issue is what I call the digital deluge. And every single humanitarian challenge you can think of somewhere, anywhere in the world, it's somewhere being dealt with by someone developing it out. As a Chair of the Humanitarian Innovation Fund, over seven years, over 50% of the applications to the fund were digital in nature. And they're often the least thought through and the least focused on humanitarian needs. And I think that instead of, as Marianne Twenette famously said about starving French peasants who wanted bread, let them eat cake, race now seem to be saying, let them eat data. And we seem to have gone from the situation of not enough data to being overloaded with data. And every app that we develop generates more data. And there's this assumption that data is just somehow down the road going to get used by humanitarian decision makers. But we actually have a profound lack of capacity to analyse and use the data. And we find it very hard to know how to verify it for objectivity or compare it. So as a result, the apps generate data, it looks very nice. You can put it in a fundraising report, you can put it on the front cover of the economist if you like. But it doesn't actually generate much for us. And what I think we've gone is from weak non-existent data to weak big data. Some of this can be analysed to generate insights for decision makers, but it seldom happens real time in a way that can really operate informed operations. And I think there's a whole range of issues. Let's say when data is used, it can lead to faulty thinking, misguided responses, misleading reporting results. It can give a full sense of reality to senior managers who far from the field and don't actually know what's going on. The numerous examples recently have a quite high profile of disregard for the rights and privacy of data-affected communities. There's quite a few incidents of that. And while there's a lot of talk of big data in the humanitarian future of the humanitarian sector, and I think there is a lot of promise, I think the reality more closely resembles the quip by the economist Dan Ariely, who said big data is a bit like teenage sex. Everyone talks about it, nobody really knows how to do it. Everyone thinks everyone else is doing it, so everyone claims they're doing it themselves. New tools in old paradigms. Innovation reliance can actually serve to reinforce existing mindsets, cultures and approaches. The classic example with innovation studies is Henry Ford saying, if I had asked people what they wanted, they would have said a faster horse, not a car. And I think actually much humanitarian innovation has been within the confines of existing assumptions, existing operating models, existing stakeholders. We're not on the whole doing double loop learning that asks why are we doing these things and how can we do this better? We're rigidly sticking to, we aren't saying are we doing the right things, we're saying are we doing things right? And as a result our efforts tend to be more limited, they're much more about incremental adjustments. If Henry Ford came along he would say you've basically got a whole series of faster horses. Innovation cliffs, this is another major hurdle. I think most of humanitarian innovations end their lives a bit like this, falling dramatically off the end of a funding cliff. And the complaints from those involved say a lack of resources, a lack of belief, a lack of commitment. But actually what happens is that you've got these lovely processes which say you need to recognise a problem, you need to analyse it, you need to develop a solution, you need to test it, then you need to implement it. But very few ideas actually go down all the way through the pipeline. A research which we did back in 2015 identified that innovation spend of bilateral agencies, it's obviously not that relevant to MSF, but it came in at less than 0.01% of the overall humanitarian budget. But that isn't actually the issue. The issue is that innovation budgets in private sector organisations are used to reorient the rest of the budget. So if you have 5% on innovation you know that in the future that 5% could transform the other 95% of the way your business operates. That's the point of having an innovation budget. But the challenge in the humanitarian sector is that our budget doesn't have that flexibility built in. It's not reoriented towards changing the way that we do things. So you can spend as much as you like on the humanitarian innovation side, if it doesn't have clear pathways into changing the way you do the rest of your business, it's going to be really problematic. We dismiss end users. We have a continued tendency to Chris Crisey's impacted communities down the road and the hope that someone else will pick up the ball and no one ends up doing it. And in our valuations we say the same thing we said in the last 30 years, we should have engaged more with communities. And we need to just work harder at doing it. And in the rush towards humanitarian innovation, there's not been nearly enough emphasis on actors in developing countries, whether it's communities themselves, whether it's civil society, whether it's private sector and government bodies. And there's a whole range of related issues. It's not just their engagement with the systems we build, which we assume will be infinitely available and infinitely compliant. But there's also issues of access to technology, selection, voice and representation, ethics and risks. And the importance of not just engagement, which we talk a lot about, but empathy is really critical. A user-centered design in the private sector talks a lot about empathy and I wonder how much we actually spend time thinking about empathy with disaster-affected communities when we're thinking about innovation. Now actually doing this gratifyingly doesn't require importing a whole series of new tools from the private sector, because we've got a whole range of pod-specary tools at our fingertips. I think the real mystery of user-centered design with affected people is not how to do it, but why so few humanitarian innovations have done so. And I'll be giving some examples of people of that. I actually tried to address this issue a little bit later. The final hurdle I want to talk about is, and this is one of the best images I've... It is a genuine one as well. Context will have its revenge. We have an institutionalised, almost legitimised lack of attention to contextual factors. The history of humanitarian aid is largely one of flawed attempts to cut and paste new ideas and context with little attention to how they actually fit in. And the current efforts in humanitarian innovation haven't been immune to these established cultural and organizational norms within aid. We don't pay attention to infrastructure to local availability of resources to train into capacity. We often forget that simpler is better. We tend to treat existing methods and new approaches as all our competitors rather than compliments. A really good example, most people in developing countries use radio as their most widespread technology. When we go in mobile phones, we don't think about, well, how can we combine mobile phones with radio? That's a really good example of people that do that, but actually we should be doing that as a matter of course, instead of just going in with our smartphones because this is going to change your lives. And context will eventually come to bite us on the backside, proverbially speaking. I say these are some big hurdles for us all, and there may be more. And some of these may need to change over time as we learn more, but my name isn't to be negative, but to be really clear headed about what we need to navigate and overcome. And as the O-line says, I used to be scared of hurdles, but I got over them. Sorry. You can blame my seven-year-old son for that one. I blame him for a lot of things that you don't know. The problem is we don't actually appear to be learning how to jump these hurdles. Instead we just seem to repeatedly crash into each one as we go into each new innovation project. And this is in part because I don't think we're being especially open and transparent about what we're learning. As usual, Dilbert has a cartoon that sums up this situation. I hope you can all read this. I apologise if you feel like 15 drunken monkeys is too close to comfort as an allergy for our sector. But I think there is something here about just how we present what we're doing in the innovation space to the wider world compared to how we're actually doing it. Say, one of the first starting points for me in starting research on my new book was to refer to research in this area. Research in this area does exist. It starts with a study I led back in 2008, which has just been described as a foundational text for the movement, something I like to repeat as often as possible, obviously. But the research speaks to many of these challenges. But I wonder how much of it's actually being used to change the way we do humanitarian innovation. Much of the research has ended up being aspirational rather than operational, and it's seldom, if ever, used to assess and evaluate programmes and apply lessons. For example, in the very first study we said we recommended humanitarian innovation needs to be open and non-competitive by default. And today there's innovation competition even between different country officers of the same international organisations. So I wonder how evident space we are in reality when we do this work. I don't think there's really enough strategic learning, and that strategic learning isn't really feeding into how we do innovation. And therefore we're not really being able to clearly articulate how our ambitions in this space match up to humanitarian objectives. There are some notable exceptions to this lack of learning. The ALNAP report, more than Just Luck, on the reddit, I'd really urge you to do so because I think it really talks about the challenges in a clear-headed way. And it deepens our understanding of the success factors for humanitarian innovation. It talks about greater attention to the how of humanitarian innovation, not just the what. It talks about the fact that humanitarian responders need support that speaks to their specific capabilities and their interests and their ability to work and be creative in crisis settings. Speaking back to that point about balancing stress and creativity. We actually need to urgently improve our culture for innovation, but we can be innovative in the humanitarian sector if leaders give us the space to do that and encourage us to do that. And that culture is something that we all need to contribute to. And we don't really think that much about our organisational culture, I think. And we obviously need much greater attention to address problems from the perspective of affected people themselves. This is a quote from John Besant, who's one of the leading UK experts on innovation, and he's been instrumental in shaping the way innovation works in the humanitarian sector and was actually part of the chair of the humanitarian innovation fund with me for a number of years. And he said that while humanitarian invasions might be rich in goodwill, they often lack the core skills needed to turn right in to something that creates real sustainable value. And the challenge is how do you learn about the discipline, the skills of innovation and how to manage it on particularly difficult conditions and limited resources with a lack of control. And in my view, this actually is central. It reinforces the point I was making earlier about the human social sides of humanitarian innovation. We're simply not thinking enough about the importance of people. And we often undervalue the potential of people to lead and undertake innovation processes. But this is not the way things have to be. So in my research for my new book, which is called Crisis Innovators, I've looked at crisis innovators in a whole range of different settings and I've looked at it historically as well as in the modern day. I've looked at it close to home in areas like humanitarian, in emergency services, in disease response. And I've also looked at it in more further field, in military and in space. And building on the work of innovation scholars, Clayton Christensen, who wrote the work book of the innovators' dilemma, I've tried to focus on the key behaviours that optimise the creative impulse within people and within organisations. Now they've had a number of skills that I think are especially essential for the innovation in different crisis settings and I've met them to 50 different case studies in different contexts and different time periods. People that have responded to crisis and creative in innovative ways and some of these, as I've shown, have gone on to make remarkable changes in the world as a result. And they're challenges, challenges of people who are able to constructively challenge and question the status quo. Crafters, they're people who are really deeply steeped in how things work and are able to come up with novel solutions. Combinas are people who work across different technical areas and they're able to bring together ideas from those areas in a systematic way. And this is a remarkable network building. This is if I was going to be anything in this space, that would be me. Corroborators, not in the legal sense, but in the evidence-based sense of people who are really thirsty for data and information. And conductors, not in the bus sense, but in the orchestration sense, people are able to bring all these things together. Let me talk you through these quickly now. And this is someone that might be named to you. A good example of a challenge at Steve Collins. Steve Collins, a doctor and an aid worker and he was running a nutrition programme in the 1990s and he was well aware of the job at hand. He was only in his mid-30s at the time, but he was an expert in tackling malnutrition by establishing therapeutic feeding centres. These large centres where malnourish patients were admitted for an average of 30 days. And Somalia in 1990 was putting charge of the first adult feeding centres anywhere in the world since the Second World War and the liberation of the death gaps. And he actually published his work in the prestigious Nature Journal. I think he was one of the youngest people to have had a single authored piece in nature up until that point. In 1996, in Liberia, there was a cholera outbreak amongst the patients that he was dealing with and the communities around them. And it led him to rethink this way of working because essentially when he set up a therapeutic feeding centre, people come from miles around, they create informed communities, the famous images of the April of 1980s where people had brought their children to the feeding centres and they created an informal settlement around them. And that's what led to the cholera outbreak. And this to him, as he put it, brought home to me the danger of bringing people together in this way in feeding centres. They had to be a better way. I knew this would come from engaging people better, looking at their strengths rather than trying to impose solutions on them. And this is exactly what he did. So using the latest nutritional products, Steve and colleagues at Validia International developed a new means of treating malnutrition that proved five times more effective than conventional mathematics at a fraction of the cost. And today, following extensive roll-up, a lot of opposition from organisations like MSF and UNICEF and others that were really supporting the previous way of doing things, but it was tested at a whole range of different settings. The reason it was able to be tested is because the Ethiopian Government banned therapeutic feeding centres in 2002 and he was therefore able to get them with an alternative that was seen as ethical. And it's now been claimed by the WHA as being at the forefront of dealing with malnutrition of the world around the world. Something like the death rates of treatments have dropped from something in the region of 30% to 40% mortality rates down to less than 10%. And as a result, it's become the standout illustration of humanitarian innovation. But it's the human story that I want to focus on. It's not just what he achieved, but it's a recognition that there had to be a better way of doing things. And even though his expertise was embedded within the existing approach. And this is really at the heart of the challenge of mentality. Now, obviously many of us have had this experience in operational response but few of us have the time or the space of the resources or the institutional space to do something about it. As a result, a lot of challenge mentality doesn't really go anywhere and I think we need to find a way of channeling in that better. So challenges like Steve they constructively question the status quo, their iconoclass and that they're willing to burn the icons literally. They redefine problems in new ways and they're willing to put their own reputation and status on the line. And what was especially important with Steve is the degree of empathy and engagement with communities that for him it was about the plight of parents and their ability and their capability to look after children better using what in medical terms as an outpatient system for dealing with malnutrition was essentially a community-based home-based approach. This is Caetano Doria. He's a professor at the Department of Civil Engineering at Caetano Doria. He's a great example of a crafter. He works on the interface of environment and public health and he works with Oxfam and UNICEF and a whole range of others. I'm sure a number of you work on water quality. Many of you will know their important trade-offs to be struck between quality and quantity of water. The transmission of water in excreta related diseases as is likely to be to the lack of sufficient quantities of water for domestic and personal hygiene as to contaminated water sources. But what he's discovered over the years of research is that it's key to get a safe water supply that's both free of pathogens technically but it's also aesthetically and culturally appropriate. It's visually clear. It doesn't have a taste. It doesn't have an odor. That cultural appropriate varies considerably between different communities and cultures. He found that the vast majority of purification kits simply didn't pay attention to they weren't technically compatible to start off with fuel conditions. There were often very innovative approaches developed by the private sector to the humanitarian sector and they were fine in lab conditions but they weren't very effective. But they didn't necessarily produce water that was culturally appropriate. So what he did over a number of years was to steep himself in humanitarian realities to try and better understand how communities used and perceived water and the kinds of processes that could be utilised. Based on this deep analysis he actually found a number of features of conventional water treatments that could be made better use of. A particular approach which brought together two aspects. One is inclined plain settling and coagulants. One is a chemical process to essentially gather particles in contaminated water and filter it quicker. One is a particular origami style approach that enables you to filter them. This led to a whole range of different applications made to be in South Sudan working with a local government body in charge of water infrastructure and it showed that this was called an inclined plain settler succeeded in delivering a measurable improvement of other water treatment systems both in terms of sufficient, acceptable quality maximum quantity over time and cost and the tools actually won awards for its potential to contribute to water security and it's one of the ones we supported in the humanitarian innovation plan. Now crafters like Doria exhibit some common features. They have a deep engagement with underlying processes and patterns that are faced by disaster affected communities. They have an obsession not just with their particular area but not just with the functional side of things but also the social, the emotional, the behavioural side the understanding that clean water goes beyond technical to the cultural. And they use this understanding to craft and adapt novel solutions to match emergency context and social situations. Combine as a third type and I'm going to take a step back into more recent history. This is UU2. Does anyone know who she is? Anyone ahead of her? Okay, one. So imagine 1967. Only one government research project was supported by Chairman Mao in China called Project 523 and it was a result of a personal request from the Vietnamese Premier Ho Chi Minh to essentially keep his allied troops combat ready during the ongoing war with the United States. Vietnamese soldiers at that time had a say we're not afraid of the American imperialists but we are afraid of malaria. And the imperialists were far from new. In 1964, malaria related casualties amongst the US forces was five times greater than the casualties from direct combat. In the following year, nearly half of all American military personnel, 800,000 men were infected. So as a result, malaria became a top priority for dealing with, for both sides. In America it was the Walter Reed Army Institute of Research in DC that launched the hunt for antimalarial drugs and it launched a massive investment. Thousands and thousands of researchers huge and they tested a quarter of a million different possible drugs. The Chinese project had 600 scientists as a fraction of the resource on the US side. It launched on the 23rd of May 1967 which gave it the project name Project 153. And although none of them knew it at the time the project would be something of a protection against the persecutionary zeal of the Cultural Revolution a malarial arc for scientists and researchers is what someone described to us. But in 1969, the project had looked at thousands of possible drugs when they success and the Walter Reed on the US side also had no success. And at this point, the Chinese government brought in the Academy of Traditional Chinese Medicine and UU2 who was a young herbologist there at the time and she was a pointed director of the overall project because she understood both sides having had some medical training. And her project started with a four month trip to Hainen a tropical island at the southernmost point of China and when she was there when she returned she was deeply affected by the plight of the people there and she said I saw a lot of people who were in the late stages of malaria and those kids died very very quickly. I really thought I had to do something about this. It gave a really deep sense of empathy and purpose and motivation which was linked to the people that she met. What was essential from UU2's perspective was that it would have two wings. It would have the traditional medicine the herbology side and the biochemical side a biomedical side. One group was tasked to test and synthesize drugs and the other was tasked to examine traditional Chinese medicines. And the different teams had to constantly combine ideas and constantly come together in order to smash ideas together. So one imagined one team screening ancient medical texts and the other working on chemical isolation of different active ingredients. And there were more than 2,000 different preparations that were tested by UU2's team. And eventually there was a plant called Sweet Wormwood that was identified and it was described in a centuries-old document. And the active ingredient was discovered by UU2 after a long process of trial and error and cross-team work. And it was synthesized by Project 523 and is now known as Artemisinin which I'm sure many of you will know. And it showed promising tests in mice and monkeys and UU2 actually volunteered to be the first human recipient. She said, I'm the leader, I should take responsibility. And it had no effect so they tried it on infected labors in Henan and the symptoms disappeared within two days. Her role was actually not widely publicised at the time. The researchers eventually published in the 70s and they came to work thanks to the work of the WHO and at the Walter Reed. And there were numerous tests in large-scale production efforts and Artemisinin moved to the centre stage of the global effort against resurgent malaria thanks actually to the work of MSF in testing and applying in a whole range of settings out quite far from where it is being applied. And today although there are issues around resistance data at Artemisinin the chance of dying from malaria in severe cases is a half from 1 in 5 to 1 in 10 the number of deaths have reduced by 75% and that's from around 2 million deaths globally in 2000 to 500,000 in 2013. And in 2015 UU2 became the first Chinese national to win a Nobel Prize for Science. She shared the prize for medicine. And when she, she's a very modest person she said, she, she was quoted saying it was a bit of a surprise but not too much of a surprise. So, combiners like UU2 they draw ideas across different fields and endeavours and they generate new associations and they're really focused on combinations of different skills. And they engage in brick a large what you might call LEGO thinking. And again the importance of empathy in creating shared goals and helping to navigate dramatic collaborators. I'm just conscious of the time and I've got a bit to go. Collaborators shall I just keep going? Okay, great, thank you. Collaborators perhaps appropriately it's not a individual but a team of people. This is the speed programme in the Philippines and this was developed after Typhoon Katsala. This is the first ever mobile based health surveillance system to go to national scale anywhere in the world. And I think it might still be the only one actually. But it was after Typhoon Katsala in 2009 in the world's biggest leptospheriosis outbreak in Manila and it highlighted the need for better disease outbreak preparedness. And it's developed an early warning system for post disaster situations to spot immediate potential disease outbreaks. And it used web based software that would get in data from mobile phones and handheld applications and it enabled the transmission of syndromic disease fairness information from primary reporting units of vacation centres to the health system up to the national level. And it was actually designed by the government in collaboration with civil society in the private sector but in collaboration with the humanitarian sector. And the emphasis across the consortium was that the actors had to build relationships with each other. They knew that if they just left it to the humanitarian sector they would come up with a system that was basically lasted as long as the crisis response then got forgotten. So they had to find a system where the battle could be passed on and there was a central importance of building relationships with each other with local governments with community based organisations. And it wasn't for this relational work this system wouldn't have gone to national scale. And I think there's some really key lessons here around basically the ecosystem. We have very few incentives within the system for actually doing this kind of system-wide work. And I think expecting this might be asking emergency responders to try and help to reform building kits. And I think a small sport experiment is quite useful here. Had speed been developed solely by the humanitarian sector one can imagine it would have been deployed once and forgotten by the next emergency. Instead it's a standing mechanism which is used after every emergency. So collaborators like the speed grid they bring together different groups around shared goals and opportunities and gaps. And they identify win-win-win solutions. The private sector was involved here. There were resources from this. The government was involved. The WHO was involved. Humanitarians were involved. And I think everyone had to find a way of negotiating their wins in this process. And the key is drawing unusual suspects who might not be seen as typically humanitarian. I think we have this notion that we in the humanitarian sector have a monopoly on the term humanitarian. But actually I think we need to break that monopoly. I think anyone can be humanitarian in the right context. The next example, he did originally have MSF here as the corroborators par excellence. But I thought that would be a bit too much like trying to flatter you all. So I'm going to tell the story of Archie Cochran who's a so-called father of evidence-based medicine. And the Cochran collaboration for randomised control trials is named in his honour. And very quickly he was experienced during the war. He was in the Royal Army Medical Corps as a captain. He participated in military action where he was captured. And he spent the rest of the war years as a prisoner of war with the speciality of medical officer in a whole range of refugee camps. And this is where he performed one of the first ever medical trials using randomised methods. At the time, randomisation and trials were mainly used in agriculture not in medicine. And what led him to conduct the trial was this high-end incidence of ankylidema of unknown origin amongst the prisoners. And it developed edema even up to above the knee. It was looking really quite grim. And he hypothesised that the underlying cause was vitamin deficiency as the prisoners were provided with really scanty nutritional levels around 500 calories per day. And he expressed his concerns to the German leaders of the camps and they refused to help. And so he brought yeast in the form of marmite and vitamin C supplements from the black market in the camp and selected a sample of prisoners and he divided them into two and he gave one group daily portions of yeast and the other group daily portions of vitamin C and limited their water intake and measured the frequency of urination and after four days he said the yeast eating group had improved and so he then wrote all this down and went to the German camps and they said we need more yeast and the German camp managers rejected him and left him feeling really frustrated and furious. But then a young German doctor picked it up and said the evidence is incontrovertible. If we don't supply vitamins to the prisoners then it's a war crime and say they got vitamin B12 and they supplied it and the prisoners recovered and the incidents of pitting edoma dropped dramatic. Now he actually wrote about this later on and he talked about it as his first worst and most successful trial ever and I think it was quite interesting. I mean it can be thought to be both randomised and controlled. At the time RCT is almost unknown to the medical community his story of doing this was one of the things that actually inspired people in the 40s and 50s to start doing trials more effectively. So corroborators like Archie Cochran they test, observe and gather data they probe and explore things in systematic fashion through experiments and they play a central role in making the case and advocating for change. The final example of the personality type I want to talk about is the conductor I want to talk about the Royal Victoria Hospital in Belfast. It's still to this day the largest hospital in Belfast and it was seen as being right on the forefront of the battle and in 1969 when the trouble started no one had seen a gunshot wound and by 1973 it became a hub for the development a whole range of groundbreaking techniques that would transform emergency medicine and military medicine around the world and they met a whole range of different challenges one was political and they actually put in place their own principle that they would treat all sides equally whether they were perpetrators or victims or they were army or the military or the paramedics or the people they'd treat them all equally to get the best possible care. Nurse O Hanlon who's the chief nurse actually said all we want to do is what happened in relation to the injuries we're not interested in politics. On the technical side the research and teaching hospital there was bolted on to the A&E team so they were able to take on board the kinds of injuries and ailments that are happening and they had frontline staff directly leading the development of new techniques and led to new techniques for everything from dealing with lung collapse of bomb victims integrating dental filling techniques into cranial surgery using titanium cranioplasty triage techniques which are still used today across hospitals in the UK and around the world for the rubberford techniques named after the head of the A&E unit there and it was a spirit of constructive engagement but I think perhaps the most important there was a kind of emotional and social support led by Mary led by sister Kate O Hanlon they drew upon this nation that we needed to be able to face up to the horror of the troubles with creativity rather than convention as she wrote there wasn't counselling because we were all together you had porters and nurses and doctors and consultants and we would all talk together every day and there was a great team spirit and she was instrumental in creating this environment in which this innovation could happen. William Rutherford who was knighted subsequently and running the department actually said the principles are very simple you have to love everybody, you have to listen to everybody and if and doubt you do what sister O Hanlon tells you and conductors, they spot the trouble problems and they ensure they channeled and addressed in appropriate ways and they ensure there is a right balance of skills and sequence of skills and they maintain a sense of mission all of this to my mind adds up to an argument for a shift in how we think about humanitarian innovation so my own Mia Culper here when I wrote the first study on humanitarian innovation I wanted to make the case for to make investing more money in it and in the sector I knew that talking about people wasn't necessarily going to get us there so I focused on a process focused approach and it seemed much more likely to attract attention and resources and this kind of process was what we put forward and this is what we essentially got lots of resources we got the humanitarian innovation fund we got ideas to move through these different things and so on but today I'm convinced that if we're going to be successful we need to rebalance this with a people-centered approach to how we think about innovation we can't think just about the process of innovation like it's a pipeline and a factory we need to think about the skills and the capabilities and how we orchestrate them together like the players of instruments in a band and we need to think about our role within that the image of the lone innovator is just one part of we need to in a way democratise innovation across our sector and between our sector and those we seek to help and again I think a people-centered approach is really important here so what would this look like in practice so I think a few ideas first of all we need to operate from the affected community backwards and not from the agency forwards we need to develop the capabilities to anticipate and interpret emerging needs and opportunities and we need to respond to them not with technologies but with empathy and with principles we need to empower teams to make collective decisions on a shared understanding of purpose and values and importantly with emotional openness between us to talk about the challenges that we're facing and yes we do need to adapt and continuously test a whole range of tools and possible ideas and models to ensure relevance and we need to foster new kinds of partnerships and networks to achieve goals in a highly collaborative fashion let me quickly try and sum up what I've said so there's been progress in humanitarian innovation and some non-trivial hurdles there's more evidence based learning is necessary and impossible but we have to remember that humanitarian innovation is much about the human and the social side is about the technical and the technological and there's some great people and some great teams and some great examples and some emerging archetypes that might help us rebalance this approach and I just want to close with just going back to the point that I started with I think humanitarian innovation could be at its best a point towards the kind of professional institutional mindsets we need to have in place to work on humanitarian challenges both now and in the future it's a way of furthering understanding of opening up new ways of seeing and thinking of unlocking our individual and collective capabilities in the face of destruction and devastation just to go back to the point about stress and creativity I started with there are some downsides to stress obviously it can lead to over stress but the brilliant thing about this development is that across a whole range of problems well managed stress doesn't actually lower our creative abilities it advances them and a whole range of examples where successful innovators have been able to tap into this already without knowing about it what the human focus does it enables is to see constraints not as restrictions but as a source of freedom and I think we in the humanitarian community could see innovation as doing the same thing freeing ourselves of dogma and hopefully pointing the way to a new kind of humanitarian enterprise that should be the kind of thing we see in the 21st century more open, more honest, more dynamic more engaged, more networked an enterprise we can point to with pride instead of down quick discomfort thank you very much for listening