We began this series of meetings without a specific goal. Our interest is in how we learn. We are using place and scale as exemplars.

The contributions have been framed by Don Berwick’s Three Era’s paper, showing difference in the relationship between policy and evidence in the health world from the time when the professions dominated (era 1), to the current legacy of new public management (era 2) and the opportunities for what he calls the third ‘moral era’.

The discussions about Berwick and other pieces have produced a series of helpful ideas. The need for pluralism for example. It isn’t a matter of either professions or a focus on outcomes it is both/and. Indeed, by some estimations, there is a need for a renaissance in some aspects of the professional ideal, of public service for example.

The challenge of language has come through strongly. Words like ‘place based’, ‘system reform’, and ‘collective impact’ loose their meaning over time, creating more confusion than clarity in the preparation of say funding strategies. These concepts are treated as novel, when in fact as evidence shared at the February meeting shows, they generally have a long provenance.

The idea of contagion was introduced to explain how to spread innovation or healthy behaviours through a population, but the network has also explored how it explains the spread of concepts like ‘placed based’ through the worlds of policy making and funding.

As the network draws to a close over the Spring and Summer, the goal is to use our reading and analysis to write down a coherent statement of what Berwick calls the third era might look like. This will comprise:

  • Ideas, for example what do we mean by a relational policy, what is the role of ethics and rigour, and can we transform the concept of ‘outcome’ into something that is meaningful to the people whose lives we seek to influence?
  • Methodological, such as the approaches used in improvement science, or the encroaching world of machine learning, and how we use tech for good.
  • Practical tools, like making logic models dynamic.
  • Place and scale will continue to be our exemplars.
  • If we can write something down, something that has utility for members of the network, we can test it with external experts. In the autumn we might invite, for example, Patrick McCarthy, for a decade President of the Annie E. Casey Foundation in the United States to reflect on how policy, funding and practice have evolved, and whether our ideas contribute to thinking about where they may go next.