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"Ukuphosa Itshe Esivivaneni" – Throw Your Stone upon the Pile

Recently I had the opportunity to visit Zimbabwe and South Africa to observe a close friend and colleague work with local health leaders to improve HIV treatment. I was able to attend the last day of a learning session where awards were given to teams. It was an invigorating experience for me to observe the pure joy and exuberance the teams showed as they were acknowledged for their efforts to improve care in their communities. The celebration honored a collective experience, rather than individual accomplishments.

While in South Africa, I went on a short safari. Since I was the only person on the 12-hour adventure, I quickly bonded with Ndu, a Zulu safari guide. Ndu was very interested and intrigued with American culture and asked me about Utah food. After sharing the recipe for funeral potatoes, I asked Ndu questions about Zulu culture in South Africa.

I learned about many Zulu traditions that day. One I will never forget is, “Ukuphosa itshe esivivaneni,” which translates to “Throw your stone upon the pile.” During our safari, he stopped at a pile of stones and explained to me that long ago when someone died, people paid their respects by adding a stone to the pile. The result is a unique monument created by individuals. The practice was used in ancient times to mark places of spiritual, astronomical and historical significance. Ordinary people were expected to contribute to great works. Ndu explained that the idea is what we create collectively is better than what we can create individually. The diversity of participation lends to a shared vision of the future where everyone does their part to realize that vision.

Not long after my return from Africa, I spent time with Qualis Health and HealthInsight colleagues at a retreat in Seattle. One of my new colleagues is also a professional musician, and he shared with our group that he has recently begun recognizing similarities between his career as a musician and his career in quality improvement. He explained that a particular commonality is how individuals need to come together to achieve a common purpose. In the performing arts world, it is not only the work of those we see onstage; rather, it is the result of many people doing their parts to create something beyond what is created individually. It is also common for members of a team to want to help where help is not needed or to be concerned about duties outside their scope. He shared that it becomes critical to “do your best and nothing more,” to allow each individual to play their best individual part in the production. Acknowledging and trusting ALL contributors’ roles and clearing the way for them to perform their part is key to any endeavor.

Both of these situations remind me of various teams I have been on at HealthInsight, as well as some of my participation in community initiatives. The most successful teams and initiatives were those in which every or most members were engaged participants. I found my handy-dandy copy of The Team Handbook and (blew off the layer of dust) and read the introduction to teams and teamwork:

A single person using quality improvement practices can make a big difference in an organization. But rarely does a single person have enough knowledge or experience to understand everything that goes on in a process. Therefore, major gains in quality and productivity most often result from teams—a group of people pooling their skills, talents and knowledge. With proper training, teams can often tackle complex and chronic problems and come up with effective, permanent solutions.

The same concept is true for community and grassroots initiatives. Too many organizations are working on similar issues across shared audiences with little coordination. In many cases, these efforts become competitive, which decreases the ultimate value to the populations they serve. At HealthInsight we are committed to partnering with community stakeholders to leverage resources and align goals to achieve the best outcome possible. To accomplish this we often follow tenets of collective impact to bring about initiatives in a “structured way to achieve social change”:

  1. Common Agenda: Participants come together to collectively define the problem and create a shared vision to solve it.
  2. Mutually Reinforcing Activities: Participant activities are coordinated to maximize results.
  3. Continuous Communication: Consistent and open communication is needed across the many players to build trust, assure mutual objectives and appreciate the common motivation.
  4. Backbone Organization: Dedicated to coordinating the collective.
  5. Shared Measurement: All participants agree to track progress in the same way.

The product of the collective is more powerful, impactful, diverse and meaningful than the work of individuals. What initiatives will you “throw your stone upon”? What work do you have that would benefit from the stones of many?

The recent merger of Qualis Health and HealthInsight creates enormous opportunity to join forces to create sustainable transformation by capitalizing on the talents and capabilities of the combined organization. I am excited about opportunities for us to throw our stones upon improving the health and health care in our respective communities. And while I only had a small amount of time there, I hope Ndu’s family in the coastal town of Durban, South Africa, periodically enjoys a helping of Utah’s famous funeral potatoes.


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