ADDRESSING WHOLE SYSTEMS AS A "SPECIALIZED GENERALIST"

The idea of a “specialized generalist” (Kates, 1967) is a phrase that is neither new nor clearly defined. The idea tends to arise in relation to strengthening capacity for applied knowledge and innovation, including the dynamic capabilities of “T-shaped professionals” and a combination of special expertise and collaborative capacities needed to respond to complex 21st-century challenges, spanning health, environmental, design, and systems contexts (Barile and Saviano, 2013; Boumeester, 2014; Donofrio et al., 2018; Ashhurst, 2019; Lisefski, 2019). The idea of a “specialized generalist” has particular relevance when addressing well-being and health oriented to both living systems and equity. This is because a WHOLE approach requires a generalist orientation (e.g. attention to and synthesis across general principles, patterns, and practices) supported by a specialized suite of knowledge, attitudes, and skills (including specific tools and processes), required to put general principles into practice in different contexts, settings, and circumstances. A sense of reciprocity is important for this framing: A generalist foundation that enables bridging across expertise may be supported by specialization, and specific expertise may be complemented by capabilities in communicating and working across different types of knowledge. In either case, an essential feature of this perspective is a forward-looking, applied, and collaborative emphasis on design, application, implementation, and change that is considered to be equally important, if not more, to specific expertise, research, analysis, and prediction. In the language of Boyer (1990), while the specialized generalist may value and benefit from the “scholarship of discovery,” emphasis and value are also focused on the knowledge and practice advances arising from the “scholarship of teaching and learning,” with the “scholarship of integration,” “scholarship of application,” and what Woollard (2006) describes as the “scholarship of engagement.”

The role of both understanding and working across and among different knowledge systems has been proposed in a variety of other health-related contexts. Adapting from the WHO (2000) partnership orientation of “Towards Unity for Health,” Woollard (2006) emphasized the value of working across the “partnership pentagram” of policymakers, health professionals, academic institutions, communities, and health administrators. In the context of emerging infectious diseases, Parkes et al. (2005, Figure 1) underscore the importance of applying transdisciplinary thinking to connecting not only across different disciplines but also among different types of knowledge (including communities and cultures, practitioners and field workers, disciplines, sectors, and units of governance). These efforts resonate with ongoing and expanding work that focuses on transdisciplinary research as a form of knowledge generation that transcends disciplinary boundaries and values other knowledge systems, often in relation to complex and wicked problems (see, for example. Brown, 2010; Pohl, 2011; Lang et al., 2012).

Brown’s w'ork elaborates on the need to identify and value different kinds of knowledge, in ways that combine a big-picture, integrative (also holistic) generalist perspective with the specialized skills required to actively engage different knowledge cultures. Brow'n recognizes "Individual” (personal lived experience), “Community” (shared place-based lived experience), “Specialized” (academic disciplines and professions), “Organizational” (strategic agendas, regulations, policies), and “Holistic” (synthesis, metaphors, images) knowledge cultures, noting that individuals are often engaged with several of these (Brow n. 2010; Brown et al.. 2019). Brown’s “collective learning cycle” (sometimes described as a “social learning cycle”) provides questions that were refined across multiple contexts, and proposed as a way to benefit from the collective knowledge that can arise working across these five knowledge cultures, in order to better address complex issues at the interface of environment, health, and community (Brown, 2007, 2010).

The four questions of Brown’s (2010) collective learning cycle commence with an aspirational and asset-based posture, considering “What should be?” underscoring the point that "how we begin matters.” The next part of the cycle is guided by objective orientation to “What is?”: grounding in the reality, constraints, enablers of what is happening, and the parameters that can be used to assess and describe this. The question “What could be?” focuses on the potential arising when considering how to move from the current state to the desired state (e.g. from “What is?” to “What should be?”) and how it could be possible to move ideas into practice to do so. A final pragmatic step focuses on “What can be?” and the practicalities arising from specific action planning associated with questions of who, how, when, where, and associated responsibilities. By completing this cycle, there is a final step to consider moving from the practicalities of “What can be?” to the development and revision of principles in relation to “What should be?" This aligns with the important question of “Now what?” (Rolfe et ah, 2001) to inform whether and how the sense of direction needs to be adapted prior to embarking on the next iteration or cycle of learning.

Brown’s collective learning cycle can guide the ongoing learning processes required by a “specialized generalist” informed by a WHOLE-systems perspective on health of animals, humans, and others. It offers guidance on how to proceed when addressing specific issues. The learning cycle also provides a big- picture overview of priorities, patterns, and questions that are also seen in other forms of assessment and practice (Table 5.1).

Brown’s learning cycle resonates with other cycles of learning and action in practice-based contexts spanning health, education, and ecosystem management. Table 5.1 presents the stages of some of these cycles, underscoring patterns of similarity across different contexts relevant to the “general” practice of a “specialized generalist.” The examples in Table 5.1 profile a series of similar questions and stages that span Brown’s collective learning cycle (2010), and they can be aligned to the features of the “clinical method” or the “clinical diagnostic approach” for humans and veterinary medicines (Shah, 2005a, 2005b; Waltner-Toews and Kay, 2005), professional learning, action research cycles (Zuber-Skerritt, 2015; Fletcher, 2015), and adaptive (ecosystem) management (Allen et al., 2011; Williams, 2011). The examples in Table 5.1 also resonate with related learning and iterative cycles emphasized in Disaster Risk Reduction (Phibbs et ah, 2016) and integration across the Sustainable Development Goals (Stafford-Smith et ah, 2017; Allen et ah, 2019). Although the rows in Table 5.1 do not align exactly, the table is intended to depict a series of patterns, commonalities, and relationships that are relevant to a specialist generalist seeking to adopt a highly contextual and learning-oriented approach to health embedded within WHOLE systems.

Other authors have observed the patterns in Table 5.1 and have proposed overall approaches that can be applied in multiple contexts such as the Adaptive Methodology for Ecosystem Sustainability and Health (AMESH) (Waltner- Toews and Kay, 2005). Although the other examples in Table 5.1 do not share the same kind of “presenting complaint” as the “clinical diagnostic approach,” there are substantive overlaps in the quality of the assessment and the nature

TABLE 5.1

Learning Patterns Relevant to WHOLE Systems Approaches: Lessons from Brown's Collective Learning Cycle (and Other Cycles of Learning)

Collective Learning Cycle, Including Four Guiding Questions3

The "Clinical Method" or Clinical Diagnostic Approaches11

Professional Learning and Action Research Cycles'

Adaptive Management for Natural Resource Management

Associated

Reflective

Questions'

What should be? What is ?

What could be? What can be?

History

Examination

Investigations

Management

Plan

Act

Observe

Reflect

Set up,

Decision-Making

Monitoring

Assessment

What?

So what? Now what?

What should be?

(Principles, ideals) Collective learning draws on multiple knowledge cultures1 to develop or revise this shared intent

Ideally, an aspiration, state, or capacity of "health” is negotiated between patient and clinician in the clinical encounter

Plan: This phase involves learning among individuals, groups, and teams informed by different contexts

Set-up” involves framing in terms of stakeholders and objectives. Technical learning involves iterative learning through

decision-making, monitoring, and assessment

Consider intentions. Who is involved? Why?

Where?

Factor into reflective questions

What is?

Uses parameters, facts, empirical constraints, and enablers to determine What is, now?

Appraise history of specific issue, starting with the presenting complaint, and through related contextual features

Act: Actions are informed by planning, context, and assessment of current situation and appraisal of Where are we now?

Structured

decision-making

requires capacity to define the problem, identify objectives, formulate evaluation criteria, estimate outcomes, and evaluate trade-offs

What happened? (description and self awareness: facts and reactions)

What could be?

(Potential, ideas) Explore possibilities for taking ideas into practice to get to: What should be?” from "What is?”

Examination and investigations via physical

examination and other diagnostic testing give more detail

Observe: Monitor, gather data

  • - How are we doing?
  • - What evidence do we have?

Decision-making needs to be complemented by higher-order learning enabled through

implementation and monitoring and assessment

So what?

(analysis, evaluation: interpretation and relationship to existing experience)

What can be?

(Practicalities, actions) Action planning, taking practicalities into account to establish what can be done to complete this iteration of learning

Create

management

plans, and design follow-up to confirm or adjust diagnosis and plan ahead

Reflect on the process and learning to date

  • - How did we do?
  • - Where to next?

Learning about management choices needs to be completed through evaluation and adjustment to inform next iteration of the process

Now what?

(synthesis, actions, application)

Notes:

a Brown (2010). In addition to the four guiding questions (What should be? What is? What could be? What can be?) collective learning draws on individual, community, specialized, organizational, and holistic knowledge.

b Shah (2005a. b) describes the clinical encounter through history, examination, investigations, and management. Waltner-Toews (2005) focuses on health of people, animals, and ecosystems through presenting complaint, clinical examination, diagnosis, setting, and achieving goals.

c Zuber-Skerritt (2015) extends on the classic Action Research cycle of “Plan, Act, Observe, Reflect," with connections to action learning and the important links to critical reflection, professional learning, action leadership, sustainable development, and social justice.

d For Allen et al. (2010). adaptive management is a “formal iterative process of resource management” combining structured decision-making and high-order learning. Williams et al (2009) links a set-up phase with iterative learning through decision-making, monitoring, and assessment.

' Rolfe et al.’s (2001) reflective questions are What? So What? Now What?

of the questions that are asked. Waltner-Toews (2004) is especially clear about the relevance of a system-informed approach to a “presenting complaint,” which can serve as a starting point for learning and decision-making about issues and challenges that may be well outside of the traditional health sector, especially in the context of health and ecosystem sustainability. Of utmost importance to the “specialized generalist,” Waltner-Toews focuses on the quality of the contextual appraisal, and the need to consider combined social and ecological factors when seeking the “history of presenting complaint.” The quality and nuance of the initial assessment can influence all subsequent learning and decisions.

This quality of initial assessment is reflected in the other cycles presented in Table 5.1, whereby any appraisal, assessment, or framing of proposed actions and next steps needs to be done in relation to intended goals, directions, and objectives. The strong tendency to “start with the issue/problem” without taking time to clarify contextually relevant goals, intentions, and priorities can be deeply problematic because it limits our ability to attend to complex system issues (Brown, 2010). This is a key issue for the “specialized generalist” and others seeking a WHOLE-systems perspective on health. Accordingly, the following walk through of the four questions in Brown’s collective learning cycle commences with attention to “What should be?” in the context of working together for WHOLE systems, also acknowledging the overlaps and relevance of related approaches included in Table 5.1.

 
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