When faced with big challenges, individuals or organizations are most likely to respond, “How can we?” One such challenge is large system change, ie, the holistic alteration in processes and behaviors across a system that leads to a step change in the outputs from that system. Meeting such challenges requires alternative framing of the question, and the contention is that several key principles assist in reframing the question from “how can we” to “why not?” In outlining these principles, this Commentary will describe lessons from my experiences with designing and delivering large system change across varying sectors (health, education, communities) in different countries.
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