From Sticky Notes to Systems Change:

Co-Producing Values-based International Partnerships

By Holly Harris, PhDc, Julia Paxino, PhD, Charlotte Denniston, PhD, Tina Brock, EdD, Sophie Soklaridis, PhD

Introduction

In August 2024, we were selected via a competitive international process to present a point-of-view-style (POV) presentation at the International Association of Health Professions Education (AMEE) annual conference. Our session was entitled Multi-directional Learning: Pathways for Nurturing Collective Wisdom on behalf of our participatory action research team at the Centre for Addiction and Mental Health (CAMH) in Toronto. At the session, we met colleagues from the Collaborative Practice Centre (CPC) at the University of Melbourne who were giving a POV presentation of their own entitled Nudging Programs to ‘Cross the Rubicon’ with regard to Interprofessional Education and Collaborative Practice, designed to encourage more collaboration in health professions education. It was clear that both teams were committed to shared values: systems transformation, collaboration, equity, diversity, inclusion, creativity, and fun. These values grounded a common goal: advancing the meaningful engagement of people with lived experience of health system encounters in health professions education and, more broadly, within health systems. We quickly connected, celebrated each other’s work, exchanged questions, and promised to stay in touch, despite the 14-hour time difference between Toronto and Melbourne. Encounters like this reminded us of the value of attending conferences; not just for sharing research, but for sparking fruitful connections.

A few emails later, momentum grew when we learned that the University of Melbourne team would be coming to Toronto. Plans took shape for a visit with the Education Research team at CAMH. That visit unfolded into a full day of learning, rich conversation, and a shared dinner, where it became clear that this was the beginning of something much larger. Together, we committed to exploring what we could accomplish in partnership, guided by our shared values.

When the University of Melbourne team returned home, we began laying the foundations of a partnership by co-developing conference abstracts on areas of shared interest, such as reflexivity in health professions education and collaborative practices grounded in equity and inclusion. Through these opportunities, we found our stride. A subset of us would meet in the evenings in Canada and early mornings in Australia. These meetings were grounded in the principle of “come as you are,” whether in a baseball cap, with snacks in hand, or joining from a train or a parked car. We also worked asynchronously, with detailed emails mapping out next steps, timelines, and action items, always open for negotiation. Drafts of abstracts and posters came together collaboratively in Google Docs, with tracked changes and comments, and a rotating point person to integrate feedback and coordinate submissions.

The University of Melbourne team presented our first joint poster at the Australian & New Zealand Association for Health Professional Educators (ANZAHPE) conference, and when both teams were accepted to AMEE 2025, we knew it was time to formalize our partnership and connect in person. Despite flight cancellations and long journeys, we gathered in Barcelona, Spain, for a Think Tank filled with immense energy.

In what follows, we share the steps we took to formalize an international partnership grounded in shared values, including agenda items, prompts, and activities. Along the way, and in Table 1, we highlight key strategies and their value, with the hope that our lessons may help inform your own efforts to build value-based collaborations across borders.

Before: Pre-meeting Activities

We decided ahead of time that the Think Tank would be facilitated by early-career researchers Julia and Holly, who both wanted to strengthen their skills in strategic planning and partnership development. By focusing on facilitation rather than chairing, the model emphasized collaboration over hierarchy. This gave Julia and Holly the opportunity to develop their skills while being mentored by senior colleagues, reflecting inclusive leadership principles in which senior colleagues intentionally create opportunities for those who are more junior to grow and take ownership (Li & Tang, 2022).

We approached the session with an emphasis on team reflexivity, the collective practice of reflecting on goals, processes, and relationships to strengthen team functioning (West, 2000; Schmutz & Eppich, 2017). In this pre-meeting phase, communication and agenda-setting established expectations and created the conditions for psychological safety. This involved Julia and Holly meeting twice via Zoom to draft an agenda, which was circulated for feedback, and creating a shared Google folder where team members could upload strategic plans, grant opportunities, and other resources. Participants were encouraged to review these ahead of the meeting.

During: The Meeting

Check-in

We gathered in the lobby of a Barcelona hotel, commandeering a table and filling it with chart paper, sticky notes, strategic plans, grant calls, and snacks. Sharing food served as an intentional approach to build community and humanize interactions, creating a relaxed environment that encouraged care, authenticity, and belonging (Ortega, 2023).

At the start of the meeting, a check-in invited participants to share how they were feeling, what they hoped to gain, and what they could contribute. This not only set a supportive tone but also functioned as an informal asset-mapping exercise, surfacing the diverse skills and perspectives each person brought (West, 2000; Schmutz and Eppich, 2017).

Comfort Agreement

Next, we co-created what we called a comfort agreement (often referred to as group agreements or ground rules). We asked: What mutual expectations should we put in place to ensure everyone can participate in ways that feel safe(r), strengths-based, and collaborative? Expectations included:

1. Direct communication: Direct is respect; clear is kind.
2. Half-baked thoughts are welcome: Respectful piggybacks are invited, meaning we all felt comfortable building on each other’s ideas.
3. Cue subtraction: Purposefully consider whether the challenge at hand is best addressed by removing a barrier instead of defaulting to the natural tendency to add a new solution.

Importantly, we agreed that if anyone felt the agreement was breached, they could raise a peace sign. This would trigger a pause in the meeting, allowing space for dialogue, a one-to-one conversation, or simply a break. This agreement will be revisited at all future meetings, revised as needed, and will serve as an important accountability mechanism as a part of our terms of reference (Delgadillo, 2016). With this grounding, we moved forward.

Reflections and Terms of Reference (Lite)

We then reviewed each other’s strategic plans, using sticky notes to respond to prompts such as:

• What stood out to you?
• Where do you see values or approaches aligning?
• What surprised or excited you?

These reflections were shared, themed on chart paper, and became the foundation for developing a purpose statement and set of shared values.

To develop our purpose statement, we reflected on the following prompts:

• Why might we partner?
• What are we hoping to accomplish together?

The purpose statement drafted was as follows:

To create an international partnership where we are seen as a resource and leader in catalyzing system-level change to facilitate the meaningful engagement of people with lived experience of health system encounters into health professions education.

We reflected on the values that we wanted to underpin our approach to amplifying the voices of people with lived experience, voices historically excluded from the systems that affect them most: collaboration, generosity, care, humility, humanity, striving to be elite but not elitist, and working at the intersection of love and outrage. Working at the intersection of love and outrage is a phrase from Patricia Deegan (2011) about peer support that captures our commitment to building more equitable and inclusive futures, embracing the joy this brings while recognizing that working equitably within hierarchical systems is hard work that demands sustained effort and holding systems to account.

Articulating our values at the outset of the partnership will enable us to engage more effectively in values-based decision-making. It will also serve as an accountability mechanism that will allow us to assess how well we are upholding these values as our work unfolds, whether through reflexive practice or more formal approaches such as Principles-Focused Evaluation (Patton, 2011).

Looking Ahead

Next, we engaged in a visioning exercise, which involved reflecting on what we want to have achieved in five years.These organically took the form of system-level changes.From there, we worked backwards to define what needed to happen in three years, and then in the first year, to lay a strong foundation. Concrete ideas emerged around grants, publications, and presentations we could pursue together. At the same time, we reflected on how to live our values as we pursued these opportunities. Questions we grappled with included:

• Who is represented in our group? Who is missing? When should we expand the group to include more diverse voices?
• How can we ensure our partnership is recognized as valuable within health and academic systems, while staying rooted in communities and amplifying the voices of people with lived experience?

These questions are consistent with the practice of critical reflexivity, which involves reflecting on our positionalities, how that shapes what we come to know, how we come to know it, and the limits of our perspectives (Norton & Sliep, 2018). It means questioning the assumptions and perspectives that shape our actions, so that we can act not according to the status quo, but in ways that align with our values and contribute to more equitable and inclusive futures.

We acknowledged that our five-year goals were ambitious and would require us to be strategic, methodical, and intentional. In this context, we explored tempered radicalism as a guiding approach for pursuing system change while staying true to our values (Meyerson & Scully, 1995). As described by Meyerson and Scully (1995), tempered radicalism involves working within existing structures to advance transformative change by balancing bold advocacy with pragmatism and cultivating relationships that support sustainable progress. Through this lens, our discussion enabled us to chart a clear path forward that is firmly grounded in community while also responsive to broader systemic expectations.

After: Debrief

As part of our reflexive practice, we concluded the meeting with a structured debrief, using the Plus/Delta method (Brookfield, 2017), reflecting on what went well (“plus”) and identifying areas for improvement (“delta”). Overall, we celebrated the meeting and its energy, agreeing that it exceeded expectations. The only suggestion for improvement was that a longer meeting would have been helpful. Members with lived experience shared that the meeting gave them hope and expressed gratitude for being part of a community rooted in shared values. We collectively agreed on next steps and look forward to the path ahead. Together with our pre- and in-action reflexivity, this created a full cycle of reflective practice that strengthened both our process and our outcomes.

Conclusion

We encourage you to reflect on how these strategies might guide your own efforts to establish international, values-based partnerships. Asynchronous preparation, structured communication, and reflexive practices can support such partnerships by enabling cohesive collaboration across time zones and contexts, ensuring that diverse voices remain connected and engaged. While much of our work was conducted in person, these strategies are also effective in online or hybrid formats, further expanding opportunities for global collaboration. When grounded in co-produced processes and shared values, international partnerships become not only possible but transformational.

References

Brookfield, S. D. (2017). Becoming a critically reflective teacher. John Wiley & Sons.

Deegan, P. (2011). Peer staff as disruptive innovators. Pat Deegan. https://www.patdeegan.com/blog/peer-staff-as-disruptive-innovators

Delgadillo, L. M. (2016). Best practices for collaboration in research. Family and Consumer Sciences Research Journal, 54(1), 5–8. https://doi.org/10.1111/fcsr.12175

Li, T., & Tang, N. (2022). Inclusive leadership and innovative performance: A multi-level mediation model of psychological safety. Frontiers in Psychology, 13, 934831. https://doi.org/10.3389/fpsyg.2022.934831

Meyerson, D. E., & Scully, M. A. (1995). Tempered radicalism and the politics of ambivalence and change. Organization Science, 6(5), 585–600. http://www.jstor.org/stable/2634965

Norton, L., & Sliep, Y. (2018). A critical reflexive model: Working with life stories in health promotion education. South African Journal of Higher Education, 32(3), 45–63. https://doi.org/10.20853/32-3-2523

Ortega, Y. (2023). Charlas y comidas: Humanising focus groups and interviews. Qualitative Research, 23(5), 14687941231176947. https://doi.org/10.1177/14687941231176947

Patton, M. Q. (2017). Principles-Focused Evaluation: The GUIDE. Guilford Press. ISBN 978-1462531820.

Schmutz, J. B., & Eppich, W. J. (2017). Promoting learning and patient care through shared reflection: A conceptual framework for team reflexivity in health care. Academic Medicine, 92(11), 1555–1563. https://doi.org/10.1097/ACM.0000000000001688

West, M. A. (2000). Reflexivity, revolution, and innovation in work teams. In M. M. Beyerlein, D. A. Johnson, & S. T. Beyerlein (Eds.), Product development teams (pp. 1–29). JAI Press.

Table 1.