My name is Tara McGinnis and I am delighted to invite you into the physical and virtual space that is New America for folks who are unfamiliar with New America. We are a Washington DC based think and action tank dedicated to revitalizing the promise of the ideals of America and the digital age, we could not be more excited about our guests today. Across New America we have a number of teams that are focused on bringing all aspects of public life and public public policy into the digital age we have teams that work. Digi on digital governance we have teams that work on bringing technologists into government. We have a team that I lead called the new practice lab that focuses on how we use technology for family. Economic security but here today. There are a few people who I've learned as much from as the, the minister of digital governance in Greece over the past year and so I'm, we're going to turn most of the session over to, to him to hear some presentation and dive into questions about your work and what the implications are for the United States. I can't say enough about how grateful we are to be here, but also the kind of the fellowship and learning so I want to say a few moments about karyakos PR cocky, the minister of digital governance in Greece. In a very unique capacity he is both a computer scientist and a full scientist, someone who has been leading on both the technology side as well as the vision. And the work that's been taking place you'll hear more about from him, but has been an inspiration not only in the forward looking nature about how you can smooth the life experience of resistance, but also in how you can build trust and government along the way. I think having picked up the New York Times, some point in 2020 and read a headline, suggesting that in the surprising in a surprising way, Greek citizens are very satisfied with their government covered response. I was inspired to speak to you and the team about the work so I'm going to turn it over for presentation and let's hear more about your work directly but thank you for being. Thank you for the invitation is a great joy to be here needless to say and let me kick off by saying that your book the book that data doesn't McGinnis and Hannah Shank road on public interest technologies power to the public has been an inspiration for the great government for myself personally for my team and it's actually mandatory reading for my team so thank you so much for this and it's a great joy to be here the New America Foundation. The work that we have been trying to do is very much in parallel with what you have been trying to describe in your book how governments haven't been provisioning public services in the manner in which would be ideal for citizens. And that's what we have been attempting to do in the last three years in Greece is effectively to change the way citizens are served in the context of their life events. This means that life events are structured basically from the government's perspective from the state's perspective rather than from the citizens perspective and technology can enable you to change this this is your vision. This is our vision and this is what we have been trying to attempt. Let me begin by quoting two numbers, the change in two numbers of our KPIs are key performance indicators to showcase what we have achieved in Greece in the last three years. The first one is the number of digital services provided. And there we started effectively having learned a lot from the UK experience from the government digital service of the UK in 2011 the gap that UK experience. We created a similar portal, got that gr. And what we wanted to do was to aggregate the pre existing services of the Greek state to begin with how many services do we have. Do they work well where are they should they should be on a single point of reference. This took us nine months we found out that we had 501 pre existing services. We added two more on day one. So 503 the rule according to which we added services we said would be the Pareto rule, meaning that 20% of the services generate as a rule of thumb. 80% of the traffic. So effectively we wanted the most frequently used services, being the ones that we will start from. So 503 in March 2020. And as of yesterday 1398 services. This means that if you look at the curve, it's effectively one service per day provided including weekends. And that manifests the scale of the work conducted by our engineers by our service designers by our UX designers by the people who are engaged in this project. Now the second number I think is even more interesting it's even more important. It's digital transactions now we can have a sense of how many times a Greek citizen interacted digitally with the Greek state, the tax services excluded from this analysis, because this was digital, even before us, we have a Greek citizens have to file their tax digitally for more than 10 years back.  That's a policy that started around 15 years ago and it's a policy that remains to this day. And it's a success because which is interesting here is that every Greek citizen has a digital idea for the tax system, which we then use which we then instrumentalize for a series of other digital services. Now, we can have a sense of digital transactions effectively by adding two numbers up. The first number is how many times you logged in the systems. How many times you logged in the systems either using the tax credentials that I mentioned which we instrumentalize further, or the authentication of the banks of the Greek banks which you have which for which we have allowed use for access in our digital public services we accept them as equivalent the European directive enables us to do so. Bundling those numbers is the direct logins but there's also a second number vis-à-vis how many times one is served interoperability. Now Estonia has X road we don't have X road but we have a version of it, we have an interoperability center. So the calls in the interoperability center are equal to physical visit not made because the Greek state already has access to your data. So the green light will obtain access to your data through the interoperability center, and effectively this is the one so only principle that Estonia has originally conceived of. So by adding those two numbers up you have a sense of digital transactions. So how how did those transactions evolve in the last years in 2018 there were 8.8 million digital transactions in 2019 there were 34 million. In 2020, there were 94 million digital transactions and in 2021, there were 567 million digital transactions. And if you do, if you look at the numbers the curve is purely exponential. Now, COVID played their role of course in the usage of such services because it was the demand catalyst. Governments had to ensure government continuity in the same manner in which businesses have to ensure business for the year. The claim here would be that it's the previous number the availability of digital services in the core life events, which was the driver for the exponential evolution of this number effectively, it was a supply, I would say, change primarily and then a demand change. So overall those two numbers if you look at any poll in Greece right now in the policy areas and the satisfaction of each policy area. So there's a consensus in Greece that digital transformation of the state was an unexpected reform. It was the vision of our Prime Minister Kiriakos Mitsotakis and it's a reform which we're delivering to citizens, and where results are being made basically every day because one new service emerges every day. Now the question is, how did we do this, apart from how we plan to continue building in an agile manner, the new services that we want to add every day. So the first lesson is preparation. We started more than a year prior to the national election. Our last national election took place in 2019. So imagine us starting mid 2018. The then leader of the opposition now Prime Minister Kiriakos Mitsotakis had personal experience on them on the topic because he used to serve previously in a previous capacity as a minister of administrative reform. So the government was part as it was called then it was part of his portfolio. But as he said to us, he felt that he had the remit but he didn't have the tools that he wanted. So effectively, when the Prime Minister created his cabinet in a very symbolic move he decided to abolish the ministry that he previously run to create a new digital ministry were effectively while we were naming it and designing it we knew that digital was not exactly the proper title, because digital is the means as you say in the book it's not the goal. The goal is service design the goal is public interest technology the goal is to change the experience of citizens when they interact with the state it's not about the technology. It's it's about the experience and about how to change things. So effectively if we conceive of the status three things structures processes and human resources. We decided to get processes out of the traditional ministry of public service or interior as we say, and create a ministry around process simplification, digitization and telecom of course being part of that mix. So the digital governance ministry was created. It took us a long time to learn the lessons from other places and the lessons from our previous experience. We looked both at the horizon and at the landscape. The horizon being, okay what is Estonia doing being the most digital of states. We studied Estonia of course but we realized well we were studying it that it's more a compass, rather than a map. It's the end result it's it's where we want to get, but getting there, the path is not the same. The government digital service that I mentioned before was a closer example of the UK to the Greek experience. So we brought people over from the government digital service to help our delivery unit and train them at the beginning. And in that process, we mapped all the digital organizations that existed previously in the Greek state up until 2019. And as you can imagine, as is the experience in all places, the way digitally evolved in the previous decades was that at some point every department of organization every ministry, in our case, had a digital department, doing the digital things of that organization, digital education, digital health, etc, etc. So we had to understand how to deliver change at speed in that scale for a horizontal policy portfolio. That's a challenge. So we decided that one we wanted to adopt a centralized model for a counter in the size of Greece that made sense. The population of around 10.7 million citizens. It made sense to have a very strong ministry of digital at the core of government. Another lesson that we learned was that in the governments and in the countries where we had success at speed. It was primarily because at the end of the day the project had the remit had the personal interest of the head of state or head of government, depending on the policy architecture of every country. So in our case, that was the case, our Prime Minister had previous experience as I mentioned, so we decided to build a very strong organization. So in effect, we knew previously that our cloud services, for instance, we're part of the Ministry of Finance, our delivery unit was another in this center which previously belonged to the Ministry of Education. We had another cloud and delivery unit together infrastructure at the Ministry of Labor. So all these organizations are election took place on July 7 2019. On the night of July 8 Monday, July 8 2019 all these organizations became part with the presidential decree of the new Ministry of Digital Governance we were ready before. So the button was pressed 24 hours after the election and the new organization was created automatically. So we played a huge role. And what also played a huge role were three policy decisions at the beginning, which in my view were extremely instrumental. The first one, and those decisions became part of our legal system that were passed parliament 10 days after our new government was created. The second one was the centralization of procurement. The new Minister of Digital Governance was endowed with veto powers on all significant procurement on digital across the state on the basis of fitness with a digital strategy which we would be developing. The second policy decision in my view the most critical was rendering the Minister of Digital Governance chief information officer of the state. And by name but in content. And by that I mean that the Minister of Digital Governance in Greece has the capacity to interoperate any data set with any other interoperate any data in order to in a sense, offer a better citizens experience in while we're trying to redesign life events. And the third one was that we made a decision that all data will be centrally stored on the governmental cloud, unless we said so unless we allowed for that not to happen. So those three policy decisions happen at the beginning of our government's tenure and in my view politically, this was crucial in order to be able to then deliver the results, of course having the proper team on the ground also played a huge role. We instrumentalized that previous year in order to headhunt and in order to know whom we would be collaborating with in the context of the Greek public service. This was again extremely important because we have extremely talented people within our public service and we empowered them with the creation of this ministry. And then we started delivering results nine months later, the government portal was created in our view the core reform. But COVID came in exactly nine months after we were into office. And then reality there we had a dilemma. There is this phenomenal essay which I strongly suggest everyone reads the Prime Minister and my team. Interestingly enough we read it simultaneously and we exchange the essay on what type on that day. It's an essay by Yuval Harari on the FT at the beginning of the pandemic. It was interestingly named after the pandemic, even though the pandemic was just beginning. And there Harari points out the dilemma that governments will face saying that from our experience, after a couple of years the pandemic will be over but what will remain are your policy choices on the ditch primarily on the digital front this time. And there is a core dilemma between empowerment and surveillance he says it's as clearly. So our decision as a government was obviously empowerment, because in effect we had a pre existing strategy. The strategy was, let's change the way citizens are served by the state. So we took that policy decision and we rendered it a tool to battle the virus as well, because we knew that as we're digitizing public services in a state which is quite conceived as being bureaucratic additionally, with lots of steps on a life event. If you simplify and digitize at the same time effectively you're eliminating interactions and doing that during a pandemic, that's a strategy. So we did that. And in reality the core life events of citizens are currently a part of our government portal. I'll use one example vis a vis how we have approached our work showcase how similar it is to the philosophy that you point out in your book, birth of a child. Prior to the portal the first event that we decided to simplify and digitize symbolically was exactly this. So it was a five step process up until February 2020. You obviously had to go to the hospital. You had to go to the citizen service center to get a social security number in Greece for the for the newborn. You had to go to the pension fund of one of the parents to have a social security enrollment and coverage. You had to go to your local city your local municipality for registration for the official registration, and we had added the fifth step, which is a stipend which we offer 2000 euros stipend for newborns on the basis of income. So five steps, and the parents are typically very happy when they have a child so they don't notice them, they notice them in other more problematic events of their life. Unfortunately, we figured that this was a great opportunity to prove the concept. So we'll prove we try to prove the concept and we did the following now, when a child is born in Greece, aren't received two messages, the first message being congratulations, and the social security number for your child is this, and the second message or it can be an email. And the second message is whether or not they will be receiving the stipend, telling them that it's automatically credited to their account. And in a sense it's the first smart social policy design that we have implemented this work miracles, this is what we have been trying to do on all other fronts. On certain things we have managed to simplify and redesign more quickly than simply digitizing but COVID forced us to do a little bit of the latter as well, but still the whole policy right now I think is running at speed and the scale as I mentioned and to add another point to this the vaccination process for us was a core, I would say policy decision on the overall digital agenda of the government because in reality we viewed vaccination as a service design experiment. And this is exactly what was the decision of the Prime Minister and of my team. We wanted to have a multiple channel approach we wanted to have predictability that you would know when you would be vaccinated and where. And that when you went to the vaccination centers you wouldn't experience long lines of people waiting, it would be maximum half an hour. And given the fact that this was the most difficult logistics exercise for World War Two. That was a challenge we had to develop the system in seven weeks. The Greek citizens view the vaccination system as a very big success, exactly exactly because we managed to achieve this multiple channel approach just namely, we had the obvious digital platform that worked where you could book your two appointments for the vaccine. We had the second digital platform, which was our e-prescription system during COVID we launched, we already had the prescription system, your prescription associated with your social security number but only doctors had access to this not citizens.  We changed that and you received your prescription on your phone with a QR code. So we said that if you're enrolled on that system you don't even need to go on the platform you will receive an SMS telling you what your proposed appointment is on the basis of your zip code. And on the basis of course of your other characteristics, your age and or your health condition, because the e-prescription system has historical data for 10 years. And we can reverse engineer them on the basis of conditions, so our vaccination authority did that. So the two digital channels played a huge role, but we didn't only have digital channels because service design is not only about digital, digital is the means. We also had physical channels for those who are not digitally skilled. And there we either used the citizen service centers, we have a thousand degrees where you could physically go and book your appointment. Or, and that was I think one of the best decisions that we made, instead of using call centers which wouldn't work. And we saw them not working in many places around the world. We instrumentalized the pharmacy stores in Greece, which are 11,000. They have an SME structure and like the United States and all pharmacy store owners are credentialed in the prescription system. So we said that if you don't want to book your appointment for the vaccine online yourself, you can go to your pharmacy store in your village or in your city and have the appointment booked for you. So overall it was a very coherent system fully digital. And it's very interesting that, as again, is pointed out in the book. Sometimes the simpler technologies play a more significant impact, have a more significant impact. And when we discuss with citizens what has played the biggest role in their impression about change overall in the Greek state. They quote, amongst other things, the SMS that they received, when they received their first job of the vaccine, exactly because the system was fully digital, they automatically received an SMS notifying them about their second appointment. So many told us that this was exactly where I felt that my state is working really well, and it's changing in the process. Now, overall, this whole process again, those projects are a function of the work of a very large team of a service delivery unit of contractors who have changed the way they operate within the context of our strategic priorities. Our digital strategy is public. It's called the digital transformation Bible. The document is interesting. It's in Greek, but the document is interesting exactly because it's not solely strategic. It's an implementation plan which codifies 448 specific projects that are going to be implemented by 2025. They're not the only projects because of course, we have crisis we have new priorities, but we will certainly fund these projects. And because it's not only about the screens of code but it's also about the books of law. The digital law which passed the Greek Parliament in September 2020. And I would say that in a quite rare for our standards manifestation of bipartisanship, the equivalent of 275 MPs out of 300 for political parties. My party and three extra parties voted for that law. And in effect, it's a digital constitution of Greece includes all facets of digital transposing European directives on telecommunications and open data. Our governance and identity, digital identity, digital signatures, and the full scope of policies like the policy, the innovative policy that we have had on the deployment of 5G networks in Greece, everything is within that law. And for us it's extremely important amongst other things to answer the challenge of continuity, which is as we're reading the experience of other states amongst other places the UK. We see that continuity of that policy is a huge challenge that needs to be answered. And by definition for to answer this, this needs to be part of the political system of every country overall, because at the end of the day it's more of an infrastructural discussion that we're having on that topic. On a final note, the whole strategy that I tried to describe is agile in nature so our plans for the future is to continue delivering services, which we haven't yet managed to do so because some of them require larger procurements, rather than quick wins and smaller services, but we're getting there and at the end of the day our goal is in 2026 to be digital by default. Again thank you so much for your invitation here and I'm obviously much looking forward to the discussion. Thank you so much and I think you covered a lot of territory there in a short time. Maybe I'll start where you ended I think that then the speed and impact of your work is unique, because it lies at the nexus of not only service design, but they're also of lawmaking I think you mentioned the 2020 law. And as digital governance, the growth of service design, new teams and shops that local and federal level across the globe advance, I think often this is thought of as a separate entity from where we make policy at the legislative body or an administrative process I'd love to ask you to open that up and talk about how much was, you know, the legislative powers you have, which I can just, we're in a virtual environment I could just hear, you know, 30 engineers and designers and policymakers say, you have total governance over you know, you can you can interoperate data. These are kind of long in the United States so many of them are interagency agreements to get a fraction of what the four powers are but I'd love you to kind of tease out how much was the governance structure and the not bipartisan quad part, you know, you know, shared goal from a legislative body mission critical to the work you've done. I'll answer this in a tweet. My legal team is equally big to my delivery team. And I think that speaks volumes about what we have been trying to achieve. The former president of Estonia Thomas Henry syllabus was extremely kind to act as an advisor at the beginning of our tenure, and to me personally and I always try to find the opportunity to thank him for that. And one of the quotes, if he doesn't mind me quoting him that he one of the phrases that I remember from his advisor capacity at the beginning was that when we were designing this plan and he was our let's say closest person where we present and said, does this work or not. He said that more or less your first year is going to be your year of legislation. And the next years are your years of coding, as a rule of thumb, you will need to legislate again and again and again in the process. But you need to get the legislation right you need to get the responsibilities right if you don't get them right. You won't manage to achieve the results that you want, because in reality here as you mentioned, we're a very strong digital ministry my colleague, my Italian colleague with audio call out was this minister of Italy and the former CEO Vodafone. We were at a conference in Italy, 15 days ago and he said that the Greek digital ministry is effectively the strongest digital ministry in Europe. He's right. We designed it, our prime minister and ourselves designed it as such on purpose because we wanted to get the results very quickly. Policies are like transplants. You need to have donor receiver compatibility. You don't have a one size fits all approach. This wouldn't work in a federal system. But what we're trying to do and what we try to do when we studied on that previous year Estonia the UK, the US, Argentina, New Zealand, Australia. That was to be inspired by those would say policy designs and then try to get the lessons out of them. And with an acute understanding of which domestic political system to have the optimum policy design for digital here in a sense you need. I think that was the support from a camp from a political campaign here but anyways, you need the knowledge of an insider and the mindset of an outsider in order to be able to deliver results in that manner. Thank you. I thank you so much for that presentation which I have like 1000 questions for you. And I'm going to pick one to start. As you were talking I couldn't help but think about the fact that I would imagine that democracy governance and government, it's are somewhat in the lifeblood for Greeks, and so that maybe citizens are coming from a slightly different perspective than in this country where we're all about privacy. And, and also maybe not as committed to certain forms of government. I'm curious to what extent do you think that the fact that that sort of that culture factors into all of the great work that you've been able to do like is the appetite, would you say for Greek citizens. Is there maybe more of an appetite for experimentation or just like more of a core faith in government that we might not have in this country. In reality, I think that, you know, our, our strategy was delivery of services. And by that I mean that overall we were trying to solve for a very large problem so if you looked at any poll in 2019 and ask Greek citizens, what are like your top three or four access bureaucracy was always topping that list top three. So in reality, we're trying to solve for a chronic condition that the Greek state has faced since its conception. So this by definition, replying to this to this challenge is by definition something that Greek citizens are endorsing every country has privacy concerns in Europe we have the general data protection regulation as you know, and we have a very strong privacy regulator in Greece with whom we interact extremely closely and we try to check all our policies and or our solutions with them so that they answer the GDP are properly. But having said this again, if the problem that you're trying to solve is quite big, then I think that you know solving it is the answer itself and this is why Greek citizens are endorsing this significantly and part of the answer is also that this reform was quite unexpected if you look at the dimensions of digital in the way they're measured by the various indicators indices throughout the world effectively, it's for things right, it's digital public services telecommunications it's digital skills, and it's the penetration of digital in the private economy. So if we pulled Greek citizens in 2018 out of the four, where do you expect to see most progress in the next four years, no one would reply in digital public services. The unexpected nature of the reform plays an all as well. I think. I think, even with low expectations you have, you know, you have gone beyond but I think this this point worth is worth bearing a little more that globally, right, citizen trust in government whether you're in Washington DC, or in Athens or is that a kind of epic low for Greece this was distinctly so say a decade ago right I am. I was reading last night at 2011 transparency international studies saw, you know, a decade ago, nine out of 10 weeks, you know, believe their, their politicians were corrupt I think the, the capacity to turn around here is worth like stopping and meditating on, but I also want to ask you, you know, what are the signs you felt in from tweets to the, to the ministry to, you know, what's coming up in qualitative work that your service deliveries. What what shows you that citizens are changing or do you have any, you know, connective data between trust in government and some of the service service design projects. At this point, it's more of a hunch, plus certain data that we have in mind like the polling that I mentioned before vis-à-vis acceptance of this policy of this government it falls in the 70s, in the 70% so the fact that people are endorsing this in every poll that we look is obvious, but we have the same sense that you do that this acts as a trust catalyst now. In my previous capacity I used to be the director of research of a think tank in Greece and I remember implementing the world value survey for Greece. And we compare the data on trust of the world value survey with other places like the Scandinavian countries in Europe or or close neighbors in the Mediterranean. And I would tell that Greece was quite low in the trust indicators I mean not only trust or its institutions even societal trust. In our view, this is one of the core elements that we want to change in the coming years, reestablishing the relationship between the citizen and the government and the state and the way the public sector works is part of that of the answer to this problem. So we feel that this policy acts as a trust accelerator as I would say, as a policy that induces trust, adds trust on behalf of the citizen. But still I think that we need to be extremely careful about, you know, the delivery of this policy, because if you remember this game called Janga, where it's very difficult to build the edifice and very easy to have it collapse if you remove the wrong brick. So we need to be extremely careful about how those services are constructed, and how trust is catalyzed and how use what vocabulary you use in the delivery of such services. For instance, you mentioned experimentation experimentation is generally not very it's closer to the American culture than the European culture would say. But we need to learn to experiment. We need to learn from our mistakes we need to learn from failing. It should be part of the design. It's the feedback loop. We need to instill this in our vocabulary and in our communications with the citizens saying look, don't expect all services to be absolutely excellent on day one. They all have challenges but if the system is built well in 24 hours, we will have responded to the challenges also having seen your feedback. Some systems, as you know from global experience both domestic here and in every country, there are certain systems which never launch, even though they have been procured and even though they have been designed for months. So the experience is that all our initiatives worked and work well and this is why trust is catalyzed, but you need the feedback loop you need to be close to the people on the front line. You need to instill the culture of experimentation so that you develop this trust with the citizens and I think that this is part that would say of my job description. And this is part of a role of our goals as Ministry of Digital Governments. One thing that you mentioned that I would love to just hear a little bit more about are the citizen service centers.  So, this is the thing that comes up often when we're like, who could, who could do that here. And it's often the post office and then there's a, or the motor vehicle department of motor vehicles. And then there's a conversation about what that might look like and it sort of feels a little dreamy. And this is something that like you've now had for, I understand for quite a while and are about to sort of enter the next stage. So I'm wondering if you could just talk a little bit about how those, how the service centers came to exist and what's, what's in the future for them. So the citizen service centers are a reform that dates, they're more than 20 years old dates in the early 2000s. It was one of the biggest reforms that took place in the last decades. They reviewed very positively by Greek citizens, they were the outcome of the work of one particular politician back then Stavros Bernos, who designed and conceived of them, and started implementing them and then all governments built on them there was governmental continuity. They never though materialize their founding vision, their founding vision was that they would be the only place where a citizen would interact with government, as is our vision for God that you are by the way. They materialize this because around 1000 processes past the citizen service centers but not all process of the state, past under the remit. And this is manifested by the fact that in I mentioned the birth of a child, which was the life event that we simplified and it was a five step process. Had they materialized their full vision it would have been a one step process, solely going to the citizen service center. So then there are certain life events that still require you to do 10 or 15 things. So overall, we plan to do more or less what we did in the vaccine, we plan to leverage them, because in reality, what will succeed, I would say in every country, not only in Greece is the multiple channel approach. You need to have digital, digital channels and you need to have physical channels for those who are not digitally savvy, or in the life events were certain physical physical presence is required I mean in Estonia you remember three things for three things you need to physically appear in the public services, getting married getting divorced buying property. Some services will remain physical so there you will need a physical one stop shop. But apart from that, we plan to do in effect the vaccine model, which means, as we said in Parliament when we were delivering the vaccine service we said the vaccine is not only about the vaccine the vaccine is about everything. This was exactly the message that we were trying to convey. So overall got that GR will be the new face of the state for all services, and the citizen service centers that we call kept will be the equivalent where physical presence will be required or if you will want voluntarily to appear in public services. I would love to talk a little bit about I think you know, in the United States, President Biden in December put out an executive order on customer service quite quite deliberately I think not on digital service to the same point of meeting people where they are means to an end this kicked off a series of processes at a bureaucratic level, including one which is at the front end of what you've been up to looking at life experiences. As a child, leaving the military turning 65. I wonder whether you have advice on the back end of a folk of a two year focus on life experiences for the, you know, the leaders that agencies who are at the front end of thinking these, or whether there's any specific story, digging into how you went from four touch points around birth to receiving a letter or an email, you know, either kind of stories from the field of birth life experience in the Greek, and also advice to some of your peers and counterparts here in DC who are working on similar effort. So the, the overall principle in redesigning life events and changing the experience of citizens is that ideally. they come to you rather than you coming to us. This is what we tried to do for the vaccine. That was the message, for instance, that if you're enrolled in the prescription system you will receive a message. This is by the way, another inspiration that we have from your book, where you mentioned the story of citizens receiving their via SMS and invitation to do their exams. So basically being inspired from your book and augmenting our prescription system we plan to launch this this month in Greece. So citizens will be receiving invitation to do specific medical exams on the basis of the pre existing conditions because we have a very interesting data set as I mentioned the prescription system data set. Now, overall, another lesson which I think is also part of your work is that you need to have interdisciplinary teams. That's an absolute necessity, you mentioned that you need to have lawyers, you need to have economists, you need to have policy experts, and you need to have public interest technologies, both engineers, and people who know technology policy and public interest technology on the table and they don't, you need to know people who understand technology not necessarily people who will write the code themselves, ideally you will have both. So for every life event that we were trying to redesign, we have an interdisciplinary mix of people on the table. Certainly at the end of the day, depending on the event you need to have a business owner. So you need to have an organization that will have the ownership of the change or the reform. On many cases, especially at the beginning as we were trying to change this culture in the Greek public service. The owner was us, and we were doing it under the Prime Minister's directions. So effectively, we were trying to do this centrally, but after some point after we managed to prove the concept. Various organizations started doing it themselves. So we're there to catalyze this for them. They decide the what we decide the how the mechanism through which this happens. Exactly because of the fact that birth of a child was the first change I have many stories, most of which I cannot share, but amongst the ones that they can, even though the law was voted. Even though the ministerial decision was signed, even though the technology was there and the program was there. And even though managerial books urge you not to micromanage, I had to micromanage in order to have the delivery of the service so my office had to call all hospitals in Greece to check. They're not that many. I mean, given the size of the country. They're not that many, but we had we called all of them. We asked all of them whether the system is working if they have comments. We told them that the plans to work tomorrow. We called all registries in all in all relevant municipalities to see whether or not it would be working. We had challenges with certain amongst them. We had to call all of them and call them again and iterate back and find all the problems that they were facing so that the system would work. Making a policy decision, having a system created or having a law passed is not enough. All those are necessary conditions. The managerial equation and the implementation equation at the end is the sufficient condition. So, in a sense, after you get everything right after you have all the laws passed all the policy shape the interdisciplinary team on the ground. Then it's time for perspiration. And then it's time to pick up the phone and see whether or not the policy is working on the ground and what you need to change so that it does. I appreciate your candor because I think, and especially for those of us who are in the smoothing and moving into the internet era. Sometimes you have to call the hospital is a good reminder of the task lie ahead for our team. I really do want to pivot and I'm looking over at Hannah to see whether there are some engaged questions from the audience to raise this up. But just to anchor in the life experience here in the United States and how I'm sort of queuing you up for audience questions. Next, you know, 40% of births in the United States are paid for by the US government, because families are too low income. That is an actually a very sophisticated payment system. You have to independently have a, you know, quasi close to your, to your benefit dependent $2,000, you know, or to your Euro infusion.  But it is a fully real about realizable vision.  We know who she is we know she's validated for her child tax credit you could send her in real time like these are not impossible dreams for us in the United States. I think thinking about what are, what are the interesting openings where we have as you thought, oh wow the pharmacies are a footprint, what are the footprints we have that we can vision life experiences differently but there's a ton to learn and I and I really want to encourage there is I think a bootleg version of your vision in English which I'm happy to make sure that some of the government officials here have a chance to look at because I think you are ahead at thinking through particularly this life experience of birth. So are there are there questions from the crowd, I have plenty more questions so if there aren't happy to use the chair of the mic but do you have questions from there. There are questions and I know I'm weighing like do I want to just ask my own question or these are also good questions. We got a question about how deep is the digital transformation in terms of reengineering or even reinventing government, or is it more the type of low hanging fruit in times of covid. I would say we did both to be fully to be full candid. So in a sense part of it is extremely deep because if you look at the policy changes that I described at the beginning, the new organization, the powers that we end out the ministry with all of those things are quite structural. And they will remain so, but there are certain things which were absolute low hanging fruits and quick wins, but low hanging fruits remain low hanging fruits until someone grabs the fruit. So, certain of these have been low hanging fruits for decades. So in reality, and they were not because of covid. My covid effect in reality was to catalyze the demand for certain services, but it helped that the delivery unit was there. The team was there, the responsibilities were aligned. The strategy was there, and the budget was there, because what I should mention in this debate is that as we were structuring our digital strategy the digital transformation Bible we had the debate with all departments of the Greek government. Originally we conducted a gap analysis, and we tried to see what systems are missing so we had any prescription system, but most of Greek hospitals didn't have the system that we would want them to have. So, having seen the full gap analysis in 2019 we didn't, we purely didn't have the budget to do 100% of cover 100% of the distance. And then covid came and covid held, especially there because there is a plan in the European Union called the RF, and this plan effectively budget wise it's a Marshall plan for our times for the European Union countries. 20% of the plan in every member state of the European Union is budgeted towards digital increases 23%. The plan did for us is that it enabled us to finance 100% of the outstanding elements of the past, and even go into the list of things that we want for the future. So right now we have a very, I would say coherent strategy vis-à-vis what we're going to achieve. Most of the low hanging fruits have been delivered. So now we're in the, in the process of doing significantly designs of services, which of course citizens are truly endorsing. All right, you want to, I also I will just open it up, please, please submit your questions. I want to ask a question about leadership, unless they're that you have other ones ready at the ready. I was really struck by the history of having a prime minister who saw the shortfalls and opportunities of the bureaucracy. In the book we talk a lot about the importance of political leadership from the top understanding the front lines. I just like to kind of tease out the ingredients of, you know, is can you do this at a technocratic level alone. Tell us a little more. The answer, the answer I think the question is, the answer to your question is obvious. You need both political skills and technical skills in this equation. And you need the vision, you need vision at the top, you need political leverage at the top. So it was very important that Kyriakos Mitsotakis, your prime minister, had the experience on that field and understood what was missing so that you wanted to create such a team that would deliver such a project. It wouldn't have happened otherwise. But having said this, when will you go into the delivery unit and you go into how this policies implemented. Yes, when we passed the three policies that they mentioned the policy on data the policy on the government platform and on the new services on interoperability on procurement, all of those things. One can think that we have all the cards in our hands. Yes, but this is not where the story ends it's where the story starts. You cannot impose digital policy on other departments. It's very useful that we have the cards, but it makes the debate more productive and it makes, in effect, the outcome closer to fruition, but you cannot do it without other departments you cannot do this without political deliberations. You cannot do this without an extensive iteration process, but at some point the iteration process ends at some point someone makes a decision, and at some point, the policy is delivered. And this is why we decided to have this model. I want to open up for any more closing questions how I can see jumping in. Yeah, we have a related question actually to what we're just talking about, which is how hopeful are you that the current momentum will endure in an uncertain future I political changes new policy directions financial strains great question. Politicians are not good at making predictions as you know, we should be good at making what we feel should happen happen. We should be good at delivery of results. So in my view I have you this question as a challenge. This is what I'll say so in reality, we should try to guarantee continuity to the maximum extent this is why we tried to get bipartisan support, even though we didn't need it we have an absolute majority in parliament, but we wanted it not only for symbolic purposes we wanted everybody's commitment towards this significant radical change happening at the core of our government at the core of our state. So in reality, this is the core challenge moving forward. I want to give you a moment to reflect on, you know, in an unstructured way if there if there's a single piece of advice, you give to your peers in Europe to your peers across the globe to us here in the United States as we embark on the smoothing of life experiences. So that may be my final my final question to you is your reflection is advice to two others who may be at a much earlier stage in the chain. Don't even think for a single moment that you cannot do it. It's absolutely feasible to deliver the this project, but the path for delivering it is singular. Each one has a different experience. The end goal is the same, what we need to deliver, but the path will be different for each one of us. We need to be inspired by one another we need to learn from each other's successes and failures and to be very candid about the latter. And but at the end of the day, you know, if you do your homework, if you prepare in advance if you have a good team which is interdisciplinary. The leadership at the top, as you mentioned, then you have all the core ingredients there, and then you can deliver significant change at that level. Maybe I'll close us out by saying when Hannah and I were writing power to the public was around the same time when you were gathering an army of folks envisioning a new way that digital governance could take place in Greek, Greece, and the core pillars in how we talk about what we see as the kind of next level of work, anchoring deeply in and designing for for citizens for residents using data in a way to say oh 80% of our, you know, action is over here or this is what matters most using data in real time to see how you're making progress. And the third is whether you call it experimentation or you'd call it trying and failing or you have the ability to constantly learn, which I've learned a lot from you in this book, I can see that you've espoused a culture of learning across the agency. These are the hallmarks of what we say that kind of the excellent looks like you have built in your work. A profound example of what we write about as should be done in the book after interviewing hundreds of people around the globe so I'm excited for the Princeton press is already on us about a next edition and I feel confident. There's an ability to articulate the story of the work you've done in a moment in a really important moment of crisis so I really wanted to have the chance to say, it's, you have some people working very deliberately on one of these three areas of the sphere, but the ability to say this is not at all about digital governance that's serving public that this is a Jenga house and you could explain it. It's really excellent on your covert rollout, but destroy something for the next generation of thing you haven't thought of the level of sophistication, a few in the team and actually the broader ministers. It is really I think inspiration and inspirational and in a moment like now where we're asking ourselves, you know how can we be doing better at serving our citizens than the United States. The answer is we have a long way to go it's a real inspiration to have you here. I hope we will be in an ongoing conversation about what inspires you, what you what you failed at what you succeed at you're headed towards your goal in 2023. But I just want to kind of there's no in a in a remote environment there's no way to kind of stand up as we would in the old days of numeric and and have some applause but I want to express my gratitude to you and the team for sharing your learnings with us today. Thank you folks really appreciate it.


Mugwump. Mugwump is an anglicized version of a word used by Massachusetts Native Americans to mean war leader.


I am Dr. Murli Raj. I am currently head of department of psychiatry here and I practice clinical psychiatry at the Manipal Hospital. Depression can be treated in several ways depending on the type of depression and the severity. Mild depressions often respond well to what is called as counseling or psychotherapy or the talking kill. You can just talk to them and make them see the other view point of depression that they need not be so depressed about the circumstances. Fairly severe moderate to severe depressions require medication. There have been a lot of myths about medication depression but the fact is that the medication available for depression these days given and used properly are relatively safe with hardly any side effects. They'll allow you to work normally in fact work more proactively and they totally change your life. So depression is not something you deliberately do. People often say you're welcome your depression or you're a snap out of it. It's not possible always. But do consult somebody for help and I'm sure when you reach out people will be there to help you.


i've actually never been to more scary books because i'm a wimp but let's hope i actually love some of these welcome back to my channel i hope you're all good today we're chatting about all the horror books on my tbr it was scary it was really scary so i did this a while back with all the murder mystery books on my tbr and it was super fun so i thought in time for spooky seasons spooky season is approaching we're all looking for some good horror wrecks i thought i'd do this video so maybe it would help you pick what books maybe you want to read in october and give you kind of a little bit of a sneak peek for some of the books i'm hoping to read in october i don't know how many of these i'm actually gonna get to but we're gonna we're gonna hope horror typically isn't a genre i read a ton of but i do enjoy it when i read it but also i'm a scary cat you guys i'm a fucking i'm a scary cat i'm a wimp don't really watch horror films the shining is the only horror film i've watched and the exorcist when i was three days old what my dad watched it and i was in the room but horror is always something i want to read more of i think horror and sci-fi are the two genres i know i always enjoy but i don't read a lot of so we're gonna go through all of the books that i own that i classified as horror now some of these you may think megan that's horror adjacent at best i think a lot of these are very much mild horror but all of them are classified as horror on good read so like i am right but they're very mild mild mild horror like mild horror we're gonna go through all the physical ones i own first for this quite a lot that i have on audiobook or ebook we'll go through them after this let's start with the one that i just received it is white smoke by tiffany jackson this is a haunted house horror book get out meets haunting of hail house so excited for this oh my god this is one of my most anticipated releases for the kind of latter half of this year you'll know i've talked about it quite a bit on my channel i very kindly received this from harper 360 y a this is an arc i'm not sure when this comes out oh hang on it's an american date 21st okay so i think this comes out tomorrow for me today for you watching this in the us but i think it comes out on the 30th of september in the uk i'm gonna be reading this in october i'm very very excited to get to it i'm ready okay whenever you're ready i'm ready okay i'm ready whenever you're ready i have never actually read a whole full length novel from tiffany jackson i do own groan tiffany jackson is just an author i feel like i'm gonna love like generally i think a five star author for me so i'm really excited to read this this is probably the only book that i'm like come rain come hail whatever happens in my life in october i'm reading this book a book on the flip side that i've owned for a long long time and has been a five star prediction for a long long time a book i've wanted to read for a long long time it is mexican gothic by silvia marino garcia i know that um this is about our protagonist's cousin has recently married into this family she's living with arspen's family and she contacts her saying like they're trying to poison me it's kind of a question of are they actually trying to poison her or is something wrong with her and her mental health and no me i think goes to go and investigate it said in 1950s mexico i've had so many good things silvia marino garcia is another author i've never actually read from before but i want to read all of their books already like i want to read all of her books right now i've heard this book is actually quite scary like i think mexican gothic is actually surprisingly scary there's something i know about it that i know other people know about it but people have told me off for mentioning it before because they're like negan it's a spoiler but like if you know you know and if you don't i don't tell you i'm just i have this idea if you get it you get it if you don't you don't if you know you know if you don't know like another one that i have heard really recently is the taking of jake livingston by ryan douglas this is about this boy who has always been able to see and hear ghosts but they've always kind of left him alone they've always just kind of been ambivalent towards him but then a serial killer ghost starts talking to him and is in his brain and i think we also follow the perspective of that ghost i was watching um live from a livery dilate speak about this and she read it she really enjoyed it but she was talking about how unsettling it is to be in that character's brain who we know has done these terrible things and like you're almost starting to understand the shitty life that he's had but like he's an awful person so like you don't want to sympathize with him at all i think there's a lot of trigger warnings in this i hadn't heard that until i watched Olivia's video but i've heard like pretty much every trigger warning you can imagine in terms of abuse and abuse for child is in there so like go into it if you're thinking of reading it with a lot of care but i i'm hoping this is another one i'm gonna read in october definitely another one i've wanted to read for ages is the luminous dead by katlyn starlin now i would love to read this in october because in november i am co-hosting the literally dead book club with books and lala and the book we're reading is katlyn starlin's new book the death of jane lorence i think it's called so i would like to read this first so that i know what i think of katlyn starlin's writing but uh this is about this woman who's like going deep underground on this mission the only context she has with another human is the human in her ear on this mission too and i think it's kind of sapphic between them but also we can't trust that other person really interested this this is like another i think five star prediction it feels perfect for this time of year so i'm hoping i'm gonna get to it but like i don't know if i am then another one i'm so excited to read is horrid by katrina leno now i can literally tell you nothing about this okay okay the level of unprofessionalism far too much because i just bought it because i loved you must not miss by katrina leno that was like literally the reason i bought it and i love the cover i love the flowers on the cover that's not a lie i know it's something about our protagonist like after her father's death moving house and there's something very unsettling about the house i think it's got the word ghost on the back is it are we haunted i don't know but i know it's going to be surreal and strange because katrina leno's writing uh so good this is another five star prediction but i literally know nothing so a super short horror that i'm very excited to get to is the woods always watching by stefanie perkins this is like a slasher of two friends who go on this three-day hike a detour leads them straight into a waking nightmare and then you do something far worse very excited i've heard mixed things about stefanie perkins kind of new slashery books but the trailer for there's someone in your house kind of got me not gonna lie kind of got me interested so i feel like this may be a good read um for october because it is so short and it's kind of like fun slashery ya and i just love the cover and the vibes of these books another one i think this is on the five star prediction list and all these horrors are on five star prediction list is the only good indians by steven graham jones this is about four friends who ten years ago shot an elk now a decade later these men are being stalked themselves hunted i have heard so many good things about this book it was really big like a year ago or so on booktube so i feel like i am really late to the party um because yeah this is like one of the books that i think i'm gonna love the most i just have struggled to fit it into a video i'm honestly looking at all these books and they are books i'm so excited for so like maybe i am a horror gal who knows who knows who knows um who knows who knows who knows this is probably one of the books i've heard the most good things about on this list so someone make me read it then i have another newer release is the final girl support group by gradey henjix so i've heard pretty good things about this as well this only just came out this is about this uh group of women who survived serial killers massacres um years ago and they have made the support group because like it's hard no one else really understands when you've been through that kind of stuff they've made a support group where they meet and talk to each other about how they're feeling and then one of them stops turning up it turns out that someone knows the group exists and wants to pick them off kind of one by one and i'm really excited for this i've heard a lot of people say that it's the kind of book you're going to like read in one sitting even though it's quite big it's like a super fast pace and it's got like some mixed media elements in it i think after every chapter there's like maybe like a newspaper entry or stuff like that i'm really excited and i've never read any gradey henjix i really want to read horror store my best friend's exorcism like i want to read all of gradey henjix stuff so i'm hoping this will be a good starting place then i have these two which are one and three number one and number three and i have a companion series but i don't think you have to read them strictly in order but i have hashtag murder trending and hashtag no escape which are these kind of dystopian horror murder novels this one is about where people vote on these executions that are like aired live and it's like a form of entertainment and this one is about escape rooms i think are aired and the and the contestants start dying gruesome deaths basically i think i got these both for my birthday at the start of the year so should read them soon let's go bitch why is she always late for everything i can't take it i picked these both up because emma from drinking by my shelf recommended them i haven't had a lot of people speak about them outside of that but i want to read murder trending soon hashtag murder trending because this is the first one and i think it's going to be like a very unique kind of like rompy horror like kind of campy horror and then the last physical book last physical horror book i own is pine by francine tune this is about a very like tight-knit community and lauren and her father find a woman stumbling along the road one night they take her back to their house and in the morning she's gone i don't really know much about it other than that this was a waterstones like thriller of the month which is why i bought it when i bought it i got influenced into buying it i often get influenced into buying their thriller of the month if it's something i'm like vaguely interested in but then i haven't heard great reviews about this one afterwards but something about it like the kind of like winteriness of it and bleakness of it gets me very excited i feel like horror is just such oh my god this is making me so excited for autumn and winter because it's so good for that kind of time of year i think i will be reading this pretty soon because i have a video idea that this will be in so i think i will be reading this in the next couple months maybe like in november or early next year and then let's just quickly go through the audiobooks and ebooks that i have i don't know as much about these so we're gonna like fly through them first we've got the last final girl by steven graham-jones all i know about this is that it's pretty much like another final girl but there's a lot out there because final girls by ronnie sager as well i don't really know what this is about i'm not gonna lie to you but i've saved it i think it's on script so i saved it because again i'm interested in steven graham-jones' stuff it's about this girl who um survived this like massacre and it says when she chooses former final girls to replace the slaughtered members of her original homecoming court it's not just a fight for survival it's a fight to become the final girl so i don't know if they're like killing each other i think it's very like 80s slash a movie inspired but i am interested my interest is peaked it's a conspiracy theory that i'm actually interested in that could be a good audiobook listen to in um in october then i have ring shout by pd jelly cock this is kind of a short novella i've really been interested in getting to pd jelly cluck's stuff as well um i think it's like this dark horror fantasy about the cluck's clan and kind of reimagining their reign of terror i've heard great things about all of pd jelly cluck's stuff so i think this is where i'm gonna start because i do have the audiobook and like i said it's not very long i think the physical book's only like less than 200 pages this was another book that was really popular i think towards the end of last year so i'm gonna be a year late but hopefully i'll read it then we have lakewood by megan giddings all i know about this is that i think it's about a black woman who starts to participate in this secret kind of medical program it pays really well um all her bills are paid like medical bills are paid and it seems too good to be true i think it's like a very much a claustrophobic really unsettling confusing kind of horror i to me the way this has been described it's always given me some of the vibes to catherine house in the kind of atmosphere that is built throughout the book so i'm gonna be interested to see whether it is similar to that in kind of the atmosphere then i have night of the mannequins by steven graham jones another steven graham jones i actually know nothing about this it's another really short novella which is why i saved it on the script because it's a short audiobook all the description says is that it's a contemporary horror story where a teen prank goes very wrong and all hell breaks loose is there a supernatural cause a psychopath on the loose or both so my interest is peeped what can i say i would like to see it next is plain bad heroines by emily m danforth i think this is split in time between present day and this girl's boarding school in the 1900s it's something to do with like this legacy curse i think i don't really know this is another one that has been super popular a lot of people have read this i've heard a lot of good things i think beth from books nest i remember her really enjoying it when she read it this one is not a short audiobook this one is like a very long audiobook because the book is like 600 pages long it's a very long book so i'm a little bit intimidated to read this book i don't know if this is going to be one i read soon but i did save it nonetheless next is her body and other parties by carmen maria mashado this is short story horror which i'm very intrigued by i don't think i've ever read or like ever heard of any other short story like anthology horror i thought it's queer it's funny it's sexy it's scary it's like everything rolled into one really bizarre horror stories and then finally um we've got wakenhurst by michelle paver i literally know nothing about this book i think i got it for free the i have the ebook of this and i think i got it for free um i think it's like historical horror i think this is like a ghost story it's gothic um it's set in this like large manor house and this is the book that was like really popular in the uk a little while back so yeah a little bit of historical horror i love historical blended with other genres we all know that like fantasy historical mystery my perfect combo i love everything about this so there we have it that is all the horror book i have on my tbr let me know if you've read any of these which ones do you think i should prioritize getting to in october if you've gone into this video comment any weapon or scary or murdery or horary emoji that you want to comment like a knife or a ghost or the worried face i don't know anything like that comment that down below i also always have the scroller up now at the end of my video thanking my patrons but i also just want to take a moment to thank my patrons so much because um without them i wouldn't be able to be doing youtube as much as i am and like putting my all into it so i just want to say a massive thank you to my patreon shout out you guys i love you very much i love you all but i wanted to shout them out because um i'm just incredibly increasingly and like overwhelmingly grateful for all of my supporters over on patreon so i just want to say a little thank you for that and yeah i hope you enjoyed the video and i'll see you very soon in another one bye


Activin is a protein that plays a role in the development of certain cancers. It has been found to be present at higher levels in tumours compared to healthy tissue, suggesting it may play a role in tumour growth. In this study, researchers investigated how Activin affects the development of skin tumours in mice. They found that Activin increases the number of macrophages in the skin, which leads to the development of tumours. Additionally, they discovered that Activin also attracts monocytes cells into the skin, which further contributes to tumour growth. Finally, they identified specific genes that are expressed in macrophages when exposed to Activin, which are similar to those seen in other types of tumours. By targeting these genes, researchers were able to reduce the number of macrophages and thus slow down tumour growth. This article was authored by Maria Anzafarova, Alexandra Picotucra, Michael Kankrama, and others. We are article.tv, links in the description below.