StemCell Therapy

Upstream: The quest to solve problemsbefore they happen, by DanHeath

Picnicking beside a river, you see a child floatingdown, in danger of drowning. You and your friend dive in and save her, only tosee another coming down, and another and another. Suddenly you see your friendclimb out the river and start running. "Where are you going?"

"I am going to sort out the person who isthrowing children in the river!"

Author Dan Heath uses the word upstream forefforts intended to prevent problems before they happen.

"So why do our efforts skew so heavily towardreaction rather than prevention?" he asks. Primarily, because the furtherupstream we go back, the more complex the solution. It is easier to call HR torecruit a new executive than it is to ensure that the organisation is a deeplysatisfying place to work.

The US will spend billions more recovering from thecoronavirus because they slashed funding for Centers of Disease Control and Prevention.And similar examples abound.

"My goal in this book is to convince you thatwe should shift more of our energies upstream," Heath explains.

There are three forces that push us downstream,impeding our ability to prevent problems.

The first is what Heath calls problem blindness,the response to problems that is similar to the way we treat the weather there is nothing we can do about it.

The second is that no one takes ownership of theproblem. Stanford researchers, in a paper exploring this sense of reluctance,wrote "what often prevents people from protesting is not a lack ofmotivation to protest, but rather their feeling that they lack the legitimacyto do so."

The third is tunnelling, where people react toproblems rather than prevent them. Tunnelling confines us to short-term,reactive thinking. In the tunnel, theres only forward. When people experiencescarcityof money or time or mental bandwidththe harm is not that the bigproblems crowd out the little ones. The harm is that the little ones crowd outthe big ones.

If upstream thinking is so obviously correct andunequivocally more effective in eliminating recurring problems, why is it sorare? Heath identifies seven significant barriers to upstream thinking andprovides solutions from lessons learned from real world successes.

Heaths three forces described above, and the sevenbarriers (of which I will describe some below) are the same whether you lead afor-profit-business, a public benefit organisation or a government department.

How will you unite all theright people who are needed to solve the problem?

In 1998, 42% of Icelandic 15- and 16-year-olds hadbeen drunk in the previous 30 days. Almost a quarter smoked cigarettes daily,and 17% had already tried cannabis. Among 22 European countries, Icelandic teenagershad the second-highest rate of accidents or injuries related to substance abuse.Todays Icelandic teenagers have grown up in a country where substance abuse islargely absent.

As in many upstream efforts, the success wasachieved by surrounding the problem, recruiting a multifaceted group ofpeople and organisations, united by a common aim "Drug-free Iceland".

The campaign team solicited help from anyone whowas willing to assist: researchers, policymakers, schools, police, parents,teenagers, singers/musicians, government agencies, private companies, churches,sports clubs, athletes, and media members.

Surrounding the problem with the right people and aligningtheir efforts toward preventing specific instances of that problem, was theirsolution.

Who would need to be involved in your organisation?

How will you change the system?

"Every system is perfectly designed to get theresults it gets."

Whether the results are good or bad, the systemthrough which the results are achieved is a complete success.

In 1967, 5 people died for every 100 million milesdriven. Fifty years later, fewer drunk drivers better roads, seat belts,airbags and better braking technologies, reduced that number to 1 death per 100million miles driven. The vastly improved system happened with no centralplanner. Thousands of people, safety experts, transportation engineers andMothers Against Drunk Driving, tweaked the system so that millions of people aresafer.

Identifying the systems that need to change is criticallyimportant.

How will you get early warning ofthe problem?

When everything is cause for alarm, nothing iscause for alarm.

The value of an early warning depends on whetherthe warning gives sufficient time to respond. A car tyre that gives a 30-secondadvance warning of a blowout, might save your life. A half-second warning isworthless.

LinkedIn discovered that the churn rate forcustomers of their flagship product for recruiters was roughly 30%. On further investigationthey found that customers who used the product in the first 30 days were fourtimes more likely to continue using LinkedIn. So, they started using all theresources they had been using to save customers, to onboard them properly sothey become users immediately.

How will you know youresucceeding?

What counts as success? If my laptop broke and youfix it, thats victory. With upstream efforts, success is not alwaysself-evident and is often misleading.

Consider a team that applauds itself for scoringmore runs. Is that because every team in the league is scoring more too,because bowling talent has declined? The team that doubled its run rate barelywon any more games, which doesnt align with their goal.

If the short measures runs starts becoming the goal,players under pressure may start cheating. Here, succeeding with the measuremakes a mockery of the goal. Care must be taken which factors really measuresuccess.

How will you avoid doing harm?

Systems are complicated. One need only consider theban of single use plastic bags that damage the waterways.

An estimated 100 billion bags that may not degradefor hundreds of years, are used annually just in the US. Paper bags andreusable bags are far better than plastic ones from the perspective of keepingwaterways clean, but they are worse in other ways.

A UK Environment Agency study calculated the "peruse" effects of different bags on climate change. You need to use a paperbag 3 times and a cotton reusable bag 131 times to be on par with plastic bagsoverall effect on the environment. Manufacturing paper bags and cotton reusablebags causes more air and water pollution than plastic, and they are much harderto recycle.

Is protecting waterways and marine life our goal,or making the whole environment better?

Systems cant be controlled, but they can bedesigned and redesigned. We need to rely on careful experimentation, guided byfeedback loops. We should think very carefully before proceeding where systemsare involved. Upstream work hinges on an attitude of care and humility.

Who will pay for what does nothappen?

A person will pay if they will reap the rewards andwhat comes out of the pocket goes back in. But what if many units in the organisationor country will benefit, unequally? Getting funding for many pockets is acoordination nightmare.

In the case of climate control, those who areresponsible for the problem (wealthy countries,) require a contribution in cashor kind from poor countries who benefit from the solution, but did little tocause the problem.

Not considering these questions will make upstreamsuccess ever harder. Considering them may go a long way to improve youroperations and I cannot think of any time when that consideration is morenecessary.

I consider this the most useful book I have read inyears. It reads easily and is rich with examples and nuances.

Readability Light--+-- Serious

Insights High +---- Low

Practical High -+--- Low

*Ian Mann of Gateways consultsinternationally on strategy and implementation, is the author of Strategy thatWorks and a public speaker. Views expressed are his own.

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