Upstream

1. Move upstream: Prevent problems before they occur

You and a friend are having a picnic by the side of a river. Suddenly you hear a shout from the direction of the water—a child is drowning. Without thinking, you both dive in, grab the child, and swim to shore. Before you can recover, you hear another child cry for help. You and your friend jump back in the river to rescue her as well. Then another struggling child drifts into sight… and another… and another. The two of you can barely keep up. Suddenly, you see your friend wading out of the water, seeming to leave you alone. "Where are you going?" you demand. Your friend answers, "I'm going upstream to tackle the guy who's throwing all these kids in the water."

Upstream thinking is about addressing the root causes of problems rather than just treating symptoms. This approach focuses on prevention rather than reaction, seeking to solve issues before they occur. The parable illustrates the difference between downstream (reactive) and upstream (preventive) approaches.

Examples of upstream thinking:

• Expedia reducing customer support calls by 75% through proactive problem-solving
• Iceland decreasing teenage substance abuse by changing the culture and environment
• Chicago Public Schools increasing graduation rates by focusing on early warning signs

By shifting our efforts upstream, we can often achieve more significant and lasting impacts with less effort and resources in the long run.

2. Overcome problem blindness: Challenge the status quo

"For a long time, people had this notion—they think when you come to high school, you're gonna make it or break it," said Elizabeth Kirby, who as principal of Kenwood Academy High School was one of the change leaders. "For these kids, this is where we'll decide who's going to be successful and who's not. And if they're not successful, it's their fault. And that's just how it is—so no one questions it."

Problem blindness occurs when we accept negative outcomes as natural or inevitable. It's the belief that certain problems are just "the way things are" and can't be changed. This mindset prevents us from seeing opportunities for improvement and innovation.

Key aspects of overcoming problem blindness:

• Recognizing that many "inevitable" problems are actually solvable
• Questioning long-held assumptions about what's possible
• Looking for examples of success in similar situations elsewhere
• Reframing problems as challenges to be overcome, not accepted

By challenging the status quo and refusing to accept problems as inevitable, we open up new possibilities for positive change and innovation.

3. Take ownership: Be the change you wish to see

"Remember, always, that everything you know, and everything everyone knows, is only a model," said Donella Meadows, the systems thinker. "Get your model out there where it can be shot at. Invite others to challenge your assumptions and add their own.… The thing to do, when you don't know, is not to bluff and not to freeze, but to learn. The way you learn is by experiment—or, as Buckminster Fuller put it, by trial and error, error, error."

Taking ownership means accepting responsibility for solving problems, even if you didn't create them. It's about proactively seeking solutions rather than waiting for someone else to fix things.

Key aspects of taking ownership:

• Recognizing your power to effect change
• Being willing to experiment and learn from failures
• Collaborating with others to tackle complex issues
• Persisting in the face of challenges and setbacks

Examples of taking ownership:

• Ray Anderson transforming Interface into a sustainable carpet company
• Dr. Bob Sanders advocating for child car seat laws in Tennessee
• Kelly Dunne creating the Domestic Violence High Risk Team

By taking ownership of problems, individuals and organizations can drive significant positive change, even in areas where they may not have direct responsibility.

4. Escape tunneling: Break free from short-term thinking

"Scarcity, and tunneling in particular, leads you to put off important but not urgent things—cleaning your office, getting a colonoscopy, writing a will—that are easy to neglect," wrote Shafir and Mullainathan. "Their costs are immediate, loom large, and are easy to defer, and their benefits fall outside the tunnel. So they await a time when all urgent things are done."

Tunneling is a state of mind where scarcity (of time, money, or other resources) causes people to focus solely on immediate needs, neglecting long-term planning and prevention. This short-term thinking can lead to poor decision-making and missed opportunities for improvement.

Strategies to escape tunneling:

• Create "slack" in systems to allow for strategic thinking
• Implement regular check-ins or meetings focused on long-term goals
• Use data to highlight trends and patterns that may be overlooked in day-to-day operations
• Encourage and reward proactive, preventive actions

Examples of escaping tunneling:

• Chicago Public Schools implementing Freshman Success Teams
• Hospitals using morning "safety huddles" to address systemic issues
• Companies like LinkedIn using data to predict and prevent customer churn

By consciously creating space for long-term thinking and planning, organizations and individuals can break free from the tunnel vision that often accompanies scarcity and stress.

5. Unite the right people: Collaborate for systemic change

"The idea of this work is that you are part of something bigger than yourself," said Iton. "You're not helpless. You have an enormous amount of individual power and collective power.… Meaningful participation in democratic processes allows you to express agency, and agency is good for your health."

Uniting the right people is crucial for addressing complex, systemic problems. It involves bringing together diverse stakeholders with different perspectives and resources to work towards a common goal.

Key aspects of effective collaboration:

• Identifying all relevant stakeholders and decision-makers
• Creating shared goals and metrics for success
• Fostering open communication and trust among participants
• Leveraging each participant's unique strengths and resources

Examples of successful collaboration:

• Iceland's multi-stakeholder approach to reducing teen substance abuse
• The Domestic Violence High Risk Team in Newburyport, Massachusetts
• Rockford, Illinois's effort to end veteran homelessness

By uniting the right people and fostering effective collaboration, it becomes possible to tackle complex problems that no single individual or organization could solve alone.

6. Find leverage points: Identify key areas for impact

Recall that Harold Pollack's point is that we don't succeed by foreseeing the future accurately. We succeed by ensuring that we'll have the feedback we need to navigate. To be clear, there absolutely are some consequences we can and should foresee. If we don't anticipate that removing the goats on an island might make the invasive weeds run wild, then that's a clear failure of systems thinking. But we can't foresee everything; we will inevitably be mistaken about some of the consequences of our work. And if we aren't collecting feedback, we won't know how we're wrong and we won't have the ability to change course.

Leverage points are areas within a complex system where a small change can produce big results. Identifying these points is crucial for effective upstream interventions.

Strategies for finding leverage points:

• Analyze systems to understand interconnections and dependencies
• Look for areas where small changes could have outsized impacts
• Use data and feedback loops to identify patterns and trends
• Consider both short-term and long-term consequences of interventions

Examples of effective leverage points:

• Chicago's focus on 9th-grade success to improve graduation rates
• Expedia's emphasis on customer onboarding to reduce support calls
• The Nurse-Family Partnership's focus on supporting first-time mothers

By identifying and focusing on key leverage points, upstream efforts can achieve maximum impact with limited resources.

7. Create early warning systems: Detect problems before they escalate

"We found that customers who engaged [with the product] in the first 30 days were four times more likely to continue using LinkedIn," said Saxena.

Early warning systems allow organizations to detect and address problems before they become crises. These systems rely on data, monitoring, and predictive analytics to identify potential issues early on.

Key components of effective early warning systems:

• Regular data collection and analysis
• Clear indicators or metrics to monitor
• Established thresholds for action
• Rapid response protocols

Examples of early warning systems:

• LinkedIn's customer engagement monitoring to predict churn
• Northwell Health's predictive modeling for emergency medical services
• The Sandy Hook Promise's anonymous reporting system for school safety

By implementing robust early warning systems, organizations can shift from reactive to proactive problem-solving, addressing issues before they escalate into major crises.

8. Measure success thoughtfully: Avoid ghost victories

Remember, always, that everything you know, and everything everyone knows, is only a model," said Donella Meadows, the systems thinker. "Get your model out there where it can be shot at. Invite others to challenge your assumptions and add their own.… The thing to do, when you don't know, is not to bluff and not to freeze, but to learn. The way you learn is by experiment—or, as Buckminster Fuller put it, by trial and error, error, error.

Ghost victories occur when apparent successes mask underlying failures or unintended consequences. Thoughtful measurement of success is crucial to avoid these pitfalls and ensure genuine progress.

Strategies for effective measurement:

• Use multiple, complementary metrics to capture different aspects of success
• Consider both short-term and long-term impacts
• Regularly reassess and adjust metrics based on new information
• Look for unintended consequences or negative side effects

Examples of measurement challenges:

• New York City's CompStat system leading to data manipulation
• The thyroid cancer "epidemic" in South Korea driven by overdiagnosis
• Boston's sidewalk repair program unintentionally favoring wealthier neighborhoods

By measuring success thoughtfully and comprehensively, organizations can avoid the trap of achieving apparent success while undermining their true goals.

9. Anticipate unintended consequences: Consider ripple effects

Systems are complicated. When you kill the rabbits, the cats start feasting on the seabirds. When you kill the cats, the rabbits start overpopulating. When you kill both, the invasive weeds run rampant. Upstream interventions tinker with complex systems, and as such, we should expect reactions and consequences beyond the immediate scope of our work. In "shaping the water," we will create ripple effects. Always. How can we ensure that, in our quest to make the world better, we don't unwittingly do harm?

Unintended consequences are the unforeseen effects of our actions, often arising from the complex interactions within systems. Anticipating these ripple effects is crucial for effective upstream interventions.

Strategies for anticipating unintended consequences:

• Use systems thinking to map out potential impacts
• Consult diverse stakeholders to gain different perspectives
• Start with small-scale experiments before large-scale implementation
• Implement robust feedback loops to detect unexpected outcomes early

Examples of unintended consequences:

• The Macquarie Island ecological disaster from attempted species eradication
• Open office plans reducing face-to-face interactions instead of increasing them
• Plastic bag bans leading to increased use of thicker plastic bags

By carefully considering potential ripple effects and remaining vigilant for unexpected outcomes, upstream efforts can minimize harmful unintended consequences and maximize positive impacts.

10. Pay for prevention: Invest in upstream solutions

We can pay to fix problems once they happen, or we can pay in advance to prevent them. What we need are more business and social entrepreneurs who can figure out how to flip payment models to support the preventive approach.

Paying for prevention involves shifting resources and incentives towards upstream solutions that prevent problems rather than just treating symptoms. This approach often requires overcoming short-term thinking and demonstrating the long-term value of prevention.

Strategies for investing in prevention:

• Develop new funding models that reward preventive actions
• Calculate and communicate the long-term cost savings of prevention
• Create partnerships to share costs and benefits across stakeholders
• Use data to demonstrate the effectiveness of preventive measures

Examples of paying for prevention:

• The South Carolina Nurse-Family Partnership's "pay for success" model
• Accountable Care Organizations in healthcare incentivizing prevention
• Companies like HomeAdvisor exploring subscription models for home maintenance

By developing innovative ways to pay for prevention, we can align financial incentives with long-term societal benefits and make

Last updated: September 2, 2024