You and your friend are having a picnic by the side of a river. Suddenly you hear a shout across the waters – a child is drowning. Without thinking you both dive in, grab the child and swim to shore. But before you recover, you hear another child crying for help. You and your friend again swung into action to rescue. Then another struggling child drifts into sight… then another… then 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 asked, to which he responded: ” I’m going upstream to handle the guy who’s throwing all these kids in the water.”
Downstream effort restores the normal state. Upstream effort maintains normalcy in the first place.
Upstream work is difficult to measure and doesn’t translate to short-term tangible results.
Conversely, downstream work is easier to measure and follow through because it almost always translate to immediate and tangible results. The problem with upstream work is that there is a maddening ambiguity which prevents people from taking action.
Imagine this. If you’re a police officer, it’s much easier to say, “I arrested this guy” than to say, “I spent my whole day talking to this wayward kid.”. Similarly if you’re a healthcare professional, it’s easier to ask yourself “How do I restore my patients’ health?” than to ask, “How can I respond to the underlying problems that make them unhealthy in the first place?”
3 Barriers to Moving Upstream
- Problem Blindness – “I don’t see the problem.”
- A Lack of Ownership – “The problem isn’t mine to fix.”
- Tunneling – “I can’t deal with the problem right now.”
Upstream Barrier #1 Problem Blindness
We grow accustomed to stimuli that are consistent. You walk into a room, immediately notice the loud drone of air conditioner and 5 minutes later, the hum has receded into normalcy.
When we don’t see a problem, we can’t solve it. As a teacher, if you accept that your job is to support the students, not appraise them, it changes everything. It changes the way you collaborate. You start to realize that you can’t adequately support your students by yourself.
Upstream leaders must not only detect problems early, target leverage points in complex systems, find reliable ways to measure success, they must also pioneer new ways of working together.
“To solve male aggression problems, we need to focus on females. If you ameliorate the quality of life of women, it will transfer to the next generation.”
Upstream Barrier #2 Lack of Ownership
Why do some problems lack owners? Sometimes self-interest is to blame. Tobacco companies are in the best position to prevent millions of deaths but of course doing so would affect their bottom line. Other times, the lack of ownership is the main culprit. At Expedia, an online travel business, many groups worked together to resolve the issue of increasing call volumes, but sadly no group stepped up to own the problem.
On the other hand, Interface, a carpet manufacturer, could have assumed that they will always be air-polluters because of the industry they’re in. Yet, that didn’t happen. Instead, they questioned the status quo and asked themselves “Can we fix this pollution problem?” And so, they did. Notice it wasn’t obvious to a carpet company to accept that burden.
The lesson is this – when you look at the world in an upstream way, you start to surface strands of causation that were always there – but buried.
Upstream Barrier #3 Tunneling
When people are juggling a lot of problems, they give up trying to solve them all. They adopt tunnel vision. It confines us to short-term, reactive thinking. In the tunnel, there’s only forward.
When a nurse discovers newborn’s security tags are prone to falling off, she has two choices: conduct an on-the-spot root cause analysis or pay attention to a dozen patients who need her right now. It’s so much easier and more natural to stay in the tunnel and keep digging ahead. But make no mistake. It’s a terrible trap. If you can’t systematically solve problems, it dooms you to stay in an endless cycle of reaction. Tunneling begets more tunneling.
7 Questions for Upstream Leaders
Question #1 How will you unite the right people?
To prevent a customer from calling at all requires integration and harmony across multiple teams. To treat to a customer call requires the effort of just one call-center representative.
Question #2 How will you change the system?
On whatever scale we work – in organizations or across communities – systems change takes time. But those changes are our best hope for improving people’s odds in life.
Question #3 Where can you find a point of leverage?
Upstream change often means fumbling our way forward, figuring out what works and what doesn’t and under what conditions. But it also means even a defeat is effectively a victory because every time we learn something, we’re getting closer to leverage.
Question #4 How will you get early warning of the problem?
With the rise of IoT, our world will be stocked with sensors. Smart watches that detect arterial fibrillation. Smart devices that warn about leaks in oil pipelines. Smart video cameras that alert a sleepy bus driver. While tech can certainly aid our early-detection efforts, sometimes the best sensors are not devices but people.
Researchers found in almost all cases of school shootings, there were early-warning signs that were missed. Most mass shootings were planned at least 6 months in advance. Typically, 8 in 10 shooters tell at least one other person of their plans, and many post threats on social media. Their actions could have been prevented if the right people had been paying attention or had taken them seriously.
Question #5 How will you know you’re succeeding?
Upstream effort unlike downstream, isn’t wonderfully tangible. Success isn’t always self-evident. On top of that, when there’s a separation between the way we’re measuring success and the actual results we want to see in the world, we run the risk of a ‘ghost victory’, a superficial success that cloaks failure.
Think about this. There’re two ways for NYPD to make the rape statistics look better. The first is to prevent rape – to project the police’s presence into dangerous areas and thereby deter the violent acts. The second way is to reclassify actual rapes as lesser crimes and thereby reduce rape count. The first way, which is an upstream effort, constitutes a victory while the second effort is an abomination. It’s true in both cases, crime numbers did go down. However in the downstream effort, it becomes harder over time to get a grip on reality and more tempting to fiddle with the numbers.
Question #6 How will you avoid doing harm?
Real world systems are complex. When you kill the rabbits, cats start feasting on the seabirds. When you kill the cats, rabbits start overpopulating. When you kill both, the invasive weeds run rampant. In shaping the water, we create ripple effects.
Consider this. You can save money for your admin department by cutting pruning budget. But when you end up paying settlements to people who got hurt by falling branches, the resulting amount is far greater than the cuts.
The cobra effect occurs when an attempted solution to a problem makes the problem worse. During UK’s colonial rule of India, a British administrator was worried by the prevalence of cobras in Delhi. He said, “I’ll use the power of incentives to solve this problem.” And then he declared a bounty on cobras, promising “Bring in a dead cobra, get some cash”. Can you guess what happened next? Yes, the plan went sideways as people started farming cobras.
Question #7 Who will pay for prevention?
One uncomfortable truth in modern day society is that our healthcare system is moving towards a model with better incentives. To prevent problems, it requires all upstream leaders to unite the right people (caregivers, insurers, patients). They must hunt for leverage points and push for systems change (unnecessary hospitalizations, ACOs). They must try to spot problems early (monitoring blood sugar levels). They must agonize about how to measure success while avoiding ghost victories and negative ripple effects. And finally, they must think about funding stream: how to find someone who’ll pay for prevention.
Take for example. When Dan had a problem with spiders, he called an exterminator. Upon arrival, the exterminator offered him a subscription service. The idea was that he would visit the house regularly without requiring any appointment from Dan and use the best strategies he had learned to keep the bugs at bay. Initially, Dan was skeptical but eventually, the beautiful vision of his bug-free house secured the deal.
Here’s the truth. Many of the world’s household repairs are caused by a failure of upstream maintenance. The air-conditioner breaks prematurely because air filters weren’t change regularly. The water heater stops working because it was never flushed. Toilet problems, gutter problems, roof problems are all preventable. It turns out that we all should start treating our homes like our cars – that need a regular oil change.
3 Suggestions for Upstream Efforts
Suggestion #1 Be impatient for action but patient for outcomes.
Bring a homeless person a meal today and you’ll feel good immediately. But to figure out how to reduce evictions in order to prevent people from becoming homeless might take a decade.
Suggestion #2 Macro starts with micro.
Upstream victories are won an inch at a time, and then a yard and then a mile and eventually you find yourself at the finish line. However you can’t help a thousand people until you understand one.
Suggestion #3 Favor scorecards over pills.
Scoreboard is a metaphor for continuous flow of data that provides a way to monitor your performance in real time. Expedia used the scoreboard approach to reduce the call volume. Don’t obsess about formulating the perfect solution, instead take ownership of the underlying problem and start marching.
Finally, what do you think of when you hear the word ‘hero’?
Our heroes shouldn’t only be lifeguards, firefighters, policemen, people who restore things to normal. We should do a better job at recognizing a teacher who skips lunch to help a struggling freshman. And a cop who makes himself a conspicuous presence around an abused woman’s home, ensuring her ex-husband will think twice before coming around. These should be our heroes too – the people who are unsatisfied with the normalcy. The people who clamor for better.
If you liked this summary, I highly encourage you purchase the original work. I believe you’ll also enjoy other fantastic works by Chip and Dan: Made to Stick (to make your messages memorable), Decisive (to make better decisions), Switch (to make change easier) and the Power of Moments (to make your experiences memorable).