Upstream: How to solve problems before they happen

by Dan Heath

In society, there is a crowded marketplace of problems, all vying for a greater share of our resources and attention.

Delage was grateful for their health, but as she reflected on the experience, she grew increasingly unsettled. Why had they needed to accelerate the delivery? Why had her doctor seemed so eager to perform a C-section?

Some argue that the C-sections in Brazil’s private health system are a kind of status symbol.

Obstetricians could make much more money performing C-sections—which require maybe an hour or two of work—than they could delivering babies naturally, which might involve intermittent work over a 24-hour period.

That verbal abuse sounds like an extreme case—but according to Brazilian women, it’s not. In a survey of 1,626 women who’d given birth in Brazil, about a quarter of them said that the doctor made fun of their behavior or criticized them for their cries of pain.

Babies delivered via C-section are more frequently sent to the neonatal intensive care unit (NICU) after birth, often due to breathing problems that come from being born before full term.

Doctors were forbidden to schedule an elective C-section before 40 weeks; the norm had been 37 weeks. They were put into shifts; if a baby was delivered during a doctor’s shift, she would handle it—otherwise, another doctor would take care of it.

Nine months later, the rate of natural childbirth had shot up to 40%.

The escape from problem blindness begins with the shock of awareness that you’ve come to treat the abnormal as normal.

The seed of improvement is dissatisfaction.

Something remarkable often happens next: People voluntarily hold themselves responsible for fixing problems they did not create.

The upstream advocate concludes: I was not the one who created this problem. But I will be the one to fix it.

Until 1994, Ray Anderson, the founder of the industrial carpet firm Interface, had lived every entrepreneur’s dream.

In 1969, on a trip to Kidderminster, England, he saw modular carpet tiles for the first time, and it was love at first sight.

Anderson founded Interface in 1973, at age 38, to bring carpet tiles to the US on a broad scale.

Shortly after receiving the invitation, serendipitously, Anderson received a copy of Paul Hawken’s book The Ecology of Commerce.

Interface’s core business was to sell carpet tile, made from nylon yarn—and nylon is a plastic made from chemicals found in coal or petroleum.

“The big head was one of those friendly ones,” she said. “You know the kind, tilting first to one side and then another in an attentive way. Driving me nuts.

“Whenever I start to get aggravated about some inane problem, I think, ‘Hey, move your chair, why don’t you?’

What’s odd about upstream work is that, despite the enormous stakes, it’s often optional.

This lack of ownership is the second force that keeps us downstream. The first force, problem blindness, means: I don’t see the problem. (Or, This problem is inevitable.) A lack of ownership, though, means that the parties who are capable of addressing a problem are saying, That’s not mine to fix.

The leaders at CPS made the graduation rate their problem. They took ownership.

In some cases, people may resist acting on a perceived problem because they feel as though it’s not their place to do so.

“what often prevents people from protesting is not a lack of motivation to protest, but rather their feeling that they lack the legitimacy to do so.”

They call this sense of legitimacy “psychological standing,” inspired by the concept of legal standing.

The addition of the words Men and Women was a simple way to extend psychological standing to both genders, and it was effective.

Note that the authors were trying to extend psychological standing to pediatricians: You are the right people to lead action on this problem. It’s yours to own.

In 1977, after intense lobbying, the Child Passenger Protection Act finally made it to the floor of the legislature for a vote, and it passed with about two-thirds support.

By 1985, all 50 states had passed child restraint laws.

The National Highway Traffic Safety Administration estimates that from 1975 to 2016, 11,274 children under the age of four had their lives saved by car seats.

Two automobile safety champions write a pediatric journal article about a problem. The article spurs a Tennessee pediatrician to take ownership of the problem. He motivates a state to act, and that state influences 49 other states, and four decades later, thousands of children are alive who otherwise would have met violent, preventable deaths.

Anderson proposed a radical idea: to eliminate Interface’s negative impact on the earth.

Was Interface really healthy enough, financially, to take on a new mission of uncertain promise? But Anderson was relentless.

The mantra internally was: reduce, reuse, reclaim, and recycle.

In one division of Interface, simply adding new computer controls on the boilers in a fabric factory slashed carbon monoxide emissions—from two tons a week to a few hundred pounds per year.

The revolution was working. Anderson told Fast Company, “The world just saw the first $200 million of sustainable business.”

This was Interface’s “move your chair” moment. We must take responsibility for fixing this problem.

They found and acquired an expensive backing machine from Germany that could break down old carpet tiles, transforming them into vinyl crumb, which could be remelted into a new carpet backing.

Old carpets became new carpets. They had closed the loop.

They went from feeling like victims of the problem to feeling like co-owners of the solution.

This, in essence, was the same thing Ray Anderson had demanded of his staff: Let’s tell our story as if we were 100% responsible for the environmental degradation we cause.

You start to surface strands of causation that were always there—but buried.

What if you told the story of your relationship problems as if you were the only one responsible?

Asking those questions might help us overcome indifference and complacency and see what’s possible: I choose to fix this problem, not because it’s demanded of me, but because I can, and because it’s worth fixing.

John Thompson, semi-retired and living in Goderich, Ontario, had been forgetting to use the twice-daily eye drops that were prescribed for his glaucoma.

So he decided to put the drops on the windowsill above the kitchen sink—that way, he’d spot them every time he made coffee in the morning.

“After putting them in my eyes, I would move them to the west side of the sill.

After I did that, I would put the drops back on the east side of the sill.”

In my research, I sought out stories like these—people who stopped reacting to problems and started preventing them.

I was always unplugging the cord, packing it, and plugging it in somewhere else. So—prepare to be astonished—I bought a second power cord.