Upstream: How to solve problems before they happen

by Dan Heath

The second way to reduce the rape count is to reclassify actual rapes as lesser crimes—in this case, Ritchie’s boss tries to reframe the incident with the prostitute as a “theft of service.”

As it became harder and harder to sustain the real decline in crime, it became more and more tempting to fiddle with the numbers instead.

So how else could the principal make the dropout rate budge?

He could telegraph to his teachers that Fs are banned from their gradebooks.

Grove made sure to balance quantity measures with quality measures.

Any upstream effort that makes use of short-term measures—which, presumably, is most of them—should devote time to “pre-gaming,” meaning the careful consideration of how the measures might be misused.

The “rising tides” test: Imagine that we succeed on our short-term measures. What else might explain that success, other than our own efforts, and are we tracking those factors?

The misalignment test: Imagine that we’ll eventually learn that our short-term measures do not reliably predict success on our ultimate mission. What would allow us to sniff out that misalignment as early as possible, and what alternate short-term measures might provide potential replacements?

The lazy bureaucrat test: If someone wanted to succeed on these measures with the least effort p...

The defiling-the-mission test: Imagine that years from now, we have succeeded brilliantly according to our short-term measures, yet we have actually under...

The unintended consequences test: What if we succeed at our mission—not just the short-term measures but the mission itself—yet cause negative unintended consequences that outweigh the value of our work? What should we be paying attention to that’s offstage from our work?

Ahead: the struggle to anticipate the ripple effects of our work.

Macquarie Island lies about halfway between Australia and the northeast coast of Antarctica.

Because of these factors—its remoteness, its unique habitat, and its lack of human beings—the island is home to many rare species, especially seabirds, such as the blue petrel, which lopes across the water to gain speed before it takes off.

Even as the sailors decimated the island’s native species, they brought alien species with them: Rabbits served as food, and mice and rats were accidental stowaways.

These new species had no natural predators on the island, so they treated the island’s native flora and fauna as an endless all-you-can-eat buffet.

Some experiments had been run in the 1960s to see if various poisons would control the rabbits.

After about 10 years of this flea-seeding, all the island’s rabbits were lousy with them, and in 1978, the deadly myxoma virus was introduced.

Meanwhile, the cats were running out of rabbits to eat. They began to dine on the rare seabirds. So conservationists targeted the cats: Park rangers started shooting them, and by 2000, all cats had been eradicated from the island.

A more ambitious multipronged plan was hatched involving: killing the animals with poison bait, shooting them, hunting them with dogs, and unleashing a particularly successful virus called Rabbit Hemorrhagic Disease Virus, which was delivered via laced carrots.

However, the island is now being plagued by invasive weeds.11 Turns out that the weeds were being held at bay by the nibbling force of thousands of rabbits.

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.

“As you think about a system, spend part of your time from a vantage point that lets you see the whole system, not just the problem that may have drawn you to focus on the system to begin with,” wrote Donella Meadows in an essay.

Stringer’s office created a program called ClaimStat—its name was inspired by CompStat—that he announced in 2014 would be a “new, data-driven tool that will help to identify costly trouble areas before they become multi-million dollar cases.”

They found, for instance, that the city had paid out $20 million in settlements over a period of years due to injuries to children on playgrounds.

When you start to aggregate it, you see what the causes are, and that the fixes are generally not that complicated.”

In planning upstream interventions, we’ve got to look outside the lines of our own work. Zoom out and pan from side to side.

“Islands are systems,” said Nick Holmes, who was the director of science at Island Conservation for eight years.

When we fail to anticipate second-order consequences, it’s an invitation to disaster, as the “cobra effect” makes clear.

He thought: I’ll use the power of incentives to solve this problem! A bounty on cobras was declared: Bring in a dead cobra, get some cash.

“But the population in Delhi, at least some of it, responded by farming cobras.

They studied two Fortune 500 companies who were preparing to transition teams of employees to an open-office floorplan. Before and after the move, many staffers volunteered to wear “sociometric badges,” which captured their movements and logged how often they talked and to whom.

F2F interactions plunged by about 70% in both companies. Meanwhile, email and messaging activity spiked. When people were placed closer together so that they’d talk more, they talked less.

“The only way you’re going to know it’s wrong is by having these feedback mechanisms and these measurement systems in place.”

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.

Feedback loops spur improvement. And where those loops are missing, they can be created.

We’ve seen, too, that we can never anticipate everything, so we need to rely on careful experimentation guided by feedback loops.

A UK Environment Agency study calculated the “per use” effects of different bags on climate change and concluded that you’d need to use a paper bag 3 times and a cotton reusable bag 131 times to be on par with plastic bags.

If protecting waterways and marine life, specifically, is our goal, then a plastic bag ban is a great idea. But if making the whole environment better is the goal, then it’s less clear.

It was Donella Meadows’s quote—about the need “not to bluff and not to freeze but to learn”—that pulled me out of my wallow.

“Systems can’t be controlled, but they can be designed and redesigned.

We can’t control systems or figure them out. But we can dance with them!”

The natural life span of human beings today is not that different than it was a hundred years ago.3 What’s different is that we’re saving a lot of people—especially babies and children—from dying too early.

The fee-for-service model in health care favors reaction over prevention.

When you get paid for something, you do more of it. (No doubt we also “lead the world” in dental X-rays. And just imagine if TSA agents were paid by the grope.)

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.

But Ridenour wondered whether people might be ready for a subscription model, where service is delivered regularly and preventively, without waiting for the moment of crisis.

Paying for upstream efforts ultimately boils down to three questions: Where are there costly problems? Who is in the best position to prevent those problems? And, how do you create incentives for them to do so?

Providers (like your doctors) want to bill insurers for as much as they can, while insurers want to pay for as little as possible, so there’s a constant tug-of-war over which procedures will be covered and how they’ll be reimbursed.

Capitation models open the door to upstream interventions, because they make it easier to justify spending money on prevention.