Upstream: The Quest to Solve Problems Before They Happen

by Dan Heath

When you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.

Downstream actions react to problems once they’ve occurred. Upstream efforts aim to prevent those problems from happening.

Expedia’s executives were not oblivious. They were aware of the huge volume of calls. It’s just that they were organized to neglect their awareness. Like most companies, Expedia divided its workforce into groups, each with its own focus. The marketing team attracted customers to the site. The product team nudged customers to complete a reservation. The tech group kept the website’s features humming along smoothly. And the support group addressed customers’ issues quickly and satisfactorily. Notice what was missing: It was no group’s job to ensure that customers didn’t need to call for support. In fact, no team really stood to gain if customers stopped calling. It wasn’t what they were measured on.

Okerstrom’s point is that focus is both the strength and the weakness of organizations. The specialization inherent to organizations creates great efficiencies. But it also deters efforts to integrate in new, advantageous ways. In upstream ways. And this is true in many parts of society. So often in life, we get stuck in a cycle of response. We put out fires. We deal with emergencies. We handle one problem after another, but we never get around to fixing the systems that caused the problems.

Therapists rehabilitate people addicted to drugs, and corporate recruiters replace talented executives who leave, and pediatricians prescribe inhalers to kids with breathing problems. And obviously it’s great that there are professionals who can address these problems, but wouldn’t it be better if the addicts never tried drugs, and the executives were happy to stay put, and the kids never got asthma? So why do our efforts skew so heavily toward reaction rather than prevention?

“It’s much easier to say ‘I arrested this guy’ than to say ‘I spent some time talking to this wayward kid.’ ”

That’s one reason why we tend to favor reaction: Because it’s more tangible. Downstream work is easier to see. Easier to measure. There is a maddening ambiguity about upstream efforts.

It’s not that the upstream solution is always right. And it’s certainly not the case that we should abandon downstream work—we will always want someone there to rescue us. The point is that our attention is grossly asymmetrical. We’re so focused on saving the drowning kids in the river that we fail to investigate why they need saving at all.

Good intentions guarantee nothing.

Most of us would agree that “an ounce of prevention is better than a pound of cure,” but our actions don’t match those words. In most of our efforts in society, we’ve optimized ourselves to deliver pounds of cure. Speedy, efficient pounds of cure. We celebrate the response, the recovery, the rescue.

How many problems in our lives and in society are we tolerating simply because we’ve forgotten that we can fix them?

Pro athletes play hard. Injuries are gonna happen. You can’t change that. That mind-set is an example of what I’ll call “problem blindness”—the belief that negative outcomes are natural or inevitable.

“Every system is perfectly designed to get the results it gets,” wrote the health care expert Paul Batalden.

To succeed upstream, leaders must: detect problems early, target leverage points in complex systems, find reliable ways to measure success, pioneer new ways of working together, and embed their successes into systems to give them permanence.

What’s odd about upstream work is that, despite the enormous stakes, it’s often optional. With downstream activity—the rescues and responses and reactions—the work is demanded of us. A doctor can’t opt out of a heart surgery; a day care worker can’t opt out of a diaper change. By contrast, upstream work is chosen, not demanded.

They call this sense of legitimacy “psychological standing,” inspired by the concept of legal standing. You can’t bring a suit in the justice system simply because something offended your sensibilities—you’ve got to show that it affected you. The evidence that you were harmed gives you standing to bring a case. The young man who’s reluctant to join a protest against date rape may feel he lacks psychological standing, since he hasn’t been affected personally by the issue.

What if you told the story of your relationship problems as if you were the only one responsible? What if employers told the story of their employees’ health as if they were the only ones responsible? What if school districts told the story of high school dropouts as if they were the only ones 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.

When people are juggling a lot of problems, they give up trying to solve them all. They adopt tunnel vision. There’s no long-term planning; there’s no strategic prioritization of issues. And that’s why tunneling is the third barrier to upstream thinking—because it confines us to short-term, reactive thinking. In the tunnel, there’s only forward.

It’s often said that a chain of bad decisions can lead people to be poor. That is undoubtedly true in some cases. (Think of the highly paid superstar athlete who later declares bankruptcy.) But Shafir and Mullainathan argue convincingly that we’ve got the causation backward: that in fact it’s poverty that leads to short-sighted financial decisions. As the authors write, scarcity “makes us less insightful, less forward-thinking, less controlled. And the effects are large.

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.

How do you escape the tunnel? You need slack. Slack, in this context, means a reserve of time or resources that can be spent on problem solving.

Escaping the tunnel can be difficult, because organizational structure resists it. Remember the quote from Mark Okerstrom, the CEO of Expedia: “When we create organizations, we’re doing it to give people focus. We’re essentially giving them a license to be myopic.” Focus is both an enemy and an ally. It can accelerate work and make it more efficient, but it puts blinders on people. (Racehorses wear blinders so they’ll ignore distractions and run faster.) When your emphasis is always forward, forward, forward, you never stop to ask whether you’re going in the right direction.

There are only two areas of concern that seem to reliably trigger our upstream instincts: our kids and our teeth. When it comes to our children, we’re capable of thinking years down the road: Are they getting too much screen time? Are they eating healthy diets? Will they be able to get into a good college? Somewhat more puzzling is the regard we show for our teeth, the most coddled organ in our body. Even as our skin is shorted sunscreen and our hearts denied a brisk jog and our immune systems refused an annual flu shot, we make it a priority on every single day of our lives, even the busiest ones, to perform a twice-daily regimen of preventive scrubbing. And then we report to a dentist regularly for a more rigorous appraisal.

Climate change is like a product designed by an evil mastermind to exploit every weakness in the human psyche: It changes too slowly to spark urgency. It lacks a human face: As Dan Gilbert wrote in the piece cited above, “If climate change had been visited on us by a brutal dictator or an evil empire, the war on warming would be this nation’s top priority.” To address climate change successfully would require people to collaborate across nations and parties and organizations in tribe-defying ways. Finally, climate change features a mismatch of acts and consequences: The people who are causing most of the harm are not the ones who will suffer the most as a result.

They’re moving further upstream: Rather than acting quickly to serve people who are homeless, they’re trying to keep people in their homes to begin with.

The writer David Foster Wallace once told a story: “There are these two young fish swimming along and they happen to meet an older fish swimming the other way, who nods at them and says ‘Morning, boys. How’s the water?’ And the two young fish swim on for a bit, and then eventually one of them looks over at the other and goes, ‘What the hell is water?’ ” The system is the water.

A well-designed system is the best upstream intervention.

In this chapter, we’ll scrutinize three kinds of ghost victories. To foreshadow the three varieties, let’s imagine a long-struggling baseball team that is determined to remake itself as a winner. Because that journey may take years, the manager decides to emphasize power hitting—especially more home runs—as a more proximate measure of success. In the first kind of ghost victory, your measures show that you’re succeeding, but you’ve mistakenly attributed that success to your own work. (The team applauds itself for hitting more home runs—but it turns out every team in the league hit more, too, because pitching talent declined.) The second is that you’ve succeeded on your short-term measures, but they didn’t align with your long-term mission. (The team doubled its home runs but barely won any more games.) And the third is that your short-term measures became the mission in a way that really undermined the work. (The pressure to hit home runs led several players to start taking steroids, and they got caught.)

Here are four questions to include in your pre-gaming: 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 possible, what would they do? The defiling-the-mission test: Imagine that years from now, we have succeeded brilliantly according to our short-term measures, yet we have actually undermined our long-term mission. What happened? There’s a fifth question, too, that should be asked, and it’s so complicated that we’ll spend the next full chapter exploring it: 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?

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?

In July 2009, a young Google engineer was walking through Central Park when he was struck by a falling oak tree branch, causing brain injuries and paralysis. It seemed like a tragic but fluke injury. Except that, later, the comptroller of New York City, Scott Stringer, started analyzing the claims paid by the city to settle lawsuits, and he discovered an unexpectedly large number of settlements resulting from falling branches. (One was the engineer’s lawsuit, which had settled for $11.5 million.) Curious, Stringer investigated further and discovered that the city’s pruning budget had been cut in previous years, in an effort to save money. “Whatever money we thought we were saving on the maintenance side, we were paying out on the lawsuit side,” said David Saltonstall, the NYC assistant comptroller for policy.

Several couples close to them had divorced, and it spooked both of them. “Over coffee one morning on our back porch, we discussed our friends’ divorces. One of us asked the other, ‘Are we headed in that direction?’ The answer seemed obvious. We decided to sit together and discuss what we could do to prevent it. We really didn’t have an answer, so we agreed to return the next morning to discuss it again, and the next, and the next.” What they both wanted was a way to have safe discussions—to talk through any issue, no matter how hard, without remorse or regret or hard feelings. It made sense to them to have a physical place where these conversations would happen. So they bought a hot tub, and that’s where they had complicated conversations. It just seemed to work. “After several years, we built the home we always wanted and of course we put a Jacuzzi on the back deck for our ‘hot tub’ conversations,” he said.

As an old proverb goes, “The best time to plant a tree is 20 years ago. The second-best time is now.”

“Be impatient for action but patient for outcomes.” That’s a quote from Maureen Bisognano, the president emerita of the Institute for Healthcare Improvement, and it struck me as the perfect motto for upstream efforts. The world is full of groups who engage in lofty discussions—and feel virtuous doing so—but never create meaningful change. Change won’t come without action. At the same time, it can take a while for action to bear fruit. Downstream work is narrow and fast. Upstream is broad and slow(er). You can 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—that might take years. What kind of work do you care so much about that you could stick with it for 5 years? Or 10 years?