Upstream: The Quest to Solve Problems Before They Happen

by Dan Heath

Systems change starts with a spark of courage. A group of people unite around a common cause and they demand change. But a spark can’t last forever. The endgame is to eliminate the need for courage, to render it unnecessary, because it has forced change within the system. Success comes when the right things happen by default—not because of individual passion or heroism.

(Upstream leaders should be wary of common sense, which can be a poor substitute for evidence.)

Managing anger became a recurring theme in the sessions. You can let your anger overwhelm you so that you act like a “savage,” Tony D taught them, or you can channel it to become a “warrior.” Anger could be a destructive force or a constructive one, he stressed, and we’re free to choose.

No donor would support an intervention that was proven not to work. On the other hand, many funders will support an untested intervention, based on the strength of anecdotal feedback.

The postmortem for a problem can be the preamble to a solution.

when he finally ends up needing heart bypass surgery, there’s literally no one who is going to ask whether he “deserves” the surgery or whether the surgery is going to save the system money in the long haul. When he needs the procedure, he’ll get it. But when we start talking about preventing children from going hungry, suddenly the work has to pay for itself. This is madness. The reason to house the homeless or prevent disease or feed the hungry is not because of the financial returns but because of the moral returns.

Let’s not sabotage upstream efforts by subjecting them to a test we never impose on downstream interventions.

Bryan Stevenson, a law professor at NYU, author, and the founder of the Equal Justice Initiative, calls this the “power of proximity.” “I believe that to make a difference in creating a healthier community, a healthier society, a healthier nation, and thus a healthier economy, we’ve got to find ways to get proximate to the poor and the vulnerable,”

“I absolutely believe that when we isolate ourselves—when we allow ourselves to be shielded and disconnected from those who are vulnerable and disfavored, we sustain and contribute to these problems. I am persuaded that in proximity there is something we can learn about how we change the world.…”

It’s amazing how often upstream efforts live or die based on mundane, does-the-plumbing-work matters such as database access.

Customer success” is like an upstream version of “customer service”—the mission is to keep customers happy with the products/services they’ve bought.)

When we can foresee a problem, we have more maneuvering room to fix it.

because there is a separation between (a) the way we’re measuring success and (b) the actual results we want to see in the world, we run the risk of a “ghost victory”: a superficial success that cloaks failure.

When people’s well-being depends on hitting certain numbers, they get very interested in tilting the odds in their favor.

They used what Andy Grove, the former CEO of Intel, called “paired measures.” Grove pointed out that if you use a quantity-based measure, quality will often suffer.

Grove made sure to balance quantity measures with quality measures.

Anticipating these abuses before the fact can be productive and even fun, in sharp contrast to reacting to them after the fact. 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 alter...

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?

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,”

When people were placed closer together so that they’d talk more, they talked less.

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,

“You can practice shooting eight hours a day, but if your technique is wrong, then all you become is very good at shooting the wrong way.”

we can formulate some questions to guide a decision about whether or not to stage an upstream intervention. Has an intervention been tried before that’s similar to the one we’re contemplating (so that we can learn from its results and second-order effects)? Is our intervention “trial-able”—can we experiment in a small way first, so that the negative consequences would be limited if our ideas are wrong? Can we create closed feedback loops so that we can improve quickly? Is it easy to reverse or undo our intervention if it turns out we’ve unwittingly done harm?

“Systems can’t be controlled, but they can be designed and redesigned. We can’t surge forward with certainty into a world of no surprises, but we can expect surprises and learn from them and even profit from them.… We can’t control systems or figure them out. But we can dance with them!”

“We under-invest in the services and policies that would keep people healthier so that they would not develop those illnesses or have the injuries or suffer from premature deaths that we know could be avoided,”

The group pegged the total national spending on public health specifically at $88.9 billion, just 2.5% of total health care spending in the United States in 2017.

Public health efforts suffer from what is effectively a punishment for success. “In public health, if you do your job, they cut your budget, because no one is getting sick,”

creating payment models to fund upstream efforts can be almost unbelievably complicated,

the “wrong pocket problem”: a situation where the entity that bears the cost of the intervention does not receive the primary benefit.

In these efforts to prepare for uncertain or unpredictable problems—like Y2K or hurricanes—we’re seeing familiar themes. An authority convenes the right players and aligns their focus. They escape their tunnels and surround the problem. And they try to make tweaks to the system—like improvements to contraflow—that will boost their readiness for the next disaster.

Scientists and technologists rarely cross a formal threshold where they ask themselves, Should this thing be invented? If it can be invented, it will be. Curiosity and ambition and competitiveness push them forward, forward, forward. When it comes to innovation, there’s an accelerator but no brake.

We never really know in advance what these technologies will yield, whether they will be mostly good or mostly bad. We just fumble our way forward and deal with the consequences.

There’s a concept called “the prophet’s dilemma”: a prediction that prevents what it predicts from happening.

“Be impatient for action but patient for outcomes.”

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).

Macro starts with micro. When we think about big problems, we’re forced to grapple with big numbers. What would it take to solve problems for 1,000 people? Your first instinct might be to say: We’ll have to think about the big picture, because we can’t very well intervene individually with 1,000 people. But that notion, as it turns out, is exactly wrong.

All of these efforts were also aided by systems change, to be clear, but those changes were often sparked by a familiarity with individual cases.

The lesson is clear: You can’t help a thousand people, or a million, until you understand how to help one. That’s because you don’t understand a problem until you’ve seen it up close. Until you’ve “gotten proximate” to the problem,

It’s true that it’s harder to imagine this “by-name” methodology working with millions of people rather than hundreds or thousands. To affect millions requires systems change. But even systems change usually starts up close: Someone understands a problem so well that they formulate and lobby for a new policy at the city or state level, and it works, and later other state leaders see that the policy works and they embrace it, too.

If you want to help solve big problems in the world, seek out groups who have ambitious goals coupled with close-up experience.

In the Scoreboard Model, the question is: How can we make progress this week?

if you’re looking for a place to contribute your talents, favor Scoreboards over Pills. Don’t obsess about formulating the perfect solution before you begin your work; instead, take ownership of the underlying problem and start slogging forward.