Want to solve intractable problems in health and healthcare? The process probably has much less to do with “solving” than you would think. We are all probably familiar with Einstein’s famous quote, “If I had an hour to solve a problem, I would spend the first fifty-five minutes determining the proper question to ask, for once I know the proper question, I could solve the problem in less than five minutes.” Yet, a vast majority of us probably experience precisely the opposite in our day-to-day duties. This imbalanced practice of problem solving has resulted in most of us becoming incredibly effective at solving for the wrong problem or the wrong scale of problem, which is not only inefficient, it is one of the most persistent threats to the health of our communities and organizations.
The Problem is the Problem
One of the greatest misconceptions of innovation is that it starts with a genius, like Steve Jobs, isolating themselves until a grand, fully formed idea emerges from the ether. Yet most of the great breakthroughs in human history were the result of someone thinking differently about the problems, not the solutions. Most organizations operationalize this misconception by starting every initiative or project by brainstorming a lot of ideas to poorly framed problems, distracting and wasting the organization’s most talented and creative employees. In fact, we argue that the biggest source of waste in the health sector today is not inefficiencies, instead it is the huge investment made in elegantly solving for the wrong problem over, and over, and over again.
Why hasn’t the problem-solving approaches that were so effective throughout the Industrial Revolution not translated to addressing the most persistent health and healthcare problems of today? While a linear problem-solving approach works well for problems that are well defined and understood, they fail when applied to problems that are ill-defined and ambiguous. In design, we call these ill-defined problems wicked problems which is defined as “a problem that is difficult or impossible to solve because of incomplete, contradictory and changing requirements that are often difficult to recognize. Moreover, because complex interdependencies, the effort to solve one aspect of a wicked problem may reveal or create other problems.”
In the face of wicked problems our natural defense is to quickly “pick” an aspect of the problem to focus on or worse, jump directly to a technical fix. A typical “problem” statement might look something like, “develop an app that helps patients track their caloric intake.” This assumes that an app (digitally) is the best way for people to engage their food environment. It also assumes that people will care how many calories they are eating or that the problem is simply a lack of education rather than a lack of time, cultural relevance or priority. This thinking describes why we now have over 165,000 health apps while experiencing greater levels of obesity, diabetes and health disparities than ever before.
There is little doubt that the best way to arrive at new and creative solutions is to start from new and creative ways of understanding your problem, but it is not a natural part of most problem-solving frameworks. In fact, as we have described here, most approaches to problem solving often force problems through ill-suited tools and 10 step-processes that do more to distract from the problem than to learn more about them. As Thomas Wedell-Wedellsborg points out in the HBR, “Even when people apply simpler problem-diagnosis frameworks, they find themselves digging deeper into the problems they’ve already defined rather than arriving at another diagnosis.”
How to Frame and Reframe Big Problems
Fundamental to framing the “right” problem is to start with the problems that need to be solved in the first place. These are those problems that do not lend themselves well to more linear problem-solving methods and are usually those problems that 1) cannot be well defined and/or 2) have persisted over time regardless of attempts to solve it in the past. These are good indicators that the problem is a wicked problem and requires a different frame. One of the keys to becoming more creative and effective at framing problems, is to find ways of making the familiar unfamiliar. To do so, we have outlined several proven design approaches that do not require special skill sets and can be deployed in your day-to-day practices with little to no additional time commitments.
- Outsider Input: Sometimes the least fertile place to look for fresh perspectives on a problem is with the people who are the “experts” on that problem. Now we are not saying that understanding their experience is not important in the design process, but if you are looking for new perspectives, you will need to look outside your department, or even your organization. This could take the form of interviewing a hotel operations director to learn more about patient experience or observing a farmer’s market to learn more about community organizing. The reality is that innovation almost always emerges from the edges of the bell curve. Attempting to understand the “outlier” condition will do more for reframing problems than any amount of traditional research ever will.
- Adjust your scale: A go to tactic in the design world is to change the scale at which you are viewing a problem. Too often, we stay focused on the granular level of a problem, paying little attention to the interconnected influences driving the problem to start with. Similarly, some of us may only view problems from the macro-scale and have little ability to become more detailed in our understanding of the problem(s). The reality is that you need to move between scales, framing problems from the most granular (single individual) to the most global (community) and understand how and why the problem changes (and for whom) when you do so.
- Get Uncomfortable: One of the most effective, yet difficult tactic for professionals is getting outside of your comfort zone. We spend our careers developing and protecting safe professional silos, where we can reliably default to our expertise and avoid “unknowns.” To reframe your thinking, get outside of your day-to-day practices and even your institutions and put yourself in environments that are less familiar or ‘known.” We become far more receptive to learning from other’s experiences and expertise when we are in less familiar environments (see empathetic engagement here). A tactic we have found success with is getting members of your organization (leadership and staff alike) to hold conversations with people within their community context, such as at a coffee shop near their home or on the train.
- Ask different questions: Because people cannot envision a future state that is substantively different than the current one, (functional fixedness) designing problems and solutions to what people think they want, is a waste of time and resources. The challenge with directly asking people what they want is that you are already suggesting a problem and people will respond to that problem even if it is not what matters most to them. Asking someone what they think is a very different activity than asking them how they feel. Instead utilize the “Get Uncomfortable” tactics above and ask questions such as, “what brings you joy” or “what are you most looking forward to” and “what are you most afraid of?”
- Change your format: Most of us have a couple go-to methods for problem solving, usually in the form of post-its and brainstorming sessions, even though brainstorming has been repeatedly proven to make us less productive and creative. Simply changing the way you, or your users are describing the problem can dramatically shift how you perceive a problem or aspects of that problem. One of the most effective methods is to ask others to diagram or create a storyboard of their problem. While almost everyone will have the initial response of “but I am a horrible drawer,” it can be the easiest and quickest way to prompt people to see their problems through “fresh eyes.” The intention behind diagramming or storyboarding is not to be graphically accurate or to create a work of art, rather it promotes having different conversations and requires stakeholders to become much more intimate with their experiences calling out pain points, assets and connections, or a lack thereof within the problem.
Professor Thomas Fisher is the Director of the Minnesota Design Center, at the College of Design, University of Minnesota. Jess Roberts leads the Culture of Health by Design initiative at the Minnesota Design Center and is Affiliate Assistant Professor at the School of Public Health, University of Minnesota.