By: Dan Heath

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Imagine that you are having a picnic at the side of the river with your friends.

Suddenly you hear a child shouting because they are drowning in the river. You and one of your friends leap up, courageously dive in the river, and rescue the child.

As soon as you get the child safely on land, you hear the same thing again. So, you both jump back into the river and save that child as well.

And as soon as you get that child to safety, you guessed it, you hear another one. And then another. And another.

Finally, your friend wades out of the water, leaving you to fend for yourself.

"Where are you going?" you ask. Your friend responds, "I'm going upstream to tackle the guy who's throwing all these kids in the water."

That is a public health parable originally attributed to Irving Zola, which perfectly describes the main point of this book.

That in order to solve the most important problems, you have to catch them upstream.

What Upstream Thinking Is

In 2012, Ryan O'Neill was the head of customer experience for Expedia, the travel website company. He had been looking at data from the call centre, and couldn't believe what he was looking at. 58% of all customers who booked travel on Expedia ending up calling in for help afterward.

Even more unbelievable was the number one reason customers called: to get a copy of their itinerary. In 2012 alone, 20 million people called for that very reason. Considering that every support call cost the company about $5, it represented a $100 million problem.

Most call centres would focus on call efficiency, trying to drive down the average cost of a support call.

But the team at Expedia realized that they needed to go upstream to make a dent in that $100 million problem.

Why weren't customers getting their itineraries? Good question. Sometimes they mistyped their email address, other times it ended up in their junk folder, and other times it was deleted by accident because they thought it was a marketing email. To make things worse, customers weren't able to get a copy of their itinerary online.

So, the executive team at Expedia went to work and created a "war room" where they met on a daily basis to review a simple mandate: save customers from needing to call.

Today, almost all of those calls have been eliminated. Overall, the number of customers who call for support has dropped from 58% to about 15%.

They went upstream and found the true causes of the customer calls and eliminated them.

Downstream actions react to problems after they've happened. Upstream efforts try and prevent them from happening in the first place.

This all sounds very simple, so why is it so hard to do?

One reason is that we tend to favour reaction over prevention. It's easier to see, it's easier to measure, and it yields tangible results immediately.

Working on upstream problems is slower and not as clear cut, but when you find the solutions upstream, they really, really work. Usually for the long-run.

Three Barriers To Upstream Thinking

Before we get into how to think like an upstream problem solver, we need to understand what's standing in our way to getting there.

There are three main reasons why upstream thinking is harder than it seems.

Problem Blindness

The first barrier to upstream thinking is the belief that negative outcomes are natural or inevitable. We tell ourselves things like "that's just the way it is around here."

Ultimately we end up treating those problems like the weather - like it or not, that's the way it is, and the best thing we can do is just accept it.

And so, we end up missing potential solutions that are sitting there, right before our eyes.

For instance, there's a belief in most team sports that injuries are just part of the gig. Especially in football.

But when Marcus Elliott joined the staff of the New England Patriots, he decided to ignore the common wisdom and head upstream to try and solve one of the most common injuries in football - the pulled hamstring.

He realised that he could dramatically reduce the number of injuries by focusing on creating individualised training plans for his players, designed to minimise injuries in the upcoming season during the offseason.

In his first year the hamstring injury rate went from 22 down to 3. A dramatic improvement because he didn't' just accept that injuries were a part of sports.

Lack of Ownership

The second barrier to upstream thinking is when a problem has no owner. When nobody takes responsibility for a problem, nobody solves it.

Sometimes it's because the problem is split up into many tiny small pieces, when what's required is to have somebody own the entire problem. That's what happened at Expedia, when different groups owned different parts of the customer experience, but nobody owned the problem of eliminating customer support calls.

Other times self-interest is the culprit. Tobacco companies are in the best position to prevent millions of deaths due to lung cancer, but solving it would impact their bottom line.

What's required in these cases is for somebody to step up and own the problem voluntarily. That's what happened when the large carpet manufacturer Interface decided to step up and eliminate their negative impact on the planet. In the first year of that mission, they grew their sales from $800 million to $1 billion without increasing the raw materials needed to create their products.

Tunneling

The third and final barrier to upstream thinking is tunnel vision. When we have a lot of problems to solve, we give up trying to solve all of them to focus on solving the ones that are the most tangible - which, as we've already covered, are the short-term and reactive kind.

In the language of Stephen Covey, this is a lot like focusing on the urgent at the expense of the important.

Eventually, of course, all problems become urgent. And by that time, it's almost always too late to solve the most important problems.

Seven Questions For Upstream Leaders

Now we move on to how to think like an upstream leader, so you can solve the most important problems facing you and your business today.

There are seven questions you need to answer in order to do this well.

Question #1: How will you unite the right people

Upstream problems almost always require the coordinated action of multiple teams of people.

The key here is to surround the problem and use data for learning.

Surround the problem and use data

When you start to tackle an upstream problem, your first step should be to pull together a team of people from every team that needs to be involved in the solution.

For instance, teen substance abuse was a big problem in Iceland during the 1990s. During 1998, 42% of 15 and 16 year olds in the country reported being drunk in the previous 30 days.

So, they got together leaders from different areas of life in Iceland - parents, politicians, sports club leaders, and many more - and tackled the problem together.

They were guided by a simple philosophy - change the culture surrounding teenagers by reducing the risk factors for substance abuse, and increasing the protective measures. Each group had varying amounts of resources and ability to help, but they could all pull in both directions.

In the twenty years since the beginning of the campaign, the teenage culture was transformed. Among other results, the percentage of teenagers reporting they were drunk in the past 30 days dropped from 42% all the way to 7%.

Question #2: How will you change the system?

Solving upstream problems is all about reducing the probability that the problems will happen, and so, you need to change the system that is causing the problems in the first place.

The key here is to fight for systems change, and to shape the water.

Fighting for systems change

A well designed system is the best way to impact problems upstream. In 1967, 5 people died for every 100 million miles driven on roads. Fifty years later, that number is dropped to 1 death for every 100 million miles.

There was no centralised planning to improve that death rate, but thousands of people, from auto safety experts to Mothers Against Drunk Driving - constantly tweaked the system so that it could be safer with the passing of each and every year.

Shape the water

Sometimes the system is very hard to see. David Foster Wallace tells a story about two young fish swimming along when an older fish passes by and asks them "how's the water?" Which causes one of the younger fish to look over to other and ask, "What the heck is water?"

The water is the environment around you that causes the resulting behaviour. As an example, fast food restaurants used to deal with the problem of people throwing out the reusable plastic tray that came with their meal.

To solve the problem, they shaped the environment by creating small circular holes for the garbage that eliminated the possibility of them throwing out the tray.

Question #3: Where can you find a point of leverage?

Archimedes once said, “Give me a lever long enough and a fulcrum on which to place it, and I shall move the world.”

As Heath points out, finding the fulcrum and the lever is the hard part. But when you find it, the results can be extremely powerful.

The key here is to get closer to the problem.

Get closer to the problem

There has always been a preconception in Chicago that the majority of gun deaths in the city were the result of gang violence.

That was until some researchers decided to dig a little deeper, and found that many of the deaths came from regular every day arguments you'd expect teenagers to have.

A detailed look at the examiner reports painted a new story about why these deaths were occurring - that it was a combination of impulsive behaviour, perhaps some alcohol, and a gun, equals a dead body.

They had found a potential leverage point in impulsive behaviour, and an organisation called Youth Guidance created a program they called BAM - Becoming A Man.

It was a combination of support groups, tough love through male mentoring, and cognitive behavioural therapy, a technique that helps people learn to change their patterns of thought, and thus, their behaviour.

The results were stunning. Students who participated in BAM saw violent-crime arrests drop by 45%.

Question #4: How will you get early warning of the problem

When we can predict a problem ahead of time, we have a lot more room to manoeuver and fix it. So one of our critical tasks is to get an early warning signs of the problem we are trying to solve.

The key to doing that is to deploy sensors, and to look for predictors.

The most dramatic example in the entire book deals with the Sandy Hook Elementary School shooting in 2012, and a subsequent campaign to try and prevent future tragedies like this one.

In a video that went viral online, the storyline followed a boy and girl flirting by writing notes to each other on desks in the school library.

In a surprise ending, as they are finally meeting for the first time, a boy barges into the gymnasium and pulls out an automatic rifle, and everybody screams and starts running for the exits.

Then, the video plays back what we missed the first time through, which were the many warning signs that something like this was coming, happening right in the background. The shooter is looking at gun videos online, is getting bullied in the hallway, and exhibiting anti-social behavior.

This video became a training program for schools around the nation, and become known as the Safe2Say Something program, and has helped prevent further school shootings, along with suicide attempts and sexual assaults.

It worked because the students were trained in how to become "sensors" who were looking for "predictors" of similar attacks happening in the future.

Whenever it becomes clear that you have an upstream problem, finding the right predictors and sensors is critical to your success.

Question #5: How will you know you’re succeeding?

It's not enough to take action, you need to understand whether or not your actions are actually helping. Obvious, but many people skip this step.

Even after you choose the right ways to measure success, you need to make sure that you are not seeing "ghost victories." There are three kinds.

First, your solutions are working, but the cause is something external to your efforts. This is the classic "a rising tide lifts all boats." When the tide goes back out, you'll be left out to dry.

Second, when measures are misaligned with the mission. When you succeed in your short-term solutions but you allow it to pull you off your main mission, you've ultimately failed.

Third (this is a special case of the second), the measure becomes the mission. This is the most destructive form of ghost victory, because it's possible to nail your short-term measures while undermining your mission.

In many cases this happens because people game the system. For instance, if you were in charge of both reporting crime rates in your neighbourhood, and also with reducing the amount of crime in the neighbourhood, you now have incentive to understate the amount of crime that's actually happening.

Make sure that the measures don't become the mission.

Question #6: How will you avoid doing harm?

Sometimes the unintended consequences of your upstream solutions will make things worse rather than better.

In India, the government once offered a bounty on cobras to try and help reduce the population. That sounds like a sensible solution, until some enterprising people set up cobra farms to take advantage of the bounty. When they were caught, they simply let the cobras go, ultimately increasing the population.

Although you can never fully mitigate all the risks your solution will provide, you should have all of the potential stakeholders do a pre-mortem - a technique invented by a gentleman named Gary Klein. Basically, you pretend that a year has passed, the project was an unmitigated disaster, and you list all the reasons why that was the case.

It's kind of like going upstream on your upstream solutions. Very meta.

Question #7: Who will pay for prevention?

One of the problems with upstream solutions is that somebody needs to pay - and the solution is ultimately something that "doesn't happen."

There are different scenarios as play here.

The first scenario is where the person who benefits is the person who pays for the solution. For instance, a business owner that solves an upstream problem will (we assume) ultimately see the benefit. This is called the single pocket concept.

The second scenario is where the organisation that bears the cost does not receive the primary benefit. This is called the wrong pocket problem, and it's a real issue with most social care solutions.

Conclusion

Short-term solutions to problems almost never work in the long-run. Finding and solving upstream problems does.

It's not easy, but the with right mindset and the tools you learned in this book, you'll be well on your way to solving the most important problems in your business and life...forever.