Wickedness

Wicked problems are problems that span disciplines and are seemingly untractable. Examples include poverty, climate change, and artificial intelligence; those issues that involve multiple stakeholders, the definition of the problem is unclear, and solving one problem usually involves creating another problem elsewhere.

To start off my series on the this topic, I thought I would provide the “textbook definition” of wicked problems.

The notion of the “wicked problem” was originated by Rittel and Webber in their 1973 paper “Dilemmas in a General Theory of Planning“.

Here they describe the changing nature of problems we face over history. In general, they suggest that problem solving solutions implemented by “professionals” were most obsessed with efficiency rather than actually doing the right thing. This approach lead to systems that had unforeseen poor consequences. This is especially true in problems that have a societal aspect to them, in contrast to say, a mathematics or engineering problem which are characterized by generally being “tame” or “benign”.

Indeed, all problem that involve planning at a governmental level have a level of complexity that classical, efficiency-based, scientific models of solving can not begin to grasp.

Therein is the “wicked problem”.

The ten proprieties of a wicked problem are as follows:

  1. “There is no definitive formulation of a wicked problem
  2. Wicked problems have no stopping rule
  3. Solutions to wicked problems are not true-or-false, but good-or-bad
  4. There is no immediate and no ultimate test of a solution to a wicked problem
  5. Every solution to a wicked problem is a “one-shot operation”; because there is no opportunity to learn by trial-by-error, every attempt counts significantly
  6. Wicked problems do not have an enumerable (or an exhaustively describable) set of potential solutions, nor is there a well-described set of permissible operations that may be incorporated into the plan
  7. Every wicked problem is essentially unique
  8. Every wicked problem can be considered to be a symptom of another problem
  9. The existence of a discrepancy representing a wicked problem can be explained in numerous ways. The choice of explanation determines the nature of the problem’s resolution
  10. The planner has no right to be wrong”

 

I will delve deeper into these characteristics in future posts….

 

 

 

On wickedness and complexity

I tend to be interested in the biggest, seemingly-least tractable problems in the world. This informed why I chose public health as a career, and why One Health issue fascinate me to no end. To unify my thinking on this topic, I have been inspired to learn as much as I can about the concept of “wicked problems” and complexity.

This topic largely excites me because it enables me to read literature across multiple disciplinary lines.

My current list of disciplines to explore includes (of course) public health, economics, environmental conservation, design, and most recently, project management.

From time to time I will be updating this blog with my learnings from a given article on this topic.

By doing this, I hope to tease out an outline of a larger document on the general topic of wicked problems.

Enjoy!

Population health in U.S. healthcare

As part of my job, I have been cultivating a growing curiosity around population health as a feature of healthcare systems writ large. This has taken me down some fantastic rabbit holes. One of which has been the rise of this topic in the United States.

I am learning that the conversation down south is largely focused on the “Social Determinants of Health”, and that “Population Health” is a more esoteric term describing largely the same principle of equity of opportunities for health.

1_6ZBw9NxVJWy3RgOEaf-rkA@2xTo tease out how “Population health” is used in the healthcare system world, I recently wrote an article for Patchwise Labs on the topic here.

For more on the American perspective around population health in healthcare, check out the Patchwise Labs Medium page here. They always have the most up-to-date intelligence on this field and are not afraid to get deep in the weeds of the topic.

Enjoy!

Health systems need to work upstream

With rising health costs and higher health care needs on the horizon, Canadian health care systems need to start thinking about ways to keep people healthy in their communities and out of hospitals. This will take an herculean effort of change, one that will require health care planners and policy-makers to make some difficult choices on how to orient financial and healthcare human resources.

Fortunately, we are getting a better handle on what really makes people sick.

Continue reading “Health systems need to work upstream” →

“What Counts” in health and health care? People

whatcounts
theajames

“We understand that when people come in the door, that there are some things going on that may get in the way of what we are trying to do. So one of the visions is that everybody will understand this.

I think our entire hospital will be a place where everybody gets it, and everybody gets an opportunity to be the best they can be.”

Thea James, MD, Vice President of Mission, Boston Medical Centre

As we begin to understand the true drivers of population health, it is important that those within the health care system are empowered with the knowledge, tools and structures to help advocate for a more holistic approach to health care.

Health Leads is an organization working to do just that. Continue reading ““What Counts” in health and health care? People” →

Basics: Health inequalities measurement

Understanding how to detect and analyse differences in health outcomes between groups of people is foundational to the concept of population health. This type of analysis of data, however, is not typically covered in depth in most epidemiology programs in my experience.

Luckily, the University of Michigan offers a free online course that explains how to calculate and interpret population health data. Called “Measuring health disparities“, the course is designed to give health practitioners and researchers the tools to conduct and appraise health inequalities measurements in their settings.

I highly recommend it to anyone looking to understand how health and socioeconomic data can interact to provide detailed insights into why inequalities emerge, and how we can quantitatively track if we are making progress on health equity.

Recommended: EY’s “Better Innovation” episode on Population Health

In my efforts to cast a wide net for resources on health and innovation, I was recently turned onto the EY Better Innovation podcast.

Hosted by tax lawyer and EY’s Global Tax Innovation Leader Jeff Saviano, the podcast features your not-so-typically highlighted innovators; the ones that aren’t necessarily raising million in venture money or closing billion-dollar acquisition deals.

The innovators he interviews are those whom attack practical problems; people who made their mark mid-career inside their own industries.

This week’s episode is with Dr. Lucy Marcil, the founder of MyStreetCred, a social start-up dedicated to providing tax and financial services inside medical clinic waiting rooms.

Dr. Marcil leverages the enormous privilege and influence of the doctor’s office to address the social determinants of health. It is this type of synergistic thinking that is needed to provide the most high-impact health and social services for populations. You’ll hear about the genesis of this idea, the implementation reasoning behind it and how to scale a health innovation.

Enjoy! 

Thirsty for evidence

evidencetopolicy

A meme after my own heart….

The evidence-practice gap is not news. In health care, 17 years is the often cited period of time it takes for evidence to become medical practice. The truth is, however, we might not actually know how long this lag exactly is….

What we do know is that the smaller the gap, the better off patients will be.

Continue reading “Thirsty for evidence” →