Outside Innovation

A Pragmatic Solution for Eldercare in the US—Designed by Elders for Elders

As many of you know, I now live year round on the coast of Maine. One of my local heroes is Chip Teel, who has been pioneering in eldercare for over two decades. He’s a local M.D., with a family practice of seven professionals. A large proportion of their clientele are elderly people. Chip, who has a specialty in geriatrics, served as director of the local nursing home. He has also been very involved as the Medical Director of a nearby retirement community.

Over the years, Chip’s elderly clients have been very clear with him about one thing: they don’t want to move out of their homes, no matter how frail they become. When their declining health and fragile mental states made it necessary for them to move out of their homes, they were often unhappy, and their conditions worsened. When Teel could figure out ways to keep them at home and provide the supplemental services they needed, they thrived. So he engaged with a group of his clients to try a couple of experiments.

How Should the Disclosures about NSA Snooping Change Things?

I can’t ignore Edward Snowden’s whistle-blowing revelation: The US government is snooping much more than our US Constitution allows on the private communications of its citizens, residents, and even lawmakers. Not to mention the rampant electronic eavesdropping being carried out by our spies hacking Internet and phone systems in most other countries. This is not a good time to be an American in the world. It’s embarrassing to be living in a “democratic” country that has turned fascist since 9/11.

It’s not my practice to speak out on politics to my clients. But I can’t ignore the fact that my most loyal customers have been discussing these events quite volubly online since the news broke. Their consternation isn’t so much political as it is technical: it appears that the NSA’s snooping has actually compromised ALL of the certificate-authority based security provisions that our entire global economy depends upon!

There are two main consequences from these revelations that I foresee. But I also fear that PR spin, human nature (bury our heads in the sand), and apathy (I have other things to worry about; I don’t have time to worry about whether I’m being spied upon) will, once again, prevail.

Tackling a Wicked Problem: California’s Water Supply

How do you address an intractable and contentious issue that’s becoming more and more urgent? That’s the problem faced by California’s newly formed Delta Conservancy. The delta region and estuary formed by the Sacramento and San Joquin Rivers provide some of the most fertile agricultural land in the country, support hundreds of species of wildlife and provide drinking water for 60% of Californians. Yet the ecosystem is fragile and beset by both man-made and natural calamities. For decades, farmers and environmentalists and water companies have been at each other’s throats. Government regulation and intervention seems to exacerbate things. So, facing the rollout of a highly controversial development plan, the Delta Conservancy took an unusual approach. They solicited key stakeholders, including farmers, fishermen, residents, water company owners, directors of environmental organizations, and members of local, state, and federal agencies to build a shared understanding of the issues. These people engaged in a six-month series of site visits and civil dialogues in order to build a common mental model. Now they’re about to engage in Phase 2: Deepen that shared understanding to help plan the future of the Sacramento-San Joquin Delta.

Tackling a Wicked Problem: Water Issues!
How the Delta Dialogues Project Is Using Dialogue Mapping to Build Shared Understanding
By Patricia B. Seybold, CEO & Sr. Consultant, Patricia Seybold Group, May 30, 2013

Jeff Conklin convinced the Delta Conservancy team that forging consensus around the future of the main California water supply was a “Wicked Problem,” and that it would be unethical for them to use strategic planning tools designed for tame problems on this much thornier, more complex, more socially fraught wicked problem. This triggered a unique 6-month initiative dubbed The Delta Dialogues, in which 19 passionate and interested people, representing most of the different constituencies impacted by water planning, agreed to engage in a prolonged dialogue to build a shared understanding of the issues surrounding the future of the Sacramento River and San Joquin River Delta area.

(Download the PDF of the entire article here.)

What Are Wicked Problems, Why Are They Wicked, and How Do You Deal with Them?

I’ve been thinking a lot about wicked problems recently.

As faithful readers know, I’ve been embroiled for the past 10 months in a local community hospital issue and have aired our progress (or lack thereof) in a series of posts.

Our recent consulting work has also exposed us to a number of wicked problems: one is the design of a transformational new product line for a highly conservative industry in which our client is both a new incumbent and a distant also ran; the other involves trying to help a well-meaning group of very smart people get rid of layers of barnacles and bureaucracy so they can do their almost impossible jobs. Blowing up and starting over is not currently an option, at least not without dealing with the evolution of the current state at the same time.

I love these kinds of challenges! But they are frustrating and intractable. What makes them so is that they involve “wicked problems.” Wicked problems aren’t just hard problems to solve. They are design dilemmas that are heavily embedded in social context for which there is no solution. There are only approaches that are somewhat better for some, but not all, of the stakeholders. But what makes wicked problems particularly wicked is that it’s really hard to wrap your collective minds around them. And it’s difficult to do so without people taking sides or putting forward their own agendas. We are human, after all. We are social animals. We have agendas and careers and values and experience and history and things we are passionate about.

So, I found it refreshing to take some time out from this brain-breaking work to read a book written by an old acquaintance and colleague with whom I’d recently reconnected (through the auspices of Linked In!). The book is Dialogue Mapping: Building Shared Understanding of Wicked Problems.

Jeff Conklin has spent his entire career helping organizations and groups of people deal with wicked problems by 1) focusing on them as his sweet spot, and b) developing tools and methods to help groups of people develop shared understanding. Here’s Jeff’s take both on why wicked problems are so wicked and why shared understanding helps.

“It turns out there's a slippery linguistic trap in the name 'wicked problem,' because the name implies there's a 'solution.’ It's more accurate to talk about the degree of 'wickedness' in a situation (or perhaps how messy a given 'mess' is). (Framing the challenge in this way might help to break our addiction to racing around creating and exacerbating 'problems' with our 'solutions'.) The truth is that a wicked problem is a set of interlocking issues across many domains (i.e., political, environmental, economic, etc.), and any attempt to bound the scope of the challenge is arbitrary. Moreover, only a tame problem can be 'solved' -- wicked problems can only be managed more or less effectively, more or less efficiently. The best we can do is to find more elegant and expedient interventions, but ultimately the human condition is that there's no getting away from the 'Whac-a-mole' phenomenon that even the most elegant intervention on a wicked problem will make some issue(s) more wicked for some stakeholder(s).”

Even getting started on coming up with a solution to a wicked problem is intractable. Everybody involved has a different definition of “the problem,” and all of those definitions are probably flawed because we (collectively) don’t yet know enough. Jeff Conklin explains:

“With social complexity, ‘not understanding the problem’ does not show up as innocent wonder about the mystery of the problem, neither does it usually occur as a thoughtful collective inquiry into the deeper nature of the problem. Rather, ‘not understanding the problem’ shows up as different stakeholders who are certain that their version of the problem is correct or at least that other versions are fatally flawed. In severe cases, such as many political situations, each stakeholder’s position about what the problem is reflects the mission and objectives of the organization (or country) they represent.”

“The Holy Grail of effective collaboration – is in creating shared understanding about the problem, and shared commitment to the possible solutions. Shared understanding does not mean we necessarily agree on the problem, although that is a good thing when it happens. Shared understanding means that the stakeholders understand each other’s positions well enough to have intelligent dialogue about the different interpretations of the problem, and to exercise collective intelligence about how to solve it. Because of social complexity, solving a wicked problem is fundamentally a social process.”

~ Jeff Conklin

Here are some of my take-aways from reading Jeff ’s seminal book:

How to Address “Wicked Problems”
Use Dialogue Mapping to Build a Shared Understanding and Evolve a Group’s Thinking
By Patricia B. Seybold, CEO & Sr. Consultant, Patricia Seybold Group, May 23, 2013

Help Save St. Andrews Hospital

Please take a moment to sign our petition--

Save St. Andrews Hospital before it closes in Boothbay Harbor on October 1st!

Aerial view of St. Andrews Hospital in Boothbay Harbor, Maine

Once we lose our LOCAL Emergency Department and hospital beds, we will never be able to get them back! The elderly people, young families and working fishermen in our 4 rural communities need the 24 hr. emergency room and hospital beds we have had locally for 107 years. But, without your help, St. Andrews Hospital will be shut down by October 1st! 65% of our population is over 65 years old. Historically a fishing and vacation community, the coastal Boothbay region has also become a coveted retirement destination. But without a local hospital with nursing care, rehab and end-of-life care, people are moving away!

St. Andrews was chartered as a rural nonprofit hosptal to serve the residents in the 4 communities on the Boothbay peninsula. 86% to 95% of the voters in these communities (the customers of this hospital) voted to keep it open. Yet, the corporate "parent" insists on closing our hospital. They claim it isn't "making money," but St. Andrews has generated a surplus of $450K per year for the past 11 years and is the first safety net for people in need. The hospital is one of two on the Maine coast that can be reached by sea, land and by air.

The people in our community are scared for their lives and angry that they have no say in their own health and wellness. Stop big corporations from making life and death decisions over our lives. Let the community control the local hospital by electing its board. We're ready and able. We've been working for 10 months to Save St. Andrews and we're going to keep up the fight until we gain control of our community's hospital! The people on our peninsula give $6 million in charity every year. We can afford to support and will improve and use our own local hospital and preventative health and wellness solutions.