The problem with thinking and communicating in actions
The problem with thinking and communicating in actions
A problem I have been looking at in recent years are the side-effects of being solution-centric in communications and decision-making.
Note: This is an edited post from 2020. I believe I am a much better writer now in 2022 but also feel there are some interesting ideas here which you find interesting. I may condense these ideas into shorter posts in the future but for now, if you find health, public policy and outcomes thinking interesting then this longer post may be your bag. Enjoy!
A problem I have been looking at in recent years is the effect of being solution-centric in communications and decision-making.
When communication and planning are strongly oriented toward solutions, one phenomenon is people seem to anchor more strongly to ideas. The desire to see them through, even in the face of evidence they are not providing the intended benefits.
Quick sidebar - Hey! Academics! This is only a hypothesis based on what seems to be happening observing many different teams and organisations. I would love to work with you on determining whether this phenomenon is reproducible in experiments.
Of course, it's easy to criticise but I always like to be constructive and I cover what alternatives look like in this publication.
Something that I covered recently in:
…is that both public policy and political platforms are often framed in the context of the action to be taken. In a way, this makes sense as its the most immediately concrete and the form of ideas are most commonly communicated and hence the most accessible and easily understood (and for that matter, misunderstood). If the public has a plethora of views on what the goal should be then understanding the rationale for the policy and new procedures is likely to be divergent. I think this can explain much confusion in the political sphere.
Additionally, if the thinking was similarly framed and focused on activities key constraints may not be challenged because they are presumed in the solution.
In my experience (which is limited to being an interested citizen, I have no direct public policy experience so happy to be corrected by those of you who do, please shout out in the comments!) public policy is usually devised with some dimension of efficacy in mind. The public policy sphere is where some great thinking on approaches to efficacy and outcomes thinking have percolated and I have certainly taken inspiration from papers published by NGOs and other entities operating in this space relating to planning, outcome thinking, causal chains and many other topics.
Political policy seems to, although big caveat - this is not my expertise and anyone with political science experience please correct this layperson in the comments, apply these ideas less so due to constraints of public opinion and political time windows; efficacy takes a back-seat to what might be accepted or voted for and might be politically convenient. Or at least that’s how it seems as an observer of domestic politics.
So let’s look at a live example. Continuing my COVID-19 theme from recent posts :
A recent tweet from Carole Cadwalla (https://twitter.com/carolecadwalla) caught my attention. She highlighted what appears to be a clear example of the aforementioned phenomenon I’ve been investigating. Carole was highlighting a video from the UK government’s daily briefings back on 27th March featuring Jenny Harries (https://en.wikipedia.org/wiki/Jenny_Harries) response to a question triggered by Dr Tedros’ recommendation to ‘Test, test, test’ and how the UK would be approaching its response to COVID-19. At this point in time 759 people had died from COVID-19 in the UK and Prime Minister Boris Johnson had been diagnosed with COVID-19 and was self-isolating at home.
'Test, test, test': WHO chief's coronavirus message to world
The World Health Organization called on all countries on Monday to ramp up their testing programs as the best way to…www.reuters.com
I think the comments from Jenny Harries may be an excellent example to look at because we have comments attributed to someone representing an expert organisation. We would expect we are getting an uncompromised opinion reflecting their position of expertise but as I will demonstrate, that doesn’t appear to be the case in this instance.
After all, courses of action are taken into consideration of insights from experts so impartiality is important. We will see how perceived constraints can contaminate expert opinion and result in less optimum decisions being made. The executive decision-makers, in this case, the ministers may believe the resourcing of the problem is adequate.
I am highlighting Jenny Harries’ comments as an illustration of a fallacy which is commonplace in organisations, the prevalence of which suggests its one we need to be aware of. By definition, fallacies are potential traps which can affect our decision-making, so we need to look at how we can improve our systems to guard against them. In this post, I will look at what may have gone wrong with the decision-making process. We will therefore see what we could learn from this example and what we can apply more broadly within our own organisations for better decision-making.
Let’s work through Jenny Harries’ comments in the video.
Jenny Harries says:
and so I think I’m just going to answer in two different sections…in fact we need to realize that the clue for W.H.O. is in its title it’s a World Health Organization and it is addressing all countries across the world with entirely different health infrastructures and particularly public health infrastructures. We have a(n) extremely well developed public health system in this country and in fact public health teams actually train and others abroad we have supported W.H.O.…
In the initial part of the video, I think Jenny Harries’ comments are very reasonable. In the first part of the response, she highlights that WHO recommendations by definition need to be very broad and applicable in a wide spectrum of contexts. I think this is inarguably true given their mission and also she is also highlighting the importance of context in any decision-making — in this case, that the specifics of a situation will affect what the appropriate actions should be. I will elaborate on the importance of context in other posts but for an even more thorough accounting of this topic, I suggest diving into Simon Wardley’s writings.
A phrase I’ve often cited related to this concept is ‘Copy the questions not the answers’ — the phrase, in my opinion, is designed to remind us that no solution can be disconnected from the problem it was targeted to address and its environment. It's very possible I first read that quote on Jessica Kerr’s Twitter and used it ever since.
But part 1 to Jenny Harries’ answer is not the focus of today’s post and it’s not specific, it’s merely context for her part 2. So now I will drill into part 2 of her response to see if it gives us a more specific answer to the narrow testing focus in the UK.
Jenny Harries says:
“…there comes a point in a pandemic where that is not an appropriate intervention and that is at the point really where we moved we moved into delay and although we still do do some contact tracing and testing for example in high-risk areas like prisons or care homes that is not an appropriate mechanism as we go forward. At that point what we need to do is focus on the clinical management of the patients first and foremost…”
Unfortunately, as we get to the second part of her response we get a response which also lacks specificity, a problem if we are trying to understand the meaning, and her comments are frankly a bit weasely (by this I am referring to ‘Weasel Words’ and not any other allusions) — its a broad statement to state UK has an excellent healthcare system, a new phase of the pandemic has commenced, the combination of which makes community testing ‘inappropriate’. To be fair, this is likely a limitation of the format of the daily briefings. We get further in a longer format session a few months later but unfortunately, not before almost a month with limited community testing before an about-face in April. We will cover relevant sections of this session as well.
Thanks to follow-up questions in this later separate session with the Commons Health Select Committee, which featured among others Jenny Harries again with relevant questions from MP Jeremy Hunt, a different and more specific rationale was revealed. He asks:
on the 26th of March you said that community testing was not an appropriate intervention for the UK both South Korea and Germany the two countries that are on those charts shown in Downing Street appear to have had much lower death rates carried on their community testing so Patrick just told us that it’s absolutely essential to know exactly where the virus is if we’re going to track it so do you still think it was right to stop community testing on 12th of March
Jenny Harries first clarifies her statements and the situation at the time:
Perhaps just to clarify the statement and apologies if I didn’t do that at the time. The 12th of March was that the period where we moved from the containment phase to delay up to the point of containment along with many other countries as we had tried to vigorously contain with very active contact tracing which is normal Public Health process to contain cases and to contact race each individual contact once you get very sustained community transmission you are likely to see
arising clinical cases and you have more difficulty in trying to contain the virus
She continues (I’ve omitted some of her statements comparing the UK with South Korea and Germany which you can view on the video links below) :
I think to answer your question in if we had unlimited capacity and the ongoing support beyond that then we perhaps would choose a slightly different approach but with the resources that we had and I mean that’s in a broad sense because many of the specialists and expertise that you need to carry out additional contact tracing will also be supporting the other changes that have been very successful for example ramping up NHS capacity so there are clinicians working on the interface between public health and the NHS and it’s appropriate that that capacity is maximized to save lives I think as well as considering the spread of disease.
To paraphrase, Jenny Harries appears to be saying:
1/ because the virus is not contained, the effort to test and trace the community was much larger than before and
2/ that some of the clinicians that would be needed for community testing would be better applied to treatment activities (very possibly true if the infection is rife and there are lots of sick people to treat).
The problem with this answer is that it suggests it’s not because it's inappropriate’ but rather because of presumed constraints in available personnel and other resources. These constraints were no doubt true but not necessarily fixed or impossible to address (yes, very hard to address, given the crisis was upon them and the pandemic was global, but not impossible and certainly not to be discounted or made invisible) and thus problematic when decisions and solutions are being presented without this context or assumptions present. You can imagine based on this, if you asked the ministers whether they had enough tests or needed to invest in training more contact tracing personnel they may conclude not as the strategy chosen did not need these investments.
Why the constraints may have seemed fixed or unaddressable are multifold;
Time wasn’t available as the need to be treating patients was growing quickly. Training people in time was not possible. Hindsight shows that it was possible.
Additional investment required may be difficult to obtain. The social and economic costs associated with a resulting higher death rate could cover the significant additional investment.
Powers-that-be may have already inferred constraints. A problem of shifting accountability — when leaders frame thinking in resources and activities they should not be surprised when similar behaviours cascade across the organisations they are responsible for.
To generalise this example of potentially unnecessary constraints limiting thinking due to anchoring solutions back to the more familiar territory of this publication, namely that of product development. A too common scenario is for organisations to anchor on ‘the big saviour initiative’. The details of the solution and its moving parts become the focus. How it addresses customer needs may be limited to a broad, untestable notion. The obstacles that need to be overcome to achieve an improved situation for customers are only loosely understood and appropriate solutions prematurely converged.
As details of the solution further crystalise any constraints and assumptions become less visible. These may resurface as solutions fail to address needs, but often this can be missed as the cycles repeat again and again. After all, a shallow understanding of the outcomes to be achieved will also mean shallow and ineffective measurement of progress towards those outcomes.
This post needs some further clean-up and work and maybe split into separate posts. Let me know your feedback in the comments and I will incorporate it into my edits.
More resources
The original question to Jenny Harries can be found at 27:46 and Jenny Harries’ comments start at 30:55: https://www.youtube.com/watch?v=UEf3yRtYgcM
The questions to Jenny from Jeremy Hunt starts at 72:27 and Jenny’s response at 73:02 and continues at 76:26 : https://www.youtube.com/watch?v=GJUWQsTWTuY