Problem-framing series. Blog 2/3: Stating the problem

This blog series is written as additional resource for an academic program where participants undertake an intervention project that falls within the scope of control, does not require additional resources and where cause and effect can be determined (i.e. ordered side of the Cynefin framework). 

As the inventor Charles Kettering noted – ‘A problem well-stated is a problem half-solved.’

With 182 patents registered in his name, across industries, including healthcare, he certainly knew a thing or two about framing problems and developing successful interventions.

Problem framing, and intervention techniques and methods has been a field of enquiry for a very long time across various fields, including empirical science, engineering, mathematics, medicine, philosophy and sociology. Despite the disparate fields, the importance of stating the problem seems to cut across. 

As mentioned in the previous blog, how the problem is stated will influence the interventions. And unfortunately, once we find a method that works for us (and might be well accepted within our field of practice), we stop questioning and being curious about other methods. We become blinded; this is where using a conceptual framework like the Cynefin framework can be incredibly valuable. It helps to the explore the type of situation that we are dealing with, guiding us to asking better questions and consider diverse approaches or ways to intervene. 

When used in a multidisciplinary team it can provide a nuanced understanding of the pain points, contexts and views. Once the problem has been identified, how it will be stated or framed is not mere semantics, it actively determines the direction, scope and possibilities for intervention. 

Certain problems can be framed using a deterministic view with the outcome clearly stated and directly linked to the cause. However, starting an intervention built on a premise that the problem is identified, the components are listed and can be controlled is idealistic. These approaches, however popular, are naïve for more complex problems. When dealing with a complex situation the more appropriate reasoning would be to acknowledge that we have an idea of the problem, but that more insights are required and that we accept that the system will shift as we intervene – thus we need to be flexible and willing to adjust as the system changes. Thus, we identify a direction for the change and not a fixed endpoint (i.e. SMART goal or fixed outcomes).

It is not as much about applying a deterministic approach (which is sometimes needed), it is about the thinking and assumptions made about the system when using these approaches. It increases the likelihood converging on solution very quickly, before probing the system testing assumptions, capturing multiple perspectives or thinking about different presenting angles. Methods embedded in deductive reasoning strongly favour expert inputs and knowledge, and it is often about convergent evidence. Thinking broadly, obtaining multiple perspective, adapting to shifts in the system are not encouraged in this type of thinking.

Most readers of the blog will be familiar with using quantitative methods to state questions, and you might be wondering how to state a problem worthy of inquiry in an operational setting that will allow more divergent thinking. There are many different ways across the fields, but I like using the Design Thinking Point of View (POV) to state the problem. 

The problem is …. (what)…it affects (who, where and when). This needs to change (what) because …(why).

Another way, is to start the statement with: How might we… 

Using words like how and might are helpful as it signals the possibility of more than one solution or intervention, making it a little bit harder for us to attach our favourite or go-to solution and reasoning about problems. A way to keep yourself in check when framing the problem is to ask whether you are stating a problem or stating a solution. 

Ban Solutionitis, where we attach our favourite intervention, which is a cognitive bias. Similarly, the Einstellung effect occurs when people continue using a familiar or established method, ignoring or disregarding more appropriate solutions. It’s been argued that experts or people with experience are more likely to be blinded, which is why it is useful to question assumptions. 

Because of bias, it is tricky to question ourselves, or to ‘keep an open mind’, but it requires intentionality. Ways in which we can test our assumptions include reflexivity, jotting down assumptions, returning to the framing of the problem to see if it requires reframing, what else could be true. Obtain multiple perspectives – a cliché that sounds easy, but in practice takes time, and creating safe spaces for sharing. 

Here are a few questions to help you refine your statement and test assumptions:

• Is the focus of the problem clear?
• Who is affected by the problem statement? (i.e. are the stakeholders represented)
• How are their (stakeholders) voices present in the problem statement?
• Who needs to care more? 
• Does anyone else need to be involved?
• Why is this a problem worth addressing? 
• Where are you starting from? 
• What is the evidence that this is a problem? 
• Is this a PROBLEM statement and not a SOLUTION statement? 

There is a lot of pressure, and pressing problems in healthcare, and you want to make sure that you spend your (and others’) precious time on addressing worthwhile problems. Some might argue that this is why there is no time to spend time thinking about the problem, I would argue that this is exactly why you need to spend time dancing with understanding the problem and then stating the problem.

A well-crafted, thought-through problem statement can be signpost for interventions. But also, take note that as you make a change or intervene, the problem might change, hence the need to be iterative – constantly shifting between thinking broadly and zooming in on small experiments.

This blog has felt a bit messier than blog one, and it felt entangled with blog one. That said, I hope the two blogs together will offer useful food for thought as you start thinking about interventions.

Food for thought:

• Let go of the ready-made solutions…and think about the framing of the problem. 
• Question your assumptions. 
• Become sensitive to the nuanced changes in the system and build on those, as opposed to forcing a set outcome onto the system.