Autoimmune: a wicked problem

wicked-probsOn the weekend I was thinking about ‘wicked problems’.

It occurred to me while I was reading a paper called Tackling wicked problems: a public policy perspective by the Australian Public Service Commissioner, that  Autoimmune Conditions are wicked problems.

Just geek out with me on this for a minute.

All I’ve done in this blog post is adapt that report.  Condensed it for brevity, and changed some of the language about public policy to language about health. Otherwise, it’s intact. I think it really relates to autoimmune.

I know that the number of kindred-nerds who are interested in this stuff might be few, but applying the existing research into wicked problems to our attempts to address Autoimmune Conditions might be useful. You be the judge:

Tackling wicked problems: an autoimmune perspective

Original by Lynelle Briggs, Australian Public Service Commissioner, with autoimmune-related edits from me~

Humans seeking health are increasingly being tasked with solving very complex problems. Some of these issues are so complex they can been called ‘wicked’ problems. The term ‘wicked’ in this context is used, not in the sense of evil, but rather as an issue highly resistant to resolution.

It is important, as a first step, that wicked problems be recognised as such. Successfully tackling wicked problems requires a broad recognition and understanding that there are no quick fixes and simple solutions.

Tackling wicked problems is an evolving art. They require thinking that is capable of grasping the big picture, including the interrelationships among the full range of causal factors underlying them. They often require broader, more collaborative and innovative approaches. This may result in the occasional failure or need for change or adjustment.

Characteristics of Wicked Problems

The term ‘wicked’ in this context is used, not in the sense of evil, but as a crossword puzzle addict or mathematician would use it—an issue highly resistant to resolution. The terminology was originally proposed by H. W. J. Rittel and M. M. Webber, both urban planners at the University of California, Berkeley, USA in 1973. In a landmark article, the authors observed that there is a whole realm of social problems that cannot be successfully treated with traditional linear, analytical approaches. They called these issues wicked problems and contrasted them with ‘tame’ problems. Tame problems are not necessarily simple—they can be very technically complex—but the problem can be tightly defined and a solution fairly readily identified or worked through.

Wicked problems are difficult to clearly define. The nature and extent of the problem depends on who has been asked, that is, different people have different versions of what the problem is. Often, each version of the problem has an element of truth—no one version is complete or verifiably right or wrong.

Wicked problems have many interdependencies and are often multi-causal. There are also often internally conflicting goals or objectives within the broader wicked problem. It is the interdependencies, multiple causes and internally conflicting goals of wicked problems that make them hard to clearly define. The disagreement among health practitioners often reflects the different emphasis they place on the various causal factors. Successfully addressing wicked problems usually involves a range of coordinated and interrelated responses, given their multi-causal nature; it also often involves trade-offs between conflicting goals.

Attempts to address wicked problems often lead to unforeseen consequences. Because wicked problems are multi-causal with many interconnections to other issues, it is often the case that measures introduced to address the problem lead to unforeseen consequences elsewhere. Some of these consequences may well be deleterious.

Wicked problems are often not stable. Frequently, a wicked problem and the constraints or evidence involved in understanding the problem are evolving at the same time that people are trying to address the problem. People have to focus on a moving target.

Wicked problems usually have no clear solution. Since there is no definitive, stable problem there is often no definitive solution to wicked problems. Solutions to wicked problems are not verifiably right or wrong but rather better or worse or good enough. In some cases, the problem may never be completely solved. To pursue approaches based on ‘solving’ or ‘fixing’ may cause people to act on unwarranted and unsafe assumptions and create unrealistic expectations. In such cases, it may be more useful to consider how such problems can be managed best.

Wicked problems are socially complex. It is a key conclusion of the literature around wicked problems that the social complexity of wicked problems, rather than their technical complexity, overwhelms most current problem-solving approaches. Solutions to wicked problems usually involve coordinated action.

Wicked problems involve changing behaviour. More innovative, personalised approaches are likely to be necessary to motivate individuals to actively cooperate in achieving sustained behavioural change.

Possible Strategies for Tackling Wicked Problems

There is no quick fix for wicked problems.

The handling of wicked problems requires holistic rather than linear thinking. This is thinking capable of grasping the big picture, including the interrelationships between the full range of causal factors and health objectives. By their nature, wicked issues are imperfectly understood, and so initial planning boundaries that are drawn too narrowly may lead to a neglect of what is important in handling them. It is in this unforeseen interconnection that problems grow and failures arise.

There are a variety of ways that people try to tame wicked problems by handling them too narrowly. The most common way is locking down the problem definition. This often involves addressing a sub-problem that can be solved.

If measures are limited to the sub-problem rather than the wicked problem, the problem can appear solved at least in the short-term. Unintended consequences tend to occur even more frequently if the problem has been artificially tamed, that is, it has been too narrowly addressed and the multiple causes and interconnections not fully explored prior to measures being introduced.

The need for innovative and flexible approaches

In these complex circumstances, people seeking health have to become adaptive. Paul Plsek likens this difference to that between throwing a stone and throwing a live bird. The trajectory of the stone can be calculated precisely using the laws of physics. The trajectory of the bird is far less predictable. The question is whether we can embrace this shift in perspective, and redefine our role as supporters of adaptive processes of change. We need to stop pretending we are throwing stones, and acknowledge that the management of health is far more akin to throwing birds.

Another way of increasing adaptability and flexibility is to focus on sharing the learnings and experiences from dealing with wicked problems. (That’s what blogs do!)

The style is not so much of a traveller who knows the route, but more of an explorer who has a sense of direction but no clear route. Search and exploration, watching out for possibilities and inter-relationships, however unlikely they may seem, are part of the approach. There are ideas as to the way ahead, but some may prove abortive. What is required is a readiness to see and accept this, rather than to proceed regardless on a path which is found to be leading nowhere or in the wrong direction.

This style displays a willingness to think and work in new and innovative ways, and requires flexible and creative thinking. A concomitant condition to increasing adaptability is a broad acceptance and understanding that there are no quick fixes and that levels of uncertainty around the solutions to wicked problems need to be tolerated. Successfully addressing such problems takes time and resources.

 

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