Sometimes a Problem needs a Radical Solution

1n the 1990’s, Cook County Hospital (of ER fame) had a problem.  The Emergency Department had to deal with 250,000 patients a year. 

One of the biggest claims on their limited resources was heart attacks.  About 30 people a day came into the ER with chest pains.  Diagnosis was often inconclusive.  Patient’s answers were often unclear, and ECG tests far from perfect.  The only sure tests took hours – the one thing they didn’t have.  So the doctors had to make an estimate.  The trouble was that different doctors made different estimates – no matter how trained or experienced they were.  Add to this the risk of malpractice, and the doctors admitted people just to be sure.  Unfortunately, they had neither the beds nor the money to deal with them.

An incremental change would not be enough, they needed something radical.

The head of the Department of Medicine turned to a cardiologist who was involved with some  mathematicians who were interested in using statistics for identifying subatomic particles.  The cardiologist had developed an algorithm that identified three of the critical risk factors for diagnosis in conjunction with the ECG.  These were;

1. Is the pain unstable angina?
2. Is there fluid in the patient’s lungs?
3. Is the patient’s systolic blood pressure below 100?

These three tests were the works of years of research, but it was only research, no testing had been done.

Eventually, they trialled the algorithm at the hospital, after two years they compared the results with the doctors usual estimates.  The new method was 70% better than the doctor’s usual method.

The point is that even with the best training and experience, severe conditions can undermine even the best practice.  Sometimes something new is required.  Because conditions at the hospital were so demanding, they had to try something radically different.


The full story can be found in Malcolm Gladwell's book "Blink, The Power of Thinking without Thinking"

Logical Solutions do not come from Intuitive Thinking

There is a curious paradox in economics called the Giffen Paradox.  Generally, if the price of a good increases, consumption decreases.  The so called ‘Giffen goods’ do not behave in this way.  For example, in poor communities, if the price of bread increases, consumption increases, not decreases, a rather counterintuitive response.  The reason is that poor people have no disposable income, so if the price of bread increases, they buy less meat (for example), and actually end up buying more bread to make up the difference. 

Counter-intuitive behaviour is all around us.  Where do most pedestrian road accidents occur?  Unbelievably, it is at pedestrian crossings. 

In fact, as soon as you start thinking about it, the more you come up with counter-intuitive results - road traffic, we have learned that increasing the road capacity does not reduce traffic jams.  The list is endless.

What seemed to be a ‘logical’ solution, in fact is not.  Our ‘logic’ is in fact our intuition, and it is this that has failed us.   We have relied on our intuition rather than our logic.   If we were to look at these problems more fully, - possibly from a systems perspective, we might be better able to deal with these problems. 

Sometimes this effect is called the ‘Law of unintended consequences’ – something that is blindingly obvious once we see it, sometimes it is called a paradox, but it is our thinking that is at fault, not the world.

Implementing a solution that our intuition tells us is correct is an inappropriate use of intuition, we may end up with a rude surprise.

How we use Abstraction for Solving Problems

Probably the single-most important capability your brain possesses is that of abstraction.  It is the ability to identify particular features of something to enable you to create a concept that groups all similar abstractions.

Without it you would not be able to think.   Take bones, for example.  There must be a zillion different kinds of bones in the world, all different shapes and sizes.  But when you pick one up you know it’s a bone- you may not know what kind of bone, but it’s a bone.  Your brain is able to look at a collection of different objects- such as bones, and note their characteristics and define their essential nature.  If you could not do that, all bones would be unique, and have no connection to any other bone; they would be completely different objects.

Think of it this way, without the power of abstraction, if I said to you ‘imagine –a  bone’, you would not be able to do it.  That’s how important it is.  It enables us to think about objects and ideas.

It is also a powerful tool for dealing with problems.  Without some degree of abstraction, every problem is unique, with a unique solution.  But if you could make it similar to another problem, or see ways in which it might be similar to another problem, finding a solution is going to be easier. 

The greater the level of abstraction, the simpler the problem becomes and the greater the number of potential solutions may present themselves.

The Gordian knot was famous for its intractability - no-one could untie it.  Alexander the Great did not see it in the same way as everybody else; he saw it as a metaphor, so he was able to come up with a simple and original solution.

Sometimes, solving difficult problems is all in the seeing.

Overcoming Inhibitions is the Key to Solving Difficult Problems

Imagine you were at a kids party and you were doing the entertainment, playing the fool and talking nonsense, it probably wouldn’t make you feel awkward.

Now imagine doing the same thing at work.  Feels a bit different doesn’t it?

Talking about stuff that doesn’t make sense is not easy for most people at work – because work is ‘more important’ than a kids party. You either don’t want to look silly in front of your boss, or you don’t want to look silly in front of your subordinates.  It’s probably worse for managers as they are the ones we look to for making sense. 

Creative problem solving sessions can be hampered because sometimes people have difficulty in engaging with a process that requires people to be fanciful.

Our education and upbringing condition our minds to disregard what we see as nonsense or irrelevant to the problem at hand, our minds inhibit irrelevant ideas.  Creative people are known to pay much more attention to ‘irrelevant’ ideas; they are ‘cognitively disinhibited’. 

Therefore to become more productive in creative problem solving, we need to overcome our inhibitions.  Fortunately, there are some exercises that we can do to help.  Storytelling is one example; each member of the group contributes a line to a story, without reference to the preceding line.  Another example, is to read a sentence out and get each member to finish it so that it does not make sense  (this is an exercise that has been used as a test for conditions such as Alzheimer’s, where people have difficulty inhibiting their normal cognitive processes).


When we can feel free to make outlandish suggestions and ask silly questions, we are able to break away from the limitations that logic imposes on our thinking.

Complexity

Finding solutions to difficult problems is not always about struggling to find a novel solution.  Sometimes the difficulty is a matter of complexity.  A problem might comprise of a large number of factors, each of which has a complex interaction with the other factors.  Complex problems may also be difficult to deal with because it may not be clear what the ideal solution looks like.  For example, social mobility is a burning political issue, but how do you measure it, what constitutes success?

The goal is to reveal the key relationship(s) that may be obscured by too many complex interactions. 

There is more than one approach to these problems.  Here is an example from a TED talk detailing the complex problems facing the NATO forces in Afganistan (its amazing what you can get into 3 minutes).  As Eric Berlow stresses, the idea is to see relationships that cause you to ask new questions.  From a highly detailed map of the factors, he extracts three basic principles.

Alternatively, there is an approach called Concept Mapping which was developed by  William M. Trochim.  This endeavours to discover underlying structures and relationships using a ‘qualitative’ statistical approach.   I showed that in Assumption Mapping, the idea was to place factors within a grid depending upon how they rated against defined key parameters.  Concept Mapping enables us to discover the key criteria amongst an array of confusing and complex factors.  Discovering these parameters enables us to simply the problem and gain new insights.

Problems come in all shapes and sizes, and ‘qualitative’ problems are amongst the most intractable.  These are useful tools that can help cut through the confusion and provide clarity and enlightenment.

The Awkward Squad

One of the things that fascinates me about creative problem solving, is its contrary nature. 

For example, over the years I have run countless meetings and I rather pride myself in being quite good at keeping the meeting moving along, sticking to the agenda and getting input from all concerned.  One of the things that I think I am particularly good at, is not letting people wander off the point.  Every now and then someone will have bee in their bonnet about something and want to make a point that is not relevant.  I wish I had a pound for every time I said “we digress”, or “can we deal with that in ‘any other business’” -  I’m sure we all know people who have a bit of a reputation for wandering all over the place. 

This control works well for ‘process driven problems’ which are encountered at most meetings.  But when you need a creative solution to a problem, this is what you DON’T want.  A tight logical process is not helpful.   You want ideas that are not obviously relevant, because they might spark a better idea in someone else.

So, if you need a creative solution to a problem, invite all those people who find it impossible to stick to the point, disrupting peoples thought processes and not sticking to the point is exactly what you want. 

Powerpoint Poisoning- Killing Creativity

I read an interesting article* about ‘what kills meetings’ – why meetings became unproductive and boring.   One of the symptoms was ‘lack of engagement’; people either took no part, or became hostile to the process.

It turned out that the main factor was the use of Powerpoint presentations.  This is because they imposed too much structure.  They provided a ‘fait accomplis’, in which people were either not required to participate, or had not been given a chance to contribute.  The people were either indifferent or energised for the wrong reasons.

This is not dissimilar to what can happen when people are supposed to be creative, they don’t want to sound foolish – they are used to coming up with sensible, logical ideas, not ridiculous ones and they dismiss the process and do not engage.

What particularly interested me was that one of the ways for overcoming this was the use of questions.  Questions energise.  People cannot resist reacting to a question (it is the reason why quiz shows have been so popular since the beginning of television).  When somebody asks a question in a meeting, people are being asked to contribute – it engages people and the meeting becomes more interactive.

Think about it, in a presentation, all you are required to do is listen, you want people to think and the best way to make people think is to question.

 But, as the article notes, this can be a source of uncertainty – you never quite know where it will take you.

Powerpoint presentations are great if you want to explain something, but should play no part in complex problem solving.  If you have a problem to solve, then one of the ground rules should be
- no Powerpoint presentations.

http://blogs.hbr.org/bregman/2011/04/the-1-killer-of-meetings-and-w.html