How to effectively solve or prevent problems before they occur

In my article, How to get better results by solving problems before they occur in a fragile world, I made an argument that it is much better to prevent problems before they occur.

If I had an hour to solve a problem, I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions. — Albert Einstein

Reactive vs. proactive problem-solving

Reactive problem-solving is about putting out a fire after it has occurred. For example, treating diabetes after it has developed.

This reactive approach is favoured because the solutions are tangible, easier to measure and short-term. After putting out a fire, a saviour hero is created. Everyone wants to be the hero that saves the day. Society worships and handsomely rewards these heroes, unfortunately.

However, the need for heroism is a sign of system failure. ‘True heroes’ stop fires well before they occur in the first place. Preventing problems before they occur is hidden work. It involves invisible heroes saving invisible victims. Efforts are not rewarded.

Proactive problem solving

Proactive problem solving is all about identifying problems and resolving them well before they occur. We should never see them at all. They are intangible.

Problem prevention starts with identifying the outcome you want to achieve in a high-risk area. Then by anticipating what could go wrong in the system when you are trying to achieve that outcome, you can take proactive steps to keep the problem from ever occurring.

Examples of preventative solutions include:

Swimming lessons to prevent drowning.
Adding fluoride to water supplies to prevent tooth decay.
Vaccinations to prevent disease.
Visible police presence to prevent crime.

The 10-step proactive problem-solving method

The essence of this method is that a person has an outcome to achieve in a high-risk area. But thanks early warning signs that are supplemented by information gathered from early warning risk indicators, they may encounter potential problems along the way.

This could be an unwelcome or harmful matter or situation that needs to be dealt with early before it occurs. It involves systems thinking and anticipating potential causes and fixing them well before they eventuate. Problems have one or more negative effects. Solutions implemented to overcome and prevent problems must provide or create value for the person.

This article sets out a 10-step way of solving, preventing or even anticipating problems well before they occur.

Ambulance services as an illustration of the 10 steps

I will use ambulance services as an example to bring home the essence of each of the 10 steps in this proactive problem-solving method.

Ambulance services aim to promote health and reduce the adverse effects of emergency events on the community. (An emergency is a situation that poses an immediate risk to health, life, property, or environment.)

Governments’ involvement in ambulance services is aimed at providing emergency medical care, pre-hospital and out-of-hospital care, and transport services that are:

Accessible and timely.
Meet patients’ needs through the delivery of appropriate health care.
High quality — Safe, co-ordinated and responsive health care.
Financially sustainable.

Step 1 — Identify the outcome you want to achieve

Focus on outcomes or impacts when preventing problems from occurring.

Outcomes are short- to medium term changes in specific knowledge, attitudes, behaviours, or conditions arising from the activity. In addition to outcomes, you can also focus on impacts, which are longer-term, sustainable results.

Ambulance services illustration — Ambulance services must operate in a financially sustainable to “promote health and reduce the adverse effects of emergency events on the community”.

Step 2 — Identify key leverage points

Focus on key leverage points that may affect your outcomes and the achievement of your objectives.

Look for key points of leverage in the form of high-risk areas or groups that can be used to gain and deliver maximum impact towards the outcomes you seek.

Ambulance services illustration — Ambulance services must operate in a financially sustainable way especially within the context of government austerity measures. This includes finding other sources of income like charging non-emergency patients for treatment without transport and ambulance membership subscriptions.

But the number of complaints received by the Ombudsman from patients who received invoices for treatment without transport has risen.

Step 3 — Detect problems before they arise by addressing early warning signs

Focus on designing a ‘smoke detector’ alarm system that forewarns a potential or future problem to come.

Collect data to learn rather than for inspection. Utilise historical data and trends — macro and micro — to create an early warning system that will enable you to take action to prevent a future problem from occurring.

Use early warning risk indicators (see Step 7) as part of this ‘smoke detector’ alarm system. These are lead indicators that provide information about any emerging problems that could arise in the future.

Ambulance services illustration— Historical data can strategically locate ambulances in areas of highest need. It will reveal the locations where there will be spikes in emergency calls on Fridays and Saturdays, during flu season, and New Year’s Eve. By pre-deploying ambulances within close reach of these key locations at designated times, ambulance services can achieve a lower response rate and provide accessible and timely emergency services.

Historical data can also show the increasing number of complaints received from people who have received their treatment without transport invoices from ambulance services. These negative trends can impact patients’ overall satisfaction.

Step 4 — Create a sense of urgency

Focus on creating a sense of urgency to attract attention and action for preventing problems that are still far off in the future.

Planning and preventing possible future problems are usually not considered as urgent action by definition.

Instead, people and organisations are used to constantly dealing with urgent short-term problems or problems that have occurred. Fire-fighting is common.

For example, the term ‘ozone hole’ was created as visual imagery and language that captures people’s imagination that helped them understand the need to take action to prevent further damage to the ozone layer — alike the urgent need to fix a hole in a roof or a boat.

Ambulance services illustration— Ambulance services will face a bigger than expected financial ‘black hole’ if it is unable to source alternate sustainable income from non-emergency transactions. Ambulance call-out fees can also be paid by health funds/insurer, etc.

Step 5 — Consider fixing the system as a whole

Focus on fixing the system as a whole, not just addressing the symptoms, to avoid other unintended or unexpected consequences.

Root causes of problems are usually found within systems. But systems are complex and systems change takes time. Expect reactions and consequences.

An important part of systems change is to give stakeholders involved a sense of their power to create change.

Prevention work is concerned with creating long-lasting systemic change for better outcomes. It is not about fixing particular parts of the system.

For example, cutting budgets for pruning trees will result in an increasing number of settlements due to injuries caused by falling branches. Financial savings in one part of the maintenance budget will only cause additional legal expenses and lawsuit payments in another part of the budget.

Ambulance services illustration— Simon is involved in an altercation with some drunken patrons outside a bar on a Friday night. Someone else (a well-meaning customer) calls an ambulance. Simon declines to go to the hospital notwithstanding his physical injuries after receiving some initial medical treatment. Sometime later, he receives an invoice from his ambulance services for the on-site treatment without transport.

People receiving treatment without transport may not be experiencing a life-threatening ‘emergency’ that requires treatment at a hospital. But such call-outs can divert ambulance services from other critical or severe emergencies. More so during peak periods on Friday and Saturday nights.

It also puts emotional pressure on call-takers to identify genuine callers who require life-threatening emergency care versus non-emergency onsite first-aid that could be provided by first-aiders employed by places selling alcohol.

Step 6 — Identify the cause and effect of future problems

Focus on identifying the cause and effect of future problems that could be found in the system.

Address the root causes of early warning signs. This will prevent potential problems from occurring. It will also achieve your desired outcome.

Your desired outcome should give you the reference point about why it’s even a likely problem in the first place and why it’s worth solving.

Choose the wrong root causes to solve and you could end up wasting time and resources. The way you frame a problem determines which solutions you come up with. This means continuously reframing the problem by consciously asking, “Is there a different way to see the problem?”

Consider using the 5 Whys strategy. It is a simple, effective tool for uncovering the root of a problem. Start by asking why it is occurring. Make sure that the answer is grounded in fact. Then ask the question again and again.

Ambulance services illustration — The primary role of paramedics is to respond to a medical emergency, not to engage in discussions about fees. The practice of charging people for on-site treatment without transport raises questions about whether people were given enough information to provide informed consent to authorise billable medical treatment before being treated by paramedics. This includes full disclosure about the potential fees for receiving the treatment without transport. [Cause and effect 1 — Lack of informed consent leads to unauthorised medical treatment and invoicing.]

Unauthorised emergency callsby a third party such as a bystander or well-meaning friends are common occurrences. The patient may not have authorised the emergency call. [Cause and effect 2 — Lack of verification of unauthorised 3rd party calls leads to non-billable ambulance call-outs.]

The paramedics must determine that no emergency clinical care is required (with the result that the call-out event is non-billable) through initial observations without ‘laying on of hands’. It could include the basic recording of vital signs that necessitates the ‘laying on of hands’, which is not implied consent for medical treatment that is billable. [Cause and effect 3 — Non-emergency clinical care diverts ambulances away from attending critical emergencies during peak call-out periods.]

Step 7 — Develop early warning risk indicators

Focus on using risk indicators to provide early warnings on increasing risk exposures or emerging negative trends.

Early warning risk indicators are typically lead indicators that are derived from specific events or root causes, internally or externally identified. They can be used to prevent objectives and outcomes from being achieved.

Ambulance services illustration — An early warning risk indicator for the root cause ‘lack of informed consent’ (Cause and effect 1 from Step 6) is the number of uncompleted “Informed Consent” section on the Patient Care Record documentation. This record should be completed by the paramedic on-site.

Step 8 — Define the resulting value you want to create

Focus on value creation when preventing problems from occurring.

The only reason why you want to solve a potential problem or prevent a problem from occurring in the future is to achieve the desired outcome or objective.

Ambulance services illustration— The value (or benefits) created by addressing the three causes listed in Step 6 are:

Improved resource allocation.
Increased patient satisfaction.
Increase employee effectiveness.

Step 9 — Measure the resulting value

Focus on measuring value and success using the best available data.

Each value claimed to be achieved from Step 8 must be supported by up to two key performance indicators (KPIs). These are paired measures that comprise of:

A quantitative efficiency measure.
A qualitative effectiveness measure.

For example, cleaning’s measures of success could be based on the size of the area cleaned during a period plus quality checks comprising of spot checks for errors or customer satisfaction.

Performance indicators that measure the resulting value must drive the solutions rather than the solutions defining what is achievable. Solutions must deliver a tangible, measurable benefit.

Specify how the key performance indicators will be measured using baselines and targets and the latest or best available data. This avoids ghost victories, unintended consequences and gaming the system.

Ambulance services illustration — To measure the success of “improved resource allocation” of ambulances, the two paired key performance indicators are:

Ambulance response times — an efficiency measure.
The proportion of patients who felt that the level of care provided to them by paramedics was very good or good — an effectiveness/quality measure.

Step 10 — Develop solutions to deliver the performance indicators

Focus on implementing outcomes-based solutions that will deliver tangible benefits.

Preventative solutions are broader, slower and harder. But when they work, they achieve long-lasting results.

Identify options and implement preventative solutions that will specifically deliver the identified key performance indicators (as responses to an identified problem. Targetted solutions must deliver tangible, measurable value. These solutions must also deliver the expected outcome.

Test or experiment small by implementing quickly and iteratively. Gaining ongoing feedback and learn from your actions. Don’t be obsessed about formulating ‘perfect’ solutions before getting started. Continuously fine-tune the solutions in an agile manner.

Ambulance services illustration — Preventative outcomes-based solutions that will “increase patient satisfaction” for ambulance services are:

Call-taker to ask whether the caller is making the emergency call at the request of a patient (assuming the patient is conscious) or as an unrelated 3rd party good samaritan. If the patient is conscious and the situation is triaged as non-emergency, the call-taker will inform the caller that there a chargeable call-out fee for the service. This information will be used to prioritise ambulance services. It is also provided to the attending paramedics. Otherwise, the call-taker will refer the caller to other services like nurse-on-call or home-visiting-doctor service.
Paramedics must ask for verbal consent from the patient before providing any billable clinical treatment including the fees to be charged and invoiced later. Where appropriate, a signature will be requested from the patient for future invoicing.

Other considerations

Implementing this proactive problem-solving steps will require you to do the following:

Take ownership and accountability for preventing a problem that hasn’t yet occurred. There is little to no attention nor demand for unknown future solutions to be implemented. Become a visionary and leader. Ask the question, “Who’s best positioned to fix it and will they step up?”
Build-in guaranteed time and resources for solving future problems. When resources are scarce or unallocated, every problem becomes a source of stress and conflict. It results in short-term, narrow and reactive thinking. There will be resistance to pay for preventative solutions despite the popular saying, “prevention is better than cure.”
Challenge your assumptions always. Assumptions, if realised, are risks or roadblocks to achieving your outcome and objectives. Don’t assume, making an ASS out of U and ME.
Formulate and evaluate a mix of cost-effective response options. Surround the problem with the right people — those close to the problem with the experience, expertise and authority to make a difference.
Chunk the responses down into smaller bits by making it more specific if you find a problem overwhelming or daunting.
Explore solutions that could deliver the expected value and key performance indicators. Your solutions must have a measurable outcome.
Consider the full range of things that you can do to address the identified problem. Ask questions like — Why is this solution better? Why not that one?
Ask whether you are intervening at the right level of the system. Take into account interdependencies.
Think about how performance indicators could be misused or achieved in such a way that would be deemed misleading. Incorrect indicators could motivate the wrong behaviours.
Consider the possible secondary effects of your solutions and interventions. Foresee potential unintended consequences of your actions.
Confirm the preferred response (following cost and timeframe assessment) and the interventions it contains.
Identify and evaluate the changes and assets that are required to implement the preferred response and deliver the benefits to achieve the outcome.
Confirm the circumstances (change in condition or an event) where the preferred response may be inadequate or inappropriate and the triggers requiring a change in response.
Implement proper governance and reporting over your actions.
Identify cost range, timeframe for project and benefit delivery, key risks and uncertainties, dis-benefits and critical interdependencies associated with the preferred solution. Adopt the appropriate project management methodologies.
Cultivate the humility to learn, to be wrong, to listen and take on
feedback, to take on the hard and complex work and not be discouraged. Be prepared to make mistakes and move on.

Finally, it’s hard work to prevent a problem from occurring

Problem prevention is hard work.

Therefore, adopt the mindset of preventative system thinking. Take personal responsibility and accountability for issues. Preventing problems to occur takes time and commitment.

It will take courage to prevent something that has not happened. Sweeping things under the carpet is much easier than opening a can of worms.

Believe in your power to solve unknown problems and to positively impact outcomes!