Book Review: Upstream: The Quest to Solve Problems Before They Happen

Posted by Kristin Arnold on March 25, 2020

As a fan of continuous improvement, I was intrigued by Dan Heath’s new book, Upstream: The Quest to Solve Problems Before They Happen.  It starts with an oft-told story of two campers who save a drowning child…only to see another struggling child drift by….and then another.  One of the campers starts to walk away when the remaining camper demands to know where he is going.  The answer: “I’m going upstream to tackle the guy who is throwing all these kids in the water.”

In an age where leaders get rewarded for rescuing children, solving problems and putting out fires, it takes a certain confluence of events for a person to wade out of the water and go upstream.  It’s not something everybody does, nor is it a natural norm.

In this book, Heath probes the psychological forces that push us downstream:

  • Problem Blindness.  I don’t even see the problem, or it seems like an inevitable consequence and no one can do anything about it.
  • Lack of Ownership.  That’s not my problem to solve.
  • I can’t deal with that right now.

He then poses

Seven questions for those who want to go upstream:

  1. How will you unite the right people? Surround the problem.  Use data for learning.  Heath says, “Grounding an effort in concrete data is the only way to unlock a solution to a major problem.”
  2. How will you change the system?  “Upstream work is about reducing the probability that problems will happen, and for that reason, the work must culminate in systems change.”
  3. Where can you find a point of leverage? To get systems change, you have to start somewhere.  So find a point of leverage by immersing yourself in the problem and look at all the factors.  Chances are you can target a small population, event, data set.
  4. How will you get early warning of the problem?  Look for historical patterns to inform your predictions so you have more maneuvering room to fix it.
  5. How will you know that you’re succeeding?  Watch out for “ghost victories” or those who try to game the system.  “Pre-game” your measures (careful consideration of how the measures might be misused) and use paired measures (a quantity along with a quality-based measure).
  6. How will you avoid doing harm?  Look beyond the immediate win.  You’re in the long game.  Create closed feedback loops to continuously improve.
  7. Who will pay for what does not happen?  Align incentives with all the stakeholders.  Stitch together “pockets of value” that will benefit from the upstream solution to preventing the problem in the first place!

In light of the recent coronavirus outbreak, I couldn’t help but think we needed more upstream people thinking about this pandemic.  And all the factors that go into play have been outlined.  I hope some people in government are reading this (there is my lack of ownership!).

While I may not want to go after preventing pandemics, there are other areas in my life that I can go upstream – and I have a model to work with that will make my efforts work!


KRISTIN ARNOLD, MBA, CPF, CSP is a high-stakes meeting facilitator and professional panel moderator.  She’s been facilitating teams of executives and managers in making better decisions and achieving greater results for over 20 years.  She is the author of the award-winning book, Boring to Bravo: Proven Presentation Techniques to Engage, Involve and Inspire Audiences to Action.

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