‘Upstream thinking’ emerges as problem-solving method

Here’s a novel idea: What if we could solve problems by preventing them from happening in the first place? It’s possible, through an approach known as “upstream thinking” or “upstream problem solving.” The notion has gained traction, particularly within the health care arena.

Katya Andresen, a digital and analytics executive with The Cigna Group in Washington, D.C., recommends the book “Upstream: The Quest to Solve Problems Before They Happen,” which was released in 2020.

 

The author is Dan Heath, Senior Fellow at the Center for the Advancement of Social Entrepreneurship at Duke University’s Fuqua School of Business in Durham, N.C.

Heath told Andresen that society is “stuck in a cycle of reaction. We spend the vast majority of our time and resources reacting to problems that we might well have prevented outright.”

 

Heath said the pioneer in the field of upstream thinking that he admires most was the late Dr. Bob Sanders, a pediatrician in Murfreesboro, Tenn. “He deserves as much credit as anyone for the fact that car seats are now mandatory for kids.” 

While serving as Director of the Rutherford County (Tenn.) Health Department, “Dr. Sanders read an article in the 1970s that convinced him that kids dying in auto accidents was exactly the kind of thing that pediatricians should be worried about,” Heath said.

 

“It sparked him to action. He led an effort to get a new state law passed in 1977. Tennessee became the first state in the country to a pass mandatory car-seat law” (the Child Passenger Protection Act), requiring parents to properly restrain children under age 4 in approved car seats.

By 1985, all 50 states in the nation had passed related laws. Dr. Sanders then set out to champion mandatory seat belt requirements for older children and adults, which became Tennessee law in 1986.

These accomplishments led to Dr. Sanders earning the nickname “Dr. Seat Belt,” one which he wore proudly until the day he died in 2006, at age 78.

Heath said Dr. Sanders’ work helped assure that more than “11,000 kids are alive today who otherwise would have died.”

 

Patricia Sanders helped unveil the historic highway marker that pays tribute to her late husband.

In a medical sense, “upstream thinking examines and addresses root causes rather than symptoms and can improve long-term outcomes while decreasing health care costs,” wrote Dr. Thea James, Associate Chief Medical Officer at Boston Medical Center.

 

“Imagine walking along a river and seeing people floating down, nearly drowning,” she said. “Of course, your first thought is to run to shore and pull them out. You feel good about it – you’ve saved them from drowning, after all – but people keep coming down the river.”

Dr. James said it dawns on you to go upstream to see “what’s the cause of so many people in the water. You discover that a safety fence meant to keep people from falling into the water is missing.”

 

While it’s important to continue to haul half-drowned people out of the water downstream, she said, “Upstream health care is about rebuilding the safety fence so that people don’t fall into the water to begin with.” 

Lillian Wald and a cadre of nursing activists who began work in New York City in 1893 continue to stand out as distinguished nursing forerunners. A hallmark of Wald’s upstream approach – more than 130 years ago – was to promote wellness as a means to prevent illness and disease. 

Dr. Patricia Pittman, a public health professor at George Washington University, Washington, D.C., wrote: “Wald’s model of care (involved) nurses working side by side with social workers at the intersection of medicine and society.”

 

Wald’s story is coming up next.