📚 Should You Read This?
Toby's Rating: 7/10
Dan Heath has written the ultimate primer on the power of prevention, a work that deserves a prominent place on every leader's bookshelf. Packed with vivid stories and practical examples, Upstream is the rare book that can both revitalize your business and make our world a better place.
👋 Hey - I'm Toby. This summary wasn't written by AI. I'm a real leader, managing teams in large organisations. I read to solve tough problems. I share book summaries to help other leaders tackle scary challenges.
💡3 Big Ideas
Big Idea 1 - Downstream actions react to problems once they’ve occurred. Upstream efforts aim to prevent those problems from happening at all. Upstream efforts look at the systemic factors that influence problems.
Big Idea 2 - Organisations have a natural tendency towards downstream thinking. It's more tangible and is often rewarded. Fighting the fire is valued over preventing the fire. The key for leadership is to shift the focus to Upstream Thinking. Rewarding and supporting efforts that prevent problems. Even if they are not as tangible or easier to reward.
Big Idea 3 - There are three barriers that block effective upstream thinking: I don’t see the problem; It's not mine to fix; I can't deal with that right now. Leaders need to be aware of these barriers and adjust the systemic factors that contribute to them. Make Upstream Thinking the natural, default behaviour.
💬 2 Most Tweetable Quotes
When you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.
A telltale sign of upstream work is that it involves systems thinking.
🎁 1 Top Takeaway
The case studies and stories within this book are fantastic. They reveal concrete examples of how shifting upstream can have big results. For example, the story of how the dutch bicycle company. To reduce damage in transit delivered their bicycles in TV boxes. Amazing!
This is a great book for anyone new to thinking about systems. It's also great for leaders faced with problems that need a new approach.
I've already started sharing the stories from this book with my network. They highlight the power of upstream thinking.
Finally, I was also reminded of how easy it is to fall into problem-solving mode. As leaders, we can often assume the role of problem-solver quickly (isn't that what we are paid to do?). Instead, this book highlighted the role of a leader is to assemble a diverse group of people and find leverage points to systemically tackle the problem.
Big Ideas Expanded
I don’t see the problem.
It's not mine to fix.
I can't deal with that right now.
Pioneer new ways of working together
Find reliable ways to measure success
Be aware of unintended side-effects
What is Upstream Thinking?
When you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.
Downstream actions react to problems once they’ve occurred. Upstream efforts aim to prevent those problems from happening. To systematically reduce the harm caused by those problems.
Downstream efforts are narrow and fast and tangible. Upstream efforts are broader, slower, and hazier—but when they work, they really work.
Upstream is broad and slow(er). You can bring a homeless person a meal today, and you’ll feel good immediately. But to figure out how to reduce evictions, in order to prevent people from becoming homeless—that might take years. What kind of work do you care so much about that you could stick with it for 5 years? Or 10 years?
A telltale sign of upstream work is that it involves systems thinking.
Upstream work is about reducing the probability that problems will happen, and for that reason, the work must culminate in systems change. Because systems are the source of those probabilities. To change the system is to change the rules that govern us or the culture that influences us.
Story - River Drownings:
You and a friend are having a picnic by the side of a river. Suddenly you hear a shout from the direction of the water—a child is drowning. Without thinking, you both dive in, grab the child, and swim to shore. Before you can recover, you hear another child cry for help. You and your friend jump back in the river to rescue her as well. Then another struggling child drifts into sight … and another … and another. The two of you can barely keep up. Suddenly, you see your friend wading out of the water, seeming to leave you alone. “Where are you going?” you demand. Your friend answers, “I’m going upstream to tackle the guy who’s throwing all these kids in the water.”
Ref: public health parable (adapted from the original, which is commonly attributed to Irving Zola)
Story - Expedia:
For every 100 customers who booked travel on Expedia—reserving flights or hotel rooms or rental cars—58 of them placed a call afterwards for help.
The number one reason customers called? To get a copy of their itinerary.
It was no group’s job to ensure that customers didn’t need to call for support. In fact, no team really stood to gain if customers stopped calling. It wasn’t what they were measured on.
This was identified as an Upstream Problem. The customer had mistyped her email address.
Once changes were implemented to this upstream issue the percentage of Expedia customers who call for support declined from 58% to roughly 15%.4.
Story - Dutch Bicycle Company:
VanMoof received complaints that many of its bikes were damaged during shipping. Bex Rad, the creative director, wrote on Medium that “too many of our bikes arrived looking like they’d been through a metal-munching combine harvester. It was getting expensive for us, and bloody annoying for our customers.”
Their solution? They started printing images of flat-screen televisions on the side of their shipping boxes, which are very similar in shape to flat-screen TV boxes.
“Our team sat together and we imagined that couriers would be more careful with packages if they knew even more precious goods were in them,” the cofounder Taco Carlier told a journalist.
Damaged goods were reduced by 70% to 80%.
3 Barriers to Upstream Thinking
I don’t see the problem (Or, This problem is inevitable.) - Problem Blindness
That’s not mine to fix. - Lack of Ownership
I can’t deal with that right now. - Tunnelling
Problem Blindness
This is the belief that negative outcomes are natural or inevitable. Out of our control. When we’re blind to a problem, we treat it like the weather. We may know it’s bad, but ultimately, we just shrug our shoulders. What am I supposed to do about it? It’s the weather.
“Inattentional blindness,” a phenomenon in which our careful attention to one task leads us to miss important information that’s unrelated to that task. When it’s coupled with time pressure, it can create a lack of curiosity. I’ve got to stay focused on what I’m doing.
Story - London Transport:
In 1894, when more than 60,000 horses were transporting people daily around London, the Times predicted that, “In 50 years, every street in London will be buried under nine feet of manure.”29 Let’s leave aside for a moment the logistical implausibility of that particular nightmare. (How exactly would the 9th foot of manure have been added to the top of the pile?) Still, it was not a totally unreasonable fear: those 60,000 horses had an average daily “output” of 15 to 35 pounds of manure. At the first international urban planning meeting in New York City in 1898, the horse manure crisis was the talk of the conference.
Story - Brazil C-Section Rate:
In Brazil in 2014, the C-section rate was 57%, one of the highest in the world. And in the country’s private health system, favoured by wealthier Brazilians, a mind-boggling 84% of children were delivered via C-section.
“The system was designed to produce C-sections,”
By implementing upstream solutions, such as educating doctors and patients, nine months later, the rate of natural childbirth had shot up to 40%.
Ref: https://www.theatlantic.com/health/archive/2014/04/why-most-brazilian-women-get-c-sections/360589/
The escape from problem blindness begins with the shock of awareness that you’ve come to treat the abnormal as normal
A Lack of Ownership
“When we create organizations, we’re doing it to give people focus. We’re essentially giving them a license to be myopic. We’re saying: This is your problem. Define your mission and create your strategy and align your resources to solve that problem. And you have the divine right to ignore all of the other stuff that doesn’t align with that.”
Mark Okerstrom - Expedia
Focus is both the strength and the weakness of organizations. The specialization inherent to organizations creates great efficiencies. But it also deters upstream efforts.
People resist acting on a perceived problem because they feel as though it’s not their place to do so.
What’s odd about upstream work is that, despite the enormous stakes, it’s often optional. With downstream activity—the rescues and responses and reactions—the work is demanded of us.
Tunnelling
Researchers have found that when people experience scarcity—of money or time or mental bandwidth—little problems crowd out the big ones. When people are juggling a lot of problems, they give up trying to solve them all. They adopt tunnel vision.
People who are tunnelling can’t engage in systems thinking. They can’t prevent problems; they just react. It dooms you to stay in an endless cycle of reaction.
To escape the tunnel you need slack. Reserve of time or resources that can be spent on problem-solving. This is where the minimising cognitive load on teams is so important.
Without the slack, the teams won't think systemically.
You also need to create an urgent demand to fix a problem that may not happen for a while. Make the upstream feel downstream.
Upstream Leadership
To succeed upstream, leaders must:
Detect problems early
Target leverage points in complex systems
Find reliable ways to measure success
Pioneer new ways of working together
Embed their successes into systems to give them permanence.
Pioneer new ways of working together
To succeed:
Surround the problem with the right people;
Give them early notice of that problem;
Align their efforts toward preventing specific instances of that problem.
Story - Iceland Underage Drinking:
Iceland was top of the table for the percentage of people drunk at the age of 13 or younger and the percentage who’d been drunk 10 or more times during the previous year.
To solve the problem they shifted progress upstream. This included 2 solutions. Firstly improving sports programs, to give students activities to do other than drinking. Secondly introducing a curfew so that students spent more time with their parents.
Perhaps the most astonishing part of the story in Iceland is that its success has been so complete as to be invisible. Most teenagers today aren’t really aware of it.41 They’ve simply grown up in a world where substance abuse is largely absent.
Story - Domestic Violence Response:
The Domestic Violence response system was splintered into specialized functions: police officers to respond to 911 calls; health care providers to mend wounds; advocates to help victims; district attorneys to prosecute cases; and parole officers to monitor abusers after they served sentences.
Women were essentially falling in the cracks between these roles. None of the groups that performed these functions had both the mission and the wherewithal to prevent homicide.
An upstream solution was introduced. A new tool asks female victims of abuse to mark on a calendar the approximate dates, over the previous year, when they were abused. Then they are asked to answer 20 yes/no questions about the abuser, including: Is he unemployed? Does he threaten to harm your children? Does he control most or all of your daily activities? For instance: Does he tell you who you can be friends with, when you can see your family, how much money you can use, or when you can take the car?
All the various response groups would then meet to review the specific cases at risk. These were not committee meetings to discuss “policy issues around domestic violence.” This was a group assembled to stop particular women from being killed.
Story - Tackling Veteran Homelessness:
Three critical shifts en route to ending veteran homelessness:
a shift in strategy
a shift in collaboration
a shift in data.
Cities have many different housing options for homeless people—supportive housing, transitional housing, shelters, and more—and there are many different agencies that interact with the homeless. Imagine a hotel with seven different front desks, each with its own set of policies for who can book a room and how long they can stay, and so on.
The strategic shift was to embrace what’s called “housing first.” In the past, the opportunity to receive housing was like a carrot dangled in front of homeless people to encourage them to fix themselves: to receive substance abuse treatment, or treatment for mental illness, or job training. The idea was that a homeless person needed to earn their way into the housing. “Housing first” flips that sequence. It says that the first step in helping the homeless—not the last—is to get them into housing as soon as possible. “I stopped thinking of people as ‘homeless’ and started thinking of them as people without houses,”
Walker and Jaeger have begun to work on the problem of “inflow”—reducing the number of new people who become homeless. It’s a thorny problem, for all the reasons you’d expect, but they’ve already identified one leverage point: evictions.
In some neighborhoods in Rockford, the eviction rates are as high as 24%.
In early 2019, the city conducted a pilot program in which it acted as an intermediary between tenants and landlords in situations where eviction was imminent.
In some cases, the city negotiated a new payment plan for the landlord and tenant; sometimes, the city also contributed money on behalf of the tenant.
Find reliable ways to measure success
“A rising tide lifts all boats.”
A question that bedevils many upstream interventions is: What counts as success?
With downstream work, success can be wonderfully tangible, and that’s partly because it involves restoration. Downstream efforts restore the previous state.
Three Ways Measures Fool You:
Your measures show that you’re succeeding, but you’ve mistakenly attributed that success to your own work. (The team applauds itself for hitting more home runs—but it turns out every team in the league hit more, too, because pitching talent declined.)
You’ve succeeded on your short-term measures, but they didn’t align with your long-term mission. (The team doubled its home runs but barely won any more games.)
Your short-term measures became the mission in a way that really undermined the work. (The pressure to hit home runs led several players to start taking steroids, and they got caught.)
5 tests to improve measures:
The “rising tides” test: Imagine that we succeed on our short-term measures. What else might explain that success, other than our own efforts, and are we tracking those factors?
The misalignment test: Imagine that we’ll eventually learn that our short-term measures do not reliably predict success on our ultimate mission. What would allow us to sniff out that misalignment as early as possible, and what alternate short-term measures might provide potential replacements?
The lazy bureaucrat test: If someone wanted to succeed on these measures with the least effort possible, what would they do?
The defiling-the-mission test: Imagine that years from now, we have succeeded brilliantly according to our short-term measures, yet we have actually undermined our long-term mission. What happened?
The unintended consequences test: What if we succeed at our mission—not just the short-term measures but the mission itself—yet cause negative unintended consequences that outweigh the value of our work? What should we be paying attention to that’s offstage from our work?
Warning: Systems respond in surprising ways
“Changes for the good of the whole may sometimes seem to be counter to the interests of a part of the system.”
- Donella Meadows
Upstream interventions tinker with complex systems, and as such, we should expect reactions and consequences beyond the immediate scope of our work.
Story - Plastic Bags:
In San Diego, banning plastic bags resulted in some truly unanticipated consequences. Some people attributed a deadly 2017 hepatitis A outbreak in San Diego to the lack of plastic bags. Why? Homeless people had been in the habit of using the bags to dispose of their own waste. When the bags became less plentiful, the other alternatives turned out to be less sanitary.
