Health Care Reform: A “Wicked Problem”

Tomorrow night I’m moderating a health care panel hosted by the Boise Young Professionals as part of their Lounging Series.  The panel, which is being held at St. Luke’s in Boise, includes:

• Mr. Dave Self – Senior Vice President & Idaho Regional Director for PacificSource
• Dr. Karl Watts – Saint Alphonsus Medical Group Family Physician, President/Founder of Genesis World Mission and the Garden City Community City Clinic
• Dr. Gary Krouth – Vice President of Medical Affairs for St. Luke’s
• Mr. Scott Leavitt – Former National President of the National Association of Health Underwriters

As I reflect on this topic, I can’t help thinking that health care reform is a “wicked problem.”  I recently came across the concept again when reading The Design of Business: Why Design Thinking is the Next Competitive Advantage by Roger Martin.  C. West Churchman, in a 1967 guest editorial for Management Science, makes reference to a seminar of Professor Horst Rittel he attended, in which the latter notes:

“…the term “wicked problem” refer to that class of social system problems which are ill-formulated, where the information is confusing, where there are many clients and decision makers with conflicting values, and where the ramifications in the whole system are thoroughly confusing.” (p. B-141)

This was expanded upon by Rittel and Webber (1973) when they identified “…ten distinguishing properties of planning-type problems, i.e., wicked ones…” (p. 160), including:

1. There is no definitive formulation of a wicked problem.
2. Wicked problems have no stopping rule.
3. Solutions to wicked problems are not true-or-false, but good-or-bad.
4. There is no immediate and no ultimate test of a solution to a wicked problem.
5. Every solution to a wicked problem is a “one-shot operation”; because there is no opportunity to learn by trial-and-error, every attempt counts significantly.
6. Wicked problems do not have an enumerable (or an exhaustively describable) set of potential solutions, nor is there a well-described set of permissible operations that may be incorporated into the plan.
7. Every wicked problem is essentially unique.
8. Every wicked problem can be considered to be a symptom of another problem.
9. The existence of discrepancy representing a wicked problem can be explained in numerous ways.  The choice of explanation determines the nature of the problem’s resolution.
10. The planner has no right to be wrong.

Jeff Conklin, of CogNexus Institute, simplified and generalized the ten properties to six characteristics of wicked problems (629 KB, .pdf):

1. You don’t understand the problem until you have developed a solution.
2. There is no stopping rule.
3. Solutions are not right or wrong.
4. Each is essentially unique and novel.
5. Every solution is a ‘one-shot operation.’
6. There is no given alternative solution.

Given the above definition, properties, and characteristics, I’d say the “wicked problem” concept appropriately sums up health care reform.

References

Christensen, K. (2009, Winter).  Building shared understanding of wicked problems. Rotman Magazine, 17-20.

Churchman, C.W. (1967).  Wicked problems.  Management Science, 14(4), B-141-2.

Martin, R. (2009).  The Design of Business: Why Design Thinking is the Next Competitive Advantage.  Boston, MA: Harvard Business Press.

Rittel, H.W.J., & Webber, M.W. (1973).  Dilemmas in a general theory of planning.  Policy Sciences, 4(2), 155-169.