PDIA and Obamacare

written by Matt Andrews

Governments often face unenviable tasks that border on the impossible, given particularly thorny political and administrative complexities. Commentators typically deride governments when they fail in their initial attempts to address such tasks. They pen new laws that are less than many had hoped for, and call public agencies inefficient (or worse) when new roll-out mechanisms go slowly or fall apart altogether. Recent experience with the Affordable Care Act (ACA) in the United States is an obvious case in point. No one seems to have an appetite for the struggles government is enduring as it tries to implement this law. We want new websites that perform miracles the first time around, and insurance reforms that solve coverage problems without rocking too many boats. The more we see government muddling in ACA execution the more we criticize it and question the President’s leadership.

This criticism reflects a view on how governments should work that is common in the world of international development, where I do most of my work. Such view reflects a belief in what I call solution and leader driven change (sldc), which holds that policy and reform solutions will work ‘if they are well planned and implemented with strong leadership from the top’. When development initiatives run into trouble, in places as diverse as Argentina, Pakistan and Zimbabwe, sldc believers typically bemoan the lack of leadership and the uselessness of government. They seem to feel that a leader should be able to do all things when armed with a good solution. Any sign of muddling in the process of making or executing change is a sign of a bad solution, weak leadership, or a flailing administration. Success comes from having the right solution at the start and just executing it properly.

This view is extremely problematic. I say this so emphatically because I find exactly the opposite storyline in most of my research examining successful government policies and reforms. The experiences I look at are diverse, ranging from civil rights reform in the United States to growth policies in South Korea and decentralization in Rwanda. Even though these experiences vary a lot, they all involved policy changes that most commentators would call successful—manifesting in more equitable service access, improved economic performance, better public sector performance, and more. I find more commonalities across the cases as well, related to the way they emerged.

Primarily, evidence suggests that these successes seldom (if ever) came about through a clean process where a leader introduced a solution and just forced implementation by edict. Rather, change was spurred by the recognition (by a group of agents) that a problem existed that warranted change; but no one knew exactly what to do. Solutions emerged over time, through many iterative experiments that provided lessons about what could be done and allowed reformers to build support and capability to do more. I call such experimentation ‘purposive muddling’ and see it fitting into an overall process of problem driven iterative adaptation (pdia) that seems more likely to characterize successful change than solution and leader driven change.

I even see purposive muddling and pdia in the story of NASA’s successful lunar missions, which some media outlets portray as a solution and leader driven change initiative (where technical experts simply did what President Kennedy told them to). In fact, the mission involved many agents (and two presidents) and emerged over a number of years; through experimentation that often looked like it was delivering more failure than success. The experimentation looked like purposive muddling that often required more budget than had been provided and required creative administrative solutions that would probably be questioned today. It spawned sad deaths on the launch pad and the messy dismissal of a legendary administrator, but also ultimately led to a number of humans doing the impossible and stepping on the lunar surface.

I believe that governments are still capable of doing great (and impossible) things, and finding solutions to our most complex problems and challenges—like those evident in the health care domain. But they will never do this in a clean, solution driven process that many commentators seem to believe in. Complex policy changes and reforms like those associated with the Affordable Care Act demand messy processes of purposive muddling. These processes can deliver great results if there is space to learn and iterate (which I wonder about with health reform in the USA). We should be grateful whenever political and administrative leaders in government recognize this, and continue to muddle despite the derision their muddling attracts. The governments we should really deride are those that don’t muddle, because they are probably side stepping the complex and demanding problems their citizens face.

This blog post also appeared in the Washington Monthly.

BSC Video 9: Constructing Problems to Drive Change

Problems are key to driving change. In this video, Matt Andrews, uses two examples about HIV in Pakistan, to illustrate how constructing local problems using data can be used to mobilize stakeholders to search for solutions that ultimately drive change. You can watch the video below or on YouTube.

If you are interested in learning more, read Looking Like a State: Techniques of Persistent Failure in State Capability for Implementation and Escaping Capability Traps through Problem Driven Iterative Adaptation (PDIA).

Tales (and Tells) of a Development Amateur

written by Lant Pritchett

Nina Munk’s new book The Idealist: Jeffrey Sachs and the Quest to End Poverty is a great read.  The book itself has been reviewed by development luminaries Bill Easterly, Angus Deaton, and Duncan Green and is on various “Best Book of 2013” lists.

One of my children required extremely complicated heart surgery as a young child and has had regular care since.  This has exposed me to the difference among doctors between heart surgeons and cardiologists.  Both are doctors, but the nature of their activity makes everything else about them different. Heart surgeons focus on discrete and dramatic interventions (surgery) in which the outcome is under their exclusive control (the patient is anesthetized) and the time of their engagement is measured in hours (the procedure) or at most days (discharge from the hospital).  Cardiologists in contrast focus on sustained interventions (medication, cardiovascular conditioning, weight loss, blood pressure) in which the outcomes are primarily under patient control (e.g. compliance, exercise, diet) and the relevant time span of impact is decades not years.  In my experience this leads heart surgeons and cardiologists, by self-selection and training, to have very different personalities and approaches. In considering surgeons to operate on our child, we were told that one surgeon had the best hands in the world (he had constructed a four chambered heart from a two-chambered heart) but was insufferably arrogant and impossible to deal with and universally disliked.  We chose him.

There is a similar analogy among economists.  While all economists might share some commonalities from selection and training there are huge differences across the sub-specialties of the discipline.   The clan called “open-economy macro-economists” deal with crises in which interventions are dramatic, dependent on decisions of few people, and in which outcomes are measured in days and weeks and two quarters is a long horizon.  In contrast the clan called “development economists” typically deal with chronic problems which rarely have discrete interventions, societies (not outsiders) are primarily determinative of outcomes, and in which a decade is the short-run, not the long-run.

There are two main points.

The most obvious that emerges from The Idealist is that Jeff Sachs’ professional training and early policy engagements were entirely as an open-economy macro-economist, which perhaps was practiced in developing country settings (e.g. Bolivia), but was not itself development economics.  He has attempted to remake himself late in professional life (in his forties) from open-economy macro-economist to development economist.  But Nina Munk’s book could have easily been subtitled: “Tales (and Tells) of a Development Amateur.”  Some poker players have obvious “tells” that reveal them as new to (or just bad at) the game.  Similarly, an obvious “tell” of a development amateur is saying any of the following:

  • “It’s easy.”
  • “We can do this quickly.”
  • “We have a solution for every problem.”

The broader—and vastly more important—point than anything about Jeff Sachs is that this book reveals that many development debates and plans and practices have suffered from an inadequate analytical basis.  Sometimes heart surgery is necessary: once a country is in hyper-inflation (like Bolivia in 1986) then a discrete, rapid, technocratic intervention like an orthodox shock really can fix the specific problem of runaway inflation—and perhaps there really is no other way. There cannot be a debate about whether “shock therapy” is good or bad any more than there could be a useful debate about whether using penicillin was good or bad: for the right conditions and in the right dosages: good, and for the wrong conditions and wrong dosages: bad. The sophistication needed is a correct diagnosis of what are the analytical types of problems in the world that are “surgery-like” and which are “exercise-diet-weight loss like.”

In our work on building state capability we have developed an analytical typology of tasks/activities based on four characteristics of the underlying nature of the task that produces five types of activities.  This is not about “sectors” as traditionally understood (like “education” or “infrastructure”) as activities of each of our analytical types exist in most sectors.

An overly broad-brush characterization of development, but which I feel still gives some insight, is that where problems really were “policy” or “logistics” then “development” succeeded (and perhaps even development assistance helped in that success).  As Charles Kenny puts it, things really are Getting Better.  There has been an amazing improvement in health status (firstly and particularly–but not exclusively–in infectious disease conditions amenable to logistical interventions like immunizations), there has been amazing expansion in years of schooling, there has been a widespread defeat of chronic inflation and exchange rate disequilibria.

In contrast, where the problems faced are “implementation intensive” or “wicked hard” there has been much less progress.  Ambulatory curative care in the public sector is often (though not always) extremely weak.  While kids are in school they are often (though not always) learning very little.  While inflation has been stabilized, sustained inclusive growth has often (though not always) been weak.

This is in part, we argue, because the expansion of “the solution” treated all problems as either “policy” or “logistics”, both of which led to “Seeing Like a State” and/or a “Tyranny of Experts”.  The Idealist is a good account of what happens when a “logistical” approach—which may work for bed nets—is stretched in Procrustean fashion to fit “implementation intensive” tasks which require organizational capability and “wicked hard” problems like income generation. If interested in learning more, read Folk and the Formula: Fact and Fiction in Development.

BSC Video 8: What is PDIA?

Problem Driven Iterative Adaptation (PDIA) is an approach we have developed to help escape capability traps. PDIA rests on four core principles:

  • Local Solutions for Local Problems: Transitioning from promoting solutions (pre-determined by external experts) to allowing the local nomination and articulation of concrete problems to be solved.
  • Pushing Problem Driven Positive Deviance: Creating environments within and across organizations that encourage experimentation and positive deviance, accompanied by enhanced accountability for performance in problem solving.
  • Try, Learn, Iterate, Adapt: Promoting active experiential (and experimental) learning with evidence-driven feedback built into regular management and project decision making, in ways that allow for real-time adaptation.
  • Scale through Diffusion: Engaging champions across sectors and organizations who ensure reforms are viable, legitimate and relevant.

In this video, Lant Pritchett, provides an overview of PDIA core principles: problem solving; authorizing positive deviation; iterating and adapting; and scaling practices through diffusion. We believe that success builds institutions and not vice versa. You can watch the video below or on YouTube.

If you are interested in learning more, read Looking Like a State: Techniques of Persistent Failure in State Capability for Implementation and Escaping Capability Traps through Problem Driven Iterative Adaptation (PDIA).

BSC Video 7: Understanding your Authorizing Environment

In the systems we operate within, who identifies problems? who identifies solutions? and how do these people mobilize the ones who have power and authority?  In our research we find that leadership is about multi-agent groups and not single-agent autocrats.

In this video, Matt Andrews, contrasts examples of anti-corruption reforms in Malawi and Botswana to illustrate that authority is cultivated, built in groups, and not around individuals. You can watch the video below or on YouTube.

If you are interested in learning more, read Who Really Leads Development? and Limits of Institutional Reform.

BSC Video 6: Understanding your Eco-system

The process of building state capability involves people, who are the ultimate complex phenomena; embedded within organizations, which are complex; and organizations are embedded in rules systems (e.g. institutions, cultures, norms), which are themselves complex. In this video, Michael Woolcock, highlights the fact that reforms do not take place in a vacuum. You can watch the video below or on YouTube.

If you are interested in learning more, read Escaping Capability Traps through Problem Driven Iterative Adaptation (PDIA) and Limits of Institutional Reform.

BSC Video 5: Typology of Tasks by Capability Intensity needed for Implementation

It is important when thinking about building state capability, to first ask, what is the “type of problem” you are trying to solve? In this video, Lant Pritchett, provides a framework to determine the capability required for implementing development projects. He begins by asking whether your task is transaction intensive, followed by whether it is locally discretionary, to better understand if the nature of the task is logistics or implementation intensive. You can watch the video below or on YouTube.