Building a coordinated service delivery model in the U.S. using PDIA

Guest blog by Debra Porchia-Usher

Initial Expectations

I entered IPP Online Course with excitement and with the expectation that guidance would be provided to simplify the proposed ‘public policy challenge’ facing myself and my colleagues. The timing was great, as my colleagues and I had recently committed to the design and execution of a coordinated service delivery model of human services. The authorizing team of 12-15 human service leaders, including myself, made a firm visionary statement (“if not now, when”), affirming the commitment to get this done. I was sure that a guidebook would assist the team to develop an outline that would lead to an immediate solution. Essentially, an opportunity made simple and I believed that we, as a diverse team of providers, had all the pieces in place were for immediate action: 1) strong partnerships, 2) a common vision and goal, 3) motivated supporters, 4) County Chief Executive Office support, 5) consultant resources, 6) diverse group of champions, 7) community commitment to pilot the model in four communities and 8) a project timeline. It became very clear in the first two week of lectures and the introduction of PDIA, that our team did not have a clear understanding of the complexity of our problem, nor did we have a concise problem statement reflective of the intended goal. Early on, it also became evident that PDIA offered the Fishbone Diagram as a tool to map out the known and unknown factors. The input of the technical support and from peers on the fishbone identified additional gaps in knowledge, potential missed entry point opportunities and critical stakeholders. In addition, the diagram generated input from the larger stakeholder group which subsequently led to further clarification on the resource gaps and small win opportunities. The use of the Fishbone Diagram promoted an expanded thought process, strategic thinking about the actual problem at hand and extensive consideration of cause and effect influence within both the planning and execution of response to a complex policy challenge. 

Continue reading Building a coordinated service delivery model in the U.S. using PDIA

PDIA and Coordination Challenges within Government

Guest blog written by Nevena Bosnic, Mehdi El Boukhari, Ama Peiris, Matthew Welchert

Over the past seven weeks, our group embarked on the learning journey of problem driven iterative adaptation (PDIA) as it applies to coordination challenges facing the various levels of government as well as civil society in addressing homelessness in Tarrant County, Texas. We had the great pleasure to work with an authorizer, Maggie Jones, who serves as the Assistant Director of Tarrant County Community Development. Our team – comprised of graduate students from the Fletcher School of Law and Diplomacy at Tufts, Harvard Chan School of Public Health, Harvard Graduate School of Education, and Harvard Kennedy School of Government – provided a diversity of perspectives and richness of insights. Together, we confronted and struggled through the challenges that come with working in complex adaptive challenges as we constructed and deconstructed the problem, sought potential entry points, developed and acted on ideas for interventions, and finally, reflected and iterated with yet another round of the process. Through this blog post, we hope to share with readers: (1) our key learnings from the course, (2) insights we gained about the problem we sought to address, and (3) words of wisdom for other students and practitioners.

1. LEARNINGS FROM THE COURSE:

  • The ecosystem is large and not all actors have a clear picture of how they fit within the larger system. Thus, they do not strategize well how they as an individual organization can encourage better coordination. It can be helpful to think of a metaphor of topographical map wherein your key organization is in a valley. You may see other related organizations and actors in some nearby hills and bluffs, but you might be blind to what exists beyond those heights. PDIA requires you to venture forth beyond the hills to get a sense of the total ecosystem. 
  • There are a lot of different stakeholders who are working independently to fight homelessness. There is little to no capitalizing on each other’s strengths because each stakeholder is bound by short term objectives and constraints. Coordination inherently requires compromising a degree of control to others, but asking organizations to share or give up some of their autonomy is a difficult ask. Constructing a problem that matters helps rally and galvanize support. 
  • It is alright to not have a big idea which might theoretically have a large impact. It is often better to try multiple small, achievable actions to shift towards greater change. Complexity is daunting, but by deconstructing the problem and identifying where there is sufficient authority, acceptance, and ability to act you can begin to take action. Rather than focusing all of your efforts on a big solution, removed from potential feasibility, taking immediate, fast action where possible provides lessons and begins the process of change. 
  • Huge challenge in understanding all of the many moving parts. Interactions and causal relationships are unlikely to reveal themselves without first pushing at the problem from multiple angles. By taking many different, small, independent actions pathways and connections might become more visible. 
  • The wonderful world of positive deviants. Do not reinvent the wheel. It sounds simple enough, but if you do not explore, ask around, look for the small successes already underway, then you risk missing solutions already in action. 
  • Deconstructing the problem is an endless process. You will always go back to redefining the problem and uncovering new root causes (rather than manifestations of the problem). Iteration can be trying, even frustrating, but the process of purposeful repetition building on what has been learned is critical to uncovering new solutions, and taking meaningful next steps.
  • Un-learning’ or learning you were wrong is still learning. Through the process of iteration and adaptation, you will likely be wrong. Indeed, you should be wrong. Embrace the potential for an idea not panning out, or an action not producing the desired result. By hitting a wall, you now know there is a wall there. In dealing with complex problems, even learning the boundaries of action is an important step. But be sure to learn and adapt. Why is the wall there? Where is a backdoor? It is in asking these deeper questions that PDIA’s repetition allows us to overcome hurdles. 
  • Examining change space is something most people don’t think about outside of PDIA. This results in a lot of efforts being made, sometimes to no avail. Crawl around the design space; which means to explore and make use of other success being done elsewhere. Perhaps a best practice has been implemented with success elsewhere. How would it be applicable to my situation? But remember to reflect inwardly as well. There is likely a great deal of latent potential within your own organization which can be brought to bear. Change will require many kinds of actions, from both without and within. 
Continue reading PDIA and Coordination Challenges within Government

PDIA for growth in Honduras: A student project with major promise

written by Matt Andrews

We at the Building State Capability program have the good fortune of working with amazing practitioners from all over the world, and on topics of real importance. This semester, for instance, I am working with a team of three mid-career students from Latin America on a project applying the problem analysis in PDIA to the challenge of growth in Honduras. Marco Midence is from Honduras, Jorge Jimenez is from Mexico, and Jose Arocha is from Venezuela.

In keeping with the PDIA approach, their work started with ‘problem construction’—identifying a problem statement to draw attention to the problem. It goes something like this: Honduras has struggled to achieve the economic progress needed to pull many of its people out of poverty or to create jobs for those people moving into middle income categories. Continue reading PDIA for growth in Honduras: A student project with major promise

BSC video 28: Problem-driven sequencing

Most problems in the public sector are wicked hard and need to be deconstructed before they can be solved. In this video, Matt Andrews, builds upon the maternal mortality example and the ishikawa diagram to illustrate how you can sequence a reform in a contextually sensitive way, by involving the stakeholders to create a strategy that has quick-wins, longer-term solutions and identify areas that will require political feasibility and practical implementation capacity. You can watch the video below or on YouTube.

If you are interested in learning more, watch selling solutions vs. solving problems, real problem driven reform, constructing problems that matter, and deconstructing sticky problems.

BSC video 27: Deconstructing sticky problems

Most problems in the public sector are wicked hard. It is like getting stuck in quick sand. In this video, Matt Andrews, uses an ishikawa or fishbone diagram to illustrate how meta problems can broken down into manageable problems that you can mobilize support for and ultimately solve. You can watch the video below or on YouTube.

If you are interested in learning more, watch selling solutions vs. solving problems, real problem driven reform, and constructing problems that matter.