Book Summary: Upstream

Assume you're enjoying a picnic with your buddies by the river's edge.

You hear a kid screaming because they are about to drown in the river. You and one of your pals spring to your feet, bravely dive into the river, and pull the kid to safety.

You hear the same thing again as soon as you have the kid securely onshore. As a result, you both plunge back into the river to save that kid.

And, you guessed it, as soon as you bring that kid to safety, you hear another one. Then there was another. And then there was another.

Finally, your pal exits the sea, leaving you to your own choices.

You inquire, "Where are you going?"

"I'm heading upstream to attack the man who's tossing all these children in the water," your pal answers.

That is a public health tale ascribed to Irving Zola, and it nicely sums up the book's major argument.

That you must catch the most important problems upstream to fix them.

What Upstream Thinking Is

A male businessman taking wise collective action to ensure better outcomes, also known as upstream thinking.

Ryan O'Neill worked at Expedia, an online travel firm, as the head of the client experience in 2012. He had been looking at call center statistics and couldn't believe what he was seeing. Expedia clients accounted for 58% of all consumers who needed assistance after booking their trip.

The top reason consumers contacted was to request a copy of their itinerary, which was even more astounding. For that reason, 20 million individuals phoned in 2012 alone. It was a $100 million problem, given that each support call cost the corporation roughly $5.

Most contact centers would concentrate on improving call efficiency to reduce the average cost of a support call.

However, the Expedia team concluded that they needed to go upstream to make a dent in the $100-million problem.

What was the problem with clients not receiving their itineraries? That is an excellent question.

They may have mistyped their email address. Or it may have landed up in their spam folder, or it may have been accidentally deleted because they mistook it for a commercial email. Worse, clients could not obtain a copy of their itinerary through the internet.

Expedia's senior team set to work, creating a "war room" where they regularly convened to examine a clear mandate: eliminate the need for consumers to contact.

Almost all of the calls have since been discontinued. Overall, the percentage of consumers that contact for help has decreased from 58% to around 15%.

They went upstream and uncovered and removed the underlying causes of consumer calls.

After an issue has occurred, downstream steps are taken. Efforts upstream attempt to prevent them from occurring in the first place.

Why is it so difficult to execute something that seems so simple?

One explanation is that we prefer to react rather than avoid. It's easy to see, easier to measure, and gives you fast results.

Upstream difficulties are harder to address, but they tend to be quite effective when you find the answers upstream. Typically for the long term.

Three Barriers to Upstream Thinking

2 individuals trying to solve the way out of the maze. This shows that when bad things happen, we need to think of the long term solution.

We must first figure out what's getting in our way before we can learn how to think like an upstream issue solver.

Upstream thinking is more difficult than it appears for three reasons.

Problem Blindness

The assumption that bad events are inherent or unavoidable is the first roadblock to upstream thinking. "That's simply the way things are around here," we convince ourselves.

In the end, we regard those issues like the weather: like it or not, they are what they are, and the most we can do is accept them.

As a result, we lose out on viable answers that are there in front of our eyes.

For example, in most team sports, there is a widespread assumption that injuries are an unavoidable aspect of the job, particularly in football.

When Marcus Elliott joined the New England Patriots coaching staff, he chose to defy conventional opinion. He went upstream to address one of the most prevalent ailments in football: the strained hamstring.

He found that focusing on constructing tailored training regimens for his players, geared to avoid injuries in the forthcoming season during the offseason, might drastically reduce the number of injuries.

The hamstring injury rate dropped from 22% to 3% in his first year. He didn't just accept that injuries were a part of athletics, which resulted in a significant improvement.

Lack of Ownership

The second impediment to upstream thinking is when no one is to blame for the situation. Nobody fixes an issue if no one accepts responsibility for it.

Sometimes, the problem gets broken down into many small pieces, but what's really needed is for someone to own the whole thing. That's what happened at Expedia, where several organizations were in charge of different aspects of the customer experience. Still, no one was in charge of decreasing customer support calls.

Other times, it's self-interest that's to blame. Tobacco corporations are best positioned to avoid millions of deaths from lung cancer, yet fixing the problem would decrease their profits.

In these situations, what's needed is for someone to take responsibility for the problem independently.

That's what occurred when Interface, a major carpet producer, decided to take action and reduce its environmental effect. They increased their revenues from $800 million to $1 billion in the first year of that objective without increasing the raw resources required to make their products.


Tunnel vision is the third and final impediment to upstream thinking. When we have a lot of issues to tackle, we stop attempting to fix them all. Instead, we concentrate just on the most concrete ones - the short-term and reactive difficulties, as we've already discussed.

This is akin to focusing on the urgent at the price of the important, in Stephen Covey's sayings.

All issues, of course, become pressing at some point. By then, it's nearly always too late to fix the most pressing issues.

Seven Questions for Upstream Leaders

A male pumping question mark helium balloon to ask the 7 question for upstream leaders.

Now we'll talk about how to think like an upstream leader so you can tackle the most pressing issues affecting you and your company right now.

To accomplish this properly, you must first answer seven questions.

Question #1: How Will You Unite the Right People?

Upstream issues nearly always need the collaboration of different groups of individuals.

The objective is to encircle the problem and learn from the data.

Surround the Problem and Use Data

When tackling an upstream issue, the first step should be to assemble a team of individuals from each group participating in the solution.

In Iceland, for example, teen drug misuse was a major issue in the 1990s. In 1998, 42% of 15 and 16-year-olds in the United States said they had been intoxicated in the preceding 30 days.

As a result, they gathered representatives from all walks of life in Iceland - parents, legislators, sports club leaders, and many more - and worked together to solve the problem.

They were led by a basic philosophy: transform the society around teens by lowering drug addiction risk factors and strengthening preventative measures.

Each group had various resources and capacity to assist, but they all had the potential to pull in both ways.

The teenage society has changed dramatically in the twenty years since the campaign began. Among other findings, the number of youths who said they had been intoxicated in the previous 30 days plummeted from 42% to 7%.

Question #2: How Will You Change the System?

A wireframe to guide the changes needed as part of changing the system.

Solving upstream problems is all about reducing the probability of the issues. So, you need to change the system that is causing the issues in the first place.

The key here is to fight for systems to change and shape the water.

Fighting for Systems Change

The greatest method to affect problems upstream is to use a well-designed system. In 1967, for every 100 million miles traveled on roads, 5 persons died. After fifty years, the rate of deaths per 100 million miles has reduced to one.

There was no centralized planning to reduce the fatality rate. Still, hundreds of people - from vehicle safety specialists to Mothers Against Drunk Driving - worked tirelessly to improve the system every coming year.

Shape the Water

The system might be difficult to see at times. When an older fish walks by and asks, "How's the water?" one of the younger fish looks over to the other and says, "What the heck is water?"

Water is the environment in which you live that influences your conduct. For example, fast food establishments used to cope with customers tossing away the reusable plastic tray that happened to come with their meal.

To remedy the problem, they reshaped the surroundings by constructing little circular rubbish holes that made it impossible for them to toss the tray away.

Question #3: Where Can You Find a Point of Leverage?

"Give me a lever long enough and a fulcrum on which to place it, and I shall move the world," Archimedes famously stated.

As Heath points out, the difficult element is locating the fulcrum and lever. However, once you've discovered it, the effects might be quite strong.

The idea is to get closer to the source of the problem.

Get Closer to the Problem

There has long been a perception that gang violence is to blame for the bulk of gun deaths in Chicago.

That is until some researchers dug a bit further and discovered that many of the deaths were caused by ordinary teen disagreements.

A close examination of the examiner's reports revealed a new explanation about why these people were dying: reckless conduct, perhaps a little booze, plus a gun equaled a dead body.

They'd discovered a possible leverage point in irresponsible conduct, and Youth Guidance came up with a program dubbed BAM - Becoming A Man.

It was a mix of support groups, tough love from male mentors, and cognitive behavioral therapy. This procedure teaches people how to modify their thought patterns and, as a result, their behavior.

The end effect was breathtaking. Students that took part in BAM witnessed a 45% reduction in violent crime arrests.

Question #4: How Will You Get an Early Warning of the Problem?

A man coming out of the computer and fighting off threats. This shows that sensors and predictions are used to get early warning of the problem.

We have a lot more freedom to move and address an issue when we can forecast it ahead of time. As a result, one of our most important responsibilities is to identify early warning signals of the problem we're trying to tackle.

The key to accomplishing this is to use sensors and search for predictions.

The most striking example in the book is the 2012 Sandy Hook Elementary School massacre and the ensuing movement to attempt to prevent similar tragedies in the future.

The tale featured a guy and girl flirting by writing messages to one another on desks in the school library in a video that became popular online.

In a shocking twist, as they are about to meet for the first time, a boy storms into the gym and takes out an automatic rifle, causing everyone to panic and flee.

The film then replays what we missed the first time around. The numerous warning indications that something like this was on the way, all of which were happening in the background. The shooter is on the internet watching gun videos, being tormented in the corridor, and engaging in antisocial conduct.

This film was turned into a training program for schools around the country, known as the Safe2Say Something program, which has helped prevent other school shootings, attempted suicides, and sexual offenses.

It succeeded because the kids were taught to become "sensors" who searched for "predictors" of future assaults.

Finding the correct predictors and sensors is important to your success whenever it becomes evident that you have an upstream problem.

Question #5: How Will You Know You’re Succeeding?

It is not enough to take action; you must also determine whether your efforts are genuinely beneficial. Although this is self-evident, many individuals overlook it.

Even after choosing the appropriate metrics for success, you must ensure that you're not witnessing "ghost successes," of which there are three types.

First, your solutions are effective, but the source of the problem is unrelated to your efforts. When the tide runs out, you'll be left out to dry, as is the case with "a rising tide lifts all boats."

Second, when the measures are out of sync with the objective. You've failed when you achieve short-term remedies but allow them to distract you from your major purpose.

Third, the measure becomes the mission (a specific instance of the second). This is the most harmful type of ghost win because it's conceivable to nail your short-term measurements while undermining your purpose.

This frequently occurs as a result of people abusing the system. For example, suppose you're in charge of reporting crime rates and reducing crime in your neighborhood. In that case, you'll have an incentive to understate the real quantity of crime.

Be certain that the measures do not turn into a mission.

Question #6: How Will You Avoid Doing Harm?

Your upstream fixes may have unforeseen implications that make things worse instead of better.

To further lower the number of cobras in India, the government offered a reward. That seemed reasonable until some entrepreneurial individuals built cobra farms to profit from the windfall. When they were apprehended, they just released the cobras, resulting in an increase in the population.

Although you'll never be able to completely eliminate all dangers your solution poses, you should do a pre-mortem with all prospective stakeholders. That's a process established by Gary Klein.

Essentially, you imagine that a year has gone, the project has been a complete failure, and you list all of the reasons why.

It's like going upstream on your upstream solution. It's rather meta.

Question #7: Who Will Pay for Prevention?

A male using his card as the payment form for threat prevention.

One of the issues with upstream solutions is that someone has to pay - and the solution is one that "doesn't happen" in the end.

There are a variety of scenarios at work here.

The first situation is when the person who benefits from the solution is also the one who pays for it. For example, a business owner who addresses an upstream problem will (we think) reap the benefits in the long run. The single-pocket concept is what it's called.

The second case is when the cost-bearing entity does not get the principal gain. This is known as the "wrong pocket" issue, and it's a significant concern with most social care systems.


Problems solved in the short term rarely work in the long run. It is the task of identifying and resolving upstream issues.

It won't be simple, but with the appropriate mentality and the tools, you'll be well on your way to permanently fixing the most fundamental problems in your business and life.

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