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Solving Wicked Problems 

Digital innovation for health and social care.

As the opening of the Nightingale Hospital at the ExCel London proved, when a compelling need emerges, executive leadership in the NHS steps up and amazing things are possible - in days. However, when it comes to the mission-critical support processes behind the frontline heroes of doctors, nurses and social workers - digital innovation must - and can go faster.

What matters is solving 'Wicked Problems' [1]. These are problems that are difficult, near-impossible to solve because of incomplete, contradictory, and changing requirements - or, as in the case of COVID-19, a totally unexpected but totally disabling 'Black Swan'. Or it could be something seemingly mundane, yet generating deceptively high costs - e.g. labour-intensive, paper-based GP surgery or hospital appointments. The latter type are the 'Quick Wins' and the best place to start.

Eisenhower Meets Churchill

As with the Nightingale Hospital during the height of the COVID-19 crisis, a World War II-like spirit was present at this time in UK government and NHS. With a sense of urgency in mind, it is worth remembering two great leaders from USA and UK: Dwight D. Eisenhower and Winston Churchill. As illustrated in the infographic below, when looking at Wicked Problems in the NHS and pursuing Quick Wins, we could combine Eisenhower's 'Urgent/Important Matrix' with the label that Churchill pinned on important memos during World War II: 'Action This Day'.

If we combine Eisenhower with Churchill we have the foundation for both the prioritisation and the intent that can apply to achieving Quick Wins and solving Wicked Problems in the NHS. In simple terms, this means breaking this down into smaller elements and then applying a sense of urgency on a clearer set of problem-solving activities.

Digital Silo-Busting

Let's take notable examples of Wicked Problems facing the UK NHS and adult social care today:

  • Eliminating bed-blocking.
  • Engaging volunteers.
  • eEquipment.
  • Your compelling need ...?

To quote Rittel and Webber [2] : 'every Wicked Problem can be considered to be a symptom of another problem'. This is certainly true for the three Wicked Problems noted above. Not least of these interdependencies is the 'silo effect' of each stakeholder organisation - and citizens - who are important actors in health and social care. This silo effect is everywhere in the public sector and we are focused on breaking through these boundaries in meeting each Wicked Problem.

As illustrated in the infographic above, the Wicked Problem of Bed-blocking is caused by the silo effect among all of the stakeholders in what should be a coherent 'Social Care Value Chain' - moving from Hospital Discharge to Ongoing Care Executed. In turn, as Rittel and Webber have stated, the bed-blocking becomes a root cause of another Wicked Problem: namely, increasing bed capacity during the COVID-19 crisis.

As an example, at Being Guided we have built a digital solution that focuses on eliminating bed-blocking - it is called The Social Care Platform. With this cloud app, we have removed the silos and enabled all stakeholders in integrated health and social care to collaborate in a Social Care Value Chain - as illustrated in the infographic above.

One Platform, Many Apps

The Social Care Platform is part of a family of cloud apps that we have created. This includes a recent addition designed to address another Wicked Problem - magnified by the COVID-19 crisis: engaging volunteers. This solution is called The Volunteer Platform.

As with The Social Care Platform, this latest innovation is built on a world-class technology: the Salesforce Lightning Platform. With the COVID-19 crisis, speed of execution and app development at the lowest-cost is of crucial importance. The key to this is No-Code, First.

With the Salesforce Lightning Platform, we have a readymade technology that allows the non-programmer ('Citizen Developer') to rapidly create forms-based cloud apps, without writing code - which is sometimes called 'No-Code' or 'declarative programming'. This is in contrast to 'Code' or 'imperative programming' - where programmers make use of a variety of languages to create cloud apps in this more traditional approach to digital innovation. This is too slow for the COVID-19 crisis and challenging economy.

No-Code innovation with the Salesforce Lightning Platform usually results in cloud apps being published 10x+ faster through declarative programming, when compared to the ground-up, imperative programming approach. This is especially relevant where the solution to the Wicked Problem is inherently based on what might be described as a combination of 'forms' and 'workflow', optimised as a 'Meaningful Journey', to execute a particular process or task.

For example, the third Wicked Problem of Delivering Equipment to NHS hospitals or home care environments (Itself, a root cause of bed-blocking) may be addressed through everyone in the supply chain sharing an app created with the Salesforce Lightning Platform - and done so in days and hours - not weeks and months.

Getting Started

And now let's think about solving every other Wicked Problem that can benefit from a forms-based app shared within and beyond the boundaries of your organisation. It starts with applying Design Thinking in five steps, iteratively: Empathize; Define; Ideate; Prototype and Test.

What follows from Empathy Mapping and an insightful Define capture of the Wicked Problem is the rapid creation of a new cloud app, through the Ideate, Prototype and Test steps executed in days and hours - not weeks and months.

Of course, in these challenging times, a strong financial case is a must for engaging in Design Thinking to apply digital innovation to Wicked Problems within a NHS Trust, CCG, ICS or AHSN. In order to find the first Quick Win, let's apply the Urgent/Important Matrix inspired by Eisenhower and a sense of urgency inspired by Action This Day memos from Churchill in World War II.

To Learn more about how the 5-step Design Thinking Method works, read my blog post entitled Design Thinking and Innovation. What matters is keeping things simple and in the first two steps of Empathize and Define. We apply the Urgent/Important Matrix to prioritise the focus for problem-solving. to quantify a compelling business case to achieve the first Quick Win. A measurable value outcome is achieved in applying digital innovation with the Salesforce Lightning Platform.

As illustrated above, a series of online Design Thinking Workshops - often just 1-hour sessions - will take the prioritised problem-solving comprising: 'Current State' ('As-Is'); 'Future State' ('To Be'); ROI Model ("The Case'); and, Salesforce ("The Platform'). When looking at the different between Current State and Future State, the 'Basis of Decision' becomes a tangible difference between the financial difference of these 'States' and, the 'Cost of Delay' or 'Cost of Doing Nothing' calculated and validated among all key stakeholders.

We share risk in these difficult times and at Being Guided we only get paid on Deliverables, Not Hours. Let's work together to solve your Wicked Problem today by applying digital innovation with the Salesforce Lightning Platform. Contact me any time to learn more.


1. Churchman, C. West (December 1967). "Wicked Problems". Management Science. 14 (4): B-141–B-146. doi:10.1287/mnsc.14.4.B141.

2. Rittel, Horst W. J.; Webber, Melvin M. (1973). "Dilemmas in a General Theory of Planning". Policy Sciences. 4 (2): 155–169. doi:10.1007/bf01405730.

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