Some personal musings on MPNE's 2nd principle: solutions, not problems.
Reposted, with an introduction and tiny edits, for the occasion of our first face2face meeting in a VERY long time, Part 2 to Bootcamp21: https://www.mpneurope.org/bootcamp21f2f.
We will be thinking through some of Melanoma's most vexing issues. And as in the past, we will be using 'thinking tools' borrowed from Design Thinking to think smarter and more systematically. We will collect the results in a research playbook, so watch the space!
MPNE principle No2 came to be after a particularly depressing gathering of Melanoma patients and carers. Everyone had been telling each other how bad just about everything was and it had kind of ended in a competition of who was the worst off right then.
We obviously knew that Melanoma was bad. It was actually SO bad that we couldn't afford losing time on pointless activities that didn't help solving it.
And that's how MPNE's 2nd principle SOLUTIONS, NOT PROBLEMS came to be.
For those not familiar with MPNE principles, these are the guides by which our network works. Melanoma has many problems in many places and we are many with many different interests and many different skills trying to solve them in parallel. We obviously can't tell people what problem they should care about. But we can help them to be as good as possible at solving the problems they care about. The MPNE principles now are very condensed versions of what we have found to be both essential and effective in advocacy. And they describe not only how we work- but also how we think about ourselves.
Principle No2 SOLUTIONS, NOT PROBLEMS now however comes with some interesting twists. While just complaining about problems obviously doesn't provide solutions, the issue in there is the complaining, not the focus on the problem. In a disease like Melanoma where people around us die, there is now doubt we need improvement as fast as possible. However, just because we so desperately need solutions, we need to make sure we find solutions that are truly solutions, not our imagination of a solution.
And oddly enough, for that, one first has to truly, deeply understand and care about the problem.
A typical example we continue to witness would be the following:
a newly diagnosed/ well-meaning other states 'there is no good Melanoma information for patients. I therefore will create a website/ leaflet to solve this problem.' (I've tried this one myself, by the way. I was very proud of my first website ever. And it had no effect whatsoever)
Once one really starts talking to newly-diagnosed Melanoma patients one however realises that before their diagnosis, they were blissfully unaware of what Melanoma really was. Most have professions that involve no research, so are unaware of how Science works, how it gets published, where to find it and most importantly, know the difference between worthy and rubbish. And unless you studied medicine, it's unlikely you were ever forced to memorise extensive tables on how to stage different cancers either. Then, a Melanoma diagnosis throws you out of your ordinary life. Most people around you will have never experienced it. You are suddenly not only faced with a cancer diagnosis but also with being the outsider in your own life.
Looking at all this, the issue was never there wasn't any information. We tend to ignore what we don't need. I started reading up on lawn mowers precisely the moment the one I had broke down and I really had to get a new one- quite surprising how many people get excited about lawn mowers btw. Then, there is just an awful lot of information and knowing how to sort it is critical. For lawn mowers, that's easy enough- something like price, technical features (anything minimising time spent cutting grass in my mind) and availability. For medical information, starting to search for the precise term 'melanoma' not 'skin cancer' and the relevant stage are good starters. Then, things become way harder. Lucky if you can access and read scientific papers. If you are dependent on accessible information, you will be surprised that even 'trustworthy' sources have outdated information on their websites and omit the sources from which they derive their information which is simply unscientific conduct. If you are interested in the topic, we therefore designed this tool called V2A2 (validity, verifiability, accessibility, agency) for reliable patient information.
So would a new website or leaflet address any of this? The answer is- in all likelihood, no. As the problem never was the true lack of information. It was rather how to find that information and how to sort it- and to have someone who cares about you in a moment your life unravels.
We want people to succeed
From a Melanoma community perspective, we don't want people to spend a lot of effort on projects with little chance of success and then get disheartened when things don't work out. We desperately need solutions, so we all should want to see anyone who cares and who is motivated succeed, not fail. Because if everyone manages to solve a little piece of the large problem that Melanoma is- that is when things get better for everyone. Besides, it takes surprisingly little to help the people around you succeed- but it makes all the difference to the type of community we are. Melanoma is bad enough.
Back to the solving problem paradox.
It's actually a bag of different issues. First, one has to realise we aren't our thoughts. Just because one has good intentions unfortunately doesn't protect from faulty thinking. Then, problems often aren't what they seem at first glance. And, there are always many not one solution- and their most important characteristic is that they solve the problem, not that they were our idea....
What tends to happen is that people with good intentions have a glance at a problem and in the desire to make a difference come up with a single solution- their favourite solution. Any evidence or criticism that that might not be the best solution or a solution to an irrelevant problem will be ignored- as it is perceived as criticism that the underlying motivation to do good wasn't there in the first place. And in order to save face people will continue to push for their favourite solution way past it has become evident it never was the right one.
A thinking tool for solving problems
The way to avoid falling into that trap is to put a mental space between one's intention to do good and one's thinking. Easiest done with a 'thinking tool'- a recipe how to think through a problem that make sure one doesn't fall for one's own mental shortcuts.
Especially in a community like ours where Melanoma is a direct threat to ourselves or the people we care about, we need to be aware that we have a strong urge to act- there's even a term for it, it's called Action Bias, you will find a nice explanation here.
And we obviously need action, so the point is not NOT to act- the point is to not to be lured into acting for the sake of acting, then spending time and resources on something that with some better thinking we would have realised had no chance to ever solve our problem.
The way to do that is to have a thinking tools that forces one to spend sufficient time on studying the problem- to fall in love with the problem.
The problem with solutions is that we usually can only think of a single one- our own. And then, we fall in love with it, because, well, it's ours.... To make matters worse, without some mental space, we fuse our solution with our intention and actually ourselves- we become that solution. And should that solution fail- well, that would make us a failure as an individual.
Sounds crazy? Next time you see someone- and this is not specific to advocacy- defend a single 'solution' at all cost, think about it....then, acknowledge their good intentions.
Lay out what the problem space is- you will see, people tend to have rather narrow insights into it (the problem are always the others, basically), so agreeing on what the problem is usually takes a lot of time. Then, agree on what a good solution would look like- and then, be ruthless on the shape of the solution or where it comes from. The point is finding solutions, not necessarily inventing them oneself.
Complex, not linear
And then, there is obviously another twist to the story. Problems in Melanoma tend to be tricky. Cancer is tricky, healthcare systems are tricky and many people in there influence many things- and that's tricky, too. Thinking of tricky problems where everything influences everything and there are many invisible parts as a simple series of events simply won't work.
So we need to find ways of thinking of our problems as tricky- or complex- from the start. And the systems we live in? They are equally complex. They also adapt to change- that's why they are called complex adaptive systems, and this is an interesting talk on the topic that is actually also worth watching as it leads to the next part as in....
That's all nice and well, but we *still* have problems which we need to solve and just studying problems won't do that. And the answer to that is that problem solving in complex systems is iterative and involves testing of ideas- remember Krusenberg 2017, Lean Advocacy?
It's about starting with a good enough understanding of the problem, have a range of solutions to chose from, pick the one most likely to succeed- and test it in a small setting. Things that work? Do more of them. Things that don't work- stop them, and go back to the start, there might be something about the problem that was missing.
And as this is a lot of thinking about thinking before one actually gets to do anything about the problem- highly unlikely to be popular with a community that wants to see outcomes ;-)-
we are working on a new thinking tool that we will use it develop research strategies for the problems we really need solving- and some of us will test it in Bootcamp21 this very weekend!
Bettina Ryll