It is no surprise that the overall problem of covid control is a combination of innumerable big and small problems. I have found it helpful to categorize problems into simple, complicated, complex and intractable problems. In this post, I will give definitions with examples, and types of solutions needed to solve each type of problem. When faced with any problem, it is worth spending the time to diagnose the problem and categorize it, so that action plans to address the problem are matched correctly.

The simple, complicated, and complex framework is from the book “Getting to Maybe: How the World is Changed” by Westley, Zimmerman, and Patton. An excellent but long summary is in this presentation available online. Situations belong to one of these types based on how close a situation and solution are to certainty and agreement.

An example of a simple problem or situation is following a recipe. As long as the recipe is tried and tested, there is certainty that following the recipe will result in an acceptable product and the results will be the same each time the recipe is followed. No special expertise is required to follow the recipe. Correct use of hand sanitizer, mask or other personal protective equipment, after learning the steps, are examples of simple problems in covid control. Step-by-step instructions and clear protocols are required to solve simple problems.

Complicated problems, unlike simple problems, are a set of numerous simple problems and a successful outcome can be guaranteed and replicated if there is very close coordination and monitoring. Regardless of how complicated a situation is, the problem can be broken down into separate simple problems and response coordinated. These problems and situations could be technically complicated or socially complicated. Technically complicated problems need formulas and a high degree of expertise. An example of a technically complicated problem is sending a rocket to the moon. Socially complicated problems involve getting a large number of players together and achieving common ground through building relationships. An example of a socially complicated problem may be team building. Examples of complicated problems in pandemic control are setting up surveillance data systems, building prediction models, setting up clinical trials, contract tracing, and ensuring vaccine distribution throughout the world (assuming sufficient vaccine is available). Most complicated problems have both technical and social components and both need to be addressed. If the process steps and formulas are followed, successful outcomes are repeatable each time the problem is addressed.

Complex problems are like raising a child. Think wildlife photography! As each child is different, recipes, formulae, relationships, and expertise only go so far. Success with one child does not guarantee success with another child. Complex problems have too many unknowns, such that making rules and establishing processes is extremely challenging, and protocols and guidelines do not lead to replicable results. The situation cannot be broken down into simple, separate parts. Examples of complex problems in pandemic control are achieving 100% compliance with mask wearing, hand hygiene, or getting everyone eligible to be vaccinated. There is increasing recognition that healthcare organizations are complex adaptive systems because of the presence of several interprofessional teams. Leading a team of teams in a large organization could be a complex task. Complex problems need discovery and action. Responding to complex problems requires investment of effort in diagnosing the situation through pattern recognition, probing, responding, and in-the-moment adaptation. These so called “wicked” problems may require reframing the problem, creativity, design of complex solutions, analyzing positive outliers, seeking multiple opinions via crowdsourcing, and other complex, iterative approaches. Even the evaluation process needs to be matched to the nature of the situation.

Intractable problems, on the other hand, persist over time, are complex, intense, deadlocked, and resistant to resolution. Each party in the problem has a story, more likely, a number of stories, and there is a complex history to the problem. Examples of intractable problems in covid control are the problem of achieving at least 80% vaccination rate so as to gain herd immunity, achieving high compliance with masking and physical distancing, racial inequities, and the great divide between the haves and the have nots. Intractable problems often call into question the problem solvers’ competence and sometimes credibility or character, and there is always a lingering question whether the problem persisted because it was not addressed correctly in the past or whether the problem defies solutions in spite of best available expertise or something in between. Intractable problems and conflicts can drain a lot of individual and collective human energy and cost lives along the way. They sometimes need expert mediation. The hopeful side of it that many problems that were previously thought of as intractable turned out to be complex and solvable with dedicated effort. Communities with better structures and cohesion may be more successful in solving complex problems. For example, this study found that communities with higher social capital were more successful in controlling the spread of covid-19. This article has some great recommendations for resolving intractable conflicts. This book seems very interesting and insightful although I have not read it yet. This article has some excellent insights into how we can take a system approach to evaluating and addressing intractable problems. Here is an entire website devoted to intractable problems if you are interested in learning more about intractable problems.

Hope you benefit from this framework in your problem-solving journey!

PS: Picture was copied from here.