Caring for Older People is Not a Wicked Problem
Author: Sarah Taylor
It is common for problems like old age, and the organisation of care and support for older people to be represented as a 'wicked problem' - some kind of particularly knotty and possibly unsolvable solution conundrum. Sarah Taylor argues that this a profoundly mistaken perspective which follows from common, but flawed, patterns of thinking.
“Life is not a problem to be solved, but a reality to be experienced”
We often hear that our systems for providing care for older people are in crisis and that being able to meet the needs of an ageing population is one of the main challenges facing developed nations. Some call it a “wicked problem” due to its seeming intractability and multifarious nature. However, population ageing does not have an automatic or linear impact on society and its implications need to be considered in terms of the institutions, systems and cultures its effects are mediated through. In this blog, I will share some findings from my literature review on wicked problems and older people’s care. In doing so, I hope to highlight some often neglected aspects of what constitutes a wicked problem and suggest how this might lead us to respond differently to them.
What is a Wicked Problem?
The term ‘wicked problem’ (Rittel and Weber, 1973) refers to a challenge that is difficult to address and which entails a high degree of uncertainty. This uncertainty relates to:
- Defining the Problem and Solution - It is not possible to first objectively understand the problem and then proceed to identify a solution because a ‘solution concept’ is required to first orient the search for information. For this reason, wicked problems often entail disagreement on the nature of the problem itself and what ought to be done. It is a matter of judgement and creativity to determine which course of action to pursue. There is also an emergent nature to wicked problems, so locking down a final problem definition at the outset is not possible
- Appraising the Success of the Solution - Wicked problems cannot ever be said to have been solved once and for all. This is due to the interrelatedness of wicked problems. Furthermore, after a solution to a wicked problem is implemented, waves of both desirable and un-desirable consequences will be generated over a potentially unlimited time frame. This prevents the final impact of a solution ever being definitively appraised.
- Ethical Decisions - Every attempt to grapple with a wicked problem matters and makes a difference to the lives of real people and so every response involves an ethical decision. Yet, wicked problems involve a range of stakeholders who will all see the problem and solutions in different ways. Whether a response is seen as good or bad, better or worse will depend upon people’s worldview.
When reviewing the literature on wicked problems, I found that there was a mis-match between the original definition and how the term was being used in the workplace. I would now like to share three key neglected aspects of the literature and their possible implications within the context of care for older people.
1. Problems are not inherently wicked
People tend to use the term wicked problem as being tantamount to systems/stakeholder complexity, the implication being that if you could only get all the stakeholders in the room, the “whole system” could be mapped and a shared understanding could be obtained about the real nature of the issue and how to best respond. It seems we struggle to give up our desire to understand and control. However, complexity does not equal problem wickedness.
In fact, the quality of wickedness does not exist solely in the problem itself, it exists in the dynamic space between the problem and our capacity to resolve it from within the prevailing paradigm (ways of thinking, being and doing). Rittel & Webber (1973) formulated their original description of wicked problems within a more general critique of the cognitive style associated with the rational planning paradigm that followed the Enlightenment and Industrial Revolution. This ‘cognitive style’ is dominated by ideas of efficiency, command and control, prediction and planning. It is the dominance and over-use of this style which requires a radical rethink rather than simply making it more palatable by enlarging the pool of stakeholders we involve in the process.
2. Rational-planning methods make problems worse
Rational-planning methods not only fail to address wicked problems, but actually exacerbate them. Rittel and Weber argued that not only do we fail to effectively address wicked problems if we apply the cognitive tools associated with a rational-planning paradigm but in doing so we are likely to exacerbate the problem or generate further issues.
In the context of care for older people, if we take a historical perspective, we learn that old age came to be seen as a biomedical problem amenable to mechanistic approaches during the nineteenth century. Geriatrics emerged as a specialism and legitimised itself based on restoring functionality to older people so as to free up hospital beds. In doing so, continued dependency became seen as a failure and older people with chronic ‘incurable’ conditions were problematised.
By focusing on organisational and medical solutions, we have neglected to address what truly matters to older people. Furthermore, our way of organising care has arisen from a post-industrialist mechanistic culture which is dominated by ideas of economies of scale, standardisation, productivity and efficiency. This culture has now spawned its own issues and the very act of caring has become seen as an intervention or task to be performed and our attention has been diverted away from quality interactions towards measurable outputs.
3. We need to look for the deeper problem
Each wicked problem can be considered a symptom of another deeper problem. In our rush to fix surface issues, we tend to neglect underpinning, deeper aspects to an issue. Looking more deeply into issues around care for older people could lead to considering what it means to be human.
The modernist perspective, shaped by liberal philosophical traditions, tends to assume the primacy of an individual self which can be defined in isolation from others and the environment. This particular view of personhood esteems two characteristics above all else: autonomy and rationality.
Within this perspective, cognitive impairment and dependency threaten our very sense of what it means to be human. As Atul Gawande (2014) puts it, “our reverence for independence takes no account of the reality of what happens in life: sooner or later, independence will become impossible. Serious illness or infirmity will strike and then a new question arises: if independence is what we live for, what do we do when it can no longer be sustained?" (p.23). This question has been neglected in our society.
Wiser Responses to Wicked Problems?
By considering the above perspectives on wicked problems, how might we respond more wisely to the issue of care for older people? We might seek to address the overall logic of a mechanistic culture and pay more attention to relationships. This culture could be underpinned by a new way of thinking about personhood as something formed through connection with others.Compassionate interactions would then not be seen as acts to be performed but would form part of the fullness of human responding which enrich the carer as much as the cared for.
Finally, rather than see care for older people as a problem to be solved, we could approach it with a spirit of inquiry into a part of our shared human experience and reimagine how we want to live out the final days, weeks and months of our lives. Let’s start there.
Gawande A (2015) Being Mortal: Medicine and What Matters in the End. London: Profile Books Ltd,.
Rittel H W J & Webber M M (1973) Dilemmas in a general theory of planning. Policy Sciences, 4, 155–169
The publisher is The Centre for Welfare Reform.
Caring for Older People is Not a Wicked Problem © Sarah Taylor 2016.
All Rights Reserved. No part of this paper may be reproduced in any form without permission from the publisher except for the quotation of brief passages in reviews.