Many solutions do not produce the desired result because the question to which the solution answers is incorrectly asked. Finding the right question doesn’t have to be hard.

The law to increase the caregiver-patient ratio of enhanced service housing to 0.7 caregivers per inhabitant is a good example. The initial problem was that institutional care was neglected due to too few medical staff. The issue became one of the key themes in the 2019 parliamentary elections in Finland, and the law on raising the caregiver-patient ratio was passed in June 2020.

It is important to note here that there is a limited number of caregivers in Finland and there is a considerable delay in increasing the number through schooling. When the ratio is given by the force of law to only one object, it is clear that in this case the caregivers are obliged to move from other objects to service housing. This means e.g. a significant decline in the level of home care service. As a result, the chances of those in need of care to cope in their own homes are declining and the demand for institutional care is likely to increase. Considering that institutional care is significantly more expensive than home care, the result is an increase in total costs.

If the question is asked whether institutional care should be adequately resourced, the answer is, in the opinion of most, yes. If, on the other hand, the question is asked whether the level of home care service should be reduced, the answer is correspondingly no. A better setting of the issue here would be how to distribute the existing care staff between the different service areas in an equitable and cost-effective way, taking into account the indirect effects.

Understanding the whole requires the expertise of people from different fields

The difficulty in finding the right question is that social systems are complex entities in which things interact through complex cause-and-effect chains and time delays. Often the problem to be solved is just a symptom, in which case the solution also seeks to correct only the symptom and not the real underlying problem. The solutions chosen in this way are often not effective measures for the whole.

The real problem, and with it a more efficient layout of the question, is achieved by mapping the whole of the cause-and-effect chains of the system. The challenge here is that individual managers and experts usually see the whole only from the perspective of their own job description. It is essential that the perspectives of all relevant job descriptions and an understanding of the factors influencing the practical work are combined in forming the overall picture.

Once the overall picture of the internal and external domain has been formed, it can be used to assess the effects of the proposed solutions by monitoring the cause-and-effect chains following the change. This substantially reduces the risks associated with decisions from the perspective of both the organization and decision makers. Another advantage is also visible: the causes and effects of the chosen solutions are easily rationalized to different stakeholders. This way the internal resistance of the solution in the organization is typically lower.