Here's how one team used design thinking to structure a complex problem

The experiment profiled in this article was a joint project between the Department of the Premier and the Department of Health in Western Cape Government, Dr Ameeta Jaga from the Department of Management Studies at the University of Cape Town, and Keneilwe Munyai and Richard Perez at the Hasso Plattner Institute of Design Thinking (d-school) at the Graduate School of Business, UCT.

Solving problems in government means tackling knotty, challenging issues. These kinds of complex problems can be difficult to define: they’re often made up of smaller, interconnected problems that span various fields, and they transform over time and place.

But it is one thing to understand that problems are complex, and another to be able to transform a complex problem into a structured or solvable policy problem.

“Complex problems can be intimidating,” says Robert Hoppe, Professor Emeritus of Policy and Knowledge and the author of The Governance of Problems. “But you do need to bring them down from what I call an ‘unstructured problem’ to a ‘structured problem’. And this is difficult, but it can be done.”

He suggests taking a methodical approach in order to move from an “unstructured” to a “structured” state. “You start by facing a large, tangled network of problem formulations, and then you look at the multiple perceptions that exist and figure out what framing will help you come up with an intervention that might really help to make a difference,” he said.

“Problem structuring”, then, can be understood as the process of examining competing problem framings and taking steps to reduce the level of uncertainty and ambiguity that surrounds a given problem.

This process helps to clear a path for more formal problem definition and clearer decision-making by helping to build up a workable frame from which to devise next steps and possible solutions.

In this article, you’ll see how one team in the Western Cape Government in South Africa followed a problem structuring approach to get closer to devising meaningful policy interventions for a complex challenge: increasing the rate of exclusive breastfeeding amongst mothers in the region.

A daunting challenge

One of the six targets set by the United Nations Decade of Nutrition is to increase the rate of exclusive breastfeeding (EBF) during the first six months of a child’s life to 50% globally as a stepping stone to eradicate hunger and end malnutrition by 2030.

Exclusive breastfeeding (feeding only breast milk to newborns) helps prevent disease and even death: babies under the age of six months who are not breastfed exclusively, but are fed other fluids and foods, are more likely to suffer from diarrhoea, pneumonia and are even at higher risk of dying, according to Unicef and WHO.

Although EBF rates in South Africa are higher than they have been in decades (the number of women who exclusively breastfeed their babies increased from 8% in 2003 to 32% in 2016), the country still has a long way to go: South Africa has one of the lowest breastfeeding rates in the world.

Despite the recent positive trend, a more detailed picture emerges once you start looking into the numbers.

“The latest research showed that EBF had bumped up to 32%,” said Tristan Gorgens, acting director in the Policy and Strategy Unit of the Department of the Premier in the Western Cape Government. “But when we looked at those numbers, we saw that there is an incredible drop-off at four months, and by six months, only around 4.6% of mothers are breastfeeding.”

Many factors influence why and for how long mothers choose to breastfeed, so he knew that defining this problem would not be easy.

Gorgens began by experimenting with design methods and, in order to arrive at an understanding of the problem that accommodated (rather than reduced) its complexity, turned to problem structuring.

Digging deeper

According to Gorgens, the question of how to increase EBF in South Africa had too often been dominated by one policy frame: this was a medical concern, and a private matter, to be solved in the realm of healthcare by doctors and nurses.

This meant that existing policy interventions had been designed around this assumption, and therefore focused primarily on educating mothers about the benefits of EBF in the context of hospitals and clinics.

But Gorgens and his team, noticing the significant dropoff at four months, realised that returning to work might be shaping mothers’ decisions to stop breastfeeding.

“In South Africa you get four months of maternity leave,” said Gorgens. “So that dropoff was suggestive that this probably had something to do with returning to the workplace. That’s how we came to initially frame the problem.”

By taking this step back, it became clear to Gorgens that the historically dominant frame had been far too limited in its scope.

Experimenting with design

In order to skill themselves in a new approach, Gorgens and his team chose to experiment with a few design methods. This required collaborating with experts in the field, so they approached a unit at the University of Cape Town’s Business School dedicated to design thinking and found some partners.

“Our small team didn’t have a grand design,” Gorgens said. They went through the double diamond approach and used a snowball sampling method in two public sector departments - social development and education - gathering informants as they went.

Qualitative research methods like these helped to break open the complexity of the situation for Gorgens and his team. “We knew that breastfeeding is an incredibly intimate choice, and there’s a lot going on societally and personally, so we wanted to get into it slowly to get a feel for what mothers really experience,” he said.

They spoke to mothers in various contexts (some were teachers, others worked in head offices), and people of different seniorities (some being managers and others occupying more junior positions), in short and informal interviews.

“With design thinking, it's actually a pretty low bar in terms of the size of your sample. You're just trying to get a plausible sense of what's out there, so it didn't have to be a huge number of mothers.”

Because design practice involves collecting insights early and avoiding becoming too attached to one frame before testing it, Gorgens didn’t carry out any extensive research — only light-touch interviews — and this was enough to illuminate a new set of possibilities for him and his team.

A new problem frame emerges

One thing that jumped out from their research was a preoccupation with the formal question of physical accommodation and time given for breastfeeding. “This completely dominated the narrative and the imagination of those involved,” said Gorgens.

As one mother put it, her department had made a room available, but it was in another building across the road from where she worked. Guidelines give mothers 20 minutes every 3 or 4 hours for breastfeeding, but it took her 10 minutes to get there and 10 minutes to get back.

“And as anyone will tell you,” Gorgens said, “your body will do whatever it’s going to do! It doesn’t take 20 minutes — there’s cleaning, pumping, bottling, and cleaning, and you can’t control how long that all takes.”

Until now, the guidelines that policymakers had devised for mothers wishing to breastfeed at work had largely failed to provide the flexibility that they needed to feel supported.

But Gorgens and his team noticed a barrier that went beyond the adequacy of the guidelines themselves: “actually the key question that emerged during our interviews was the relationship between the mothers and their supervisors,” he noted.

“The relationship between a mother and her manager is crucial,” he said. “You need someone in your camp rather than someone who strictly follows the rules.”

The team’s structuring process allowed them to surface and foreground this mother-manager relationship: using design, they negotiated their way to a structured problem frame from which workable policy solutions could be devised.

“We started out thinking that healthcare provided the most logical frame, or things like family relationships and cultural norms, but when we actually asked the mothers then this whole new set of possibilities arose,” Gorgens said.

New frame, new possibilities

With a new frame, a whole new set of questions and potential solutions started to emerge.

Gorgens and his team started asking questions about how to build relationships between mothers and their supervisors, and about building a culture in the workplace that acknowledges breastfeeding as a right.

“We wouldn’t have asked these kinds of questions before,” he said.

“Problem redefinition really blew the whole thing open for us about what we actually needed to tackle. We had this new swirl of things that we now saw.”

It became clear, said Gorgens, that a wider cultural shift towards a more values-based leadership was a good place to start.

“We need leaders that really understand the value statements that underpin the work,” he said, “rather than leaders who follow strict rules mechanically.”

Following these findings, Gorgens has launched into a set of conversations with Human Resources teams in the public sector to begin to lay the ground for policy that will encourage these wider changes.

“This isn’t a silver bullet, and change won’t be immediate,” said Gorgens. “But we feel more confident that we’re on the right track.” - Kathy Rawlings

What they learned

Problems are complex — you can frame one problem in many different ways: “There’s this pervasive idea in the public sector that if you do the right research, you’ll find ‘the truth’ and then will answer the right problem,” said Gorgens. But problems are far more complex than this. “There’s still very little appreciation that you can slice any one of these things any which way and that those initial choices are going to be profound for deciding where you end up—this is why it’s important to invest time into framing it well upfront.”

Reflect on your process constantly: “We tried to come together to debrief as a group and to track our own processes often. We had two researchers and then an anthropologist who studied us and our process,” he said. Focusing on the process rather than the outcome helped them to prevent taking shortcuts.

Collaborate with experts: “We connected with other individuals and organisations who are working on the same problem, and found collaborators across sectors,” Gorgens said. “It worked because there were people who were passionate about different pieces of this puzzle and wanted to make it work.”

Qualitative data helps, and you don’t need a lot of it: A small sample size was enough to surface ideas that Gorgens and his team had not yet thought of, with short surveys and interviews helping to shift their frame significantly. “Mothers know better than us what’s blocking them from breastfeeding, so we made it a priority to really listen.”

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