example Archives - The Systems Thinker https://thesystemsthinker.com/tag/example/ Fri, 23 Mar 2018 17:02:10 +0000 en-US hourly 1 https://wordpress.org/?v=6.8.3 The Journey to Z: Realizing the Potential of an Organization https://thesystemsthinker.com/the-journey-to-z-realizing-the-potential-of-an-organization/ https://thesystemsthinker.com/the-journey-to-z-realizing-the-potential-of-an-organization/#respond Thu, 21 Jan 2016 09:25:51 +0000 http://systemsthinker.wpengine.com/?p=1799 ead the business media today and you’ll see that organizations of all types, from all sectors, are in deep trouble. There are many reasons for this organizational crisis – and many excuses for the poor performance that organizations are delivering. However, the thread present in all organizations that are experiencing this dynamic is that managers […]

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Read the business media today and you’ll see that organizations of all types, from all sectors, are in deep trouble. There are many reasons for this organizational crisis – and many excuses for the poor performance that organizations are delivering. However, the thread present in all organizations that are experiencing this dynamic is that managers aren’t aligned in a common view of where the business is, where it is going, how it should get there, and how they can contribute. This lack of alignment leads to reactive thinking and less-than-optimal outcomes.

Fortunately, the problem isn’t insurmountable; in fact, it is resolved quite easily – if senior managers commit to working together to have a better understanding of where the organization is today and where it is going. This article introduces four different tools – the Vehicle Analogy, the Fire-Fighting Matrix, the Vision Deployment Matrix, and the Conceptual Framework – that can be used in tandem. The first two are diagnostic tools, designed to surface people’s perceptions of the organization’s current reality and future potential as well as to expose barriers to success. The second two provide frameworks for identifying a shared vision of a desired future and outlining steps for achieving that goal. By utilizing these four tools together, a management team can create an environment that can help their organization realize its potential.

From X to Z Through Y

All organizations are on a journey from a current reality (“X”) to a desired future (“Z”). That desired future might be to attain a specific set of goals, such as a certain market share or earnings. It might also be a series of milestones that would signal to stockholders that the company’s management is the right team to continue to run the company. The road from X to Z contains a series of initiatives and targets along the way, symbolized by the letter “Y.”

The road from X to Z contains a series of initiatives and targets along the way

Here’s the problem. On the surface, the best route to get from X to Z is a straight line. And in business, a straight line means a clear, concise, understandable path of activities. However, in many organizations, the path from X to Z begins to wander a bit. Instead of going directly from X to Z through the Ys, managers find that the Ys have suddenly shifted and are no longer on the direct route to Z. And too often, the overwhelming number of Ys causes workers to lose sight of how to get to Z, or even where Z is.

This dynamic – losing sight of Z – is even more complicated when some managers see different and conflicting Ys. An even worse scenario is when people begin to believe that getting to a particular Y carries the same importance and focus as getting to Z.

managers find that the Ys have suddenly shifted and are no longer on the direct route to Z

So how can an organization maintain a common understanding of what Z is, where it is, how to get there, and why it is so important? The solution is to make sure that everyone in the organization – from the senior management team right on down to the evening shift workers – knows the answers to these questions at any given time. Equally important is to make sure that they have a clear picture of how they fit and how their work activities contribute to reaching Z. The first step to creating this focus is to ensure that everyone has a common understanding of the company’s current situation, or “X.”

Surfacing Current Perceptions

The good news about understanding the current situation in an organization is that there is a plethora of data available: competitive analyses, revenue projections and forecasts, globalization trends, workforce shifts, inventory turns, asset valuations and utilization, productivity effectiveness, and so on. The bad news is that hardly any of the data available looks at people’s mental models of the organization. Most of us agree that employees are the most important asset of any organization; therefore, knowing how they view the business, its potential, and their role in reaching organizational goals is critical.

Getting people to articulate their view of the organization can be difficult. Workers’ reluctance to be open with their perceptions often stems from the fear of possible retribution from management, the fear that they are alone in their view, or just an inability to articulate their observations and feelings. One way to get past these obstacles is to have employees compare the organization to a type of vehicle. Using the vehicle analogy creates a non-threatening environment in which people can discuss their views of the organization creatively and descriptively.

This process usually works best with groups that represent a cross-section of the company to provide representative thinking across the organization as a whole. Once you have your group together, ask these four questions:

  1. If our organization were some kind of vehicle, what kind would it be?
  2. What is the condition of that vehicle?
  3. What part of the vehicle are you? (You cannot be a driver or passenger, but must be an integral part of the vehicle itself.)
  4. What kind of vehicle will the organization be in three years (or whatever time range you are interested in)?

In question number 1, you are looking for the year, brand, model, and color of whatever type of vehicle the participant chooses. Participants usually select automobiles, but they could also pick bicycles, boats, airplanes, trucks, rockets, or whatever. The only criterion is that the vehicle must be something that was manufactured, which precludes using animals such as camels or horses.

In question number 2, you are seeking a detailed description of how the participants evaluate the current condition of the vehicle, such as rusted, dented, cleaned on a regular basis, or receives regular maintenance. This question surfaces perceptions about the organization’s health and its ability to realize its potential.

Question 3 is meant to get participants to think about how they contribute to the organization’s functioning. The role people play is too often confused with their job title or description. After they respond with something like “the fuel,”, “the carburetor,” or “the windshield,” the facilitator can surface additional mental models by asking, “And what function does that component perform in the vehicle? What would make it operate more effectively?”

Question 4 is used to identify what participants believe the organization will be able to achieve in the timeframe selected. Sometimes people report quite a change from the current vehicle (question 1) to the future vehicle (question 4) – the Wright Brother’s plane to a space shuttle; a skateboard to a new BMW. Equally, we have seen almost imperceptible shifts between the current and the future – a 1985 Ford Taurus to a 1985 Ford Taurus with new paint, a 2001 Mercedes Benz to a 2002 Mercedes Benz. On occasion, we have even seen the analogy seem to go backward – a 1999 Volvo wagon to a 1996 Volvo sedan.

This exercise helps to surface people’s assumptions about the organization and highlights any gaps in alignment among the perceptions of different participants. To show these discrepancies, the facilitator plots the results from questions 1 and 4 from all participants on a graph (see “Vehicle Graphs”).

For each individual, the results will be a straight line between two points, one for “current reality” and one for “future potential.” If the person’s assessment is that the company is currently an old bare-bones Volkswagen Beetle but has the potential to become a next-generation space shuttle, then the line will start at the bottom left corner and travel up to the top right. If the individual thinks the company is a middle-of-the-road performer now and will remain so in the future, a short, horizontal line would appear halfway up the graph.

The plotting is relative. So if one person characterizes current reality as a VW Beetle, but everyone else says its a pogo stick, then the VW plot line would start at a higher point than the pogo-stick plot line. An old car today that in three years will be the same car but clean would result in a horizontal line that doesn’t go very far to the right; again, the actual positioning would be based on the other answers.

The responses in example A represent an organization with a good level of alignment in the perceptions of current reality and future potential. The responses shown in Example B appear to be quite scattered, that is, participants had little common understanding of where the organization is and where it is going.

VEHICLE GRAPHS

VEHICLE GRAPHS

Conversation about the graphs centers on the following questions:

  1. What does this graph tell us about our alignment around our current reality and future potential?
  2. What is the impact of these assumptions on our ability to deliver consistently high performance?
  3. What level of alignment do we need?
  4. What do we want to do about it?

So, if most of the people view the future organization as a sturdy Toyota Camry but a few others see it as a jalopy, the group has a common language for exploring why their opinions diverge so dramatically. From this foundation, they can begin to create a common understanding of what their expectations are, where they want their organization to go, and what they will need to do to get their organization there.

The Curse of Fire-Fighting

Unfortunately, many organizations spend too much time on their journey to Z fighting fires. This may seem counterintuitive. Most certainly, if there is a crisis, it must be resolved. The problem comes when people put out the same fires year after year. The key to high performance over time is to extinguish fires and then make sure that they stay out. Doing so requires a different set of mental models about handling critical organizational problems than most managers have today.

In order to break the cycle of fire-fighting, we first must have a clear picture of how much of it is really happening. The best way to accomplish this is to have each member of a group plot on a four-block matrix how much and what kind of fire-fighting he or she thinks is taking place in the organization (department, team, etc.) (see “Fire-Fighting Matrix”). Participants use circles to represent current activities and squares to represent activities at some point in the past. A facilitator then combines all the data on one matrix.

FIRE-FIGHTING MATRIX

FIRE-FIGHTING MATRIX

In this example, people believe little learning has happened in the organization. This is demonstrated by the fact that, for the most part, the circles (today’s fire-fighting) are in the same area as the squares (fire-fighting two years ago). If learning were taking place, the circles would mainly appear in the upper-right quadrant of “new and high-value” problems.

The composite matrix often shows that people believe little learning has happened in the organization. This is demonstrated by the fact that, for the most part, the circles (today’s fire-fighting) are in the same area as the squares (fire-fighting two years ago). If learning were taking place, the circles would mainly appear in the upper-right quadrant of “new and high-value” problems. The fact that learning is not taking place means that the organization will continue to relive the same problems year after year, lessening its ability to realize its potential over time.

The vehicle analogy and the fire-fighting matrix are complementary diagnostic tools. In a company in which there is a distinctly low set of expectations (as shown by the vehicle analogy exercise), you generally find high levels of fire-fighting – fighting the same fires over and over again. By using the vehicle analogy and the fire-fighting matrix together, managers and employees can begin to see the impact of their collective actions. This is the first step to shifting behaviors and removing the roadblocks to organizational success.

ChemCo (a pseudonym), a global organization from the chemical sector, recently used these two tools. The management team and their direct reports were closely aligned in their perceptions of where the organization was and where they thought it would be in the future. However, their expectations about what the company would accomplish were rather bleak. Likewise, the output from the fire-fighting matrix showed that the company was not learning from experience. In organizations, perceptions are as important as reality. At ChemCo, the belief by managers and workers alike that the company had little possibility to realize its potential threatened to become a self-fulfilling prophecy.

Through this analysis, participants should have a good idea as to why the organization might struggle on its journey to Z. To overcome these barriers, they need to create a common vision of a desired future, with a detailed list of the actions that will support it. The next two tools – the Vision Deployment Matrix and the conceptual framework – can help an organization do just that.

Understanding Z

We usually describe Z – the organization’s overall goal – in terms of what we might call “events.” Events are the organizational outputs that are most easy to see and, consequently, most often measured. They are typically variables such as revenues, market share, headcount, and stock price. For energy companies, the list probably includes barrels per day; for healthcare facilities, the number of patients discharged; for manufacturing, production levels; and for service organizations, customer service ratings. These are fine measures, but they represent a rather myopic view of Z.

To get a true picture of Z, it is important to be able to describe not only the events, but also the patterns of behavior that lead to certain actions; the systemic structures (both the explicit and implicit policies and procedures) that will support the process; and the mental models of the managers and employees necessary for achieving the goal. The Vision Deployment Matrix is useful for compiling this detailed view of Z.

The Vision Deployment Matrix™ (VDM) is a tool designed by Daniel H. Kim to enable managers and employees to describe the organization’s current reality as well as what they want the organization to look like in the future (see “Vision Deployment Matrix”). By describing these two points in the journey in detail, the path from current reality to desired future becomes clearer – and more achievable. The difference between the vehicle analogy and the VDM is that the vehicle analogy paints a picture of people’s general impressions of the organization today and what they think it will become; the VDM offers a detailed look at the organization now, as well as specifying what employees want it to be in the future

Each participant fills out a matrix, and the results are then compiled. For ChemCo, there was a startling difference between what the ChemCo managers expected to happen, as shown in the vehicle analogy, and what they wanted to happen, as shown in the VDM. This gap is a serious problem, because it means that the organization as a whole lacks the confidence to reach Z.

To help bridge the gap, the group must come to agreement on a common vision, the steps for achieving it, and progress indicators to make sure they are on the right track. At the same time, individuals list action items for how they can contribute to the overall process. Because the VDM includes not just actions at the event level but also at the pattern, structures, and mental models levels, the actions people take are likely to be more effective than when they were operating only at the event level. By using the VDM, employees gain confidence that the organization is working toward a common goal and that it is achievable, regardless of past experiences.

Evaluating Individual Progress

Especially for managers, the process of closing the gap between the organization’s current reality and desired future means changing how they think, how they influence others, how they achieve goals and targets, and how they lead. To help draw attention to each of these areas and evaluate progress, the conceptual framework can be useful.

VISION DEPLOYMENT MATRIX

VISION DEPLOYMENT MATRIX

The conceptual framework has four columns labeled “thinking,” “influencing,”, “achieving,” and “leading.” These leadership competencies are critical for an organization to be able to reach its potential. The rows are labeled with company values, specific initiatives, organization-wide goals, key competencies, or other variables that are important to the particular organization (see “Conceptual Framework”).

To complete the framework, managers fill the cells of the matrix with the demonstrable behaviors they will need to exhibit in order to make progress in those areas. This exercise can be particularly challenging for leaders who are used to focusing on “achieving” at the expense of the other competencies. After the managers fill in their frameworks, they present what they have written down to the others in their group. After the presentations, participants then commit to what they will do differently in support of each item in the framework; that is, how they will change their behavior in ways that will be visible to others.

A management team at ChemCo did this exercise together. One month later, the team met to evaluate their progress. The facilitator had prepared an assessment for the group. Each manager read the list of commitments for the other members and evaluated whether they saw no evidence of change, some evidence of change, or a clear difference in the manager’s behavior. The assessment documents were then collected and compiled, with the compiled data presented in aggregate form for each manager.

At this first assessment meeting, both individual and team scores were largely unchanged. The team was disappointed by their lack of progress, but realized that, without this data, they wouldn’t have known how well they were doing in achieving their goals. The assessment gave them the motivation to continue to focus on improving their performance.

CONCEPTUAL FRAMEWORK

CONCEPTUAL FRAMEWORK

Managers fill out the cells of the matrix with the demonstrable behaviors they will need to exhibit in order to make progress in those areas. They then identify what they will do differently in support of each item in the framework; that is, how they will change their behavior in ways that will be visible to others.

One team member asked, “How often do you think we should do this assessment?” Another wanted to know, “Can we use this assessment with our own teams as well as with this team?” Both questions showed that managers were beginning to think in a different way than they had in the past. They saw the value of the exercise and wanted to be assessed not only by their peers but also by their subordinates. This is a sign of a senior leadership team that was serious about both getting better at being leaders and staying on a positive course on their journey to Z.

Bridging the Gap

Most managers lack clarity about their organizations’ visions and aspirations. Just because an organization has a printed vision statement doesn’t mean that people know what it means. Too often, the vision statement is just a set of cleverly worded phrases that tell of a glorious organizational future without giving workers a sense of how they fit into creating that future. If managers and employees don’t see the connection between what they do on a daily basis and where the organization is going, they will not be able to ensure that the company gets there.

These four tools, in combination, help people make the connection between current reality and desired future, and provide concrete ways to bridge the gap. They are not meant as simply opportunities for participants to vent or whine about why their companies are having problems. Rather they provide an opportunity to elevate the conversations about why the organization is where it is and where it is going. The tools also help to create an environment in which an organization can realize its potential. And that is what the journey to Z is all about.

NEXT STEPS

  • Evaluate where your organization is on the “road to Z.” Is the destination clear to everyone in the organization, or are there disagreements – spoken or unspoken – about where the organization is going and how you’re going to get there?
  • If you think your group, department, or organization would benefit from the framework presented in this article, come up with a plan for working through each of the exercises as a group, perhaps at a working retreat or series of strategy meetings.
  • If you think your organization needs help but isn’t ready to commit to the entire process, you may start by introducing the vehicle analogy. If people see the disparate views that individuals hold of the organization and its future potential, they may want to find ways to create alignment by using the other tools introduced in this article.

– Janice Molloy

James B. Rieley (jbrieley@boardrush.com) is a leadership development advisor for senior management and their teams. He has a doctorate in organizational effectiveness and has written extensively on the subject of improving organizational performance. He is the author of Gaming the System (FT/Prentice Hall, 2001) and Plain Talk about Business Performance (PenPress, 2004).

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Making Better School Policy Decisions Using Computer Modeling https://thesystemsthinker.com/making-better-school-policy-decisions-using-computer-modeling/ https://thesystemsthinker.com/making-better-school-policy-decisions-using-computer-modeling/#respond Fri, 15 Jan 2016 05:19:22 +0000 http://systemsthinker.wpengine.com/?p=2036 chool superintendents, administrators, board members, and others involved in public education face a Herculean task — gaining enough understanding of an infinitely complex system so they can make good decisions about how to allocate resources; determine the impact of district, state, and federal policies on their system; and anticipate future challenges. System dynamics and computer […]

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School superintendents, administrators, board members, and others involved in public education face a Herculean task — gaining enough understanding of an infinitely complex system so they can make good decisions about how to allocate resources; determine the impact of district, state, and federal policies on their system; and anticipate future challenges. System dynamics and computer modeling are largely untapped tools that can help decision-makers illustrate the possible results of differing policy and resource allocation decisions and unearth unintended consequences of these decisions, all in a no-risk, time-compressed environment.

Anticipating System Behavior

School districts are made up of many components, including district staff, individual schools, teachers and administrators within those schools, parent councils, and students. The sheer number and variety of these actors make it difficult to see their interdependence and to notice how an action in one part of the system affects the others. Add to this complexity policies originating from agencies outside the district, such as state education departments and the U. S. Department of Education, and the task of assessing how best to direct resources to meet students’ needs becomes almost hopelessly confusing.

Systems thinking and system dynamics tools, including casual loop diagrams, stocks and flows, and computer simulation, can shed light on the interrelationships among components and, perhaps more important, illustrate how outcomes may result from feedback loops rather than from simple, linear chains of cause and effect. These tools also make explicit the delays that often occur between a change in one component of a system and its effect on others. The interplay of feedback and delays can produce unanticipated system behavior, as shown by the mandating of smaller class sizes in California. When the legislature passed the new law, schools had to increase the number of classes they offered at each grade level to accommodate the same number of students. To do so, they needed to hire more teachers. Because becoming a teacher through traditional means requires at least four years of pre-service training, the number of teachers available fell short of meeting the needs of all schools. Suburban districts with greater resources filled their spots by recruiting teachers from urban districts, leaving those schools woefully understaffed. Proponents of the new law had failed to anticipate this unfortunate outcome of the change in class size.

By showing the potential behavior over time of multiple scenarios based on specific inputs, computer modeling offers policymakers and administrators the ability to visualize the long-term effects of specific decisions before those decisions are implemented. We can also use models to identify unexpected interactions between system components; ask “what if questions about changes in system parameters; run no-cost experiments that compress time and space; and reflect on, expose, test, and improve the mental models upon which we rely to make decisions about difficult problems. Thus, computer modeling could allow school-system leaders to make more effective decisions by building their understanding of long-term consequences of resource decisions in a complex environment.

Evaluating Professional Development Programs

To illustrate how a district can use computer modeling to analyze its options, I have created a simulation that explores the impact of professional development programs for teachers. Many school districts have responded to the call for better educational performance by implementing a standards-based curriculum. They offer professional development workshops to increase teachers’ ability to communicate this new curriculum to their students. The workshops are often formatted as multi-week summer programs.

Research has shown that teachers can learn to communicate the new curriculum through professional development training, so the question for a district is not whether summer workshops can build capacity, but whether they can do so for a critical mass of teachers in a reasonable time period. What factors play a role in this issue? Which workshops are most effective? What are the costs associated with this form of professional development? These questions are amenable to modeling because we can determine quantitative values for most of the important variables — such as the number of teachers in training and the turnover rate of teachers — and reasonable estimates for the qualitative variables — such as the effectiveness of the workshops and the relationship between the length of the workshop and the willingness of teachers to enroll in it.

I followed these steps to build the model:

1. Define the teacher stocks. All the teachers in the district fall into three stocks: Those who are not familiar with the standards; those who are attending a workshop to learn about the standards; and those who are familiar with the standards.

2. Establish the flow between stocks. Teachers who aren’t familiar with the standards can take a workshop to gain familiarity; teachers in the workshop may become familiar with the standards and move into the “familiar” stock or may not gain much from the workshop and return to the “unfamiliar” stock; and both “familiar” and “unfamiliar” teachers may leave the system each year.

3. Identify and assign values to the important system parameters and variables.

4. Incorporate funding components.

The model is based on the following assumptions:

  • The number of teachers in the system remains constant at 10,000, and at the starting point, 10 percent of the teachers are already familiar with the standards-based curriculum. Workshops vary in length from one day to five weeks.
  • Ten percent of the teachers leave and are replaced each year (with 10 percent of new teachers entering in the “familiar” stage), and the rate at which teachers leave the system is higher for teachers in the “unfamiliar” pool than in the “familiar” pool.
  • In the baseline simulation, 1,000 teachers participate in the three-week workshop; this number can vary up or down by a factor of three.
  • Fewer teachers participate in longer workshops, more in shorter ones. However, longer workshops are more effective. The initial success rate for teachers reaching the “familiar-with-standards” stage in a three-week workshop is 30 percent. This base rate increases linearly over time as more and more teachers (those for whom training was not effective the first time) retake the workshop.
  • There are 25 teachers in each workshop. The cost of the workshop includes a stipend of $300/week/ teacher for each of 25 participating teachers and an additional cost of $2,500/week for the instructor, supplies, and space.

“Modeling Professional Development” illustrates the model’s basic features.

Analyzing Results

The simulation yields several non-intuitive results, the most important being that these workshops alone cannot adequately deal with the problem of building the necessary capacity in the teacher workforce. Even after 10 years of providing three-week workshops, only 52 percent of the teachers are skilled in presenting a standards-based curriculum — and this number includes teachers who were capable before they enrolled in the workshops. The results clearly show that the workshops do not produce a critical mass of teachers with the desired capabilities in a reasonable amount of time.

MODELING PROFESSIONAL DEVELOPMENT

MODELING PROFESSIONAL DEVELOPMENT

Another unexpected result of this analysis is that the five-week workshops result in the largest number of trained teachers over a 10-year period, even though the smallest number of teachers enrolls in them. Holding all else constant, approximately 5,200 teachers achieve the desired level of ability after participating in a five-week workshop, while only about 2,800 teachers reach this stage through one week workshops. The longer workshop is also the most cost-effective per teacher trained: $2,300 per teacher for a five-week workshop; $2,635 for a three-week workshop; and $3,100 for a one-week workshop.

We can generalize this kind of model to other areas of professional development, because the results are independent of the workshop content. Administrators have access to the quantitative data for their district (such as number of teachers in the system, distribution by length of service, teacher leaving rate, funding available for workshops) and can reasonably estimate values for the qualitative variables (such as percent of teachers who require specific professional development, workshop effectiveness, relationship of workshop length to teacher resistance and workshop effectiveness) from prior experience. Plugging these numbers into a computer simulation would give them a general tool for predicting the impact of a summer workshop on professional development in any content area.

Similar models could let stakeholders examine other questions, such as the impact of rationing workshop participation depending on teachers’ average time of service in the system.

Should administrators concentrate on those who will remain in the system longest, that is, younger teachers? Or is there value in offering training opportunities to experienced teachers, who can serve as opinion leaders in changing the system’s culture? This analysis could also be incorporated into an expanded model to include the use of mentors and school and web-based professional development. By exploring these variables as well, districts might come upon a formula for producing a multi-component professional development system with the capacity to bring a critical mass of teachers up to speed on new curriculum requirements in an acceptable time period.

As I hope I’ve shown here, computer modeling offers a valuable planning and decision-support tool for school districts. This approach permits “no-risk” analysis of competing policy choices and resource allocations and, while it does not offer definitive answers, it can help school-system leaders understand the impact of their decisions and guide them toward making better-informed allocations of scarce resources.

Daniel D. Burke, Ph. D., has a broad understanding of K-graduate educational systems. As deputy director for education, the CNA Corporation (CNAC), he leads the research and analysis activities of CNAC’s public education group. Before joining CNAC, Dan was a researcher in molecular biology and produced an extensive record of curriculum innovations. He also played an important role in the National Science Foundation’s K-12 education reform programs.

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The Risk of the Cure in Public Health https://thesystemsthinker.com/the-risk-of-the-cure-in-public-health/ https://thesystemsthinker.com/the-risk-of-the-cure-in-public-health/#respond Thu, 31 Dec 2015 00:12:29 +0000 http://systemsthinker.wpengine.com/?p=2664 ccording to the World Health Organization, vaccines and clean water are the two public-health interventions that have had the greatest impact on the world’s health. In the U.S., vaccination programs have played an important role in virtually eliminating serious diseases such as diphtheria, whooping cough, polio, and measles. And vaccines aren’t just for kids anymore—immunizations […]

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According to the World Health Organization, vaccines and clean water are the two public-health interventions that have had the greatest impact on the world’s health. In the U.S., vaccination programs have played an important role in virtually eliminating serious diseases such as diphtheria, whooping cough, polio, and measles. And vaccines aren’t just for kids anymore—immunizations against flu and pneumonia save adult lives as well. But distrust of immunization programs is on the rise. As William Schaffner, M. D., chairman of the Department of Preventive Medicine at Vanderbilt University, says in the Consumer Reports article, “We’re prisoners of our own success. When formerly dreaded diseases have been pushed into the shadows—or eliminated—questions about the vaccines themselves spring up.”

Weighing the Risk

In recent years, groups that oppose vaccinations because of their potential health risks have sprung up. For instance, some activists claim that the mumps, measles, rubella vaccine is linked to autism, although medical groups studying the possible connection have concluded that the vaccine is not to blame. Anti-immunization groups also doubt the government’s ability to oversee vaccine safety, pointing to, among other things, its delay in banning mercury from injections, despite the fact that it can impair children’s cognitive development.

In response to such concerns, more and more people are choosing not to vaccinate. When weighing the risk of contracting vaccine-preventable diseases against that of experiencing one of the rare catastrophic reactions to the vaccine itself, they are banking on current low levels of infection and deciding to avoid the injections.

Health officials acknowledge that vaccines can cause side effects, ranging from mild (temporary pain at the injection site) to serious (between 1960 to 1999, 8 to 10 children a year in the U. S. contracted paralytic polio from the oral polio vaccine).

But they also point out that as more people avoid immunization, the incidence of certain serious diseases is bound to rise. As just one example, the Consumer Reports article cites the case of Mary Catherine Walther, who contracted Hib meningitis on her first birthday. Her local hospital in Tennessee hadn’t treated a case of the illness for eight years, since the introduction of a vaccine against it. Fortunately, the toddler recovered.

THE SWING OF RELATIVE RISK


THE SWING OF RELATIVE RISK

As the incidence of a disease rises, people’s perception of the risk to their own health increases. Under these conditions, they are more likely to overlook the vaccine’s side effects. Use of the vaccine reduces the incidence of the disease. When infection rates fall, people’s concerns about vaccine safety grow. If enough people choose not to use the vaccine, the disease begins to spread again.

One reason that formerly dormant diseases can reappear is that they haven’t yet been eradicated worldwide. Travelers from countries where immunization programs have been limited can carry a disease to other regions. Or such illnesses could reemerge through more diabolical means. In June, a simulation exercise depicted a smallpox attack by terrorists that infected 24 people in Oklahoma. After an imaginary two weeks, 16,000 people in 25 states were infected; 1,000 were dead; and 10 other countries reported cases. Following these trends, within three weeks, there would be 300,000 victims, a third of whom would die. Without continued vigilance, such an epidemic could also happen with other serious illnesses that we have long thought were cured.

Relative Risk

The pendulum swing between concerns about disease to concerns about the vaccines themselves represents a classic balancing process (see “The Swing of Relative Risk”). When the threat of a specific disease is high, the vaccine’s desirability rises, regardless of safety concerns. When incidences of the disease are few and far between, people start raising questions about the vaccine’s side effects.

Rather than writing off such concerns as irrational, by recognizing this dynamic, public-health officials can anticipate and manage them through ongoing investments in vaccine safety, education, and immunization programs around the world. In fact, officials might consider activists’ skepticism to be a positive force, in that it keeps pressure on manufacturers and governmental agencies to continually improve these life-saving products. After all, no one wants the cure to be worse than the sickness.

Janice Molloy is managing editor of The Systems Thinker.

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