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  • Writer's pictureJosh Vaisman

Tossing Puppies in a River - Upstream Leadership

Updated: Jul 15, 2020

On a back-country hike with a friend recently, we came upon a beautiful mountain river.

The water was cool, and flowing just fast enough to carry a floating log downstream, but gentle enough to wade into.

Just when we were soaking in the serenity of our surroundings we heard a yelp. Looking out into the river we saw a puppy struggling to stay afloat.

Without thought we both ran into the water to rescue this poor pooch.

Not a moment after returning to shore we heard another cry. Looking out into the water we saw yet another puppy doing its best to swim.

As I held the first puppy, my friend dove back in to rescue the second.

Just as he got back to shore some meek barks rang out from the middle of the river. This time there were TWO puppies perilously floating on by.

I sprang into action. But just before getting into the water I spied my friend walking away.

Shocked, I stopped and yelled, “Where are you going? We need to save these dogs!”

Between clenched teeth he said, “I’m heading upstream to kick the crap out of the jackass tossing dogs into the river.”

Upstream Thinking

Confession – that story is made up.

It’s actually based on a parable Dan Heath shares in his latest book, “Upstream: The Quest to Solve Problems Before They Happen”.

Got your attention, though, didn’t it? Maybe even got your blood boiling.

There’s so much to take away from a parable like this, not least of which is how we often get so caught up in putting out the fires in front of us, we neglect to solve the problems that started them in the first place.

Often, leading a veterinary organization is no different.

At the last hospital I managed, our appointments consistently ran late. The later in the day it got, the less likely appointments would start on time. Sometimes it got so bad 5 PM appointments were really 6 PM appointments.

We tried everything from streamlining the medical records system to assigning exam room technicians to having clients pre-complete forms to tracking and sharing doctor timeliness.

These were all efforts to dive into the river and save the puppies. This was downstream problem solving and, while it sometimes helped or helped for a period of time, none of these interventions actually solved the issue.


I failed to encourage an UPSTREAM approach to problem-solving.

If we had, we might have considered the possibility that we were expecting to do too much in the time allotted each appointment. Or our scheduling system wasn’t working. Or the way we staffed the hospital didn’t match it’s needs. Or some other leading indicator I’m not thinking of right now.

The point is, we never sat down and openly, in a safe environment, considered the upstream problem and how to solve it.

When we’re caught up in a downstream approach we tend to be:

  • Reactive: the fire hits and we quickly jump to put it out

  • People-Focused: some person or people are to blame

  • Short-Sighted: we might find a work-around but the problem tends to happen again, and again, and again…

Upstream problem-solving, however, tends to be:

  • Preventive: the fire never happens, or it happens infrequently

  • System-Focused: we recognize the system is setting the people up for failure

  • Long-Sighted: eliminates the need for immediate workarounds because the issue never comes up again

Effective leaders understand that more often than not, problems in the workplace are system-problems, not people-problems. With this in mind, they find ways to formalize routine upstream problem solving.

I’ll share one way you can do the same.

Create an Upstreaming Task Force

As we grew, our appointment timeliness problem grew too. Since I was the Hospital Administrator and on-site owner (and because I had unintentionally enabled a system in which I was at the center of it all) every problem came to me.

“Appointments are 20 minutes behind today, Josh”

“We got another bad review because someone had to wait an hour, Josh”

“Josh, you need to talk to Dr. Smith. She’s never on time for her afternoon appointments!”

All this while I’m juggling the day-to-day of managing a large, busy practice.

Save a puppy, someone tosses another one in.

Don’t take my old approach. Get intentional about building upstream thinking into your practice. Create an Upstreaming Task Force.

Here’s how:

  1. Select 3-5 people from the team. If you’re an exceptionally large practice you may want a team per department AND a whole-organization team.

  2. The task force members can be anyone from leadership to doctors to techs to CSRs. The most important criteria is they are aware of and interested in the concept of upstream thinking, thoughtful, and engaged.

  3. Carve out at least one hour, once a month, for the task force to meet. This should be on the clock (i.e., paid) and free from any other responsibilities (i.e., off the floor and uninterrupted).

  4. Each meeting they have this simple agenda:

  • How are the latest Upstream Interventions working?

  • What’s a “fire” we keep seeing lately?

  • What’s the most likely system factor contributing to this fire happening?

  • What are some (2-5) recommended changes to the system to prevent these fires from happening again?

5. Someone on the task force is assigned to keep notes of the meeting and share those notes with the hospital leadership afterwards.

6. You, as the leader, consider and ACT on their recommendations

BONUS - Ask them to play the game of predicting future fires. What are some systems in place now that might contribute to fires later? Have them recommend systemic changes the hospital can make now to prevent them from ever happening.

Re-Framing "Heroes"

On a podcast with Dan Heath talking about his book, he says the way we think about heroes is limited.

We tend to view heroes as those who rush in and save the day in the face of chaos. They are reactive.

The problem here is we leave out the possibility that a hero may also be someone who prevents the chaos from ever happening. Sometimes the best superpower is the one that's unseen.

Maybe it would be better to call your task force the Hero Squad.

After all, if you commit to them, and they do the work you task them with, they’ll be saving the day for you, your team, and your clients.

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