Fundamental Care is a ‘wicked problem’

Professor Alison Kitson, ILC Founder talks about: Fundamental Care is a ‘wicked problem’

I think I had an ‘Aha’ moment recently. It was when I was preparing a keynote presentation for the Nordic Nursing Research Conference in Copenhagen in October this year. The conference was supposed to happen in 2020 and has gone ahead a year late with a mix of virtual and face-to-face presentations. I had been invited to talk about why fundamental care matters to you.

And this was when I had the breakthrough thought. I realised getting fundamental care right for our patients, clients, and ourselves is not a straightforward cause and effect thing; it’s not about blaming people for not caring or pointing the finger at nursing leaders who don’t speak up for their frontline staff or indeed accusing educational establishments for not teaching care properly or failing to recruit the right calibre of student. My breakthrough thought was that not getting fundamental care right was due to all of these and many more issues that together make it a ‘wicked problem’.

What then constitutes a ‘wicked problem’? Well, if you have a look on the internet and read Wikipedia you will find that ‘wicked problems’ are hard to define clearly; they are hard to work out whether you’ve ‘crack it’ or not; there’s no definitive right or wrong outcome but degrees of improvement or worsening of the situation. You can’t really test the solution therefore you can never prove it has worked in the traditional scientific view of the world. Each ‘wicked problem’ will have to generate its own possible solutions that need to be tested incrementally.

Problems whose solutions require a lot of different stakeholders to change their mindsets and behaviours are likely to be of the ‘wicked’ variety. Think COVID vaccination; think climate change; think aged care reforms; think person-centred care delivery; think getting fundamental care right for our patients and clients. Now that we can stop blaming ourselves for failing to act compassionately or appropriately, we can begin to work out how we systematically engage those other key stake-holders in focused conversations about why we can’t get fundamental care right and what we can try and do about it.

Multiple conversations with multiple stakeholders, rigorous analysis of perceptions about why the problem exists and thought given to solutions are the data that the ILC members ought to be collating so that we can generate a credible database of the range of challenges and solutions facing our efforts to solve this wicked problem. Our recent two years effort during the COVID pandemic will also have drawn attention onto what continues to be overlooked in the delivery of safe fundamental care to patients and staff in our health and care systems.

So, I encourage you to start a conversation with a friend or colleague about fundamental care delivery as a wicked problem.

And let us know how it goes…

You can share your thoughts about Fundamental Care Delivery as a Wicked Problem here.