Upstream Strategies, Barriers & Runaway Bulls

By Beth Krah

When you spend years responding to problems, you can sometimes overlook the fact that you could be preventing them.” Dan Heath, Upstream –The Quest to Solve Problems before they Happen. “So often in life, we get stuck in the cycle of response. We put out fires. We deal with emergencies.”1

But the whole purpose of a first responder is to serve his or her community by responding to emergencies and putting out fires, right? Would you put out the fire as opposed to preventing it in the first place? There’s a good chance you can keep your crew and community safer by preventing issues before they turn into out-of-control situations that warrant a larger response.

While attending a leading healthcare conference for C-suite professionals, we were challenged to adopt “Upstream Healthcare” measures and focus on mitigating risks before they become life-altering issues. Whether the topic is ensuring firefighter safety, the latest outbreak, or mitigating the nasty effects of carcinogens and cancer, prevention is critical in your mitigation efforts.

Training our minds to think in terms of preventative measures takes time – and thinking through things instead of reacting after the fact. Coach and teacher Toby Sinclair gives an example of children caught in the river. 

You and a friend are having a picnic by the side of the river. Suddenly you hear a shout from the direction of the water – a child is drowning. Without thinking, you both dive in, grab the child, and swim to shore. Before you can recover, you hear another child cry for help. You and your friend jump back in the river to rescue her as well. Then another struggling child drifts into sight…and another…and another. The two of you can barely keep up. Suddenly, you see your friend wading out of the water, seeming to leave you alone. “Where are you going?” you demand. Your friend answers “I’m going upstream to tackle the guys who’s throwing all these kids in the water.”2

Barriers and Runaway Bulls

Heath mentions three barriers that often come into play:2

I don’t see the problem (problem blindness). When we’re blind to the problem, we treat it like the weather. If someone left the gate open and the bull escaped, would you laugh as you finish your hamburger or alert someone else and get on your horse and go catch that thing? Or do you just accept the fact that bulls escape and that’s life? The concern with not paying attention to smaller issues, or saying “that’s just how it is,” is that they’ll turn into all-out war if you’re not careful. Maybe not immediately, but by the time it happens, it’ll slap you upside the head and you’ll wonder how you got there.

It’s not mine to fix (lack of ownership). The runaway bull wasn’t your problem – you didn’t leave the gate open, but you can only ignore the bull so long as it doesn’t charge at you. Are you willing to get out of your comfort zone and go after it? Doing nothing allows the problem to fester and reach unintended consequences thereby creating a bigger problem. Help pull together a solution instead.

I can’t deal with that right now (tunneling). Are you overwhelmed juggling many other issues that you’ve had to just let the bull go? What you don’t realize is that (out of your purview) the bull is charging toward a group of kids and wreaking havoc in a nearby playground. How did it get this bad? Find out why the bull escaped. Train the ranch hand, fix the gate, insert the nose ring – whatever it takes to make sure this doesn’t happen again and you’re not unintentionally putting children or others at risk.

Starting your Upstream Journey

Three suggestions when embarking upstream:3

1. Be impatient for action but patient for outcomes. Implementing the change from reacting to preventing will come with plenty of resistance. It’s much easier to react. Keep your goal in sight and take one step at a time when tackling such changes, knowing that in the long run, it will be cheaper, it will save more lives, and you will be mitigating unwanted outcomes. If you need to rebuild the fence that was responsible for letting the bull out, it’s going to take time, but start now – it’s only going to get worse the longer you wait.

2. Macro starts with micro. It’s easy to get overwhelmed when looking at lofty goals and wanting to tackle the big things right away, but if you break it down and help one person at a time, or tackle one small thing at a time, the results will start to build on each other. In time, you will begin to see just how much has been accomplished on a grand scale and marvel about how you got there. One small step at a time in the right direction, and don’t quit, it will be worth it. Keep the goal in mind and keep plugging away. When you stand at the other side of the gate as you finish your fence, you’ll be exhausted, but satisfied that you did everything you could to keep those children safe from the runaway moo.

3. Favor scoreboards over pills. Don’t focus so much energy on the perfect solutions (i.e. the pill) that you ignore the little victories that have been made. How can you make progress each week that is within reach? Celebrate the little victories. Thank the neighbors that helped you build the fence, the team that refused to let you quit, the spouse for putting up with you during this time.

First step is identifying the problems. If you can’t think of anything, in particular, ask your team. What are you complaining about when you get home? What keeps you up at night? Is there anything boiling underneath the surface that needs attention before it flares up into a full-blown catastrophe?

The Long Race

In the long run, if it will help save lives, or even release funds back into the constraining budget, you must travel upstream and see where the issues stem from. Preventative measures take a good amount of planning, strategy, and forethought. It’s easy to purchase something to solve a problem after the fact, but challenge yourself to think ahead, be on the lookout for simmering issues, and concentrate on mitigation strategies before they grow into something uncontrollable. 

Initially, prevention sounds like it will take too much time away from your job and serving the community, but it will cost infinitely more time, money, and lives, in the long run, to react on the back end of an unanticipated tragic event. The sudden and immense impact of COVID-19 showed us that preparing for when these events happen is much wiser than preparing for if they happen. Be serious about your strategies. Unforeseen circumstances are a part of life – view them as training materials. Learn how to prepare and respond effectively.

Rational Problem-Solving Approach

Above is a chart adapted by John Dewey (1910) recommending a six-stage process that individuals can use to solve a problem.5 Don’t rush it, think it through carefully, devise a plan, and start mitigating yourself into a better position for life’s unexpected turns.

Educate is Key

Whether it’s bringing in a consultant, tapping into the knowledge of a colleague who’s been around the block a few times, or reaching out to the Fire Dept. Safety Officers’ Association (FDSOA), educating yourself and your team is key. Gather info, evaluate strategies, pick the best option for your situation, then implement that solution. 

Just don’t be the bull, for Pete’s sake!

Beth Krah is founder and CEO of The Krah Corporation (dba Krah Health Solutions). She has served the healthcare community for over a decade providing non-toxic infection prevention measures with a special focus on EMS, Disaster Preparedness/Response, Medical Care Facilities and the Military. Previously employed by Solvay Pharmaceuticals in their Quality Assurance/Quality Control group, her passion to serve is of utmost importance for her and her team’s role in serving their customers and keeping them healthy so they can focus on the pressing needs of saving the lives of others. She can be reached at


1. Heath, D. (2020) Upstream: The Quest to Solve Problems Before They Happen. Avid Reader Press/Simon & Schuster; Illustrated edition

2. Sinclair, T. (2021) Book Summary: Upstream by Dan Heath | How to solve problems with Systems Thinking. Retrieved from

3. The Growth Faculty (2020) How to solve problems before they happen from the bestselling author of Made to Stick. Retrieved from

4. Sage Publishing. Problem Solving. Figure 11.1 Rational Problem-Solving Approach. Adapted from Dewey, J. (1910) p. 208. Retrieved from

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