Abstract
This critical review identifies the key constructs of the new Addressing Wicked Problems conceptual model. By using their leadership, communication, and collaboration skills, occupational therapists are well suited to be key stakeholders in addressing wicked problems, which have no obvious solutions.
Problems that are messy, complex in nature, persistent, and consist of “interdependent tangles” can be classified as wicked problems (Hamshire et al., 2019; Juzwishin & Bond, 2012). The term wicked is used to describe the “complexity, importance and persistence of a problem” because they have no obvious solution (Hamshire et al., 2019, p. 8). The fields of health care and social services are full of wicked problems. Examples include the current opioid epidemic, obesity, poverty, and the spread of the Zika virus (McGrath & McGonagle, 2016; Sherman, 2016). Each of these examples presents micro- and macro-complexities that provide opportunities for occupational therapists to get involved at the client–therapist level, as well as at a system level, to address various impacts on health, well-being, and social circumstances, including, but not limited to, preventing the marginalization of groups of people, providing housing solutions, and addressing disparities in care. When wicked problems arise, there is no single root cause of the complexity, uncertainty, and wickedness that characterize them (Head, 2008). Wicked problems are challenging to identify and can change over time (Hamshire et al., 2019). If wicked problems are not addressed, they are likely to intensify. They have been described as “malignant,” “vicious,” “tricky,” and “aggressive” (Juzwishin & Bond, 2012; Rittel & Webber, 1973). Unlike issues on which scientists and engineers typically focus, wicked problems are not tame or benign, and they require a different approach to both their definition and resolution (Rittel & Webber, 1973). Other terms for wicked problems include social issues, social messes, and complex issues.
The term wicked problems was coined by Rittel and Webber in 1973, but discussions about such problems were first introduced in 1967 by C. West Churchman (Hutchinson et al., 2015). In this current critical review, we identified literature that focused on how wicked problems are addressed and solved in areas such as engineering, business, management, nursing, architecture, agriculture, environmental science, biology, and, more recently, occupational science. Although occupational scientists have demonstrated some engagement in addressing wicked problems, the field has yet to contribute to this body of literature (McGrath & McGonagle, 2016). Many articles have discussed wicked problems, and several elements of the concept of wicked problems have been identified; however, a comprehensive list of the key constructs or factors involved in addressing wicked problems, and an overarching model, are not present in the literature. The current state of information on wicked problems and the key factors involved in addressing them highlight the need for this review.
Wicked problems are said to develop as a result of person–environment transactions, making them intrinsically occupational in nature (McGrath & McGonagle, 2016). This is important to consider when addressing wicked problems because the occupational performance of individuals, groups, and populations could be negatively impacted (McGrath & McGonagle, 2016). For occupational therapists to be part of addressing wicked problems, they would need to work at a systems level, otherwise known as “top of scope” (Mental Health and Addiction Workforce, 2015). “Working to top of scope” refers to “enhanced opportunities and capacity to utilize specialized knowledge and expertise in a way that is efficient, adaptive, collaborative, holistic and ethical” (Mental Health and Addiction Workforce, 2015, p. 3). Occupational therapists can contribute their expertise in occupation and person–environment interactions to address wicked problems at a systemic level. Occupational therapists embrace a transdisciplinary mindset and a holistic approach to care, positioning them to change wicked problems into “wicked opportunities” (Sherman, 2016).
Although occupational therapists in practice are called to address wicked problems, there is currently no literature that has addressed how they can work to top of scope to address such problems. For occupational therapists to truly be leaders and change agents in the health and social services systems, they need to advance their knowledge of wicked problems and determine the best practice approaches to addressing them (Canadian Association of Occupational Therapists, 2012). The objective of this critical review was to identify the key constructs involved in addressing wicked problems, discover considerations for occupational therapists, and develop an overarching conceptual model that represents the key constructs.
Method
This critical review had a critical review design. We chose this design because it is a demonstration of a thorough review of the literature and results in the production of a hypothesis or conceptual model (Grant & Booth, 2009). The methods of this review were informed by the scoping review methodology outlined by Arksey and O’Malley (2005) and Levac et al. (2010). No ethical issues were identified pertaining to the methods or potential outcomes of this study.
Studies that addressed topics such as defining and describing the key concepts of wicked problems, or approaches to solving wicked problems, were included in this review. In consideration of the varying terminology used to discuss wicked problems, studies that used terms such as complex issues, hard problems, system-level concerns, social issues, and social messes were included. We focused on how authors have addressed wicked problems, specifically, those focused on the health and social services sectors. The search strategy initially included literature spanning January 1973 to November 2020. We selected the year 1973 to encompass literature starting from Rittel and Webber’s (1973) coining of the term wicked problems; however, because of the high volume of articles the exclusion criteria were further refined. After conducting a primary review of full-text articles, we decided to exclude articles published before 2010 to ensure that the most recent and relevant sources were included. Only articles in English were included because of the time and cost involved in translating foreign language materials (Arksey & O’Malley, 2005). Although critical reviews do not embrace an appraisal of quality, authors may opt to evaluate the literature according to contribution (Grant & Booth, 2009); therefore, all types of articles were included if they met other inclusion criteria. At the full-text and data extraction stages, articles were not included if they only discussed the concept of wicked problems or did not add to our knowledge of key considerations for solving wicked problems.
We applied our search strategy to the Scopus, CINAHL, and Ovid databases. Additional articles were sourced by hand-searching pertinent journals, reference lists, and gray literature. Gray literature is typically not published through conventional means and may be excluded from more prominent databases, or it can encompass articles that are challenging to find (University of Toronto, 2022). Articles that resulted from the search strategy were imported into Covidence (Veritas Health Innovation Ltd., n.d.). Two reviewers conducted both title and abstract screening and full-text review. Full-text articles were sourced for all relevant studies at the full-text review stage. Articles for data extraction were reviewed by one author. The extracted data were then used to create a conceptual model. The research team discussed this model until a consensus was reached.
Results
A total of 2,148 articles were initially screened after duplicates were removed, resulting in 396 full-text articles to be assessed for eligibility. Thirty-six articles were included in the final analysis (Figure 1).
Flow diagram of the study selection process.
This review drew on literature from the health (n = 13), policy (n = 7), business (n = 3), management (n = 3), leadership (n = 3), planning (n = 2), and administration (n = 1) sectors. The four key constructs needed to address wicked problems are (1) collaboration (n = 16), (2) leadership (n = 14), (3) perspective (n = 7), and (4) innovation (n = 6; Table 1). The other notable themes identified in the literature were “identifying the problem as wicked” (n = 4) and “occupational perspective” (n = 3). Full data details are highlighted in the Appendix.
Prevalence of Constructs in the Literature
Identifying the Problem as Wicked
Sharts-Hopko (2013) reported that being able to recognize that a problem is wicked is the first and most important step in addressing them. According to Head (2019), the way in which a problem is defined is closely related to the type of solution that may be achieved. A lack of recognition of the wicked nature of a problem could lead one to invest in interventions that result in poor and insignificant outcomes (Hamshire et al., 2019). Finegood et al. (2010) indicated that by acknowledging a problem as wicked, the tendency to seek simple solutions will dissipate and more comprehensive methods of addressing such problems can be considered.
Collaboration
Collaboration was identified as a key construct in the literature, having been discussed in 16 of the 36 included articles. Collaboration was described as the most formal of interorganizational relationships, involving the exchange of information among stakeholders, resource-sharing, willingness to enhance the capacity of others, working toward a shared goal, and exploring problems and solutions that are beyond each stakeholder’s possible responses (Alford & Head, 2017; Brunswicker et al., 2017; Daviter, 2017; Elia & Margherita, 2018; Julian & Ross, 2013; Salignac et al., 2018). Salignac and colleagues (2018) identified that an effective collaborative environment is one that establishes clear roles and responsibilities, demonstrates commitment to a common mission, adopts a governing structure, evaluates the effectiveness of its mechanisms, fosters open and frequent communication, has a process for conflict management, and is formed on the basis of trust-based information relationships. Collaboration enables organizations and stakeholders to broaden their “pool of resources and skills to develop distinctive capabilities” and achieve objectives that no individual organization could have attained on its own (Salignac et al., 2018, p. 94). We synthesized the literature regarding collaboration into three subthemes: (1) interdisciplinary teams and diverse perspectives, (2) visualizing interdependencies, and (3) team communication.
Interdisciplinary Teams and Diverse Perspectives
In this review, we identified that the importance of multidisciplinary teams (n = 9 articles) was important to acquire diversity in knowledge. McGregor and Donnelly (2014) indicated that considering input only from single sources and disregarding input from society are insufficient to address wicked problems. Collaborative efforts in addressing wicked problems must incorporate multidisciplinary perspectives and a variety of stakeholders, including experts and societal and nongovernmental actors, to reflect the diversity and complexities of such problems (Alford & Head, 2017; Brunswicker et al., 2017; Daviter, 2017; Elia & Margherita, 2018; Julian & Ross, 2013). Wicked problems do not function with finite boundaries; thus, there is a need to involve relevant stakeholders to identify the scope of a problem and its impact on different populations (Dennis & Dailey-Hebert, 2015). As Brunswicker and colleagues (2017) indicated, “Nobody wants to be ‘planned at’” (p. 168); therefore, addressing wicked problems should support the development of solutions that consider context and local circumstances and attempt to gain critical, practical knowledge about the problem being addressed.
Addressing the complexities of such problems requires a broad range of specific knowledge and skills, that are achieved through sharing, creating, and synthesizing information among stakeholders (Daviter, 2017; Hogan et al., 2018). Collective intelligence and collaboration create opportunities for stakeholders to recognize one another’s perspectives, establish a common understanding of the problem, and translate this knowledge into implementable strategies for collective action (Daviter, 2017; Hogan et al., 2018). Finegood and colleagues (2010) indicated that successful teams match capacity with complexity by setting functional goals and directions for improvement; identifying what is known and not known; distributing decision, action, and authority among group members; creating competition and feedback loops; and assessing their effectiveness.
Visualizing Interdependencies
Visualizing interdependencies was discussed in this review. Establishing a plan of action for addressing a wicked problem may be best achieved by understanding its interdependencies (Sturmberg & Martin, 2020). Modeling such interdependencies using a visual format allows stakeholders to establish relationships between agents within a system, explore dynamic relationships, consider different interventions, and compare potential outcomes at a system level (Sturmberg, 2020; Sturmberg & Martin, 2020). According to McLeod and Childs (2013), consideration of interdependencies allows stakeholders to consider different ways of understanding management styles, work patterns, and connections, thereby increasing sophistication. Managing interdependencies within wicked problems requires “a neutral space for negotiations, discourse, and conflict resolution” (Sturmberg & Martin, 2020, p. 1366).
Team Communication
Head and Alford (2015) acknowledged that communication is a key factor in collaboration. Communication that is inconsistent and nontransparent can limit the collaborative efforts needed to make decisions in uncertain environments with competing demands (Sturmberg & Martin, 2020). According to Hudson and colleagues (2014), communication can act as a fundamental barrier to successful planning. The inclusion of multiple stakeholders can increase complexity, demonstrating the need to engage in clear and regular communication (Head & Alford, 2015 ; Hudson et al., 2014). As Innes and Booher (2016) alluded, collaborative dialogue fosters new ways of solving problems, assists in broadening the perspectives of stakeholders with rigid positions on a matter, and creates an environment that encourages the acquisition of new insights for the purpose of reframing “the wicked into the manageable” (p. 8). Hogan and colleagues (2018) indicated that communication issues are often a result of a “lack of openness and ability to listen with curiosity[;] the challenge for the facilitator [is] to be able to recognise and communicate stakeholders’ voices in the process . . . [and the ability] to translate ideas into ‘languages’ understood by a diversity of stakeholders” (p. 911). Effective communication practices encourage stakeholders to share matters of concern more often, increase the likelihood of the identification of connections within and underlying issues of a particular problem, and promote ongoing problem-solving and forward thinking (Head & Alford, 2015).
Leadership
We identified leadership as the second most prominent construct in the literature, and it appeared in 14 of the included articles. Subthemes that emerged include leadership style, leader communication, and having a shared vision.
Leadership Style
Leadership styles, such as adaptive, collaborative, collective, transformational, authentic, rotating, and transleadership, were discussed in the articles. Although each leadership style possessed its own characteristics and may be beneficial in the realm of wicked problems, the most abundantly discussed style was adaptive leadership. Solman (2017) explained that adaptive leadership embraces thorough analyses of the complex problem-solving that is required for wicked problems. Adaptive leadership fosters a multidisciplinary approach whereby leaders solicit the expertise of others from various fields and with differing levels of experience (Solman, 2017). The goal of engaging multiple stakeholders is to promote idea sharing and elaborate on various approaches to address a wicked problem (Solman, 2017). Adaptive leaders actively participate in the problem-solving processes alongside their team members (Sturmberg, 2021). An adaptive leader challenges stakeholders to engage with complex problems and provides the correct conditions in which the work will thrive (Head & Alford, 2015).
Common leadership qualities included transparency, honesty, trustworthiness, resilience, collaboration, compassion, confidence, courage, and commitment (Czabanowska et al., 2014; Hutchinson et al., 2015; Juzwishin & Bond, 2012; Peterson et al., 2018; Torfing et al., 2020). Other qualities worth noting included patience, especially for wicked problems, an undeniable passion for the collaborative process, and being present during problem-solving (Juzwishin & Bond, 2012; Yeo et al., 2015). Czabanowska and colleagues (2014) noted that leaders’ actions should be based on their personal values and their desire to do the right thing while still demonstrating humility. Being adaptable, questioning insight, and learning from mistakes or failures were outlined as well (Edmonstone, 2011; Sturmberg, 2021).
Leader Communication
Closely related to the importance of leadership to supportive collaboration is communication, which is also crucial for effective leadership. McLeod and Childs (2013) explained that when addressing wicked problems, leaders must support team collaboration by asking the right questions, not simply providing the right answers. Leaders should facilitate team sharing and encourage team members to voice their ideas (Edmondson, 2016). Leaders can initiate problem-driven conversations with team members, leading to an advancement in problem-solving through feedback and critical reflections (Edmondson, 2016).
Having a Shared Vision
When addressing a wicked problem, leaders need to facilitate the identification of a shared vision (Chrobot-Mason et al., 2016). The sharing of ideas among team members and continuing to recognize the importance of an evolving vision then create a shared vision (Edmondson, 2016). Edmondson (2016) explained that leaders with a captivating vision will motivate team members and promote collaboration. The vision should be clear even if the problem is messy; it should work well when framed in a way that can inspire team members (von Thienen et al., 2014). This process is supported by creating a safe team environment that encourages members to share their thoughts, lending to a less hierarchical leadership style that helps promote the inclusion of others (Chrobot-Mason et al., 2016; Czabanowska et al., 2014 ; Edmondson, 2016).
Perspectives
Seven articles discussed the importance of considering different perspectives when dealing with wicked problems. This construct is connected to collaboration but is also worthy of its own identification. Sturmberg (2021) suggested that people will develop an alternative outlook when viewing a situation as interconnected wholes instead of individual parts. Developing a different perspective involves looking for new insights, considering wicked problems with a broader view, and reflecting on assumptions (Hudson et al., 2014; von Thienen et al., 2014). Termeer and Dewulf (2019) suggested that teams should celebrate and recognize small wins, leading to the promotion and development of new understandings of the problem. Reframing could also allow stakeholders to look at the problem differently and propose new ideas (Grint, 2010; von Thienen et al., 2014). Solutions to wicked problems require consistent modifications and the acceptance of imperfect solutions, both of which are necessary to make progress (Grint, 2010 ; Head, 2019). Caulfield and Brenner (2020) suggested that promoting a sense of urgency when dealing with wicked problems can encourage collaboration, cooperation, and increased commitment from team members.
Innovation
Innovation emerged as a subtheme in 6 of the included articles. The literature suggested that adaptive or nontraditional solutions are needed to address wicked problems given that previous solutions have not been successful (Head & Alford, 2015; Hudson et al., 2014 ; von Thienen et al., 2014). Team members should be open to sharing and discussing new, innovative, and bold ideas (Head, 2019; Head & Alford, 2015; Hudson et al., 2014; Torfing et al., 2020; von Thienen et al., 2014). Wicks and Jamieson (2014) discussed Sharpe’s (2013) three-horizons framework, which has been used to facilitate change and innovation. The second horizon describes innovation as comprising new ways of doing things and transforming a situation on the basis of limitations and opportunities (Wicks & Jamieson, 2014). The authors also considered imagination—comprising creativity, vision, and insight—a key ingredient in addressing wicked problems. Imagination is needed to facilitate a “creative spark” and to persevere through any limitations to the way a group thinks (Wicks & Jamieson, 2014).
Occupational Science
The link between occupational science and wicked problems was discussed in 3 articles. Occupations are key determinants of health and well-being (Huot et al., 2018). According to Huot and colleagues (2018), there is a call for occupational scientists to work toward “socially transformative goals” that bring attention to the social and occupational inequalities resulting from wicked problems. They shared that, for knowledge of occupation to contribute “to the eradication of social problems” (p. 432), a basic introduction to occupational science is necessary.
These articles discussed the need for occupational scientists to engage in interdisciplinary and transdisciplinary collaboration as a means of addressing wicked problems (Huot et al., 2018; Wicks & Jamieson, 2014). Huot and colleagues (2018) and Wicks and Jamieson (2014) have identified a lack of collaboration between occupational science and public health. With a shared objective of promoting health, there is an opportunity for these disciplines to benefit from sharing knowledge to gain a better understanding of complex issues and enact social change (Huot et al., 2018; Wicks & Jamieson 2014). The authors of these 3 articles shared that current problems are a result of previous narrow solutions that resulted from traditional methodologies, further identifying the need to integrate new and alternative ways of thinking about and addressing wicked problems.
Discussion
In this critical review, we sought to draft a conceptual model that represents the key constructs in addressing wicked problems and how occupational therapists can engage in this process. We identified that the key constructs required to address wicked problems are interconnected; specifically, identifying the problem as wicked is an all-encompassing step in addressing wicked problems, one that involves a collaborative process and strong leadership while fostering the sharing of different perspectives, effective communication, and innovative ideas.
The themes of this critical review emerged early in the data extraction phase, at which point we adjusted the exclusion criteria to eliminate articles that solely defined wicked problems and include only those that supported the understanding of how wicked problems are solved. Resilience was thought to be a key construct in the early stages; however, the literature proved quite limited. Our original intent was to review literature with a health and social services focus, but it became clear these sectors also draw knowledge from business, planning, policy, and management.
We noted many commonalities among the key constructs, including a shared need for the inclusion of a multidisciplinary approach, the use of effective communication, the consideration of multiple perspectives, and a shared understanding of the problem and desired outcome. The common themes and, ultimately, interconnectedness of the constructs led to the development of the Addressing Wicked Problems conceptual model (Figure 2).
Addressing Wicked Problems conceptual model.
Identifying the problem as wicked is the first, and arguably most important, step in addressing wicked problems. As a result, a guide to identifying a problem as wicked is depicted in Figure 2 at the top of the conceptual model. It requires the engagement of the key constructs. Collaboration was the most prevalent construct identified in this review; therefore, it is represented in the largest circle and by the boldness of the arrow pointing to “Addressing Wicked Problems” on the right-hand side of the figure. Leadership is also of great importance, followed by perspectives and innovation, all of which are depicted by circles that correspond in size to their prevalence. The interconnectedness of the constructs is demonstrated by the overlapping circles. The arrows corresponding to each construct are weighted differently to further reflect the prevalence of each construct in the literature. This model provides occupational therapy professionals and decision makers with a visual representation of the constructs that are necessary to address wicked problems. Next steps include testing the conceptual model with relevant stakeholders, informing future research, and implementing the key constructs into practice to address wicked problems. This is an important step in the evolution of a model and road map for how wicked problems can be addressed and potentially solved.
The key constructs identified in this review do not exist on their own. Concepts from collaboration, leadership, perspectives, and innovation must be considered when addressing the most wicked of problems. The review has identified a shared need for a multidisciplinary approach, the use of effective communication, the consideration of multiple perspectives, and a shared understanding of the problem and desired outcome.
Occupational therapists are highly capable of practicing and incorporating each of the key constructs into their practice to address wicked problems. We acknowledge that occupational therapists may be addressing wicked problems in their day-to-day practice; however, the literature on tackling wicked problems from an occupational therapy perspective is silent. We believe that occupational therapists possess the competencies essential to influencing how interdisciplinary teams address and solve wicked problems.
As scholarly practitioners who base their work on the basis of the best evidence from research and use a holistic lens to consider changing conditions and differing perspectives, occupational therapists are well positioned to engage in this step of the process (Canadian Association of Occupational Therapists, 2012). They can also collaborate effectively with multiple stakeholders and contribute their perspective on the occupational impacts of a problem.
The literature on occupational science and wicked problems, although limited, identifies a need for occupational scientists to bring attention to the social and occupational inequalities that result from wicked problems (Huot et al., 2018). Moreover, occupational scientists must engage in interdisciplinary and transdisciplinary collaboration to foster new relationships with the public health sector to integrate new and alternative ways of addressing wicked problems (Huot et al., 2018; Wicks & Jamieson, 2014). By integrating the key constructs into their research and practice, occupational scientists and therapists will open the door to the conception and integration of new ideas to address wicked problems.
In their Minimum Standards for the Education of Occupational Therapists, the World Federation of Occupational Therapists (WFOT, 2016) stated that collaboration is outlined numerous times as a skill and attitude that all occupational therapists are expected to practice. Occupational therapists are also expected to be collaborators, collaboration being one of the major constructs needed to address wicked problems. WFOT (2016) explained that the purpose of their minimum standards is to ensure that occupational therapists are empowered and ready to be leaders both locally and globally, and they noted that leadership, communication, and a greater focus on interpersonal skills are important in the occupational therapy education process. WFOT recognizes all occupational therapists as leaders and acknowledges their skills in communication, which demonstrates again that occupational therapists possess a unique skill set to address wicked problems.
The occupational therapy profession embraces a holistic and broad perspective, making occupational therapists well suited to help shift the perspectives of teams addressing wicked problems (WFOT, 2021). Wicked problems also require constant modifications to the proposed solutions, which occupational therapists consistently do in practice (Head, 2019). WFOT (2021) explained that occupational therapists modify the occupation or environment to enhance occupational engagement, and they monitor and modify intervention plans as a necessary component of practice (Townsend, 2007). Occupational therapists offer a unique perspective and skill set, enabling them to modify solutions and interventions with regularity. As Schmid (2004) noted, creativity is a fundamental pillar of the occupational therapy profession and is most effective when used in a supportive and collaborative environment. Occupational therapists demonstrate both creativity and innovation in their daily practice, both in clinical and nonclinical environments.
Limitations
A limitation that arose while conducting this review is that there is no gold standard for a critical review. Therefore, we followed a scoping review methodology and were influenced by other authors in their approach to synthesizing information. Not having a formal quality assessment for this critical review is a limitation. A critical review is also a starting point for further research, and it can be subjective in nature, posing another limitation (Grant & Booth, 2009). One limitation worth noting is that, during the data extraction phase of this review, each article had only one reviewer, as opposed to two reviewers for title and abstract screening and a full text review. This could have impacted the results that were extracted during the review. Access to the literature also posed a limitation. Some articles were excluded because a full text was not available at no cost through the Ovid, CINAHL, or Scopus databases.
Implications for Occupational Therapy Practice
Occupational therapists embrace and embody leadership, collaboration, innovation, and the ability to shift perspectives, all of the key constructs that were noted in this critical review. Although we recognize that a critical review is a starting point and not an endpoint, it is time for occupational therapists to embrace their role as key stakeholders in addressing wicked problems. The results of our review have the following implications for occupational therapy practice: Occupational therapists possess an extensive and unique skill that includes, but is not limited to, being creative and innovative, adaptable, solution focused, leaders, collaborators, and occupation focused, all of which are assets in addressing wicked problems and working to the top of scope. This study may be a gateway for occupational therapists to join the discussion about addressing wicked problems and become more vocal about the importance of occupational therapy’s involvement in the realm of wicked problems in health care and social systems. This review sought to improve the knowledge and understanding of the key constructs involved in addressing wicked problems and to discover how occupational therapists can be part of creating solutions to wicked problems. Our review presents a conceptual model that can be viewed as a call to action for occupational therapists to be more involved in addressing wicked problems and working to the top of scope, with the hope that they can help change wicked problems into wicked opportunities. This review provides a foundation for other occupational therapists to further research occupational therapy and wicked problems. Our discussion highlights how occupational therapists are well suited to address wicked problems and sets the stage for future research to determine how they can be involved in top-of-scope positions, address wicked problems, and further understand the relationships between wicked problems and occupation. Further research is necessary to test the newly developed Addressing Wicked Problems conceptual model in practice.
Conclusion
The key constructs involved in addressing wicked problems—leadership, collaboration, perspective, and innovation—are important and are strongly interconnected. The interconnectedness and prevalence of these constructs is demonstrated in the new Addressing Wicked Problems conceptual model. There is an identified need to adopt an adaptive leadership approach that supports the collaboration of key and relevant stakeholders and multidisciplinary teams as well as the use of effective communication and consideration of multiple perspectives to achieve a shared understanding of the most complex and wicked problems of our time. Occupational therapists, with their extensive skill set, are well suited to work to the top of scope and be key stakeholders in addressing wicked problems by using their leadership and collaboration skills and attitudes, along with their creativity, innovation, and ability to shift perspectives. Occupational therapists need to engage in discussions and further research about addressing wicked problems.
Supplemental Material
Supplementary material for Developing a Conceptual Model for How Occupational Therapists Can Address “Wicked Problems”: A Critical Review
Supplementary material, sj-pdf-1-aot-10.5014_ajot.2023.050015.pdf for Developing a Conceptual Model for How Occupational Therapists Can Address “Wicked Problems”: A Critical Review by Maggie McDougall, Raven Brooks and Andrea Duncan in The American Journal of Occupational Therapy
Footnotes
*
Indicates articles included in the critical review.
Acknowledgments
We extend our thanks to Associate Professor Nick Reed for his continued support.
Summary of Data Charting
| Author/Date | Function of the Study | Core Findings or Comments Related to Wicked Problems |
|---|---|---|
| Alford & Head (2017) | Addresses shortcomings in the scholarship about wicked problems and suggests ways of tackling them; argues for a more realistic standard of success in dealing with wicked problems. | Multiple inputs and insights are needed, and many heads are better than one; more knowledge and experience can help with the identification and implementation of appropriate interventions. |
| Brunswicker et al. (2017) | Explores the process and outcome of a crowdsourcing project and derives actionable design principles for a 3-phase civic innovation crowdsourcing process. | “Nobody wants to be planned at”: Experts and nonexperts need to be involved in the process; stakeholders who are affected by the problem should be involved; solutions must be contextualized. |
| Caulfield & Brenner (2020) | Uses a case study approach to explain how one Midwest community in the U.S. applied collective leadership within a community network to reduce teen births. | Collective leadership can assist in addressing wicked problems; urgency drives collaboration, commitment, and change. |
| Chrobot-Mason et al. (2016) | Introduces the concept of a boundary-spanning mindset using both theory and research. | Leaders need to create a shared vision or goal to create a sense of “we”; common identity for team members; collective action. |
| Czabanowska et al. (2014) | Presents the meaning of contemporary public health leadership on the basis of qualitative research and proposes a curriculum model for contemporary public health leadership. | A transleadership style can be used when addressing wicked problems; leadership qualities such as honesty, trustworthiness, and commitment are crucial; a collaborative style of leadership is necessary for complex public health challenges; leaders’ actions should be based on their personal values and desire to do the right thing while still demonstrating humility. |
| Daviter (2017) | Identifies and explicates three distinguishable strategies of problem governance: (1) coping, (2) taming, and (3) solving. | A network of societal stakeholders and nongovernmental organizations is necessary to reflect the diversity of relevant views; collaboration enhances knowledge. |
| Dennis & Dailey-Hebert (2015) | Reviews a university-wide innovation project in which a unique project team approach was used to tackle an institution-level wicked problem. | Wicked problems do not function with finite boundaries; therefore, the involvement of many stakeholders is necessary to identify the scope of the problem and its impact on different populations. |
| Edmondson (2016) | Discusses four key leadership practices: (1) fostering an adaptable vision, (2) enabling psychological safety, (3) facilitating the sharing of expertise, and (4) promoting execution-as-learning. | Leaders should encourage others to share their thought processes and should help them do so; leaders must clarify the underlying values of addressing a problem and then discuss and celebrate the evolving vision; a clear vision is motivating for others; leaders should initiate problem-driven conversations for feedback and reflection. |
| Edmonstone (2011) | Reviews the history of competence-based leadership and management development in the NHS. Explores some of the assumptions underlying the competence approach and spells out the nature of the developing critique of the approach. | Leaders need to be adaptable and should question insights. |
| Elia & Margherita (2018) | Presents a conceptual framework for the study of wicked problem-solving as a complex and multistakeholder process characterized by a number of different interrelated perspective or dimensions. | A combination of multidisciplinary knowledge, a variety of actors, and a consensus among team members is necessary. |
| Finegood et al. (2010) | Outlines the implications of the Foresight Obesity System Map for solutions to childhood obesity. | A problem must be acknowledged as wicked if more comprehensive methods of addressing the problem are to be developed; successful teams match capacity with complexity by setting functional goals and directions for improvement; identifying what is known and not known; distributing decision, action, and authority among group members; creating competition and feedback loops; and assessing their effectiveness. |
| Grint (2010) | Outlines a typology that differentiates tame, wicked, and critical problems and links them to management, leadership, and crises. | Reframing should be used to look at a problem differently; problem-solvers must accept imperfection to continue moving forward in addressing wicked problems. |
| Hamshire et al. (2019) | Applies the wicked-problem approach to the challenge of student attrition in health care education, using data from a cross-sectional study. | A lack of recognition of the wicked nature of a problem could result in the investment of interventions that result in poor and insignificant outcomes. |
| Head (2019) | Outlines the background to the wicked-problems debate about science and policy knowledge, the recent widening of these debates, and some areas where new agendas for policy research are being fruitfully developed. | Constant modification and continual adjustment are needed when addressing wicked problems; innovation is necessary for dealing with these problems. |
| Head & Alford (2015) | Examines the main organizational and cognitive dimensions emerging from the research literature on wicked problems. | Communication is a key factor of collaboration; members must share matters of concern to promote problem-solving and forward thinking. |
| Hogan et al. (2018) | Draws on the collective intelligence of a multidisciplinary group; highlights challenges to integrating content expertise and methodological expertise in team-based efforts to address complex social issues. | Communication issues result from a “lack of openness and ability to listen with curiosity[;] the challenge for the facilitator [is] to be able to recognise and communicate stakeholders’ voices in the process . . . [and the ability] to translate ideas into ‘languages’ understood by a diversity of stakeholders” (p. 911); groups must synthesize diverse knowledge and skills in efforts to address the complexity of problems. |
| Hudson et al. (2014) | Synthesizes the current body of knowledge concerning transitional care for patients age 65 yr and older moving from an acute-care setting to home. | Communication can act as a fundamental barrier to successful planning; complex webs of relationships create a potential communication challenge. |
| Huot et al. (2018) | Demonstrates how a partnership among three universities created educational opportunities for future researchers and practitioners in public health, occupational science, and occupational therapy to integrate knowledge from all three disciplinary perspectives. | Occupations are key determinants of health and well-being; there is a call for occupational therapists to work toward socially transformative goals that bring attention to the social and occupational inequalities resulting from wicked problems; in order for knowledge of occupation to contribute to the eradication of social problems, a basic introduction to occupational science is necessary; occupational scientists are necessary for interprofessional collaboration when addressing wicked problems; there is a lack of collaboration between the fields of occupational science and public health. |
| Hutchinson et al. (2015) | Argues that one proactive, adaptive approach in addressing the volatile challenges of our time requires leaders to exercise moral courage. | Developing solutions to wicked problems requires leader transparency, perseverance, and the courage to risk failure or to appear inactive; leadership qualities such as transparency and courage are essential. |
| Innes & Booher (2016) | Argues that although classical modern planning cannot solve wicked problems, collaborative rationality can successfully move beyond them and develop useful and innovative strategies. Outlines the characteristics of a collaboratively rational planning process. | Collaborative dialogue fosters new ways of solving wicked problems, broadens the perspectives of stakeholders with rigid positions, and creates an environment that encourages the acquisition of new insights for the purpose of reframing “the wicked into the manageable.” |
| Julian & Ross (2013) | Explores infrastructure and functions that can serve as a foundation for collaborative community problem-solving. | Addressing wicked problems must be a collaborative effort that incorporates multidisciplinary perspectives and the involvement of numerous relevant stakeholders. |
| Juzwishin & Bond (2012) | Explores the leadership capacities and behaviors expressed in the LEADS framework and ways a virtue approach in ethics might assist leaders striving to address the wicked problems encountered in complex and rapidly transforming health systems. | Characteristics of health care leaders include care, compassion, discernment, trustworthiness, integrity, and conscientiousness. |
| McGregor & Donnelly (2014) | Shares the genesis of a new idea called transleadership, according to which transdisciplinary knowledge can be created to address, using transdisciplinary thinking, wicked problems facing humanity. | Considering input from a single source and disregarding input from society are insufficient approaches to addressing wicked problems; collaborative efforts must incorporate multidisciplinary perspectives and a variety of stakeholders. |
| McLeod & Childs (2013) | Provides an approach to viewing the wicked problem of ERM, using the Cynefin framework, a sense-making tool. It reconceptualizes the ERM challenge by understanding the nature of the people-related issues. This supports decision-making about the most appropriate tactics to effect positive change. | Considering the interdependencies of a problem allows stakeholders to consider different ways of understanding, management styles, work patterns, and connections; leaders need to support team collaboration by asking the right questions. |
| Peterson et al. (2018) | Reviews wicked problems and discusses the epistemological foundations of the Deliberate Leadership construct. | The qualities of an effective leader include courage, collaboration, creativity, community, candor, capital, and compassion. |
| Salignac et al. (2018) | Reviews the literature on network-based interorganizational collaboration and the Collective Impact approach and its implications for theory and practice. | Collaboration requires an effective collaborative environment, enables stakeholders to broaden their pool of resources, and supports the development of solutions that are beyond the scope of a single stakeholder. |
| Sharts-Hopko (2013) | Considers so-called wicked vs. tame problems in health care and how nurse educators prepare students, in particular, at the doctoral level, to think about both types of problems. | Recognizing the problem as wicked is the first step in addressing its components and potential solutions. |
| Solman (2017) | Discusses the need for the integration of information beyond the scope of nursing. There is a need for leaders in nursing who are highly creative in their thinking and their ability to compile different perspectives and test out new approaches in the pursuit of new meaning in support of nursing patient care. | Adaptive leaders embrace complex problem-solving, foster a multidisciplinary approach, and actively participate in problem-solving processes alongside their teams. |
| Sturmberg (2020) | Brings awareness to the complexity of problems and the necessity of approaching problems as a whole and understanding their interconnected components. | Consideration of different perspectives, establishing relationships between agents within a system, and exploring dynamic relationships are all important when addressing wicked problems. |
| Sturmberg (2021) | Discusses the characteristics of leaders and decision-making in the solving of real-world VUCA problems. | Adaptive leaders need to actively participate in the problem-solving processes; leaders need to be adaptable and learn from their mistakes or failures. |
| Sturmberg & Martin (2020) | Discusses how the COVID-19 pandemic demonstrated the fragility of health and societal systems and highlights the intrinsic and tacit dynamics underpinning these systems. A high degree of uncertainty is present, creating a state in which previously proven interventions no longer maintain the status quo. | Understanding the interdependencies of a problem requires a neutral space for negotiations; inconsistent and nontransparent communication can limit collaborative efforts. |
| Termeer & Dewulf (2019) | Analyzes how the concept of small wins can contribute to evaluating progress in wicked-problem areas in a way that energizes a variety of stakeholders instead of paralyzing them and embraces complexity instead of reverting to taming and overestimation. Presents a small-wins evaluation framework that is rooted in the underlying policy perspective of making progress through accumulating small wins. | Teams should recognize and celebrate small wins, leading to the promotion and development of new understandings of the problem. |
| Torfing et al. (2020) | Discusses how the challenge for collaboration innovation is to nurture the diversity of views, ideas, and forms of knowledge while still establishing a common ground for joint learning. | Team members need to be open to sharing and discussing new and innovative ideas; leaders must possess qualities such as transparency and being “hands on.” |
| von Thienen et al. (2014) | Takes a psychological perspective to analyze the particular challenges wicked problems present. | A clear vision is necessary when addressing messy problems; developing different perspectives involves looking for new insights, considering problems with a broader view, and reflecting on assumptions; team members should be open to sharing and discussing new and innovative ideas. |
| Wicks & Jamieson (2014) | Discusses the role of occupational therapists in addressing complex socioenvironmental problems that are considered wicked. | The key ingredients to addressing wicked problems include Sharpe’s (2013) three-horizons framework, imagination, creativity, vision, and insight; occupational science and health promotion share a common objective to promote health. |
| Yeo et al. (2015) | Offers a practice-based understanding of leadership based on the concept of “leaderful” practice. In supporting this concept, the authors describe the contexts that shape leadership capacity and introduce an integrative framework that further illustrates leaderful practice. | Leaderful actors promote autonomy among their employees; leaders of tomorrow must be present today; timely and mindful actions are required to create change. |
Note. COVID-19 = coronavirus disease 2019; ERM = electronic records management; LEADS = Lead Self, Engage Others, Achieve Results, Develop Coalitions, Systems Transformation; NHS = National Health Service; VUCA = volatility, uncertainty, complexity, and ambiguity.
References
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
