Leading collective action to address wicked problems

• Author: Benjamin N. Alexander
• DOI: http://doi.org/10.1002/nml.21394
• Date: 01 March 2020
• Published date: 01 March 2020

RESEARCH ARTICLE

Leading collective action to address wicked

problems

Benjamin N. Alexander

Management, HR and Information Systems

Area, Orfalea College of Business,

California Polytechnic State University, San

Luis Obispo, California

Correspondence

Benjamin N. Alexander, Orfalea College of

Business, California Polytechnic State

University, San Luis Obispo, CA 93407.

Email: balexa02@calpoly.edu

Abstract

The alleviation of wicked problems requires collective

action because these issues are characterized by significant

uncertainty and complexity. This research extends prior

work by examining how conveners' use robust action to

navigate wicked problems' defining characteristics in the

mobilization process. It provides a longitudinal study of a

health care nonprofit attempting to engage other stake-

holders in addressing the high costs and inadequate quality

of health care in a region of the United States. Specifi-

cally, the convener sought to address this wicked problem

by developing a health information exchange. The find-

ings relate five robust action tactics through which the

convener advanced collective action.

KEYWORDS

collective action, health care, health information exchanges, robust

action, wicked problems

1|INTRODUCTION

The defining complexity and uncertainty of wicked problems (Head & Alford, 2015; Roberts, 2000)

relating to poverty, gender equality, environmental protection, and health care (e.g., George,

Howard-Grenville, Joshi, & Tihanyi, 2016), the focus here, exceed any individual organization's

capacity to resolve them unilaterally (Dorado, 2005; Emery & Trist, 1965). If societies are to make

progress on these important issues, nonprofits must be adept at mobilizing and coordinating other

stakeholders in collective action.

There is considerable research examining efforts to address wicked problems. Much of this work

explores efforts' collaborative nature (O'Toole, 1997; Head & Alford, 2015), including the role of

networks (Weber & Khademian, 2008), funding relationships (e.g., Jones, 2018; Mayhew, 2012),

and system leadership (Senge, Hamilton, & Kania, 2015). The prospect of contention among a

diverse group of stakeholders is often salient due to divergent interests (e.g., Berrone, Gelabert,

Received: 26 September 2018 Revised: 24 September 2019 Accepted: 2 October 2019

DOI: 10.1002/nml.21394

Nonprofit Management and Leadership. 2020;30:445–465. wileyonlinelibrary.com/journal/nml © 2019 Wiley Periodicals, Inc. 445

Massa-Saluzzo, & Rousseau, 2016; Head & Alford, 2015; Jones, 2018). Extant research also

addresses the need for efforts to be flexible because the comprehension of wicked problems and pos-

sible solutions evolve over time due to these problems' defining uncertainty (e.g., Bartley, 2007).

Broadly, wicked problems' characteristics complicate the mobilization process, necessitating robust

action in efforts to address them (Ferraro, Etzion, & Gehman, 2015), “action that accomplishes

short-term objectives while preserving long-term flexibility”(Eccles & Nohria, 1992, p. 11).

This study is an early effort to integrate research on wicked problems, which clarifies the neces-

sity of diverse collectives, and robust action as a means for effectively convening them. Although

Ferraro et al. (2015) proposed that robust action is essential to address wicked problems, there has

been little research to date examining how nonprofit conveners enact it in mobilizing other stake-

holders. The present research addresses this gap by empirically examining how a health care non-

profit leveraged robust action as elaborated by those authors. This purpose emerged from a broader

study on how a nonprofit mobilized regional stakeholders to improve health care in its region. In ana-

lyzing interview, observational, and archival data, the convener's efforts to advance a solution in the

face of complexity and uncertainty were salient. With this recognition sharpening my analytical

focus, I used an abductive approach to extract a plausible explanation of how the nonprofit convener

deployed robust action to further collective action.

The focal wicked problem in this research is the provision of high-quality health care at a reason-

able cost—the quality-expense challenge. It is one of several challenges in the United States health

care system, where 2017 expenditures totaled $3.5 trillion (17.9% of GDP), more than any other

country in the world (Centers for Medicare & Medicaid Services, 2019; Organisation for Economic

Co-operation and Development, 2019). This equated to $10,207 per capita, about 30% more than

Switzerland, the second-ranked country by expenses (Organisation for Economic Co-operation and

Development, 2019). Moreover, the United States ranked last in quality of care among wealthy coun-

tries according to a recent evaluation (Schneider, Sarnak, Squires, Shah, & Doty, 2017). In contrast,

the United Kingdom ranked first in quality of care while spending only $3,943 per capita

(Organisation for Economic Co-operation and Development, 2019; Schneider et al., 2017).

Health information exchanges (HIEs) have emerged in recent decades as a potential means to

address the quality-expense challenge (Menachemi, Rahurkar, Harle, & Vest, 2018; Vest & Gamm,

2010). HIEs are the infrastructure for sharing electronic health records among health care stake-

holders (Dixon, 2016). Conceptually, HIEs work if they reduce information discontinuities and

enhance care coordination. For example, an HIE can only transmit notifications regarding a patient's

emergency department admission to that patient's primary care provider if the patient, the admitting

emergency department, and the patient's primary care provider are all connected to the HIE. If the

exchange occurs, primary care providers can initiate follow-up to ensure that the patient receives

appropriate care and will therefore be less likely to return for costly emergency treatment (Galvez,

2013; Unruh, Jung, Kaushal, & Vest, 2017). Broadly, HIEs' effectiveness depends on engagement by

health care providers, patients, payers (i.e., insurers), and governments.

This research furthers the literature on nonprofits' efforts to address wicked problems by illumi-

nating one nonprofit convener's robust efforts to alleviate the quality-expense challenge by develop-

ing an HIE. It applies and extends understanding of the three robust action tactics defined by Ferraro

et al. (2015), participatory architecture, multivocal inscription, and distributed experimentation, by

empirically exploring practices and characteristics through which the nonprofit enacted them. In

addition to elaborating existing tactics, I identify two new robust action tactics—operational resource

development and role adjustment—which emerged from the analyses. Finally, this study contributes

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