In the early days of the COVID-19 crisis, nursing homes in Denmark faced a terrifying situation. They had residents who were considered high risk for this infection and they had to protect residents from infection at all costs to preserve their lives. Soon, visits were banned. Doors were closed. Distance was enforced. As a consequence, infection curves flattened.
And yet, new problems that harmed the psychosocial health of residents and nursing home communities quietly rose.
The policies were rational, necessary, and evidence based. So we need to ask: What went wrong? The problem wasn’t a lack of science. It was a matter of overlooking ambiguity.
Ambiguity is unavoidable in complex contexts and challenges behavioral policy approaches that are built on clarity
Behavioral public policy usually follows clear steps: Define the problem, identify the target behavior, design the intervention, and measure the outcome.
This way of thinking works when problems are well defined. However, many societal challenges aren’t clear-cut problems, but instead represent systems of competing views of what the problem is and what the desirable solution might be.
For example, in the case of nursing homes, there are multiple views of what a “nursing home” is, depending on who is looking at it.
A nursing home can be:
- A healthcare institution, where health and medical needs can be identified and addressed
- A workplace for healthcare workers, administration, and support staff
- A community of individuals who socialize, bond over time, and grieve when members pass
- Someone’s home; not just a place to live, but a personal reflection of their identity
Each view is a valid interpretation of what the situation is and what the desired situation might be. Ambiguity lies in these multiple manners of framing the problem and solution. Thus, in complex problems, ambiguity is not noise but part of the structure of the context.
Ambiguity implies that different frames are correct, yet none is complete.
When a nursing home is seen as a healthcare institution but is simultaneously a home, behavioral policy that only looks through a single lens risks suppressing or overlooking the others. This can fracture the delicate balance of frames, which can lead to negative downstream consequences.
A case study in ambiguity: COVID-19 in Danish nursing homes
We can better understand ambiguity in the context of systems like healthcare by thinking in layers. In general, complex behavioral challenges operate across multiple system levels, in which ambiguity appears differently at each one. Here we use the case of covid-19 crisis in Danish nursing homes to illustrate how ambiguity appears at different levels and the risks of overlooking it.
Masks were hiding facial expressions. Residents started reporting feeling lonely. Care workers noticed a decline in the physical health of certain residents. Care workers started feeling they had betrayed their values, even though they knew it was important to isolate residents to protect them. Residents felt less like people and more like patients.
Individual context
A nursing home resident is simultaneously a person in need of assistance to do daily tasks, and one with agency and autonomy. A care worker is both a professional following medical protocols, and a key source of emotional and social connection.
When infection control policies reduced residents to a risk group, the notion of agency in individuals of this group disappeared. When care workers were asked to prioritize distance over compassion, conflicts about what caring entails emerged. Ambiguity at the individual level describes the state of holding multiple roles at once. When those identities and roles are flattened or some are prioritized at the expense of others, well-being declines.
Interpersonal context
Care in nursing homes is relational. In this sense, performing care is not about performing a series of tasks; it is about becoming almost a family member, providing an emotional anchor and company. Disrupting these relational characteristics by focusing only on infection prevention disrupted the nature of care activities by reducing interpersonal relationships to a single dimension, reducing the capacity to nurture residents’ psychosocial well-being.
Community context
Nursing homes function as micro-communities with their own norms. Before COVID-19, acceptable behavior balanced hygiene, social connection and shared activities.
During the pandemic, hygiene became the priority and social activities were disrupted. Suddenly, signs reminding people to distance replaced shared rituals. Colleagues monitored each other. Norms shifted weekly as guidelines changed. When one value dominated and others were suppressed, the community lost its coherence.
Institutional context
Nursing homes sit between two institutional sides. One is driven by healthcare efficiency and risk management. The other is driven by the ethos of being a home and a place that respects residents' self-determination.
When infection prevention dominated, nursing homes drifted toward becoming a healthcare efficiency–driven institution. Visits were restricted, rooms became controlled spaces, and relatives felt excluded. As a consequence, staff were perceived as enforcers rather than caregivers and what used to be a home became a facility.
Understanding ambiguity at the institutional level requires acknowledging their competing purposes. When one erodes the other, there is a loss of purpose, function, trust, and the fundamental definition of what characterizes an institution.
Structural context
At the policy level, ambiguity often becomes strategic. Policies must satisfy multiple stakeholders, balancing autonomy, safety, cost, and political feasibility while also showing measurable results.
During the pandemic, structural authority understandably centralized power to act quickly in Denmark in order to stabilize health uncertainties and minimize the spread of infection. However, that decision to place structural emphasis on health outcomes overshadowed longstanding commitments to self-determination and community-based care.
When structural ambiguity is ignored, however, the resulting imbalances cause systemic tension that cascades downward towards individuals.
The risk of brittleness when we ignore ambiguity
Behavioral approaches can be clearly defined when it is possible to isolate a behavior, identify its drivers, and design interventions to change it. This logic usually assumes that the problem is stable, bounded, and shared across actors. However, in systemic challenges, these assumptions rarely hold.
When complex behavioral problems are too tightly defined, or when a single frame is selected and interventions are optimized around it, this natural plurality can be reduced or simplified.
While this can produce partial clarity and speed, it also introduces blind spots. The Danish nursing home case study illustrates what can happen when ambiguity is treated as something to eliminate rather than something to navigate:
In addressing only one aspect of a challenge, behavioral public policies can become brittle.
As illustrated in the Danish nursing home case, what counts as “the problem” depends on perspective. For some, the problem was infection transmission. For others, it was the loss of autonomy, the erosion of relationships, or the decline in quality of life. They are competing—yet equally valid—interpretations of what matters most or ways of framing the same situation.
In this particular case, three types of brittleness became visible:
- Contextual brittleness emerged when interventions failed to align with how people actually experienced the situation, as when policies failed to align with the lived reality of nursing homes as both care institutions and places people call home. In nursing homes, for example, defining the problem solely as infection control neglects the lived reality of residents and care workers, who see care as being more about dignity, autonomy, and connection.
- Secondly, systemic brittleness arose because interventions did not account for the multiple actors and forces within a system. Interventions and policies that were narrowly framed around preventing COVID-19 transmission triggered tensions between municipalities, relatives, care workers, and voluntary organizations—each operating under different values and expectations—when well-meaning policies focusing narrowly on health behaviors ignored the multidimensional nature of residents’ lives.
- Finally, anticipatory brittleness appeared when the focus on a short-term goal (in this case, preventing infection) overshadowed longer-term psychological, social, and physical consequences. For example, many residents experienced declines in their physical condition due to prolonged isolation and the absence of physical activities when interventions focused exclusively on immediate outcomes while overlooking how those conditions may evolve over time.
These policies designed to limit the spread of COVID-19 were certainly well-intentioned, and not wrong. In failing to account for the ambiguities inherent to nursing homes, they were just incomplete. In this sense, brittleness is not the result of poor intentions or flawed evidence. It is the consequence of reducing the existence of ambiguity linked to multi-framed situations into a single definition of the problem; when ambiguity is denied, behavioral approaches for systems are more likely to become brittle.
Considering ambiguity and how design may help
Rather than narrowing the problem too early, design approaches often begin by exploring how a situation can be understood from multiple perspectives. This does not mean abandoning rigor. It means recognizing that, in systemic challenges, perspectives are often plural.
If behavioral science tends to reduce ambiguity, design offers a different stance: It works with and embraces it.
In the nursing home context, for example, multiple priorities coexisted:
- The need to ensure safety and the need to preserve autonomy
- The importance of efficiency and the importance of equity and access
- The responsibility of professional duty and the value of human care and connection.
Design approaches can help make these tensions visible and workable.
For example, user-centered perspectives can surface how different actors experience the same intervention differently, revealing tensions that may otherwise remain implicit. Co-design practices can bring together residents, care workers, and policymakers to articulate and negotiate these differences, rather than assuming a single shared definition of the problem. Service-oriented perspectives can map how policies unfold across interactions, showing how decisions made at one level affect experiences at another.
Across these approaches, the role of design is not to resolve ambiguity by selecting one “correct” frame. It is to hold multiple frames in view long enough to understand their implications.
In systemic challenges, this shift matters: A policy that selects one truth and suppresses others may achieve short-term compliance. But by overlooking the plurality of the system, it risks undermining long-term resilience.
Reframing Policy
The nursing home case suggests that the challenge is not simply to design better interventions, but to rethink how problems are framed in the first place.
Behavioral policy often starts with the question: “How do we solve the problem by designing for behavioral change?” While this may work in simpler situations, in systemic contexts, this question may be too narrow.
But behavioral researchers could instead ask:
- What system are these behaviors part of, and what might be considered problematic?
- Who are the actors involved in the levels of this system?
- How might these different actors frame these situations involving these behaviors?
- What does each frame reveal about behaviors?
This moves the focus from solving a predefined problem to understanding the plurality of perspectives within the system in which the problem is embedded.
Adopting such a perspective requires integrating systems thinking into policy design. It means recognizing that interventions do not act on isolated behaviors, but on interconnected systems of actors, values, and contexts. It also requires acknowledging that policies inevitably privilege certain interpretations over others, and that these choices will have consequences.
Design, in this context, offers a way of engaging with this plurality. Not by eliminating ambiguity, but by making it explicit, exploring its implications, and allowing space for adaptation as situations evolve.
Rather than striving for a single, stable definition of the problem, policy-making in complex contexts may benefit from embracing ambiguity as a feature of the system. Because in such contexts, the goal is not to eliminate competing perspectives—the goal is to design with them.
