Tuesday, October 21, 2014

The Management Culture Impacts How People Respond to Statements

> I still don’t really understand how “breach of protocol” could somehow be
> interpreted as “the nurse did it intentionally

Interpretation depends on logic and psychology. Fear and blame based cultures predispose people to think blame and take things as blame. Even when the words don't say that people take it that way.

This is one of the many reasons why the management system is so important. Even the exact same statement is taken very differently by people. In a good management system the statement 'breach of protocol" can be seen most employees as fine - an indication of yet again seeing a systemic issue and raising it to be dealt with. In a blame based management system it is taken as threatening and maybe even disrespectful.

Response to: Talking about Breaches of Ebola Protocol is NOT “Blaming Nurses”

Related: Creating a Culture that Values Continual Improvement - Building a Great Software Development Team

Thursday, October 09, 2014

Ebola Spotlights Poor Health Care and Security Systems

response to: Ebola & Systems: Can We Do Better? Can We Learn? What Comes Next?
So how did this happen? Bad processes? Bad planning? THR had received Ebola information before Duncan arrived. But, they didn’t put the pieces together and they sent him home.

What’s your take on this situation? Can we get better at anticipating problems and improving workflows, processes, and systems in advance? Can we learn from each other to avoid having to all make the same mistakes? How can we better protect caregivers, first responders, and the public? Or are we just not very good at systems and processes… at being proactive?
There are many bad processes involved, sadly.

But the most serious to me, is we have unrealistic proposed processes for dealing with an epidemic. This is potentially catastrophic but I know of no serious efforts to find realistic strategies. I am sure there are plenty of smart people working on things in isolation. But I do not have confidence in the expectations of how well those processes will be followed.They seem very susceptible to likely failures - such as people breaking quarantine (the idea that you don't endanger society for your own whims is not held by enough people - and the government does a pitiful job of dealing with this year after year).

That the government is all of a sudden going to start following the scientifically prudent actions that, after ignoring them and participating in encouraging security theatre for years (moving towards decades now) is very questionable. You can't encourage society to ignore science for decades and then expect they will respect scientifically necessary processes when the failure to do so will be catastrophic (such as in a deadly epidemic). Maybe you will get lucky and society will, but that is a very risky gamble.

The huge amount of waste on security theater and trying to spy on everyone and classifying (gag orders, "national security letters…") their actions to hide them from public ridicule and disgust would be much better spent on things that will actually make us a safer society.

I don't think the answers are simple, but if we don't take seriously how critical it is to plan better to cope with epidemics we will be sorry. And the money in the billions is there to do so - all we have to do is stop spending money on the atrocious things the Department of Homeland "Security" is spending money on now.

There are risks that are real and large (include health care risks and terrorism risks). But with so much bad behavior by government that erodes any sensible confidence government is focused on the rights and safety of citizens creates a horrible climate for coping with real risks to society. Government that doesn't demonstrate honesty, openness, a respect for the law and the people is creating exactly the wrong climate to cope with real security risks.

The science seems pretty clear that ebola is not going to be a series epidemic in the USA. But something else may well do so and we are pitifully prepared to cope with it. We continue to increase the odds of such an event with very bad antibiotics practices and foolishly failing to take vaccines creating the perfect conditions for epidemics.

Thankfully certain aspects of our health care system make coping with disease like ebola a problem that can be dealt with effectively. But the systemic problems are huge and ill suited to a real large scale crisis. And the pitiful behavior of government over the last 10 years gives no indication they are focused on sensible security that will help citizens.

Even worse though is how poorly we (as a global society) dealt with the initial conditions in Africa as well as our continuing efforts now. We had poor processes in place. We didn't commit funds early enough. We got behind and are not doing enough now. Lots of people are taking heroic action in Africa but without good processes it isn't enough.

Additional comment I added on the original blog post in response to another comment.

What the USA's role should be in helping people outside the USA is indeed a tricky question.

Even if you take the position those in the USA don't believe other people are worth protecting (which I don't believe) just a purely selfish government with an understanding of science and epidemics understands the risks of external disease vectors.

Just like those failing to use vaccines create a risky health system that everyone suffers from when things go bad, ignoring disease until it strikes your body is a bad way to protect yourself.

Plus when rich countries like the USA show disregard for people living elsewhere that drastically increases terrorism risks. Coping with that by allowing frustration to grow feeding crazy people's use of terror and then trying to spend hundreds of billions on weapons and the like is a lousy strategy.

It isn't like this is some shocking idea. Pretty much everyone that studies this understands that link. In the Bush administration they talked a lot about it and did some things especially with Karen Hughes. But even forgetting any terrorism concerns or humanitarian feelings, allowing dangerous virus and bacteria to infect lots of people (anywhere in the globe) is hugely dangerous for rich countries health. It is just a hugely foolish (looking at it completely selfishly and even when doing that ignoring positive externalities of action and negative externalities of inaction) to stand by while dangerous epidemics grow.

I believe the first reason to act is because all people matter, not just those inside your border. But even for people that don't care about that the completely selfish reasoning means not acting is foolish. And an understanding of disease makes it obvious you need to act a long time ago. Yes after failing to act more sensibly for a decade or more we should have acted drastically a few months ago. But even that would have been too late. Though actually for Ebola from a 100% USA selfish perspective it might not be too late - because it is likely like to become a huge problem in the USA. But something similar easily could and we have failed to prepare (which in this instance means failed to make sure the larger global health system is much better able to cope).

2nd update, good video by John Green on the subject: