This Christmas season I am learning my leadership lessons at an Ebola Treatment Unit (ETU) in Sierra Leone. It has been a privilege to be caring for wonderful people with brave national medical staff and a cadre of international health care professionals. It is a horrible disease and the medical system in this nation has been strained as any health care system would be. For those of us who have joined the fight it has been an exercise in delivering care in crisis.
The ETU where I work is a relatively new center as are most of the facilities caring for patients with Ebola in this country. There was no care delivery center here two months ago. The site was developed and staffed rapidly and patients began coming right away. Although there are limited resources available, the pocesses and procedures are evolving even as the center cares for increasing numbers of patients.
It has been an exercise in examining our natural response to crisis.
These thoughts came to me as I was picking up trash.
Trash in the hospital or on the hospital grounds is an obsession for me. Even today when I visit hospitals I find myself picking up litter from the ground. My wife reminds me quietly, “This is not your hospital” but it seems that I can’t help myself. I notice it. What is on the ground to me is a reflection of what the hospital staff think about themselves and what they do. It is one of the “cultural indicators” that I have adopted for assessing a new organization. When I arrived in Sierra Leone at the ETU one of the first things that I noticed was litter. And my need to address is led to an observation about myself.
My reflection came in the context of noticing that a significant number of my new colleagues began making patient lists on their computers. There are several score patients in the unit but none of us are responsible for all of them. Still, a number of staff members generate complete computerized lists and update them daily. One colleague poured himself into a policy on standardizing an emergency procedure. Another worked hard on specific nursing policy. Each effort represents a tactical exercise; a task we can do and feel that we have completed something. Medical professionals are inherently tactical by nature: we tend to see our practice one patient, one hospital or operating room bed, on examination room at a time.
It struck me that we naturally revert to our tactical natures when we attempt to exercise leadership in crisis. It is not necessarily bad. As soldiers we were taught to enhance our fighting positions (aka “foxholes”) continually. And frankly the only fight that we really needed to pay attention to was the one that took place right in front of us.
But leadership requires us to be aware of a bigger picture. Our tendency to “be tactical” will trump our need to see and operate strategically. If as leaders we don’t think and plan strategy it won’t get done. I have seen that too many times.
Emerging from our foxholes may start with a general recognition of the battle beyond them. In medicine, each patient has a family, the family is a part of a “clan” or extended family that is in turn a part of a community. The patient also has a professional or social “clan,” a network of unrelated contacts. Together they represent regional and even global populations all potentially touched by the decisions we make about an individual patient. This is very clearly true in the battle against this epidemic disease in Africa. But it is just as true in our hospitals and health care systems at home.
The absence of strategy is a strategy. “Strategy abhors a vacuum. If strategic function is lacking, strategic effect will be generated by the casual accumulation of tactical and operational outcomes” (Colin Gray). We will have a strategy in every endevour. It is only a matter of whether we shape the strategy, or it shapes us.
Strategy begins with the regular discipline of looking beyond mere litter and lists.
Chuck Callahan – Lead from the Front – https://henryv43.wordpress.com
Henry V 4.3 