Covid-19: How this could have gone…

March 17, 2020
The events of the day offer, unfortunately, an opportunity to discuss systems thinking, a key aspect of my book Leading Successful Change, perhaps to good effect.
“What are we looking at?”
— “We don’t know for sure.”
“Might it matter?”
— “Potentially, it could matter a lot.”
“Do we know the odds, the actuarial shape of the risk?”
— “Not really, we’re mainly uncertain.”
“Ok, then let’s stop and think, carefully and systemically.”
— “You mean systematically?”
“Yes, AND systemically.”
We may never know whether or not the Chinese or their American counterparts held the above conversation. If they had, might an alternative history of this pandemic have played out? What could this hypothetical teach us? What could officials have done?
A three-step process, one consistent with our approach in Leading Successful Change:
1)    Identify the key stakeholders. The healthy, the infected, sick, grievously ill, healthcare providers, the population at large, researchers, and the world community.
2)    Define the outcome. Play out the scenes that they want each type of stakeholder to be living 30-60 days from now.
3)    Create a solution. Once we know where each type of stakeholder will end up, we can design the work systems that surround those stakeholders in order to bring those scenes to life.
Here’s how this might occur in a “real life” example for a strategy of disease containment in the population at large: a working woman manager easily accesses information about the disease — including its spread, treatment, access to care (and testing), and more. She forwards a question to an open and dedicated government site where she chats with a health expert, who gives her clear instructions for private, public, and healthcare provider options. All-in-all, the entire process is easy and concise, and the system even offers instructional guides for at-home care, including the opportunity to opt-in to digitally GPS tracking her whereabouts while the virus is active. It also offers a survey of transparent measurement of sampled adherence to instructions, as well as a clear statement of authority and responsibility both nationally and locally. She closes the app and checks her investment account.
How about mitigation? The desired, focal scene might have a 79 year old man living alone with longstanding asthma and mild coronary disease who now has a cough and more than usual shortness of breath. He recalls something about covid-19 and shortness of breath from an alert that came across his phone. He checks his phone for symptoms warranting action and then decides to present himself to a specially-designated testing facility by calling a designated paramedical transport service. He spends a few minutes reviewing the instructions, making sure he understands what to expect from both the transportation and the testing site. As a diligent user of the app, he’s already been tracking his movements over the previous 72 hours, and he can allow access to the data for public health officials. He can sends an automatic message of concern to five of his elder corona support group, all of whom he recalls having been within close proximity recently.
Most probably, these scenes did not occur regularly in China or in the US. China experienced a systems collapse when the contagion erupted. They waited to quarantine, and then they scrambled frantically to keep up with cases. Even worse, this lag meant that they generated little if any knowledge of any kind for anyone. Not having enough (any?) reliable testing kits — or faulty processing of the results — created an inability to track the virus.
Combine that with the lack of supplies for healthcare workers, and the virus continues to spread relatively unchecked — aided largely by a lack of information. Insufficient availability of ICU’s means that the system of care also lacks the capacity to isolate and care safely for the sickest, most vulnerable, and perhaps most contagious.
Imagine if the Chinese (or the US) had, at the expression of the first scientific concern, said, “Let’s assume this is SARS-like. What should our citizenry experience 60-90 days from now? Let’s construct a few scenes and then build (or at least ready ourselves to build) the systems to make them happen. Let’s focus on illustrative scenes that we want to see for a person at large or for a high risk contractor of the disease or for a health care worker, a concerned relative. Let’s be specific and clear. Next, let’s use systems thinking, perhaps the Work Systems Model, to organize how to make those systems drive the occurrence of the desired scenes.”
It’s not too late for such an exercise, especially pertaining to mitigating the effect on the most vulnerable. The exercise might well lead to setting-up temporary ICU’s, generating national protocols, centralizing training/learning/and international scientific collaboration, offering special recognition for those who self-identify as ill as well as speeding and deepening resource allocation to state and local authorities, fostering and aggressively sharing disease tracking and care advances, opening information flow (internally and internationally, including manning rumor chat rooms) and working through a framework for what decisions are local and which national.
More generally, humans have designed complicated, interconnected systems of business, government, and, indeed, simply of living. We can easily squeeze them to cough up a scapegoat or two just as we can celebrate the timely emergence of heroes. Certainly, individuals remain responsible for their actions, but a leader needs to tend carefully to the systems that shape our behavior, both day to day and in crisis. Failure to think systematically means a greater chance of failure, including failure of the first order.