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Protocol versus Passion – EBOLA and the Doctors Without Borders Leadership Model

The EBOLA crisis is giving us a pointed lesson about leadership. On the one hand there’s a rules-based approach to addressing the crisis adopted by government and the US medical bureaucracy. On the other there’s the passion-based approach championed by the NGOs and particularly Doctors without Borders (donate to this great organization here). The protocol approach is down for the count.

The US government has reflexively resorted to the rules-based approach because that’s what bureaucracies do. So far it has failed miserably. The US medical literati still don’t know exactly what failed in their approach. Their assumption is that they didn’t follow the rules well enough. They haven’t considered the possibility that the approach itself is wrong.

One of the nurses involved in the crisis put it well. There are no true believers around. The carers are just doing a job. Admittedly a dangerous, difficult job with little to guide them except the rules. But as this nurse put it, there’s no passion. People don’t really believe in it. There’s no visceral commitment to the fight.

How unlike the DWB approach! The doctors and nurses in DWM are fighting in the most extreme way possible. They are in environments that are medically bankrupt with few resources, no working medical system. An exploding patient count and not even the most basis tools available to them. Without DWB the three most affected countries in Africa would undoubtedly have collapsed as functioning societies.

Of course, the DWB is also using protocols. But they are using them in a different way. Their passion drives them to make the most of what they have got, to change flexibly according to the circumstances, to take the initiative when they don’t have any resources, to invent, cajole, manipulate, massage, fight, change, adapt, retreat – all as needed, on the moment, according to whatever circumstances exist at that particular moment.

That’s what people do when they have passion. You need passion to make protocols work when circumstances are extreme.

Of course these are all precisely the things that bureaucracies and government are not good at. In fact usually they stink at it. In bureaucracy and government you follow the rules, inflexibly. You don’t allow people to use their own initiative since that’s just not their gig. Initiative and flexibility is seen as the antithesis of protocol. So in the protocol approach they are not allowed. Passion and flexibility and individual initiative are seen as being the enemy.

And it’s not just our government and medical bureaucracy either. The WHO has just admitted the obvious, that this massive organization has failed miserably in the EBOLA crisis. Part of the problem, it acknowledges, is that many of its senior appointments in Africa are “politically motivated.” That is another euphemism for saying that there’s no passion in its approach, maybe even not any real belief.

There are enough words written on leadership to sink a planet. But most of leadership comes down to passion. It doesn’t matter what protocols, science or rules you adopt, if you don’t have passion, you’re already lost.

If the problems you face are routine and have been met before, then maybe you get by using protocol without passion. That’s where bureaucracy (arguably) excels. But bureaucracy is the opposite of passion. Crises need passion because they are usually unpredictable and require new forms of response that will rarely be forthcoming from the suits. That bodes ill for our future response to the EBOLA crisis.

Clearly NGOs like Doctors without Borders offer us the alternative, passion-driven model. DWB pays its people a minimum wage, or less. No perks, benefits, fancy hotels etc. Just a sense of purpose, infinite resourcefulness and a passion for caring for others.

It looks to me like the best response to the EBOKLA crisis would be to rely more on NGOs like DWB and less of the feds and the professionals. Why not invite DWB to come into the US and take over the running of the EBOLA crisis until it’s under control, then let the bureaucracy take over? Let them take over the running of all hospitals in the US that are designated as EBOLA centers?

Maybe DWB personnel should form the crisis response teams that the feds are talking of forming to be dispatched to hospitals taking care of emergency patients? So far the official response has been so ineffective – nay dysfunctional – that one really can’t have any confidence in the professional – or the protocols – at all.

Yep, I know, what am I smoking? But that’s the way we need to think right now.

Let’s hope the new Federal czar for EBOLA, Ron Klain, realizes some of this. Let’s hope he understands the deficiencies in the protocol-first approach. We can only hope, right? If not, we are in for a very bumpy ride.

Disclaimer: I have been a donor to DWB so long I have forgotten when I started.



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