Epidemic Leadership. Larry McEvoy
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sauce of epidemics for leaders, the idea of self-organization that offers a flywheel to scaling the deliverables of leadership: performance, learning, and vitality.
The second section focuses on the practice of epidemic leadership and how leaders can design and sustain positive epidemics as systemic leverage in human systems. Chapter 5 emphasizes the identification of a positive pathogen as the basis of a constructive epidemic. Chapters 6 through 9 explore the elements of self-organization with respect to epidemics—conditions, interactions, and multipliers—with a special focus on networks and their unique capability to accelerate or obstruct leadership efforts. Chapter 10 explores the paradox of technology in supporting and complicating epidemic leadership. Finally, the type of thinking and the foundational sorts of social pathogens we need moving in today's world comprise Chapter 11, the final chapter.
The reason I write this book intertwines with the impact the pandemic meted out: the realities of our world are unsettling. I write this book because, as a doctor, anything that threatens the vitality of individuals, populations, and communities rouses my concern, and there are far more causes for concern than I could ever address as one lone healer. There is no single bedside I can rush to, no drug I can prescribe, no diagnostic algorithm I can wield. An ethic of healthy twenty-first-century community has to swarm everywhere—through our schools, our economies, our neighborhoods, our corporations, our conflicts, and our institutions. Many people would say such permeation is not possible. But somewhere, in or near Wuhan, China, in late 2019, arose a virus that was nameless, without money or power, with no business plan or Twitter following, with no passport and no cognition—and now it's everywhere, because we passed it among ourselves.
The good news about our current reality is that we have the knowledge and access to exploit these same conditions to create innumerable positive epidemics. It is not just time to lead in the middle of an epidemic, to prevent the next one, or to arrest bad ones. It is time to lead like an epidemic, launch multiple epidemics, and have an epidemic of leaders who know how to “epidemic.”
1 My No Good, Very Bad Night in the Emergency Department
You're gonna need a bigger boat.
—Amity Island Police Chief Martin Brody in Jaws
Friday Night in the Emergency Department
August 15, 2003, Billings, Montana
We begin in illness and injury. On this hot Friday evening, patients swamp the emergency department in the regional trauma center where I work. In the late summer heat, the night is just starting and has already flooded us with a raft of patients, and it promises to keep building. The waiting room overflows with more people. I have worked hundreds of nights like these in the previous decade plus, and I know the pattern. The quiet heat and the coming sunset belie the more ominous certainty of my shift ahead. People would get sick, some dramatically so. People would die. No one had gone about their day thinking these things would happen, but we know. In the emergency department, we check our equipment and ready ourselves with certainty.
As I cross the threshold of the automatic double doors into the department to begin my shift, I know it's busy even without scanning the electronic register we call “the board,” a remnant of the days when we used to list each patient and their chief complaints in bright dry erase marker on a big whiteboard before privacy concerns made it obsolete. I can hear the beeping of monitors, the shift in cadence of nurses' feet, and a low kind of ER buzz. The source is hard to pinpoint, like the low but incessant sound of unseen insect wings. To a casual observer, the department seems quiet, orderly, bright with fluorescent light. We like it that way—who wants to work in, let alone be sick in, a chaos of noise and motion?
The full cornucopia of unexpected disaster and discomfort bubbles out of the streets and homes and open spaces of life in America and flows into every room in our emergency department: automobile trauma, diabetes, cardiovascular disease, emphysema, diverticulitis, stroke, assault, cervical cancer, migraines, lacerations, domestic abuse, and opioids. The terms are medical and numbingly antiseptic, but the reality is stark: as the people of my town enjoy the warm summer evening, they are also crashing, dying, bleeding, fighting, and writhing in droves. While they go about their daily lives, they are part of a large, oddly silent tsunami of ill health that washes over the entire population.
No one is catastrophically ill at the moment, so I ease into my shift, getting labs and X-rays started on a few patients while I mentally accept that we will be working behind for a few hours. No one on the team likes working from behind. We prefer to stay ahead of the wave, seeing people as they come in. It is safer that way, and psychically easier for us. When the wave breaks over us, when we get behind, delays pile up and surprises happen, and surprises mean a higher chance of bad things for patients. Some nights, despite our best efforts, especially hot ones on summer weekends, the wave breaks, and we are playing catch-up. Tonight is one of those nights. The department has been behind since the afternoon, and it will be several more hours before we can get on top of the wave again.
The patients are varied, which is normal for us. The ER is the funnel for anything that can go wrong anywhere, at any time, for anybody. I see an obese patient whose knees hurt, a woman with vaginal bleeding, a middle-aged man with chest pain, a mom with back pain who can't lie down comfortably, an 80-year-old man with bad lungs. Nothing out of the ordinary, except I see all those people in the first 15 minutes, because twice that many wait unseen after that. I use my “30 seconds to meaningful rapport” to inspect and connect with each person I see. My trained eye scans breathing dynamics, skin color, tone of voice. I see eyes and facial expressions, plumb for fear or hidden motivations, search for the best way to settle every person who meets me for the first time in this place that is their bad detour and my daily work. My hands find theirs, and I rest them on shoulders and knees.
I step out of an older man's room into the low hum and look right, then left. I am impressed and grateful for what I see in the team of nurses, techs, registration clerks, and my emergency physician colleague seeing patients alongside me. Several years before, we weren't so much a seamless round-the-clock clinical team as a collection of technically proficient individuals. We couldn't elevate our game in the face of unrelenting pace. We didn't work that well together, and we weren't able to mesh the technical craft of our job with the human presence of connecting to each and every person who was ill, whatever their circumstances.
Eight years later, almost everything is different. More people come to us for care, and the metrics that define “good department” are positive: patient satisfaction and staff engagement have rebounded to high numbers from low ones, safety and quality metrics are strong, and the department sustains itself financially. Nurses are on a waiting list to get a position in the ED from other places in the hospital. Patients come by foot and ambulance, airplane and helicopter. Thank you notes dot the bulletin board in our break room, some with pictures of healed patients on vacations or hikes in the nearby Beartooth Mountains. Nurses, techs, and physicians work hard to help each other across the shift: quiet high-fives, thank-yous, and smiles pepper our interactions.
This night, we are at the top of our game. The patients are getting attentive and skilled care, and the team works fluidly without stress under the pressure of pace and pathology, moving fast without hurrying. We flex and bend to the needs of each patient and the staccato flow of the pace. As an emergency physician, I am at the peak of my craft. Well-trained and supported by capable nurses and skilled physicians alike, taught by thousands of patients, I am in the sweet-spot overlap of state-of-the-art training and sufficient experience, eight years out of a leading residency in my specialty of emergency medicine. I am comfortable on such weekend nights,