This post has been written by Michael Newman who kindly offered to publish it here
Who do we try to save and who do we let die? The dilemma has become familiar in stories from intensive care units on the Covid-19 frontline. Most doctors never expected to have to face this appalling choice, but it has been thrust upon them, and now they must decide.
- What if this was you? How would you cope? Which criteria would you use to decide?
This blog offers thoughts on decision making in times of risk and the effects on leaders who must make those necessary decisions. It is addressed to all those in a leadership role in the current crisis. Few of you will be required to take the immediate life or death decisions that ICU teams must deal with; but most of you must take decisions concerning the level of risk you will be asking your team members to accept.
As the rate of infections falls, the question of returning people to the workplace has become a hot topic. We are all aware that by returning we risk further mass infections and subsequent spikes. Unhelpfully, we cannot yet quantify the level of risk. Despite mitigation measures, extra cleaning, and social distancing, as leaders we will inevitably be asking people to expose themselves to a heightened physical risk. You will need to prioritise who to bring back first and, crucially, who must be told to stay in isolation.
- How do you choose who to select, and what are the consequences if those returnees become infected?
Why do I feel qualified to share my thoughts? The story starts on 17th January 1991. I was a young Captain in Britain’s Royal Engineers, a small part of the military coalition against Saddam Hussein…
Early that morning, Coalition air forces had started bombing Iraq as a precursor to the liberation of Kuwait. The UK Armoured Division was concentrated in a training area less than 100km from the frontline and presented an appealing target. Saddam Hussain had an extensive arsenal of chemical weapons, with the ability to deliver them from aircraft, artillery and Scud missiles. The chemical weapons were our biggest fear and we were at high alert.
Later in the day I was out in the desert with five of my soldiers. Suddenly, from a road 500m away, we heard the repeated honking of a vehicle horn. On turning, we saw two crewmen with their gas masks on frantically waving at us. This told us we had been hit by chemicals. In training, we must prove we can get a gas mask on in 9 seconds; I can confirm that when it happens for real, it can be done in about 6…
Unfortunately, we had no sophisticated detector equipment with us, nor could we break radio silence to check what was happening, so we had to continue with our task. After 30 minutes, it became clear that working in the desert in full chemical protection equipment is a deeply unpleasant experience. Worse still, it significantly reduced the speed and quality of our job and meant we had no possibility of completing it to schedule. A decision was needed; Stop the task altogether and stay ‘safe’? Continue in full equipment and do a partial job? Drive somewhere to find more information, then hope we can get back and finish? Or do we prioritise the task and risk our lives by unmasking?
This is the same dilemma facing many leaders today; making the trade-off between ‘safety’ and getting the job done. Amidst all the uncertainty, who actually makes the decision and bears responsibility for the consequences?
In the desert, there was no doubt that the decision was mine alone. The rank system made that clear. Also, although we had all been trained in chemical warfare, I had no subject matter expert to help me improve the quality of my decision and possibly share responsibility with.
This clarity about decision rights is a core part of the military. Being in Command gives you the responsibility and authority to deliver a task, but also moral and legal accountability for the wellbeing of those you lead. The system expects a commander to nominate who replaces them if they fall, so there is no paralysis if the leader is out of action.
Things are rarely so clear in business. Decision rights are much less well defined. Responsibility and accountability are diffuse. Decisions emerge from a consultative process. Such systems have their advantages; but are found wanting when the situation calls for focus, speed of action and a clear audit trail.
If leaders are to be held to account, they must believe that the system is fair and honest. With the benefit of hindsight, any investigation after a crisis will be able to find errors made under pressure. If people expect the start point of an enquiry to be: “that went badly; who can we blame”, then we should not be surprised if decisions are avoided or attempts are made to claim collective or diffused responsibility. On the other hand, if expectations for the start point are: “this leader was in stressful and ambiguous conditions and had difficult choices to make; what can we learn from the experience”, then people are more likely to step up and provide leadership.
Throughout my service in the Army, I knew where decision rights lay. I believed that the military system had my back and would recognise my best intentions when in command.
In the present context, leaders in all walks of life are being asked to make choices in time of crisis and increased personal risk. Do you believe that, in your organisation, you are providing clear expectations and creating sufficient confidence and trust about how people will be judged afterwards?
In 1991, I had a decision to make. Again, clarity came to my aid. The task we were doing was reconnoitring, measuring, setting out and recording a range to practice explosive demolition. Even in wartime, there are critical safety factors when using demolitions, so I knew the job had to be done to a very high standard. It could not be done at night, as we were operating without lights, so I had a limited number of daylight hours. I knew that early the next day, the first unit would be arriving to use the range, and every day thereafter other forces would be coming to prepare for battle. Delay was not an option. Finally, I could not call on reinforcements to speed up the job. It was time to decide.
Too often in business we see people with too many ‘priorities’. When invited to reduce them to a more manageable 2 or 3, we notice a deep reluctance to let go. Multiple tasks are disguised as a single priority and the focus remains unclear. This ineffective behaviour may be tolerable in normal times. These are not normal times. Absolute clarity about expected outcome is a necessary condition for assessing risk.
When choosing how and when to return people to a workplace your train of analysis could start with; “What is so important that we can justifiably expose people to risk?” Follow on questions might be; “What would be the impact if we did not do this?”, “What impact would a delay have?”, “What minimum standard of execution is necessary?”, and “What is the minimum number of people needed?” A more negative, but possibly useful, line of enquiry would be to imagine how history (or a court of law) would judge us if some of our people were asked to come back to do a task that turned out to be non-critical and they became infected.
My decision was to take a risk and complete the mission. That did not mean us just taking off our protection and cracking on; there is an Army protocol called the Sniff Test to check the atmosphere. This requires a soldier to pull the mask off their cheek, take 3 deep breaths through their nose, and then replace the mask. A second soldier watches them through the mask’s glass lenses for a few minutes looking for symptoms of poisoning. This prompts another interesting decision, which soldier is selected for the Sniff Test? Is it the most junior soldier; the least skilled; the least competent? What about their personal situations? Is it the married man; the divorced dad with 3 kids; the recently engaged youngster; the person who supports their mother; the orphan; or………? Maybe we vote? Hopefully it’s not as unprofessional as choosing the least likeable crewman, or the one who let me down yesterday. Do I call for volunteers, or go first myself to set an example? This is the kind of situation that decision trees are designed for. We didn’t have one.
As we select who is asked to come to work first, leaders will soon be faced with such choices. Whatever decisions you make, some will disagree and morale may be affected.
Some organisations are building decision trees to help leaders make choices. There are pros and cons to this. A sound tool can give the appearance of consistency and fairness across the organisation. However, it also sends a signal of disempowerment. It is the line managers and leaders who (should) know their people, task, customers and context well enough to make good local decisions. Equally, with so many factors to consider, it may be impossible to build a comprehensive and watertight algorithm. If the decision is then abdicated to the model, we can expect people to find loopholes to satisfy their personal or task needs. For doctors making life and death decisions this can be a real challenge; there may be frightened relatives and opportunistic lawyers ready to contest their interpretations.
So, which is it; algorithm, delegated leadership or hybrid?
Situations and contexts differ too widely to offer a general rule. One thing is certain, however: the intention must be clearly, frequently and assertively communicated from the very top. For example, if choice is delegated to leaders, supported by a framework of principles, the message might be:
“We, the Leadership Team, have created a general framework and a set of principles. They are based on our interpretation of the facts currently available to us and we accept they may not be perfect. We are empowering and trusting our managers to interpret them locally and we will support the decisions they make. We are continuously reviewing both the principles themselves, and how they are enacted by our leaders, to ensure the best outcomes for our people, our organisation, our customers and our suppliers.”
Without clear and consistent communication, the upcoming transition period is likely to sow seeds of discontent with long term negative effects.
So, who was the guinea pig who lifted their mask and sniffed the air on that desert day?
Before you turn to the next page please take a moment to imagine yourself out in Arabia. How would you make the decision?
Who was the guinea pig who lifted their mask and sniffed the air that day?
I called over one of my Sappers (the base rank in the Royal Engineers, a Private in other arms) and said “Sapper D, it is time to do a Sniff Test. Do you know why I have selected you?” He said calmly “Yes sir, it is because I am the most expendable”. I thought that was an extraordinarily mature response from a young soldier, and he was entirely correct. Everyone else with me that day had a specialist skill that was critical for our team in the upcoming battle; Sapper D1, at that time was learning the ropes. Whist he could not have refused the direct order, his reaction made it a lot easier for me.
Ideally each person in a team knows their role and has a sound awareness of their own capabilities. When combined with an understanding of their colleagues’ competencies, it allows them to make their own informed interpretation of the situation. Not only does this make the leader’s role easier, it also reduces tension in the team. When generosity of spirit has primacy over ego or self-interest, then ‘taking one for the team’ becomes a reality rather than a cliché. Time invested in building connections, understanding and trust during ‘peacetime’ as well as during the unfolding crisis will pay dividends when potentially divisive decisions are needed later.
Before exposing one of my men to danger, I wanted to mitigate the risk. I made all the soldiers dig out their chemical warfare notebooks and remind themselves of the correct procedure. We looked at the potential symptoms (changes to the eyes, skin, breathing or muscles) and revised what we would do if any effects were noticed. We readied the syringes with the atropine antidote. Sapper D completed the 3 sniffs and replaced his mask. I then stood toe to toe with him staring into his eyes through the lenses of both our gas masks. It was, as we English say, an “interesting” experience; staring from 20cm away into the eyes of a man who I had just ordered to do something dangerous. He was sweating…but was that just from the heat and his completely justifiable nervousness…were his eyes starting to dilate…or is that my imagination….is he shaking? I knew if I made the wrong interpretation, we might inject him unnecessarily with atropine, which is itself harmful and could see him needing medical evacuation.
In the end, there was no adverse reaction; it seemed we had not been hit with chemical weapons. However, I ordered each other person to complete the Sniff Test before unmasking and we stayed at the highest alert for the rest of the day2. Later we found it had been a false alarm, that had spread like wildfire across the Division, but in hindsight it was a valuable test of our operational drills3.
In the coming months, there will be leaders everywhere asking people to come to work, or continue self-isolation. Both involve a risk to the person’s physical, mental or emotional wellbeing. There are four lessons I offer to all leaders:
- Prepare properly and mitigate the risks. Do all you can in advance to prepare yourself, your people and the environment; rehearse new practices or revise existing protocols. Discuss the symptoms and ensure people are looking out for each other, both in the workplace and in lockdown. Establish a clear policy on testing and protective measures. Everyone must know what to do if warning signs are seen; as a leader, you cannot be everywhere.
- Own the decision. If you need to make a tough decision that impacts one of your people, be the one who gives them the news. Be clear why you made the decision and why you believe it is beneficial for the task and the team. Be present as the consequences play out.
- Be clear what you are trying to achieve; weigh up the risks of different options. There may not be a ‘good’ option, but avoiding or abdicating a decision is likely to be even worse. As an example, how are you going to manage the risk of asymptomatic infection?
- Get to know your people. Really know them. Understand their personal perspectives in this transition phase. Put extra effort into forming trust and connection to build a spirit of generosity and support. Ensure they know each other.
For those in senior positions and those with an HR or other organisational responsibilities there are two additional lessons:
- Be clear how return-to-workplace decisions will be made. Make the criteria explicit. Communicate them widely and frequently. Review and adjust them as new information emerges.
- Support your leaders and managers, publicly and privately, now and later. They have tough choices to make. How you support them now, and especially how you treat them after the crisis, will leave a strong signature in your organisation. Create space for them to share their experiences, calibrate their responses and learn from each other. Thank them.
- Sapper D turned out to be an outstanding soldier who I ended up giving responsibilities to that would normally be taken by a Sergeant or above
- Saddam did have chemical weapons and had used them not long before against both Iranian soldiers and his own people. When we returned to the battlefield in Iraq in March we found plenty of artillery pieces that had survived the air attacks, together with stockpiles of chemical shells. They were within 20 km of their front line so were a clear and present threat. We believe it was only our disruption of their command and control system and the speed of our movement that prevented their use in the ground war.
- For those who imagine that I callously ordered a subordinate to put himself at risk, I’d like to say that the Sniff Test is a two-person drill. Whilst Sapper D was sniffing, so was I. He was watching me for symptoms at the same time as I was watching him. I considered it important to be a role model, though to this day I wonder if that was the right command decision. A purely rational choice may have been to pick a second soldier instead of me.
This post is dedicated to my crew. I don’t think I ever told them how much I came to value and trust them, and I wish I had taken the time to say a heartfelt Thank You for everything they did.
Thank you SSgt S, Cpl L, Spr G and Spr D.
Thanks also to my sounding board and sub-editor, Marvin Faure, for improving the clarity, flow and coherence of this blog.