September 2020

Time to Think and Act Differently

Martin Lush shares his thoughts, as well as links to useful resources, on leadership fit for a chaotic, uncertain world and how the industry must use this crisis as an opportunity to reflect and rethink everything. Martin speaks about global institutions like the World Health Organization, as well as the need to rethink supply chains and globalization.
Man presenting to group

One thing COVID-19 has given us is something previously in short supply – time to think and reflect.

As we navigate this uncertainty, two things are certain.

  • We will get through this.
  • The post COVID-19 environment (PCE) will be very different.

Let’s make sure it’s better by making the right progress. COVID-19 is not a one-off but a painful warning, so let’s not waste the opportunity to reflect, learn and improve. We can start by agreeing to rethink everything.

Listen More and Learn Faster

In 2003, SARS was the pandemic that didn’t happen, despite infecting 8,600 people and killing 860. Its epicenters (Hong Kong, Toronto and Singapore) had robust public health systems able to implement mass quarantine protocols. Had SARS hit less-developed centers, it would have been catastrophic.

In West Africa the 2014-2015 Ebola outbreak killed and orphaned thousands and paralyzed economies. Since 2003 over 600 cases of H5N1 (bird flu) have been reported in 15 countries. More than 60% of H5N1 patients die.

Over the last 20 years, disease experts have identified dozens of new or resurgent pathogens. It’s a biological certainty that pathogens will relentlessly assault our increasingly packed and connected populations. COVID-19 was not a surprise, it was predicted. To progress we must listen more and learn faster.

Rethink the Things We Take for Granted

My dad always said the most important things in life are those we take for granted: food in the shops, family and friends around the table and those responsible for making everything happen, from the delivery drivers and shop keepers to doctors and nurses. We must not forget the vital importance of health care systems capable of dealing with a pandemic like COVID-19. As governments applaud our health care workers, let’s make sure this appreciation (and extra funding) lasts beyond COVID-19. Global health care in the PCE will need more funding, not less.

Rethink What We’re Really Capable of Accomplishing

Elite athletes and soldiers are taught the 40% rule. When you think you can give no more, you’re only operating at 40% of your capability with 60% still in the tank. Want proof? Look at what’s been achieved in the last few months. Can we build a 4,000-bed hospital – the UK’s largest – in nine days? No problem. Can we continue to manufacture our medicines and medical devices with 30% fewer staff? Certainly. We still have very tough times ahead, so remember the 40% rule.

Rethink Supply Chains and ‘Globalization’

COVID-19 has exposed the harsh reality that our supply chains were built for efficiency and profit, not resilience. Assuming the world to be predictable, companies embraced things like lean inventory management and just-in-time delivery while making no provision for risk. Will COVID-19 force companies to build in redundancy? Will manufacturing move closer to home? Will industry question the wisdom of hyper-globalized, hand-to-mouth supply chains? Will artificial intelligence, predictive analytics and robotics have a bigger impact? After decades of getting longer and thinner, will supply chains contract and reconfigure for a bumpy new world? Reality check: resilience = surplus, and surplus = extra costs. Will companies and governments invest in robust supply chains in the middle of a global recession? Can we afford not to?

Rethink How We Develop and Manufacture Medicines and Vaccines

The world has asked “When will there be a COVID-19 vaccine?” They are astonished to hear “in 18 months at best.” They’re staggered by the cost ($1 billion), the normal timeline of development (12-15 years) and the failure rates (90%+). When I say processes have remained largely unchanged for decades, they can’t believe it. We have 21st century science, managed by 20th century minds, regulated by 19th century laws. We must rethink how we develop drugs faster and cheaper without compromising safety.

Rethink Global Institutions Like the WHO

Fighting an exponentially replicating virus requires a level of global cooperation that seems beyond our governments. Step forward the World Health Organization (WHO), a specialized United Nations agency with a broad mandate to act as a coordinating authority on international health issues like COVID-19. It's been warning us about the threat of pandemics for years. We didn’t listen. Established in 1948, the WHO undoubtedly needs modernizing. Its reliance on voluntary and earmarked contributions is not enough; when pandemics are considered "high risk – high probability," the WHO must be given the resources needed to deliver its mandate. COVID-19 is not a singular event, it’s a warning. Our institutions need to be better prepared and react faster.

Rethink Leadership Fit for a Chaotic, Uncertain World. Peacetime vs. Wartime Leaders?

In moments of uncertainty, people turn to trusted leaders for direction and reassurance. Events like COVID-19 expose two types of leaders: peacetime leaders and wartime leaders. The best, and they are rare, are those who can quickly pivot, depending on the circumstances. In times of peace and certainty they focus on growth, expansion and profitability across a broad range of activities. In peacetime, you can get away with tried and tested protocols, methods, processes and ways of working, including micromanagement and centralized decision-making. You also have the luxury of more time to gain consensus and reduce uncertainty before decisions are made. In wartime, it’s about survival and resilience, by galvanizing the entire workforce around one mission. Wartime leaders are prepared to rip up the rule book and start again. They encourage a questioning attitude over blind compliance. They know decision-making must be faster than their competition, viral or otherwise. They delegate as much decision-making as possible to those on the frontline. They remove silos, flatten hierarchies, suspend non-critical activities and install quick feedback loops to fail fast and fail well. Throughout the crisis they balance honesty about the challenges with optimism and reassurance.

In peacetime, leaders often rise through the ranks through knowledge and competency. They’ve been prepared to lead in a predictable world. COVID-19 has removed predictable from the dictionary forever. In the PCE, acute supply chain shortages will need to be managed and simplified. Some markets will be lost, others gained. An increase in falsified medicines and cybercrime will boost volatility. As we enter a global recession, politics will enter a new era of volatility. We need to select and prepare our leaders accordingly. We need leaders comfortable in managing uncertainty, ambiguity and risk with the resilience and agility to ignore the playbook and start again.

Rethink Complexity: Simplification Is SURVIVAL

In an uncertain world, agility is more important than profitability. To be agile you must have simple systems and practices. Three years ago, I helped a client simplify its QMS. A 360-page batch record was slimmed down to 23 pages with over 200 signatures reduced to 23 that mattered. SOPs were reduced by 37%. The simplified deviation and CAPA system reduced repeat incidents by 52%. The streamlined change control system allowed changes to be approved within 30 minutes, not three weeks. Two weeks into COVID-19 they told me, “We’ve continued making product with 25% fewer people. We couldn’t have done this unless we had focused on simplification. Simplification is survival.” We must implement simple systems and ways of working that can adapt to the next surprise.

Shift Our Thinking From Predicting to Reconfiguring

Most of our systems, practices and ways of working presume a level of predictability. COVID-19 is a red flag we can’t ignore. We must accept that we face unpredictable threats and plan accordingly. We must reconfigure everything to roll with the punches, so we bounce back stronger. As described by Nassim Taleb, fragile systems are damaged by shocks and robust systems weather them. Our urge to reap efficiencies and impose our demands for unnatural predictability has damaged our resiliency. If we can’t control the volatile tides of change, we must build better boats.

Your Call to Action

  • Consider my top points and how we must think differently
  • Let me know what you think at martinlush@nsf.org
  • Share with your network so we can help each other make the PCE a better place

There are decades when nothing happens and weeks when decades happen. This is a singular opportunity to rethink everything and make real progress. During the COVID-19 pandemic the UK developed a new habit. Every Thursday at 8 p.m. in cities and villages across the land, we stood on our doorsteps and balconies to applaud our health care workers. Streets, villages and towns have set up groups to stay connected. Will this continue in the PCE? I hope so. We must adapt to this new world and make it a better place.

Spoiler alert: Humankind has the habit of saying "never again" and then forgetting.