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May 08, 2006
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Administration Most Fowl

Having just finished a chicken salad, the HR Doctor thought it would be a good idea to write about bird flu. In reality, though, this is an article not just about the risks of bird flu, but more generally about an issue we have not really had to face in Public Administration - a major, pandemic public health crisis.

As a former county chief administrative officer in California, this author remembers well the Mediterranean fruit fly and gypsy moth agricultural crises. Souvenir traps still adorn my office. However, even those battles against pests are not quite the same as the pandemic risks of a human health catastrophe.

The HR Doctor’s work history includes service as a vice president of human resources for the country’s second largest public health system - University of Miami/Jackson Memorial. This was before and during the Sept. 11 crisis. In our limited-term administrative memory, we focused brain power and some limited resources on bioterrorism and questions of capacity, planning and coordination should there be a smallpox attack, an anthrax attack or any other attack, real or perceived, that affects the public’s physical health. However, any such attack or even media sensationalism about the possibility of an attack also affects the public’s mental health.

As we saw in reviewing the Tokyo subway bioterrorism attacks of a decade ago, there were few actual victims of the sarin poison exposure, but there were thousands of hysterical people believing that they, too, had been victims.

Are the country and its public sector responders prepared for the consequences of a pandemic? In this author’s opinion, the answer is a very clear "no." The interagency dysfunction still being felt six months after the last hurricane season is one dramatic example of a preparedness gap.

A very smart and very experienced trauma surgeon who was a senior officer in the Israeli Defense Force and was sadly often involved in mass casualty responses made a very profound comment when he said that "mass casualty" incidents are not medical problems. They are management problems.

The spores, viruses and bacteria, if not radioactive particles that may be involved in bioterrorism, chemical or radiological assault, have no awareness at all of what jurisdiction they are in - or whether they are violating a federal regulation - or, for that matter, how much the budgets of public agency emergency planners and responders have been cut.

They also do not care about interagency squabbling, different badge shapes, wording or whether the responders, let alone the victims, are Democrats or Republicans. They just do what for them is natural. That is, they find and exploit hosts in order to multiply and grow at the maximum possible sustained rate.

It is we, the human public administrators, who live in worlds marked by silos, interagency bickering, jealousies or competition that can be as destructive as the germs themselves.

In previous articles entitled, "Silos Are for Grains" and "The Department of Homeland Insecurity: Forging One Nation Out of Separate Tribes," the HR Doctor spoke of the inherent difficulties in a bureaucracy when the core values are narrowly defined.

For example, the core value of service in a county government should not be service to my department or my union bargaining unit. The core value has to be a focus on public service. The motto of Rotary International, "service above self," should never be forgotten in any form of public service.

The place to start putting grain in silos instead of bureaucrats is at home at the local level where neighboring fire departments should come together and share resources. Perhaps they can even consider merging when the merged unit could be a better service delivery agent than individual departments. It is a time for multi-year budgets for responding agencies with strong financial incentives for inter-agency work.

It is a time for more cooperation than ever before between hospitals, the physician community and local governments based on a very realistic set of assumptions. The assumptions should be that there will be, rather than there might be, a major public health crisis coming to a county near you soon. "Normal" bureaucratic responses will not be enough and will do harm instead of help to solve the problem. The first obligation of a physician, such as the HR Doctor Daughter, Dr. Rachel, is to "do no harm." Taking no action in the face of very realistic threats is a form of doing great harm. I hope the leaders of the nation and the states are listening, as I know local government leaders are.

Cooperation and innovation must be the norm and must be rewarded and recognized rather than discouraged. It will not only be the doctors, nurses and paramedics, as well as the few members of the National Guard who are not otherwise committed, who will be involved in the management of a medical pandemic catastrophe. Rather, every one of us who works for government - therefore, works for the people - must begin now to put aside narrow loyalties and "get with" a national program of renewal of the spirit of caring and innovation in public service.

The message to each of us and to our federal friends, who often intend well but implement poorly, is to accept the imperative of the higher loyalty of service.

That was some chicken salad!


Phil Rosenberg
The HR Doctor


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