Lori Walsh: As South Dakota hospitals work to build their surge capacity and South Dakota residents are asked to stay home in order to help slow the spread of coronavirus we look at the uncommon wisdom of leadership during this pandemic. Mike Wagner has traveled the world working with organizations, teams and executives on the challenges of leadership and culture. He earned a master's in public administration from the Harvard Kennedy School and a Bush Foundation Leadership Fellowship. He's a former South Dakota state lawmaker, founder of the blog, uncommonwisdom.org and a frequent guest on In The Moment. Mike, welcome back. Thanks for being here.
Mike Wagner: Thanks so much Lori. It'd be nice to be in person, but our social distance here at least allows a phone interview.
Lori Walsh: We are practicing what we preach here, aren't we?
Mike Wagner: There you go. Absolutely.
Lori Walsh: Let's talk about two of the big questions that people just keep asking me are, how bad is it going to get? I mean, they just really want to know what's going to happen here and what's not going to happen here, and when do we get back to normal? And so what I want to start with you is are there better questions to be asked, or if not better questions, are there more nuanced questions? Because the answer to those questions are that depends on how good we are at this physical distancing that we're doing, this social distancing, and how much we can flatten that curve, and we don't know. So it depends and we don't know the answers to those questions. But what about some better questions? What are some of those questions we could be asking right now that are very useful?
Mike Wagner: You're correct. I mean, part of the challenge here is that we are learning about this disease as we are suffering it. That means that we're going to be focused on a moving target and there's always going to be a degree of uncertainty. In addition to the immediate question, what do we do today? I think the question, some of the questions we need to ask is, what should the new normal actually look like? My hope is that we can, worldwide, that we can actually use this as a dry run if you will, of learning for what we know is likely to be an even worse pandemic in the future.
The tragedy I think of this entire situation is this has always been predicted, that a pandemic was not a question of if it was a question of when. I think that what we're seeing is how poorly prepared we are as a society, as a healthcare system, as an economy, how very poorly prepared we are for this kind of shock to the system. I think what we need to actually do is ask ourselves the hard questions as we go along, what can we learn and take forward as we go through this crisis.
Lori Walsh: What are some of the early answers to that? What have we already learned?
Mike Wagner: I think one is that for pandemic itself, we need to have every bit the preparedness that we have for tornadoes, floods, war. There are a lot of things we do in society that are all about preparedness and yet we don't seem to have brought that over into our healthcare system. And so I think number one, how do you prepare? How should laws and how should systems be changed in order to make sure that even even simple things like that people are encouraged to have a financial cushion or that governments have a financial cushion. So there's a lot of different lessons there, so to be prepared. That's kind of the easy stuff the obvious stuff. I think that in the healthcare system more specific, we've known this for a long time, but financial incentives keep us from doing it. Our healthcare system should be far more community based than hospital and professional based.
And there's a lot of experiments, successful experiments around the world with community delivered healthcare. People kept in their homes rather than being hospitalized. America is very quick to bring people into the hospital, very slow to build community capacity. And so I think what this is teaching us is sure, we need a lot more respirators, but if you think about it, we tend to build big buildings, we tend to build a lot of beds when in fact what we need is more flexible capacity, more community based capacity. And this would be true even for chronic disease, congestive heart failure, what have you. We really need to move the healthcare system out of the hospital, out of quite frankly, professional offices. We need it to be much more community-based moving forward.
Lori Walsh: Before we get to the third thing, are you talking about Tele? Telewellness, Telehealth appointments, or what does that mean? What does keeping it home based? What does that even look like?
Mike Wagner: Sure. I mean, on one level I think it absolutely, it means Telehealth. If you do need to see a doc, well, not even a doc, you need some professional advice. The first thing you should be able to do is go to a virtual care system, whether that be artificial intelligence, like Alexa, or whether that would be a tele visit or what have you. But then it's also about community capacity. The Isle of Jersey off the coast of England does an amazing job keeping the elderly at home and out of the hospital because they've equipped their postal workers to actually be community visitors. And so their postal workers actually check in on the elderly and deliver medications. They have this in place for regular community care. And I've been in contact actually with the leader of that program over the last couple of days.
And they're better positioned to weather this storm because they have that community based system already in place. I think it also means enabling families to provide even somewhat complex care. I'm reminded, interestingly enough, a couple of years ago, my mother had to go through antibiotic regimen and Medicare would have paid to put her in a nursing home for 10 days, give her the antibiotics or what have you. Or we could give her the antibiotics through a port, but then she had to pay for her own drugs. So even our financial incentives were to spend a lot of money putting her in a nursing home for care when we were very successful in just delivering that antibiotic regimen at home. It's Telehealth, but it's also family empowerment, at home equipment, and community based monitoring.
Lori Walsh: All right. What was the third thing?
Mike Wagner: Oh, the third thing. Oh, the third thing is, I think one of the things that I hope we learn from this is that I think we've actually normalized bad behavior. I've been intrigued by the conversation about, "Oh, is this worse than the flu? Is it the same as the flu? The flu kills more people." There's been all this comparison to the flu. I think we've become a little bit too lax even around the flu. The flu is a deadly, deadly plague. It killed tens of thousands of people. I'm hoping that we can even take simple sanitation discipline and increase it to reduce flu deaths in the future.
I've been on a soapbox for a couple of years in all my travels to hospitals, and I've visited hundreds of hospitals around the world, I have only come across one hospital in all those travels, it was in Ireland, where when you walk into the lobby, there are sinks as part of the construction, sinks for hand washing. And in fact, they're on a glass wall. So everybody in the waiting area can see if you wash your hands or not. We spend millions of dollars on glorious buildings and I've never seen a sink in a lobby of a hospital or a clinic. And that would be cheap, quite frankly, to implement.
Lori Walsh: It was sort of like that transition when people started putting garbage cans next to the bathroom door exit, or outside, or all of a sudden they just said, "You should open the door with a paper towel after you wash your hands." And everybody said, "But the garbage can is by the sink." And I remember hearing one consultant say, "So drop your paper towel by the floor in front of the door, they'll move it."
Mike Wagner: I mean, every hospital in America should, that should be as their next construction project, right? Is sinks and sanitation support, if you will. In England, I know that I've seen where they have sort of portable bathrooms and toilet hand washing facilities right as part of the portable toilet. So some of these are really simple changes. But again, I think, you talk about what questions should be asking. Rather than asking how is the flu, or is this any worse than the flu? We should be asking, "Wait a minute, what can we learn to even reduce the flu and other disease related deaths?"
And so again, I think we should just normalize good sanitary behavior. We were on vacation recently on a cruise ship actually, they had a system where as soon as you got up from the table, somebody came and it was like bleach water, clean the tables and the chairs for the next guest. It didn't take a lot of effort. It wasn't even highly costly, but it was rigorous and it was really focused on, "You know what? We're going to take this seriously." This was a cruise ship that had no infection on board, no disease, no symptoms, no infection, nothing. But it was like, "You know what? We're going to stop this."
Lori Walsh: I want to talk about this other thing that we're seeing, as people, and one of the things we're noticing, Mike, is that some people have been paying attention for a very long time and have taken some pretty drastic actions. Other people are just tuning in now to what's going on and just now sort of awakening and asking some questions about the economy and about COVID-19 and sort of this balance of we've got this many cases, but we've got this many people out of work. This chart of positive cases is going up, but this chart of unemployed people is going up faster and higher and there's vulnerable people, healthcare, but there's also economically vulnerable people and that's all of us. And so we're kind of dealing with merging these two issues in our minds. Getting the economy restarted, like the president says, we're not meant to be shut down. So help us sort of find the uncommon wisdom and how we should think about, are we really balancing these two things against each other, public health and the economy?
Mike Wagner: Well, my answer would be that it's a mistake to merge these issues. Are they linked? Is the public health crisis causing an economic collapse? Absolutely. But the solution to the economic problem is not to short circuit or to short change or to speed up. The trying to speed up the disease cycle as Dr, Fouche on the news said the other day, "The disease is going to set the timeline for the disease." And I think it's really incumbent upon leaders to not assume that fixing the virus will fix the economy. Again, I think the danger of that is that... My worry is that we flatten the curve and it looks like we're improving and we go back to old behavior and then we have a resurge. And so I think it's really important to separate these issues and look at the fact that we have a lot of people with with a new normal, social distancing and so forth, that are out of work, and at the same time we have to manage the disease.
So I think we need public health experts. We need to support them. We need to manage the disease and we need to do whatever it takes to not just [inaudible 00:13:16], but to bring the disease cycle to a closed if that's possible. We need to address that as a health issue, as a specific issue and fix that regardless, quite frankly, of how that spills over into the economy. Then we need to look as leaders of the economy and ask ourselves, how do we get people back to work? Whether it's in their old jobs, whether it's in a new job, or how do we hold them over? What do we do to in fact make our economy more resilient? And again, I think, there's two ways to look at economic intervention here. One is a quick fix. Let's give everybody $1,200 to keep the lights on. The other is, are there things that we need to do to actually shift, if you will, how the economy specifically works and do we need to, again, whether it's changing payment systems or how schools operate or whatever.
Are there new jobs that we need to create or new ways to employ people moving forward? I was intrigued on the broadcast right before In The Moment started, one of the guests on the previous show was talking about a program similar to the WPA and the public works projects. And I think that's an interesting concept. Maybe we should be paying people, I don't know what the right amount is, 50 cents, $1, to sew masks. Maybe we should be mobilizing the community into some of these almost warlike jobs but go ahead and come up with economic solutions that helped people find work or what have you. But bottom line, I think the two issues are separate. You don't solve one by solving the other. You have to solve them separately.
Lori Walsh: And I want to also just close here with this sense of how some people are, what I'm hearing in their voice is not only fear but a sense of despair. And when we talk about creating a more resilient healthcare system, creating more resilient economy, how do we create more resilient families in the sense that we might... What are some of the things that we can start thinking about now as some things crumble around us to say this is what I'm going to do going forward? Do you have ideas on how to kind of create...
I mean, clearly many of us have learned, "I never stockpile anything. I go to the store when I get it, when I'm out of something." You shouldn't stockpile, but I could have had a slightly deeper supply pantry in my house, which had just never occurred to me that I would need that for more than two days because I live in the city very close to a grocery store. There are things that we're already learning. Are there other things that we can learn about how to be together, how to be more human to one another, how to lift each other up in these times?
Mike Wagner: This I think is the one really bright spot that I have seen. Watching communities form and watching people come together. It's funny, my sister lived in Colorado, so we are always socially distant from her. And yet the other night we had a virtual cocktail hour with her. We sort of set up the screen and we had our drinks and she had hers. We probably had the longest conversation that we've had with her in many, many months. I'm starting to see, again, my daughter-in-law was talking about a virtual book club. I think that the good news here is I think people are trying to come together. I think we need to encourage that level of community support and connectedness.
I think what's nice to see in this crisis is that people are learning new technologies, they're learning new ways to connect on a one to one basis. I think the emphasis has been more on how does my teacher talk to my kids at home and how do we talk to one another rather than how do we have big social media. And I think that's going to be the key. The key is strong communities and communities are about relationships. They're not about big impersonal networks. They are about one-on-one. And that's what I think every family needs to do is just strengthen those relationships, spend that time to build those connections moving forward.
Lori Walsh: Mike Wagner, you can find his work at uncommonwisdom.org. We hope to have you back very soon to continue guiding us through this with the experience that you have. We appreciate your time. Thank you.
Mike Wagner: Thanks, Lori.