Good morning from a very rural France...
First visit to the local open air market since lock down.
Gendarme road block at both ends of village - checking attestations prior to entry - no papers, GO HOME!!
Public health officials directing people and everyone in masks and gloves for serving - no customer is allowed to touch any produce - such an anathema for a population who select by touch and smell.
Psychology 101 ..... If a service is allowed to open, why would you not go and use the facility.
A super article from an Australian doctor on why the mixed message are not getting through.
(...)
The brief answer, IMHO, is that we have a serious clash of two vastly different medical cultures. Neither culture should see the other as the enemy when frustration boils up – the enemy is always the virus.
The front line culture is modern, highly networked, often social media savvy, collaborative, a diverse multidisciplinary team. This team knows the best results come from brainstorming problems with a hive mind of connections, often online and involving international experience, respecting all inputs, rapidly iterating them and distributing resource and decision making. All members are equal in calling out issues as they see them, and contribute ideas to solving complex problems. Evidence base is the currency for respect here.
Pandemic central command culture on the other hand is paternalistic. It operates by command via multilayered bureaucratic structures. What it says goes and cannot be questioned as there is no process for that. Evidence is not required, as the decisions have authority. Information goes up through filters, is processed by distant experts, and decisions come back down through filters.
An excellent example of how this might look is the stockpiling. People on the ground get frightened because they receive news from many sources. The politicians, who they do not normally ever engage with, tell them to “just stop it”. The people do not listen because they do not respond to paternalism or respect that type of management. The politicians then start to look like frustrated Dads whose kids won’t listen to them any more. The people are used to evaluating evidence for themselves and drawing their own conclusion. A better way to settle them would be to validate and empathise with their concern, and assuage their fear by guaranteeing food supply.
(...)
Solutions
Command and control was rejected in modern clinical medical practice long ago.
Far better to be transparent now about all the facts, all the assumptions, involve working front line staff in a collaborative decision making process, and get the politicians out of the room. The decision makers should have professionally moderated online access in Whatsapp to every doctor, subdivided into appropriate groups to provide real feedback.
Then listen to the front line in an iterative way and adjust. Make the comms tight and two way. This is how the Hong Kong civil resistance organised itself from the ground up with no commanders.
Distribute resources and decision making direct to front line, and bypass the command line which is incredibly inefficient. Allow local innovators to use their incredible brains to work out problems central command has not even contemplated. They will then spread word as to what works online. They are doing this already but if unfettered in decision making, they could save many lives.
Doctors on the front line can contribute also by being respectful to the central command, and politicians, it is not their fault that they have a different culture at this time. It is a problem of structure not personal failing. Avoiding conflating the people with the problem. Displaying empathy, understanding and willingness to collaborate from both sides can take us forward together over the next few weeks. And hopefully save some lives.
https://drajm.blog/2020/03/21/op-ed-210320/