Three Lessons in Global Health Management

Adam R. Frange1,2

1Community Health Council, Cambridge, MA, USA
2Harvard Medical School, Boston, MA, USA
Address correspondence to: adamfrange@gmail.com


Amongst global health practitioners here at Harvard, it is often said that global health is not yet a discipline, but instead, more accurately, a set of interdisciplinary problems. Given the diversity of fields that global health spans, one must continue to learn global health continually throughout one’s career. However, the things that we need to learn in this line of work are not purely epidemiological, clinical, legal, or otherwise based in formal scholarship. Rather, it is important also to acknowledge and to learn from the often overlooked underlying natures of both global health projects and management in general. Below, I briefly present three invaluable lessons I have learned as the executive director and co-founder of a global health nonprofit, Community Health Council (CHC).

Learning from our challenges in improving health care access and delivery in resource poor settings will allow the global medical community to make long-term improvements, without focusing on previous successes or failures. Photo Credit: “Extracurricular Sports” via Compfight cc.

Learning from our challenges in improving health care access and delivery in resource poor settings will allow the global medical community to make long-term improvements, without focusing on previous successes or failures. Photo Credit: “Extracurricular Sports” via Compfight cc.

#1: Alone, You Can’t Do Much

A few years ago, when I was working in the CHC office in Cambridge, Massachusetts, I can vividly recall the 17 other people working there, all of whom were under my direct management. It helped me to keep track of everyone to require all employees to keep records of their upcoming assignments for each day in shared Google Calendars. One morning — I still can recall — it was about 9:15am, and I was still sipping my morning coffee. Going over everyone’s Google Calendar, I was able to see in a single glance the assignments that everyone was working on from 9 AM to 10 AM and an amazing feeling washed over me. I was able to see, in real-time, that 17 hours worth of work would be accomplished before I finished my morning coffee. It was a great revelation. Seventeen hours, after all, would have been a long day’s work for me. In this moment, however, we were accomplishing this workload in one hour. In this moment, I felt the true power of having a team help you with the legwork, and indeed, there is a lot of legwork to be done in global health work.

To illustrate further the power of teams, I often share an analogy from the life of Walt Disney. A “person-year” is equivalent to 2,000 hours of work (40 hours per week times 50 weeks per year equals 2,000 hours per year). Snow White, the first cartoon-movie, required two-million drawings and 200 person-years worth of work. This means that if, in February 1936, Walt Disney had begun drawing the first pictures of Snow White alone, he today would have only the first 31 minutes of the movie completed. Because Walt Disney, in February 1936, had a team of 900 people, Walt Disney Corporation was able to release Snow White before Christmas, just nine months after beginning. When I told this anecdote to a friend, an executive at a Fortune 500 company, he shared with me that it was recently determined that his company’s marketing department alone had accomplished in a person-eon of work the past year — that is, a billion years’ worth of work for a single person. By bringing to bear this volume of hours on today’s global health crises, we will be able to affect real change. Let’s consider how this compares with working alone. Even if you work 100 hours per week, 50 weeks per year, you are still only accomplishing 6,000 hours’ worth of work every year, which is not enough to affect change at the population-level. It is important, therefore, to answer one of two questions: “What team do I want to join?” or “What team do I want to build?”

#2: Know When to Take Off the Turban

In applying a philosophy of teamwork, one sometimes find oneself caught amongst the competing interests of different parties or individuals, struggling to keep people and partnerships together. In order to maintain unity, it is important to compromise but it may fall upon one’s own shoulders to broker this in times of stress, often putting aside one’s own preferences in the process in order to achieve goals and avoid conflict. This kind of situation reminds me of an anecdote I once heard about Mohandas K. Gandhi, the Indian civil rights leader of the early 20th century. Early in Gandhi’s career, before concluding that India must have independence from Great Britain, he, a lawyer by trade, had taken the British government to court to in order to contest the legality of racist laws that enforced untouchability in British India. However, he was wearing a turban as he was about to walk into the courtroom, and the judge would not let him enter unless he removed it. Gandhi removed his turban and entered the courtroom, and many of his supporters were very upset by the compromise. Gandhi explained, “On this day, we were not fighting for our right to right to wear our religious garments in a government building. We were in court to fight the immorality of untouchability (paraphrased).” Gandhi would later write that, if one compromises on the non-essentials, one is more likely to achieve the “essentials.” Indeed, Gandhi had won that court case, which would not have been possible had he refused to remove his turban [1]. From this, we derive our lesson: know when to take off the turban. Compromising on non-essentials helps one achieve what’s essential and it is an important skill that can be employed to keep teams and partnerships together. This, after all, is essential in the pursuit of ambitious objectives.

#3: Success is a Batting Average — Take Your Next Shot

When a baseball player gets a .300 batting average, it means that he gets a “hit” 30% of the time. The other 70% of the time, he is getting “out” in some way. Yet, we consider a 30% success rate to be so impressive that we put many such players into a museum (the Hall of Fame). The former president of Motown Records in the 1970’s, Skip Miller, once told me “I’m a 5% man…because only 5% of my artists generate most of our revenue.” This person, at the top of the music business, expected of himself a batting average of .050. Yet in medicine, when it comes to serving patients, we expect extraordinary batting averages of 0.950 and above. All this is to say that it is important to know what sort of “batting average” to expect from yourself in a given project; it is easy to imagine that a baseball player who expected to bat .950 might be perennially frustrated. More than this, if we can learn to think of success itself as a “batting average,” we’ll probably be more effective in the field. Sometimes you strike out, but other times you get a hit, so It is important to set batting expectations appropriately. Your attitude will affect your happiness and your ability to push forward on a project.

Consider also the advice of Mike Krzyzewski, head men’s basketball coach at Duke University, who advises players to always be thinking of the next shot. Krzyzewski teaches that if a player is thinking of his last shot, and it was a miss, then at the next, he will be more likely to miss again because he’s shaken up from the last [2]. If he hit the last shot, then the player is likely to be cocky, and thus in fact more likely to miss the next shot. For this reason, Krzyzewski says, he does not keep track of his wins or losses. Put your last shot out of your mind completely. Learn from your failures but avoid dwelling on them — put them out of your mind when it is time to move forward. At the same time, do not keep track of your successes; sooner or later they may make you cocky or complacent and cause you to miss your “next shot.” This advice very nicely complements the idea of success as a “batting average,” for it teaches us how to behave when we miss (or hit) our most recent shot.

Conclusion

To be sure, in global health — a discipline that many say does not yet exist — there are many occasions to reflect upon the philosophy of batting averages, both after the occasional home runs and the all-too-common strikeouts. In all cases, we can seek to increase our batting averages and achieve our goals by working in teams. In global health, as in other fields, population-level impact can only be created now through large teams, for it is not individually possible to put forth the hours required. There is no choice but to work together — we cannot work alone. One must answer one of two questions: “What team do I want to build?” or “What team to I want to join?” Thereafter, each person will necessarily encounter the need to “take off the turban” at times, but the results are worthwhile.

Endnote

† Learn more at www.communityhealthcouncil.org.


References

  1. Berkeley Lecture Videos (2006) Peace and Conflict Studies. Available: http://webcast.berkeley.edu/playlist#c,s,Fall_2006,D9592FA7CAC67331. Accessed 10 January 2014.
  2. Krzyzewski M, Spatola JK (2006) Beyond Basketball: Coach K’s Keywords for Success. New York: Warner Business Books. 112 p.