by Hannah Jara

There is nothing that caused the same ​massive fear around the globe in the 21st ​century as the COVID-19 pandemic. Akin to ​how we discuss about companies that are ​forced to change due to disruption, the ​pandemic was an international disruptor ​that required governments to respond as ​quickly as possible. In terms of the Cynefin ​Framework*, most of the problems that ​surfaced revolved around the chaotic, ​complex, and complicated realms. An added ​difficulty was that there was hardly any ​room for mistakes, because any time delays ​meant more lives at stake. It was particularly ​more challenging for health systems in ​developing nations such as the Philippines.

During my stint as the OIC-Deputy Team ​Leader and Vaccine Specialist of a World ​Bank loan to the Philippines for the ​pandemic, I had a front row seat of how the ​Department of Health (DOH) mobilized the ​national effort to control the spread of the ​virus, and later on, perform the national ​vaccination program. This role allowed me to ​work directly with a small project team, but ​coordinate with several key stakeholders in ​other government agencies, non-government ​organizations, and key offices in the DOH.

*The Cynefin Framework was developed by David ​Snowden that categorizes situations in a spectrum from ​simple, to complicated, complex, chaotic, and disorder. ​Each level has its unique nature and appropriate response ​needed.

Upon my discovery of complexity science as a means to recalibrate ​organizations, I could not help but see the pandemic response in my country as ​a good case study on how the “old system” was costing us lives, and how ​complexity science principles could have been useful, in hindsight.

Now, it is prudent for me to say that the response may not have been ideal, but ​it was likely the most rational one given the systems in place and the limited ​information available to decision makers during that stressful period. An ​interesting article from Harvard Business Review has mentioned how people ​default to heuristics and gut instincts when faced with immense stress [1]. ​Hence, it was greatly possible that emotionally driven decisions were made not ​just by management, but also by technical and regional officers who were both ​fearful of the pandemic and their supervisors’ reprimands. It would be ​unfortunate, however, if the same mistakes were repeated in the future should ​another health disruptor come into play.

One of the interesting concepts in complexity science is how control is an ​illusion in any organization; you cannot control a complex system, but you can ​regulate it. By simply looking at the causal loop of pandemic response (Figure 1) ​[2], one would know that a complex organization is needed to tackle this ​problem. However, the structure of the DOH shows that a very strict ​hierarchical system was utilized to maintain “order”, up until the vaccination ​period (Figure 2). During the initial response, there was immense desire to ​control the DOH regional offices, the local government units (LGUs), and the ​populace. However, we know that control is not possible, and the national ​directives were not uniformly followed at the local level.

The LGUs alone were used to autonomy on health-related solutions and were ​structurally not under the DOH. Hence, attempts of the latter for the former to ​implement imposed solutions and report weekly did not sit well with many ​politicians, and their local health officers bore the pressure to face the national ​committees instead.

A study reported that it was also more common for the LGUs to practice their ​autonomy on short-term solutions, and defer long term planning to the national ​government [3]. This was why when the “Bayanihan to Heal as One” Act was ​implemented and centralized the powers back to the President, this further ​disempowered the LGUs. Although the goal was synergy, the absence of a clear ​crisis communication channel prevented this from materializing, resulting in ​tensions between the national and local government.

In the government’s defense, they did not have the leeway to “try out” new ​organizational strategies with no guarantee of success. Indeed, the concept of a ​more holocratic form of governance* was perceived as more applicable to the ​private sector. However, flat organizations** were found to thrive more during ​the pandemic [4]. As the leading global consulting company, McKinsey & ​Company would put it:

“As companies adopt new ways of working at speed and at scale, three lessons ​are emerging: a vindication for flatter, faster, nonhierarchical structures and ​approaches; the need to turbocharge decision making; and a reminder of the ​role of talent in making everything go” [5].

Figure 1.Causal Loop for Policymaking during the COVID-19 Pandemic (Sy et al. 2020)

Figure 2. COVID-19 Vaccine Cluster Organizational Structure (DOH, 2021) [7]

And although there was an attempt to create “task groups” composed of ​multiple offices that mimic the “team of teams” concept by best-selling author ​Stanley McChrystal [6], the offices still strictly adhered to bureaucracy ​concepts that centralized decision making to the executive committee ​members. Hence on the surface, it seemed that the organization was more ​granular but in reality, condensed accountability to top management ​persisted. For example, instructions from one office to another were not ​recognized as “official correspondence” unless these were signed by executive ​officers, or co-signed by the officers-in-charge. This resulted in exponential ​delays in action, as it is relayed from one office to another since signatories ​were bombarded by huge paperwork on a daily basis. Unfortunately, this ​“domino effect” in slow information movement from central to local levels ​meant that more lives were being lost. The slow information channels resulted ​in supply chain delays and bullwhip effects that meant that government-​sponsored medicines were running out in hospitals with severe cases.

Hence, we can see that there was a lack of motivation and disempowerment ​from the local government and central technical offices due to the absence of ​autonomy and an incentive-driven system. By trying to control a demotivated ​workforce in a rigid bureaucratic system, the pandemic response suffered.

The persistent miscommunication between the national and local units also ​fostered a sense of mistrust. As the LGUs perceive slow response from the ​national government, they started to take matters into their own hands. Once ​the vaccines became available, the LGUs started purchasing their own stocks ​with the assumption that the DOH would take months to deliver the national ​supply of vaccines to them. This was not without basis, as the DOH did have ​multiple delays in medicine deliveries to the regions for several years in the ​past. Due to the lack of credibility over the years, the LGUs ended up ​overstocking vaccines as the national supply unexpectedly arrived earlier than ​expected. This eventually resulted in vaccine wastage by the millions, with ​everyone pointing fingers at each other. Complexity science principles point ​to the importance of trust to delegate accountability. In this case, the ​accountability was concentrated to the central government and there was ​strong mistrust by local politicians.

*Holocracy is a decentralized form of management developed by Brian Robertson that heavily ​relies on adaptability, transparency, and employee engagement.

**Also known as horizontal organizations, it is characterized by the absence of hierarchies and ​fancy titles, with emphasis on an independent working culture.

To prevent such an unfortunate event to recur in the future, the DOH has to build ​its relationship and trust with the LGUs in the next several years by collaborating ​instead of imposing, and delivering timely solutions while admitting to their lapses ​in the past.

This was even more crucial because the LGUs regulate the private and district ​hospitals in their jurisdiction. The DOH did not have direct reign over these ​institutions, and imposing control without the power to penalize them was futile. ​Hence, even the decentralized system of healthcare in the country calls for power ​and accountability to be spread rather than concentrated.

The bureaucratic system in place also encouraged a mindset of prioritizing fear ​over action. By concentrating the decision making to heads, staff were afraid to ​cascade information or make proposals that would divert the accountability to ​themselves. Employees from the central offices would have to wait for a “go-signal” ​from their bosses before doing something. Any negative consequences of late action ​would be dismissed as not their fault, because they had no choice but to wait for a ​decision from the top. And the bosses themselves were not able to make quick ​decisions due to overlapping meetings and engagements­–and sometimes even ​vacation leaves—before they could be presented with the problem.

The workforce is further disincentivized by the fact that many of them have no ​security of tenure (contract-based employment), delayed salaries, and even delayed ​hazard pays and special risk allowances (SRAs). It was common for one to hear a ​colleague say in government: “Bukas na ‘yan, delayed naman ang sahod eh” (“Finish ​that tomorrow, the salary is delayed anyway”). As this rings of work-life balance, ​comments like these can mean magnified delays in government response during a ​critical pandemic. The delays themselves are rooted to mistrust that the staff may ​be underworking, to the point that they are made to detail every two weeks all their ​accomplishments in writing, signed by their direct supervisor. Hence, the culture of ​mistrust in the central office, apart from being a by-product of bureaucracy, ​contributes to the poor pandemic response at the national level.

The Need for a Change: Applying Complexity Science in the Government

To drive the change in the nation’s pandemic response, or any health strategy ​implementation for that matter, there should be a clear culture that directs the ​people to this goal, and should be aligned with their intrinsic motivation. As Peter ​Drucker would put it “Culture eats strategy for breakfast”. This means that ​organizational culture can overpower strategic planning. If there is a disconnect ​between the two, one’s strategy is more likely to fail.

To change the culture, there is a need to change the systems that drive ​this culture. The following are some suggestions to improve internal ​efficiency and align strategic responsiveness with organizational culture:

Restructure the Hiring Process. To change the culture, there is a need ​to change the hiring process. Typically, government hiring is focused on ​finding the right fit for the job, but not the right fit for the organization’s ​culture. In the paper “Hiring for the Organization, not the Job” by Bowen, ​Ledford and Nathan, they emphasized a new model wherein the “whole ​person” has to be considered if he/she fits well into the organization’s ​culture [8]. It also mentions how in bureaucracy, a basic assumption is ​that “individuals cannot be trusted to manage their own behavior” and so ​there is tight managerial control. By focusing heavily on credentials and ​not person-organization fit, the government may hire for the sake of ​hiring, but not retain them nor motivate them to the goal.

A new hiring process needs to be put in place, wherein the prospect will ​have an opportunity to observe the workplace and its culture. This can be ​done by prolonging the hiring process to include not just initial ​screening for basic requirements, but also a probation period wherein ​the employee can assess their personal fit in the organization. An ​alignment of values must be assessed through comprehensive inventory ​questionnaires. Fortunately, such techniques are applied in some ​international non-government organizations that the DOH can learn from ​and replicate. The DOH has to review its values, reflect on whether these ​still ring true, and assess if their people actually align to these values.

Create an incentive system for people. The lack of funds is used to justify why ​the government is unable to provide permanent employment to most of its ​contractual workers. However, this does not remove the fact that it is a root ​problem, and the fact that there is a way around it.

The hierarchical system created huge salary disparities among individuals in ​different governance levels. As executives are paid huge salaries and benefits ​monthly, they are expected to make most of the decision-making and take ​accountability. Attempts to delegate the responsibility and accountability to ​lower staff are met with either direct hostility (“Why would I take ​accountability? I am not the one paid xxx amount”) or hypocrisy (“I will say yes ​so I will not lose my job, but there is no way I will do it to the best of my ​abilities”). Both results will yield the same ending: a poorly functioning ​organization with mistrust. The huge disparity also encourages corruption in ​low ranking levels to compensate for their needs. This can go as little as using ​the printers for personal use, to taking thousands of pesos in bribes from ​bidders. It was almost sad for me to know that among the colleagues I worked ​with in the past, most of them had no knowledge on passive investments ​despite knowing for a fact that their pension during retirement will not be ​enough. This was completely different than the experience of my spouse who, ​during the release of their performance bonuses, his company invited different ​groups with legitimate investment opportunities for their employees to think ​long-term.

Without the sense that the organization takes care ​of them, the DOH cannot expect that the employees ​will want to take care of it, let alone be bothered by ​its long term goals. So how will it do it? I propose ​that the government ought to lower the ​compensation of executives, and elevate the ​compensations of all supporting staff, both ​technical and administrative while providing them ​with permanent employment. By doing so, they are ​able to delegate the responsibilities to more people, ​thereby hastening response efforts. This will also ​create an incentive system where more is expected ​from employees in terms of their participation in ​different task groups. Unlike the belief that an ​imaginary nationalistic spirit will drive them to ​work, there is a very real source of motivation.

By providing permanent employment to its staff, it ​sends a message of trust that “you do not need to ​summarize every two weeks of what you did; I know ​you will deliver the outputs you said you would”. ​For many organizations with flatter structures, this ​was always an initial risk they had to take, but paid ​off handsomely. With the permanence of the ​government, it has enough cushion to take this risk, ​unlike some private companies that can go bankrupt ​for incremental mistakes. Of course, this is under ​the assumption that the DOH is already composed ​of people with aligned values. As much as I met ​people demotivated by the lack of excitement or ​personal fulfillment of their jobs, I also met a few ​gems who would willingly do more than expected, ​because that is just who they are. It is now the goal ​of the Human Resource to find those kinds of ​people to hire.

Find the natural leaders. Complexity science states that ​true leadership is not found in titles, but in how a person ​is able to bring others together to a common cause. If a ​manager is only followed because he/she is in an executive ​position and for no other reason, then he/she is not a ​natural leader. To create a responsive system where ​everyone works synergistically, there is a need to find the ​natural leaders who command authority not by their ​position, but because they inspire others. Creating small ​groups with these natural leaders while giving them ​accountability and the ownership of projects (both the ​successes and failures) will motivate them to do better. By ​creating an atmosphere of trust, this also means that there ​is room for tolerable mistakes. It should not be the case ​where despite an executive being blamed for something, ​they are merely given a suspension without the threat of ​dismissal, while their subordinates are immediately fired. ​This will only aggravate the divide and mistrust within the ​system.

Create credibility. It was already previously mentioned ​how among its partner LGUs, there is already a poor ​reputation by the Department because of years of poor ​supply chain management. In my opinion, there is a need ​for a drastic change within the supply chain division that ​necessitates the application of international best practices ​like the Lean Six Sigma in its methodology. Of all the ​offices in the Department, it is this particular division ​where the antiquated ways of bureaucratic processes can ​be felt down to the grass root level. There is a need to hire ​supply chain experts who may not necessarily be medical ​doctors, to direct this unit. Likewise, it must work in ​tandem with the Knowledge Management and Information ​Technology Service (KMITS) Division in creating real-time ​information channels. It is only through this massive ​recalibration of processes that it can build credibility to ​the regions that it is able to deliver timely medical ​supplies.

Hannah Jara is a current MBA student

at the Asian Institute of Management in

the Philippines. She has worked for over five

years in government and private organizations

related to public health.

All views expressed in this blog belong solely to the author, and in no way represent the institutions ​she is affiliated with.

References

1. Tulshyan, R. (2020, April 10). How to Be an Inclusive Leader Through a Crisis. ​https://hbr.org/2020/04/how-to-be-an-inclusive-leader-through-a-crisis
   
2. Sy, C., Bernardo, E., Miguel, A., San Juan, J. L., Mayol, A. P., Ching, P. M., Culaba, A., ​Ubando, A., & Mutuc, J. E. (2020). Policy Development for Pandemic Response Using ​System Dynamics: A Case Study on COVID-19. Process Integration and Optimization ​for Sustainability, 4(4), 497–501. https://doi.org/10.1007/s41660-020-00130-x
3. Navarro, S., Yusingco, M. H., & Sison, V. (2020). Interrogating the Centralization-​Decentralization Tension in the Philippines in the Midst of the COVID-19 Pandemic. ​SSRN Electronic Journal. https://doi.org/10.2139/ssrn.3721883
4. Martinez, L., & Frauenheim, E. (2021, January 26). COVID-19 Reveals Why Flat ​Organizations Thrive: Steal Their Secrets. Great Place To Work Philippines. ​https://www.greatplacetowork.com.ph/reports/covid-19-reveals-why-flat-​organizations-thrive-steal-their-secrets-2/
5. McKinsey & Company. (2020, May 15). Reimagining the postpandemic organization | ​McKinsey. https://www.mckinsey.com/capabilities/people-and-organizational-​performance/our-insights/reimagining-the-post-pandemic-organization
   
6. McChrystal, S. A., Collins, T., Silverman, D., & Fussell, C. (2019). Team of teams: New ​rules of engagement for a complex world. Penguin business.
   
7. Department of Health. (2021). The Philippine National Deployment and Vaccination ​Plan for COVID-19 Vaccines. https://www.fip.org/files/content/priority-​areas/coronavirus/The_Philippine_National_COVID-​19_Vaccination_Deployment_Plan.pdf
   
8. Bowen, D. E., Ledford, G. E., & Nathan, B. R. (1991). Hiring for the Organization, Not ​the Job. The Executive, 5(4), 35–51. http://www.jstor.org/stable/4165035