Sunday, November 06, 2005

To Fight the Flu, Change How Government Works

The New York Times
To Fight the Flu, Change How Government Works


LAST week, President Bush released plans to prepare the nation for the possibility of an outbreak of deadly influenza, calling for Congress to appropriate $7.1 billion for research and the stockpiling of vaccines and antiviral drugs. As a summary of goals and strategies, the president's plans are commendable. But drafting them was the easy part. Putting them into effect will be the challenge.

The problem with President Bush's plans is that they can't succeed in the current bureaucratic structure. Were the federal government ever entitled to the benefit of the doubt, it forfeited that presumption in the aftermath of Hurricane Katrina. Unless these shortcomings are fixed, we have no grounds to presume the administration's laudable avian flu strategies will be translated into action.

What we need to do to prepare for and respond to a pandemic is change the very way the government delivers services. And to do that, the following initiatives must be integrated into the government's response:

Designate a single, accountable leader. An avian flu pandemic is among the greatest threats to our country today. Given our vulnerability and the amount of work to be done, the president must appoint a leader who is singularly focused on avian flu. This leader must be fully accountable for the government's progress. And the president must make it clear that this leader speaks on his behalf.

Fragmented authority will cripple the administration's efforts. In the president's plan, responsibilities are spread out among a number of United States departmental and agency heads. This is a recipe for disaster that could result in confusion, finger-pointing and neglect. If after the failure of Hurricane Katrina the administration hasn't understood the need for a single, dedicated leader, it hasn't yet faced up to the scale of disaster that a flu pandemic presents.

Replace bureaucratic administration with entrepreneurial management. If an avian flu pandemic sweeps the United States, it will pose a tremendous challenge in terms of speed, lethality and complexity. Federal, state and local governments will need to act with the speed and agility of the information age.

Unfortunately, our government cannot operate at anything approaching this level. Despite modest civil service reforms over the years, the government remains caught up in a bureaucratic process-oriented approach to business. The government's pandemic preparations must be equipped with 21st century entrepreneurial management practices that mirror those of America's best-run corporations. The government will need to stop focusing on process and concentrate instead on results.

To do this, it will need a management system that allows for collaboration between the government and communities similar to the Compstat crime system used by the New York and Los Angeles Police Departments. Compstat links headquarters to each precinct, allowing for accurate intelligence, rapid deployment and relentless follow-up.

Prepare for the days of a phony war mentality. Until we receive word that a pandemic is loose in this country, last week's announcement could well be the high point of public attention to the threat posed by avian flu. The pressure to prepare will decline. And as this happens, government attention will be pulled in other directions.

Resisting this temptation will require strong leadership from the administration and from Congress. But it will also be aided by concentrating on efforts that have multiple uses in peacetime as well as during a pandemic. These dual-use investments will be easier to justify if they are presented as an essential step in preparing for a deadly flu outbreak.

A leading example of such an investment is an electronic health record system, which would allow the federal government to track the course and impact of a pandemic in real time. Public health experts widely agree that this kind of network would not only allow for safer and more efficient care under normal circumstances, but would also equip federal, state and local governments with the data needed to direct scarce therapies, medical teams and supplies to where they are most needed as a pandemic unfolds. There's no good reason why every American couldn't have a preliminary electronic health record by the end of 2006.

While we can be grateful that President Bush has acknowledged the seriousness of a possible deadly flu outbreak and outlined strategies to prepare the nation to respond, much more needs to be done. Focusing on these three initiatives will ensure that we are prepared. The success of the president's plans hinges on getting this right.

Newt Gingrich, a former speaker of the United States House of Representatives, is the founder of the Center for Health Transformation. Robert Egge is a project director at the center.