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When Things Go Wrong

With excerpts from Zeger Degraeve’s Risk: How To Make Decisions in An Uncertain World

Risk & When Things Go Wrong

At what point could Ebola be classified as a risk?. 

Every person, government or business makes decisions.  Every decision maker takes risks.  For some people risk is right at the centre of their profession, like doctors, nurses and healthcare workers in the front line battle against Ebola.  But risk is actually a central consideration in a much wider range of occupations, including general government and in many aspects of citizens daily lives.  The national treasury, personal relationships, jobs, the economy, livelihood are all at risk from time to time.  The problem is that we tend not to view the world this way.  Most of the time, we are unaware of risks that we bear in a million everyday acts, in and out of government.  And when we do think about risk, our minds are mostly filled with big and largely false imaginings.  We think more about unlikely hazards like plane crashes, and big threats to government like coup plots, than we do about the long terms costs of citizen illiteracy, health care accidents or unexpected errors in governance.

In analyzing the migration of the Ebola Virus disease across Africa in the two decades, it appears to have cropped up mostly in villages and outlying rural areas, been hurriedly contained and brought under control and died down in a relatively short period of time.  What is making this outbreak different?

Risks can often be quantified in terms of tolerances and probabilities, but these do not tell the whole story.  Important risk related processes both precede and follow risk taking, in terms of readiness to bear unexpected risk and in how governments judge and learn from the consequences of risk taking.

The common trends in these Ebola outbreaks have been rural settings, poor and challenged health care systems and primate diets, including the sale and consumption of monkeys and other game.  One statistic sticks out.  The correlation between level of education and the management of viral outbreaks like Ebola and Lassa fever.  A literacy level of 65% can make the difference between optimal and suboptimal management of processes including the management of response to outbreaks like Ebola and Lassa fever.  Uganda’s  67% point index compared to Sierra Leone’s 35% says a lot.  Even more interesting, Liberia’s 57% was not enough to prevent the myths circulating which contributed directly to the uncontrollable spread of the disease.

Viruses are some of the biggest threats to mankind because they use our own cellular machinery against us.  There are several anti bacterial drugs but very few anti-viral  medicines that actually work and the evolution of viruses is very rapid.  Viruses that have RNA genomes (HIV, Flu, Ebola) evolve even more rapidly because RNA polymerases or reverse transcriptases, in general, are more error prone than DNA polymerases.

We make decisions all the time.  For them to lead to the outcomes we want, we need to understand the concept of risk and learn to manage it better.  If government had taken into consideration the strong connections with mythical stories and ethos, would they have paid more attention and expense to public enlightenment than they did.  If they had, would the native doctor who claimed she should heal Ebola patients have ventured into Guinea, where she was exposed to the virus?  Had she been better informed, would she have continued encouraging sick people to come to her for treatment, thereby creating heavy traffic inwards of ebola patients?  If others in the community had been better informed, would they have shouted out sooner for help rather than take patients into the bush for healing rituals?  We are making decisions all the time, whether we realize it or not.  We need information to help us make decisions, but there is no information about the future – only possible outcomes and different probabilities.  Measuring risk helps us get to grips with uncertainty by understanding the probability and impact of different possible outcomes.  It also helps us to prepare for the future and learn more about the way in which we make decisions.

Patrick Sawyer, a Liberian American crossed four countries to enter Nigeria with full fledged Ebola inflection.  What was his decision based on?  His widow says he was looking for superior health care.  Superior to what he might get in Liberia.  We asked why he didn’t decide to go to America, presumably the health care there is superior to Nigeria’s.  Today, Nigerians refer to the relatively small outbreak there, all linked to the Liberian American as 'Sawyer’s Ebola'.   In other news, Sawyer’s sister was engaged to be or married to a Nigerian man who fled when she contacted the virus.  Perhaps his decision was to spread the virus in Nigeria as a vendetta.  Other explanations were that his mental faculties were already affected by the virus and he wasn’t thinking right anymore.

Risks, like Sawyer, can be of different types.  Understanding them is useful when comparing them with one another, or building up all the risks our world faces.   Risks can be operations, strategic, financial, or project based.  Each different type has a dependant impact and has the potential to combine and form a risk of greater  significance.  Sawyer’s decision affected operational life cycles of airline, airport, sea port and international migration and travel.  It challenges the strategy of many organisations.  So far Sierra Leone has almost emptied its coffers to contain the outbreak, and even Nigeria where the outbreak is relatively minimal has voted some $11m to combat the spread of the virus.

As we have seen, all decisions involve risk.  To deal with risk we need to understand our decisions in as much depth as possible.  This means getting to grips with probability and impact.  Probability is the likelihood of an outcome, expressed numerically but are often subjective.  Impact is the effect that a particular outcome will have.  Decision trees help us to get a grip on our alternatives.  Risk profiles take us beyond expect value to consider unacceptable or fatal downsides.  Getting more information to reduce subjectivity in decision making takes time and costs money.

What alternative responses are there to risk? Elimination, Tolerance, Minimising, Diversifying, Concentrating, Hedging, Transferring and Insuring risks.  The right response to risk depends on the specific situation and on our calculation of probability and impact. Transferring and Insuring against risk involve others in risks, to the benefit of the organization.  The trade-off is increased costs.  Managing risks well depends on sharing information, clear responsibilities and consistency of approach.

Our responses to risk may not help us make good decisions. Our personal values, organizational values, and our decision frameworks mean we may not always process information well when making decisions.  This problem needs to be managed.  When things go wrong, we need to recognize that every cloud has a silver lining because every mistake is an opportunity to learn. Good risk management and informed decision making can help us learn from errors.

In Uganda commentators say the Ebola outbreak had an unintended consequence.  The markets are now clean.  The restaurants are more safety conscious than before.  Houses are cleaner.  Diets are more restrictive.

We make mistakes because our brains are not suited to the processes of rational decision making.  If errors occur, we need to ensure that they have some positive impact.  We need to learn from them.  Although blame is a natural reaction, it benefits organizations to create a no-blame culture.  A no-blame culture implies that those who get bad results, but make decisions in the right way, should be rewarded.

Now we need to build on collective learning and decision making ability to ensure a better future.