This morning a friend posted an article about a situation in Philadelphia and it fired me up.
Washington Post: Philly Let College Kids Distribute Vaccines.
Here is the gist of the story: A group primarily made up of college/grad students, was given the responsibility of setting up and running Philadelphia’s first mass vaccination clinic. Early in the pandemic, the group (Philly Fighting COVID) had produced free face shields for frontline workers using 3-D printing and had eventually expanded into running COVID-19 testing clinics. When it came time for mass vaccination clinics, the group was tapped to lead the first one at the Convention Center, using doses provided by the Health Department. It did not end well. Due to overbooked appointments, seniors were turned away. Yet, there were reports of the unused doses at the end of sessions, some of which may have later been administered in private homes. The organization reclassified itself as for-profit and may have planned sell some of the data it had collected. There are witnesses claiming that vaccinations were given by unqualified individuals. The group is denying allegations; however, the City is no longer working with the organization.
(Sources: Washington Post; The Philadelphia Enquirer; Philadelphia Magazine; WHYY)
There is A LOT that could inspire anger in this story. First, there’s the lack of wisdom demonstrated by giving the responsibility of running a vaccination clinic to a group lacking leaders with medical and/or public health credentials. Second, other groups (including the Black Doctors COVID-19 Consortium) that were more qualified to lead this type of effort appear to have been overlooked. But the thing that got me most angry as I read more about the situations were the statements like this one:
“The old best practices in healthcare in terms of intramuscular injections were written for a hospital visit that would take 30 minutes that you would bill for as a provider visit,” Doroshin told HealthDay in an interview last week. “Most of those best practices can go out the window.”
quote pulled from WHHY; HealthDay Interview (original source)
Remember the person speaking IS NOT A DOCTOR. Or a public health expert. He is a master’s student in psychology. In an interview with Today, he claimed that the varied (i.e., non-medical) backgrounds of the group allowed them to “think a little differently” about the approach for mass vaccination.
Lack of expertise is NOT a qualification.
The narrative floating around the edges of this story — and similar ones — that “outsiders,” just by virtue of being outsiders, have some kind of special insight is absolute madness. Yes, non-experts can have great ideas that experts don’t see for a variety of reasons. Yes, research supports the idea that diverse groups produce more creative solutions (also, HBR on importance of cognitive diversity); . Yes, groupthink is a bad thing.
However.
Expertise is vital. Expertise has value. It is important that we do not confuse true expertise with confidence. Or with boldness.
Think of it this way. I have a PhD is social psychology. As an expert on topics such as cognitive dissonance and persuasion, I could probably be reasonable trusted to explain and advise how these concepts could be applied to public health issues such as mask wearing behavior. It is where my expertise intersects with that public health issue. However, being able to speak to those topics does not make me qualified to speak as an expert on other mask-related topics like the best type of masks, virus particle sizes, or airborne virus transmission.
Here’s the rub — experts know what they don’t know. Well, they don’t obviously know it, but you get what I mean. They are aware of the limitations of their knowledge because they have an understanding of the scope of the field. Take the paragraph above, I initially hesitated to call myself an expert on cognitive dissonance and persuasion because those concepts were not the focus of my dissertation. But I have spent more time learning, reading, and teaching about these concepts than 99% of the US population. Objectively, compared to the average American, I am an expert. Ironically, understanding the breadth of the field means I am aware of how much I still don’t know, which makes me feel less competent than I actually am. Someone without that perspective will likely lack that awareness and subsequently overestimate their abilities. (Dunning-Kruger effect is relevant here.) What you end up with is a mess of experts underestimating their abilities while non-experts overestimate their own.
The current COVID-19 situation is further complicated by the fact that many of the tasks that need completing (e.g., caring for the sick, testing, vaccination) pull from the same well of experts — healthcare providers — a group that is already suffering from overwork and burnout (and illness) due to a protracted pandemic. So when a outside group stands up and says, “Hey! We can do that! Let us help!” health organizations may jump at the aid without fully evaluating qualifications or potential issues.
It is 100% possible that Philly Fighting COVID had valuable suggestions about how to streamline a vaccination clinic and that they could have played an important role in carrying them out. Lots of people were vaccinated. But an expert is necessary to determine which “best practices” are expendable and which ones are not. And it is clear that a lack of oversight played a role in what ultimately happened.
This story is also a great example of mission creep. The group appears to have done solid work with producing face shields. But it also seems as though that production (via 3D printing) was closer to their areas of expertise. Then they expanded into testing. Then they thought they could expand into vaccination administration. Creep, creep, creep. Each step took them further from the initial area of competence. Early successes with simpler tasks bred overconfidence. As beautifully stated in an article in Stanford Social Innovation Review:
Mission creep can stretch an organization so thin and so far that it can no longer effectively pursue its goals. In the private sector, it would seem preposterous for a coffee-roasting company to jump into the biotech business or to start manufacturing baseball gloves. Yet nonprofits routinely extend their operations in equivalent ways—they expand their programs far beyond their organizational scope and far beyond their core competencies—and no one raises an eyebrow.
Kim Yonker & William F. Meehan III, Mission Matters Most
So what is a possible solution for strained health departments and healthcare workers?
- Determine where expertise is most valuable and make sure it is represented there. What tasks require information that only experts will know?
- For large projects, take the time upfront to break it down into pieces. Then assess which types of expertise are necessary.
- Match experts to relevant roles.
- In the absence of true experts (or due to a shortage of experts from overwhelming need), identify experts in adjacent fields who may be able to help. An example of this is using nursing students and paramedics to help administer vaccinations. Or create a collaborative team of experts and expert-adjacents that can work together.
- Remember that non-experts may need additional oversight compared to experts because they may lack the knowledge for certain types of decision-making.
The bottom line is that grassroots groups have an important role to play, in the pandemic and in other forms of community service and outreach even if they aren’t necessarily experts in a given field. Outsiders can drive innovation and their disruption of the status quo can add value; I am not arguing that such attempts to help are a waste. But the best situation is created when a diverse group of relevant experts collaborate in pursuit of a larger goal or when an outsider works with those who have greater knowledge in a given space.
Photo Credit: Photo by Nataliya Vaitkevich on Pexels.com
Katherine Tuttle, Ph.D. 