Sense Of Urgency and Things that Don't Scale

As an Israeli living in the US, I often get asked why the US is doing such a worse job of vaccinating its citizens. Israel has already vaccinated more than six times per capita than the US. The operations professor in me initially tried to explain it using the notion of centralized control over the healthcare system rather than the much decentralized, market-led system of the US. But this is too simple. If this were the main explanation, you would expect the European countries or Canada to do better.

I think now it's more about urgency than systems. As I explained near the end of an interview on ABC News, Israel simply has a greater sense of urgency than almost any other country.

Israel Vaccinating on Shabbat

One of the prime examples is Israel’s approach to vaccinating on Saturday (Shabbat). For religious (and also political) reasons, there is no public transportation on Saturdays in Israel. However, when vaccination began, there was a broad agreement that it should occur on weekends. The message was clear: saving lives in the short run takes precedence over religious values (and political math).  Similarly, Facebook groups began to emerge, directing people to clinics about to have excess vaccines at the end of the day, ensuring that they were not spoiled. This led to stories where the pizza delivery guy was offered a shot just to ensure that nothing goes to waste. 

Where is the sense of urgency coming from? It may sound cliche, and I am sure there are thousands of articles written about Israel’s reputation as the original “Startup Nation” and the (perhaps debatable) feeling of being persecuted. Still, this survival instinct elevates the sense of urgency.  And this is drilled at every stage. In my military service, we called it “sleeping with shoes and uniform on.”  

Elon Musk Sleeping on the Factory Floor

This is not only true for Israelis. When Tesla fell behind schedule on launching the Model 3, Elon Musk revealed that he sleeps on the factory floor: “I don’t believe like people should be experiencing hardship while the CEO is, like, off on vacation.” But this goes beyond being a role model. It’s about taking actions that deliver a message of intensity even if such urgent actions are not sustainable.

I have not heard any governor say that he or she will not be vaccinated until all of his or her citizens above the age of 75 get vaccinated. 

I didn’t see a single hospital manager (manager, not physician) say that she or he will not get vaccinated until their final patient above the age of 65 gets vaccinated. 

I got many emails that claim, “we do the best we can.” 

Many words.  No “out of ordinary” actions. 

Urgency is best demonstrated by choosing to do things that clearly cannot persist. People see they're prioritizing speed over sustainability and take notice. 

Y Combinator co-founder Paul Graham has identified the notion of “doing things that don’t scale” as one of the main tools of startups. While big firms use scale as the primary lens to make business decisions, startups’ main advantage is their ability to choose areas where they believe they can make an immediate impact without the need to justify whether these processes are sustainable. It’s that focus that ultimately drives success. 

The US: Vaccinations and Schools

We spent the last 11 months in the US since Covid-19 first appeared in the US  without preparing our health care systems to handle it. In trying to explain the dissonance between the urgency in drug development efforts and the utter inattention given to the actual vaccination process, one should not fall into the trap of just blaming governments but the leaders driving these.  Joe Kotter writes that when trying to drive change, complacency is the biggest enemy.  

But this does not stop with the vaccines. Many kids spent the last year at home. Our students are not in the classroom. While I would like to believe that everything will be back to normal next year, I don’t know whether that’s going to be the case. New strains emerge, and it’s possible that some students will not be able to get vaccinated. I see zero planning towards that. Did I mention complacency? 

While I do not develop vaccines, I try to drive a similar sense of urgency in my backyard. For the last two months, I taught in person a group of dedicated MBA students, and Tuesday was my final class. It was clear it’s not sustainable for the school to teach 24 students in a 78 person classroom. It’s not scalable to require everyone to wear masks continuously and test twice a week.  It felt like the riskiest thing I did since my military experience (it wasn’t). Many other people take a much bigger risk than I did, and many other teachers do the same. But I had a choice, while many of them didn’t, which is precisely why I did it. I needed to display my commitment to my students. It was my way of showing my appreciation for those who do not have a choice: My kid’s school teachers. Health care employees, the cashier at the supermarket. A sense of urgency.  

First actions, Then words

As political theorist Hannah Arendt said, the meaning of action itself depends upon the articulation given to it by our own narration. If you want to create a sense of urgency, change the attitude towards the current situation, do things that don’t scale. In the same interview mentioned above, Elon Musk says, “I am personally on that line, in that machine, trying to solve problems personally where I can, We are working seven days a week to do it. And I have personally been here on the zone 2 module line at 2:00 a.m. on a Sunday morning, helping diagnose robot calibration issues. So I’m doing everything I can.” 

First actions, then words.