More Lessons From Ebola Mistakes

A foolish consistency is the hobgoblin of little minds. New Jersey Gov. Chris Christie made precisely that mistake.

I speak of Kaci Hickox, the nurse Christie forced into quarantine when she returned from Ebola relief work in West Africa last week, even though Hickox was not sick. Christie, eager to score political points with the Republicans’ law-and-order crowd before this week’s elections, had Hickox confined to a field tent adjacent to a hospital in Newark. Hickox had no shower, television, or reading materials—and unfortunately for Christie, no fever, vomiting, or any other symptoms of Ebola, either. Then again, why would she? Blood tests done here in the United States found no virus in her body.

Christie then did what he does best: reverse course, trying to portray himself as a reasonable man rather than a blowhard who proclaims bold policies before considering their consequences. He agreed to let Hickox return to her home state of Maine, where she still hasn’t been sick and hasn’t obeyed a quarantine order there. A state judge did rule that she should stay at least three feet away from other people, avoid public transportation, and avoid crowds, but since that passes for daily life in rural Maine anyway, I think Hickox’s threat to the Republic has passed.

Christie, however, has given compliance officers yet another teachable moment. Namely, do not roll out new policies without the proper procedures to back them up.

I don’t dispute the need to quarantine people who are sick with Ebola, even against their will if necessary. But Christie’s policy failed on two fronts: it included no risk assessment to determine who needs a quarantine, and it did not have the right procedures behind it to quarantine those who do.

Let’s start with the risk assessment. Risk assessments exist so you can understand the situation in front of you and help you decide what to do. The implication for policy management, however, is that risk assessments help you decide when to deviate from policy. That is, if risk assessments help you decide what to do, by definition you will sometimes decide on one course of action, and sometimes decide another. That’s what an exception to policy is: deciding to do something else.

Policies without a vehicle to grant exceptions court disaster. They alienate and disempower employees, who eventually stop caring whether the policy in question actually works; they only want it followed, so they can go home at the end of their shift and collect their paychecks at the end of the month. That’s the fundamental flaw of zero-tolerance policies, whether they are about weapons in school, facilitation payments in Africa, or medical workers at the Newark International Airport. And that’s why we have kids suspending for making gun gestures with their hands on the playground, employees hiding $20 payments at customs, and nurses without Ebola doing media interviews from field tents at a Newark hospital.

Christie should have spelled out: people returning from West Africa, with no symptoms of Ebola and no detectable virus, and therefore unable to infect others, are allowed to continue on to their destinations. He should have allowed airport officials administering the policy to use judgment, which would make everyone respect the policy more.

So what about that next returning medical worker, who is starting to run a fever and does test positive for the virus, but isn’t yet vomiting everywhere? Of course that person should be quarantined. Unfortunately Christie was not in position to enforce Hickox’ quarantine, either. Airport officers took her temperature incorrectly (because they had not been trained on proper procedure, the same mistake Texas Presbyterian Hospital made in Dallas) and got the wrong result, and then shipped Hickox off to a hospital unprepared to hold a quarantine patient for extended periods.

Now, I’ll be the first to say we do not need to host suspected Ebola victims in private rooms at the Ritz. But we are not a poor nation, and everyone knows it, so when you see someone cooped up in a field tent without even rudimentary amenities like a book to read or a shower stall to use, the policy behind all of it starts to look like a farce. It looks like a policy thrown together in a rush, in slap-dash fashion without any thought of how to make it work—which is, of course, exactly what Christie did. You try rolling out invasive new policies at your company in the same manner and see how seriously employees take them.

And that’s the most alarming mistake of all, since we’re still a long way from defeating Ebola, and sooner or later another American will return home who is sick, and we need a policy for handling him or her a lot more thoughtful than anything Christie has done.