Performing Under Pressure: Lessons from the Ebola Story

When you have to solve a problem big or small, the difference between success and failure often depends on the simplest actions. Consider the massive problem of containing a virus like Ebola. What separates contagion and containment comes down to little details, like using three pairs of gloves instead of one, and applying hand sanitizer after stripping off each layer.

Ebola treatment guidelines reveal the importance and the difficulty of paying attention to details when you need to perform under pressure. It might seem easy to follow basic procedures for removing parts of a protective suit in a particular order. But remember that doctors treating Ebola patients are often physically and mentally exhausted by the end of a shift; under these circumstances, following the most rudimentary sequence of steps can be a challenge. When experienced professionals are tired and stressed, mistakes happen.

The most basic behaviors are easy to overlook, but they make all the difference in avoiding errors. As Atul Gawande observes in The Checklist Manifesto, the operating room checklist for surgeons begins with a deceptively simple question: Am I operating on the correct patient? Perhaps an obvious question, but one that is easy to forget for that very reason. In the case of Ebola, the CDC created a tailored checklist – a set of procedures that would instill new habits in care-providers that are appropriate for managing the unique characteristics of this virus. The Ebola situation is a reminder of how important it is that you follow the right routines for managing specific risks, especially in circumstances where you are pushed to the limits of your capacity.

Anyone who has tried to exercise more or eat healthier has had to deal with a version of this problem. When you are drained at the end of a long day or under stress from tight deadlines, you have trouble resisting the allure of that late-afternoon donut or forcing yourself to go to the gym. Now, imagine you are physician who has spent an hour treating patients in a hot, humid Ebola ward. Do you think it might be hard to remember a simple routine like using hand sanitizer after removing each layer of gloves? You bet it is.

Doctors Without Borders implemented a buddy system for care-givers getting undressed. One physician in the program explained the value of these observers in a NYT article:

In the exit area, he said, “there was someone in charge whose sole focus was helping you get undressed safely.”

“You stood in front of them and did nothing until they said so,” he said. “They didn’t care if it was your first time or your 800th time. I was exhausted and emotionally drained. I looked forward to it.”

A buddy system works for creating new lifestyle habits, and you can see why it works for stressful work environments as well. Buddies—let’s call them “observers”—supply the willpower and focus when your own is depleted. Observers make a difference in the clinics of Sierra Leone and in many other situations. Coaches play the role of the observer for professional athletes, placing conscious attention on unconscious movements so that bad habits can be corrected and productive behaviors internalized, and consultants serve this function for executive leaders.

Most people underestimate the difficulty of following the right routines and catching the small errors that create big consequences. It is difficult if not impossible in the day-to-day flux of work to ensure you are following your own behavioral “checklists.” Tapping colleagues to be your observers (and doing the same for them) can help you internalize new habits that enable you to adjust to a dynamic and challenging environment. The Ebola story reminds us that when the stakes are high, small things make a big difference.