Dr Irina Cojuharenco discusses the importance of building rather than dividing capacity, especially in the wake of COVID-19, based on an exercise she frequently runs in modules on leadership and decision-making at Surrey Business School.

Who lives?

Titled “Who lives?”, the exercise hits very close to home at the peak of COVID-19, or as we fear, virus resurgence. It was developed by Northwestern’s Dispute Resolution Research Center to teach a powerful lesson: do not waste resources (time, mental effort, conversation) on fighting access to a limited capacity when the same resources can be spent building capacity.

Students are asked to imagine that they are members of a hospital committee that decides who would get access to kidney dialysis out of 12 end-stage renal disease patients. The patients differ in age, occupation, gender, number of dependants and nationality. Sadly, notes Dr. Cojuharenco, that’s enough to set up a powerful trap for the quality of committee deliberations, which quickly devolve into a discussion of whose life is more important.

Ultimately, most groups fail to decide anything within the limited time available for making the decision. And yet, the biggest blow is served in the debrief, when students are told that all lives could be saved because the patients on the list did not all need the same type of care in terms of pace, duration or mode of administration. Capacity could be thought of more broadly to include the possibility of extra-shifts, sharing patients with partner hospitals and dialysis centres, and even simply verifying some of the assumptions about existing capacity which may have been false.

“Before we ask ourselves how to divide a limited capacity, let’s ask ourselves: What are we to divide?”

Let’s build

The problem the students encounter in “Who lives?” teaches a powerful lesson well beyond crises. For example, when research funding agencies encounter too many grant proposals that meet the criteria for high quality, additional efforts may be invested in ‘splitting hairs’ over who to fund. Alternatively, the funding agencies could choose proposals at random and invest in efforts to secure additional sources of funding or other resources that may help high-quality research. The time spent on dividing a limited capacity could be spent on building more.

It’s a lesson for all times. Yet, the relevance for dealing with COVID-19 is striking. Another outbreak will undoubtedly make people face horrible decisions, working with limited capacity at any given moment in time. And yet, while we have time on our hands, we mustn’t engage with efforts that are outright wasteful. We need to say no to divisive rhetoric of any form, and yes to conversations about better health care and vaccines, tracking apps, services that help the vulnerable, innovation that makes it possible to work at distance, exploring how the young can help the elderly and how people in different countries can learn from each other.

“Let’s build, and it will protect us from horrible decisions in the future.”