From TB epidemics to the flu pandemic in 2009 and the recent fungal meningitis outbreak that has killed 36 people in the United States, Dr. Thomas Frieden has dealt with public health crises for more than two decades. As director of the federal Centers for Disease Control and Prevention for nearly four years, Frieden has led an Atlanta-based organization with an $11 billion budget and 11,000 employees who work in 50 nations to identify and control epidemics, as well as to promote healthy behaviors.
Prior to leading the CDC, Frieden, 51, was New York City’s health commissioner. Known for his expertise in controlling tuberculosis and as an anti-smoking advocate, he began his public health career with the CDC in 1990. He first worked in New York and then spent five years in India battling TB. He talks about his experience there, as well the best ways to manage a crisis, regardless of what it is.
Q: What’s the best advice you received from your father, a cardiologist?
A: That you can learn a lot from other people. Mentors have been very important to my professional development. I’ve sought out people who can teach me. I never thought, “I have to do this myself.” The goal is to climb a mountain, and so you get all the good advice you can about what are the best routes to take, not to take, and what to carry with you.
One mentor told me about the value of being “very rigorous, very modest and very focused.” New York City Mayor Mike Bloomberg taught me that the most important thing you can do is hire staff who are smarter than you are.
Find good sources of insight and bounce things off of them. It’s not a formal mentoring program. You call, email, write a letter — we used to do that, remember?
Q: How do you manage such a large organization?
A: In an executive position, there are an infinite number of things you can focus on. There are things that are going to happen no matter what. You’re not going to make much of a difference, good or bad.
Then there are things that are on the bubble, that could go either way. Success is not guaranteed, but if you really make a focused effort you can succeed.
These are priorities or “winnable battles.” I try to take a simple approach and ask, “How do we save the most lives? How can we have the most health impact?” That’s how you pick your priorities, where you can make the biggest difference.
To implement that, three things are important. One is you have to have feedback loops that tell you how you are doing. You need data.
The second thing that’s necessary is hard work. The third thing is to never forget the big picture. Public health is at its best when we never forget the faces behind the numbers. It’s about people’s lives.
Q: Speaking about life and death, you’ve confronted many public health crises during your career. What is the best way for a leader of a business or organization to deal with any crisis?
A: There are a few things you’ve got to do right. The first is you have to have a division of labor. You need to know who’s doing what.
Second, you need data. You need to quickly figure out what is going on and where your data stream is coming from.
Third, expect a fog of war environment. It’s always going to be a little confusing. You have to be comfortable with ambiguity. We will get in the most trouble if we assume we know things that we don’t. In medicine, there is the “dangerous intern syndrome.” The guy who kills someone as an intern is not the guy who doesn’t know anything. It’s the guy who doesn’t know he doesn’t know anything.
The final thing is communication. You’ve got to be upfront with the public. You’ve got to over-communicate. You’ve got to tell them what you know, what you don’t know and when you’re going to find out what you don’t know. You’ve got to do it in real time.
Q: Should the top leader of a business or organization manage the crisis?
A: No. The CEO should not be the person running the day-to-day crisis response. That would be a mistake. There should be an incident manager who is not the CEO. The incident manager should be orchestrating the division of labor I talked about before.
The CEO needs to be protecting those people from outside forces and communicating with others outside the organization, such as the media or Congress or the White House.
The buck still stops with the CEO. But you need to hire people who you trust and then trust them. If a CEO tries to manage every aspect of an emergency, he or she is going to mess it up. Other things are happening and the CEO will never be able to focus as much energy as you need to.
I didn’t fully understand that until a crisis hit when I was the health commissioner in New York City. I realized that if I tried to manage the crisis, I wouldn’t be managing the context so that the department can do its job right. I can either manage the response or the context, but I can’t manage both.
Q: You spent five years in India battling tuberculosis? What did you learn?
A: By far, it was the hardest thing I’ve ever done. I was an adviser to the government of India and to state governments there, but I didn’t have any authority whatsoever. I was prominent in tuberculosis control in this country, but that was invisible to them in India.
I had to recognize that most of what I knew was not relevant to the situation there. I had to relearn things.
The first thing I did was to go out to the 18 pilot sites throughout the country. I figured out what was working well and what wasn’t. Within about six months, I knew more about what was happening on the front lines than other people did. So they started to come to me and ask questions about what works.
It was difficult. There’s more than a billion people and the government system doesn’t always work as well as you’d like. I used to say that in India irrational optimism was a prerequisite for success.
Each week, Sunday Business Editor Henry Unger has a candid conversation, called “5 Questions for the Boss,” with a top executive in Georgia. Some remarks are edited for length and style.