Lessons from a 1944 CIA manual

The now declassified CIA Simple Sabotage Field Manual was created in the 1940s to help CIA agents “harass and demoralize the enemy”. It came to my attention via Atlas Obscura, and I thought some of the tactics might be familiar to those who work to implement change within hospitals and healthcare systems.

Here is the list of 8 methods for “General Interference with Organizations and Production” (page 28):

• Insist on doing everything through “channels”. Never permit short-cuts to be taken in order to expedite decisions. 
• Make speeches. Talk as frequently as possible and at great length. 
• When possible, refer all matters to committees, for “further study and consideration”. Attempt to make the committees as large of possible—never less than five. 
• Bring up irrelevant issues as frequently as possible. 
• Haggle over precise wordings of communications, minutes, resolutions. 
• Refer back to matters decided upon at the last meeting and attempt to re-open the question of the advisability of that decision. 
• Advocate “caution”. Be “reasonable” and urge your fellow-conferees to be “reasonable” and avoid haste which might result in embarrassments or difficulties later on. 
• Be worried about the propriety of any decision—raise the question of whether such action as is contemplated lies within the jurisdiction of the group or whether it might conflict with the policy of some higher echelon. 

Other key advice to managers and supervisors includes: 

• Hold conferences when there is more critical work to be done. 
• Multiply paperwork in plausible ways. Start duplicate files. 
• Apply all regulations to the last letter.

Now go forth and do the opposite!

Putting the "or" back in your org chart

Having trouble figuring out how to reward and promote people within your department, hospital, or infection prevention program? Maybe you should try this. Playing off the age-old Peter principle (that every new member of an organization eventually is promoted to his/her level of incompetence), these investigators use game theory to demonstrate that the best way to improve organizational efficiency is to promote people at random.

Active resisters & organizational constipators: Do you know them?

A new qualitative study by Sanjay Saint at the University of Michigan appears in the May issue of the Joint Commission Journal on Quality and Patient Safety. His team interviewed multiple individuals at 14 hospitals to determine barriers in the implementation of evidence based practices to reduce HAIs. Through these interviews he identified two prototypical personalities that wreak havoc for infection control programs. The first is the active resister, a person who vigorously and openly opposes change. The active resisters were often identified as surgeons and anesthesiologists. The second problematic individual is the organizational constipator. This is a mid- to high-level administrator who prevents or delays actions without active resistance, forcing infection control personnel to invest more energy to work around these individuals. Though the authors note that the findings of the study may not be generalizable to all hospitals, I’d bet a sizable sum of money that what they describe is a universal phenomenon.