The Vasa: A Cautionary Tale for Covid-19 Vaccine Development...

What is the Vasa? It was a Swedish warship built in 1628. It was supposed to be the grandest, largest, and most powerful warship of its time. King Gustavus Adolphus himself took a keen personal interest and insisted on an entire extra deck above the waterline to add to the majesty and comfort of the ship, and to make room for the 64 guns he wanted it to carry.

This innovation went beyond the shipbuilder knowledge of the time... and would make it unstable. No one dared tell him. On its maiden voyage, the Vasa sailed less than a mile and sank to the bottom of Stockholm harbor in full view of a horrified public, assembled to see off its navy’s—and Europe’s—most ambitious warship to date.

What reminded me of the Vasa? The time has been ripe for visible motivational speakers to weigh in on Covid-19 and “inspire the troops.” From a speech using the Vasa as a backdrop:

“I want to see healthcare become world-class. I want us to promise things to our patients and their families that we have never before been able to promise them.... I am not satisfied with what we give them today.... And as much respect as I have for the stresses and demoralizing erosion of trust in our industry, I am getting tired of excuses....

“To get there we must become bold. We are never going to get there if timidity guides our aims.... Marginal aims can be achieved with marginal change, but bold aims require bold changes. The managerial systems and culture that support progress at the world-class level... don’t look like business as usual:
1. Bold aims with tight deadlines
2. “Improvement” as the strategy
3. Signals and monitors—providing evidence of commitment to aim, giving visible evidence of strategy via managing monitors
4. Idealized designs
5. Insatiable curiosity and incessant search
6. Total relationships with customers
7. Redefining productivity and throughput
8. Understanding waste
9. Cooperation
10. Extreme levels of trust

“The lesson about the Vasa is not about the risk of ambition. It is about the risk of ambition without change, ambition without method.”

Oops! Wrong speech. These words are from... 1997!

The above is extracted from a plenary speech given by Donald Berwick (link to video at end of article), an acknowledged leading expert in healthcare improvement.

Look at his 10 challenges. What’s changed in the 23 years since that speech? Here’s the long version of my answer (short answer: not much), and I wonder: Did improvement become an industry that ironically just got better at building various versions of a Vasa?

Berwick published yet another inspiring article the other day—somewhat of an update of his words from 1997 transplanted to a “bigger... better... faster... now!” world. As I read it, noting how shocked… shocked! he was at how long it takes improvements to become accepted and inculcated, it begged the question: Are ongoing organizational improvement efforts a waste of time unless there’s a violent “whack on the side of the head” to upset the status quo?

Even then: Are highly visible leaders who shout from an armchair, “C’mon, people—the time is now!” going to make such things magically appear in today’s unprecedentedly stressful environment? (And I’m also getting tired of high-profile people “getting tired of excuses.”)

Joining this chorus are the consultants with their own distracting chants of “Tsk-tsk,” “Tut-tut,” “Applying lean principles...” “Dr. Deming says...” “Most problems are due to bad processes,” and, “Leaders: Help your employees take joy! in their work.”

Want to know what the front-line folks, once again feeling patronized, hear? “Blah, blah, blah.”

As President Eisenhower said in 1956: “You know, farming looks mighty easy when your plow is a pencil, and you’re a thousand miles from the corn field.”

Back to the Vasa

To refresh my memory a bit, I looked up the Vasa and found a paper (please read!) that gave a chilling account of its chaotic design and development process as well as a sober analysis of 10 lessons to be learned.

Is this where we could be headed in a Covid-19 vaccine development... especially when very visible, big-ego people get involved?

Is it also time to reevaluate our efforts at improvement and blow up some of the Vasas that have been unwittingly built... and continue to be encumbered with more decks and cannons? Start here.

Link to Berwick’s 1997 Vasa speech (you will have to register with the IHI site, but it is very reputable). Actually, I think Berwick’s speeches from 1993 and 1995 (links to videos) are just as inspiring (especially 1995), if not more so, and well worth your time. Note that my recommendations end there (here’s why), and come to your own conclusions.

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