(HHS photo by Chris Smith)

Dr. Nicole Lurie is the assistant secretary for preparedness and response at the Department of Health and Human Services (HHS), where she leads federal efforts in preventing and responding to the adverse health effects of public health emergencies and disasters.

She spoke about her experiences and management philosophy with Tom Fox, a guest writer for On Leadership and vice president for leadership and innovation at the nonprofit Partnership for Public Service. Fox also heads up their Center for Government Leadership. The interview has been lightly edited for length and clarity.

Q. What role are you playing in supporting the international response to the Ebola outbreak in West Africa?

A. We're partnering with the CDC (Centers for Disease Control and Prevention) and other HHS agencies to ensure that U.S. healthcare providers, hospitals, health clinics, emergency medical services and healthcare coalitions have the information they need to be prepared to identify and treat Ebola infections, in case anyone in the United States becomes sick after traveling from affected countries or from contact with infected individuals.

We're also building on our interagency and industry partners to accelerate the development and testing of vaccines — and to be prepared to scale up manufacturing if they prove safe and effective.

Q. What led you to a career in public health?

A. I was a rebellious kid, but not your typical rebellion. Instead of going to high school for my last two years, I worked every day with some pediatricians in my community who were involved in a screening program for lead poisoning. So early on, I learned firsthand about the relationship between poverty, housing, education and health, and I dedicated myself to making a difference in urban poverty. I saw that working in health was a way to do that.

Q. What are your top organizational goals?

A. Our ability to respond to a crisis is built on the back of our day-to-day systems, and how strong they are. If everyday systems are rickety, they’re not going to work very well in a disaster. So one of my priorities is ensuring our preparedness work focuses on strengthening day-to-day systems and building their resilience, whether they’re the public health system, the emergency system or our health-care system at large. We all know we have a lot of work to do in all three of those. The systems that influence health also need to be able to withstand stress and function well through adversity, which means not simply returning to normal, but becoming better and stronger after any disaster.

Q. What do you look for in terms of a workplace culture?

A. I strive to create an environment that constantly promotes innovation. It’s a way for people with good ideas to bring those ideas to the table. I’ve been amazed that there are all kinds of people in this organization with hidden talents, and it’s great to be able to have those surface and for people to contribute to the mission in novel ways. We also work toward a culture where people can share without retribution things that don’t go so well, so we can improve — that’s always part of good emergency response and we want to normalize that kind of feedback.

Q. What are the steps your office has taken to ensure that the United States is prepared for an adverse public health event?

A. We’ve made tremendous progress — and have a long way yet to go. We’ve created unique partnerships with industry to develop new drugs, vaccines, and diagnostic tests to help protect health in bioterrorism incidents and pandemics; we have a dozen we didn’t have 10 years ago and more on the way. We’ve done a lot to improve our response capabilities to be more nimble and flexible, and we’ve done a huge amount to partner with states, local communities and industry to build readiness and response capabilities.

One of the challenges following 9/11, the anthrax attacks and then Hurricane Katrina was that they all happened after a quarter century of disinvestment in the public health system. We’re reinvesting, modernizing, and moving from constantly digging out of a deep hole to a culture where we really try to prevent problems before they’re created.

Q. What steps do you take to collaborate across sectors, across agencies and within your department?

A. We’ve established great day-to-day relationships with state agencies and within local communities to be sure that health is considered in every emergency response. In fact, we’re partnering now with the Rockefeller Foundation to connect our regional emergency coordinators with new resilience officers that their grants support in U.S. cities. We want the health-care community positioned to work well as a coalition.

Q. What have been some of the lessons you’ve learned from handling disasters?

A. When I think of Hurricane Sandy, I can remember driving through the Rockaways in New York — because I insisted on going down there and seeing it for myself. I had been told, “There’s no reason to go there. Nobody’s out there, the streets are empty and people have evacuated these buildings.” I was driving down the street and all of a sudden we came upon a line of around 300 people outside in the cold. I spent 45 minutes on the streets talking to people who had gone back to these high-rise buildings. They had no heat, no food and no medicine, and many were wheezing. I got an incredibly different perspective about what was going on. Seeing it with your own two eyes and talking directly to people who are affected is crucial.

Q. Have you had situations that have gone awry that ended up providing you with important leadership lessons?

A. Learning from every incident is a fundamental leadership skill, and it’s not always easy. During the H1N1 flu pandemic in 2009, we couldn’t get flu vaccines out fast enough to meet demand. Around the same time we also had other hiccups in product development. That caused us to take a step back and examine the whole system of developing emergency drugs and vaccines — how the economic incentives work, and how the governance and decision-making work. We retooled the governance and decision-making structure so it’s strong and we’re better positioned for the next pandemic and other emergencies. And we’re seeing payoff as we help to respond to this Ebola crisis.

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