Introduction

When I started writing this book, epidemics didn't hold the attention of many people beyond epidemiologists and risk-policy wonks. Then, COVID-19 hit. By a freak of timing, I found myself writing as the pandemic ended hundreds of thousands of lives, closed our schools and workplaces, crashed the global economy, monopolized the daily news cycle, and drove us out of the open and into hiding, from our parks and streets and deeper into our screens and phones. Like all of us, I watched as the spread of a brainless virus exploited our societal divisions and inequalities, exposed the inadequacy of leadership and supply lines, and tilted a presidential election. A microscopic clump of genetic material enveloped in proteins made the reality of epidemics a palpable threat and an urgent teacher. It challenged our notions of command and control over our environment and opened the possibilities around what leading must become in a changed and changing world.

I write from my perspective as a doctor and particularly as an emergency physician. My clinical career began as a medical student at Stanford University and took root in the garden of pathology we call the emergency department during my residency at Hennepin County Medical Center in Minneapolis. I learned the highly specialized skills that allowed me to diagnose, treat, and resuscitate patients whose unpredictable palette of disease, distress, and destruction flowed into my workplace every day, night, and weekend. Over the course of my clinical career, I learned to find a sense of ease amid the chaos of lives abruptly unhinged from the illusion of "normal." I learned that high-trust team intelligence outpaced disconnected expertise. I learned that all the algorithms and protocols in the world don't equip us to match the way disease and illness multiply in our populations, a reality our health care personnel recognized only too well from the strain on them during this most recent pandemic.

I also write from the perspective of an executive who has worked with hundreds of leaders and teams over the course of my career. I had the opportunity to help an emergency department and two health care organizations work their way through duress and subpar performance to results both objectively demonstrated and subjectively immeasurable. As the CEO of my state's largest trauma center, I watched several thousand people turn an entire organization around when it was listing badly during the national financial meltdown of 2008 (and when cynics predicted our inevitable collapse). Perhaps befitting an emergency physician and others who find themselves facing the braver work of leadership, I have always worked and learned in places where what used to work doesn't anymore, where people are trying hard and wearing out, and where hope is essential and hard to find.

We live in such times and places today. We have too much to do and not enough time to do it. Our technology ambiguously speeds things along and rushes us so fast we can't think straight. Our models of organization, leadership, and governance are breaking down, or at least groaning and cracking, under the weight of problems that are large, complex, and interconnected. Our world, whether we measure it in divisiveness, environmental degradation, or the vitality of our workplaces and communities, grows unhealthier and more stressed. The future arrives and beckons our response, yet we resist. Leaders have to grapple with all these things in a way that enables people to deliver better results, to learn relentlessly, and to re-energize and reconnect. Somehow those things have to happen not once, not in a few places, but repetitively, everywhere.

Along came coronavirus, specifically SARS-CoV-2, an obscure idea of a germ morphed into a worldwide infectious, political, social disruption with catastrophic and fracturing consequences. No more hiding. It's in our face, here and real. It has threatened our bodies, rattled our minds, split our towns and neighborhoods, and shocked our systems. More quietly, it has asked us if we're ready, really ready, to accept a present reality that invites a powerful shift to a better future.

Epidemics represent and expose the scientific principles underlying networks, complex systems, biology, and, in the case of humans, neurobiology. Such disciplines are rife with research, complex mathematical and statistical formulations, and underlying concepts of physics and biology that can be bewildering. This book is not meant to be an in-depth scientific exegesis. Instead, it is intended as an invitation to think about leading with a new framework, a framework that unfolds into simple, accessible concepts and techniques that leaders can put to work wherever they are to create both individual participation and collective wisdom in a world where scaling both stability and adaptability has become non-negotiable.

The unsettling reality is that epidemics are here to stay; they're going to keep coming, and not just because of wet markets in China and close-clustered human populations and degraded habitats where long-locked pathogens can get loose, leap to us, and multiply across the globe. We have invited and designed a world of networks and swarms, and now we will have to adapt. Our computing power lives in clouds and networks; our social momentum rides on platforms and movements of easily accessible information and even more accessible-and influential-disinformation. Our small local worlds are linked, and the uptake and spread of ideas and actions-healthy and unhealthy-defines leading and following today.

These realities of the modern world-call it "high-velocity, high-volatility," VUCA, Industry 4.0, or just the twenty-first century-raise compelling questions for leaders.

• How do we deal with phenomena that come from nowhere and end up everywhere?
• How do we respond and act with agility without rushing ourselves into regressive patterns? How do we match the speed of what is coming at us while slowing down enough to create wide patterns of insight and intention?
• What do we keep, discard, and learn anew from a leadership perspective? What works and what doesn't anymore? How do we know?
• What do we need to understand to shape a positive future in our lives, teams, companies, and world?

The powerful possibilities are perhaps most compelling. We think, sensibly enough, about stopping epidemics, limiting their damage, returning to normal. At first glance-and second and third-the coronavirus is simply badness, destruction, hindrance. It exposes our operational bottlenecks, our leadership division, our social inequities. Look deeper, and it carries a leadership blueprint for effective action in a connected world.

If I have learned one thing in my lifetime of work as a doctor and a leader, it is that the world is abundant with good ideas and good people. I am only a single searcher of the billions of people who seek better ideas and ways, and I find them every day and everywhere-in the ER in the middle of the night, in slums in Africa, in schools and basketball teams, in start-ups and bureaucracies. Too often those ideas and people stay hidden and "uninfectious." We need them to rise now, to go epidemic and flood into every nook and cranny where their humble origins can metastasize into florid impact.

I have learned a great deal from the patients I have cared for and from the people who taught me and mentored me (which would include those conventionally labeled "followers"). I learned a great deal also from decades of long days out in bad weather and good in my Montana homeland, where the ubiquitous surging of living things defined my experience and shaped my subsequent thoughts. The science of my profession and the land of my upbringing have helped me understand the beauty and wisdom in biology. Amid a world that has ignored the lessons of biology for too long, my hope now is to share a bit of what biology knows to participate in an epidemic of good.

This book is about our changing concept of leadership in a century when things move faster and overwhelm sooner, where anything can become very big very quickly, and each of us can feel very small. This book is about how leaders can shape and scale both stability and adaptation far beyond their individual contact points; as such, it is also a book about the design and ethic of social power. The epidemics we face, whether Ebola or COVID-19, whether QAnon or racism or opioids, are not going away. Indeed, conditions are set that will invite them to flourish and erupt.

This book has two sections. The first section builds from the universal experience of well-intentioned individuals who find themselves overwhelmed, starting with my sobering encounter with that reality as an emergency physician. Chapter 2 explores the potential advantages of how epidemics arise and grow for those who are encountering the "math problem" of personal effort in the face of diffuse and powerful obstacles. Chapter 3 delves into the implications of complex environments on what leadership does and how it will need to operate in our era of immense challenges. Chapter 4 explores the secret sauce of epidemics for leaders, the idea of self-organization that offers a flywheel to scaling the deliverables of leadership: performance, learning, and vitality.

The second section focuses on the practice of epidemic leadership and how leaders can design and sustain positive epidemics as systemic leverage in human systems. Chapter 5 emphasizes the identification of a positive...