The silent killer — toxic ambiguity

One of the most overlooked, yet lethal forms of organizational rot is toxic ambiguity. Basically, killing people with fog, Jim VandeHei writes.

Why it matters: 

Think of all the time wasted, relationships ruined, budgets missed and moods fouled by leaders or managers offering hazy direction.

  • Ambiguity is a silent killer — like a slow natural-gas leak. You don’t realize until it’s too late that you have a massive, spreading issue.

Gallup developed a workplace survey system for companies to track engagement and performance. We use it at Axios to spot pockets of emerging staff issues.

  • We often score lower than I’d like on the first question — whether “I know what is expected of me at work.” This drives me nuts: How can any person at any level not know what their damn job is?
  • Turns out, this is common. Many people feel foggy, even if leaders feel they’re being crystal clear.

The toxicity comes when the ambiguity is so thick others can exploit the cloudiness, or suffer from it. Here are some common manifestations to watch for:

  1. Fuzzy strategy. In an ideal world, any person under you should be able to jump out of bed at a moment’s notice and recite the three most important things you’re doing as a company or organization. If they can’t, how can they guide others or prioritize? The only remedy for this is constant, clear repetition of what matters most.
  2. Fuzzy thinking. If you’re a leader and you can’t articulate those three things with precision and certainty, you’re screwed. It means you didn’t sharpen your own thinking before trying to sharpen the thinking of others. This is why I constantly write down what matters most so I can stress-test my own clarity.
  3. Fuzzy communications. You might have strong, concrete thoughts — but not explain them clearly. That’s akin to having the perfect, delicious recipe, but not following it — and then wondering why people don’t love your dish. Your ideas might be brilliant. But if you don’t find strong, memorable words to express them, they will be lost.
  4. Fuzzy accountability. This one often trips me up. People don’t know they own something unless explicitly told and empowered. And others don’t know whom to listen to unless you make it clear who’s the decider. Little gets done right without clear accountability, dictated and announced in advance.
  5. Fuzzy feedback. Few things cripple individuals, teams and companies more than foggy feedback. Many managers are afraid to be direct, and hide what they mean by over-talking or over-complimenting. This leaves people confused about their standing and what they need to do better.

💡 What you can do: If you’re unsure what’s expected of you, that’s on you!

  • Ask your boss: “What’s the No. 1 thing I’ll be judged on?” or “What is Job 1 for me — the biggest specific thing I need to do for the team?”
  • If you get a foggy response, push for clarity. It’s tough to crush a performance review if you don’t know what’ll be reviewed.

The big picture: 

Clarity and candor are tough but essential — especially in anxious or uncertain times.

Threats of prison time put gynecologists in impossible circumstances

In states with laws that criminalize performing abortions, physicians are facing the dilemma of having to wait until a pregnant patient’s death is imminent to perform a potentially lifesaving procedure. Reporting from STAT News reveals how these laws are disrupting care. A physician in Missouri, which outlaws all abortions unless the life of the mother is in danger, described having to spend hours getting clearance from a hospital ethics team to perform the procedure on a patient with an ectopic pregnancy.

Even non-pregnancy care is being impacted. An arthritis patient taking methotrexate, which can also be used for abortion, was told by her doctor that all prescriptions for the drug are on pause due to legal uncertainty.

The Gist: Doctors and hospital legal counsel are dealing with a new legal landscape, marked by restrictive, ill-defined anti-abortion laws that fail to clarify what constitutes a medical emergency.

Physicians are forced to interpret unclear laws, often written without help from medical professionals, and many feel compelled to wait until patients are in dangerous, life-threatening situations to provide care—the opposite of what was instilled in them during years of training.   

COVID vaccine strategy still murky after FDA experts meet

The COVID-19 vaccine strategy for the fall remains beset with unanswered questions after an FDA expert panel on Tuesday spent hours debating how and whether to update the shots.

Why it matters: Time is running short to develop a game plan with existing vaccines losing effectiveness against new variants and more than half of Americans still without a booster dose.

Driving the news: The Vaccines and Related Biological Products Advisory Committee voted 19-2 to recommend an Omicron-specific update to COVID-19 booster vaccines expected to be rolled out within the next few months.

But key questions were left unanswered:

  • The panel didn’t formally decide whether to update shots with the prevalent Omicron strain in circulation, currently the fast-spreading BA.4 and BA.5 subvariants, or the BA.1 lineage that emerged late last year, as the World Health Organization recommended.
  • The consensus appeared to be for a bivalent, or combination, booster combining the original COVID-19 strain that emerged in late 2019 with BA.4 and BA.5.
  • The FDA will continue to evaluate what to do about the primary series of vaccines for the fall.
  • Experts were split on whether there was enough data to recommend the updated shots for kids, or whether more studies are needed on dosage and possible side effects.
  • There also were concerns about what effect an updated vaccine would have on developing nations’ willingness to use older COVID shots to inoculate their populations.
  • And above all, it’s unclear whether all the questions about who gets which shot when will add to public confusion and apathy that’s dogged the vaccination effort in recent months.

What they’re saying: “None of us has a crystal ball and we’re trying to use every last ounce of what we can from predictive modeling and data that’s emerging to try to get ahead of a virus that’s very crafty,” said top FDA vaccine regulator Peter Marks.

  • “Unfortunately, looking in the past doesn’t help us a great deal to look in the future for [a] virus that has baffled a lot of us and made predictions almost irrelevant,” said acting panel chairman Arnold Monto, a University of Michigan epidemiologist.

The timetable: Pfizer-BioNTech said an updated mRNA vaccine could be ready in October if regulatory uncertainties are ironed out. Moderna said it could have large amounts ready in late October or early November. Novavax is still awaiting emergency use authorization for its protein-based shot, but said it could have an updated vaccine by the fourth quarter.