---
narrator: Chi Ling Chan
subject: Public health systems
facilitator: Nathan Schneider
date: 2025-10-31
approved: 2026-04-19
summary: "A co-architect of Singapore's COVID-19 response now designs health protocols in diverse settings."
location: "San Francisco / Denver"
headshot: "chi-ling_chan.jpg"
topics: [bureaucracy, health, government, organizations, science]
links:
  - text: "Equitech Collective"
    url: "https://equity.tech"
  - text: "Speedback"
    url: "https://speedback.com"
---

*How would you like to introduce yourself?*

My name is Chi Ling. I'm from Singapore. I've been working in healthcare for the last decade, mostly in public health, where I work with clinicians and practitioners to protocolize and systematize care.

*How did your journey with public health begin? When did you decide this is something you wanted to focus on?*

When I first started my career, I didn't think I was going to go into public health. My background was in symbolic systems.

*What are symbolic systems?*

I did my master's in symbolic systems at Stanford. It's where you apply computer science to a variety of disciplines, including neuroscience and linguistics. The idea was to not just do software development but to apply software and computing in multidisciplinary and interdisciplinary domains. There were only two schools, I think, in the States that offered this. It was MIT and Stanford at the time.

I was a stranger to healthcare until I started work in Singapore. My foray into healthcare came mainly through my first posting with the Singapore government in the prime minister's office. We do this thing called scenarios planning, an exercise borrowed from the Defence Ministry. The idea was for a country to look ahead twenty years and then see what are the driving forces that would shape this country so that we can be prepared both to harness the opportunities or to prepare for black swan events. I was part of the National Scenarios Team 2015, projecting to 2030. That's how long the time frame was for Singapore planning. I was looking across the driving forces, and one day I realized we didn't write about aging. But the demographic challenge is real. The numbers don't lie. The writing's on the wall. By 2030, about one in four Singaporeans will be sixty-five years of age and above. That's actually huge. There's a tsunami coming that we don't quite feel in the moment. It's going to change how we care for our parents. It's going to change how we run our healthcare. The demands of the system and the strain of the system are real. People were thinking about it, but not in a very systematic way.

Healthcare in Singapore is very top down. It's a highly regulated industry. It's corporatized. It's got three clusters that compete with each other or collaborate at times, but it's highly regulated. I thought, this is a domain where we could have so much impact if we get our policies right--if we get our protocols right. I looked at the stats, I looked at the scale of the problems, and I thought, I'm going to work in healthcare. It was a very intellectual exercise. It wasn't because I had a family member who was ill thatillhad cancer that sort of nudged me in that direction. But I felt that something needed to be done after looking at this holistically.

I did my second posting in the Ministry of Health and the Agency for Integrated Care. We looked at aged care. How do we make sure there are enough doctors and nurses to take care of the population? How do we think about new care models? Something about healthcare also appealed to me because I remember someone did an interview with me when I was about 18, the local press. They asked, "What do you want to do?" I said, "I want to build good systems with good protocols because I think that good systems and good protocols are the foundation for good defaults." Defaults are things you don't think about. They're habitual. They're reflexive. They govern your instincts. You don't think about being a good person when you help somebody on the road. It's just reflexes. Those reflexes are more powerful than willpower.

*Did you experience good defaults or good protocols earlier in life? Were there moments that you look back on as teaching you that this is important?*

I think so. So much of life is things that are beyond your control, like the parents you're born to, the environments you grew up in, the country I was born in. I look back at how I got the opportunities that I got, to study at some of the top institutions, to get the kind of quality education that I had. Somebody had put in place the systems to invest in the next generation, and I was a beneficiary of that. I just happened to be lucky enough to be born to a good system in Singapore that believed in the value of education, that believed that everybody should have the chance to own their own homes. Those are defaults that people are born into, unthinkingly. But if you take a step back, you know that you can't take that for granted. I've traveled around the world to know that these are not defaults everywhere. It didn't take me very long to appreciate the value of good systems. You can say we just need people who do good. But doing good takes a lot of willpower, a lot of thinking, and a lot of cognitive bandwidth. If you have good systems, you don't even think about it. It is good by default. I value good systems more than philanthropy---they create much better defaults than billionaires giving away some of their wealth after having made a vast fortune.

*That could be an expression of a broken system.*

Exactly. It's as if you've already exploited a broken system, and then you're trying to atone for it or redeem yourself. I don't think that's as meaningful as just building good systems by default. Nobody has to give anything to anybody if there are good systems. You shouldn't have to count on goodwill. I just felt that good governance is where you have intentional system architects who think about, from a very utilitarian perspective, how you maximize the good you can create for society.  It's faceless, but I also think that's a very beautiful way of giving. It's a very anonymous way of giving, like how parents give. If you have kids now, they're not going to appreciate you for what you're doing right now. It might take them years to grow into adulthood and mature and look back and go, "Oh, actually, my parents did all these things for me." But you're creating those defaults. That's a beautiful thing. In the very early days, since I was 18, I thought, I would love to build good systems and good protocols where people can, by default, exist in a virtuous sort of environment where their being creates good for others---where you don't have to do good, you can just *be* good.

*How did living in the United States affect your view on system design?*

I came to the US from 2011 to 2015, and mostly spent my time at Stanford, on the West Coast. I worked a little bit in San Francisco and saw the astonishing inequality. I was in the richest country in the world, and there was this endemic homelessness. That was the biggest cognitive dissonance I experienced. I went back to Singapore in 2015 to serve in the public service.

*What kinds of things were you doing there in the office of the prime minister?*

It was like an extended master's program. I had so much fun during my first posting. I was basically given a lot of latitude to think about the future. My job title then was Futurist/Strategist. Of course, we weren't actually gazing into crystal balls. We were looking at all the driving forces in the world that could affect this little red dot that is Singapore. It was partly a very intellectual exercise, but it was also very grounded in empirics because we had to get out there in the world and interview experts. I remember we were looking into blockchain before blockchain was popular. It wasn't just about having a view of everything you could see coming. We were thinking about the present. How do you nudge the system to think a little bit more strategically or with a bit more foresight of what's to come? That was my first role. It gave me good insight into the inner workings of bureaucracy and governance. People talk about the word bureaucracy with a lot of disdain, but I've seen how a good, well-functioning bureaucracy can be so instrumental to a country's success.

*And it was in that role that you identified public health as a set of systems?*

After those two years, I told my boss, "I want to work in the intersection of healthcare and technology. Send me to those places."

*I imagine you might narrate that experience as a pre-COVID period and then a COVID period. Is that fair?*

I would break it down to pre-COVID, COVID, and post-COVID. I think those are bookends that most people understand.

*What were you doing pre-COVID?*

Pre-COVID, I was working in manpower and community care in the Ministry of Health. Eighty percent of the healthcare operating budget goes to manpower---doctors, nurses, allied health professionals, salaries. I was working a lot on policy planning. I was also looking at community health. How do we get people out of the hospital? The hospital system is where a lot of resources are invested, and we know that good health happens outside of it. I also looked at how we create systems where people would value care work, not just through rebranding but by addressing bread and butter issues like workforce salaries and progression.

Why are Singaporean youth not going into healthcare, even though it's a very respectable job? It's hard work. Shift hours are long. It's not awfully well paying, even though there's a lot of human value being created. In Switzerland, you've got young graduates who work geriatricians at a very young age. We just don't see that in Singapore. A lot of that is outsourced to foreign workers. I was trying to see, "Can we change that system of how people value care work?" Uphill task! I don't think I made a lot of headway. We tried to increase salaries, we tried to rebrand jobs.

I had this idea---because Singapore has compulsory military service---17-, 18-year-olds get basic military training as part of mandatory conscription. What if there were basic medical training instead? We aren't actually fighting a war, but you have another kind of war domestically: our minister had waged war against diabetes in parliament just years ago. I came up with the idea of a volunteer corps---and the basic idea was, "Can we create what the police and military already have: a volunteer corps that engages civilians as extenders to full time service people?" I drafted the plan, did the research, and proposed it to management. They said, "Okay, great. But unless there's a crisis, there's very little impetus to just launch it." Then COVID happened.

My bosses quickly took the plans I drafted out of the drawer and said, "Hey, this is the right time. We need a reserve. We don't have enough people taking care of everybody, whether it's in the infectious disease departments, swabbing operations for testing, vaccine deployment, lots and lots of manpower being needed. Why don't we make a public call for retired nurses to come back, for private sector practitioners to come back?" We created protocols and systems to systematically recruit volunteers, train, deploy volunteers. About twenty-two thousand of them stepped forward. We managed to put a lot of laypeople through training so they could get basic infectious disease control training and administer swabs. It was interesting to enable people to step forward and provide care. That was my dream. How do you get people to value care? You have to make the need clear. If people don't see the need, they don't see the value of people doing the work. COVID was the best time to do that. People had time on their hands because of the lockdown, and wanted to do something to help. We launched it, and within two weeks, thousands of people started registering their interest.

Later on, I did a lot more on building good technology and systems and software for a range of healthcare operations. That included vaccine deployments, testing operations, home recovery programs. If you remember, in the thick of COVID, we had Omicron, Delta, and various surges, and every public health system had to completely rethink their plans and improvise on their feet. What would take people years had to manifest in weeks. I was part of a team, one of many teams, that had to come up with these systems and protocols within weeks. I could go more into that if you want, but I'll skip ahead to the post-COVID era. 

There were a lot of lessons that were learned during COVID that I think we weren't harnessing. We weren't applying them to other domains of healthcare. Lots of systems worldwide became sluggish. Things were really fast during COVID. But the protocols and systems that we set in place were very much wartime. Then things fell back into peacetime. I saw a lot of opportunity. If you've seen how quickly things can move, and how we could move mountains during COVID, you could apply that to many challenges in global health. If you keep that momentum up, that would be tremendous. We've learned so much from COVID. Why are we not applying that to everything else? I decided there was no going back.

*I can understand why people didn't want to go back---it was exhausting, right?*

It was, but I think some of us saw that it could be done. You don't have to be on a war footing all the time, but there are lessons we've learned that can be applied.

That was the next chapter, I would say, when I left the government and did a lot more regional and global health work outside of Singapore, because I saw that the need was a lot more acute outside of Singapore, which is very well resourced. When you talk about Cambodia, Malaysia, Timor-Leste, these countries with millions and millions of people. I was asked to go to Vietnam to help with some of the vaccine deployment---one hundred million people. I said, "I can't help you. I only built systems that served five million people, and most of them didn't live in remote rural areas like Vietnam did. But I can tell you what worked for us." I would be under no illusion to think that our protocols could work for them, but I could share some principles.

*To go back a little bit, I wonder if you could say more about what changed when COVID hit. You were already developing new kinds of systems to solve systemic problems in the health sector in Singapore. What lessons do you think you'd already learned that then you were able to apply?*

I think systems are not abstract things. They're mainly made of people. If you don't know the people in the system, you're not going to make the system work. Most of my time pre-COVID was just understanding how people functioned in a bureaucracy. It's a great lesson in anthropology. Sometimes it's collaboration and sometimes it is competition. You have to deal with both. Pre-COVID, I was getting an education about how people work in real life, which is totally not what the textbooks tell you. If you study political science---I did political science as my major at Stanford for undergrad---lots of theories completely fall flat in real life. You could apply them selectively, but there's just a lot more ambiguity, a lot more uncertainty and chaos in real life. People are a lot less predictable. They're not definitely the *homo economicus* that a lot of philosophers talk about. They're not entirely rational. Pre-COVID was just understanding people and how to work with people, as any good training ground might be.

I also was very lucky to have mentors who believed in me and gave me a lot of latitude in imagining and refashioning things. They never discouraged me. There are a lot of things that are discouraged in a bureaucracy. It is, by definition, about the status quo and about inertia. You don't want a bureaucracy that is unstable. It's meant to be a very stable system. But there is also a need for progress. Not everybody needs to be stirring the pot all the time, but maybe 10 percent of people might need to nudge the system in a different direction. I was one of the restless ones who always saw things that felt a little off. Pre-COVID, I was seeing parts of the system that had potential, protocols that were built on legacy systems. There were defaults that people didn't question because they were just there.

The thing about protocols is that there was once a time when these protocols worked. They were built for a given time. It's just that things have evolved, and the protocols couldn't keep up. In software development, you do updates and patches and fixes very quickly. But in systems, human systems, we don't do that as much. We can't just release a new system. It takes time to make a change in human incentives, behavior, and habits, which is a lot harder than just pushing code. These protocols are systems of humans and their embedded habits that need to change in order to get to a different destination. 

During COVID, there were a lot of protocols in place that didn't serve the COVID scenario anymore. We had to conjure, improvise, and come up with something on the spot. What you saw in Singapore---and a lot of people celebrated the Singapore model---it looked like we had our act together. But it's more like what we call the Stanford duck syndrome, which is serenity on the surface but frantic paddling underneath. I was beneath that waterline where I saw all the frantic paddling, where protocols and systems were being created overnight with very limited information. Then you realize that actually all protocols can be changed. What makes us think that these legacy systems and beliefs can't be altered? They absolutely can, and we see that in a crisis.

*Can you give an example of a way in which your anthropological insights applied in the design of a COVID protocol?*

Most of the insight is around why people resist change and why people conform. People are generally creatures of comfort. We don't like change because change is hard work. We have belief systems that don't like to be challenged. But when situations change, or if there is a vision that could bring us to a better place, the default in a bureaucracy is to resist it. There's very little incentive to take risks, because if you take a risk and it doesn't work, it's very obvious and the cost is individually borne. Whereas if you just conform and go with the flow, and don't rock the boat, nothing will happen to you. There's no upside to taking risks, but there's a lot of downside. It's not that people are bad. Most people are just there to do good work, do the job, and go home. That's okay. How do you work with that?

If you're a public service leader---and you don't have to be a leader, you can be a small cog in the wheel and still want a good outcome---and you see potential for something to be different, how do you then mobilize a group of people who are living under this incentive structure? I learned that people can be motivated, people can be co-opted, people can be inspired. Even the most conservative bureaucrat who has plenty of inertia can be moved. How do you move them? It's not so different from how you do anything---with empathy. "There's nothing wrong with wherever you are. Here's where I'm coming from. I see something, and I believe that this is important. I need your help to do this."

*Does that mean that in the context of something like masking or immunization, you were trying to make a major change feel less like a change?*

I think so. I think it means being very specific and concrete with what you're trying to change in protocol. If you say, "I'm going to overhaul this protocol," people get scared. Because what does it mean for me? In computer science, there's this concept called "no-opt." No-opt is to say that when you try to do a system change, you try to keep everything constant and you just change a tiny little bit. It's like gene editing---just snip a little bit. Don't disturb the rest of the things so that you know whether this change in protocol is working before you move on to the next thing and the next thing. You have to be strategic.

I would say, "I'm not changing anything. Just this one little thing here. Can we start with this?" Once we've got that done and it feels like nothing has changed, then let's go to the next thing.

*Do you remember a particular example like that?*

When we tried to work on changing salaries of low-wage workers, it could be very disturbing because people would think, "Oh, you're going to increase the cost of healthcare." But actually, you can do the math. The system cost is actually only *x* percent. You create certainty. You're saying that if we increase the salaries of these low-wage workers, for the providers, this is what this means for them. For the system, this is what this means. You make very clear what the impact is. You say, "This is tolerable risk. We can stomach this." Whereas if you just philosophically go, "We should valorize care work," there are all sorts of problems. Not everyone agrees that this is a good thing. But if you're very, very concrete---"Hey, actually this is very little, it's not going to rock the boat"---then you know that if you've done this one thing, it allows you to do the next thing and the next thing. If we raise the wages of support care staff, we get more young people interested in that job.

That beats any sort of rebranding exercise. After we do it, we can do the rebranding if that makes sense. Unlocking this one thing allows you to do the next thing, and sequentially, over time, the entire protocol has changed. But it was less scary than doing it all at once.

*You talked earlier about the war footing of COVID and how afterward you felt some longing for that because it enabled good things to happen. What are some of the things that war footing made possible?*

It's a very human instinct that when you have a war and you have a crisis, people stand together. I don't think it's any surprise.

*Not in the United States. In our case, we became extremely divided and unable to do anything but argue.*

I can imagine. In my case, thank goodness, I think there was a reservoir of trust and good systems that had been built over time. You saw that play out well in a crisis. People banded together. People who don't normally see eye to eye, they were on the same page during wartime. That's very energizing and very motivating. I couldn't have found a better time to be part of the health ministry. I met some of my closest friends and closest colleagues during that time. We were in the trenches together, through late nights, just trying to solve problems. It's a specific kind of experience.

*You spoke earlier about designing protocols for an experience of continuity. But in that moment where there is a shared sense of crisis, was there more of a demand for people to feel like somebody's doing something drastic? Did the moment of crisis shift the way you might design to make it look like a lot is being done? Or did you find that trying to optimize for comfort and for continuity still mattered in that case?*

It was a very different time. People all got the memo that it's not the same. Nobody was expecting things to stay the same. It was easier to move. In many countries during COVID, procurement rules were changed. What typically requires three bids and a long tender process became, "We can do this right now." Emergency protocols were activated. The mindframe of people had completely shifted, we were operating at a much faster clockspeed. It made me realize that the defaults that exist in peacetime can be changed when the circumstances warrant it.

But that also has a cost. You can make mistakes very quickly. That's the reason why in peacetime we have these protocols. Lots of countries have examples of how many millions of dollars had gone down the drain when procurement rules are suddenly waived . There can be a lot of wastage. I'm not saying it's all perfect during the wartime protocols, but that shake-up definitely created a lot of room for us to move. We could launch the Volunteer Corps overnight. That's not something that would have happened otherwise.

*What were some other aspects of Singapore's response? There were tools around immunization systems and contact tracing. What were the major pillars of that response?*

A lot of this is very well documented by now, but if I break this down, with any country, you've got contact tracing. You've got care for people who have COVID. Then you have testing to identify who needs to be quarantined and who can roam free. You also have control over people's mobility, because at the time you had restrictions around gatherings, groups, which places people could go to, and the enforcement regime around that. Then you have vaccination when the vaccines become available, and you have to distribute vaccines to create herd immunity. Then you have border control. There are so many pieces.

*What were you particularly focused on?*

I was focused more on vaccination, the care, and the conveyancing part---sorting people to different treatment or care pathways. Also, the manpower necessary for testing and care, making sure that we had enough practitioners and clinicians. Those three things had been my focus. And the last is technology and data. How do you make sure the data flows? If you get tested and if you get vaccinated, that data needs to go somewhere in order for it to be actioned on. Those were the key things I was working on during COVID.

*You talked earlier about that duck image. What did you call it?*

The Stanford duck. Because every student loves to act like, "Oh, this is chill. I'm totally not studying." MIT is the opposite. They're like, "I've been studying for ten hours yesterday." It's a syndrome of everything looking calm, but underneath you are panicking and frantic.

*Can you give an example in one of those cases where an external view was one of a functioning system and the internal view was a bit different?*

I think from most accounts, Singapore did an incredible job. Our death rates were very low, our systems did not collapse, people were well taken care of generally, for the most part. But nobody, at the time, knew what was the right thing to do. For a time, we were saying we shouldn't have everyone wear a mask. There was a time when the government had to backpedal. We struggled to do simple things. There were lots of different rules. At one point you could gather in twos, at one point you could gather in fives, and then there'd be all these different permutations. Families just could not keep up. That paddling was not just internal but actually very external. We could bicycle only if it was in groups of five or something like that. In restaurants, it probably should change depending on whether you have a family, have kids, or no kids, vaccinated, not vaccinated. There are hundreds of permutations. Underneath that complexity, 
we didn't know what the answer was, so we would just place our bets on as many protocols as possible. That's the frantic paddling. Maybe if we were a bit calmer, we would have kept it simpler and not moved these protocols as quickly as we did. But then again, hindsight's twenty-twenty. Sometimes it's just not possible. You just have to keep trying.

*I want to come back to that reservoir of trust you mentioned. We all went through that back and forth---no mask, mask, changing expectations around vaccination and gatherings. But here in the US, every time a change happened, the other side of the political spectrum was attacking whoever made the change and trying to use it to score political points. It was this crazy nightmare where every bit of uncertainty was exploited, and people died because of it. It seems like the ability of Singapore's protocols to be successful depended in important ways on that sense of trust---that sense that when the rules change, people are going to trust that authorities have their best interests at heart.*

If you ask me, "What's the secret to success?"---we were just not as distracted by political extremities. It felt more like a big village. That trust helped us to weather the storm. Because there's no right answer, it matters more that people stay together regardless. It's like when a canoe or a kayak capsizes. The rule is, just pick one direction and go in the same direction, whichever it is. That's what was happening. It's really difficult when one part of the group is going, "It should be this," and the other part of the group says, "It should be that." Then you just go in circles. That reservoir of trust is what keeps people going in one direction---just choose one and go.

*I suppose it also helps to have a health system that has some kind of centralization where decisions could actually be made in a systemic way, right?*

Yep. It's very interesting to observe the resistance in the States around state centralization. I can understand it. There's a whole history behind it. I've also seen that there are upsides to it when the right people are in place, but that's of course the whole benevolent prince thing. Ultimately I think structures matter a lot less than people. If you have the right people in place and not the right structures, the right people will create the right structures. If you have the right structures but not the right people in place, it's a lot harder.

*Now that you have moved into working in other kinds of contexts, what kinds of lessons have you found yourself leaning on most when you're going outside of Singapore, and outside of that well of trust? What is transferable? What kinds of new lessons have you had to learn in other contexts?*

I think what's transferable is just that people will always be people. Cultural differences, language, differences in society---people are not so different. We have some very basic needs that will be constant, and if you understand those basic needs, you can work with them. Those basic needs are things like people want to be seen, people want to be heard, people want to be respected.

I moved to the States and, insurance here costs, what, $15,000 a year for some people? That's more than what I would spend on healthcare in a few years. The system is broken in a way that is unfamiliar to me. A lot of lessons I've learned in Singapore are not transferable. I don't know how you recreate the reservoir of trust in a setting like the US. But working with refugees, what I've learned is that there are resources everywhere. If it's not in the form of structures or money, it's in human resilience.

I was so impressed with the kind of healthcare I was seeing along the Thailand-Myanmar border, by people who have very little. I was working to create health systems and digital health records for them and with them. It's one thing to say we have all these resources and that's why the healthcare system is excellent, but they have few resources and they're able to punch above their weight. I learned from these communities what systems and protocols can emerge out of very few resources.

*How would you approach protocol design in a context that is much more resource scarce, where you don't have a centralized government to lean on? Do you have to approach the design of systems differently?*

It always comes back to people. I had a conversation with a friend a few days ago about the difference between Russia, Singapore, the US, and various other cultures. Historically, there have been these moments in history of massive reimaginings. Marx wanted to reimagine the whole world system in the form of communism---a grand, sweeping theory. But because it wasn't accompanied with the rigor of systems and actions, it couldn't withstand cronyism, bribery, and corruption. In Russia, these fantastic ideals---I spent some time in Russia, so I studied a lot about these ideologies---they just did not bring anyone to the promised land. The attention was all on narratives but not on the nitty-gritty details.

It's as if you might have grand ideals for your children in a parenting philosophy, but then you forget to make breakfast in the morning for your child, and they go to school hungry. The attention to details is not commensurate with the grandeur of the philosophy. I see across different cultures a variance in how congruent their actions are with the theory and the narrative. Systems that work very well---they might not be very loud with the theory. In a low-resource setting, you don't see people write about philosophy or intellectual theories. 

*No TED Talks.* 

But they're doing the right things. In the community, a lot of the work goes unheard. But in the context of the local ecosystem, it's functioning because people are paying attention to the details. The opposite is lots of grand theories, and people are all enamored with it because, "Yeah, we're going to have a revolution." But then the details of what is needed for a good functional system---no one's paying attention to that. I was having a conversation with my friend about this. A lot of people recognize the contribution of Lee Kuan Yew, who is the founding father of Singapore. But very few people understand that behind him were various architects, like Goh Keng Swee, who had both the vision and also the attention to what this needs to look like from a protocol and system perspective. The reason why I think Singapore's protocols work is we were fortunate enough to have both: someone who charted the future and the vision, and got people excited, but also the follow-through was there.

*As you continue this work, tell us a bit about what you're doing now and how you're drawing on the lessons of your past experience.*

I'm running a company and a non-profit. The non-profit is focused on low- and middle-income countries and creating sustainable health systems through technology. It's called Equitech. Equitech stands for "equitable technology," because I think a lot of big tech is really about concentrating wealth and creating profit. But, if put in the right hands, technology can also create equitable outcomes. Think about using AI for countries like Timor-Leste, where two-thirds of children are born without midwives, where primary care doctors don't have access to good clinical guidance. If you put AI, trained on the right clinical guidance, into the hands of these primary care doctors, the impact is massive. How do we spot these opportunities where we can take the best of technology and put it in the hands of those people who need it the most? Never mind that there's no commercially viable model, no money to be made from that; the human value is tremendous, and we can find other ways to make the money part work. The non-profit prioritizes that.

Then I have a business that is creating a steady revenue stream to support the non-profit work. It's very much like one of my favorite brands, Patagonia. Patagonia is actually owned by a non-profit. They run a profitable apparel business, generate revenue, and plow that back into the non-profit. Equitech has a very similar vision and model. I created a small team to transform health systems through technology in Singapore, New Zealand, and now in the States. Everything that I'm doing now is a result of what I've learned that came before. It's not in the context of a big government machinery or bureaucracy. It's about running a tight ship that's small but lean and mean.

I've experienced so acutely the contrast between talking about the brand narrative and actually getting things done. Running a company, running a business, running a team is about making good on your promises, whether big or small. That requires paying a lot of attention to what you've said and whether you've done it. Ninety percent of it, if you get that down---if you just do what you say you will do---that's ninety percent of it.

*Some people run businesses on an infinite supply of unfulfilled promises, but I'm glad you don't.*

You could because there are so many ways you could punt it. But it will all add up, and either it collapses at some point or you find a bigger hole to bury the mess in.

*As you bring people onto your team, as you are inevitably training people in the design of health protocols and the use of technology, what kinds of lessons do you hope to teach them? How do you make sure that your team is also able to carry the lessons that you've learned?*

I don't think I try to teach. When you're running a team, you're shaping the norms. Language matters a lot. I try not to use the phrase "in my experience," because when you say that, you're referring to experience from a previous scenario in history that might not even be the best solution now. It just was what it was. Being open-minded means recognizing that things can work in many different ways. The best is yet to be. I try to say instead, "This is what I see. What do you see? What can we do?" When I run teams, whenever I hear the phrase "in my experience," I say, "So what do you see now?" Because I don't think that the situation is the same. The things we're doing are not the same. We will learn a lot more if we just see it for what it is rather than what we want it to be.

I was intrigued by your interest in protocols because I don't think a lot of people pay attention to them. They're unsexy. It's a lot sexier to go, "All humans should be equal, therefore communism, revolution." That rouses people. But historically, if you look at societies that functioned well, it's not that. It's actually the things that people don't see or don't hear about. Protocols are just not sexy. But I think it's important that people notice things that contribute to success but have received little attention and acknowledgement.

I'll just end on this: for people who want to understand how good systems work, pay attention to defaults and how defaults can change.
