Blog | Friday, December 4, 2015

Lessons from a 1944 CIA manual

The now declassified CIA Simple Sabotage Field Manual was created in the 1940s to help CIA agents “harass and demoralize the enemy”. It came to my attention via Atlas Obscura, and I thought some of the tactics might be familiar to those who work to implement change within hospitals and health care systems.

Here is the list of 8 methods for “General Interference with Organizations and Production” (page 28):
• Insist on doing everything through “channels”. Never permit short-cuts to be taken in order to expedite decisions.
• Make speeches. Talk as frequently as possible and at great length.
• When possible, refer all matters to committees, for “further study and consideration.” Attempt to make the committees as large of possible—never less than 5.
• Bring up irrelevant issues as frequently as possible.
• Haggle over precise wordings of communications, minutes, resolutions.
• Refer back to matters decided upon at the last meeting and attempt to re-open the question of the advisability of that decision.
• Advocate “caution.” Be “reasonable” and urge your fellow-conferees to be “reasonable” and avoid haste which might result in embarrassments or difficulties later on.
• Be worried about the propriety of any decision—raise the question of whether such action as is contemplated lies within the jurisdiction of the group or whether it might conflict with the policy of some higher echelon.

Other key advice to managers and supervisors includes:
• Hold conferences when there is more critical work to be done.
• Multiply paperwork in plausible ways. Start duplicate files.
• Apply all regulations to the last letter.

Now go forth and do the opposite!

Daniel J. Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. This post originally appeared at the blog Controversies in Hospital Infection Prevention.