“I’m just an intern”—why flat structures matter

Tuesday, August 20, 2019
Niisoja Torto
Niisoja stands by WHO Director-General, Dr. Tedros, during the Walk the Talk campaign

As a student, you get used to the red marks that line page margins with detailed feedback from your supervisor. A close-to-final draft just as quickly becomes somewhat of a first draft. It’s a natural part of the territory of being a student. For the last few weeks, I’ve been working on a report in the Department. As usual, I received detailed feedback on a draft from my supervisor, but her accompanying email perplexed me. Her email read: “If you agree [with my changes], please accept them and save the file under a new name.” If I agree? The discretion she gave me completely contradicted the traditional ‘do as I say’ supervision model. After all, what did I know? She has decades of experience doing nutrition work while I have, well, less. She planted a seed on which I began to ponder. There was indeed a method to her madness.

Our Director-General, Dr. Tedros Adhanom Ghebreyesus has an ambitious agenda: one billion more people protected from health emergencies; one billion more people benefitting from universal health coverage; and one billion more people enjoying better health and well-being. These triple billion targets, enumerated in the World Health Organization’s (WHO) 13th General Programme of Work, frame the organization’s vision for the next five years. Inherent in this vision is a demand for transformative change in WHO’s DNA. As part of this transformation, Dr. Tedros envisions a flattened organizational structure. Now ten weeks into my internship at WHO, I have finally come to understand why a flat structure matters, especially for the nutrition community. Photo caption: Niisoja stands by WHO Director-General, Dr. Tedros, during the Walk the Talk campaign.

Flat structures, by definition, break down hierarchical walls. They facilitate communication among staff in the same unit, department, division and organization. They are also founded on the idea that everyone has valuable input to contribute, even the most junior member of a team (i.e. me, the intern).

Now, to address the elephant in the room: yes, I know that as an intern myself, of course I would favor an organizational structure that valued my input. But setting my conflict of interest aside, I’ve seen firsthand the power of giving everyone a platform. I’ve been in meetings where the ‘lowest rank’ individuals shook up the conversation with critically insightful comments. I’ve also been in meetings where the voices of junior members were silenced and where their ideas (which I discussed with them afterwards) would have been useful for the full group to hear.

I think we sometimes believe too wholeheartedly into the idea that it is only experience that can give insight or the correct answer. While I contend that having expertise cultivated over time is a valuable asset to any team, the less experienced, fresher perspective can sometimes be just as ground shaking.

The food and nutrition landscape is complex and constantly changing, especially as new information emerges almost daily. New reports shift our understanding—such as the 2019 EAT-Lancet Commission report that for the first time defined a global reference diet that is good for both human and planetary health. New concepts, such as nutrition in universal health coverage, frame the complexities of the nutrition landscape but at times also exacerbate how complex the field is. And the way some industry leaders distort evidence, such as with the inappropriate marketing of breastmilk substitutes, takes new faces with time.

In this complex and rapidly changing landscape, there is urgent need for stronger collaboration to accelerate our progress in achieving our ambitious nutrition objectives globally. Yet, in hierarchical organizational structures, it is easy for staff to rather silo their work, failing to build off of each other’s valuable expertise. In my opinion, Dr. Tedros’ work to flatten WHO’s structure will pay dividends for the nutrition community.

I admit that a flattened organizational structure may have some potential consequences, such as confusion over who is accountable for which decisions. However, in the fight to address some of the most formidable health challenges of our time, a new approach that challenges the traditional hierarchical approach is necessary.

While attending a meeting during the 72nd World Health Assembly, someone asked me why I didn’t say anything during the discussion. Instinctively, I responded saying, “I’m just an intern.” I hadn’t realized it in the moment, but I did have something to contribute…and so do the most junior members of teams in health organizations around the world. It only took a simple email from my supervisor to realize it.

Niisoja is rising senior at Duke. He is interning at the Department of Nutrition for Health and Development at the World Health Organization headquarters in Geneva, Switzerland.