Preparedness: COVID-19 Reminds Leaders Why it is so Important

I was recently drawn into watching a movie with my teenage daughter—you know the one with the apocalyptic zombie invasion where a subset of overly prepared and heroic characters leads the rest to safety and ultimately an overwhelmingly victorious ending.  

Despite the plot of the film being based in science fiction, filled with near misses and unbelievable escapes, it raised thoughts about how being prepared is a driver of success but is often neglected.  We spend our whole lives steeped in preparation from our first steps to planning our last steps.  We are constantly engaged in preparation in our lives, with analysis, resource allocation, strategy, and ultimately execution.   

So why do we often find ourselves playing catch up and unprepared for a challenge to the known and the status quo?  Unfortunately, in many cases reflection after the event shows that it comes down to bad planning, not enough planning, or a poorly executed plan. After all, it was only six years ago that we healthcare leaders were thrust into the Ebola epidemic that forced us all to take a long, hard look at how well we were prepared for the unthinkable. Then we slipped back into our daily management of metrics, safety, and revenue and forgot the stressful, albeit important, work we had completed in the previous months.  The reality is we tend to get comfortable and slide back into our routine, and we far too often forget how important it is to be prepared until we are faced with an emergency such as COVID-19, which has challenged the globe like no other in modern history. 

Being prepared is not that difficult when one takes the approach of being proactive, defined, processoriented and focused on execution to avoid as much risk to the status quo as possible.  That really is the goal of preparedness to preserve the routine and avoid disruption as much as possible.  To do that, we as leaders must plan preparedness with as much vigor as we plan our budgets and get as granular as possible to see all angles and threats to maintain our status quo.   

In my experience, being prepared comes down to four key steps: 

1. Escalation 

Whenever a threat to the routine is identified, there must be an escalation protocol in place to allocate resources, assign roles and define decision authority, establish communication plans, and identify external partners that can assist. 

During the early stages of the COVID-19 pandemic, we witnessed hospitals overrun with patients in the Emergency Departments and ICUs, yet precious resources were being further taxed by not having escalation in place to trigger suspending elective procedures. 

2. Emergency Operating Procedure 

There must be a plan for when the routine is no longer in place. This should be facilityspecific and include step by step actions the staff can take and implement should certain conditions arise.  Loss of utility, power anomalies, and pharmaceutical shortages are examples of situations in which a defined plan with simple, easy to follow, step by step instructions ensure that operations and safety continue during even the most challenging emergency.   

This plan should be granular and reviewed at least annually for accuracy and revision.  Nothing could be more detrimental during a crisis than to find out the EOP is giving guidance on, for example, using handheld radios when they have been replaced by cell phones.  

3. Training 

There is a reason the military, airlines, nuclear plants, and NASA spend billions of dollars annually on training.  Staff should be trained on the EOP, escalation, and protocols.  The time to discover that your workforce is insufficiently trained on RACE to PASS is not during a five-alarm fire.   

Training should be integrated into the new hire process and required at least annually to ensure the staff’s knowledge.  

4. Drills 

Drills are a test of how prepared we are in the event of crisis and challenges to our routine.  The ability to test our plan is a crucial process step that can decrease or eliminate the potential for harm during an emergency.  

Tabletop drills are an excellent method to test scenarios that would require escalation and potentially the activation of the EOP.  These tabletop exercises should go beyond weather, fires, and floods.  What would happen if there were a shortage of 0.9 Normal Saline?  Where do you house staff during emergencies?  How do you feed them?  Table-top drills should be conducted at least quarterly. 

A valuable tool in performing tabletop drills is to assign a “devil’s advocate.”  A crucial role during this exercise is someone to challenge the plan and make arguments against it.  This forces the team to apply standards to decision making and ensures a diversity of ideas to prevent false confidence. 

Live drills should be conducted at least annually to ensure processes are fully vetted and to set the standard throughout the organization that planning, preparedness, and safety matter.  Additionally, live drills provide an opportunity to test how well external partners can execute their role with the EOP.

If 2020 and the COVID-19 pandemic has shown us one thing, it is that we can be and are vulnerable.  In this case, a tiny virus has posed an existential threat to us all, and we are still in the midst of combatting this disease.  We as leaders have a responsibility to not flee from strategy and to rely on tactics to shoulder the challenge.  Leadership is required when all else is failing, and it is the key to ensuring preparedness is a critical driver in our survival.  The adage that hindsight is 20/20 can no longer be the mechanism for learning and adapting, for it might be too late and at an extraordinary cost.  The time is now to make foresight 20/20, and being prepared is that catalyst.


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