Anticipation, preparation, resilience: Key lessons for organizations responding to COVID-19

Kathleen Sutcliffe has built a career on examining the ways organizations behave, especially when facing the unexpected.

Relatively few people anticipated the outbreak of COVID-19, a novel coronavirus that has infected more than 250,000 people and caused more than 10,000 deaths, driven millions of people indoors on urgent recommendations of social distancing, and unleashed bull markets around the world.

Talk about your great unexpectations.

Sutcliffe—a Bloomberg Distinguished Professor who holds appointments at the Carey Business School, School of Medicine, and School of Nursing—says the current crisis might not have been prevented outright but would have been better contained if public and private organizations had made a routine practice of the approaches she has highlighted in her research—namely, always anticipating and preparing for a crisis, and then reacting to it with intelligence and resilience.

Johns Hopkins responds to COVID-19

Coverage of how the COVID-19 pandemic is affecting operations at JHU and how Hopkins experts and scientists are responding to the outbreak

In your recently published book from Oxford University Press—Still Not Safe: Patient Safety and the Middle-Managing of American Medicine (co-authored with Robert Wears)—you noted the continuing prevalence of medical mishaps in the health care system. How concerned are you that the COVID-19 outbreak will stress the system beyond its capacity?

Certainly COVID-19 is going to tax health care systems in unexpected ways. Performance and production pressures increase the possibility that health care professionals are going to miss things in their everyday caregiving situations. If there are added burdens on people because they don't have resources such as personal protective equipment, have to work overtime, and generally are stressed out and exhausted, that could have unintended consequences on the care that is given and possibly increase the number of medical mishaps.

However, I do want to say that, as studies have shown, nurses, especially on the front lines, are incredibly resilient. Sometimes that resilience is good because it enables them to improvise and catch errors in the making. But sometimes it can be a negative thing because it means that the organization will not get the information it needs about the types of resources that are lacking and how people's work is affected by pressure situations. In that way, the organization never learns.

People providing health care don't intend to mess up. But when they're in the course of doing work, particularly during such a stressful period as this, they might overlook a lot of small signals that are relevant to a patient's care.

What are the most important lessons that health care systems around the world might take away from this crisis?

Not just health care systems, but all kinds of significant organizations, need to operate through a mindset of anticipation and prevention, and of resilience. Efficiency isn't the only virtue, especially the kind of efficiency that means cost-cutting. You also need resources devoted to anticipating and preventing crises. Those lean models serve companies and shareholders well, but you also need to think about the people you're trying to serve. You can't always be as lean as you want. You need some redundancy and reserve capacity.

For example, after the 1993 terror attack on the World Trade Center in New York, the New York Board of Trade invested a lot of money in a back-up facility in Queens, away from their usual location at the World Trade Center. They got a lot of flak for that because of the high cost. Critics said, "Why are they spending money on a backup facility that isn't being used and doesn't help in their daily operations?" The critics saw it as a redundancy. In fact, not long after the 9/11 attacks, the exchange was up and running, thanks to that preparation, while other financial entities in the city were still on their knees.

As an organization expert, would you offer an opinion of how our leading organizations—in both the public and private sectors—have handled the COVID-19 outbreak?

They don't get high marks from me, at least so far. Something that drastically harmed our capacity to anticipate and prevent a lot of the damage from the COVID-19 outbreak in the United States was the administration's disbanding in 2018 of the global health security unit of the National Security Council. That unit was created expressly for crises such as this. We've also seen cuts in CDC funding, as well as the departure of many CDC scientists.

And looking at the private sector, it's equally concerning pharmaceutical companies, to cite one example, have left their supply chains so thin. The public relies on these companies, but they haven't had enough foresight to consider and anticipate that things can go wrong. Sometimes very wrong.

The economic impacts of the #COVID19 pandemic continue to grow. To talk about what we might expect to come, @JohnsHopkinsCCP's @SDesmon spoke with @KathleenDay, an expert in the history of financial crises.

https://t.co/Hhv12HWCt8https://t.co/pI4VQ3BY8r

— Public Health On Call (@PublicHealthPod) March 19, 2020

We won't really know how we've handled this crisis until the dust has settled. What I can say is that we weren't prepared as well as we could have been, and that's a concern, because I believe strongly that organizations should always be operating with anticipation, prevention, and resilience as guiding principles.

When we're through this, there needs to be a serious in-depth study of where we were weak and what we could have done better.

A lot of companies talk about how they prepare for crises, and how they have crisis managers and crisis management teams. But how much actual preparation do they do?

The general concept of crisis management is that crisis is an event; it's something that came from out of nowhere; it happens, and then you recover from it. So any preparation is about getting back to normal after the fact. But crises usually don't come from out of the blue, including COVID-19. We've known for years that coronaviruses exist, and that there are going to be pandemics. The reaction we've seen in most of the world certainly doesn't indicate we were anticipating it to any degree.

Look, all organizations are going to be surprised. It's inevitable. But we can design systems to be more anticipatory, so that we catch problems earlier, and to be more resilient, so that we cope more easily and decisively with the situation. If we can think about crisis not as an event but as a process, then we'll be able to develop ways to see it coming and then mitigate it more promptly.

Using the sport of expedition racing as a backdrop, you've done research showing that organizations encountering crisis benefit from "resilience-in-action." This includes the positive processes of "drift management" (carefully noting and adjusting to changing circumstances) and "meaning management" (being able to see a way through adversity to a brighter future). How might these approaches benefit organizations in the midst of COVID-19?

These ideas are basically about intelligent reaction and improvisation. We have to keep attuned to what's going on and make adjustments as we go along. Don't panic, we'll figure this out. Balance realism with optimism.

It's also critical for organizations to avoid the blame game. My research shows that entities do worse when they get into a blame game, compared to entities that avoid blaming and share in all aspects of an experience, the good along with the bad. Blaming takes energy and focus away from the main mission—that mission being how we're going to work together to figure out realistic solutions to the problem in front of us.