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Post Emergency Preparedness for Ebola; Stanford Hospitals
Created by John Eipper on 11/10/14 1:22 AM

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Emergency Preparedness for Ebola; Stanford Hospitals (Paul Pitlick, USA, 11/10/14 1:22 am)

As a follow-up to my post of 9 November, I am nowhere near an authority on Ebola, but I'll contribute an anecdotal experience.

I went to a talk about 2 months ago, several weeks before the Liberian gentleman appeared in Texas. The talk was given by the head of the Emergency Room at Stanford, and he described what they are doing in preparation for possible Ebola case(s). The first step was that all visitors, before entering the waiting room, are screened by a guard, with one question--"Have you been to West Africa recently?" If not, they go on in to the regular triage process. However, if they have been to West Africa, they are shunted to an isolation room, not into the regular waiting room. If they have a fever, they are treated as if they have Ebola--the ER personnel are garbed in the complete protective gear, and meticulous care is taken in drawing blood, handling lab samples, etc., until it's proven that they are Ebola-free. Knock on wood, there have been no cases so far; I don't know how many patients they have had to isolate until the tests came back negative.

What made this talk especially impressive is that the same gentleman had given a talk to the same forum about 9 months ago summarizing Stanford's response to the Asiana Airlines crash at SFO on July 13, 2013. It happened around noon on a Saturday, and he happened to be on duty at the time. He said that a nurse was doing something in a room with a patient, and overheard on a TV set that there had a crash at SFO, so she passed that information along, since Stanford is one of the designated trauma sites. Although they were not officially notified by anyone at the airport, they began getting ready--moving non-critical patients out of the ER, figuring out ambulance flow into and out of the ER receiving area, locating gurneys, calling in medical teams, etc.

Somewhere like 20 or 30 minutes later, the ER got a call from the guard at the helipad on the roof of the hospital. A helicopter had just landed with 2 critically injured patients, and nobody had alerted him. About that time, the ER did receive an official call to expect more patients, and then ambulances, and even buses with less-injured patients, began rolling in, and the medical teams went to work. Very impressive. However, what was even more impressive was an added wrinkle. The plane had started in Seoul. Many of the passengers were not American--many spoke no English, and there were several Chinese school groups of minor children, whose parents were still home, as well as passengers from Japan and Korea. Passports and other identifications had been left behind on the burning plane. So into a virtual Babel, we insert unaccompanied minors, with no identification, probably no health insurance, and anyone who has ever had any involvement with the INS can imagine how they reacted. Eventually, a command and control center was set up with interpreters, hospital administrators, representatives of various consulates, etc., etc. I recall that Stanford took care of more than 100 plane-crash victims that (very long) day.

To prepare for emergencies, the hospital runs occasional mock drills, to practice what to do with respect to the medical stuff, lines of authority, communication, etc. I don't know how many of the legal, language, health insurance, and immigration problems related to the plane crash had been anticipated, but the ER folks are smart, resourceful people, and they were able to improvise to solve the problems. The recent Ebola talk was not just a description of what the ER is doing; it was also intended to educate the medical staff about what we need to know if we are involved in the care of possible Ebola patients.

My point here? Whether it's an airplane crash or Ebola, there is no place for hysteria. Preparation is everything. Learn from your experiences. At some point, you have to trust people who know what they're doing, and you can ignore the rest; it is important to figure out the difference.

JE comments: No place for hysteria: that's good advice for all of life's unexpected dramas.  Let us hope that smaller hospitals, with far fewer resources than Stanford, are able to emulate this level of preparedness.


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  • Emergency Preparedness (Rodolfo Neirotti, USA 11/11/14 6:57 AM)
    "Preparation is everything"



    This recommendation emphasizes the importance of the five Ps: Proper Preparation Prevents Poor Performance. Because history is shaped by "Black Swans," events that seem impossible until they happen, this approach is applicable to almost everything in life. So why do the leaders of some organizations fail to identify key problems and act before things turn catastrophic? They don't want to see, they can't see, because the group isn't designed to see, and there are other people who are doing their best to keep them from seeing--motivated blindness.

    As described by Paul Pitlick (10 November), Stanford's response is an example of good crisis management and adaptive leadership--the capacity to adapt that enables both individual and business needs to be met through making changes to the time (when), location (where), and manner (how) in which people work. This attitude requires flexibility, a mindset that allows leaders to adapt, to react and to operate according to the needs of different contexts and to move fast. These are the most difficult things to do when handling uncertainty in the first hours and days.


    Adding estimative intelligence to gauge uncertainty and make assumptions about different scenarios, to anticipate the consequences and probabilities, can improve analytic capabilities and outcomes. Another important element in this situations is honesty. Accurate and correct information is crucial. Misinformation invariably backfires.



    Imagine applying these concepts to Iraq and Afghanistan. It would have prevented loosing many lives and saved billions of dollars.


    JE comments: The CYA (cover your ass) phenomenon is what defines most organizations.  It prevents people from sticking their necks out to make the changes necessary to prepare for contingencies.  CYA isn't just limited to the military (full disclosure:  I've been listening to Catch-22 on my commute during the last couple of weeks).  One can imagine, for example, how individual actors in that Dallas hospital were more motivated by self-preservation than by identifying and treating Ebola patient #1.

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    • Thoughts on Emergency Preparedness, Organizational Change (Tor Guimaraes, USA 11/16/14 5:32 AM)
      The 11 November posting from Rodolfo Neirotti addressed a subject close to home: "Business Innovation and the Management of Change." Indeed, "preparation is everything," and this wisdom "is applicable to almost everything in life." Rodolfo stated, "the leaders of some organizations fail to identify key problems and act before things turn catastrophic," because "they don't want to see, they can't see, because the group isn't designed to see, and there are other people who are doing their best to keep them from seeing--motivated blindness."

      Based on my 50 years of experience studying the management of organization change, trying to integrate the academic knowledge with what actually goes on in practice, I have noted one critical dimension which Rodolfo does not address in his posting: the degree or intensity of the change required. Ranging from the slow and continuous change needed for organizations to improve under the prescriptions of Total Quality Management (TQM), to more "dramatic changes" prescribed under Business Process Reengineering, to the even more dramatic changes necessary under severe crisis management, where many people are risking death, such as in the last Ebola crisis.



      My most effective model (empirically tested in the manufacturing, hospital, and banking sectors) indicates that the likelihood of success in change management can be improved by preparation in four major areas: the right kind of leadership, awareness/knowledge of the environment surrounding the organization, the organization's ability to manage relevant technology broadly defined, and the characteristics of the change process used to implement the required changes. I have not studied severe crisis management, but I venture to say some new factors may be important. Similarly, most of what is relevant to manage slow change has also been found important for increasing success managing more dramatic changes. The main difference is as the uncertainty, risk, and intensity of required change grow, so does the importance of leadership at the strategic and project levels.



      Trust in the leaders and other group members is not sufficient for success in managing change, but it has been found to be absolutely critical for efficient (quick) implementation of solutions. Please note that trust is the antithesis of the CYA syndrome discussed by John Eipper, of poor communication within the group, and of perceived dishonesty.



      Last, Rodolfo mused about "applying these concepts to Iraq and Afghanistan," and how "it would have [saved] many lives and saved billions of dollars." For these disasters our leaders indeed failed "to identify key problems and act before things turn catastrophic."


      However, it is not applicable that "they don't want to see, they can't see, because the group isn't designed to see." The American people told the Bush/Cheney neocons not to stay in Afghanistan and not to invade Iraq, but the American people were lied to and deliberately ignored. Finally, regarding "there are other people who are doing their best to keep them from seeing--motivated blindness," the statement in this case is spot-on: the media chicken hawks did their best to fool the American people but failed, but the neocons went ahead anyway. In the case of war, President Eisenhower was right: beware of the military-industrial complex. I like to add: beware of being a pawn for global business interests disguised as American companies.


      JE comments: Has anyone bought President George W. Bush's new book, 41: A Portrait of My Father? I heard a couple of GWB interviews last week on National Public Radio, and it appears that after a six-year sabbatical, Bush 43 is now energetically working on his legacy.  From the snippets I heard, GWB is willing to offer a few "mistakes were made" half-excuses, but he stands firmly by his position that in the wake of 9/11, US national security absolutely required the removal of Saddam Hussein.


      Organizational behavior under crisis is a fascinating topic.  It always gets me thinking:  what would happen to WAIS if IT Director Roman Zhovtulya and I were hit by the same bus, or by different buses at the same time?  David Duggan, it's time for more training on the care and feeding of our website.  (I don't plan to go near any buses, but it's best to fix the roof while the sun shines:  does anyone else volunteer for potential WAIS crisis management?)

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