Todays post is written by Jeff Kaliner. Kaliner is a public health emergency preparedness professional with twelve years in the field. For the last few years he has spent an unreasonable amount of time considering the intersection between complexity science, lessons that never get learned and homeland security. He holds a Master of Arts degree in Security Studies from the Naval Postgraduate School and a Master of Science in Education from Northern Illinois University.
Over the last few days the media has suggested that hospital emergency plans and procedures are basically unsuccessful with respect to the ongoing Ebola event. The narrative lays out that hospitals (and in effect the larger public health system) have failed to plan properly and in turn are now reaping the consequences of poor preparation. The evidence is apparent: one dead Liberian national and two infected Texas nurses.
Connecting these dots in a linear fashion gives us the proof we need to believe what this narrative suggests: The last twelve years of federally fueled funds to enhance emergency health and medical programs at the state and local levels have not worked. The implication is easy to understand; better planning and procedures (and more money?) would have prevented this very serious situation.
Although the story seems to have a tidy and easily understood cause and effect relationship, it is wrong.
The problem with this tale is the dirty little secret that a well-crafted plan or procedure cannot and will not be enough to manage a complex event. When implied that they can, these documents take on a symbolic quality that suggest they are somehow able to control reality. As Lee Clarke (in his book Mission Improbable: Using Fantasy Documents to Tame Disaster) points out, plans in this realm “…are rhetorical devices designed to convince others of something.” The “others” in this case might be federal or state grantors, the public, the media, response agencies, etc. Clarke goes on to state:
It seems that fantasy documents are more likely to be produced to defend very large systems, or systems that are newly scaled up. When they are proffered as accurate representations of organizational capabilities then the stage is not only set for organizational failure but for massive failure of the publics those organizations are supposed to serve.
In other words, the plans the media have been referring to are fantasy documents. They were partly crafted to give an illusion of safety and security.
To be clear, I am not arguing that plans should not be written and that capabilities should not be exercised. What I am saying is that the best we can ever do in the face of an increasingly complex catastrophe is write a bad plan and admit that a capability that was pulled off flawlessly during an exercise will probably not produce the same results during the actual bad day. This is not an indictment of all the dedicated and committed emergency planners across the world. This is an invitation to acknowledge what the best of them already know: response documents become more useless as the event becomes more complex.
Maybe one possible solution to the plan as fantasy document is to conceptualize an emergency situation as an unfolding set of unpredictable events in a unique eco-system. Every eco-system has a pre-determined elasticity or resiliency that allows it to bend a certain distance before it breaks. In this narrative, instead of asking whether or not our plans have worked (and in turn placing blame on a variety of systems) we might wonder if the resiliency of our current health and medical system has actually been compromised and to what extent by an emergent event.
This idea has become clearer to me as I have been reading The Age of the Unthinkable by Joshua Cooper Ramo. Ramo suggests that one way to think about the resiliency question is to visualize the eco-system of a lake. He writes
“The stability of a lake ecosystem can’t possibly be reduced to a few variables. What matters isn’t something you can score quickly but rather the strange mesh of interactions that make a lake resilient or not…. What you can easily measure in these systems matters much less than what you cannot: How strong are the relationships between different parts of the lake ecosystem? How fast can it adjust to shocks? How far can you bend the food chain on the lake before it breaks? In short, how resilient is it?”
What if we tried to apply aspects of this idea to how we define, manage and evaluate emergency response? What if instead of trying to bend reality to our whims by absurdly trying to measure the potential success or failure of our plans, procedures and capabilities (before the event), we looked a little deeper at the complex set of variables that make up a health and medical eco-system during an event and drew conclusions about how well we were doing based upon a more nuanced and admittedly ambiguous set of factors? Factors including our ability to adapt, learn and change in real time.
As Ramo states: “Resilience allows us, even at our most extreme moments of terror (in fact, precisely because we are at such a moment), to keep learning, to change. It is kind of a battlefield of courage, the ability to innovate under fire because we’ve prepared in the right way and because we’ve developed the strength to keep moving even when we’ve been slapped by the unexpected.”
Preparing in the right way certainly means developing plans and procedures. But that’s just where it starts. Ultimately there is no one playbook or plan that will quickly solve the multitude of problems that occur during complex events. In an unordered world, we all will have to become more comfortable with the messy reality that there is not just one factor that means we have won or lost the battle (think: Mission Accomplished).
In the book Complex Adaptive Systems: An Introduction to Computational Models of Social Life, Miller and Page write, “Complexity arises when the dependencies among the elements become important.” Certainly there are many elemental dependencies involved in the current Ebola outbreak. Understanding and learning how these dependencies interact with one another to create new and unexpected aspects of this ongoing situation is critical to an effective response.
We can no longer reduce the negative events (the death of a Liberian national and the infection of two Texas nurses) that take place within quickly evolving eco-systems to simple platitudes. In this respect, false narratives (such as the ineffectiveness of a magical plan) need to be quickly identified and confronted as the simple and all too easy explanation for a very complex set of events that will probably never be truly understood.
If we do not identify these narratives for what they are, we diminish the two critical capabilities that we will need to consistently practice if we are to truly be prepared for 21st century challenges:
1) an emergency response system that has the political will and ability to quickly learn and adapt during the course of an emergent event; and
2) a media and public that will provide a type of unconditional support and understanding to let it happen.
Regardless, until we are all prepared to think about and understand the world in ways that reflect a more interdependent and non-linear sensibility, our reliance on simple narratives will remain. That reliance certainly works well for the media, but it’s just bad news for the rest of us.