This post is one of a series that discusses the possible lessons identified in post crisis reviews.
The topic is the World Health Organisation (WHO) post event reviews from major health events. The WHO have carried out two major reviews following the H1N1 Pandemic and the Ebola outbreak (http://apps.who.int/gb/ebwha/pdf_files/WHA64/A64_10-en.pdf and http://www.who.int/csr/resources/publications/ebola/ebola-panel-report/en/ ).
Reading the documents, my first observation is that the Ebola Interim Assessment Panel reports that the ebola event would have been handled better if the findings from the H1N1 event had been implemented! This is a big ‘fail’! Learning is only useful if it is ‘double loop’ or ‘active’ learning (check out the book’ Learning from Disasters’ by Toft and Reynolds). Knowing something is not good enough, it is actioning the risk mitigations required that provides the change of preparedness. The question about governance remains as to why actions were not taken after H1N1?
The WHO review reports are valuable because they highlight the way that the interface between an international body and the nation state works or does not work. This is where the interesting ssues are to be found. While health is the topic, I think this is a good indication of the way the interface will work in other international crises e.g disease with limited vaccine supply, food group supply failure. The world institution says one thing but the national authorities will continue to decide and act for their interests and sovereignty. Each nation has its own perspectives, national culture and stakeholders to satisfy. Where science is lacking there will also be wide divergence in risk understanding, communications, government position and in this case health provision and effectiveness.
The reports also highlight the ‘gravity’ that bad news carries – scary information weighs heavily and reporting outside of national government is only carried out when an internal threshold is crossed or revalation is forced. I think the Ebola report is frank and it recognises that the Ebola event was a defining moment for the health of the global community. The follow-on recommendation is that the WHO must re-stablish its pre-eminence as the guardian of global public health and to do that will require significant change.
Following on from the from Interim Assessment Panel there is a WHO Secretariat response and then the ‘Roadmap for Action’. The Roadmap is an interesting read ( http://www.who.int/about/who_reform/emergency-capacities/WHO-outbreasks-emergencies-Roadmap.pdf ). So while outcomes and outputs are defined, suspicion remains that knowing the requirement is not the same as doing something to actually put capability in place. But this roadmap is a useful example of a strategy and a plan and enables a programme to be built. Each deliverable is defined and milestones set. For example, the 1st Output is a unified WHO platform for outbreaks and emergencies. The deliverables list (serial 1.1 to 1.6) shows the expected elements of governance, the definition of the operation model, planning and plans, process, shared awareness technology. The ‘takeway’ is that if you are building a crisis management or organisational resilience programme much of what is required as stated in this roadmap is useful. Basic component elements are defined, e.g roles, accountabilities systems etc. You may wish to review the report to see what it says about culture changes required, perhaps this is the critical point? Preparedness can only be achieved in the right culture.
- The case for strong organisational resilience planning remains for major organisations. If ISO22316 was used then perhaps the WHO might have the components of resilience in place so that it can meet it’s role.
- If you are involved in organisational resilience and crisis management capability building, the learning reports and the WHO ‘roadmap’ and priorities may be valuable in providing wider context?
- The commitment to learning from crisies does not mean improved risks mitigation – unless it is carried through by leadership to action (and an assurance mechanism is required)
- Reactive crisis management is not enough in the pace of world events – pro-active and escalation criteria should enable an organisation to be ahead of issues. Planning is required if capability is to be put in place!
- Collaboration and communication remain the key areas to enhance response and they require routine work to lay the foundations for use in a real event – exercise, exercise, exercise!
- Finally, these learning reports from the WHO – unfortunately highlight to me that major world bodies are likely to be reactive and ‘behind the curve’ due to culture. For your organisation you should expect reactive world bodies and governments. Ensure that your organisation knows this fact. You are likely to be on your own for a while – you will need answers before world bodies can provide them – so plan accordingly!