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Tectonic shifts in society and business occur when unexpected events force widespread experimentation around a new idea. During …
In scandals, the conversation often turns to individual “bad apples,” but the real culprit is more often the climate of the organizations where unethical behavior happens. The Yale Center for Emotional Intelligence in collaboration with the Faas Foundation conducted a national survey of more than 14,500 employees across industries …
The coronavirus epidemic is increasing demands on health care’s front line, primary care physicians. And even before the outbreak emerged conventional wisdom held that we’re facing a PCP shortage. But some simple math would suggest that we should have more than enough primary care physicians. The …
Given that it will take a year to develop a vaccine for the new coronavirus, the development of an inexpensive, point-of-care, diagnostic kit for use in clinics and homes should be a high priority. It is needed to allow communities to quickly detect and contain the disease. Such an effort requires an accountable leadership, decisive science-based governance, significant financing, and the application of reliable principle-based scientific protocols to determine whom to test, how to interpret results, and how best to treat and quarantine those infected. The U.S. must take the lead in spearheading this effort.
In the meantime, the best measure is to test symptomatic patients to prevent or slow the spread of the virus. Testing can also pinpoint “hot spots” where community-wide measures like social distancing (having people avoid others, for instance, by working at home) and home isolation (requiring people with the Covid-19 to stay at home) can be considered. China is already implementing this strategy.
Currently, most pandemic-prone diseases, including coronavirus, are diagnosed by polymerase chain reaction (PCR), a molecular technique that often requires special laboratory machines and highly trained technicians to operate them. PCR tests are difficult to scale or decentralize. Bill Gates points out that portable versions of these molecular diagnostic machines need to be distributed throughout Africa to prevent the spread of coronavirus.
However running the test machines also requires a consumable test kit, and the number of coronavirus cases in China has exceeded its laboratory testing capacity due to a shortage of PCR testing kits. Consequently, China has had to resort to using CT scans as a hospital-based rapid test to screen infected patients for coronavirus, followed up by laboratory-based testing for confirmation. Many clinics do not have the expensive machines to do CT scans. If the number of people who need to be tested in the United States exceeds a small percentage of the population, the U.S. health system may face similar scale challenges. During the Zika public health emergency some pregnant women in affected states found it hard to get tested, and pregnant women comprise only about 2% of the U.S. population.
In response to a congressional request, the CDC developed a PCR-based test for coronavirus that requires a laboratory, and these test kits have been authorized for emergency use by the FDA. But it’s easy to imagine the demand for test kits outstripping the supply, like it has in China. However, news in the United States suggests there were some early problems with CDC’s tests so they could only be utilized in a dozen out of over 100 public health laboratories across the United States.”
While development of diagnostic kits is less complex and expensive than creating new vaccines, it still requires testing and validation. The U.S. Food and Drug Administration (FDA) has an accelerated pathway for “emergently needed” diagnostic tools, but relies on developers to submit results from clinical validation studies that the developers need to conduct or sponsor themselves.
As was the case with developing point-of-care diagnostic kits for Ebola and Zika, developers of one for coronavirus may face hurdles to obtain clinical specimens from the CDC and local health authorities. These are needed to validate their tests in order to obtain FDA authorization.
In the absence of a standard methodology for quickly and confidently conducting these evaluations using sufficient number of clinical specimens, agencies such as the CDC or the World Health Organization (WHO) may question the accuracy and conditions under which those results were achieved, stalling their deployment (even after FDA emergency authorization is granted on the basis of developer-conducted clinical evaluations). This is exactly what happened during Ebola. A rapid diagnostic kit that showed promising results as early as October 2014 was not authorized by the FDA until January 2015, and its performance was unclear until June 2015, when field tests were published. Although it was fast-tracked, it was never used in the field during the peak of the Ebola epidemic.
Given that the U.S. government has both expertise and needed budget to develop rapid, point-of-care diagnostic kits for coronavirus, it should take the lead in doing so. It needs to charge a single agency, task force, or executive structure to spearhead this effort and remove unnecessary impediments — one that’s similar to a pandemic directorate that Ron Klain, President Obama’s “Ebola czar,” recommended be created inside the National Security Council. It should be empowered and held accountable for proactively fast-tracking the development of new diagnostic kits.
We also need “grand challenge” prize grants (e.g., $100 million) to incentivize these efforts in the private sector. Without sufficient incentives, many developers and companies will deem the investment needed to develop diagnostic kits too much of a financial risk.
To develop a widely accessible, inexpensive point-of-care diagnostic kit requires an accountable leadership, decisive science-based governance, significant financing, and the application of reliable principle-based scientific protocols to determine whom to test, how to interpret results, and how best to treat and quarantine those infected. Taking these actions now cannot only greatly help contain the current Covid-19 epidemic; it can also create a system for developing similar tools to stop future pandemics. By taking the lead in creating such an infrastructure, the United States can help itself and the rest of the world.
Have corporations fundamentally changed their raison d’être from creating value for shareholders to benefiting society-at-large? The authors say no. We haven’t seen real change yet, and we won’t without first transforming firms’ performance measurement systems. CEOs continue to be hired, fired, and compensated based on metrics, such as revenues, profits, and share prices. Fund managers, who make investment decisions on behalf of dispersed investors, continue to be rewarded based on how their investments performed relative to the market. The board of directors continue to be selected by shareholders to protect their interests.
If you read the headlines coming from the 2020 World Economic Forum at Davos, you may start believing that public corporations have fundamentally changed their raison d’être: from creating value for shareholders to benefiting society-at-large. In our opinion, this conclusion is premature. We haven’t seen real change yet, and we won’t without first transforming firms’ performance measurement systems.
Let’s look at some recent news: A group of 200 influential CEOs declared that the main purpose of the corporation is to serve all Americans, not just capital providers. Blackrock announced that it will shift its investments toward firms that support sustainable growth. Goldman Sachs recently declared that it would stop supporting the IPOs of companies that have all-male board of directors.
CEOs continue to be hired, fired, and compensated based on metrics, such as revenues, profits, and share prices. Fund managers, who make investment decisions on behalf of dispersed investors, continue to be rewarded based on how their investments performed relative to the market. The board of directors continue to be selected by shareholders to protect their interests. So, how likely is it that a CEO would get up one day and suddenly change his or her focus from revenues, profits, and stock prices toward wider Environmental, Social, and Governance (ESG) goals? Some CEOs might, but for most, the predominant objective would continue to be to maximize shareholder value while keeping ESG objectives in mind, instead of the other way around.
Change also appears unlikely when you consider how businesses are funded and held accountable. Firms are funded by entrepreneurs by way of ideas and capital; these entrepreneurs are later joined by second-stage investors, public investors, and banks – all of whom expect to be rewarded with financial returns. Government-mandated accounting systems, audits, and financial disclosures are principally created with shareholders in mind.
Take the income statement, for example, whose top-line and bottom-line elements of revenues and profits, respectively, drive most decisions in a modern corporation. The bottom-line number is supposed to represent the amount that the firm can pay out in dividends to shareholders, while leaving the firm equally well off at the end of the reporting period. So, the summary net income during a financial year is calculated based on the increase in a firm’s potential to pay dividends to shareholders, not its contribution to society. As far as the balance sheet is concerned, shareholders’ net worth equals book value of assets minus the book value of liabilities, not the value of ESG investments.
Imagine what an altered reporting system from an ESG perspective might look like. It doesn’t take long to realize what a monumental task this would be. Let’s focus on a simple measure like Return on Investment. To calculate the value of total investment, an organization would first have to calculate the value of all resources used in its day-to-day operations. Those resources would not just be warehouse, factories, land, and inventory owned by the company, but also intellectual capital (intellectual property, systems, procedures, and protocols), natural capital (air, water, land, minerals, forests, biodiversity, eco-system health), social/relationship capital (shared norms, key relationships, brand and reputations), human capital (competencies, capabilities, experience, motivations), and strategic capital (purpose, business model, governance, culture).
Suffice it to say, calculating the value of all these capitals is practically impossible. The accounting standard setters have not even been able to provide a framework for calculating the value of in-house innovation, forget calculating the value of nebulous resources like shared norms and business purpose or the value of external resources like air and water.
Calculating the return part of ROI would require a calculation of not just accounting revenues and expenses, but also the value of creation and consumption of all of the ESG resources during the year. Again, the accounting standard setters have not even been able to provide a framework for calculating the increase in value of Facebook because of increase in subscribers, forget calculating the value of depletion of society’s air, water, or biodiversity.
While we admit that considerable progress has been made in developing theory, models, and disclosure norms for ESG objectives, we believe that we are nowhere close to achieving “integrated reporting,” as some people might claim.
Consider SASOL, a South African oil company, which purports to offer integrated reporting. It honestly discloses: “We impact negatively on natural capital by using nonrenewable resources, and through our emissions and wastes,” and “we also impact adversely on human and social and relationship capital through competition for resources such as water.” But then it also claims that “by converting natural capital into value-added products, we boost the stocks of all the other capitals,” which is an indirect way of saying “earning profits.”
In our view, these boiler-plate disclosures do not make financial reports “integrated,” and they make little or no difference to the decision of capital providers. Can ESG stakeholders force a firm to change its operational policies based on those disclosures as much as an activist shareholder can for missing an earnings target?
So while we admire and support the move toward a wider organizational purpose, we are reluctant to believe that, at the operational level, things have changed as significantly as claimed by the current news headlines. CEOs continue to be fired for missing earnings targets. The Fortune 500 list continues to be based on revenues, profits, and assets. Society continues to eulogize people based on their amassed wealth. As we praise the efforts of the CEO roundtable and the WEF in Davos, let’s not ignore just how much more needs to be done.
For many organizations, cultivating a community will mean cultivating a new capacity. This is a democratic, not autocratic, route to building customer relationships. It requires trusting instead of controlling, and commitment instead of flightiness. Take inspiration from organizations like LEGO, TEDx, and Twitch. Though there may always be companies that prefer the path of building for their customers, the companies who decide to build with are reducing their risk—and growing their opportunities—in a changing world. Begin to collaborate with your customers by asking:
Today, does our company hope for the best at the big reveal? Or do we build trust with customers throughout our process? Does our team know the answer to who we want to invest in and why those people want to come together? Have we “followed on” our initial investment in this community? When and how?
In the early 2000s, facing growing competition from video games and the internet, LEGO found itself on the brink of bankruptcy. The company continued to struggle before staging a remarkable turnaround and surpassing Mattel to become the world’s largest toy maker. Central to that transformation was a fundamental shift in how LEGO approached their customers. For more than 75 years of its history, LEGO made toys exclusively for customers in a closed innovation process. But over the last decade, LEGO learned how to build with their fan community.
One of the defining features of the past decade is the diminished power companies have in controlling customer interactions. While marketers used to initiate nearly all of the interactions a business might have with its customers, today a Twitch streamer can enjoy free-flowing dialogue with other gamers online, Instant Pot fans can swap cooking successes (and failures) in specialized Facebook groups, and sneakerheads can critique the latest Nikes on Instagram stories without ever interacting directly with those businesses.
LEGO’s success — and recapturing of the toy market — came from understanding this. In 2008, LEGO launched the LEGO Ideas platform, allowing fans to submit new concepts for LEGO sets. Proposals are voted on by other fans and top vote-getters are reviewed by LEGO staff. Chosen ideas are turned into sets for sale. The fan designer receives 1% of the royalties. This community has grown to over a million users, more than 26,000 product ideas have been submitted, and twenty-eight sets produced, including a Women of NASA set and playable LEGO piano. Through LEGO Ideas, the 87-year-old company successfully transitioned from simply building for customers to building with an engaged community.
In our work researching community-driven companies like LEGO and helping others to build communities, we’ve learned that true communities are more than groups of customers, they are groups of people who keep coming together over what they care about. This is true of Porsche, who we helped shift from talking at their audiences through ads and marketing, to forging a place for their superfans to connect directly with one another on apps and in clubs. With their app ROADS, Porsche enables passionate drivers to share routes they recommend and connect with each other over their love of driving.
The past decade brought many of the technical tools that were necessary to build communities. In the next decade, collaboration with customers will become both easier and more vital. To not just respond to this shift but to embrace it, here are the three crucial lessons to consider.
Lesson 1: Be willing to trust your customers.
Think of community-building as progressive acts of collaboration — collaborations big and small that demand trust from the company or original leader. Consider TED’s decision to invest in TEDx. Founded as an invitation-only conference in 1984, TED made a bold decision to introduce TEDx in 2009, empowering volunteers to independently organize TED-style conferences in their own cities. By doing so they allowed massive numbers of attendees to participate, including those who could never afford the central TED conference’s elite price tag ($10,000 for the 2018 offering).
Before launching TEDx, TED organized the entire process. But they knew that if they only offered private, curated events for a certain audience, their impact would eventually plateau. Through trusting and empowering an external community, they’ve been able to spread ideas at a remarkable scale. More than 30,000 TEDx events have been held in the last 10 years with a supporting HQ staff of fewer than 20 people.
In our conversation with Jay Herratti, TEDx executive director, we asked him why TEDx exists and thrives when so many other media companies have failed at cultivating a community with their audiences. “Ultimately, Chris Anderson [the head of TED] just really trusts people,” he told us. “For him this is really about finding the people who are most passionate about TED, those who really love what we do and believe in spreading ideas. Then you trust the people who support you the most and don’t freak out.”
Some organizations simply don’t want this two-way relationship with their customers. Earlier this year, we spoke to a senior employee at a luxury cosmetics and clothing brand. She told us that a community strategy didn’t make sense for their brand. Why? Their customers want the company to make luxury products for them. This reflection helps illuminate what companies who want to build communities need to understand: Co-owners act differently than standard customers. If you’ve misjudged trends, co-owners will tell you. Some companies might think of this as a risk. But it can — if handled appropriately– actually reduce risk. If you miss the mark on a product change, co-owners will help you get it right.
Lesson 2: Start with “who,” not “what”
Building a community isn’t about what an organization can achieve; rather, it’s a manifestation of what an organization and a group of passionate people can do together. With LEGO Ideas, LEGO pinpointed an energetic who, teen and adult fans of LEGOs, who were already devoted to dreaming up ideas for new LEGO sets. The LEGO Ideas platform supercharged what community members naturally wanted to do, which aligned with LEGO Inc’s own interests.
Like LEGO, don’t try to conjure motivation out of thin air. Organizations that jump to tactics without pausing to set a community’s purpose risk building a space where no one shows up. These organizations often park community-building efforts under a proxy function like marketing, social media, product management, or support without a potent strategy, and the resulting initiatives are organization, not community, led.
Instead, start by identifying keen participants (or who you think they might be). Community-building is an ongoing practice of trusting and collaborating with a specific group of passionate people who bring energy to your brand. Maybe they already even engage or contribute in ways that you haven’t yet recognized. Supporting those people may start as a responsibility under one department but at its best becomes a cross-functional effort to supercharge a core group of stakeholders.
Lesson 3: Consider a sustained collaboration, not a short-term investment.
Twitch and Instagram are both platforms with thriving communities that were essential to their early growth. Both platforms have been acquired and are now owned by public parent organizations (Amazon and Facebook, respectively). But they’ve taken remarkably different paths with their community investments.
Instagram was once a community-building darling. As co-founder Kevin Systrom explained, “Anyone can create a photo-sharing app; not everyone can create a community. If you can protect that asset — if you can help nurture and grow it — and your product doesn’t suck, you have created something much more valuable than a great product with a terrible community.” But in recent years, the company reduced its community investments. They eliminated their global community team, reducing their investments in storytelling about passionate community members. They’ve automated customer support. A few years ago, they halted their support of InstaMeets, the meetups passionate users put on organically. And they even removed “community first” from the company’s values statement. Yet in the short term, their bottom line continues to grow and grow. (One of us, Bailey, was one of the first Instagram team members.)
Twitch, on the other hand, has continued to make deep investments in their community even as they’ve grown. Their Twitch “ambassador” program trains burgeoning streamers and flies them into HQ to speak directly to product and data teams. New product ideas are shared with community members before they ship. The Twitch team continues to spotlight remarkable users in their product and editorial. And they have invested in a fast-growing series of meetups around the world.
Why does Twitch continue to invest in these relationships if they’ve already reached such scale? Erin Wayne, the Head of Community Marketing at Twitch, told us: “Our community has strong opinions about what we at HQ do because they spend so much time on our platform…Six years ago there were 50 million people using the site. Now there’s four times that number, and we should still be doing the same things. It doesn’t mean that our community’s opinions are less important because there are more members.” The Twitch community’s passion is remarkable: members give their time to advocate and organize on behalf of the brand. So Twitch continues to show up for their users and offer a higher standard of care, building with, not for them, even as they’ve reached the scale most companies can only dream of (more than 1 million users on the site at any moment).
In the early days of Instagram, there was a thriving community, but it was never guaranteed to stay that way. Twitch, by comparison, is investing in deep relationships with customers. A company can continue to thrive — as Instagram so far has — without investing in their community but if you don’t sustain your relationships you are at risk of taking on community debt. For most companies the loyalty of a set of customers is one of their most defensible assets.
A community is only a community if people keep showing up. Thus if companies want to build communities, they too will need to keep showing up. They need to be consistent. The ROI of community investments can’t be measured as immediately or evidently as other tactics like digital advertisements. But beware: Organizations who don’t make real sustained investments, putting resources and time into nurturing relationships with their most passionate people, simply won’t succeed at building a community. They will get out what they put in.
For many organizations, cultivating a community will mean cultivating a new capacity. This is a democratic, not autocratic, route to building customer relationships. It requires trusting instead of controlling, and commitment instead of flightiness.
Take inspiration from organizations like LEGO, TEDx, and Twitch. Begin to collaborate with your customers by asking: Today, does our company hope for the best at the big reveal? Or do we build trust with customers throughout our process? Does our team know the answer to who we want to invest in and why those people want to come together? Have we “followed on” our initial investment in this community? When and how?
As we move into the coming decade, your customers will be acting on your behalf anyway, driving interactions themselves. You can either stand on the sidelines, or you can take an active role by empowering them.
Culture can be a powerful lever for maintaining, renewing, and shaping an organization’s viability. While global teams can provide cost savings and help firms access talent from around the world, cultural differences and divergent expectations around workplace norms can be sources of friction. That’s why it’s so important to understand how cultures tend to differ around the world.
Building upon the integrated culture framework we presented in “The Leader’s Guide to Corporate Culture” (written with our collaborators Jeremiah Lee and Jesse Price), we launched an online assessment to allow HBR readers to explore their own organizations’ cultural profiles. We received over 12,800 responses from across the globe between December 2017 and May 2019 (you can explore your organization’s cultural profile here).
The assessment gave us a window into HBR readers’ organizational cultures: the shared, pervasive, enduring, and implicit behaviors and norms that permeate an organization (rather than individual employees’ own culture styles). For each respondent’s organization, we examined the relative rankings of eight distinct culture styles that map onto two dimensions: how people respond to change (flexibility versus stability) and how people interact (independence versus interdependence).
A few patterns emerged across the full sample of responses: Caring and results were the most salient culture attributes across respondents’ organizations, reflecting an orientation toward collaboration and achievement in the workplace. Meanwhile, authority and enjoyment ranked lowest overall, indicating that decisiveness and spontaneity were lower priorities.
Differences across regions
Cultures can exist on many different levels. Within organizations, variations in culture can be found by functional area or even by work group. More broadly, patterns in behavioral norms and values can also exist at the national or regional level. Prior research has shown how culture varies across countries in systematic ways.
HBR’s readers provided a great global lens through which to examine organizational cultures across regions. We received survey responses from around the world, with 43% of responses coming from readers outside North America. In this global sample, some patterns were remarkably consistent across regions: On average, caring ranked highly across all regions, while authority ranked among the least salient culture attributes. However, when we examined whether certain culture styles were more heavily represented in specific regions, some interesting differences came to light.
How people respond to change. First, we examined the culture attributes that explain how people respond to change (more specifically, organizations’ tendencies toward stability versus flexibility). We found that organizations in Africa exhibited substantial flexibility. Many organizations in this region were characterized by learning and purpose, indicating an openness toward change through innovation, agility, and an appreciation for diversity. In contrast, many firms in Eastern Europe and the Middle East were characterized by a strong degree of stability. An emphasis on safety was prevalent in these regions, revealing the prioritization of preparedness and business continuity. Particularly in the Middle East, we found many firms in which authority ranked highly.
How people interact. Second, we analyzed how people interact with one another. In other words, we examined whether people are inclined toward independence or toward interdependence. Firms in Western Europe and in North and South America leaned toward a high level of independence; however, this tendency manifested itself in different ways. Western European and North American firms exhibited an especially strong emphasis on results, goal-orientation, and achievement. Relative to other regions, enjoyment ranked highly in South America, reflecting a propensity toward fun, excitement, and a light-hearted work environment. On the other hand, firms in Asia, Australia and New Zealand were more likely to be characterized by interdependence and coordination. In these regions, we found workplaces that embodied caring, and a sense of safety and planning. Particularly in Asia, we found many firms that emphasized order through a cooperative, respectful, and rule-abiding culture.
What does this mean for employees?
The external environment can shape the cultures of the organizations in which we work, but we all have our own individual work styles. It can be informative to take stock of how our own work styles mirror or differ from regional culture patterns, especially when considering how our behaviors and actions will be perceived by others. For example, taking the initiative to update standard operating procedures to implement a new software package might be applauded in a region where learning and agility are valued, but might be met with frustration in a region that emphasizes order and consistency.
Furthermore, with the increasing prevalence of telecommuting, freelancing, and contract work, it is becoming ever more common to work with others across regional boundaries. Recognizing that fellow team members may be coming from regions where norms and behavioral patterns differ from our own is critical when communicating and collaborating with a diverse work team.
What does this mean for managers?
Recognizing the potential influence of the external environment on workplace behaviors is critical when managing others. For example, when designing work teams and setting reporting structures, managers should take into account whether regional cultures might drive employees toward collaboration or independent effort and to what extent employees expect hierarchy and structure. Not taking these factors in consideration is one reason so many global expansion efforts fail.
Particularly when managing global teams, employees’ implicit values and beliefs can lead to misunderstandings and tension. For example, when eliciting participation in meetings and conference calls, managers should consider whether potential differences in culture may drive participants to reserve comments until their opinions are specifically solicited or whether they might offer their views voluntarily. Cultural considerations also come into play when motivating employees, designing incentive schemes, training new employees, and implementing decision-making processes.
Although the regional environment can guide workplace norms and behaviors, these influences are just one factor among many that can shape organizational culture. In some cases, regional influences and the culture within the organization may even clash. These tensions often rise to the forefront when firms enter new markets, leaving managers to contend with the challenge of managing their organization’s culture within a new regional context. In these cases, a careful analysis of the culture attributes that are essential to supporting the firm’s strategy is needed in order to determine which culture attributes to preserve and which to evolve.
Culture can be a powerful lever for maintaining, renewing, and shaping an organization’s viability. While global teams can provide cost savings and help firms access talent from around the world, cultural differences and divergent expectations around workplace norms can be sources of friction. Cognizance of these regional patterns provides valuable contextual information; however, it is also important to remember that a wide range of organizational cultures exist in all regions. Managers should take care not to make broad assumptions or to stereotype others based solely on regional origin. Regardless of leaders’ specific goals and ambitions, making an active effort to understand and acknowledge the cultures that operate within the organization is a critical undertaking for effective management in today’s global environment.
The reality is that the risks hospitals face today are different than what they imagined a decade ago – and that a rapidly changing climate poses yet unforeseeable hazards for the future. In Santa Rosa, California, Kaiser Permanente has learned from evacuating under the threat of wildfire twice in the past two years. From these experiences, they’ve built systems and solutions that health care systems anywhere can learn from, including conducting a system-wide bed availability assessment, controlling patient transfer prior to mandatory evacuation, preparing for patient evacuation early, and using an evacuation toolkit including a tracking system.
In 2017, as the Tubbs Fire made its dramatic and rapid assault on Santa Rosa, California, our doctors, nurses, and support staff faced the unimaginable task of evacuating the hospital. It was a job that many, if not most, of them never imagined doing in their careers. And yet, again this fall, wildfire threatened the facility. As the Kincade Fire made a slower — though no less deliberate — approach, our staff again halted surgeries, labor deliveries, and more and packed up patients. Both times we safely evacuated more than 120 patients and ensured care continuity under extreme duress.
While it’s practice we wish we never had, these two emergencies have helped us build and prepare a resilient emergency response operation and this year’s evacuation demonstrated significant improvements; we were able to evacuate more efficiently and calmly. Here’s how we’ve refined these practices in two emergencies.
1. Develop a turnkey command center
Kaiser Permanente had previously created regional ad-hoc command centers to respond to specific incidents, but we learned that critical time can be lost during an emergency when summoning personnel to a new location, connecting and re-connecting communications equipment, and establishing the physical command center to accommodate the required support staff.
With this in mind, in 2018 we opened a fully operational, turnkey command center at our regional headquarters in Oakland outfitted with the appropriate telecommunications and IT equipment needed to coordinate emergency response across multiple sites and disaster scenarios. The center has the technology and trained personnel to provide constant visibility into the operational performance of each of our hospitals during an emergency, enabling us to provide the necessary resources and support in real-time.
2. Open a command center before the threat becomes acute
The 2017 Tubbs fire swept quickly through Santa Rosa and up to our hospital’s property line in the middle of the night, with little advance notice. The decision to evacuate and manage the associated logistics was made swiftly at the ground level and was ultimately carried out safely. At our debrief after the incident we reviewed ways to gain additional time and improve communication in a similar scenario. The answer lay in a common medical practice: Treat potential problems before they become acute.
Now we open a command center at the first sign of a potential threat. This allows emergency teams to communicate issues in real-time, develop planning scenarios and anticipated reactions, and set expectations and priorities across multiple locations. This is done long before emergency decisions must be made.
In October 2019, we opened our command center long before the Kincade Fire became a presiding emergency situation. And we began the process of proactively transferring patients out of our Santa Rosa Medical Center eight hours before the formal evacuation notice came through. In this instance we had the benefit of time; the regional electric utility had announced planned power outages across multiple counties due to the high possibility of fire. Still, the decision to not wait until we felt seriously threatened helped us improve our response by putting critical steps in motion sooner. These steps included preemptively reducing hospital patient count through a controlled transfer process and moving patients to other nearby Kaiser Permanente medical centers. Early patient evacuation preparation was initiated as well, including assessment for evacuation transport needs, printing of evacuation reports, and completing patient evacuation tags well in advance of the actual evacuation.
3. Identify interdependencies and activate resources
Urgently evacuating 122 patients from the hospital in the dead of night in 2017, our sole initial focus was getting them out of harm’s way as the air filled with smoke and flames came within yards of the hospital grounds. Ambulance resources were scarce as our neighbor hospital had begun evacuating 45 minutes prior. Out of necessity, many of our patients were transported by city buses and private cars with hospital staff. There was no time to distribute patients equally between nearby Kaiser Permanente medical centers; instead, most went to the closest one.
During the 2019 Kincade Fire we connected with our unaffected hospitals and medical centers early on, as conditions deteriorated, asking them to proactively assess their patient capacity, and open additional inpatient capacity in anticipation of planned transfers from the evacuation of the Santa Rosa hospital. We also asked them to activate their command centers to ensure operations were in place 24/7 to manage potential transfers to their hospitals. This allowed our unaffected hospitals to be ready and able to receive Kaiser Permanente Santa Rosa Medical Center’s patients safely and expeditiously, while our integrated electronic medical record system allowed physicians at the receiving hospitals to provide seamless continuity of care for patients.
But we still had to get the patients to those open beds. As part of the command center structure, our regional transportation hub organized all ambulance and medical transport required for the evacuation and transfers. We had dozens of emergency service transports lined up and waiting as our first patients from Kaiser Permanente Santa Rosa Medical Center were readied for transfer to another medical center. Not all hospital systems are integrated to this level, but the lesson is that coordinated responses happen most seamlessly with advance planning. Knowing who was in our network, and who we could call on for help, was key to making the plan work.
4. Consider incremental action
There are many intermediate steps a hospital can take before a full evacuation is required. For example, a strategy to begin sending non-critical patients and those who may take the longest to prepare for transfer to other nearby hospitals in planned transfers can help avoid overwhelming the receiving facility and reduce the at-risk patient population in case of emergency.
In addition, time spent gathering equipment, filling out paperwork, and doing any other “pre-work” will enable a rapid evacuation of the remaining patients should that become necessary. Ideally this will be part of a comprehensive evacuation plan and toolkit — including evacuation checklists, evacuation tags, and a patient tracking system — already tested and in place. Educating and training for employees and physicians on these processes in advance of an emergency will help achieve optimal performance and the best possible outcomes for patients in a real event.
The reality is that the risks our facilities face today are different than what we imagined a decade ago — and that a rapidly changing climate poses yet unforeseeable hazards for the future. Some of our solutions may best fit a multi-hospital integrated delivery system like Kaiser Permanente, but we also believe that hospitals and health systems of any size can learn from our experiences and changes we made between the two fires — and then had the opportunity to pressure test — including conducting a system-wide bed availability assessment, controlling patient transfer prior to mandatory evacuation, preparing for patient evacuation early, and using an evacuation toolkit including a tracking system. While we hope that we won’t have to evacuate again, analyzing these experiences, learning from them, and continuing to develop emergency plans is part of what we know we have to do to keeping our patients and communities safe.