Lessons from the Disaster Field Office

March 13, 2007

Another "All Hazards" Risk

Einstein is credited with saying:

"The ultimate insanity is to continue to do the same thing and expect a different result"

Einstein obviously met the people who direct our healthcare disaster preparedness in America.

Harsh, let's look at the track records for disaster preparedness and response around the nation.

  • The single greatest failing in disaster preparation and response has been the planning and delivery of care to special needs populations (children, the elderly, the specially enabled and the homeless). Put these groups together you have the majority of the population of the United States.
  • Repeated surveys of hospitals and healthcare organizations has shown no increase in the percentage actually instituting an "All Hazards" disaster plan. While many hospitals are making great strides, more refuse to invest the manpower and money needed to get the job done right.
  • Out of 300 million Americans, fewer than 1 million own a 3 day survival pack to use in case of disaster or pandemic.
  • Despite a history of mismanagement, the Department of Health and Human Services was again placed in charge of the nation's medical rapid response force. The National Disaster Medical System (NDMS) was founded in the US Pubic Health Service, but after years of inept management was moved to the Department of Homeland Security. There response efforts were hampered by FEMA's unfamiliarity with medical rescue operations. Rather than moving NDMS to a response agency like the Coast Guard it was placed back in DHHS.

These few examples demonstrate the risk that faces disaster preparation for healthcare, hubris. It is not the unwillingness to change, or even the unwillingness to spend money, but the utter refusal to admit that we were wrong the first time that will be our down fall in the future.

  • Even after the lessons of the past three years and despite the threat of pandemic influenza looming large on the horizon, emergency planners still fail to plan adequately for those with special needs, preferring to shift the responsibility and the burden to healthcare.
  • Rather than facing the reality of an unfunded mandate and investing the money needed to become "All Hazards" prepared, hospitals and healthcare institutions spend their money on patient satisfaction scores, billboard advertising and memorial gardens.
  • Instead of ensuring the safety of their family members with a weather radio or a disaster pack, Americans buy video games and neck ties as holiday gifts.

Everyday those in charge of disaster preparedness do the same thing and expect a different result. Einstein was right, it is the ultimate insanity.

February 24, 2007

Spiritual Resilience for Business

Of all of our sources of resilience, spiritual resilience, it is the only one that is self replenishing.  It is proven that the very act in believing adds to our resilience.  Like emotional resilience spiritual resilience grows when shared.  But unlike all other canteens of resilience it is spiritual resilience that refills itself.  Since we know that it does not matter in what we believe, but that we believe in some form of high order, high wisdom, or higher power a “God” or guiding force in life.  It makes sense that acting on our beliefs would add to our resilience.

It was spiritual resilience that sustained me during the multiple field response deployments of 2005. Hurricane Katrina was an absolute catastrophe in both humanitarian and a physical nature.  What the hurricane had not directly destroyed the levee breaches soon did.  Lawlessness and anarchy brought a few to the basis of human emotion and behavior.  But the tragedy also brought out the best in many people.  Like 9/11 before it Hurricane Katrina’s “ground zero” was dotted with signs that seem to reproduce like mushrooms each one declaring “God bless New Orleans” or we have faith, we will be saved.

These people not only publicized their beliefs (and their spiritual resilience), but they lived it.  These individuals shared not only their stories with us as we treated their physical ailments, they  told us that they would pray for us or that we were the answers to their prayers.  It is not unusual to receive perfunctory thank you’s in healthcare, but to be asked to pray with a group of survivors and then be the object of their prayerful thanks is both humbling and rejuvenating.

And for these wonderful survivors it was the act of expressing their spirituality that renewed them. Remember this is New Orleans, we are not just talking Christianity, Islam, Judaism, but Santorista and Voodoo.  Every form of religious expression both familiar and exotic and yet they all served a common end: they bound a people together and renewed them. The found the way to refill their own 40,000 gallon bathtub by pouring from their canteen of spiritual resilience.

It is this type of resilience that every business must have to handle catastrophic adversity. “Business Katrina’s” fill the news almost every week and those affected are often left bereft of emotional resilience and the financial impact literally bankrupts their physical resilience. It is at these times that an abiding faith is imperative.

But faith in what?

In the 1980’s the study of Sun Tzu and The Art of War introduced American executives to the concepts of balance and flow in battle and business. Sun Tzu wrote not only of strategy, but of the need to understand one’s place in one’s world. More importantly, Sun Tzu emphasized planning with respect and consideration of the environment and the greater forces that determine the fate of our efforts. At the deepest level, The Art of War was about victory through surrender.

In more modern times, masters of Indian philosophy have reintroduced the principles that build spiritual resilience to the American corporate community. Jeff Korhan (www.truenature.com) is the most respected of these new corporate philosophers. A protégé’ of Depak Chopra, Jeff Korhan has successfully made the jump from businessman to business guru in the truest sense of the work through the use of his spiritual resilience both for himself and his clients. How will your spiritual resilience serve you?

(Excerpted from my lecture series and book The Wounded Dog: Avoiding Business Disaster - Lessons Learned from the Disaster Field Office)

February 23, 2007

Relationship Resilience for Business

Keeping the relationship canteen full is more than just accumulating friends and acquaintances.  The relationship canteen is filled by the richness of those relationships and the connectedness created through the friendships and family.

It is said that a person with friends is never truly alone and when your resilience is tested a full relationship canteen is proof of that statement. Jim Cathcart, the guru of relationships and business (www.cathcartinstitute.com) has made a career teaching the nation’s CEO’s, Executives, Elite Sales People and Entrepreneurs to create business success and business resilience by paying attention to both sides of a relationship, you and your relationship partner. His books and seminars are sold world wide and have been the basis for some of the most successful sales campaigns in recent history. In short, the idea of relationship resilience is not new.

In my life I am fortunate to be blessed with a wonderful marriage.  My wife, Laura, is intelligent, caring, compassionate, supportive and beautiful.  She is a fantastic mother and my best friend. Laura is absolutely supportive of me in everything that I do.  No only my disaster response work but my every day life, my beliefs (even when she disagrees with them), my dreams, my goals, and even my desires. Laura and I share a relationship that is special and in modern society increasingly rare.

Because I strive for physical preparedness both in body and in resources we maintain family preparedness in the same realms.  We have a family plan in the event of an emergency and each of my children, as well as Laura, are well versed in every aspect of that plan.  I know that I can count on Laura to keep the family safe no matter where I may go, what kind of disaster I respond to, what may befall them in my absence, or even in the event that I should never be able to return home.

When I must call upon my resilience, I have a full relationship canteen.  Not only does my marital relationship contribute to this reserve, to this relationship resilience, but I have similar relationships with each of my four children and with my mother.  What is more, even though my father is now deceased, my relationship with him remains a source of relationship resilience.  I know that he is proud of me in the work that I do. This limitless source of renewing strength ensures that I am able to endure and ultimately overcome any challenge ahead of me.

But relationships are a twoedged sword when it comes to resilience.

Several years ago my younger daughter Tiffany suffered challenges of her own and I was away to assist in response and recovery for a declared national disaster. As a result of Tiffany’s hospitalization my resilience was seriously compromised. 

I was conflicted. 

I was physically strong and physically prepared.  I had all of the equipment and resources I needed to perform my disaster response duties.  But the challenges facing somebody who I cared about caused my relationship resilience to suffer significantly.  Rather than being a source of strength my need and desire to be home caring for my daughter sapped my strength.  I was no longer sipping from my canteen of resilience.  I was gulping deeply.  My 40,000 gallon bathtub had sprung a leak. 

The fact that I could do nothing even if I were at her side did not make a difference in how badly her needs affected my resilience.  The fact that I would not even be allowed to be at her side in the first week of her hospitalization did not change the impact of her needs on my resilience.

Relationship resilience is not only important those of us in the disaster field office. A major jewelry retailer saw both sides of relationship resilience. In 2003, a member of the corporate C-suite developed cancer. The diagnosis was made early and the company rallied behind their stricken leader.

Surgery, radiation and chemotherapy drove the illness in to full remission and it looked like a celebration of a cure might even be in the offing. Through out the illness, the executive drew strength from her resilience in all its forms. She was an inspiration to the company’s employees as she came back to work and assumed the reigns of leadership with full vigor.

Then she relapsed.

It had been two years since her illness and the recurrence of cancer hit hard. Not only was there the emotional blow of having cancer again, but the physical rigors of new and stronger chemotherapy. The company and its employees again rallied to her side, but this time resilience waned, the relationship resilience could not fill the void left by the loss of emotional and physical resilience.

Again the company stood by their stricken leader and again she returned to the reigns of power, but this time she had no vigor. Soon her executive assistant was her nurse and her Senior Vice President had been placed in a shadow leadership position. Confusion ruled the day as each division tried to follow two often divergent business directions. Finally, the board had had enough. They wanted to stand by a loyal career executive, but the stock price was falling and the industry wolves were preparing for the attack. The Senior VP assumed full control and the ill executive made a graceful exit.

Relationships are a two-edged sword for resilience but this does not mean that we should limit our relationships based on their potential impact.  Quite to the contrary it means that we should expand our relationships. Make them as deep and rich as possible and share in providing for the resilience of those of whom we care most deeply. Are you growing relationships that fill your Canteen of Relationship Resilience?

(Excerpted from my lecture series and book Wounded Dogs: Avoiding Business Disasters - Lessons from the Disaster Field Office)

February 22, 2007

Emotional Resilience for Business

Emotional resilience is the product of our own experiences.  The unique thing about emotional resilience is that unlike physical resilience are experiences need not be the same as the adversity that we now face.

In the training environment this type of "cross over" is exploited to help create emotional resilience in a number of professions.  Airline pilots, the military, sales people, law enforcement officers and most recently healthcare professionals employ Immersion Simulation Environments to introduce controlled, simulated stress in a way that allows these professionals to develop emotional resilience.

The Internet abounds with software programs and even video games that allow a business person to "practice" their financial forecasting skills in their business management.  Computer games and board games even provide an opportunity for emotional growth and the development of life skills.

But there is no “Flight Simulator” for life… or is there?

The “Flight Simulator" for life adversity and business adversity however is experience.  The confidence that comes from encountering and overcoming the ebb and flow of daily life gently fills our canteen of emotional resilience.  It is in the dealing with the burnt dinner, the flat tire, the person in the ten item checkout line with 12 items, and the crying babies in the theatre they give us the opportunity to build our emotional resilience.

A fine example of emotional resilience occurred during the late years of the Dot.com craze of the 1990’s. Robert had built an online business with his two brothers. The business had grown slowly to over a million dollars in sales per year with virtually no overhead because it was a virtual company. Each of the brothers were professionals with successful careers and solid business credentials so their success seemed inevitable. Unfortunately, the bubble was about to burst.

By March of 2000, Robert saw that sales were beginning to fall and inquiries to buy the brothers out, previously an almost weekly event, had completely ceased. Unlike his brothers, Robert had recently quit his job as a mortgage company president to devote himself full time to the business. The change in business climate would have caused most people in his situation to panic and in fact that was what happened as the Dot.com bubble burst. Robert however drew deeply from his emotional reserve and accomplished what most in those days could not, he calmed his fears and charted a new course.

An objective analysis of the company and the business plan disclosed a flaw that was common to most Dot.com’s of the day, there was no unique selling proposition and the product had not benefit not found for a similar price in most cities in the United State. The company was doomed!

In the book and the movie Dune fear is referred to as, “The Mind Killer.” It is through emotional resilience that we overcome the fear that chokes out thought and suffocates creativity. Robert and his brothers now took a great gulp from their canteens and took a bold move, sell a company who’s sales are falling. They accomplished this by getting creative with marketing and actually improving sales. They knew that the improvement would not be sustained and they resisted the urge to “hang on” when sales finally turned around.

When they sold the company, they made a small profit above the capital it had taken to turn the company around. The new buyer, who had seen all the financials, was thrilled when the company continued profitable for another 9 months, long enough for the new owner to add new products and develop relationships with the existing customer base. Everybody won!

Whether or not we in fact use these "life lessons" to fill or drain our canteen is entirely our choice.  We all know individuals who spend their lives complaining.  Every little set back is a major problem, every challenge an insurmountable object.  Some of these individuals when faced with a truly tragic adverse life event "rise to the occasion."  Everyone one around them is amazed that this individual is "managing so well."  Unfortunately this is the rare outcome of failing to build emotional resilience from everyday life.  In reality these individuals when studied (and they have been) are really drawing their resilience from the other three canteens and in fact most often from their spiritual canteen.  When studied objectively it is often discovered that these individuals are emotionally overwrought or emotionally numbed.  Their emotional canteen is bone dry and they are compensating from their other canteens.

On the other hand we all know people for whom life's little tragedies are nothing more than minor tribulations.  These individuals are lights in the lives of their friends and colleagues.  They are safe harbors when the emotional waters become stirred.  They are often described with phrases such as "unflappable" or "steadfast", or "strong."

With these individuals the trials of everyday life reassure them of their own strength and fill their emotional canteen.

It is not just our challenges that fill our canteen.  While our relationships fill our relationship canteen the emotions that are relationships create within us fill our emotional canteen.  That is right, we get a two for one return on our investment.  Even better, our emotional canteen is filled by the casual relationships we have at work.  While is true that some of these work relationships fill our relationship canteen by being friendships as well, the encouraging pat on the back from a boss, the applause or accolades of colleagues and even the comradery at the water cooler provides a sense of belonging and inclusion that quickly fills our emotional canteen to overflowing.

Our emotional canteen is also one of two that we can share with others.  During times of adversary we can actually help fill another person's emotional canteen by sharing the life experiences and the feelings that surround those experiences with that other person.

The beauty of this ability to share emotional resilience is that it does not take even one drop from own canteen.  In an almost miraculous fashion the sharing of the contents of emotional canteen allows us to pour almost perpetually into the canteens of others and yet retain a full canteen for ourselves.  It is not until we begin to sip or gulp from our own emotional reserve that we, ourselves, need to seek replenishment. Live richly, love honestly and fill the canteen of emotional resilience.

(Excerpted from my lecture series and book The Wounded Dog: Avoiding Business Disasters - Lessons from the Disaster Field Office)

February 21, 2007

Physical Resilience for Business

Executive Health and Corporate wellness programs have been on the rise since the early 1990’s. Main stream business magazines such as Fortune, Business Week and even the Wall Street Journal feature articles on everything from getting fit at home, staying fit at work and working out while on the road. Last year I had over 53 separate business related hotel stays and found that each facility either had health club quality equipment available or was in the process of remodeling to ensure the health and well being of their corporate guests. Most executives and entrepreneurs know that they must take care of their bodies and corporate America is making that easier every day because the benefits to the bottom line are readily evident… healthy executives are more productive.

But, imagine being 50 pounds overweight, woefully out of shape, and recently discharged from intensive care after suffering an infection that devastated your liver and kidneys.  You've regained your physical health through the skill of your doctors and nurses, but you can barely walk across the room.  You are beyond couch potato… you're Jabba the Hut! 

This was my exact situation after a simple case of salmonella food poisoning resulted in severe dehydration and hepatorenal failure.  In essence, my liver and kidneys had all but shut down and my body spent two weeks using not fat, but muscle as it's primary fuel source.  While I had lost 15 pounds, but I had not lost more than a pound or two of my excess 50 pounds of fat. 

I had been a competitive swimmer in my youth as well as a competitive martial artist while in medical school. I had intended to begin exercising after the first of the year. The holidays had not yet passed, but it was clear that I had to do something to regain even the barest minimum of physical strength and stamina. 

Imagine jumping into your 40,000 gallon bathtub in December, literally.  Even in Florida, even in a heated pool, it is a shock.  Fortunately fat floats, so my risk of drowning was low.  The first few strokes were incredibly painful.  Not only had I not exercised at all during my extended illness, but these were muscles I hadn't used to any great extent in decades.  By the time I had swum the 200 yards it took me to warm up I was physically exhausted and panting like a greyhound after a race.  By 400 yards my now warm limbs were screaming and my face was hot and flushed.  I could almost feel steam rising from my body even while I was in the water.  By 500 yards I called it quits for the day. 

Not much of a story on physical resilience except that the next day I got back in the water and again the day after that and the day after that.  By February I was swimming two miles three times a week.  I had lost 35 pounds of weight and an estimated 45 pounds of fat.  My muscle mass was up and at the end of two miles I was not breathing any harder than when I entered the water.  My kidney and liver function were back to normal and I was in the best shape that I had been in since medical school.

Physical resilience is about dedication to repeated practice, to education, to creating resources needed for any event or situation. Physical resilience is the development of perseverance through perseverance.

Physical resilience is also the easiest resilience to develop.  In the disaster field office, training it is simply the accumulation of knowledge and materials.  Five days of training, a 72-hour survival pack and four pocket handbooks shrink wrapped into a waterproof brick are sufficient to turn any healthcare provider into a proficient disaster response professional.  It is not the knowledge or the "brick of books" but the whole of physical resilience that is the key. What will you do to fill your canteen of Physical Resilience?

(Excerpted from my lecture series and book Wounded Dogs: Avoiding Business Disasters - Lessons from the Disaster Field Office)

February 14, 2007

The “Choke Point” is Management

One of the lessons learned early on in the disaster field office is referred to as “span of control”.  Span of control is a two-dimensional concept of personnel and project management.  Span of control dictates both the breadth and depth that an individual leader may effectively exert control and leadership.

Decades of experience have taught us that even the most experienced project manager, leader, CEO or company president can only effectively lead a breadth of three to seven subordinate divisions and ideally the number is five.

That same experience has also taught us that a leader becomes detached if the organization they oversee grows greater than five to seven layers deep with, again, the ideal number being five for efficacy.

But why does this occur?  Why should your organization be no more divisions wide under any one leader than the number of fingers on their hand and no more layers deep in that organization than the number of toes on one foot?

The answer in part lies in the functioning of the human brain.  Immediate memory, that portion of the brain capable of receiving information almost instantaneously, less than .037 milliseconds, and maintaining it until it can be written into permanent memory is only seven blocks wide; this is why your telephone number (excluding the area code) is seven digits long.

However, just like a telephone number, by grouping batches of numbers your brain treats each group of numbers as one block.  The area code becomes one block of information rather than three discreet numbers.  The prefix, another group of three numbers, is again considered a single block of digits.  Hence a ten-digit telephone number is now treated by the brain as only six blocks of information—the area code, the prefix and each of the last four individual digits.  Similarly your Social Security number is divided into the same sequence—three-digit prefix, a two-digit place code and the terminal four digits. 

Span of control pays attention to this same basic brain limitation.  You can most effectively pay attention to five simultaneous branches within your chain of command without becoming distracted because you have two “available” blocks of memory in which to store “distractions.” 

Depth in any one branch works the same way.  When you must pay attention to one branch with any degree of specificity, your brain turns your memory “sideways” and looks at the depth in blocks of information. Limiting depth to 5 layers leaves two “available” blocks for “distractions” or to share among the other branches of your organization.

But how does this impact actual management?

Taking these decades of experience from the disaster field office and combining them with the neurophysiologic knowledge of how the human brain works, we discovered that in any organization, the organization must be subdivided when the number of first-level subordinates exceeds five.  Therefore, if a CEO must run four divisions of a single company, he can do so with four vice-presidents, but when that number exceeds seven, the company must be in some fashion broken up, grouping each of those greater divisions under individual presidents who then report to the CEO. Thus the company becomes one layer deper, but the CEO has only 2 divisions under his span of control (each with a president).

Similarly, imagine we now have one CEO with two presidents, but the organization becomes greater than seven layers deep with the seventh layer being the customers.  The CEO is in danger of losing touch with those customers.  In this circumstance, a new division in the company reporting directly to the CEO can be established that provides for information to be disseminated directly by the CEO to customers and feedback directly from customers back to CEO.

A fine example of this is seen in Zales Corporation.  Zales Corporation operates multiple divisions under multiple jewelry sales brands.  Each of these brands is grouped according to their market.  Thus, they grouped brands with each group led by a senior vice-president.  The corporate president oversees senior vice-presidents and thus their groups and brands.  The problems for Zales Corporation came when in their corporate C suite, became embroiled in a personnel problem.  This highly publicized personnel problem impeded the ability of the higher echelon of leadership to exert their span of control and required that a lower level of leadership assume a dual role.

Dual roles are death!

Worse, the individuals in duel roles supervised the same people, creating two parallel chains of command. The company and its employees were literally shackled by conflicting instructions and expectations. In the disaster field office we know that when needs exceed resources it is a disaster, but when needs exceed all ability to respond it is a catastrophe. Zales became a wounded dog because management issues (needs) exceeded their ability to respond. Investors responded to the catastrophe and stock prices fell.

Span of control dictates that one person fills one role and that even like organizations not be combined, but that if one leader must supervise two separate divisions or organizations, that that leader do so through a subordinate to whom those organizations individually report.  In the disaster field office we call this “Unity of Command” and it ensures that each individual in the chain of command knows precisely what singular individual to whom they report and from whom they take direct instruction.  With this unity of command and span of control principles in place, management issues cease to be a choke point.

Zales ceased to be a wounded dog when they corrected their C suite personnel problems, reestablishing a unity of command and a manageable span of control. Investors rewarded them with a two-fold increase in stock price in two months.

(Excerpted from my seminar series and book, Wounded Dogs: Avoiding Business Disasters – Lessons Learned in the Disaster Field Office)

February 03, 2007

A Fuel Gauge for Resilience

Wouldn’t it be great if it were possible to measure how resilient you were before you faced adversity? 

How would it change your behavior and your preparation if you could take inventory of your ability to stave off disaster? 

What would you pay to have enough advanced warning of potential catastrophe to avoid it entirely?

The concept of avoiding disaster and catastrophe relates directly to the ability to maintain sufficient resilience that needs never exceed resources and that needs never exceed the ability to respond.  Physical, emotional, relationship and spiritual resilience are well known as the four categories in which resources are mapped to ensure survival through adversity in business and in life. 

But how can we measure our resilience when we are not facing an adversity? 

How can we firm the depths of our own reserve when we are not facing disaster or catastrophe?  What we need is a fuel gauge, an ability to measure how well our resilience is being taken by our every day life and how well we are replenishing that supply, our resources. 

In the late 1960s researchers developed a four part stress inventory that ranked the impact of various life changes (adversities) on four aspects of American life.  These aspects of life are:

  • Financial
  • Personal
  • Family
  • Career

The title for each of these were based on the predominant factor in each inventory and not wholly encompassing of the spirit of each category. 

The “Financial” category deals not only with issues of income and expenses, debt and savings, but almost all other non-personal health related physical resource issues in one’s life including the provision of food and water, housing, clothing and even transportation. 

The “Personal” category deals primarily with physical health and personal emotional stressors.

The “Family” category encompasses all you non-workplace relationships. 

The “Career” category deals not with just having a job but with the relationships that surrounded your workplace and your community.

It is not difficult to see how each of these 100 point gauges has a different aspect of our resilience.  Personal measures our emotional and spiritual resilience as a small portion of our physical resource.  Financial is an excellent gauge of our total physical resilience as it relates to our ability to provide for our own resources, personally and in our business.

The family inventory when combined with the career inventory provides an accurate gauge of our relationship resilience as between these two inventories they account for all of the significant relationships that impact our ability to obtain both emotional resources as well as physical resources from those in our network of support.

This quartet of “choke point” inventories provides us an estimate of our resilience in the physical, emotional, relationship realms.  The higher the score, the lower your resilience.  When there is an area of high score, we then know to focus our efforts on improving our resources in those areas of resilience.  This is often done by eliminating the choke point to resilience and occasionally by eliminating those things that are taxing our reserve. 

Unfortunately there is no inventory for spiritual resilience.  Instead, there is one simple question.  Do I believe?  Note, this question does not ask do I believe in …?  It only asks “do I believe?”  This yes no question is an all or none on the 100 points for spiritual resilience.  Research has time and time again proven that through the act of believing regardless of what we believe in, we retain all 100 points of resilience. 

(Exerpted from my Keynotes and Book, Wounded Dogs: Avoiding Business Disaster - Lessons from the Disaster Field Office)

January 20, 2007

Bipartisanism and Silos of Authority

The new balance of power in Washington, DC, has sent pundits scrambling to predict how the Republican Party and the Democratic Party will interact.  Conservative pundits tout theories that the Democrats will be forced to the political center, if not slightly to the political right by a conservative President Bush.  Simultaneously, liberal pundits are celebrating the projected migration of a hawkish Executive Branch from the radical right to the conservative left. All this while our elected officials go to great pains to promise they will work in the 'spirit of bipartisanism' and that there will not be 'gridlock' in Washington, DC.

In the disaster field office, we learned long ago that it is not business or even political theory that insures the rapid inefficient movement of information and eliminates political or bureaucratic gridlock.  The process that works best for eliminating gridlock and territorialism comes to us from a Harvard in the early 1980’s.

Gergen and Marcus described a concept in economics known as 'silozation'.  In this groundbreaking theory the author is positive that traditional business models allow for the progression of information from the base of the 'silo' up to the highest levels of management at the top of the silo or the dissemination of information from the top of the silo downward, but prevents communication between organizations (silos) through the wall at any middle level of management.

This model, they claim, prevented the development of relationships between various levels of an organization or even a division within a single corporation.  It also resulted in 'choke points' for communications.  Communication between organizations has to funnel through the top to the bottom of the silo before it could be disseminated to the other members of each organization.  Gergen and Marcus recommended that in business and economics that the silos be cut or totally removed.  By doing this, organizations could communicate risk, benefit and opportunity, relying on their unique capability to insure customer loyalty and market success.

Commander Peter Marghella, USN (Ret.) has introduced this theory to the disaster field office.  Commander Marghella correctly identified that individual professions within disaster medicine and individual organizations within emergency management maintained thick walled silos that prevented cooperation and efficient in austere environments.  The recommendations to remove the silos were impossible and cut through them where they could not be completely removed has improved the efficiency in responding to disasters large and small.

Washington, DC and our nations elected officials need to remove their silos.

The artificial divisions created by classifying candidates as Republican or Democrat, conservative or liberal helps poorly educated voters select from often near identical choices.  However, once elected, candidates represent all of us and they must work with every other elected official in government, even if they do not agree with them.  It is only by removing the silos that pen them in that our elected officials can do the work through which we, their constituents, have charged them.

The government is not a college football game and Washington, DC is not a bowl stadium.  Republicans and Democrats cannot and should not don partisan uniforms, strap on helmets and prepare to do battle.  As the people who place them in office, we cannot sit on the home or visitor's side of the stadium, paint ourselves in our favorite team's colors and scream for the blood of our opponents.  If we do, in the end, the blood on our hands will be our own.

January 16, 2007

Mechanisms of Injury and The All Hazards Approach

The “all hazards” approach to disaster preparedness is based on the concept that while adverse events can not be predicted in their timing, location or type there are limited ways in which they can impact a community, business, or individual. In disaster medicine we call these limited “mechanisms of injury.”  In individuals the mechanisms of injury that may arise regardless of the type of adverse event are:

  • Asphyxiation
  • Burns
  • Crush injury
  • Drowning
  • Environmental exposure
  • Fractures
  • Group infections
  • Historically poor health
  • Impale
  • Jolts
  • Knucklehead
  • Laceration
  • Mental health
  • Nutrition

Asphyxiation covers everything from smoke inhalation to oxygen-poor environments to noxious gasses to chemical weapons.

Burns may be thermal burns, such as those found in fires and explosions; chemical burns, as found in chemical weapons and inadvertant chemical releases; as well as radiation burns from criticality and non-criticality events alike. 

Crush injuries include everything from motor vehicle accident related injury to entrapment under a fallen building and cave collapses. 

Drowning is quite obvious. 

Exposure includes exposures to hot, cold environments as well as radiation in both the criticality and non-criticality type event.

Fractures are not limited only to bones, but to any body tissue or shock sensitive organ system.

Group infections deal with the events of the sanitation that impact evacuees, refugees and even the rescuers (everybody has heard of the “FEMA flu”). Group infections also include epidemics, pandemics and biological weapons.

Historically poor health deals with that 97% of all medical care rendered after the disaster.  It is the exacerbation of pre-existing medical conditions that is inherent when chronically ill people are exposed to austere medical environments. 

Impalement is again as obvious as drowning.  It includes not only falling upon an object, but being thrown against a penetrating object or having a penetrating object thrown through you.  Thus, it includes bullets as well as shrapnel. 

Jolts are simply electrical injuries. 

Knuckleheads represents all of the group events that culminate in the social anarchy like that which surrounded Hurricane Katrina.  It was the knuckleheads who threw there fellow evacuees from the tops of parking structures and shot at the rescuers and rescue helicopters that attempted to come to the aid of survivors.

Lacerations are again obvious.

Mental health issues are often difficult to differentiate and are only now being recognized as the largest portion of healthcare surge after and event. 

Finally, nutritional issues are perhaps the most difficult to deal with.  A poorly prepared citizenry who themselves have not yet stocked sufficient amounts of food and water for even three days begin the problems while amassing large numbers of refugees and evacuees are a challenge for even the most organized of government agencies.

The predominant theme in “all hazards” preparedness is to develop resilience around the mechanisms of injury and ensure that there are sufficient resources to mitigate any stress along any mechanism.

January 08, 2007

Don’t Let Your Business Become a Wounded Dog

In business, as in life, adversity is a recurrent and inescapable event.  The cliché:

“Into every life a little rain must fall”

is true no matter one’s education or level of success.  The key difference between the businesses that close never to reopen again and those that thrive through their adversity is resilience.

Everyone knows that there is nothing more dangerous than a wounded animal.  An injured animal seeks to protect itself by striking out against all who approach.  However dogs are unique in that they will invariably find one person with whom to bond.  This difference is inexplicable, but predictable.  They may not even choose their owner or master.  Nonetheless wounded dogs will drag themselves to the feet of their chosen protector, nuzzling and begging for help.  These wounded dogs know that they are no longer capable of caring for themselves and that one more adversity befalls them and they will die. 

Businesses become wounded dogs when they fail to ensure that an adversity does not evolve into a disaster.  In two decades of disaster field work and consulting to companies large and small I have seen and helped more than my share of wounded dogs.  In all cases it did not matter whether the adversity came from outside the company such as a hurricane, earthquake or terrorist attack or if the adversity came from within; poor product design, marketing mishaps, financial missteps, or employee sabotage.  The result is always the same.  Some critical business pathway collapses resulting in a business disaster. 

Observers both inside and outside the wounded business say that the disaster was “inevitable.”  In the disaster field office, we know that no disaster is “inevitable.”  Disaster is a simple equation no more different than profit and loss. 

Disaster = Needs > Resources. 

The most basic analogy is the financial disaster of “want” exceeding “wallet,” but this same equation holds true in all other critical areas of business. Conversely, resilience, the ability to cope with adversity and stave off disaster, is also represented by the simple equation: 

Resilience = Resources > Needs. 

Again the analogy is the financial resilience of “wallet” exceeding “wants.” 

Now if this were the end of the story, one short speech, one short consultation, one small article in the Wall Street Journal and I could end all business disasters.  The trick here is being able to identify what resources to have in abundance since nobody can have resources for all contingencies.  Resource identification is based not on determining every possible adversity that can face a business.  This is an incalculably high number and bounded only by the imagination not only of those that run the business but all of those who may wish it ill. 

Rather, resource determination is based on an evaluation of the processes and pathways unique to each business.  It requires the identification of “choke points,” those critical pathways that, if narrowed or destroyed, will choke off the life of the business.  It is these critical steps for which resources are amassed. The goal is to ensure that no choke point becomes so narrow as to strangle the life of the business.  This ensures resilience.

Some have adapted well through the application of the lessons I learned in the disaster field office.  Others have failed to learn these lessons resulting in business disaster. In a few cases, the businesses stumbled upon their resilience.  In others they were guided to it.  But in all cases it was the identification of choke points and the allocation of resources that ensured that a business remained in business and did not become a wounded dog.

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