Patrick Lagadec and Doctor Matthieu Langlois provide some timely advice for leaders attempting to navigate through the turbulent waters of the coronavirus health crisis
“We are all here with the aim of navigating this ship through the storm successfully. We are not the representatives and defenders of each particular niche. If we play personal power games or act individually, we will have already lost."
In all hospitals, health establishments, and in countless other organisations – from the most central to the most decentralised – crisis cells are being called upon to deal with the effects of Covid-19.
The immediate operational question is how to manage, organise and support these crisis cells – and of course here we are thinking first of all of the Crisis Medical Directors in hospitals – along with everyone who supports them.
This context has already been the subject of work by the most advanced teams and practitioners, with the specific objective of preparing to manage the unexpected, and even of the unknown, to train doctors to think quickly, nimbly and outside the box. Such training to deal with these advanced concepts has already existed for three years, organised by Professor Mathieu Raux and Doctor Matthieu Langlois, under the authority of Dean Bruno Riou, who is currently Medical Director of Crisis with the Paris Hospitals Institution (Assistance Publique-Hôpitaux de Paris).
With regard to leading or steering these crisis cells, more detailed analysis is available, but time is certainly too limited for this to be possible right now; although there are also basic slides that you can browse through rapidly (in French, see sources and further reading, below).
However, in this commentary, we would like to offer some targeted benchmarks to facilitate the immediate work of those who have the heavy burden of helping to navigate the current situation.
VISUALISE THE LANDSCAPE
The initial requirement is immediately to break out of the ‘accidental crisis’ mindset and work on developing a fresh, general roadmap that is more suited to major systemic ruptures.
Extreme and chaotic concepts jostle with each other in this current landscape of great instability. These concepts include: Surges; internal haemorrhages; general anxiety; ethical chasms; an incident of protracted duration and intense fatigue; the rigidification of behaviours; territorialism; working within or against enclosed – almost feudal – domains; overwhelming and repeated reconfigurations of organisations; poor preparedness for classic crises; no preparedness for systemic ruptures; isolation of structures from those on the upper floors, leading to a feeling that ‘we have been left alone’ to deal with this crisis; few channels of exchange with counterparts; constant loss of reference points; and excessive expectations vis-à-vis the pilot and denunciation of all his or her decisions. And on top of all this, leaders will also have to deal with people who have oversized egos that are always ready to compensate for their anxiety by blocking actions, along with instances of destructive arrogance.
DO NOT LET YOURSELF BE DOMINATED BY THE CRISIS
We must clearly understand that the crisis, which by definition is already an extreme crisis at this point, is not a standard immediate urgency. We are already beyond answers that have been codified for the known; it is in the unknown that the most important answers lie, and constant questioning will become the basic line of action: with extra-curricular questions, ill-posed subjects, illegible rules and non-existent information ...
We must remember that any crisis, let alone such a major crisis as Covid-19, comprises ten per cent explosive and 90 per cent incapacitating and perverse effects. These breath-taking blast effects can engender a loss of intelligence, discernment and efficiency, all set against a backdrop where a steeper curve lies constantly in wait. So everyone bunkers down and erects barriers. Egos swell, defences harden ...
The crucial thing is to know how to step back and bring real-time intelligence to bear, in order to prevent and overcome harmful conflicts.
And herein lies the skill in navigating through this crisis, the importance of clarity in working practices, the ability to provide rhythm and harness the goodwill of everyone involved, which makes it possible not to be snared by the many traps or become mired in the quicksand of crisis.
Of course all this is facilitated by preparedness prior to the shock. By default, we should at least put ourselves, personally and collectively, in a situation of real-time preparation for big surprises – this can be achieved by flash mindset that reframes the whole team, synchronising it with the confrontation of the chaotic and the unknown. And this can be expressed simply: Prepare before, adapt during and improve afterwards.
We should therefore mobilise quickly and get fully involved, immersing ourselves completely. We will have to fight to be free, because we know that the crisis will seek to put the actors under its thumb and control our thoughts and actions. The challenge is to take up the task and give everyone back their freedom of judgment, their creativity, the latitude to invent and combine the best analyses and initiatives. This will take intellectual, decision-making and tactical courage, to invent, bring about and interweave new answers. However, this does not mean ‘do anything and everything’.
The objective remains clear: the quality of care is not negotiable, but strategic agility in the use of resources, public-private sharing and balancing incoming / outgoing flows to avoid reaching the point of rupture – this is the scenario in which we must deploy intelligence, rigour, efficiency, cohesion and invention.
We will have to think ‘leadership’, and here, steering is the vital key – the key to the vault that cannot be left at the mercy of the crisis. The driving forces of such navigation are creativity, rhythm and speed of training, all the while knowing full well that it will be necessary to empower the maximum number of people, drawing upon the broadest requirement of information. This is because crisis cells, which are very dynamic small groups, are only there to facilitate the tasks of those who are manoeuvring directly across the most immediate landscape confronting them. These people must be granted the essential ingredient of trust across the entire chain of intervention. To help, we can set some simple principles below.
HOLD ON TO KEY PRINCIPLES
We must constantly bear in mind the fundamental principles that have been drawn from the know-how of experienced units in extreme situations:
- Keep an overview and analysis from a heightened vantage point
- Try to anticipate without wasting time planning (which would make any decision too late)
- Act effectively while thinking about the flow objective
- Inspire trust
- Have the ability to innovate quickly without being trapped in doubt
FOR THE CRISIS DIRECTOR
- Strategic Observer: The Director will find a solid and trustworthy person who will help him/her to step back constantly, to accept surprises, setbacks, breakdowns of all kinds, refusals from superior structures, disobedience – some of it of the most intolerable kind, the most painful shocks, etc (excessive egos must be excluded immediately).
- Rapid Reflection Force: For crisis management in large organisations, it would be very useful to supplement the ‘strategic observer’ initiative with a true ‘Rapid Reflection Force’ (FRR). By this, we mean three to five people working permanently on examining challenges that could emerge outside the framework.
- The battle for real-time efficiency: Naturally, everything we know about the functioning of crisis cells will be applied: people in direct contact with the multiple components of the system must be around the table.
- Bring together the crisis unit within a direct framework: We must all understand the scenario. Words such as the following could be helpful: "Let’s not indulge in fairy tales; we are entering the unknown. My role will be to do my best to manage, with you, an intolerable situation in an unbearable universe. But we will do it together, and it is the combination of everyone’s energy and intelligence that will allow us to endure this testing challenge."
- Mission framework: “We are all here with the aim of navigating this ship through the storm successfully. We are not the representatives and defenders of each particular niche. If we play personal power games or act individually, we will have already lost."
- The battle of time: “Time is going to be our enemy. We are therefore going to have to speak in a very synthetic – possibly even unnatural or counterintuitive manner – to get directly to the essential crux of findings and propositions."
- The battle of the black holes: “We are going to come up against many impossible questions. We will forbid ourselves from drawn-out brainstorming sessions, which would be exhausting and paralysing. For any question that is too difficult to be answered quickly here, we will ask one or more subgroups to clarify the dilemmas within a very tight timeframe."
- The battle rhythm: “We must not allow the crisis to lead the dance. We will clarify the immediate subject of reflection and decision at any time; we will give ourselves very compressed times and will impose a sustained pace on our work”.
- The battle of standing back: "Crises of this type prevail over us by their ability to put our heads in a vice. We must rely on the strategic observer who will be able to intervene at my request to make points on all the dimensions, the traps that lie in wait for us, the aberrant signals which might have escaped us, the background reading which deserve new attention, new ideas that we could consider. The strategic observer (the Rapid Reflection Force) will, at my request, feed us with questions, observations, suggestions from his or her work of reflection while standing back and taking an overview".
- The battle of the ridge line: "Finally, I will recall the rule of the game in the universe that is ours at this moment: we will have to work with a logic that is in permanent mutation. We will constantly have to anticipate and remain questioning, while not losing our effectiveness. We are going to learn while running, to operate constantly in phase with a highly turbulent context.”
FOR MEMBERS OF THE CRISIS CELL
- I am mentally mobilised: Yes, the situation is complex, surprising, serious. But that is precisely why I'm here – to deal with this type of challenge.
- I put myself in a position of leadership: I am not here as a follower, to wait and see what happens, or to be indolent. I will fight step by step against the crisis, with all those who are here with me. And I am not alone, this is not a competition – it is an orchestra. The Crisis Director is the conductor.
- In it for the duration: Each member of the cell supports the Crisis Director and must avoid complicating his or her task with interventions that are off brief. Care must be taken not to introduce additional confusion. Any signal of change in a level of problem, or of a mutation should be reported. Everyone must be able to give a 20-second summary of the key issues at their level, at any time. We must be prepared to pass the baton to those who will relieve us, in order to perpetuate endurance and last the course.
- Attitude: We will be careful to constantly inject listening, respect and personal modesty. This is absolutely no place for battles of ego, territorialism, personal games and so on.
And so, into action.
Patrick Lagadec (click here for all CRJ articles) is Honorary Director of Research at l’École Polytechnique, Paris, France, and Member of CRJ’s Advisory Panel. Doctor Matthieu Langlois is an anaesthesiologist and resuscitation medic at CHU Pitié Sorbonne Université Paris 6, and Member of the French Society of Disaster Medicine (click here for interview)
Sources and further resources
- Borel M, Damm C, Debien B, Akodad H, Dolla E, Bouhaddou A, Lamberdière F, Raux M: S’exercer à l’afflux massif de victimes hospitalières... Comment faire? Ann. Fr. Med. Urgence, DOI 10.3166/afmu-2019-0128
- Hough E: Evolutions in terrorism, a tactical medic’s perspective, Crisis Response Journal 12:3
- Patrick Lagadec : Cellules de crise – Les conditions d'une conduite efficace, Éditions d’Organisation,1995.
- In www.patricklagadec.net, onglet: Power-Points – Gestion de crise: Grammaire de gestion de crise; Tableaux Salle de crise; Guide Dirigeant – Pilotage; Cellule de crise Dirigeant; Force de Réflexion Rapide: une méthode d'aide au pilotage; Force de Réflexion Rapide: Repères opérationnels
- Patrick Lagadec: La Force de réflexion rapide – Aide au pilotage des crises, Préventique- Sécurité, n° 112, juillet-août 2010, p. 31-35
- Patrick Lagadec: Intervention dans le cadre d’une mission de préparation de documents pédagogiques sous forme de témoignages vidéo, confiée à CRISOTECH par le SGDSN, sur le thème de la fonction d’anticipation au sein de la Cellule Interministérielle de Crise, 16 janvier 2019
- Military strategist William Boyd proposed his OODA method – observation, orientation, decision, action – which sequenced the work by proposing this loop of systematic intervention. What matters is the general pace that we set for ourselves. Boyd noticed during the Korean War that the Americans, who had planes far superior to those of the Chinese, were losing their engagements. He understood that the reason for these failures was that the Chinese were much quicker in their feedback: their learning rate was higher. It is therefore necessary from the start, in the confrontation with the abundant novelty, to apply a very sustained pace of intelligence and action, far from the too usual "follow-ups" of crisis. Here, likewise, it will not be possible to print such a tempo if the milieu concerned is not in a constant search for substantive questions, and trained to anticipate and implement mutations that make sense and cohesion. Otherwise, the speed will only be precipitation and the action will only lead to even faster routes (extracts from Le Continent des imprévus - Logbook of chaotic times, Belles Lettres, 2015, pages 239-240)
- Video: Complexity Crises – Never Fight the Last War, Mike Granatt, Partner at Luther Pendragon, London; Visiting Professor, University of Westminster. Previously Chair of the national Media Emergency Forum, Head of the Cabinet Office Civil Contingencies Secretariat, Head of the UK Government Information and Communication Service, Communication Director of three major departments, Communication Director of London's Metropolitan Police Service, talking to Patrick Lagadec, editing Aurélien Goulet, June 2004.