Continuing our series of articles inspired by conversations with clients and sector leaders during the COVID-19 pandemic, here we reflect on how looking at challenges from a different perspective allows us to break free of traditional – and perhaps unhelpful – processes. In the wake of COVID-19 we’ve been forced to look afresh at many aspects of our lives and our livelihoods. Two areas in particular have stood out for us: the importance of planning for vulnerabilities rather than risks, and the need for healthcare and other support to recognise and account for trauma.
Looking first at risk management, we now see the inadequacy of an approach that encourages managers to think about what might happen and to plan for that eventuality: the event-based approach. Something as simple – albeit catastrophic – as a building fire can be managed because we can both reduce its likelihood and deploy firefighting equipment and response protocols. We can plan for how we will move operations to another building (or online), and how best recover our business to a near normal state quite quickly. Something as all-consuming and complex as a pandemic, however, brings a whole host of challenges and opens our eyes to vulnerabilities within businesses and communities that we could not have imagined through an event-based risk approach. It’s no secret that a good proportion of risk managers duly listed ‘pandemic’ on their risk registers, yet found themselves woefully under-prepared for what they experienced in the wake of its outbreak. Pandemic was somehow both inevitable (at some point), yet ‘inconceivable’ (right now). The evidence of probability was freely available, had we chosen to consult but probability without an indication of proximity (how soon it would happen) left us faltering. With a lack of even weak signals to give us confidence of its imminence the depth and breadth of the effect were simply not planned for. Facing the enormity of a pandemic is perhaps beyond the natural limit of traditional risk management capabilities.
If a focus on individual events or risks doesn’t take us far enough, how should we be thinking? Now, we believe, is a good time to truly understand our organisations from the viewpoint of their critical vulnerabilities. We should be identifying the critical success factors – the ‘must haves’, the vital links in our chain – and working out how we might respond to their being breached, broken or removed. This is the type of thinking that is often done only once a disaster has happened. Turning the process ‘back to front’ and planning now for what we would do if this piece of equipment or that part of the supply chain were suddenly rendered inaccessible puts us in a much more resilient position. It gets us to the heart of creative response without having to preconceive the specific events that will cause the problem. It’s an approach that encourages us to think about our organisations as systems that can evolve and adapt…and that can cope with shocks.
There are, however, situations when a focus on events is actually more helpful than the systems vulnerability approach we’re advocating for risk management. COVID-19 – or more specifically the recovery process facing those most severely affected – is shining a spotlight on an alternative approach to healthcare and other services. Centuries of medical science have led us to understand our bodies in minute detail. We know what can go wrong, we know a lot about how it goes wrong and have detailed pathways of treatments to help get it going again – repairing and renewing as necessary. Getting back to normal is a key goal for many health and social care professionals.
What happens, though, when it is a traumatic event (or series of events) that have caused complex harm to us as individuals? Examples include those who have suffered domestic violence, who have grown up in war zones whether literal or domestic, whose families have been struck by sudden death or critical illness, or who undertake professional roles that bring high levels of primary or secondary trauma. Many medical pathways are designed to remedy failures – to cope with vulnerabilities – they aren’t designed to cope with or account for the deep, intricate and inhibiting effects of trauma. In some cases, a referral to ‘mainstream’ recovery or mental health pathways might even knock a person back into a more intractable position.
We’re hearing from clients in various sectors, but notably (at the moment) in physical and mental healthcare settings, that a ‘Trauma-Informed’ (TI) approach is much more effective in such cases. Understanding the root of behavioural or mental health issues and acknowledging the causative effect of events can, for some people, mean that they are led into alternative recovery approaches. From there they may benefit fully from traditional approaches, or may find that they can cope without them. The main difference is that they are not cycling round a system that is designed to treat effects, not primarily to embrace the cause when that cause is long-standing or one-off traumatic events.
In the wake of COVID-19 we’re hearing a lot about situations where both of these ‘approach reversals’ seem to be valuable. Treating an organisation like a living system that faces disruptions and has the capacity to heal itself regardless of the nature of injury, makes sense. Conversely, acknowledging the nature of the injury that inflicts trauma on a human being – long periods of induced coma and intubation on a COVID-19 ward, for example – can be a vital step in finding the right road to recovery.