How can we prepare for what we can’t predict?
It’s a question many in the aged care sector have been asking since the Coronavirus pandemic began, finding themselves with dwindling supplies of PPE, staff shortages, gaps in infection control training, unclear government guidelines and unprecedented lockdown restrictions to enforce.
On the surface it seems rhetorical, with no obvious answer.
However Professor Paul Arbon, director of Flinders University’s Torrens Resilience Institute, and Professor of Nursing (Population Health) believes there is an answer, and it lies in changing the way we think about risk.
Arbon says the essential problem in the way service providers across various sectors address risk, is that we view potential risks as separate events or threats.
“We tend to think about how likely it is that an event might occur and what the consequence would be, if that event occurred,” he tells Aged Care News.
“And we do that for every individual risk, whether it’s flood, earthquake or terrorist attack, whatever it might be.
“That’s a traditional approach to risk management and causes you to invest your funds in preparing for the most likely and consequential risk that you can see.”
The reason this approach is problematic, Arbon says, is to do with global interdependence, and the things we depend on such as fuel, food and pharmaceuticals often being at a great distance from us.
This has created weakness in our communities, he says,
“In the modern world, the thing that has flipped is that we have become increasingly interdependent and interconnected, in terms of the things that we need to live normally and safely and to be prosperous,” Arbon says.
“So today, when we think about the events that we see happening, the real impact often isn’t so much associated with a single threat, or risk.”
A wildfire for instance, might cause a blackout, threaten fuel supply, or might stop the local hospital from functioning.
“We see people that are at more risk of losing power to their homes for days on end, for example, and that has flow-on effects in terms of the healthcare support that they might need and have, it has flow-on effects in terms of supply and isolation and all of those kinds of things,” he adds.
“So what we’re focusing on these days is, not throwing away traditional risk management, but [looking at] not only the risk you can see, but the cascading consequences of any disruption to the systems that we depend upon.”
Arbon heads up the Torrens Resilience Institute, which was born out of the National Strategy for Disaster Resilience developed by Council of Australian Governments (COAG).
Much of his work there is around encouraging collaboration across government, organisational and community leadership, building resilience and promoting stability in times of crisis.
For aged care providers wanting to build resilience in the face of future disasters, he suggests an important first step is understanding what you really depend on to provide for those in your care.
“Sometimes that’s staff being able to get to work, sometimes it’s having more supplies of some things than you would normally keep if you were thinking of just-in-time supplies for your facility or service,” he says.
“And it is then also looking at where those things come from, and how certain you are that they will keep coming in the event of a crisis.
“What do your suppliers look like? Do you think they can stand up? And are they only supplying you?
“So if there’s an excess demand for something like masks, will you still be able to get them?”
Arbon also says partnerships and connectedness are very important for building resilience, and providers should focus on strengthening partnerships with suppliers they depend on every day, as well as those they come to rely on in times of crisis.
“The other principal link is into the government and governance of emergency response,” he adds.
A strong link in this area means providers can have early access to information, an awareness of the evolving situation, safe exit routes in case of natural disaster, or whether invacuation might be the preferred response, as opposed to evacuation.
“All of those kinds of questions relate to conversations with government.
“In the aged care sector that’s often conversations with Federal Government and that’s a tiny bit problematic, because in Australia the responsibility for emergency management is a state and territory jurisdiction responsibility,” Arbon admits.
“There’s a bit of a siloing between the government connections you normally have and ones that you need to have.
“So for aged care service providers I’d be arguing they reach out to state and territory jurisdictions, to talk more about what the plans are and what your place in those plans are.”
Arbon delivered a webinar in August, for the Australian Association of Gerontology (AAG) on the topic of disaster recovery for older Australians.
As part of the presentation, he outlined some other practical steps for providers.
These included building a management culture that allows flexibility, is adaptable and that can respond to things that are surprising.
As well as a culture which notices small signals sooner.
“So if something is starting to go awry, how do you find out?
“Often you find out from your staff, but do they feel that they are able to tell you?,” Arbon asked.
He also suggested aged care providers encourage trusted accountability and constructive disobedience within their organisations.
“Trusted accountability is about letting people inside your organisation or your service, make decisions. Not having too many decisions come up to the top before the decision is [dealt with],” he said.
This he says, allows for a more flexible system on the whole.
“But constructive disobedience in the disaster and crisis space is actually a step further.
“It’s about saying, if you see something going wrong and the protocol says you should ring home base and ask permission, but if you don’t turn that valve off now the plant’s going to blow up … then you want people who will turn the valve off.
“So you need a management culture that allows people, sometimes, to be disobedient in a way that saves your organisation from the harm it might have suffered.”
If there’s anything that can be taken from the Coronavirus pandemic, Arbon says, it’s a greater awareness of what lies ahead.
“I think one of the lessons we need to learn is that we should pay attention to forecasting and possible futures work that has been going on for decades and coming out of certain kinds of forums, that indeed did predict that there would be a pandemic disease of some kind in the coming years,” he says.
“Now there was some work done to prepare for that, but the focus was principally on an influenza pandemic and WHO was probably arguing that that was not where the focus should be.
“So learning a bit more about looking at the future and paying attention to it and building stronger systems. We absolutely could have done that,” he says.
