6 steps I observed while crisis planning for COVID-19 in the healthcare sector that could be part of any institutional planning process.

Is your organization in a crisis? Or, some sticky mess? Generally, there are two keys to crisis management:

1. Being prepared in the first place; and
2. Trying to ensure the bad does not get worse.

In March 2020, the global COVID-19 pandemic was declared. At the time, I worked for a provincially-funded health authority. This health authority is unique in that it has responsibility to deliver health services to a massive geographic area – two-thirds of the province of British Columbia, Canada. This is an area of almost 600,000 square kilometres. A little larger than Washington, Oregon and Idaho all put together.

It is a largely rural and remote area, with the largest community about 100,000 people and the other 200,000 people spread across 55 First Nations (almost 80 communities), various villages, towns, and regional districts. Some communities along the northwest coast have boat and plane access only – no roads.

Only three hospitals across that entire area had the level of services and staff able to support those that had COVID-19 with more severe symptoms. And in two of those hospitals, not many beds and equipment were available. This was also a time of booming economies with at least two major pipelines under construction in the region, a major hydro-electric dam and facility, and numerous other major projects.

Like many areas, the region was facing a crisis of unfathomable proportions. How to potentially move C-19 symptomatic individuals for testing and isolation (especially those of high risk); how and where to support isolation; how to support families and those that needed to be moved for hospitalization; where and how to support families that had individuals that needed be isolated (quarantined); how to respond to outbreaks, and so on.

Thankfully, the region, communities, and organizations also had a history of crisis and disaster management that had rolled out in recent years – wildfire and flood evacuations, and planning for tsunamis and earthquakes on the coast. This was part of the preparedness factor.

In late March, the health authority I worked for partnered with numerous other organizations and professionals (e.g. physicians) to immediately devise a rural, remote, and First Nations COVID-19 response framework. For weeks on end, representatives from the many organizations were essentially locked in a rooms planning for all contingencies possible. Those that could not the attend planning in-person joined through online networks, all in the midst of various challenges with the Internet.

Plans needed to be devised for COVID-19 testing, transportation (including emergency air transport); hospital routing, accommodation and housing for those isolating along with health monitoring, food and social supports; decision-making trees for determining when to transport someone or have them isolated in community; in-community isolation centres; community inventories; contact lists for all communities; communication and coordination; call centres; and so on.

Not only was the plan and response framework being built while the pandemic grew in scope and severity, it was also rolled out through online 'tabletop exercises' with community representatives. Planning (and the plan) had to be iterative, rapid, and comprehensive. It also had to contend with many things we simply did not know. Knowledge of the virus grew daily (as did the unknowns); guidelines also changed daily (e.g. testing, personal protective equipment (PPE), isolation requirements, etc). Planning changed daily. There was no time for hurt feelings and personal agendas.

Here are some critical steps that I observed that were engaged to support rapid rollout and implementation. These are not complex and certainly not just out of my head, as they are adapted from other documents.

These are transferable to any planning process; and yet, I see in many organizations that relatively simple planning principles are not engaged. Far too many planning processes I've participated in languish in small details, hiring consultants, unclear roles and responsibilities, terms of reference that read like War & Peace, personal agendas, and poor interpersonal communication. And, when in doubt, return back to slice and dice the terms of reference.

If you're part of a planning process that returns to terms of reference - the process has most likely become akin to that of a ground fish: flounder. In crisis planning, there is little time to ponder processes of engagement. Everyone must plan, act, plan, act...

Here's 6 steps, and sub-components, I observed while crisis planning for COVID-19 that should be part of any institutional planning process. Say for example, institutions that may be facing significant forecasted budget deficits.

1.????Preparedness: Plan for the planning - Act quickly.

• Determine authority and governance – whom, and whom is responsible for what? (Be open to this changing).
• Establish, communicate and agree on some sort of terms of reference, or principles of engagement. Simple and clear. When the process gets sticky, folks will recall these.
• Identify potentially affected and functioning operations. Assess and document capacities.
• ?Determine team size for planning. Identify key team members, experience and skills required. Identify core team, and those ‘on-call’ to assist in planning (e.g. content experts).
• If this is a crisis - get on with it. Planning, Acting, planning, acting.

2.????Assess and Identify. Act.

• Assess internal and external environment(s)
• Conduct gap analysis, fill where possible. Plan to adapt to gaps that can’t be filled. Recognize not all gaps will be identified; nor filled. That's OK.
• Identify vulnerabilities, hazards and threats.
• ?Consider any legislative and organizational requirements. The "must-do's" and "must do not's".
• Conduct hazard and risk assessment:

????????????i.????Determine risks.

????????????ii.????Consider likelihood and severity of further emergencies and crisis.

??????????? iii.????Consider consequences: e.g. action, no-action, partial-action.

????????????iv.????Consider impacts on organization(s) and/or communities.

?????????????v.????Determine priorities.

?????????????vi.????Identify risk response, mitigation controls, and roles engaged.

?????????????vii.????Prioritize (and document).

????????????viii.????Evaluate and monitor. Check assumptions.

• If it’s a crisis. Get on with it! Act.

3.????Develop Elements of a Plan

• Determine and document priorities. (Document the planning process, you may need it again).
• Determine goals; think through known unknowns, and unknowns (e.g. ignorance). Be ready for fluidity and flexibility.
• Identify limitations and clarify scope(s) of plan or framework.
• Establish or re-confirm governance (e.g. roles and responsibilities in roll-out), make sure these are clear, communicated, and possible (e.g. capacity to deliver).
• ?Examine prevention, mitigation, preparedness, response, resources, and recovery requirements. Be ready for agility.
• Be uncomfortably comfortable with the reality that some things may have been missed, or not known. Be prepared for flexibility. ?
• Get on with it! It doesn't have to be perfect. A Plan is a noun; planning and acting are verbs.

4.????Develop and Articulate a Plan

• Determine, as best as possible, timelines, and resources required.
• Engage rights-holders, stakeholders, and others in development and confirmation of the plan, or at least elements of it. Iterate, communicate, iterate, communicate, iterate...
• Document the planning. Outline the Plan. Get on with it.
• Re-engage with those in (b) and others as required.
• Revise and update as necessary. Don’t be attached to any one part.
• Seek final approval from those required. Let them know: things change. Communicate.
• Check back on governance, is it clear? Communicate it.
• Get on with it!

5.????Implement, Roll Out, and Adapt the Plan as needed

• Roll out the plan. Communicate the plan. Be open to feedback. All plans should be living, adaptable, and clear.
• Educate rights-holders, stakeholders and response teams about the plan – and those that need to resource it. Be open to feedback. Communicate.
• Allocate and monitor assets and resources, and prepare for unknowns. Be fluid and flexible.
• Identify, consider, and adapt logistics as needed. Communicate.
• Conduct required training (this step can occur even earlier and on an ongoing basis - use these to pilot or beta-test plan components).
• Conduct exercises, or implement plan components as needed. Be open to feedback. Change as needed.
• Update the plan based on lessons learned from exercises and changing factors.
• Review and update the plan at scheduled intervals, or as needed. Communicate, iterate, communicate, iterate.
• Get on with it!

6.????Monitor and Evaluate.

• Always include feedback loops for monitoring and evaluation, during planning, while implementing plan, and afterwards.
• Task certain individuals or organizations with a disruptor (e.g. devil’s advocate) role – always explore and confirm assumptions.
• Communicate often, frequently, consistently, and throughout. Evaluate communication channels: what's working? what is not working, or could use improvement? Do it.
• Rinse and repeat as necessary.

The fundamental base value of a plan is not the thing itself - the plan- but the value of planning; the value of the networks and communication required to build a plan, implement it, evaluate it, change it, adapt it, and carry on.

Far too many organizations - especially those in the public sector (post-secondary especially) - are focussed on producing the noun (the thing), and not the processes that precede, are in the midst of, and follow acts of planning. It's the spaces between the words that are critical to planning; the ones which are filled with social networks, communication, and commitments.

I've seen, participated in, and heard of 'planning processes' that take over a year for an uncomplicated concept or process. Leaders waiting for the perfect data; waiting for a consultant; engaging through online comment forums and wondering why there's not much commitment; bickering with their other manager colleagues over who's planning process is a higher priority.

When in doubt, get on with it. A 'plan' doesn't have to be a written thing; it can be the processes that surround organizational and professional commitments - and crises. The COVID-19 response framework I was engaged in took 5-6 weeks, day in and day out, to outline, to train, to communicate, while also being implemented in the midst of documenting it.

Crises have a tendency to instigate focussed attention and action. However, don't forget principle #1 - be better prepared in the first place.