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波士頓馬拉松爆炸案給危機(jī)管理的啟示

波士頓馬拉松爆炸案給危機(jī)管理的啟示

Eric Goralnick/Ron M. Walls 2013年10月23日
波士頓馬拉松爆炸事件中,3人當(dāng)場(chǎng)死亡,但送到醫(yī)院的264名傷員全部得以幸存,當(dāng)?shù)匾患裔t(yī)院高效的應(yīng)急響應(yīng)機(jī)制在其中發(fā)揮了決定性的作用。它的經(jīng)驗(yàn)教訓(xùn)對(duì)于人們有效的管理突發(fā)危機(jī)極具參考價(jià)值,而其核心就是悉心管理團(tuán)隊(duì)和信息流。

????在我們供職的布萊根婦女醫(yī)院(Brigham & Women's),特定的醫(yī)生、護(hù)士、醫(yī)療助理團(tuán)隊(duì)并肩而立,隨時(shí)準(zhǔn)備救治傷者,而文書(shū)、診斷和運(yùn)輸人員為他們提供支持服務(wù),共同應(yīng)對(duì)這場(chǎng)危機(jī)。內(nèi)科醫(yī)生和護(hù)士幫助清理急診室,從而為轉(zhuǎn)入醫(yī)院的幸存者提供了充足的治療空間。在我們的急診科,外科、骨科、麻醉、急診醫(yī)師和護(hù)士長(zhǎng)攜手努力,以確保病人及時(shí)轉(zhuǎn)至手術(shù)室。這就是哈佛商學(xué)院(Harvard Business School)領(lǐng)導(dǎo)力教授艾米?埃德蒙森所稱(chēng)的“團(tuán)隊(duì)協(xié)作”。

????穿上一件明亮的黃色背心

????爆炸剛發(fā)生時(shí),斯頓街陷于一片混亂之中。但波士頓的愛(ài)國(guó)者日正是這座城市一直在規(guī)劃并準(zhǔn)備應(yīng)對(duì)的災(zāi)難時(shí)刻;因此,每個(gè)人都有一個(gè)預(yù)先確定的角色,都穿上了可見(jiàn)標(biāo)識(shí)。馬拉松比賽開(kāi)始前,為這場(chǎng)賽事服務(wù)的每一位醫(yī)生、護(hù)士和其他志愿者都領(lǐng)到一件帶有顏色編碼的背心。醫(yī)療急救隊(duì)、警察和消防員身著正規(guī)制服,其中一些人也穿上了背心。爆炸發(fā)生時(shí),應(yīng)急者和旁觀者通過(guò)背心就能識(shí)別應(yīng)急行動(dòng)的指揮者。

????一旦你的公司面臨緊急事件,誰(shuí)將“穿上”象征領(lǐng)導(dǎo)者的背心?在危機(jī)期間,普通的命令和控制措施往往過(guò)于遲緩,采用委員會(huì)之類(lèi)的管理方式是不恰當(dāng)?shù)?。作為HICS系統(tǒng)的組成部分,領(lǐng)導(dǎo)者穿上特定背心,這樣他們就可以很容易被識(shí)別。為你的企業(yè)建立類(lèi)似的準(zhǔn)備機(jī)制:無(wú)論爆發(fā)的一場(chǎng)物理事故、公關(guān)過(guò)失、股東慘敗,還是其他任何事件,人們應(yīng)該向誰(shuí)報(bào)告?誰(shuí)說(shuō)了算?你的團(tuán)隊(duì)如何識(shí)別領(lǐng)導(dǎo)者?

????一等于無(wú),而二等于一

????超過(guò)50萬(wàn)觀眾參加這場(chǎng)新英格蘭地區(qū)最大的年度體育盛會(huì)。波士頓每年都做足了萬(wàn)全準(zhǔn)備。各種組織提前進(jìn)行協(xié)調(diào)演練,其中包括附近的創(chuàng)傷中心和三家兒童醫(yī)院,這些醫(yī)療機(jī)構(gòu)全部位于終點(diǎn)線的2.5公里半徑內(nèi)。

????但其他的災(zāi)難往往不會(huì)發(fā)生在這樣的環(huán)境之中。最近的例子是:今年4月17日發(fā)生的西德克薩斯州西化肥廠(West Fertilizer Plant)爆炸事件;5月20日那場(chǎng)席卷俄克拉荷馬州摩爾市的龍卷風(fēng),以及7月6日韓亞航空公司(the Asiana Airlines)班機(jī)在舊金山國(guó)際機(jī)場(chǎng)(San Francisco International Airport)的墜毀事故。

????為了應(yīng)對(duì)這些事件,醫(yī)院頻繁地進(jìn)行各種嚴(yán)苛的演練。我們必須根據(jù)墨菲定律(Murphy's Law,即認(rèn)為會(huì)出錯(cuò)的,終將出錯(cuò)的論斷)制定計(jì)劃。災(zāi)難可能發(fā)生在公司CEO不在本州之際,或者夜半時(shí)分。在這種情況下,一位中層管理者必須挺身而出,根據(jù)最低限度的信息肩負(fù)起責(zé)任。每一個(gè)人都必須是可替換的,所有相關(guān)方務(wù)必緊密合作。一個(gè)人能夠做的事情少之又少,但并肩作戰(zhàn)的兩個(gè)人則擁有巨大的力量。

????溝通再溝通

????爆炸當(dāng)天,整個(gè)城市的醫(yī)院面臨巨大的不確定性,這種狀況持續(xù)了多日。是否還將發(fā)生爆炸?是否將出現(xiàn)更多的傷者?整體反應(yīng)處于什么狀態(tài)?應(yīng)對(duì)行動(dòng)是否正在產(chǎn)生效果?

????在多次發(fā)布簡(jiǎn)報(bào)期間,溝通提供了一個(gè)持續(xù)改善的機(jī)會(huì)。臨床醫(yī)生需要準(zhǔn)確和及時(shí)的信息以優(yōu)化病人的護(hù)理方案,但災(zāi)難嚴(yán)重破壞了我們?nèi)粘J占蛡鬟f信息的流程。你是否預(yù)先制定了應(yīng)對(duì)這種狀況的溝通計(jì)劃?有沒(méi)有一項(xiàng)后備計(jì)劃,以及這項(xiàng)后備計(jì)劃的替換方案?

????你需要悉心管理你的團(tuán)隊(duì)和信息,唯如此,面臨危機(jī)時(shí),你才能獲得掌控權(quán)。

????本文作者埃里克?格羅爾尼克是布萊根婦女醫(yī)院應(yīng)急準(zhǔn)備科醫(yī)療主任,急診醫(yī)學(xué)部臨床副主任。羅恩?沃爾斯是布萊根婦女醫(yī)院急診醫(yī)學(xué)部主管。兩人均任教于哈佛醫(yī)學(xué)院。(財(cái)富中文網(wǎng))

????譯者:任文科??

????At the hospital we work for, Brigham & Women's, designated teams of physicians, nurses, and medical assistants stood side by side, at the ready, supported by clerical, diagnostic, and transport personnel to respond to the crisis. Internal-medicine physicians and nurses helped clear emergency departments of patients to create space for incoming survivors. In our emergency department, surgeons, orthopedists, anesthesiologists, emergency physicians, and nursing leaders collaborated to ensure patients were sent to operating rooms without delay. It's what Amy Edmonson, a leadership professor at Harvard Business School, refers to as "teaming."

????Wear a bright yellow vest

????The initial scene on Boylston Street was chaos. But Patriots Day in Boston is an occasion on which the city plans and prepares for disaster; thus everyone has a predetermined role and wears visible identification. Prior to the start of the race, color-coded vests were issued to physicians, nurses, and others slated to volunteer at the event. Emergency medical services, police, and firefighters wore their regular uniforms, and some of them also donned the vests. When the explosions went off, responders and bystanders used the vests to identify responding leaders.

????At your company, who would wear the (figurative) leadership vest during emergencies? Ordinary command and control is slow, and management by committee is not appropriate during crises. As part of HICS, leaders wear specific vests so they can be easily identified. Establish the same prep for your business: Whether it's a physical accident, PR gaffe, shareholder fiasco, or anything else, to whom do people report? Who is in charge? How does your team identify that leader?

????One is none and two is one

????Over 500,000 spectators attend New England's largest sporting event every year, and Boston is more than ready for it. Various organizations coordinate exercises in advance, including the nearby trauma centers and three children's hospitals, all within a 2.5-mile radius of the finish line.

????But other disasters don't occur in such an environment. For recent examples, look no further than the West Fertilizer Plant facility explosion on April 17 in West Texas, the tornado in Moore, Okla. on May 20 or the Asiana Airlines flight crash at San Francisco International Airport on July 6.

????Hospitals train for these events -- rigorously and frequently. You must plan for Murphy's Law, the idea that what can go wrong will. Your disaster may strike when your CEO is out of state, or in the middle of the night, and a middle manager must step up to take charge based on minimal information. Everyone must be replaceable, and collaboration is essential. Alone, one person can do little, but two people acting together are powerful.

????Communicate; then communicate again

????In hospitals across the city on day one, there was a great deal of uncertainty, and it continued for days. Would there be more explosions? More patients? What was the status of the overall response? Was it working?

????During multiple debriefs, communication offered a consistent opportunity for improvement. Clinicians rely on accurate and timely information to optimize patient care, but disasters wreak havoc on our usual process of collecting and transferring information. Do you have predetermined communication plans for such a scenario? And is there a backup plan, and a backup for that backup?

????Manage your teams and information carefully, and you will gain control over your crisis.

????Eric Goralnick is medical director of emergency preparedness and associate clinical director of the Department of Emergency Medicine at Brigham & Women's Hospital. Ron M. Walls is chair of the Department of Emergency Medicine at Brigham & Women's Hospital. Both are on the faculty at Harvard Medical School??

??

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