Functionality = Initial Functionality + Direct Impacts + Indirect Impacts + Competence • Resources,
for each part of the community.

John Plodinec of CARRI

In previous posts in this series (Part One and Part Two), I’ve laid out the bases for a model of community resilience and then fleshed out the model (with appropriate mathematical hocus pocus, I hope!).  In this post, I want to look at some of the implications of the model and how I’ve used it in my resilience work.

All of us are bombarded with data on a daily basis.  Making sense of it all can be an almost impossible task.  The model is my tool for not only organizing the data flowing in but also for drawing inferences and conclusions.  Although I’ll save us all from going into the differentials here, each of the following comes directly from the model’s mathematical formulation.

• Although I’ve developed the model in terms of a shock to one or more parts of a community, it remains useful to me even in the absence of a shock (i.e., no direct or indirect impacts). In this case, functionality changes by investment (competent application of resources) or its lack, i.e., a community’s trajectory prior to a shock is determined by how much it invests in itself.  For those of you who’ve read my screed before, this is one of the reasons I’ve harped on resilience requiring investment.  In my experience, one of the indirect impacts of a positive trajectory is an increase in confidence that will be felt in many other parts of the community; that increase in confidence leads to an increase in competence.
• Each part of the community has its own resilience to a given shock; some will recover faster, some slower, and some may never reach pre-shock levels.  Compare NOLA’s Garden District, the Broadmoor neighborhood, and the Lower Ninth Ward.
• Further, the resilience of any part of the community may well be different depending on the type of shock.  An economic shock is different from a natural disaster which is different still from a health crisis. The direct impacts are different leading to different indirect impacts.  This is inherent in Butler and Sayre’s work on the Gulf Coast looking at recovery from Katrina and from the BP oil spill.
  

  New Orleans, LA–Aerial views of damage caused from Hurricane Katrina the day after the hurricane hit August 30, 2005.
  Photo by Jocelyn Augustino/FEMA

• An important implication of the model is that it “allows” a community’s New Normal to be more functional than its Old Normal (compared to the Bruneau’s 1 – q(t) formulation).  The model implies this improvement happens through the competent application of community capital.
• While I have talked about “shocks” in terms of loss, they may actually be an abrupt improvement in one part of the community (e.g., see Not all disasters are the color of doom) that results in negative impacts on other parts (i.e., no direct impact, but significant indirect impacts).  Or the “shock” may not strike the community directly at all.  Think of the Great Blackout – setting a protective relay in Ontario led to a loss of power for much of the northeastern US (which in turn led to a spike in births nine months later – talk about your cascading consequences and interdependencies!).
• While I’ve discussed the model in terms of shocks, mathematically it also works for those chronic stresses that are slow processes.  Insufficient maintenance of roads and bridges is an example.
• As I’ve indicated before, “resources” includes all forms of community capital.  This helps to explain Rick Weil’s observations about well-connected lower income groups recovering almost as rapidly as those with higher incomes.  As a corollary, competence above all implies connectedness – connections to capital and to people.  Thus, the (competence x recovery) product implies a learning organization that either has experience or has planned for the shock.
• In the first of this series, I threatened promised to deal with stresses.  I don’t want to go into too much detail but – based on the model – I’ve developed a sort of taxonomy of community stresses.
  • As I indicated above, some stresses can be considered slow processes that can be dealt with as if they were shocks.  They will have both direct and indirect impacts, although the indirect impacts will be incrementally small though eventually significant.  As an example, poor road maintenance eventually degrades transportation performance.  These are often manifested as a negative trending trajectory.
  • Some stresses can be considered as resource constraints.  Poverty is a good example.  A small community that does not have personnel trained in grant-writing will not be able to access available resources, indicating a lack of human capital.  This often will be seen as a low initial capacity or functionality.
  • Others can be considered as constraints on competence.  A community with great internal disconnects and conflicts – for example, Ferguson, MO – may have all the resources needed for recovery from a shock, but may not be able to use them effectively.
  • The model also leads to my somewhat unconventional view of metrics.  Perhaps the most important aspect of the model is its explicit recognition of the time element.  As a result, I am more interested in a community’s trajectory and its structure than in a snapshot of attributes.  I find that the community’s trajectory and some idea of who is connected to whom provides more practical indicators of the ability to recover than single instant statistical data.  Further, many of the commonly used “resilience metrics” change so slowly that they have little value as measures of progress. Thus, in CARRI’s Community Resilience System (and its Campus Resilience Enhancement System) we try to understand the structure of the community (or campus) and to judge its competence to deal with the shocks it may face.

I don’t pretend that this model is right or even that it’s unique, only that it’s useful (at least to me) for drinking from the fire hose of information which inundates us all.  Thus, it has played an important role in my work to help communities become more resilient.

Republished with permission of: Dr. John Plodinec of CARRI

About the Author

John Plodinec, Ph.D is the Associate Director for the Community and Regional Resilience Institute (CARRI) at Meridian Institute.

In this role, he is responsible for identifying and evaluating technologies useful for enhancing community resilience.

He also is playing a leading role in development of CARRI’s Community Resilience System. He has also been heavily involved with CARRI’s engagement with the Charleston, SC, region. John recently retired from the US Department of Energy’s Savannah River National Laboratory (SRNL), as its Science Advisor. In this position, he led SRNL’s Laboratory-Directed Research and Development program, as well as developing strategic partnerships in areas aligned with the laboratory’s primary thrust areas.

Read additional insights by Dr. Plodinec.

We’ve heard the following “reasons” from a variety of companies, organizations and institutions (I’ve arranged them in groups to facilitate discussion):

We’ve never had a crisis

• That’s (whatever the problem or risk is) never happened to us in the past and we’ve been around a long time.
• We are well respected.  Nobody would hurt this company.
• We live in a safe area. Violence is not going to happen here.
• Our people are good people. Nobody would hurt anybody else.

If we have a crisis, I can handle it

• I’ve spent my entire life learning how to lead; I know how to respond to emergencies and crises.
• We’ve never had plans before; we don’t need them now.
• We’re really good at solving problems, and we’ve always been able to solve problems when they arise.
• We’re not big enough to need plans.
• We’re too small to attract the attention of bad guys

Recovery will be easy if something happens

• If we do have a problem, we can recover quickly.
• We can meet our commitments – even if we have a few people out sick.

We don’t have the resources

• I’m too busy “fighting alligators” to “drain the swamp.”
• There is no budget for plan development.

If we have plans and don’t follow them perfectly, then we could be sued.

Let’s take a look at these groups of “reasons.”

We’ve never had a crisis – Well, good for you.  When do you plan to cease operations?  I ask that, because no matter how unlikely a risk is, if you stay in operation long enough, you will experience it – the cumulative probability gets bigger the further into the future you plan to remain in operation.  It’s very important for leaders to appreciate how cumulative probability (this is one of those courses in college that everyone hated) works.  A once-in-a-hundred year event can happen tomorrow – or it can happen in ten thousand years.  Probabilities are just that – the probability that something will happen.  A high probability doesn’t mean that something will happen any more than a low probability means it won’t happen.  Probabilities are just the way to bet.  Speaking of betting, the real indicator for investing in preparedness is not just the probability, but also the impact.  The probability of the Cascadia Fault generating an earthquake in the Northwest U.S. is pretty small – but the impact is projected to be ginormous.  Some of the seismologists are saying that all connections (road, rail, air, sea) could be shut down for weeks or even longer.  That’s a serious impact, and the reason that Washington state is worried about the Cascadia Fault – so worried that they are even starting to invest in preparedness.

If we have a crisis, I can handle it – I’m genuinely impressed.  When was the last time you actually faced a crisis and responded to it capably and as effectively as possible?  Personal defense experts will tell you that you’re only about a third as good in a real defense situation as you are in practice – and if you’ve never practiced, you might as well “fuggetaboutit”  All of the psychological research emphasizes that humans (which normally includes leaders) respond to an emergency or crisis in one of three ways – we freeze, we flee or we fight.  Every single human being on the face of the planet will respond that way in the beginning of a threatening event.  The best and fastest way out of that genetically compelled, stone-age response is to have a plan and to have practiced it (there is nothing magic about that plan that you have holding down your bookcase but that you’ve never looked at).  No matter how much leadership experience you have, you need that plan and you need to practice it.  I’ve flown with some genuinely incredibly expert pilots and they all knew and continued to practice emergency procedures – there’s nothing quite like shutting down the wrong engine in an emergency because you haven’t practiced.  It gets real quiet in the cockpit when the motors aren’t running (we call propellers pilot-cooling devices because the pilot really starts sweating when those propellers stop turning).  This applies whether you’re an international mega-organization or even a one-person shop in your parents’ garage.  Sure, it’s easier to have situational awareness in small organizations, but that doesn’t mean that you aren’t going to freeze up when faced with a crisis that you are prepared for.

Recovery will be easy if something happens – Maybe so, but (going back to that probability/betting thing) how do you know?  If the crisis is a leak in the roof, it’s probably going to be pretty simple to get back into business-as-usual operation, but if the leak drips onto your brass-board power supply and fries your entire (and only) prototype the morning before the venture capitalists want a demo, who ya gonna call (Ghostbusters are booked solid)?  You need to have developed a plan (which, in this case, should have included ways to prevent your prototype from being at risk from that leaky old roof.  While you can’t ever be sure that recovery will be easy, you can be sure that a well thought out and practiced plan will make it easier than trying to drain that recovery swamp while the alligator has you by the ankle.

We don’t have the resources – What else is new?  No one has the resources just sitting around in their bottom desk drawer – not GM, not IBM, not Google.  They all have their resources fully allocated.  Leading an organization means establishing priorities.  Going back to my earlier question about when you plan to cease operations – if you plan on staying in operation “forever,” then your cumulative resources are enormous (even a couple of hundred dollars a year adds up when you stay around “forever”).  Similarly, your cumulative risk, looking out to “forever” is huge.  So, as a leader, dust off that old probability and statistics textbook, figure out your risk profile and establish your priorities.  That will help to tell you where to put your resources.  Remember Aesop’s grasshopper – in the real story, the ants let the lazy #@%&* starve, because he didn’t prepare for winter (a risk with both a high probability and a high impact).

If we have plans and don’t follow them perfectly, then we could be sued – This is actually not uncommon.  Actually, you could be sued, but even worse, you could get pilloried in a viral rant on Facebook or Twitter.  You may smile, but social media can have an even more devastating impact on your organization than a lawsuit.  Recall the recent social-media-published videos showing United Airlines in less than flattering behavior.  The cost of the settlement was a tiny fraction of the reputational cost to United.  Getting back to the lawsuit, a good attorney (or even an ambulance chaser) will make the point that “you should have…”  In fact, I heard on the news just last week, “They should have known…”  Law courts (and particularly juries) have been finding that organizations have been at fault when the judge or jury decides that an injury occurred and “something could have been done.”  Think about that – I’ll assert that you’re far better off to be criticized for an imperfect execution of your plan than for ignoring preparedness completely.

The bottom line here is that there may be excuses for failing to prepare, but there are no valid rationales.  I recently stumbled over a quote from Edward Everett Hale, “Because I cannot do everything, I will not refuse to do the something that I can do.”  I think that is a good way to look at preparedness in the face of the constant urgency of conducting business as usual.  While I may not be able to fully prepare by lunchtime tomorrow, I can figure out what I can do and then do that.  When leaders take that approach, organizations get more prepared and become far more resilient.

Comments?

Steve Crimando, MA, CTS, CHS-V

some of the grim statistics associated with terrorist vehicle attacks. While only four of the attacks discussed in the report used commercial trucks, the TSA note they are particularly effective as killing machines.

Over the past three years, more than 170 people have been killed and more than 700 wounded in about 17 ramming attacks around the world. The report reminds us that, “No community, large or small, rural or urban, is immune to attacks of this kind by organized or ‘lone wolf’ terrorists,” and that locations particularly vulnerable are those with “large numbers of people congregate, including parades and other celebratory gatherings, sporting events, entertainment venues, or shopping centers.”

NBC TV News aired a good synopsis of recent vehicular terror attacks that you can view here, but the report has not yet been posted on the TSA’s public website. While unclassified, the report was distributed directly to law enforcement, intelligence and homeland security agencies across the country, and serves to remind those involved in public and private-sector security roles of this emerging risk.

If you have not previously read my post from February 28th, “The Escalating Risk of Vehicular Attacks,” please note that it offers several suggestions for personal and family safety and survival in vehicle ramming attacks that you might find helpful and worth sharing with those in your personal and professional circles.

Steve has kindly allowed us to share various articles over the years. Check out a few of his insights below.

• The Hajj, the Pope and Crowd Safety
• Bioterrorism, Fake News & Alternative Facts
• Strategies for Safety and Survival in Vehicular Attacks
• 5 Tips for Fearless Business Travel
• Social Media, Violence and the Herostatus Syndrome
• Smokejumper Logic & Civil Unrest

Learn more about Steve Crimando and connect with him on LinkedIn.

Running a nightclub is about creating an environment where patrons can leave behind their daily worries and enjoy themselves. Unfortunately, conflict can develop and lead to individuals attacking staff or other customers. When that happens, owners and managers have to be ready with carefully considered security measures.

As a business owner, the safety of your customers and employees is your No. 1 priority, so plan ahead for the possibility of danger. Take these essential steps to keep your nightclub secure.

1. Set clear policies

Protecting your business starts with setting rules to minimize the chances of an altercation. Presenting explicit policies against provocative or dangerous behavior ensures customers are aware of the boundaries. Post notices of the dress code and any prohibited activities so entering patrons can easily see them.

You can back up those requirements with a range of security measures. Security cameras keep tabs on what’s going on in and around the club, rooting out individuals who are causing problems. Installing ID scanners can serve as a deterrent and make it easier to track down people who commit crimes in your establishment.

2. Provide specialized training

Your employees are the most vital line of defense against violence, so getting them up to speed makes a big difference in heading off incidents. Nightclub workers should be highly alert for signs of violence or harassment and prepared to step in to remove individuals as necessary. The host stationed at the door, security personnel and bartenders all need to be skilled in communication and observation, catching signs that a patron is becoming aggressive or dangerously intoxicated.

The staff should not be involved in escalating conflicts or overly quick to resort to restraining unruly customers. When workers are themselves violent, it contributes to a dangerous atmosphere that may lead to injuries. Instead, maintain a safer environment for everyone by training workers in peacefully solving problems and managing disputes whenever possible.

To watch over the crowds at larger clubs, management should consider hiring contracted personnel from a security firm. These professionals receive consistent training, so you can be confident they’ll be capable of resolving confrontations.

Related: Assessing Active Shooter Risks at Education Facilities

3. Maintain strict enforcement

A nightclub’s policies are only as effective as the efforts that go into making sure they are followed. The host in particular is key to stopping problems before they happen by barring people who are underage, caused trouble in the past, are already overly intoxicated or otherwise fail to meet the requirements for entry. Conducting routine checks for weapons or other prohibited items can prevent heated exchanges from becoming more dangerous.

Staff must always be visible to patrons and ready to help if asked or step in to end a disruption. Workers should be equipped with radios or other means for communicating instantly with one another in case of an emergency. Anyone who violates the club rules against violence or harassment should be removed from the building immediately and not allowed to come back inside.

Security cameras can be the most important tool at your disposal to enforce rules for both employees and guests. With eyes on strategic locations like the entrance and the bar, management doesn’t have to rely on anyone’s word to know how a conflict broke out.

4. Insure your business

Taking wise security precautions is an important part of keeping the establishment running properly, but owners and managers also need to prepare for when something goes wrong. Ensure the business offers protection from liability in case someone is hurt due to violence on the premises.

Bar and nightclub insurance from McGowan Program Administrators is designed to suit the specific needs of these establishments. Thanks to the “Power of the Pen,” you can purchase a policy that covers the unique risks for bodily injury that can arise from a night out gone wrong. MPA offers general and liquor liability limits of up to $2MM, property limits up to $5MM and coverage for assault and battery as well. Guard your patrons and employees against violence by establishing strict policies and enforcing them, and protect the business with the right insurance policy.

More from McGowan Program Administrators:

What Kinds of Businesses Should Consider Active Shooter Insurance

Senior Care’s Emerging Threats – A Point of View Paper from McGowan

A Disruptive Approach – Active Shooter Exposures and Predictive Programs

CMS Rule Preparedness – Are you Rule Ready?

RELATED:  *Register for an informative, no-fee Firestorm CMS Rule Preparedness Program Session TODAY!

The Centers for Medicare & Medicaid Services (CMS) have reviewed existing Medicare emergency regulatory preparedness requirements for both providers and suppliers. CMS found that while many providers and suppliers have emergency preparedness requirements, those requirements do not go far enough in ensuring that these providers and suppliers are equipped and prepared to help protect those they serve during emergencies and disasters.

There is consensus that these existing emergency preparedness requirements are generally insufficient in the face of the needs of the patients, staff and communities, and do not address inconsistency in the level of emergency preparedness among all types of healthcare providers. Some providers have no emergency preparedness requirements at all, and current emergency preparedness requirements are not sufficient to handle the complexities of actual emergencies.

This rule establishes a consistent framework that mandates incorporation of best practices and lessons learned in emergency preparedness.  The rule details the 17 types of “facilities” that are covered under the regulation. This final rule will be enforceable as of November 15, 2017.  Failure to comply will cause loss of all Medicare and Medicaid reimbursement. No extensions are anticipated.

RELATED: *Register for an informative, no-fee Firestorm CMS Rule Preparedness Program Session TODAY!

The Seventeen Medical Facility Types Affected by the CMS Final Rule:

1. Hospitals
2. Hospice
3. Transplant Centers
4. Religious Non-medical Healthcare Institutions: RNHCIs
5. Ambulatory Surgical Centers: ASC
6. Psychiatric Residential Treatment Facilities: PRTF
7. Program for the All-Inclusive Care for the Elderly: PACE
8. Long Term Care: LTC
9. Intermediate Care Facilities for Individuals with Intellectual Disabilities: ICFs/IID
10. Home Health Agencies: HHA
11. Comprehensive Outpatient Rehabilitation Facilities: CORF
12. Critical Access Hospital: CAH
13. Community Mental Health Center: CMHC
14. Organ Procurement Organization: OPO
15. Rural Health Clinic: RHC
16. Federally Qualified Health Center: FQHC
17. End Stage Renal Disease: ESRD

Firestorm® CMS Rule Preparedness Program

Firestorm® is in the process of launching an educational program, based up Firestorm Intellectual Property, to empower impacted medical facilities to meet these requirements. This train-the-trainer program will combine an interactive virtual webshop along with template planning tools, ongoing virtual training, virtual exercises, and Crisis STOP™ (24/7 support in a crisis). Firestorm will offer these services under an annual license fee.

• Learn more by visiting firestorm.com/cms
• Contact Firestorm

RELATED: *Register for an informative, no-fee Firestorm CMS Rule Preparedness Program Session TODAY!

*INFORMATIVE SESSIONS ARE FOR HEALTHCARE ORGANIZATIONS AFFECTED BY THE CMS EMERGENCY PREPAREDNESS RULE ONLY

Read part 1 of the series

[Earlier this month was] the 10th anniversary of the Greensburg, KS, tornado. Its population was almost instantly halved by the tornado, and apparently continues to slowly dwindle. The town made a desperate bet that it could reinvent itself and thus begin to thrive again. While it appears that that bet was lost, let us acknowledge that there is a kind of nobility in the attempt – a love of community, a reverence for its past, a commitment to its future. And let us hope that the leaders of our own communities have that same nobility.

In the previous post in this series, I broke down the loss-recovery curve into four components: pre-shock capacity, trajectory, loss and recovery. As I pointed out, this is simply a mathematical identity, i.e., if we know those four then the loss-recovery curve for that part of the community is defined. If we can do that for all parts of a community, then we’ll have a model we can use to better understand a community’s resilience – how it will respond to a disruption.

The trajectory and pre-event capacity of a community are relatively simple concepts that I’ll discuss more when I talk about using the model. The loss and recovery functions are more complex and I want to focus on them here.

My conception of both is colored by two observations:

• When a shock occurs it may directly impact some part of the community (e.g., a hurricane knocking down houses in a neighborhood), or its impacts may be felt indirectly (e.g., roads and bridges leading into and out of the community are washed away or blocked so that food and other supplies can’t readily be brought in.). The latter can lead to cascading consequences that may extend far beyond the area directly impacted by the original shock (This led me to coin the term “Disasters have Direction”). The flooding in Big Sur in February is a great example of these indirect effects: very little direct damage but bridges washed away and other roads blocked by rock slides isolating the inhabitants. Understanding the impacts of a shock requires some knowledge of a community’s “structure” – its internal and external physical, social and financial connections and especially its interdependencies.
• Recovery is very much dependent on those connections as well. Excellent work by Dave Butler and Ward Sayre shows that the path to recovery of Gulf Coast communities impacted by Katrina was very different than the same communities followed after the BP oil spill. A very nice paper from Shade Shutters found that greater connectedness led to more disruption after the Great Recession but also faster recovery.

Thus, an important part of the model involves breaking down a community into its constituent parts so that I can envision its “structure.” There’s really no magic in how to do this; several approaches are available – for example, the service area concept we at CARRI have used for our Community Resilience System, or the Triple Bottom Line, or the 18 functional areas proposed by ANCR. The key is to be able to discern in a reliable and consistent manner a community’s internal and external connections. In the following I’m not going to favor any approach. I’ll simply refer to “Whole of Community” to imply that I have a systematic way to parse the community.

With that as backdrop, let me look at loss and recovery. When a shock occurs, it will directly impact one or more parts of the community, e.g., a tornado will knock down buildings. If the buildings are schools the capacity of the entire educational system will be reduced, i.e., an indirect effect resulting from the direct impact of the tornado. Longer term, families and businesses may leave the community reducing the community government’s tax base (e.g., Greensburg, KS).

Thus, for a given part of the community, its loss function or change in capacity or functionality over time is the sum of the direct impact of the disruption on that part of the community and the sum (over the Whole Community) of all of the indirect impacts:

Loss for each part of the community

= (Direct impact of the shock + the sum of all of the indirect impacts)

Each of these will vary over time. In math-speak (see trigger warning from the previous post), if “S” denotes the shock or disruption, the loss over time, Li(t+dt), in functionality “Fi” of the “i”-th part of the community, becomes

The term in which i = j in the sum represents the direct impact, and the rest of the terms capture the indirect impacts (As I’ll discuss in a later post, some of these terms may be positive; i.e., the “loss” may actually be a net gain. Conversely, a positive change for one part of the community may result in a negative change for others.).

If we consider a community’s recovery from a disaster, we know that resources are required. These may be of various types – usually financial and human, but often including all of the other types of “Community Capital.” But resources are not enough – there must be the knowledge and the ability to use them to restore the functionality of that part of the community. If we dub this competence, then

Recovery of each part of the community

= the sum of (the resources available to that part of the community

x the competence of that part of the community to use resources)

Again, each of these will vary over time (I’ll discuss this further in a later post.). In math-speak, recovery, Ci, of the “i”-th part of the community becomes

Thus, if we look at how the functionality Fi of each part of the community degrades and then recovers according to

Fi(t+dt) = Li(t+dt) + Ci(t+dt), or

Functionality of each part of the community = Loss + Recovery, over time.

The pre-event capacity, Fi(0), and the trajectory set the initial conditions. In my next posts, I’ll discuss some implications of the model and how we’ve use it to guide our efforts with communities and institutions of higher education.

Republished with permission of: Dr. John Plodienc and CARRI

Learn More About the Author: Dr. John Plodinec

John Plodinec, Ph.D is the Associate Director for the Community and Regional Resilience Institute (CARRI) at Meridian Institute.

In this role, he is responsible for identifying and evaluating technologies useful for enhancing community resilience.

He also is playing a leading role in development of CARRI’s Community Resilience System. He has also been heavily involved with CARRI’s engagement with the Charleston, SC, region. John recently retired from the US Department of Energy’s Savannah River National Laboratory (SRNL), as its Science Advisor. In this position, he led SRNL’s Laboratory-Directed Research and Development program, as well as developing strategic partnerships in areas aligned with the laboratory’s primary thrust areas.

As part of this effort, he developed CARRI’s Resilient Home Program, aimed at improving the survivability of American homes to disaster. This built on earlier work he did while at Mississippi State University, where he led the University’s efforts to establish programs related to severe weather. Dr. Plodinec helped his research group become the first entity in the state of Mississippi – and one of the first in the nation – to win a competitive award from the Department of Homeland Security… (learn more)

Author: Dr. Don Donahue

These complications can affect anyone, but are more pronounced in children younger than five years of age and adults over 20. One in 10 children with measles will experience ear infections, possibly leading to permanent hearing loss. Five percent of children with measles will contract pneumonia, the most common cause of death from measles in young children. About one child out of every 1,000 who contracts measles will develop encephalitis (swelling of the brain) that can lead to convulsions and can leave the child deaf or with intellectual disability. For every 1,000 children who get measles, one or two will die. Measles may cause pregnant woman to give birth prematurely or have a low-birth-weight baby.

Prior to widespread immunization, measles outbreaks were common, causing some 500 deaths annually; dropping from the early 20th Century toll of 6000 a year, largely due to advances in medical care. Measles were eliminated from the U.S. in 2000, but continue to appear when imported from overseas. Significant outbreaks have occurred in 2013, 2014 and 2015, primarily among unvaccinated populations with some contact with international travelers.

From January 1 to April 22, 2017, 61 people from 10 states (California, Florida, Michigan, Minnesota, Nebraska, New Jersey, New York, Pennsylvania, Utah and Washington) were reported to have measles. Since April, 50 additional cases have been reported in Minnesota among Somalis who have been led to believe that vaccines cause autism and other maladies, resulting in only 42% of that population being vaccinated.

No vaccine is entirely safe. The rate of adverse reactions for the Measles, Mumps and Rubella (MMR) vaccine is less than one in 100,000. Compare this with two deaths in 1000 cases, and the value of immunization is clear.

The problem arises when unvaccinated people travel to places where measles is still common, which encompasses large parts of the world. Returning to the United States, these travelers carry the virus, which spreads via coughing and sneezing. Measles is so contagious that one person will infect 90% of those close to that person who are not immune.

CDC considers you protected from measles if:

• You received two doses of measles-containing vaccine, and you are a(n)—
  • school-aged child (grades K-12)
  • adult who will be in a setting that poses a high risk for measles transmission, including students at post-high school education institutions, healthcare personnel, and international travelers.
• You received one dose of measles-containing vaccine, and you are a(n)—
  • preschool-aged child
  • adult who will not be in a high-risk setting for measles transmission.
• A laboratory confirmed that you had measles at some point in your life.
• A laboratory confirmed that you are immune to measles.
• You were born before 1957.

The vaccination for measles is safe, effective and readily available. Which leads to two questions for those traveling overseas.

1. Why would you risk exposure?
2. Why would you risk exposing others upon your return?

Making a child, expectant mother, or co-worker miserable with the symptoms of measles would seem heartless. Causing encephalitis in a child is unconscionable.

Read additional insights from Dr. Donahue:

The Right to Pose a Danger to Others? Commentary by Dr. Don Donahue

Enterovirus 68, TB, and Ebola in the U.S. – Analysis by Dr. Donald Donahue JR

Ebola Crisis Planning Includes Post-Crisis Measures – Analysis by Dr. Don Donahue

Virus Plagues the States: An Analysis by Dr. Don Donahue

The TV show airs out of Washington, D.C. on ABC7 News Sundays at 11AM; NEWS Channel 8 at 6PM, and streamed at TheBridgeOnTV.com.

This weekly 30 minute program features panel discussions and interviews with leaders from the government, business, academia and associations. The Bridge is part of an outstanding broadcast environment anchoring a Sunday morning information block of This Week with George Stephanopoulos, Full Measure with Sharyl Atkisson, Government Matters, and The Bridge.

Episode 6 featured Harry Rhulen, Co-founder of Firestorm Solutions, LLC, Bruce Blythe Chairman R3 Continuum and The Honorable Bruce Morrison (D CT) – Chairman of Morrison Public Affairs Group

Some, like The Coca-Cola Company and Bank of America, have such confidence in their corporate governance policies that they post them to their websites. So what does it take to create a good one? Is yours up to snuff?

Build a Strong Board of Directors

Responsible for overseeing your company’s affairs, your board of directors should be comprised of experienced, passionate people who possess the time and energy needed to fulfill the role. Generally nominated by long-term shareholders, board members should also be a diverse group that brings varied insights to the table. Just as your company makes an effort to attract and retain top management talent to ensure a competitive advantage, so too should you work to create a skilled and decisive board.

That means giving them the tools they need to do their job effectively. Expose them to an orientation program that will prepare them to delve into your industry and familiarize them with the competitive landscape. Educate them on an ongoing basis, and keep them engaged to maximize the value of each director’s unique perspective.

Your directors should be well aware not only of their responsibilities, but also of your company’s existing policies. For example, does your board have a maximum length of service? What kind of evaluation process do you employ to ensure that all members are performing? Make your stance clear, so that directors know what’s expected of them and can focus fully on the task at hand.

Foster Loyalty and Trust

A public company’s loyalty is, above all else, to its shareholders. Directors must therefore uphold the shareholders’ interests and maintain the highest ethical standards.

The secret lies in collaboration and an open dialogue. Some companies encourage board members to have direct contact with shareholders or assign select directors to liaise with them on key issues. As directors are tasked with making the company’s most critical decisions, contact with shareholders is important to ensure that those decisions have the desired outcome.

An offshoot of loyalty to shareholders is transparency, not just about quarterly financial results but roles and responsibilities within the company, goals, challenges, strategic decisions, and upcoming mergers and acquisitions. In its report on corporate governance in the public sector, Deloitte explains, “It is becoming more important than ever to… maintain faith in the system and promote better service to the public, accompanied by transparent and controlled operations.” Creating a culture of trust can also have a ripple effect that positively influences your company’s reputation, employees and brand.

Streamline Processes

On the logistics front, it’s vital that companies have a system in place to set and carry out the board’s agenda and activities, including tasks like mapping short and long-term strategies, electing a CEO and determining compensation, and assessing opportunities and risks. This involves routinely asking whether you’re meeting objectives and doing what you set out to do. Communication is key:

Communication and information flow between the board and management, along with communication with all shareholders and stakeholders, are among PricewaterhouseCoopers (PWC)’s rules for good corporate governance.

There are tools designed expressly to facilitate this. Board portals, for example, allow directors and administrators to interact with each other through a secure platform, which can significantly boost mobility and productivity among top decision-makers.

Corporate governance isn’t a one-size-fits-all solution. But keep these best practices in mind and you’ll be better equipped to execute your company’s plans — big and small.

About Diligent

Diligent is the leading provider of secure corporate governance and collaboration solutions for boards and senior executives. Over 4,700 clients in more than 70 countries and on all seven continents rely on Diligent to provide secure, intuitive access to their most time-sensitive and confidential information, ultimately helping them make better decisions. The Diligent Boards (formerly Diligent Boardbooks) solution speeds and simplifies how board materials are produced, delivered and collaborated on via any device, removing the security concerns of doing this by courier, email and file sharing. Visit www.diligent.com or follow Diligent on Twitter @diligentHQ to learn more.

Image Credit: CDC

Despite these well-documented benefits, there remains a gap in sufficient communication education and training for health care providers. Literacy and patient communication play an important role in the effectiveness of health care overall. However, there are few requirements to teach communication knowledge, skills and abilities grounded in communication scholarship, theory and research in undergraduate and professional schools to health care providers. The topic of patient communication is rarely systematically addressed in schools of medicine, public health, nursing, dentistry or pharmacy. It is more rare for students to have access to specialized curriculum and instruction overseen by communication scholars and researchers. In practice, health care professionals may not appropriately and thoroughly know how to address the challenges of effectively communicating with each other and their patients. For example, a survey of nearly 700 professionals and policymakers found low levels of awareness of strategies to effectively communicate health information literacy or promote health literacy skills. Exploration of the effectiveness of communication between health care professionals themselves offers additional insights into communication education challenges and opportunities. Communication and information transfer between health are providers is critical to enabling the reduction of medical errors, as well as effectiveness of the health care system as the costs associated with ineffective communication between heath care professionals are very high. Ineffective communication between providers has been linked to issues of patient safety, medical error, low patient satisfaction and complaints by patients and caregivers. This can pose challenges for communication across the various (interacting) health care professions if providers are unable to understand or lack a shared understanding of key acronyms, jargon and concepts. These challenges are then exacerbated when providers make assumptions about other professionals’ comprehension, meanings they attribute to situations, values, beliefs, behaviors, etc. Skills that enable communication between health care professionals traditionally are not taught to students in existing common academic and professional curriculum.

Furthermore, there are challenges, obstacles and opportunities for communication between health care providers and patients lying in the vast landscape of new media. Drawing upon the research, scholarly and technical expertise,  as well as the insights from communication academics and professionals alike, the quality of communication can be adjusted and enhanced much more so than a reliance on those who are experts in other subject matter topics but not new communication tools and techniques.

Another communication education and training gap is found in the need to connect cross culturally with diverse communities. The consistently demonstrated inability to provide culturally sensitive health information to diverse populations has been identified as one of the key variables contributing to disparities in health care. It is imperative that health care providers understand the meaning different communities place on health and wellness, rather than assuming that the assumptions of the dominant Western medical model is shared interculturally.

One recent development is the emergency of health communication academic programs (largely residing in the communication studies disciplines) which are open to health care provider professional students and offer to them an interdisciplinary educational opportunity. Further, these new program developments have spurred interdisciplinary conversations that have advanced the research and practice of health communication greatly.

Image Credit: CDC

I believe that such rigorous academic and professional communication training should be available and incorporated in the preparation of health care provider professionals. Here are several significant benefits and advantages for the next generation of graduates to be far better prepared to be effective communicators in the health care professional context. Specifically, based on the research surveyed, improved provider communication knowledge, skills and abilities include the following advantages:

1. Improved health care quality for patients (variables include; increased physical benefits, increased emotional benefits, higher rates of symptom resolution and better control of chronic diseases).
2. Higher levels of patient behavioral compliance with healthcare instructions.
3. Higher levels of patient satisfaction with the health care experience.
4. Higher levels of clinical professional (health care provider) satisfaction with professional experience.
5. Lower levels of medical malpractice risk (fewer medical malpractice claims by patients against providers).
6. Higher levels of health information literacy. (More effective public health information campaigns)
7. Lower levels of intercultural or cross-cultural communication misunderstandings and conflict.
8. More effective utilization and integration of new media and new communication technologies consistent with research findings for effective communication.
9. Lower levels of medical errors in health care contexts.
10. Respond to the requirements of accreditors for improved communication quality in the health care context.

Communication matters!

References:

http://www.fmshk.org/database/articles/607.pdf

http://www.hypothesisjournal.com/wp-content/uploads/2011/09/vol8no1-hj007.pdf