As our partners field questions from various organizations standing up response capabilities, we realized we should share our guidance.

This is what to do first, as your organization begins to work out plans and resources for reducing the slope of infection counts and raising the ceiling on health care capacity:

We believe the only successful working model for a response of this complexity among conditions this dynamic is to immediately instantiate an operations body with direct access to executive decision making.

The staff you recruit to work as incident lead in this operations body must be someone experienced with incident command, production operations, or emergency response at or near the executive level.

A successfully integrated operations body will have these features:

  1. A single, shared, always-on, communications line monitored by a designated single point of contact, an “operations lead” or incident commander. This position should be staffed in rotating shifts if possible. The single point of contact also owns reliability and accessibility of the communications line.

  2. Low-complexity, easily distributed information for accessing that communications line. Phone conference bridges with stable dial-in and join information have proven very effective in the past.

  3. Direct (zero degrees of separation) access to the top of the chain of command (president/secretary/governor/CEO) or their delegate. This person must be able to make decisions requiring any magnitude short of an act of legislation.

  4. Convening power for the leads of each line of effort.

  5. A daily “working rhythm” of morning and evening check-ins from the single leads of each area of effort, and experts who know ground truth on issues firsthand. These check-ins happen at the same time every day and are mandatory.

  6. Facility to track the top three issues and top three needs on a daily basis for each line of effort.

  7. A daily read-out of the operational terrain – issues, needs, and personnel status – directly to the top of the chain of command (president/secretary/governor/CEO) or their delegate.

Rules for the integrated operations body:

  • Rule 1: The integrated operations body and its check-ins are for solving problems. There are plenty of other venues where people devote their creative energies to shifting blame; we do not need another one. We don’t shoot the messenger, including (and especially) when the message is, “I screwed something up” or “I don’t know.”

  • Rule 2: The ones who should be doing the talking are the people who know the most about an issue, not the ones with the highest rank. If anyone finds themselves sitting passively while managers and executives talk over them with less accurate information, we have gone off the rails, and intervention is necessary.

  • Rule 3: The operations body needs to stay focused on the most urgent issues, like decisions and actions which need to happen in the next 24/48 hours. There are lots of things that are important but not urgent, and they should mostly be handled away from the check-in meetings. They can be tracked in a “slow zone” for less frequent updates.