By Rose O. Sherman, EdD, RN, NEA-BC, FAAN
I was recently asked by a critical care nurse whether I believed that if there is a second wave next winter, we will be better prepared to deal with it. Her concern was that she was not sure she would be willing to work in her role through another crisis where healthcare staff was assuming so much of the risk. This is one of those challenging questions to answer because to address a second wave more comprehensively requires a level of upstream thinking that may not be taking place.
In his new book, Upstream; How to Solve Problems Before They Happen, Dan Heath points out that we all tend to work around problems. We are resourceful. We are great at improvising at the moment. We have become so accustomed to dealing with emergencies that we don’t reflect on how we could have prevented them in the first place. It is our inattentional blindness that can lead to a lack of peripheral vision. Upstream thinking takes wise collective action to ensure better outcomes. It means carefully looking at the social and economic determinants that landed us where we are.
One of the significant challenges in organizational and governmental planning is convincing policymakers about the value of preventative measures. Upstream thinking takes wise collective action to ensure better outcomes. Paying to solve problems before they happen is not top of mind in a world that has been more focused on short term gains. Yet in the COVID-19 pandemic, we are seeing the outcomes of not being more proactive. When you fail to work at prevention and proactive planning, you are forced into a reactionary mode to deal with the fallout of a crisis. Individual health systems are left to their own devices to do their planning. Upstream thinking has been particularly challenging in healthcare because of how it is funded by a variety of different payers, some public, others private with different agendas.
Many nurse leaders have talked with me over the years about their frustrations in trying to present a business case to stop often foreseeable problems from happening. Some Chief Financial Officers are often quick to point out that they are not in the business of spending money on something that “could happen but might not.” Sadly, this often proves to be shortsighted.
If there is one lesson learned from our experiences with COVID-19, it should be that we do need to become better upstream thinkers. Most leading infection control experts will tell you that it was only a matter of time before we had a pandemic of this magnitude. Yet, getting someone to own the problem and the planning has proved very challenging. It is easier to wait and then respond. Despite the warnings of pandemic experts, no one wanted to look closely at where our supply chains were, and how they could be interrupted in a crisis. We have not heeded the warnings of our public health experts that the dismantling of public health at the local, state, and national levels would have serious long-term ramifications.
And so, my answer to this critical care nurse based on what I know now would be that I am not sure, especially at a national level. I think some health systems and states will be much better positioned than others to deal with a second wave, but certainly not all. The hard part is that she is right – collectively, we owe it to nurses and other first responders who have assumed so much of the risk to do this upstream thinking now.
Lead to Read
Heath, D. (2020). Upstream: How to solve problems before they happen. London: Bantam Press.
Read Rose Sherman’s book – The Nurse Leader Coach: Become the Boss No One Wants to Leave
© emergingrnleader.com 2020
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