Combating pandemic planning fatigue

(CIDRAP Source Weekly Briefing) – Business people convinced of the possibility of an influenza pandemic agree: Convincing reluctant managers, organizing continuity planning, and educating employees can be challenging.

But if getting better prepared for a pandemic is tough, business managers say, keeping prepared is tougher.

It's bad enough, they agree, to have to convince reluctant managers and educate busy employees that a pandemic will be unlike any other hazard a company might face, like earthquakes, hurricanes, or terrorism. Such events are local or regional and occur over minutes to hours. Recovery resources from other areas of the country can be accessed quickly and the recovery process begun--even in the face of physical destruction.

But for those responsible for private-sector pandemic preparedness, what remains untested and unclear is how companies and organizations will respond. How stable, for example, will today's public utilities be? Will companies supplying critical parts or services be able to deliver? How many employees will come to work and over what period? The unknowns can be so confounding as to bring preparedness activities to a halt.

Another challenge is finding reliable sources and information to act on for both meaningful planning and for delivering company information campaigns and training.

After that, they say, comes the truly hard part: Sustaining the planning effort over the long haul.

Experts say that preparing well for a catastrophic event takes time, thought, and repetition--but the more time that elapses, and the more repetitions employees go through, the more likely it is they will develop planning fatigue.

Pan flu war games

"This is a very serious issue," said Len Pagano, president and CEO of the SafeAmerica Foundation, a Georgia-based nonprofit organization that has staged pandemic-planning business summits in Chicago, New York, and Philadelphia. "If you come up with a plan, and then over a year you don't touch the plan, you won't only forget key points in the plan--you'll begin to think the whole issue isn't very important."

But keeping up awareness of the possible consequences of a pandemic--a global event that could last 8 to 12 weeks in any one location, cause up to 24 months of disruption around the globe, and kill 200,000 to 1.9 million just in the United States, according to the US government--is as essential as it is challenging.

Pagano and the SafeAmerica Foundation recently landed on a new idea: They are staging a war game, with flu as the enemy.

The exercise will last a week and take place in 2 to 6 plants belonging to a Fortune 100 heavy-industrial company that asked not to be identified for competitive reasons. The company will ask its workers to follow the social-distancing techniques that the US Centers for Disease Control and Prevention (CDC) recommends as a first-line defense. SafeAmerica will observe employees to gauge compliance, then report to the company's management what recommendations were followed or ignored.

An actual pandemic, of course, will last months and mean that employees will be subjected to many other stressors (loss of loved ones, trouble finding food or routine drugs for themselves or family members) that will change how employees respond during the real event. But if the experiment is successful, Pagano said, it will deliver what scenario exercises lack: the energy and creativity provoked by a real-time challenge.

Keeping plans fresh

Keeping fresh in pandemic planning is a preoccupation for Steve Bergfeld, vice president of corporate services and administration at Baxter Healthcare Corp. of Illinois, part of Baxter International Inc.

Baxter makes a range of medications and medical devices, including home dialysis solutions. The company is in a category the government calls critical infrastructure: 14 business sectors (from food production to energy to banking to information technology) that must keep functioning during a crisis in order for the United States to keep running.

"As I go around and talk to my colleagues, everybody is saying the same thing: How do you keep this [planning] as a front-burner issue when we have so many other priorities and so much demanding our time," Bergfeld said.

Bergfeld was brought to Baxter 10 months ago to head a threat-management team of 23 people. The company's process is arduous: monthly meetings to rank facilities worldwide against a list of "accountabilities"; regional audits that score facilities on 7 aspects of pandemic and disaster planning; on-site inspections; and tabletop exercises. Yet "I am always looking for new tools, new resources . . . the next creative way to keep this in front of people," Bergfeld said.

Mega-retailer Target Corporation, which has 7,000 employees just in its Minneapolis headquarters, formed a 30-person pandemic response team a year ago to work with its existing business continuity experts, who, up to then, had chiefly anticipated store closures due to natural disasters such as hurricanes as well as technology crises such as crashes in the company's worldwide electronic networks.

"What we do for business continuity prepares us for pandemic planning, and pandemic planning becomes a scenario within business continuity that we haven't addressed in the past," said Birch Holt, Target's manager of business continuation.

The pandemic team, Holt said, draws broadly from throughout the company, including representatives from crisis management, merchandising, and government affairs in addition to the pre-existing business continuation department.

They began meeting in January 2006, starting with face-to-face, twice-monthly gatherings of at least an hour, initially mapping out plans for each major division, using pandemic flu–related information from the CDC ( and the World Health Organization ( as well as a private risk-information company. With most of Target's divisional plans now written and under review by senior management, the team has cut back to hour-long, face-to-face meetings once a month.

Target will shortly hold its first pandemic tabletop exercise. Participants will represent each company sector that has prepared written plans. The results, Holt said, will expose new vulnerabilities to think through.

Holt acknowledges that written documents (no matter how thought-out and granular) are not enough. On a board near his desk, he keeps a saying he attributes to World War II general and President Dwight D. Eisenhower: "In preparing for battle, I have found that plans are useless, but planning is indispensable."

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