波士顿马拉松爆炸案给危机管理的启示

    半年前，在4月15日那天，在距离波士顿马拉松赛终点线仅几步之遥的地方，两个简易爆炸装置在几秒钟内相继爆炸，当场造成3人死亡。值得注意的是，在活着到达医院的264名伤者中，没有一个人死亡。

    应急准备圈已经从这一悲剧性事件中汲取了经验教训。商界领袖也可以从爆炸发生后不知疲倦地工作的医护人员身上获得一些启示。但更为宝贵的教益，或许来自那些早在这场危机发生前就采取措施的有识之士。

    简化组织

    医院与公司并无多大不同：各种事件总是迅速且出人意料地发生。反应需要及时且果敢。你的组织能够多么迅速地予以应对？谁有权做决定？谁做这些决定？谁在事后承担责任？组织的指挥链清晰吗？每位重要参与者是否扮演一个明确且可管理的角色？

    就复杂性而言，今天的医疗保健机构完全可以跟大型企业相媲美。医疗机构通常由住院和门诊部门构成，其中或许包括多家医院、诊所和健康中心。医生、护士、管理人员、技术支持人员、承包商、供应商、患者和家庭皆是“利益攸关方”。这些复杂的组织拥有矩阵式管控结构，其中往往包括为医生、护士和管理人员设置的独立“筒仓”。

    1970年9月，圣安娜风（Santa Ana Winds）引发的野火在加州四处蔓延，席卷400平方英里。数百家消防部门按照各自的章程和组织结构对抗这场大火，但由于隶属于不同管辖区，这些消防部门深受协调和沟通不畅之苦。

    这场大火之后，七家加州消防部门开发了一套突发事件指挥系统（ICS）。它允许率先作出反应的部门在事发现场成立一个临时领导机构，以巩固和澄清指挥链，无缝协调来自多个机构或管辖区的救援人员。随后的30年间，全美各地的大多数消防部门和医疗急救队都完善、实施了ICS系统。1991年，奥兰治县紧急医疗服务队和医院一起开发了一套适合医院实际情况的ICS系统，这套系统最终被命名为医院事故指挥系统（HICS）。HICS系统建立了一个明确的指挥链、共同的术语、清晰的报告系统和角色职责，以及基于事件性质迅速扩大或收缩反应规模的能力。HICS系统并不是一种临时性活动，它是相关部门坚定地致力于计划、准备和培训的结果。波士顿马拉松爆炸事件发生的爱国者日，波士顿的每家医院都启动了HICS系统，一如它们在此前的真实事件和演习期间进行的操练。这套系统实实在在地发挥了作用。

    灾害应变是一项团队运动

    波士顿的成功医疗救助反应建立在精心发展的跨部门关系之上：大医院创伤中心、医疗急救队、消费部门、地方和州执法部门、公共医疗服务提供者、波士顿田径协会（Boston Athletic Association），以及地方和州政府，以上仅仅是参与救援的一部分机构。

    Six months ago, on April 15, two improvised explosive devices went off within seconds of each other, just steps away from the finish line of the Boston Marathon, killing three people almost instantly. Remarkably, of the 264 injured people that reached the hospital alive, not a single one died.

    The emergency preparedness community has already been cultivating the lessons learned from that tragic event. Business leaders, too, can gain insight from the experiences of the health care professionals who worked tirelessly in the wake of the bombing. Even more valuable lessons can come from those who acted long before the crisis took place.

    Streamline your organization

    A hospital isn't so different from a corporate workplace: Incidents occur quickly and unexpectedly. Responses need to be immediate and decisive. How rapidly can your organization respond? Who has the authority to make decisions? Who makes these decisions and who is accountable for them in the aftermath? Is your organization's chain of command clear? Does every key player have a defined and manageable role?

    Today's health care organizations rival large businesses in complexity. They include inpatient and outpatient components that may comprise multiple hospitals, clinics, and health centers. The "stakeholders" are physicians, nurses, administrators, support personnel, contractors, vendors, patients, and families. These complex organizations have matrix-style management control structures that often include separate silos for physicians, nursing, and administrators.

    In September 1970, wildfires sparked by Santa Ana Winds spread across 400 square miles of California. Hundreds of firefighting agencies struggled with coordination and communication across various jurisdictions as they fought the fires with their own protocols and organizational structures.

    In the aftermath, seven California firefighting agencies developed the Incident Command System (ICS), which allows first responders to establish a temporary leadership structure at the scene that consolidates and clarifies lines of command and seamlessly incorporates responders from multiple agencies or jurisdictions. Over the next 30 years, ICS was refined and implemented by most fire agencies and medical first responder agencies across the country. In 1991, The Orange County Emergency Medical Services and Hospital worked together to develop a hospital adaptation of ICS ultimately named HICS (Hospital Incident Command System). HICS establishes a clear chain of command, common nomenclature, clear reporting and clarity of roles, and the ability to quickly expand or contract a response based on the nature of the incident. HICS is not an ad hoc activity. It's the result of a determined commitment to plan, prepare, and train. On Patriot's Day, the day of the Boston Marathon bombing, every hospital in Boston utilized HICS, just as they had drilled during prior real-life events and exercises. And it worked.

    Disaster response is a team sport

    The successful medical response in Boston was predicated on well-developed relationships across disciplines: major hospital trauma centers, emergency medical services, fire services, local and state law enforcement, public health providers, the Boston Athletic Association, and local and state government, to name just a few.