Innovative technology in a modern hospital operating room

Situational Awareness for Multi-Stakeholder Collaboration

In an emergency response, multiple groups of stakeholders such as city, county, state, and federal agencies are brought together to solve a crisis or execute a mission. While groups of individuals from within an agency may have a shared understanding of their mission, organization, hierarchy, and norms of engagement, proper coordination between distinct groups takes time, trust, and practice. By the nature of these missions, these are scarce and often intangible resources. Situational awareness through software and expert practitioners substantially increases the odds of mission success.

Situational awareness should enable stakeholders to perceive, comprehend, and predict their environment. However, leaders must understand that if their solutions do not enable lower-order situational awareness (i.e., to enable basic perception and comprehension), their ability to meaningfully predict will be limited, fancy graphs notwithstanding. Data analysis is dependent on data collection, which in turn relies on the underlying workflow. The generally underappreciated aspect of situational awareness is that it is predicated on tooling that must span from end-user workflow to higher-order analytics.

Tooling & Process

However tempting it may seem to standardize workflow for the purpose of convenient higher-order situational awareness, effective workflow must principally meet the operational realities on the ground. It is highly unlikely, for example, that data that would fail to help stakeholders perceive or comprehend an issue can still hold meaningful and causal predictive power. Therefore, situational awareness is predicated on and inseparable from workflow and process.

For example, mass vaccination sites must leverage a collaborative tracking solution to administer thousands of vaccines per day that can be configured to have multiple steps – for example, appointment validation, screening, data collection, vaccination, and observation. For sites that are administering only a couple hundred vaccines a day, such a process would be excessive since two or three people could manage the entire workflow – with everyone doing more of the process and the site requiring fewer specialized queues.

If situational awareness is predicated on workflow, workflow is in turn dependent on a system that spans training, feedback, and supervision.

Training, Feedback & Supervision

If situational awareness is predicated on workflow, workflow is in turn dependent on a system that spans training, feedback, and supervision. When running an activated site, even if fully staffed with individuals familiar with the software that is being used, it is important to recognize that users may not be familiar with the configurations or the implicit assumptions underpinning the workflow.

For example, there is a centralized system used across the country for data collection, including for data that is submitted to the U.S. Department of Health and Human Services (HHS). However, each state has its own deadline on when data must be submitted. Several states allow several hours for their data teams to be able to review and analyze data before it is sent to HHS, whereas some states prioritize giving their stakeholders additional time. Underlying every operation is a host of such assumptions that must be made explicit to stakeholders as a precursor to training on the technology.

Next, training must be coupled with feedback – human or automated – for it to be appropriately absorbed. For example, daily reporting for HHS data collections automatically displays errors that violate certain logic – such as when the total number of occupied beds is less than the number of pediatric occupied beds – so that users are able to correct these mistakes and trace them down to source systems that may be configured inappropriately to generate this data. Feedback could also be delivered by a person. As an example, several states use their healthcare coalition leaders to ensure data accuracy and provide real-time feedback in instances where that is missing.

Finally, there needs to be a mechanism to hold people accountable to ensure that the workflow is being followed and data is being recorded accurately. This could also be automated or not, which may not matter but most often is missing as part of the initial design. Early adoption should include thinking about how to spotlight appropriate and inappropriate use of workflow. This could take the form of a dashboard that highlights individuals or entities that are following the processes consistently, flagging those that are lagging behind, and surfacing recurring data quality issues.

Governance & Planning

The ability to train people on systems and protocols becomes easier as general governance, planning capacity, and competency increase. Multiagency responses may occasionally have strategic ambiguity at the top. Stakeholders may believe that they have secondary and not a primary responsibility of an operation in order to protect their agencies from public consequences of poor mission performance. Even with strategic ambiguity, leaders must institute strong governance for processes that provide clarity to their operational teams and create psychological safety for them to conduct their duties.

A governance failure that will become a standard in case studies for future generations is the lack of clarity on a hospital dataset at the onset of the COVID-19 pandemic. In the absence of clear federal guidelines or recommendations, states created their own datasets to understand the impact of COVID-19 in communities, only to have to substantially redo the work in the onslaught of a new dataset, and a subsequent forced change in reporting mechanism that excluded the Centers for Disease Control and Prevention from the hospital data collection business.

Planning and technology are similarly intertwined. It is not uncommon to assume additional reporting obligations as a condition of receiving resources from stakeholders such as the Federal Emergency Managemenet Agency. Part of planning, then, must be to explicitly make a path to compliance for reporting obligations and ensure that the workflow supports such needs. For example, when required to report on requests for public assistance during a disaster, it is highly unlikely to retrospectively collect that information without resorting to anecdotal evidence or collecting scraps of paper. Planning must account for collecting that information as a part of daily duties.

Perspectives & Tradeoffs

Experienced emergency management professionals know that they are constantly making trade-offs with each decision. Exceptional professionals can also quickly categorize them in order of importance and communicate these tradeoffs effectively. For example, agencies may forgo regular processes to formulate data requirements and ask their stakeholders seemingly simple data such as the number of beds available, only to find that hospitals have spent hours in meetings to decipher how to provide such a metric because of the lack of specificity in the official request. Solutions that improve situational awareness must be able to promptly correct such policy ambiguity to assist stakeholders in focusing their time on their local response. For example, the system that allows informational alerts and flexible updates to data definition prompts can be configured by each regional administrator precises to ensure that communication is clear and direct.

An often underappreciated area where leaders can meaningfully contribute to situational awareness is by reviewing data and its underlying assumptions and sharing it appropriately with their stakeholders. How much to share often comes with experience – striking the right balance between too much and too little. Effective solutions must be able to partition exploratory analysis, which requires testing prior to wide consumption from reporting that must be shared. By accessing data through a data lake (a centralized repository to store all structured and unstructured data at any scale) and selectively sharing insights with specific groups, organizations can navigate this situation.

Situational Awareness Solutions

Although theoretically easy and intuitive to define, situational awareness is as much an art as it is a science. Software solutions enable the savvy practitioner to perform at the top of their skill and enables emerging professionals to do more than they otherwise would. Regardless of expertise and tenure, however, response professionals have access to more data than ever before to support more informed decision-making. Situational awareness solutions without corresponding expertise are at best incomplete. Since it can be overwhelming, it is best to partner with a technology partner that is deeply grounded in the preparedness and response domain to help translate expertise into scalable workflows, insights, and solutions. It is this type of partnership and mutual collaboration that helps truly further situational awareness.

Akshay Birla

Akshay Birla is the chief client officer at Juvare, a provider of emergency management solutions for public and private organizations committed to optimizing their resilience strategies. He previously served as Juvare’s vice president and chief marketing officer. Juvare’s solutions are used across various industries, including healthcare, aviation, education, utilities, state and local governments, federal agencies, and government defense organizations.



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