Are you in Crisis Mode? Lessons from Japan's Tohoku Earthquake | Joe Bormel, M.D. | Healthcare Blogs Skip to content Skip to navigation

Are you in Crisis Mode? Lessons from Japan's Tohoku Earthquake

March 28, 2011
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A checklist of crisis management issues relevant for every C-level hospital executive

A professional colleague, Stacie DePeau, MBA, PMP, and parent extraordinaire, sent a link to me last week. The link took me to an article that detailed how one company and its local Tokyo retail store management dealt the earthquake in Japan. Although some will be distracted by the feel-good marketing halo the story inspires, the account contains a check list of crisis management issues in narrative form that are relevant for every C-level hospital executive. And I mean every C-level exec, not just the CIOs and CMOs who own their respective crisis management plans. Said differently, there’s a leadership story here.

What did I learn from the article?

1. Admirable local management behavior of a commercial entity and their decision to own their supply chain played a positive role in crisis management. This multi-billion dollar, multi-national corporation has invested in a local retail presence, as opposed to and unlike their competitors. Those competitors tend to use third party franchisees with big-box, retail chain store distribution. This company was already well aware of, and invested in, controlling the local experience, just as larger health care delivery systems build and protect their brand experience at their facilities.

2. There was a distinct benefit to owning the building (related to #1). Its design contributed to survivability, business continuity and sustainability. The strong wooden tables, the isolated building attributes, the open floor plan. Again, compare the retail experience you see in the photo above with the cramped, high-stacked shelf space of their competitors.

3. The specific contribution of free WiFi and FaceTime service to connect to the outside world. Not cell phone connectivity. Although the reliability of Japanese WiFi services varied in the face of the disaster, I suspect those of us in the U.S. would not do as well. My video conferencing quality-of-service often degrades at 4 p.m. on non-crisis weekdays when school lets out!

For more on the critical role of information systems and communications technology in response to disasters, I suggest you visit two links, here and here.

These links will acquaint you with Jennifer Leaning, MD, SMH, with whom I studied about a dozen disasters in depth during my MPH training. The course I attended was called Disaster Management 205, and it’s still being taught 20 years later. Not surprisingly, Dr. Leaning led the discussion session of the Harvard coordinated relief effort for the current relief projects in Japan.

4. The strengths and weaknesses of infrastructure in response to disasters, i.e. Skype, FaceTime, etc., outlined in the account echoed a recurring theme. Mobile communications infrastructure has long played a critical role in responding to disasters. However, 20 years ago, during the course I mentioned, we discussed how U.S. cellphone networks became useless because of saturation issues during a crisis. Protecting the bandwidth for relief workers was not in the design. I am frequently reminded that this still happens on a very regular basis. The only phone my public health physician friends trust is the satellite phone, which requires a line-of-sight to the area of the sky containing the satellite.

On the other hand, last year I discovered how trivially easy and inexpensive it was to add WiFi extenders to bring the Internet to my backyard. But, I digress. For a current review of communication strategies, see the 2009 working paper, "Applying Technology to Crisis Mapping and Early Warning in Humanitarian Settings - Crisis Mapping Working Paper I of III."

5. The "anticipate and contain" mentality of management to quickly stock up on food, chargers, etc., implied forethought. Were they simply executing a pre-scripted plan? Were they composed and improvising? Were they trusting and empowered such that, despite being in survival mode, they were actually following checklists, as well as planning and executing as though they were in growth mode?

What did you learn about crisis management from the earthquake?


“America's health care system is in crisis precisely because we systematically neglect wellness and prevention.”

Tom Harkin

Dear Joe,

Your reference to the disaster course you took with me years ago and to current work that HSPH is doing around the disaster in Japan is very generous.  I very much appreciate your reference to this work.  It is indeed accurate.  The disaster course continues as ID 205.

Your comments about corporate disaster preparedness are very well placed.  I hope you are well and thriving.

Thank you very much for writing and I send all best wishes.


Doc Benjamin,

Thanks for your comment. You are obviously both knowledgeable and thoughtful. I found value in several points you made: a) reasonable efforts at prevention are important, b) there are limits to how much preparation and response can be provided, c) human generosity with relief efforts (different from crisis response) are not unusual, and d) crisis management is complex, requiring our best and brightest. I did not, however, follow your point on "... deception involved in our plan."

Can you clarify?

Thank you for connecting crisis management/disaster recovery concepts and leadership. I've long felt that the two were interrelated, and of course, everything will play out different in different industries in different places, etc. But it's important for healthcare IT executives to consider how their planning might fare when a real disaster occurs, during which the normal parameters are blasted out from under us!

Dr. Bormel,
By "deception" in my comment, I was referring to those few who, from time-to-time, contribute to plans, but their purpose is to make the plan fail.

In retrospect, by the way, I did learn something from your post and the media concerning this particular crisis. I learned that there still exist societies where thugs, thieves, and other vermin do not use a disaster to add even more misery on a devastated population.

Doc Benjamin

Mark, Thanks for your perspective and the kind words.

The feedback I'm getting from readers is recognition of how other organizations and institutions have responded in the past to Katrina, Andrew and other local disasters.

Several people directly familiar with Coors, for example, shared the same story of how they produced and shipped free, bottled (canned) water in relief efforts. Again, based on insider reports, they did it for faith-based reasons, although the intangible loyalty to brand benefits are evident.

To your point, leadership and competent management is critical to disaster and crisis management. If an organization has flawed (ie not flawless) execution practices in general, a crisis will only make things worse. On the other hand, when an organization has and demonstrates the capacity to respond to the unexpected needs of people, there is always a previous internal investment in people that is showing its dividends.

Dr. Bormel,

With great sorrow for what has happened in Japan, I don't think I actually learned anything from your post. Rather, what you described, also looking at Katrina and other disasters, was to reinforce my knowledge of certain facts concerning crisis management.

I look at crisis management as a plan a plan that begins with doing whatever can be reasonably done to prevent the crisis in the first place. The government, and many companies, in Japan did what was reasonable at the very high end to prepare for earthquakes and their ramifications. The fact is, Japan has consistently been rated as the best prepared nation for this type of crisis.

But no government or company can prepare for every level of a specific crisis, particularly when the level of such a crisis is at the high end of catastrophic. There is a point at which no matter how well prepared, you will become overwhelmed, because you can only prepare for a crisis that's feasible, not one that is outside your ability, overall, to prepare for it. Such is what happened in Japan.

Allow me to give you a scaled "for instance" in your own geographic area to put things in perspective. I am not being insensitive, and understand my example does not take into consideration loss of life.

Dulles International Airport gets about 16.5 inches of snow per year. During the winter of 2009-2010, it received 72 inches. The airport prepares for up to 30 inches to maintain normal operations. That's prudent and reasonable. But 72 inches, at this point of "global warming," is a "once-in-a-century" crisis. The Virginia governing body for airports simply can't devote the funds necessary to prepare for an event that will probably occur once or twice every 100 years.

Your example of what has happened in Tokyo, with the company you mentioned, will make many of your readers rethink some of their crisis management plans. That's a good thing. But what happened in Tokyo was not at high level catastrophe. Further, for centuries, we've seen almost countless examples by hostile nations, competing companies, and fiercely prejudice individuals helping their defined foes in time of crisis. All that is called "human nature." And it accounts for some of the best moments in our collective history.

Truly catastrophic acts of nature, in particular, are rather difficult to equate to things that humans can actually control. In essence, we plan to do what we can, do it in crisis, and if the crisis exceeds our ability to properly respond, we rethink and revise our plan based upon reality . . . and ask for help. During that after action reevaluation, we must also strive to learn if there was any deception involved in our plan, and if so, take the most severe action possible against the perpetrator(s). Something, unfortunately, we seldom do.

Finally, in my experience, I truly dislike linking crisis management with disaster relief. Crisis management, even in the nuclear disaster Japan is currently experiencing, is far more complex and in need of our best minds, as compared to the mechanical and logistical needs for disaster response. These two terms are absolutely not interchangeable, and can be confusing for those tangential to the planning and execution of these vitally necessary functions.

Thanks for jarring me back to reality with your blog. I sincerely appreciate you insight.

Doc Benjamin

Thanks for your comment, Jennifer. Thanks, more importantly for your decades of contribution to the field of executive leadership in disaster preparedness, especially as continually informed by events like the recent Tohoku earthquake.

I have many strong and positive memories from your course.

The two biggest:

The KC Hyatt Walkways collapse. For those who aren't familiar, a construction-time design change put an unsustainable pressure on a set of support pins. As with most disasters, there were many take-home lessons. In this case, respect design discipline when re-work becomes necessary. Another was the need for onsite extremity amputations to preserve life. Rarely do you see this in civilian life.

The other major memory for me was re-living my role in a corporate response to a disaster in the form of their formal escalation processes. This allowed me, at 23 years old, to get the support and focus in an otherwise tough bureaucracy. As retold in the "Learning From Failure" issue referenced above, the 23 year old (or equivalent) engineer at NASA did not have that kind of effective support in dealing with the Columbia, pre-disaster executive influence burden.

My hope is that every executive gets the kind of formal training in disaster avoidance and response that your course provided me. Thanks again for your fantastic and ongoing work.

Doc Benjamin,

Two news stories from today make your point:  crisis and disaster management often do require our best and brightest.

1) Reuters:  "[CEO] Immelt said GE would cooperate with TEPCO on restarting and strengthening its thermal power generation in anticipation of the rise in power demand for the summer," a TEPCO official told a webcast news briefing.

2) NPR:   Southwest Airlines Boeing 737-300 that made an emergency landing at an Arizona military base after a hole was torn from the passenger cabin.

"Obviously we're dealing with a skin issue, and we believe that these 80 airplanes are covered by a set of (federal safety rules) that make them candidates to do this additional inspection that Boeing is devising for us," Rutherford said.

The role of vendors figures prominently in disaster management as it can with troubleshooting in general.  The vendor relationship actually resembles marital one.  There are design issues that may or may not change over time, present before the engagement and wedding that persist thereafter. And, once married, it takes two to tango.  Back in the business world, as suggested by Immelt's comment above using the word "cooperate," the legal, financial and other considerations do not disappear with the passing of time.

Before the earthquake in Japan, the Harvard Business Review was readying an entire issue, April 2011, on "Learning from Failure."  It appears this issue is now a must read.  Further, I've written my new blog, to post next week, on how our learning from failure might relate to HCIT, MU and the beta software we are all now contemplating or working with.   

It's worth understanding, learning from, and recovering from failure, as a discipline.


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