I have railed against what I call the stakeholder model for some time now. I really didn't understand it months ago when this pandemic started, but I have come to despise it. The stakeholder approach to decisioning making is based on speaking to multiple stakeholders in order to try to develop some type of quasi consensus. I use the term quasi consensus to differentiate the stakeholder model from other consensus models that utilize experts and essentially keep out politics and other motivations.
During a crisis, and a pandemic qualifies as a crisis, the decisions one makes need to be based as much as possible on facts. The priorities must be on the greater good, in this case, saving lives. For example, if a fire was about to engulf a town, would you spend weeks speaking to various stakeholders in order to determine the impact of the fire that is about to burn the town down. Would you speak to the bank owners in order to ascertain what the impact of the fire would be on the bank? Is there enough federal deposit insurance to not have to worry about whether the bank actually burns down? How fireproof are the safe deposit boxes? Is anyone actually working at the bank right now and might they be in danger if you don't act before the flames engulf the bank? What's more important, the money and physical assets in the bank or the people who work there?
How about the restaurant owners? Do they have insurance that will cover their losses? What about the owners of the restaurant real estate? What type of insurance do they have. The people who eat at the restaurant? Are there people there now? Are they in danger? Are there restaurant staff preparing the ingredients for later in the day service? Are they in danger? What will be the impact of the fire on the jobs of these people, if they manage to survive the fire? Will they be able to find new jobs? Will they be eligible for unemployment insurance? Are they only part-time workers, who work in a few restaurants, so they won't be eligible for any benefits or support?
What about the nursing home, where low wage workers perform menial tasks while delivering compassionate care for vulnerable older adults? What about the older adults themselves? What type of help will they need to be saved before the nursing home is engulfed in flames? Are there buses available? Do they have the necessary handicapped setup to allow for wheelchairs and gurneys? Are there enough people to move all of the residents out in a timely fashion? What about the real estate? Do the owners have enough insurance to cover their losses? What will happen to the staff if the nursing home burns down? Will they be able to find another job? Will they qualify for unemployment insurance?
Who should be making the decision to evacuate the town? Who should be deciding whether to close the bank and send everyone home? The restaurant? Who should be making the decision as to whether to evacuate the nursing home? Has someone ordered buses? Has someone found "homes" for the residents? Are hospital beds available for those who need specialized care? Who is making these decisions? Is the local government convening an advisory committee composed of bank, restaurant and nursing home real estate owners? Are they asking for recommendations from the unions who represent bank, restaurant and nursing home workers? Are they including the community in the discussions to determine the impact of the bank, restaurant and nursing home being shut down or burned down?
Who is talking to the vulnerable older adults who live in the nursing home? Who is asking their families for to share their thoughts and concerns? Are the clinicians who care for the residents being asked to help the decision makers understand the impact of transfer trauma? On how to effectively move people who have dementia? Are the subject matter experts in the care of vulnerable older adults even being considered as the flames approach the nursing home? For that matter, are the residents and families at the table? Or, are they about to become the meal?
Decision making during a crisis is poorly informed by a stakeholder model. Crisis management requires an incident commander to make decisions at the level of the bank, the restaurant and the nursing home. Crisis management dictates that the local fire department and health department look out for the safety and lives of the people who work in the bank and restaurant, and particular for the workers and the vulnerable residents they so compassionately serve.
As we've observed the response to COVID-19 over the past 9 months at the federal, state and local levels, what type of crisis management have we seen? What has been the decision making process? When we look back, will we discover that a focus on stakeholders has kept us from making the right decisions?
No comments:
Post a Comment