High-Reliability Organizing (HRO), Decision Making, the OODA Loop, and COVID-19

To prepare for and operate in stochastic environments, we study and even master academic models. The environmental stochastic Noise separates the world of practice from scientific theory. Oscillating and fluctuating processes create frequencies of power, the color of Noise, and unpredictability. These environments also contain the determinants of stress, putting individuals at risk of the peculiar Logic of Stress and the ecology of fear. We effectively engage these environments by logic, a logic of practice shared by those who crossed the threshold with us -not classical logic, however. Modal logics conform to changing events and support flexible thinking. Paraconsistent logics support inferences from contradictions. In topology, the central concept is continuity and how the elements preserve a notion of nearness by a continuous function. They maintain connectedness during deformation without tearing apart to create a new boundary.

Section: "Without the Dominance Of Any Frequency Events Are Random An...mentioning

confidence: 99%

Operational Logics and Inference During [1/f or f -1] Noise Events: High-Reliability Operations (HRO)

2022

“…uted to the decision are absent from public exposure. These contributors are unaware of the effects of thinking while acting, the topological nature of decision-making in context, and the influence of contextual thought and actions (6,12,13). When removed from the intimate context where these decisions are made, deciding whether to evacuate or shelter becomes an abstraction; we can discuss and evaluate such decision abstractions from a distance, using what ''we'' personally would have done as our standard for judgment.…”

Section: Neonatology Today Via Our Twitter Feed @Neotoday "Nicu Prepa...mentioning

confidence: 99%

Disaster Series: Prolonged Improvisation during Hurricanes – High Reliability Organizing in the NICU

Stralen¹,

McKay²,

Mercer³

2022

NICU preparation for a hurricane includes evacuating or sheltering neonates, agreements to transfer neonates, communication, and emergency transport systems to move neonates to safer ground. Under-represented are identifying the skills and capabilities to support a neonate for hours, if not days, in an austere and adverse environment. The successful operations that sheltered and evacuated 235 neonates with only two deaths and no adverse events recorded are under-recognized. Such accomplishments came about from the actions and improvisations of local Neonatologists and NICU staff who extended an ordinary workday into the consequences of major hurricanes.

Disaster Series: The Abrupt NICU Evacuation – Disasters without a Plan

Stralen¹,

McKay²,

Mercer³

2021

An abrupt disaster brings the environment physically into the NICU. We describe immediate evacuation measures taken because of a ruptured water pipe, hospital fire, unexploded WWII bomb, and two earthquakes. These abrupt changes thrust the Neonatologist into an environment with new structures, rules, and threats. The intruding environment dictates actions at first as the Neonatologist addresses safety for the neonates and staff while continuing medical care for the infants. The environment has just become the pathology, a new comorbidity. Operations during abrupt change mean the Neonatologist must hand off direct minute-to-minute care for the neonates, trust staff, then begin the more demanding work of figuring out next and future steps. Personal stress and fear responses must be modulated while supporting staff during the uncertainty. While these events at first appear disparate, they share the common problem of rapid movement of neonates to safety, ensuring the safety of infants and staff while solving problems embedded in a threatening environment. Faced with an abrupt environmental threat, we must maintain awareness that disaster and medical professionals will not appreciate the unique responses of the neonate to the raw environment. We must accept and rely on our colleagues' strength, fortitude, and creativity in the NICU to resolve problems embedded in the environment.