The Pandemic Healthcare Crisis and the Domino Risk Effects

The following discussion unpacks several systemic risk factors within public healthcare. 

Each of these risks individually presents a significant point of concern.

However, when viewed sequentially or as a series of cascading relationships, even greater risk, harm and peril become the principal cause for concern. 

For many western and democratic societies, most public healthcare has not been in the hands of public administrations or government for decades. 

Modern-day public health is a disparate, self-interest and self-determining network of private enterprise and actors. 

Routinely competing for greater market share, profits and conflicting self-determined priorities. 

Often governed or administered by individuals and departments lacking specific healthcare experience or concealed preferences. 

That is, where governments administer public healthcare, the dominant views are that of finance and general administration, not public health or risk management. 

Paradoxically, where public health is provided by private enterprise, it is a predominately 'for profit' undertaking, therefore motivated, shaped and prioritised on commercial, revenue dominated principles. 

As a result, significant aspects of public health are 'just-in-time' logistics models. 

Surging only after demand, business case approval or public outrage leading to reinvestment in the sector. 

Public healthcare has become a crisis and response model for years. 

Many researchers, insiders and healthcare professionals cautioned that the healthcare system was rapidly approaching catastrophic failure long before COVID-19.

Now, consider some of the following contextual risks and realities. 

Community healthcare is routinely forecasted and staffed on a per capita basis. 

That is, 100,000 people are entitled to x amount of hospitals, x amount of ambulances, x amount of doctors, x amount of clinics and a scattering of specialist healthcare facilities for the aged, pediatrics, maternity and disability. 

The process is a quota, not ailment or virus determined. 

Investment by government and commercial entities are largely metadata analysis models of people based on age, gender and ex-ante forecast of needs based on historical trends. 

They are not dynamic, nuanced or highly accurate. 

They are also not modelled with pandemics, significant surges or other major variables or disruptions in mind. 

For example, many people have fled their local government areas (LGA) for one reason or another. 

This includes healthcare professionals. 

In short, the 100,000 people model has been distorted because benefactors, providers and systems have changed significantly. 

As a result, there is inequitable supply and demand. 

This deficient has been come extremely concerning for the vulnerable. 

First Nation people, remote communities, the elderly, the critically ill, emergency medical intervention, those with a disability, those with mobility issues, mental health… and the list goes on. 

This systemic risk, not well understood, rarely discussed and largely 'invisible' throughout the pandemic, continues to create significant risk for all communities at different rates, temporal variance and scale. 

Now let's consider healthcare workers, professionals, expertise and resources. 

Firstly, experts are not minted overnight, nor are they clustered equally across communities. 

Moreover, they 'drift' from one facility, community, location and service outlet to another. 

In other words, they are highly transient and routinely service hospitals, clinics, general practices, public facilities, charities and specialist care facilities such as aged care and those with disability/ies. 

There is not enough to go around already. 

Restricting movements or containing vector-borne pathogens by means of restrictive movements… results in significantly reduced access to health care providers and services. 

There is a considerable risk that communities and facilities are not receiving adequate healthcare support, oversight and expert advice. 

Let alone resources such as oxygen, PPE, laundry services, medication, vaccines and the like, because the entire ecosystem is stressed, disrupted, overstretched or in various stages of collapse. 

Life and death decisions are being made behind the scenes by people, departments and organisations far removed from the face of the threat, loss, risk and harm. 

Repurposing other professions and skills to supplant these workers and healthcare needs is a temporary, stop-gap measure, concealing even more risks. 

That is, tourism, retail, service industry, and travel staff can't become healthcare professionals overnight. 

They add volume, not quality. 

They add volume but not expertise.

They add volume but require healthcare management and guidance. 

Expanding on this premise. 

"Doctor", "nurse", and "healthcare worker" are not universal terms. 

That is, they don't mean the same thing or result in the same experience and qualifications. 

General, specialists, exclusive and hyper-capability permeate the profession. 

In short, the total volume or population of doctors and nurses are not available to the entire healthcare system or community. 

Some work for private practice. 

Specialise in specific aspects of medicine or healthcare or aren't physically proximal to all citizens and communities. 

Many even service multiple locations, as noted earlier. 

They are still humans. 

They are impacted too. 

They have families, friends, need sleep, food and rest. 

That is, they are not 24/7 robots dispensing healthcare and medical support on every street corner. 

They are also not 'flowing' into countries and locations that need them more or pay them more. 

This includes volunteer charities and communities that for decades have improved local healthcare knowledge, support and access for decades. 

That has, for the most part, stopped. 

Cutting across all this is the lack of continuity in management, priorities or services from government and commercial providers. 

"New wheel, new deal.", as the expression goes. 

Progressive government leaders, political parties, commercial entities and CEO's have all had 'different' views on the matter of public healthcare and community service. 

Further fragmenting services and conflating priorities and subsequent capabilities. 

A perfect storm, as it were.  

In closing, consider the following. 

Schools, sporting events, workplaces, leisure activities and the like function on the ability to 'surge' medical support, 

That is, critical resources are diverted to support these undertakings rather than having full-time medical resources on-site or allocated to these activities. 

This works when there is capacity, people and resourcing. 

Subsequently, these events can't be adequately supported if there is no surge to support, as the system is unable to the respond. 

This 'risk homeostasis' (or Peltzman effect) no longer works. 

That is, communities, events, worksites and people can't take what has become a routine and extended risk because the 'back up' resources empowering this risk to be taken is no longer available. 

In other words, what was once a 'routine' risk is now a significant risk as there is an inconsistent and capable response. 

The same now applies to aged care, paediatrics, disability service, general healthcare and public medical support. 

Especially if already stretched to breaking point to administer vaccines, care for the critically ill, run testing facilities and other mounting mental and physical illnesses. 

No people, no service. 

The risk is now systemic across healthcare. 

The consequences are far more dispersed than realised. 

This new threat is cascading across other systems, communities and healthcare services at different rates and scales. 

It remains invisible for most. 

But it affects us all. 

Everyone's resilience is undermined. 

Fragility is now likely the normal state for most communities. 

Other emergency services such as police, military and fire are also affected. 

The result could be a tinder box of potentially new and amplified harms. 

Healthcare is just the early warning that many have overlooked or missed. 

Are you paying attention? 

Have you updated your assumptions?

Tony Ridley, MSc CSyP MSyl M.ISRM

Security, Risk & Management Sciences