Team Defense is based on a system of help
In the March 30, 2020 webinar on Resilience Engineering and Covid-19 pandemic, a colleague asked how should society make the trade-off between the consequences of massive economic disruption versus the aggressive actions needed to turnaround virus transmission, reduce hospital overload, and minimize fatalities.
As is always the case in systems safety, efforts to prevent harm and deaths runs into pressures to reduce economic costs and increase productivity. The history of systems safety reveals a longstanding struggle to manage the trade-off. For the most part, we see an oscillation where a dramatic public accident shifts the balance toward investments to reduce risks. But the investment is usually narrow as discounting processes take hold — the lessons don’t apply to me because my activity is different or we are more careful than those people or that group. Even in the areas that make new investments in safety, the investment isn’t sustainable as pressure for optimality on economic criteria dominates again.
Resilience Engineering began with identifying fundamental trade-offs and basic patterns in how human systems across scales navigate the multi-dimensional trade space. Some patterns increase risks of breakdowns in adaptive behavior and others reveal key sources of resilient performance. Simply moving an operating point back and forth on one trade-off curve is ineffective.
The current situation in the rolling Covid-19 outbreaks across the globe reflects the science about managing and mis-managing the multiple trade-off dimensions. In particular, the current situation highlights the importance of anticipation — building the readiness to respond before a crunch happens despite the impact on usual practices that balance efficiency pressures. Otherwise, the risk of decompensation gets too high.
We see the consequences of waiting too long to act in several areas around the world. When jurisdictions miss the window of opportunity for aggressive action, the consequences get much more severe in economic disruption, more overstressed hospital systems, and fatalities which reflect higher excessive death counts.
Then various perspectives argue about a single trade-off dimension asking whether the consequences of economic disruption are worse than higher excessive death counts. Like the battle between safety vs economy in the history of system safety, the opposition between these two poles is both false and ineffective.
However the science about complexity and adaptation behind the above result is far from simple. We are in the middle of a crisis and how authorities and the public perceive the trade-off can and have delayed actions to turnaround transmission rate, led to overloaded hospitals, and rising deaths in those areas slammed by the patient surge.
How to explain and connect the science on complexity and adaptation to facilitate actions that reduce deaths and mitigate economic disruption? Sleeping on it, the metaphor that came to mind is team defense in basketball (maybe since we would normally be glued to the screen watching college basketball these last couple of weeks).
I asked one of our graduate students, Carmen Grande Pardo, who also happens to have been the starting point guard on the OSU basketball team and on international teams to explain how team defense is built up as a metaphor to understand how this virus is affecting our society, our economy, and our medical response. She writes:
“We all love sports. Basketball is one of the most popular sports in the world at the moment but the seasons are cut short due to the Covid-19 virus. However, we can use the sport of basketball as a metaphor to understand how this virus is affecting our society, our economy and our medical response.
Like any healthcare system, basketball has front end workers (the players and coaches), and blunt end workers (those in administration, basically anyone who has influence on how the team, season, competitions are run). Right now we are in an extended competition between Team USA (everyone in the country plays a role) and Team Covid (which has evolved a strategy that is working for the moment to infect large numbers of people given its transmission characteristics, lethality, time delays, etc.).
In Team USA’s basketball game against Team Covid, The players on the court for Team USA represent our nurses, doctors, respiratory therapists, and anyone who is working face-to-face with a patient to save a life, delivering care. The coaches represent our hospital supervisors, epidemiologists, infectious disease specialists, administrative health care staff, or anyone who is directing workers and making sure that our front lines are prepared and ready to play strong defense against Team Covid. Our scouting on Team Covid tells us that they are a very offensive-oriented team, meaning that our defense is going to need to be on point to stop Team Covid. We are going to have to be able to adapt and run some defenses that we have not even worked on, depending on what offense Team Covid decides to run and how they surprise us. We have been learning a lot of the plays that Team Covid likes to run.
In the beginning, we started with man-to-man defense. The person guarding the ball has poor footwork and the opposing player on Team Covid keeps driving to the rim. The person whose role is ‘help’ for Team USA has to make a decision: leave her person and help defend, or stay where she is to prevent a pass to the player she is guarding.
Given Team Covid has two easy scoring options, which move — stay or help — is the correct answer for the defender at that point? The solution can only arise from the plans and skills for team defense.
The helper will step up to double team the Covid player driving because the team defense plan/practice means a team member will recognize what is developing and rotate to cover the other Covid player. The team defense skills provide a way to cover both Team Covid scoring options.
Unfortunately, Team Covid has been scoring easy points because Team USA’s defense plans have been slow and weak. The lack of sufficient testing resources has blocked deploying the classic test, track, isolate defense. Team USA has needed to develop some alternative defensive plans and bring in new playing skills to slow down Team Covid’s momentum.
In our metaphor, Team Covid got ahead leaving our medical system to scramble to increase our resources to mitigate the virus scoring excessive deaths. We are improvising multiple ways to help the hospital systems from overload by finding ways to supply and conserve PPE (Personal Protective Equipment), shift care for non-Covid-19 patients to tele-health, drive-thru testing, and many more. All of the players and coaches are stepping up to provide help to the player under pressure. Building a new plan and capability for team defense relies on common effort, trust, adaptation, coordination.
But Team USA is still in a scramble and the whole team has to rotate in order to stop the Virus. The players, our front line health-workers, are working to offset Team Covid’s aggressive offense. They will be on the court as taking care of others is their passion despite the personal stress and risks from being behind. Our metaphorical coaches, athletic directors, trainers, etc. can make all the resources available to help our players succeed. Governments, leaders, supervisors can make all the resources available and expand the capabilities to protect front-line workers and provide the resources to treat severely ill patients.”
Ultimately the answer to the dilemma of economic disruption and excessive death is build team defense. Team defense is based on a system of help. When the help is missing or comes too slowly, the virus scores easy points and gets a big lead — spreading more widely, triggering new outbreaks across the world, generating more seriously ill, producing more overload on hospital systems.
Building and executing team defense brings many roles and levels of society together to coordinate help so the front line team can play well against Team Covid and adapt swiftly as the details on the ground shift. Team defense goes beyond the players on the court to include the front office, the referees, the fans, the league — every one. This is the need to build solidarity across all of the roles and layers to reduce excessive death tolls and to compensate for the economic disruptions that accompany building the team defense.
But as in our own systems safety work, we see other classes of responses – notably, defection from team defense as individuals retreat to selfish short term behavior and exploitation of the breakdown of team defense to pursue unrelated contentious policy, political and economic goals. So what will we see — solidarity or exploitation across the roles in society? Regardless, there will be those on the front lines who will struggle on, despite the personal risk, to care for the seriously ill no matter the help or lack of help from everywhere else.