Lessons learned or lessons lost?

By Peter Power.

This article deliberately pushes the boundaries of business continuity. In fact, it goes way over the edge of orthodox business continuity thinking and the restrictions often associated with compliance, to ask fundamental questions about learning from past events and joining up all the features under the still emerging concept of wide scale resilience.

We live, work, and travel in an increasingly fragile, interconnected and interdependent society (or perhaps more accurately, clusters of societies if we look more closely at a multicultural UK) where national infrastructure and just about all essential services we rely on are more entangled than we sometimes realise. When something goes wrong the consequences are therefore more sudden and widespread, made worse perhaps by secrecy, scapegoats and silos: we cannot be told, we need someone to blame and in any case, we work separately.

I frequently wonder why so many UK post major disruption reviews keep on identifying the same problems? Lessons identified consistently fail to become lessons learned. For example, some of the UK Environment Agency report entitled ‘Lessons Learned’ into the severe flooding in 2001 was repeated almost word for word, in the initial report (Sir Michael Pitt) following the serious flood in 2007. Quite simply, not enough lessons had been learned.

However, if we look much further back in history to what is still the world’s largest man-made accidental explosion, lessons can actually be transferred from one crisis to another, albeit at a local rather than national level.

On 6 December 1917, much of the city of Halifax Canada was flattened by a massive detonation when the ship Mont Blanc exploded, having accidentally collided with the Norwegian ship Imo a short time earlier and caught fire. Many residents of Halifax were watching the flames unaware that the Mont Blanc was fully loaded with tons of wartime explosives.

About 2,000 people were killed by debris, fires, or collapsed buildings. The explosion caused a tsunami in the harbour and a pressure wave of air that snapped trees, bent iron rails, demolished buildings, grounded vessels, and carried fragments of the Mont-Blanc for many miles. But what happened next is no less interesting as it relates very much to this article.

The handling of so many bodies afterwards was both quick and efficient, oddly enough as a direct consequence of the Titanic sinking on 14 April 1912. White Star Line who owned the Titanic, chartered the cable ship Mackay-Bennett from Halifax to retrieve the 1500+bodies from the sea and bring them back to the same port.

In 1917 the mortuary for the Titanic victims was used once again, this time for the Mont Blanc tragedy. The person who managed the mortuary in 1917 was also the son of the man who did that the same job five years earlier and no doubt others in the Halifax community, presuming they survived the Mont Blanc explosion, also re-lived the actions they took years before.

These days could we rely on similar social conditions to re live or, at least, pass on similar knowledge? It seems unlikely in an age of far greater social mobility, notwithstanding modern technology (the lessons from Halifax were not documented until 1998 and it seems even today there is not adequate acceptance of what took place all those years ago).

Back to 2010 and a recent and extremely readable discussion document by the Royal United Services Institute (Jennifer Cole) under the banner of ‘Combined effect: A new approach to resilience’ which makes a series of assumptions that I believe are very well focused and I suggest, cannot be refuted. The report mentions “barriers affecting communications interoperability, especially in the arena of public sector crisis response, are not only deep and pervasive, but also that they are not specific to communications networks and systems. Instead, they impact far more widely on resilience in general”. Also, the most striking aspect of the research was how widely recognised the issues are, how often they are raised in internal and independent reviews, and how frustrated the practitioners are that so little ever seems to be done to address them.

The RUSI document refers to a “resilience community that is fragmented with numerous agencies sitting under completely different Government departments, each with its own Minister and separate agenda”. Moreover, it points to frameworks intended to encourage closer working being “under-resourced, undervalued and with little if any legal powers”.

But I do want to add just a note of caution here in case we assume UK crisis response structures are completely inadequate. Comparatively speaking they rank amongst the best seen in any country, especially at the sharp end and in relation to certain threats, such as terrorism. It’s more to do with a wider sense of policy making, accountability and culture above the point of delivery or silo expertise that seems to prevent logical moves to coalesce emergency resources, as for example, in the public sector, where single control rooms to coordinate all front line responders (e.g. fire, police and ambulance) appear to make sense to just about everyone, but seldom if ever exist.

Just like the above example of previous UK flooding reports where problems were identified, but not adequately dealt with, RUSI also produced an earlier report in 2006, entitled ‘Communications Inter-Operability in a Crisis’ (Dr Sandra Bell & Rebecca Cox) that stated "Within the current UK emergency and disaster context, there is no single body with ownership of the joint response. This has resulted in … incoherent strategy … in a timeline extending well beyond 18 years". A point I will return to later.

In 2008/9 I was a small cog within the Institute for Public Policy Research (IPPR) Commission (the resilience subgroup) on National Security that published an aptly named and wide ranging report entitled ‘Shared Responsibilities’. This also talked frankly about the need for “fundamental changes to Government structures, the strengthening of strategic decision making at the centre and the breaking down of departmental stovepipes….if we remain trapped in the old ways of thinking and the old ways of doing things, the security of our country will suffer”.

So where does this leave us?

My purpose in writing this short article is not to identify let alone capture, the many elusive answers about truly learning from past events and then joining up all the features under the still emerging concept of wide-scale resilience. I merely want to encourage debate to add to what others are already doing (e.g. RUSI). Just one problem I have seen when trying to do this in my own career in both the public and private sectors focuses on a contradiction: on the one hand it’s blatantly obvious that lessons do need to be learned when many would, as the poet Christina Rossetti once said, “rather forget and be happy, than remember and be sad” and this of course requires accessibility and sharing of information. Not least between the public and private sectors, which all too often is just the former occasionally telling the latter, even though ideal emergency personnel in a catastrophe may not always be the traditional police, fire, and ambulance.

Recent events have shown the first need might be for persons to restore communication lines, drive heavy equipment, clear blocked roads, or reconnect power supplies. When considering disaster responses the Government must distinguish between the public at home and the public at work.

On which point, it is the private sector who on many recent occasions have been brought into Government to tell the former what they should be doing. For example, successful business people such as Lord Digby Jones (then head of the CBI), Philip Green (head of Arcadia Group) and Sir Alan Sugar (UK entrepreneur and TV personality). Their contribution to central Government thinking presumably did not migrate to those responsible for pan-UK crisis response. Not least, because the UK has no dedicated Minister with this responsibility, let alone a single department to do it. Oddly enough the need for such a department was recognised at the end of the 1980s, which history has rightly labelled ‘the decade of disasters’. However, persuading anyone senior and capable enough to sit at the Cabinet table as ‘Minister for Disasters’ was another matter.

This leads to the other part of the contradiction: legal proceedings and/or the involvement of covert operations that often follow a major disruption require secrecy, or at least confidentiality, which all too often becomes the reason given for withholding information, let alone suggesting innovative solutions. It will of course, never be easy to strike the balance, but on past performance we have to do better.

Joe Scanlon, an international academic on disaster management and Director of the Emergency Preparedness Unit at Carleton University Canada puts it rather neatly: “The biggest concern is that there is little evidence that we are learning from experience. When events do occur, the response is to restore rather than innovate. After the 1998 ice storm, power lines were again placed overhead, ready for the next such storm. There were no plans to take advantage of the storm by restoring lines underground”. Anyone reading the report by Sir Michael Pitt mentioned earlier might draw a few similar conclusions...

Meanwhile other countries are being innovative. As an example, a few weeks ago I had the pleasure of spending several days at the Australian Emergency Management Institute on a course dedicated solely to building organizational resilience. Speakers came from around the world to help stretch minds rather than just promote government doctrine. Creative ideas from the global private sector comfortably rubbed shoulders with international risk assessments to create an atmosphere where at long last, silos were being replaced with synergy.

But all countries still share a common problem: No one thinks that the next report into some major disruption in the UK or anywhere else, will recommend anything other than, once again, a need to improve resilience; yet all too often we seem hard-wired to wait for tragedies to occur first before really tackling the root problems we already know exist. An attitude that surely has to change.

Author

Peter Power is the managing director of Visor Consultants (UK) Ltd and is one of the most requested UK public speakers on all aspects of crisis management. His research on crisis decision making is quoted in the UK Government (Cabinet Office) Guide on Integrated Emergency Management. He sits on the Cabinet Office/BSI working party on new UK crisis management guidance and was a member of the 2008/9 Resilience subgroup within the UK/IPPR Security Review Commission.

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Reader comments

I think it is important to look through a few different lenses at this problem though is hard to disagree too much with the sentiments of Peter’s thesis. For example, the response to the economic situation in the UK is forcing a change of attitude amongst public sector staff. The result might be more people moving to the private or at least ‘third’ sector to rub shoulders with people who see the world slightly differently. This migration of employment may just be the answer albeit medium to long term. The same thing happened a few years ago when many switched from private to the public sector because it seemed a ‘safe option’! What we do not know is the profile of such people but my point is – no need for a conference. ‘Synergy’ could already be happening under our noses.

Climate change remains very prominent across the public and private spectrum and here I witness something to contradict Peter’s argument. I believe the UK has a minister for Climate Change? For local authorities, certainly the one I last worked in, a strategic team was co-ordinating the effort across the whole organisation. This generated a risk based approach (which was my input area) to future operations and strategy; ranging from preventing heath fires, upgrading future drainage projects to ensuring care homes are habitable in extreme weather.

But it is not all good news. Sir Peter Gershon (a UK Govt Efficiency guru) told a recent project managers conference, ‘Projects in the public sector do not fail for novel reasons, they fail the same boringly repetitive reasons’. He notes that public tolerance for such failure will now likely reduce.

Finally, I would invite you look through the ‘risk lens’, for I think the issue at hand should really be addressed by examining attitude to just that. Unfortunately, for many, looking at the risk of things going wrong can be inconvenient. This is because our leaders have to take time to stop and think critically about uncertainty when many around them are looking for more positive vibes. It also makes people feel vulnerable, challenges authority and, not least, feeds a whole industry of experts who attack the balance sheet in difficult times. Well, how else is that conference going to be paid for?

Alan Pawsey MA, Risk and Resilience Consultant.

Peter's point is that *the* major obstacle to 'learning lessons' is lack of communication between resilience professionals in the public and private sectors. If you agree, as I do, then you will ask yourself, 'what's the single most important first step to overcoming that obstacle?' I've decided that it’s making opportunities for the two sides to rub up against each other. There is a global shortage of such opportunities. I have some ideas.

Let the organizers of the major Western conferences -  the World Conference on Disaster Management,  DRJ World conferences, the BCI's BCM World Conference, the Continuity Insights conference, the IAEM conference & EMEX, the Contingency Planning & Management conference (and ones I've missed by living in Asia)- know that you want to hear from the other side, that you want a chance to learn from the other side.  Resilience conference programs are, inevitably, tending toward similarity, so their organizers are looking for ways to differentiate their events from the others. This seems a plausible, useful way to do so.

Perhaps you know the aphorism that good judgment comes from experience, and that experience comes from bad judgment. Not making a concerted effort to bridge the public-private sector communication gap would be terribly bad judgment that would inevitably led to more of the disaster experiences Peter described. The first step to good judgment is clear, obvious and simple: it’s conversation. We just need a place to hold it.
Mr. Nathaniel L. Forbes, MBCI, CBCP.

In response to Peter Power’s article on “Lessons learned or lessons lost?”, all I can say is “The only thing that man learns from history is that man learns nothing from history”.

•Date: 12th Nov 2010 • Region: UK •Type: Article •Topic: BC general
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UPDATED 7TH DECEMBER 2010
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