Since the spring of 2020, variables such mistrust of government leaders, anti-maskers, and economic concerns complicated COVID-19 community response. The Cynefin framework is a sensemaking theory in the social sciences to create a framework for emergency managers in large-scale events. It is useful because it can help identify the complexity of an infectious disease problem to inform resource allocation across many domains in the hopes of identifying gaps that can be addressed. This article looks at the pandemic as an event outside the realm of regular expectations due to the scope, duration, scale, and social climate.
In mid-March 2020, the World Health Organization declared COVID-19 a global pandemic. Some have argued that leaders should have seen a pandemic coming given all the influenza and other public health plans and exercises that were conducted over the past 10 years, but others say it was a “black swan” event given that no sector had been untouched. The duration of the pandemic has eroded trust in government leaders and has been a stress test for society. Regardless the level of precautions taken to restore health from COVID-19, communities need to be better prepared to deal with future pandemics. The Cynefin framework is a sensemaking theory that can help identify patterns within the complexity of an event to inform resource allocation across many domains, diagnose situations and shortcomings, and develop communication strategies to reach the masses.
Complexity is more of a way of thinking about the world than a new way of working with mathematical models. Regardless how convoluted a situation is, especially when trying to decipher case counts, hospitalizations, or deaths, and gauge government support for infectious disease public health measures to maintain standards of public safety, decision-makers need to stay connected to what is happening in order to spot change in context (or patterns). Since COVID-19 has led to over 910,000 deaths in the U.S., decision makers need to make policy decisions about ways businesses can safely reopen based on biomedical advances and the availability of personal protective equipment (PPE), masks, vaccines, antiviral pills, and other supplies. In 2021, the U.S. was in the midst of several overlapping crises (e.g., health, economic, social, political, educational, commercial) and the cost for not having prepared for this large-scale incident appears to be higher than the cost of anticipating and preventing the spread of the virus. In addition, emergency management capabilities were overextended because 2021 was deemed by the National Oceanic and Atmospheric Administration as another historical billion dollar disaster year in terms of the number of extreme weather events due to floods, severe storms, cyclones, and a large wildfire, drought, and winter storm/cold wave.
A Framework for Knowledge Management
The Cynefin framework allows decision-makers to diagnose situations and act in contextually appropriate ways, since complexity plays off multiple unknowns and variabilities to allow solutions to emerge. This framework sorts the issues facing decision-makers into four quadrants (simple, complicated, complex, and chaotic) defined by the nature of the relationship between cause and effect. It can help emergency managers sense if the incident is simple, self-evident, and easily addressed with a standard operating procedure or if it is an irrational or unpredictable problem that would fit into a complex domain. Three tenets that can be put into practice to shift decision-making include:
- Sense of temporality of a situation, which refers to an instinctual sense that in the moment something complex is simple
- Perspective of complexity, which depends on one’s perspective of a catastrophe and experience in taking the perspective from medical providers on how to handle
- Historical patterns of behavior during past pandemics and public opinion on how to stop the spread
The COVID-19 pandemic has led to a call for action to invest in public health preparedness and prevention actions to secure the country’s future economic security, loss of loved ones, and human suffering experienced by individuals and families directly affected. COVID-19 caused high mortality and morbidity in the U.S. and around the world and, in some cases, led to public panic. Despite all sensitizations done by the government about preventive measures (e.g., handwashing, wearing masks, social distancing), people often have not been following them in their daily life. The spillover effect from people’s experience of COVID-19 has led to a pervasive sense of fear and stress and may have resulted in relational problems due to physical distancing from loved ones, friends, and communities.
A 16 September 2021 report by the National Emergency Management Executive Academy Cohort VIII (Team 3), “Post-Mortem Analysis of Community Response to the COVID-19 Pandemic with Recommendations for National Preparedness,” conducted an evaluation of real-world experiences during the COVID-19 response. Views captured from all levels of government were summarized into five lessons learned:
- Communications (e.g., lack of communications and coordination between agencies and partners with mixed messages)
- Training (e.g., Lack of familiarity with ICS/NIMS which inhibited unity of effort between public health and emergency management and a need for cross-training at all levels)
- Financial/Logistics and Supply Chain (e.g., No prioritization of PPE, testing equipment, ramp up production)
- Integration/Coordination (e.g., No integration across public/private partnerships and a need for information sharing to ensure a unified national response)
- Federal vs. Federalist (e.g., lack of consistent guidelines and cultural/political obstacles to resolve challenges)
Applying the Framework to Masking
The Cynefin framework is useful for knowledge management and is still applicable two years after the start of the pandemic, since the virus has mutated into a highly contagious variant strain, infecting people who had been previously vaccinated, causing death, and resulting in a workforce healthcare crisis. The Harvard Business Review article by David J. Snowden and Mary E. Boone suggests the framework has application when leaders are required to diagnose situations to make decisions.
The authors applied this framework to mask use during the COVID-19 response and showed disorder applied to across each quadrant. The authors present a conceptual picture using the framework in the four quadrants (simple, complicated, complex, and chaotic), but they are not separate stages with clear boundaries:
- Simple – lack of communications and coordination between agencies and partners at all levels to support standard operating procedures
- Complicated – changing supply chain logistics and prioritization of PPEs from single cloth masks to KN95, N95, surgical, or double masks
- Complex – unsatisfactory communication on how infectious diseases spread and coordination between emergency management and public health
- Chaotic – lack of coherent, consistent guidelines from the federal government
In this article promoting the wearing of masks could be considered a simple standard operating procedure. Research studies have demonstrated the cause-and-effect relationship supporting the protective action of masks against COVID-19, provided masks are worn properly to reduce face-seal leakage.
It becomes complicated when public health professionals make claims on which masks are better. The public relies on experts to conduct analysis to make sense of the various types of masks, and how to prioritize limited resources when shortages of masks exist in hospitals and medical facilities.
The U.S. is currently unprepared to manage future pandemics given the scale of disruption caused by COVID-19. Using this framework could help change that.
Face masks becomes a complex problem when public reaction from groups of people believe their freedom and civil liberties are infringed or when political leaders refuse to follow scientific guidelines. What makes it complex are group norms and beliefs that make human behavior less predictable. Mask use remains a controversial topic for a significant portion of the U.S. Various policies have inspired defiant and even violent behavior over the right to wear or not wear one. Complex problems require decision-makers to look for patterns. Even during the 1918 pandemic, a proportion of the population wore masks, and some did not.
It becomes chaotic when the rules of businesses or store owners are violated by people refusing to wear masks. The cause and effect of noncompliance leads to altercation or violence at a store that requires masks to enter. Action is needed to ensure that standards, policies, and procedures are clearly defined and enforced. Better government efforts to address misinformation through public service announcements (with accurate information about COVID-19 and ways to stop the spread of the disease) could have been taken to empower citizens, reduce fear and resistance to masking, and more rapidly restore health and normalcy to the economy.
Building a Collaboration Force
To accelerate decision-making, emergency preparedness professionals can apply a new crisis leadership concept at the start of a crisis by including a rapid reflection force (RRF) comprising leaders from different backgrounds to help chief executives grasp and confront issues raised by unconventional situations. Real-life incidents and exercises have shown that RRF can help prevent the fall into crisis by bringing in a new perspective in an operative context. In Switzerland, the federal government brings in an RRF to assist with the development of a sense-making plan for complex crises.
Open sharing with diverse groups can account for the cascading effects and help expand solutions that may be blinded to counterintuitive responses based on experience, training, and success. Introducing multiple perspectives also could help shine a light on behavioral or economic outcomes previously not considered to help prevent conditioned responses. To confront emerging infectious diseases in a way to flag alternative solutions based on early warning triggers could prevent issues from being oversimplified or incorrectly classified (in the context of a chaotic and simple, or complicated and simple problem).
The pandemic has revealed that the U.S. is unprepared to deal with future pandemics given the scale of disruption that COVID-19 has caused. To assist with proper situational understanding, the Cynefin framework could be used by all levels of personnel (strategic and tactical) during focused assessments. Tabletops, exercises, and cross-collaborative trainings among public health, emergency managers, and other key stakeholders could help prepare for future infectious disease threats and address gaps in preparedness plans that challenge public health emergency management. There is a need for collaboration and further coordination to confront emerging diseases and adopt a proactive versus reactive stance to assimilate complex concepts with real-world problems. The Cynefin framework should be used to enhance communications and decision-making when trying to make sense of a rapidly unfolding situation and to understand the response options to develop open-minded mitigation strategies.