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  • Justin Cuckow

Pandemic was on the risk register – what else are we ignoring? The art of near miss management

Updated: Jun 25





Let’s face it, many organisations have had pandemic in the top right hand quadrant of their risk register for years, including as the image above shows, the UK Government. Indeed the National Risk Register 2017 clearly says “The emergence of new infectious diseases is unpredictable but evidence indicates it may become more frequent.”

To those who say, “But we had no early warning of this, how could we have been expected to prepare?” Really? In the last few years in addition to Ebola and Zika, we’ve had two other Novel Coronaviruses, SARS and MERS. But whilst these largely left the UK untouched, that wasn’t the case in Hong Kong. Anyone who has navigated the pavements in Tsim Sha Tsui or travelled by MTR (metro) will know how densely populated it is. So if we are looking admiringly at Hong Kong just now with 4 deaths (the UK announced 413 today alone) what can we learn?

What are they doing that clearly many countries haven’t? Put simply, they have invested in effective public health surveillance and incident management capabilities and mastered the art of identifying and learning from incidents and near misses. When SARS caused an “economic tsunami” in Hong Kong, the public health capabilities brought into place stayed in place.


I’ve travelled in and out of Hong Kong on many occasions over the years (teaching business continuity) and like fellow travellers am used to having my temperature scanned and receiving public health leaflets about signs and symptoms of circulating infectious diseases when I arrive at the airport. Signs on the MTR (metro) escalators, carrying thousands of people an hour, tell us that the handrails are cleaned regularly and quickly become common place. The active use of positive case tracer apps may understandably be causing controversy in the UK just now. However the foundation of infectious disease management is to contact trace and isolate, and we have much to learn from Hong Kong’s approach where each case is published on a publically available map to the nearest building and floor.

So what is the art of near miss management and how do we bring it back? The trick is to invest in making sure that every small incident is reviewed for learning and we build in robust change management processes to maintain resilience. Sure we tend to focus on Major Incident response. Let’s face it, big bang incidents can be more interesting. But most staff in Acute hospital trusts will respond to perhaps a few Major Incidents in a career and yet be involved in the response to hundreds of internal incidents and low level disruptions.

If we actively review these frequent internal incidents and make incremental improvements we build capacity and resilience. So, for example when running monthly load tests of the generators we confirm that no critical equipment is plugged in to non essential power sockets. We check that clinicians in A&E, where there is rarely any day light, have back up lighting and charged torches at the ready for patient examinations. Then we’re ready for the digger that accidentally takes out the power supply. And when the IT is unavailable (a case of when not if), we don’t end up with patient records unavailable or operations cancelled because the latest IT patch wasn’t applied (remember wannacry). More importantly still, all that learning from the frequent internal incidents means that staff know what is expected of them and are able to react with confidence using trusted business continuity plans.

So what else are we ignoring on the risk register? Do we understand well enough the cascade impact between risks. Back to that national risk register entry on the escalating risk from infectious diseases. “This may be linked to a number of factors such as: climate change; the increase in world travel; greater movement and displacement of people resulting from war; the global transport of food and intensive food production methods; humans encroaching on the habitat of wild animals”

If we are over using the word “unprecedented” it is because risk management as we knew it has failed. When COVID-19 is over, we need to stay crisis and incident ready. That starts by paying attention to the near misses. It requires learning from incidents and investing in building a culture of continuous resilience improvement. It requires robust stress testing and exercising of business continuity and incident response plans. When we are out of this we want to be confident that when they are next needed (and they will be), that the incident and business continuity capabilities that we all need to maintain our job security haven’t been ignored.

If you’d like to learn more about embedding business continuity please download the free guide from the resources page on my website, and give me a call to discuss how I can help.


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