In the early hours of January 1 this year, Geneva University Hospital (HUG) received an alarming call. A fire had engulfed a bar in Crans-Montana, mid-New Year celebrations. Forty people lost their lives, and over a hundred were injured, many severely. No single hospital or even nation was equipped to handle the influx. Patients were quickly transported to burn centers across Switzerland and neighboring countries in what became an ad-hoc international network of care providers.
This incident underscores a critical truth for health leaders: future crises will differ from past ones. These could include mass casualties, extreme weather, or cyberattacks. Sometimes, issues could arise simultaneously. Preparing for these unknowns is crucial, but the approach must shift from fixed plans to flexible actions.
Resilience in Governance
From nearly three decades with the International Committee of the Red Cross (ICRC) and leadership at one of Europe’s largest hospitals, I’ve learned that resilience isn’t about a rigid plan. Instead, it’s a dynamic governance style. While evaluating preparedness by checking plans, beds, and supplies is essential, they reveal little about real-time performance under stress.
What defines effective systems during crises is their ability to anticipate, decide, mobilize, adapt, and learn under pressure.
Anticipate
Anticipation involves considering potential scenarios and preparing for them, even when the likelihood seems low. During a recent G7 summit in Evian, contingency measures were enacted though violence was uncertain. The preparatory process tested decision frameworks, relationships, and identified unnoticed vulnerabilities.
Decide
During crises, data often arrives fragmented and changes rapidly. Waiting for certainty can be a costly decision. At the ICRC, remote delegates couldn’t rely on constant guidance from Geneva, necessitating independent, well-informed decisions based on clear intent and trust.
Mobilize
Infrastructure, technology, and plans are crucial, yet people and trust drive real action. Trust is developed over time and cannot be created amidst a crisis. Collaboration among hospitals and external partners has expanded, emphasizing the need for a comprehensive understanding of the entire ecosystem’s vulnerabilities.
Adapt
Plans must meet the real-world challenges. When Geneva faced an extraordinary heatwave, existing plans fell short but led to practical enhancements from frontline staff input. An outdated plan, although comforting, might not be effective.
Learn
Learning from crises transforms resilience into improvement. A past IT failure taught that paper redundancy does not guarantee functionality. Consequently, comprehensive solutions involving monitoring, backup procedures, and tests were implemented.
Successful adaptation and learning turn past experiences into future capabilities. The story of alcohol-based hand rubs invented at HUG, later adopted globally via WHO, exemplifies this transition.
Nassim Nicholas Taleb’s concept of antifragility – gaining strength from external pressures rather than merely enduring them – aligns with this philosophy. A preferred descriptor could be adaptive growth.
Leadership should address crucial questions: Who makes decisions during crises? Have we tested our dependencies? When did changes occur based on direct frontline feedback? Effective pre-crisis preparation, built on ordinary days, is imperative. The focus is on readiness to adapt and improve as new challenges arise.
About the Author
Robert Mardini is the director-general of Geneva University Hospital (HUG) and a member of the Newsweek CEO Circle. Previously, he served as the director-general of the International Committee of the Red Cross from 2020 to 2024.