Coordination Mechanisms: Design Notes for the Health Security Context
Coordination Mechanisms are essential to achieving collaboration in settings with many moving pieces and overlapping (though not always conflicting) objectives. Health Security is a perfect example of a space with multi-sectoral, multi-stakeholder collaboration imperatives. In the literature, the most common way of thinking about coordination mechanisms is using Mintzberg’s organizational theory of coordination mechanisms as points of departure. Without recourse to this reference point, I will provide a simple definition of coordination mechanisms that is useful for health security and the emergency response context. A coordination mechanism is any device, platform, a framework that provides a common rallying point for stakeholders to share information, resources, eliminate inter-agency red tape and otherwise collaborate. The platforms that facilitate coordination (e.g. a National or State level Emergency Operations Centre, technical working groups, etc.) are the key elements in the conceptualization, design and evaluation of whether a coordination mechanism is effective. These pointers will help you set-up more effective coordination mechanisms.
The focus of this piece is exploring some of the areas in which deliberate design must be brought to the set-up of Emergency Operations Centres, Technical Working Groups, Committees, Task Forces and other coordination mechanisms. Consider the following part an ‘Advanced Introduction to Coordination Mechanisms in Health Security’ (there is meant to be a semi-ironic emoji at the end of this sentence). The points here are necessarily anchored in my experience facilitating collaboration and designing collaboration mechanisms in some of the most difficult settings. Lately, I have given a lot of thought to coordination mechanisms because I have had to design them for National and [several] subnational systems including airports and seaports and public health emergency response platforms. I have worked to develop frameworks for Public Health Emergency Response Teams at Airports, Core Planning Teams for the development of Public Health Emergency Contingency Plans (at airports, seaports and ground crossings), A National Public Health Emergency Response Committee and a National Technical Working Group. These platforms have all been anchored on guiding devices like contingency plans and communication and coordination protocols that have to pass through an iterative process of review and validation. I have also led, facilitated and been part of these processes. I have spent quite the number of hours in After Action reviews and debriefs for both real events and simulation exercises. I have facilitated a fair bit of these. What follows are my early-stage, semi-rigorous thoughts on these experiences.
Emergency Response should strengthen Coordination Mechanisms not establish them
How well stakeholders collaborate to achieve common objectives during emergencies is a central indicator of the effectiveness of coordination in response, but it is often rather hard to judge the effectiveness of the Adhoc Coordination Mechanisms involved, contrary to a necessary and vital assumption of after-action reviews and debriefs. When forcing devices like pandemics, terrorist attacks, etc force stakeholders with parallel, non-converging objectives to sit at a table — because they all now have one urgent goal — without pre-existing rules guiding their coordination, we cannot say with a high degree of certainty that they could have moved faster, worked more efficiently, or otherwise gotten a better outcome. Where documented, established coordination mechanisms never existed and the majority of the response is coordinated through an Adhoc mechanism (like a presidential task force), it is difficult to conduct an objectively useful evaluation of the effectiveness of collaboration during the emergency.
Sidenote: Presidential Task Forces often act as the Supra coordination mechanism (coordinating the other coordinators) and may not at all be amenable to the kind of evaluation I am speaking of here. For one, they are often constituted too late (usually when we are nearly past critical action points) and disbanded too early, they are usually single-purpose incident-specific committees and have no triggers, guidelines for action etc. They are essential for the political coordination of the response effort (a critical and often highly underrated part of sustained emergency response). However, when they are deployed as mechanisms with operational functions (some of the PTFs currently in operation in response to the COVID-19 pandemic have subcommittees taking over the operation (planning, implementation and monitoring) roles of existing coordination platforms and shouldn’t be judged as Supra-coordinators.
It is important to map out and design all the possible stakeholder/inter-agency interactions that will be required in response and build pre-existing and standardized communication and collaboration pathways and affordances for them. The design of coordination mechanisms [should] necessarily build in the elements through which they will be evaluated.
Now, it is true that a great deal of the infrastructure for collaboration and multi-stakeholder coordination is forged in the crucible of emergencies. In many instances, this is probably the only time we even become aware of collaborative imperatives and affordance across sectors and agencies. What emergencies should do is provide leverage and gains, and clarify and optimize our designs (which will necessarily be limited by constraints of the design and simulation settings). We need to be deliberate about priming and setting up coordination mechanisms before emergencies hit.
How do we design coordination mechanisms during non-emergency times to ensure we are primed to make the best of a forcing device (like an emergency)?
Coordination Mechanisms Need Anchors
For coordination mechanisms to function well we need a solid anchor, preferably backed by a legal instrument. These anchors, like a contingency plan, guidelines for the operation of a TWG or Task Force etc. provide rules and constraints that guide what happens in the early stages of a response. This is probably a good time to mention that when we are designing guidelines for a coordinated response through one of these mechanisms (triggers and the response to them etc.) what we are mostly concerned about is what happens in the first few hours/days/weeks of the response, and in the early hours as scale/severity of the event changes. This is the most critical time in a response — before political machinery starts moving, before executive declaration provides an imperative to collaborate and get things done, before the Presidential Task Forces are constituted. The overall leadership of the emergency management may change in the course of an emergency, rules and strategy may change, influenced by the political leadership, etc. What is done in the first few hours, days, weeks, or months of the response will be down to members of existing coordination mechanisms/platforms, the rules that guide them and the sensitivity of the triggers that guide their operations. This is why a coordination mechanism needs a carefully and collaboratively designed anchor — essentially a Plan, set of Protocols, etc. And it is this anchor that forms the baseline when the time comes to evaluate the response and document lessons learnt. An anchor will necessarily need to pass through several iterations based on simulations, response, change in science and government structures, etc. But it is key to have an up-to-date, living and responsive coordination mechanism anchor.
Coordination Mechanisms should Collapse Formality across Agencies, Not Create or Exacerbate them
It may seem at first glance that another TWG, task force or committee is just the multiplication of red tape and bureaucracy. In fact, when properly designed, they should help to collapse formality across agencies and achieve a swifter, more effective response. Coordination mechanisms need infrastructure like secretariats, etc. that help collapse all the formality and bureaucracy that a functional governance process necessarily requires. For instance, during an Emergency, an Emergency Operations Centre (EOC) may set-up a multi-agency incident action plan (IAP) that is funded for the emergency. Requests for funding to execute tasks on the IAP should not be required to pass through the regular government request/procurement process. The Secretariat will provide the necessary documentation to show the implementation/execution of the IAP. Tools like IAPs and how Secretariats deploy them are vital to how effective coordination mechanisms like EOCs are in cutting through the [sometimes] essential red tape of governance. During emergencies, response communication between government agencies and offices (about the activities being undertaken, requests for permission, funding, etc) should occupy as little as possible of the time of response personnel, and tools that allow this to happen are priceless.
Familiarity is, in fact, a lubricant of Collaboration
As simple as this may sound, familiarity actually lubricates collaboration, and it doesn’t have to be of the personal kind. Stakeholders who meet regularly outside the forcing device of a response to talk about what they may have to do when such a response is required are better primed to bring their agency’s resources to bear when they are needed. In response to an emergency with a lot of unknowns (like COVID-19) the direct value of time-savings may not be immediately apparent to response parties (unlike how clearly urgent the needs are in response to a fire or an earthquake). Ensuring agencies know each other so well, that they understand the bureaucratic peculiarities (written and unwritten) of each office within an agency is critical. This will save time and resources and prevent a negative cascade of domino and second-order effects.
I suspect I may have inadvertently developed a blind spot for the obvious and may have skipped some of those in the discussion here. I hope to revisit this in the coming months as I continue to work with and think through coordination mechanisms.
