Talk 4 Summary COVID Series
11 May 2020
By Jakob Svensson*
This conversation explores perspectives from different countries and industry sectors, relating to the value of expertise within the current pandemic scenario, how to make the most of various sources of expertise, and how people can be “brought up to speed” in the face of rapidly and radically changing circumstances. We combine insights emanating from both NDM and RE, and discuss how these communities can contribute to the capabilities of society to act and respond when dealing with crises.
Speakers for this webinar were: Jan Maarten Schraagen (Netherlands), Laura Militello (USA), Gary Klein (USA) Pedro Ferreira (Portugal – hosting)
Jan Maarten Schraagen led off the webinar by introducing the concepts of NDM and RE, followed by the question of how these perspectives illuminate the understanding of the Covid-19 pandemic? Many governments rely on experts in their decision-making process, but we also need multidisciplinary and even citizen-empowered approaches. The coronavirus presents us with a lot of novelty and an element of surprise. As the Prime Minister of Netherlands expressed it “We need to take 100% of the decisions based on 50% of the knowledge.”
Jan Maarten Schraagen discussed the concept of expertise and related it to intuition. In a metaphorical manner, he compared Covid-19 to an expert chess player, and we must try to recognize the patterns of moves in order to fully counter the attack. However, since we are a novice player against this opponent, we need to consider alternative moves. Experts that give advice on how to counter the pandemic have general knowledge which they can apply in combination with general strategies. These have replaced the specific knowledge in our novice situation, which policymakers base their decisions on. Policymakers can take the advice of experts, but it is hard to measure the effect since many strategies can only be measured in hindsight. The way ahead is instead to implement changes in piecemeal fashion. It is about small changes in course rather than large ones. This means that e.g. schools could be partially opened with only half the number of students, then the strategy is evaluated and before the rest of the students are sent back to school. A piecemeal strategy or “the low-cost probing” has been proven effective in dynamic environments.
Governments need to take into account not only medical, but other areas of expertise as well to form their exit strategy from the pandemic. Experts from railways, shop owners, airline managers and other local experts have crucial information on how to manage social distance in their field. This is the knowledge we need to tap into. Jan Maarten Schraagen ends his session by underlining that expertise is a social phenomenon, resilience is a network phenomenon, and expertise needs to be distributed and tapped broadly.
Our second speaker was Laura Militello who talked about three challenges for supporting expertise in the Covid-19 crises.
1. Developing just-in-time scenario-based training for healthcare workers.
Healthcare personnel needs to learn new skills and adapting to the situation. It includes, to mention a few: evolving signs and symptoms of Covid-19, evolving treatments, limited exposure. This brings out a lot of new training materials, such as power-point slides or fact sheets on how to use protective equipment. Health systems use high fidelity simulation training but this is not practical in the COVID evolving context, as it requires lots of efforts to implement. A more profound learning experience is shown in those embedded in context scenarios. This means that the new rule or guideline has a deeper impact if they are portrayed in realistic scenarios. Augmented Reality is one way to remotely get the feeling of scenario-based training e.g. shifts in skin tone in a manikin. Virtual patients together with a physical manikin is another example where staff can perform and train on critical interventions.
Laura Militello highlights the assessment action pairing. NDM experience advises to link actions and assessments in training. In that way, to imagine yourself in a situation, what interventions (augmented reality or paper and pen scenarios) and assess it, experience shows that this is more powerful than handing outs lists of interventions to do.
2. Collecting and capturing lessons learned from hotspots
What do we want to do, and what do we want to avoid doing if the virus moves into our region? Laura Militello suggests that we use some of the tools from the NDM-community, in particular the cognitive task analysis strategies and interview techniques. Working with multidisciplinary teams to analyze the data could also be a valuable tool to highlight contradictions and common misconceptions, as well as recommendations. In the same way “knowledge representation” that emphasize boundary conditions and uncertainty would be beneficial. Compelling stories can be used to illustrate findings and their limitations.
3. Supporting people in assessing credibility – “what information can you trust?“
The safety of the individual is dependent on the behavior of all. It’s hard for the individual to navigate when he/she is bombarded with contradictory information about how to act and what to believe. This is all happening at a time in history when there seems to be a lot of skepticism about expertise. So, who do people trust? Research shows three antecedents of trust; benevolence ability and integrity which are well documented. But one recent study shows that people found other people more trustworthy if they were seen as similar to themselves, both physically and cognitively. One important effect of this is that we should think, not just about the content of messaging but also the Messenger, and the credibility of that person in that specific context.
Gary Klein was the last speaker who provided a naturalistic decision-making perspective on the Covid-19 crisis. He highlighted experience and expertise as a concern and reconnected to Jan Maarten Schraagen’s and Laura Militello’s previous talks, but added that there is an additional need to invent expertise. We are learning what the symptoms are, but new symptoms are still being discovered. Therefore, we need to do more than just disseminate expertise. We need to rapidly grow expertise. Gary Klein stressed concern about plausibility and validity. Something that can seem plausible to act on in the Covid-19 crises may not be valid because the mental models we have, and that we use to appraise plausibility, are incomplete and are being revised as we learn more. This provides challenges for NDM, which relies so heavily on expertise. It also provides challenges to evidence-based medicine, since healthcare workers have to trust plausibility and improvise using social media and anecdotes rather than carefully controlled double-blind experiments.
Gary Klein presented some suggestions on how we can speed-up our growth of expertise on different levels. For instance, we can unpack expertise using cognitive task analysis methods. We can compile expertise using the Pre-mortem Method. The Pre-mortem Method suggests that you imagine your action to be a fiasco, generate the reasons why it failed and then consolidate the list of failures and go from there. Another method is management by discovery (because healthcare managers have to be prepared to revise their goals based on what they learn) or appointing discovery teams (to quickly harvest the expertise within a unit).
To understand the assumptions behind simulation models for the spreading of Covid-19, a cognitive tutorial could be used for individuals or organizations so that they can get a better sense of how the analytical technology works — what are its strengths and its limitations and how to apply it to local conditions.
Gary Klein ended his session by emphasizing the core of NDM is expertise. One strategy for disseminating expertise is a technique called ShadowBox which is a way for trainees to see the world through the eyes of the experts.
* Jakob Svensson is a PhD Candidate at the Faculty of Engineering, Division for Risk Management and Societal Safety, Lund University, Sweden