Rebuilding networks after a crisis

Provider networks around the world were impacted by the pandemic, as the healthcare sector faced increased workloads, staff shortages and new ways of doing things. All of these challenges necessitated a review of care and cultivated a growing reliance on virtual tools, as Alerah Turner, Director of Global Provider Networks, World Travel Protection, revealed: “For us, the pandemic demonstrated the need to alter how we delivered care to customers in their time of need. Our service providers were forced to alter the delivery of patient care, often from traditional in-person models to virtual care access, and we needed to work in tandem with them to find the best solutions.”

Getting to grips with reality

Building a picture of what the new landscape looks like is the first step following any crisis, requiring a physical, boots-on-the-ground approach, as AMREF Medical Assistance Manager, Jane Munyua, articulated: “Assistance companies’ staff should visit the region as soon as it is safe to do so. This allows them to see the medical infrastructure for themselves and be able to audit and classify the facilities. Up-to-date, reliable information in conflict areas with near collapse of facilities is very difficult to get and often, in our experience, phone enquiries are usually received with suspicion. Physical visits establish rapport and facts on the ground. Meanwhile, the intelligence provided by local networks and agents may prove useful.”

Lara Helmi, Managing Director, CONNEX Assistance, also emphasised the importance of understanding the situation on the ground as early and clearly as possible: “Identifying the new topography allows you to set aside parts of the network which may no longer be as relevant, and focus only on what you need to rely on most,” she told ITIJ. “You also have to understand the impact of events on the way you conduct operations. The obvious one would be to the geographical coverage of your network; will you still be able to service the same area or require new providers? Understanding the impact in the early stages of a situation and during the recovery will be the difference between efficient or disrupted operations.”

Daniel Martins, General Manager, Alliance International Medical Services (AIMS), agreed with the need to assess the lie of the land: “First and foremost is identifying the state of the network post any disaster event, both internally and externally. Communication would be key in managing such a task. Touching base with providers and identifying their current status quo helps us rebuild, either in the same direction or with a slightly amended trajectory. Being at the coalface and meeting with all medical providers strengthens the partnership. This collaboration would not just be verbal or digital, but face to face.”

While assessing the situation on the ground, accessing reliable local intelligence is crucial, stated Chris Watson, Chief Operating Officer, AMI Global Assistance: “Having a primary and reliable source of information is invaluable. It gives you the ability to get real-time situational updates of security and medical capabilities. Where intelligence is not available in-country, or is unreliable, I recommend either deploying trusted assets from within the region or, once flights resume and restrictions ease, sending a team to assess the region. This positions assistance companies to have a higher probability of success on the ground.”

Filling in the gaps

The next step is auditing the network. “In the same way that an early understanding of the impact of uncertainty on the business environment leads to efficient operations, so too does understanding the effect of uncertainty on your network provider’s resources or ability to deliver a service,” stated Helmi. “The sooner you assess their abilities, the sooner you will be able to onboard new network providers to fill in the gaps within the same financial and administrative framework.” Again, the best method is in-person which, ultimately, helps to strengthen knowledge and facilitate the navigation of a challenging, liquid situation. “These fine adjustments to your network information will reveal many changes which can affect assistance services, including: pricing, regional coverage and capabilities, and mobility throughout the country,” Helmi continued. “These audits go towards strengthening on-the-ground knowledge, which is key when reassessing network capabilities and will make it easier to navigate the situation as it unfolds and during recovery; often at a time when clients and policyholders in the area will need your network most.”

Effective collaboration can help establish an accurate picture of the situation, and ... means working with local humanitarian agencies

When it comes to resilience in the face of adversity in the form of network disruption, adequate preparation can help minimise adverse repercussions, but depending on the nature of the crisis, this is not always feasible. “With situational awareness, responses can often be planned prior to deployment, and proactive measures taken to supplement the network. On other occasions, local conditions change in a flash and require a reactive response,” Watson said. “For instance, AMI Global Assistance was in Libya when the 2019 war began. Our local and international team remained on site, actively responding to medical cases, while feeding ground intel back to headquarters daily. We remained operational for the duration of the war, constantly needing to supplement and improvise our network of providers so we could pivot with the geopolitical changes, logistical demands and restrictive circumstances.” Lyngdoh emphasised the need for assistance companies to be diligent in their preparations: “The task of rebuilding networks in major disaster areas becomes more pronounced if local partners do not have adequate business continuity plans. As such, the onus falls on assistance companies to collate their constituent’s travel data and identify areas of travel where crises could potentially arise in the future. Thereafter, assistance companies need to make a diligent effort to map out local capabilities and the fallback options for resources for their constituents.”

In addition to advanced preparation, due diligence before, during and after an incident is invaluable, along with agility and flexibility: “Rebuilding a medical provider network is multifaceted, focusing first on whether the provider has the suitable capacity, systems and processes in place to ensure the delivery of safe, effective and equitable healthcare, regardless of the setting. Robust practices must be positioned to effect positive patient outcomes. Following a crisis event, what was once considered a reputable, safe and financially viable option may have experienced impacts that have now rendered the provider substandard for patient care,” confirmed Turner.

Protecting and building bridges

Each of these steps requires effective, ongoing communication and strong collaboration with partners and other stakeholders. “When a situation like this arises, it is imperative that organisations collaborate with partners to develop an understanding of the new vulnerabilities, and work together to address and mitigate any adverse exposure to access, equity and patient outcomes,” Turner stated. Effective collaboration can help establish an accurate picture of the situation, and facilitate a two-way channel for advice. For AMREF, this means working with local humanitarian agencies, among others, as Munyua articulated: “Collaboration and information sharing with local humanitarian agencies such as the Red Cross, Médecins Sans Frontières (MSF), other local non-governmental organisations (NGO) and security agencies who may have set up in areas where these calamities have occurred is important. They’re sometimes better placed to advise on which medical providers are still operational, especially at the height of calamity.” Sanjit Kandel of Air Dynasty Heli Service underlined that collaboration can be productive: “Assistance companies should not hesitate to share the challenges they faced during the crisis, help the medical providers to improve. They should reach out to previous medical providers as well as new ones, to impart views and experiences. Building a standard operating plan to follow if such a crisis arises in the future can be invaluable.”

Watson, too, highlighted the importance of strong relationships: “After a natural disaster or medical crisis, there is an influx of humanitarian organisations and international governments who deploy teams to the affected area. We have had success working side by side with these organisations. Assistance providers should seek to understand who is doing what, what capabilities are available locally, which medical centres are operational and the services they offer.” Lyngdoh noted that it may also be necessary to join forces with competitors: “While it may seem counterintuitive, following a major calamity, assistance companies are encouraged to collaborate with other industry peers, in order to facilitate better use of few resources at the time of incident, in the area of impact,” he stated. “It is often the case that such partnerships translate to better network resource capacity moving forward.” Despite any destruction caused, Kandel pointed out that there’s an avenue for growth: “After each crisis, business opportunities are created over time. In Nepal, we have seen medical providers become more professional and prepared.”

Crises are often unexpected and create uncertainty and disruption. By having contingency plans in place and a strong provider network at the outset, assistance companies can maintain operations and systematically rebuild in the aftermath. This involves first assessing the situation on the ground, then completing a network audit – including reviewing and revising operations. Providers can harness digital services, including virtual healthcare tools, to minimise disruption in times of adversity. Communication with partners is also crucial.

Ultimately, everyone in the network is affected, and only by working together can a solid network become even stronger through a crisis. “It is not only medical providers who are affected. The entire infrastructure, including transport and finance, are impacted. So, when called to assist, we need to get creative by thinking laterally and leveraging alliances as well as relationships,” Watson concluded.