Daved van Stralen, MD, FAAP, Thomas A. Mercer, RAdm, USN
Abstract:
COVID-19 has changed the social, financial, and political environments for healthcare. Healthcare organizations have abruptly changed operations for a new environment due to pervasive threats to the organization, patients, and healthcare professionals. While the direct, infectious presence of COVID-19 as a threat would seem to cause the greatest stress to the healthcare system, perhaps the absence of the threat may cause more severe and wide-ranging problems. Ecological studies demonstrate a greater decrease in prey populations from the predator’s absence due to an “ecology of fear.” By analogy, organizations share these trait responses and can develop an organizational culture of stress or stress. HRO describes functional traits for effective operations in environments of severe threat.
Introduction:
The tendency to discuss stress and fear as responses to threat may have misled us to diminish people’s feelings, reasoning, and behaviors when the threat is absent. When nearby and visible, we can discuss measures to avoid attack and how to reduce psychological effects. The absence of threat, however, creates a pervasive unease that requires a response. The functional stress responses, fear reactions, and threat reflexes (1) work well to direct reason and action toward the threat. Without a target, however, these behaviors become misdirected and maladaptive.
Predators reduce prey populations to a greater extent by the absence of the predator rather than direct predation. The “ecology of fear” describes predator-prey interactions in the absence of the predator (2). Not only do prey populations decrease, but the ensuing trophic cascade changes the landscape to become a “landscape of fear” (3, 4).
COVID-19 has changed the social, financial, and political environments for healthcare, creating a new landscape. Healthcare organizations have abruptly changed operations for this new environment. While the direct, infectious presence of COVID-19 as a threat seems the greatest challenge, perhaps the absence of the threat may cause more severe and wide-ranging problems.
This paper will translate the ecology of fear through analogy to understand HRO as a culture for fear. By their absence, threats create an environment containing fear that interferes with operations. HRO, as a verb, actively responds to the waxing and waning of threats while continuing operations in a normal manner. This combination of the environment with threat and continuous actions in response to the threat forms a culture that resists the stresses and fears or succumbs. HRO describes the functions not only to resist but to grow.
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