Crisis nerve centers: Supporting governments’ responses to coronavirus

Subnational (provincial, state, and municipal) governments are on the front lines in responding to the spread of COVID-19. The magnitude of the pandemic poses daunting challenges: officials must coordinate fast-moving and interconnected work streams across the private and social sectors while communicating vital information to residents, stakeholders, and the media—all in a clear and consistent way.

Our experience suggests that a crisis nerve center—a highly agile, coordinated body that brings together crucial organizational skills and capabilities—can provide senior government leaders with the structure and clarity to mount an effective response and mobilize every part of society.

This COVID-19 government nerve center shouldn’t supersede existing crisis-management structures. Rather, it is an additional executive-support structure for senior leaders that works closely with all existing emergency-management channels. By using this approach, governments can be better positioned to manage a crisis.

Crafting a rapid response

Nerve centers are particularly appropriate under three conditions:

• Significant disruption to regular activities that threatens to overwhelm existing resources
• Highly unfamiliar, highly novel situations that are unlike anything the organization has faced before, impeding rapid pattern recognition
• High-velocity disruptions, in which organizations do not have enough time to truly understand and interpret threats using traditional means

In these situations, nerve centers provide several integrated benefits that improve leaders’ overall decision-making speed and quality:

• They increase response efficacy by coordinating and adjusting activities around real capabilities—instead of just formal roles and responsibilities—and providing a mechanism to balance what’s important and what’s urgent.
• They increase the quality of information flow by connecting and coordinating disparate efforts through a central source of data collection and analysis.
• They improve response agility by allowing for rapid assembly of cross-functional teams in response to changing needs.

Structuring the COVID-19 government nerve center

Each nerve center should be designed to reflect local context, capabilities, personalities, and needs. A typical structure includes the following:

• A strong, trusted leader with the capabilities and operating rhythm to manage fast-moving, disparate teams. The overall response leader, often a senior official in government, oversees the operational leads. Selecting a person with the right skills is critical to the success of the crisis response. In our experience, outstanding response leaders are decisive, have authority to act, and bring significant judgment, maturity, stamina, and communications skills to the task.
• A set of agency or cross-functional teams representing the areas of work that are the highest priority. Each team should have a dedicated project manager and core team personnel in addition to a leader. These can be existing or new teams but should reflect actual, on-the-ground needs, not historical organizational divisions. See the exhibit for examples of what this could look like for a COVID-19 government nerve center.
• Representatives of legal, regulatory, and other critical bodies.These representatives should be available to provide on-the-spot guidance and advice.
• Data and analytics team. In recent years, governments have made strides in building their analytics and data-sharing capabilities. An effective crisis response requires operations to have the latest data available—and in formats that can be shared and understood—to aid planning and the allocation of resources and equipment. It is essential that the government have access to a “single version of truth” (as far as that is known) and that the COVID-19 government crisis nerve center be accepted by all parties as the owner of that truth, rather than having competing voices across the agencies.
• Links to stakeholder groups that require regular communications. In the case of a COVID-19 government nerve center, these connections could include citizens, legislatures, the business community, social-sector organizations, and educational institutions, among others.
• Links to other major external partners. In the case of local government, these links could include federal or national partners.

The center is tasked with developing a unified approach to short-term response and long-term stabilization. The primary objectives are to coordinate efforts across multiple operations to serve a focused mission: bring together the disparate sources of information required for decision making, set and act on priorities for the short and long term, craft solutions with all the relevant voices, and execute.

In the initial stages of the response, COVID-19 government nerve centers have often focused on the key medical lines of effort:

• Testing. In many countries, a lack of test kits has been a major obstacle. The COVID-19 government nerve center team could work with multiple suppliers, the healthcare system, and the national government to secure the needed capacity; identify any requirements, laws, or regulations that may prevent rapid test acquisition; facilitate the collection and analysis of critical testing data (including collecting not just positive but also negative testing data); and work with partners to develop creative alternatives.
• Personal protective equipment (PPE). Procuring and distributing PPE to healthcare workers requires governments to identify and overcome supply bottlenecks. These efforts are crucial, since the pandemic will quickly overwhelm healthcare systems crippled by infected workers. Nerve-center teams often work with state emergency-management agencies and others to secure supplies, organize and track donations, project future PPE needs and shortages, and support the issuance of guidance to affected stakeholders.
• Critical care. Governments must determine the capacity of healthcare infrastructure such as hospital beds, ventilators, and healthcare workers. They need to find quick ways of bridging the gaps, including by leaning on private- and social-sector infrastructure, medical students, and retired medical staff; easing procurement rules; and even asking for help from other governments. In addition to other tasks, teams often track, coordinate, and help procure beds of all types; develop additional capacity for a range of discharge needs; and identify and project staffing shortages.
• Telemedicine. Governments can help hospitals and healthcare facilities focus on the most severe cases by making certain that they are fully equipped to provide care and advice. Key tasks include ensuring active call centers, low wait times, and ample capacity—perhaps by tapping more trained personnel, such as nurses.
• Quarantine logistics. The general population and businesses that are essential to remain open (such as grocery stores and pharmacies) will need advance notice to prepare for large-scale quarantines and stay-at-home orders. Governments must clearly communicate restrictions and timelines, model the appropriate quarantine response, and take necessary enforcement actions.

When setting up a nerve center, governments should address a number of key elements:

1. Focus on practical planning scenarios that can be used for real execution, not theoretical scenario planning.
2. Set goals that are concrete and achievable and force the trade-offs that make them credible.
3. Reset those goals frequently—at least once a week—as the situation evolves.
4. Provide tools and structure, such as situation reports, threat maps, and regular interaction cadences, that help people rise above the day-today details.
5. Streamline the hierarchy; ensure it doesn’t take multiple steps for leaders to get to the person who knows the answer or multiple steps for the answer to travel back through the chain of command.
6. Recognize the need to constantly evolve the teams and structure, as the core competencies needed to address crises change quickly.
7. Keep a group protected to think about the next horizon; the here and now is critical, and so is the outlook for 30, 60, and 90 days and longer. Blocking off people for long-term planning allows for better decisions today.

The COVID-19 pandemic has forced all organizations, especially governments, to dramatically elevate their response strategies. The crisis nerve center provides governments with the structure and agility to mobilize resources quickly, execute, and shift gears as conditions change.