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Book Review: Catastrophe and Systemic Change by Gill Kernick

Book Review: Catastrophe and Systemic Change by Gill Kernick

Reading Time: 4 minutes

 

Every now and then a book comes along that is so spot on, you can’t believe it hadn’t already been written.

That’s the case with Gill Kernick‘s book Catastrophe and Systemic Change: Learning from the Grenfell Tower Fire and Other Disasters.

Book cover: Catastrophe and Systemic Change by Gill Kernick

Gill lived on the 21st floor of Grenfell Tower between 2011 and 2014. We all have our own recollections of the morning of 14 June 2017. Like many of us, Gill watched the Tower burn. Unlike many of us, her former neighbours were amongst the 72 people who tragically died. Her book is dedicated to them.

In part, the book is an exploration of the systemic issues behind why we don’t learn from disasters. Kernick has worked in high hazard industries and brings examples from there as well as from other disasters to show repeated failures to bring about post-disaster change. But her book is also intensely personal, and in parts reads like a diary, like she is making sense of her own emotions and thoughts, and processing all of this during a pandemic when other learning is also falling by the wayside.  I didn’t expect the book to make me emotional, but it did.

Before discussing what I found particularly resonant about the book, a little disclaimer. I’ve been involved in the response to Grenfell since the early hours of that night in 2017. I’m still involved now. The Grenfell Tower Public Inquiry is continuing. For those reasons, I won’t be commenting on chapters 1 and 2 which consider the specifics of Grenfell, but will focus on the themes of learning and systemic change.

The book catalogues failed opportunities to learn. There is a whole swathe of documents, reports, investigations, inquiries and research that show that despite assurances rarely do ‘lessons identified’ translate to ‘lessons learned’ at either the scale or pace required. And this continues, on 24 June 2021 at the Manchester Arena Inquiry, there was considerable discussion about the collective failure to learn lessons from an emergency exercise. 

Right there on page 6 my frustration is in black and white “the system is designed to ensure we do not learn”.

My biggest personal professional frustration is the repeat lessons. To ‘learn’ something, again and again, is to demonstrate that it is not actually being learned or addressed sufficiently. I’ve worked in organisations where the focus is on putting in place systems and processes to ‘help’, but which all too often just result in shuffling bits of paper around.

Kernick draws a distinction between piecemeal change (which involves looking at the system and making changes within it) and systemic change (which considers the conditions and cultures within which the system operates). She asserts that systemic change requires disruption of the status quo, but observes that kindness can be more disruptive than aggression.

We live in a complex, messy, often unpredictable world. I think it gives us a sense of comfort to think that we are ‘in control’ and can forecast what will happen in a given situation, but the reality is that emergent behaviours and complex dynamics between systems mean that we are only just scratching the surface.

I’ve blogged previously about work to understand emergent behaviour (‘sit in the messiness’ and ‘pop up emergency planning’), interdependencies between systems as well as my desire to see more empathetic approaches towards emergency management. It’s heartening to see that somebody outside the emergency management field also sees the same issues. It gives me a new resolve to try to address them.

To operate effectively in an increasingly complex world, Kernick suggests that governments need to change how they approach public engagement. I’d go further; this is not limited to engagement, governments need to embrace flatter, more organic structures for emergency response and move beyond ‘command and control’.

Emergencies and disasters often have high levels of uncertainty. This calls for what Kernick refers to as ‘the democratisation of expertise’. None of us individually have all the answers; we need to work together to make sense of a situation and determine a course of action. It’s an unspoken principle that runs through emergency management. That’s why we have COBR, once described to me as “Whitehall in miniature”, which brings together a bunch of people to find a collective answer. The same applies to Local Resilience Forums and Strategic Coordinating Groups. They are structures that allow knowledge and expertise to be pooled.   

And those structures need to be more representative of the communities they serve. We need people with different lived experiences to shape a response that will be better for everyone.

Kernick moves then to consider the role of accountability and scrutiny in Government. The conclusion generally seems to be that structures for scrutiny are okay, but the willingness or ability of governments to act on that scrutiny is low. There is no structure that can compel public inquiry recommendations to be addressed. Similarly, the Prevention of Future Deaths reports and rail industry incident reports and many others too. They all swirl around, unaddressed, in a soup of known issues ready to boil over the next time there is an incident.

So, why don’t we learn? It’s a question I come back to a lot and which this book has helped me to explore. Through the book Kernick goes on a journey about learning, expressing what initially seems to be curiosity, but then becomes increasingly frustrated and ultimately becoming incredulous. I’m not quite at that stage just yet, but I do think that there is a requirement to turn the mirror on ourselves and really examine the conditions and beliefs which we hold on to, which might be stopping us from making more progress.

And so, we come back to where we started, that systemic change requires “a tribe of disrupters” and I hope this book galvanises emergency managers across the land to be braver and to disrupt with kindness.

Sit in the messiness a while…

Sit in the messiness a while…

Reading Time: 2 minutes

I’ve just listened to this In Our Time podcast from December 2013. I’m not normally a massive fan of Melvyn Bragg, but with Prof. Ian Stewart (who I met 5 years ago) and Prof. Eve Middleton-Kelly (with whom I worked in the run up to the Olympics) on the panel, I thought I’d take a listen.

Emergence

It sounds counter-intuitive , but most people are well accustomed to handling complex systems. Whilst the terminology is typically academic, I expect we can all relate to the idea of things happening as a result of unforeseen consequences. That is, to me, what complexity science is about; trying to better understand the factors which lead to things happening. My particular interest, of course, is in enhancing our understanding of how disasters happen.

I’ve blogged before about emergence (Pop Up Emergency Planning), as one of the facets which interests me most when looking at most disaster response case studies. Essentially it’s the idea that when a system is stressed, it can cope up to a point but then finds a new way of coping by developing new structures, relationships or rules. We see this when people on twitter reach out to people who are stranded at airports due to volcanic ash clouds, we see it when spontaneous Broom Armies take to the streets to clear up riot debris; and following conversations in December with @CazMilligan #SMEMChat colleagues – emergence also seems to underlie initiatives like Virtual Operations Support Teams.

Almost exactly 12 months ago I initiated Anytown for London Resilience Team. This was an attempt to look at the interaction of different city systems to see if we could model their interdependencies and better understand the likely and emergent consequences to improve future resilience to disruptions to these systems.

If we were designing a city from scratch then I expect many of its systems would look rather different. Out of the construction of individual buildings and infrastructure components emerges something which has structure (and, buy extension, traits such as culture, tradition and ‘personality’), which is partly planned and partly evolved. We need to embrace the messiness, work with it rather than trying to control it.

New Year is a time of resolutions, so I’m resolving now to take Anytown ‘to the next level’ in 2014. I’d be interested to do this in collaboration with others who are interested in similar issues – get in touch!

 

Image Credit: Doug Neil at TheGraphicRecorder (who has an interesting comment about the obvious spelling mistake!)

Banish the Hi-Viz Jacket

Banish the Hi-Viz Jacket

Reading Time: 2 minutes

Family stories and media-influenced interpretations of the past often depict communities coming together in times of adversity. Typically in Britain it’s referred to as Dunkirk Spirit, but I’m sure there are examples of it the world over.

banish the hiviz

Although we often have a positivist view of the past, one only has to look to the Good Deed Feed in London’s free morning paper or to the banding together of London’s communities after the riots in August 2011 to see that this trait remains just under the surface for most of us. I’ve mentioned that we, as emergency managers, shouldn’t forget about emergent behaviour, but we also should remember that people often have a way of coming together in response to an incident. None of these community responses arose because there was a ‘plan’.

With the threat of coastal flooding last week it’s taken me longer than I anticipated to get my thoughts on the first National Community Resilience meeting down on the blog. Firstly, I should start that calling it the first meeting is a bit of a misnomer. Since I’ve been working in this field in the UK there have been at least 3 attempts to ‘launch’ the concept. It’s currently defined as “Communities and individuals harnessing local resources and expertise to help themselves in an emergency, in a way that complements the response of the emergency services.”

In the past, my main bug-bear has been around the definition of community (people are simulatenously members of numerous communities, which onces are we talking about?), and whilst I think that remains an issue, there was another aspect which became apparent, which is aspiration.

There were a range of presentations from different areas of the UK, but what struck me most was the continued fixation on developing a plan. Whilst this may have been ok 30 years ago, the nature of modern life means we’re more Global Village than ‘Vicar of Dibley’. For me, the days of Community Resilience based on intricate hazard specific plans and networks of local wardens are long gone.

I’ve been searching for some time to find a phrase which, I think, more accurately captures what I think community resilience should be striving for, and I think I’ve found the answer. Optionality – the quality or state of allowing choice.

  • Less community plans, more people in employment and therefore better positioned to look after themselves should there be an emergency
  • Less high visibility jackets, more people focused on education (not necessarily just formal education either, it could be education on risk exposure perhaps?) thereby enabling choice between different options.
  • Less grab bags and wind up radios, instead a generation of healthier people less prone to illness and injury.

Developing a plan is easy, anyone can do it. Engendering change and instilling resilience into all aspects of society is a far greater challenge, but I believe that is where the focus of effort should be on Community Resilience. It might be aspirational and difficult to measure, but I have a feeling that it’d be a better use of energy than a community flood plan.

Alternative views welcomed – my ideas are in their infancy and constructive challenge will help me develop them!

 

Image Credit: Imperial War Museum

Pop Up Emergency Planning

Pop Up Emergency Planning

Reading Time: 3 minutes

From one off exhibitions and sample sales to short term high-concept bars and restaurants, the trend for temporary, ephemeral retail and leisure has gripped London, and many other places, in recent years.

wave

The cynic in me knows not to be drawn in by the marketing and hype, but then I get a serious case of FOMO and hop aboard the ‘for a limited time only’ train. From eating deep fried crab in petrol stations, to sipping rum from watermelons in a faux 1950’s holiday resort; it’d be fair to say I’ve participated in the trend.

However, it wasn’t until this week that I thought about transitioning this from a retail context to resilience.

Emergent behaviour in response to disasters is nothing new. There are countless stories of unplanned, improvised and spontaneous responses which should give us all a warm feeling: despite not knowing our neighbours, community spirit really is alive and kicking.

Perhaps though, there is room to develop, enable and facilitate these pop-up responses in the event of an incident? Are there any lessons to be learned from retail for our own pop-up planning, both within the responder community but also at the individual and community level?

In a study conducted in 1983, Quarantelli identified a typology of emergence, shown below.

Structures

Tasks

Old

New

Old

Quasi-Emergence

Task Emergence

New

Structural Emergence

Group Emergence

Remember the London Riots Broom Army? The task was new, the clean-up of the mess and debris left by several days of consecutive looting and vandalism. The structures used were also new and so this would be classified as Group Emergence.

With the Volcanic Ash Cloud of 2010, people near airports offered spare rooms to stranded passengers – a new task (the provision of shelter), but using existing structures (people’s homes rather than camp beds in a village hall), giving rise in this case to Task Emergence.

Whilst this is a useful model for understanding different motivating factors behind emergent behaviour, as with most things, I expect there is a degree of overlap between the different groups, and it’s hard to classify all examples of emergence as just one of these types.

However, in thinking about this typology, where can we help enable emergence in the future? It’s easy to identify the ‘old’ structures and tasks, this is  what we do every day and in the way that we currently do it. Even identifying ‘new’ tasks isn’t that complex, as whilst they may not be everyday tasks, they’re likely to be foreseeable. I think it’s the identification of ‘new structures’ which presents the challenge. (I have a feeling that VOST could be one of these new structures, and I’ll get round to blogging more about the use of volunteers to support operations soon!) It’s easy to say ‘communities’ but who? What are the factors which make someone a community leader, how do they get people onboard with their vision? How do they coordinate spontaneous activity?

There is a tendency for emergency planners to seek to ‘control’, when actually that’s both extremely complicated and largely not desired by affected communities. We need to dispel two myths, that the public is incapable and that we can solve everything alone. There is going to be emergence in disasters, so we should include emergence in preparedness activities.

 

 

Image Source: kimchiandchips.com