درسهایی که می‌توان از پاسخ ایتالیا به شیوع کرونا گرفت!

Lessons from Italy’s Response to Coronavirus

در اواخر فوریه، برخی از سیاستمداران مشهور ایتالیایی که مشغول انجام امور روزانه در میلان بودند، اظهار داشتند که اقتصاد نباید به دلیل شیوع این ویروس متوقف شود. یک هفته بعد، یکی از این سیاستمداران خودش مبتلا به کووید۱۹ شد.

«هاروارد بیزینس ریویو» در مطلبی به قلم گری پیسانو، رافلا سادون، مایکل زانینی نوشت: سیاستگذاران در سراسر جهان مشغول مقابله با همه گیر شدن سریع کووید-۱۹ هستند. آن‌ها همزمان نیم نگاهی هم به شیوه‌ها و سیاست‌های اعمال شده در کشورهایی مانند چین، کره جنوبی، سنگاپور و تایوان برای سرکوب این بیماری همه‌گیر دارند. متأسفانه، در حال حاضر در بیشتر نقاط اروپا و آمریکا، همه‌گیری کووید-۱۹ تازه در ابتدای راه قرار دارد و سیاست گذاران در تلاش هستند تا از شیوع بیشتر این بیماری جلوگیری کنند. با این وجود، آنها در حال تکرار بسیاری از اشتباهاتی هستند که در ابتدای راه ایتالیا انجام داد، اکنون این بیماری همه‌گیر در ایتالیا به یک فاجعه تبدیل شده است. هدف از این مقاله، کمک به سیاستگذاران آمریکایی و اروپایی در همه سطوح است که از اشتباهات ایتالیا درس بگیرند بلکه بتوانند چالش‌های بی سابقه‌ای را که به واسطه بحران در حال گسترش به وجود آمده، شناسایی و برطرف کنند.

 طی چند هفته از ۲۱ فوریه که ایتالیا از کشف اولین مورد ابتلا به کووید۱۹ خبر داد شرایط به سرعت بحرانی گردید تا جایی که دولت تصمیم به تعطیل کردن کشور گرفت. در این بازه زمانی بسیار کوتاه کشور با سونامی از موارد ابتلا به بیماری رو به رو شد. این بدون شک، بزرگترین بحران ایتالیا از زمان جنگ جهانی دوم به این سو است.

برخی از جنبه‌های این بحران ناشی از بدشانسی سیاستگذاران ایتالیایی بود چرا که بحران در ابتدا برای بسیاری ناشناخته بوده و البته هنوز هم هست. با این حال، جنبه‌های دیگر نشان دهنده موانع عمیقی است که رهبران ایتالیا در شناخت بزرگی از تهدید بوجود آمده توسط کووید ۱۹ داشتند.

شایان ذکر است که این موانع حتی پس از آنکه کووید-۱۹ کاملاً در چین تأثیر گذاشت، در ایتالیا ظهور کرد و برخی از مدلها برای مهار ویروس چه در چین و چه در کشورهای دیگر قبلاً با موفقیت به اجرا درآمد، همچنان وجود داشت. آنچه ابعاد این بحران نشان می‌دهد یک عدم موفقیت سیستماتیک در جذب و اقدام به اطلاعات سریع و مؤثر به جای عدم آگاهی کامل از کاری است که باید انجام شود.

در اینجا توضیحاتی در مورد شکست طرح‌های کنترل وجود دارد که مربوط به مشکلات تصمیم گیری در زمان حال است.

تعصبات شناختی خود را بشناسید. در مراحل اولیه، بحران کووید-۱۹ در ایتالیا چیزی شبیه بحران نبود. اعلامیه‌های اولیه در مواقع اضطراری توسط مردم و بسیاری از افراد در محافل سیاسی با شک و تردید‌هایی روبرو شد، چرا که پیش‌تر چندین کارشناس هفته‌ها هشدار داده بودن که این مساله قابلیت تبدیل شدن به یک فاجعه را دارد.  در حقیقت، در اواخر فوریه، برخی از سیاستمداران مشهور ایتالیایی که مشغول انجام امور روزانه در میلان بودند، اظهار داشتند که اقتصاد نباید به دلیل شیوع این ویروس متوقف شود. یک هفته بعد، یکی از این سیاستمداران خودش مبتلا به کووید۱۹ شد.

واکنشهای مشابه‌ای در بسیاری از کشورها به جز ایتالیا نیز دیده شد و نشان داد که نگرانی‌ها کارشناسان در ابتدای بحران کاملا به حق بود، اما متاسفانه نادیده گرفته شد. تهدیداتی مانند همه‌گیری‌های که به شکلی غیرخطی پیش می‌روند یعنی کوچک می شوند اما قبل از کوچک شدن به شدت اوضاع را بحرانی می‌کنند خظرناک هستند. این بحران‌ها چالش‌های عمیق و در عین حال سریعی را به وجود می‌آورد و این باعث بحرانی شدن شرایط می‌شود. مؤثرترین کار برای مقابله با بحران این است که سیاستگذاران به سرعت نسبت به آن واکنش نشان دهند. متاسفانه اگر این مداخله واقعاً مؤثر باشد بعدا می‌گویند که این اقدامات واکنش‌هایی افراطی و بیش از حد بوده که اقتصاد کشور را تحت تاثیر قرار داده است، این همان نگرانی است که باعث می‌شود بسیاری از سیاستمداران علاقه‌ای به انجام آن نداشته باشند.

ناتوانی سیستماتیک در گوش دادن به نظرات کارشناسان، نشان می‌دهد که یک شرایط ساده هم ممکن است به سرعت بحران ساز شود.

از اقدامات جزئی و ساده خودداری کنید. درس دوم که می‌تواند از تجربه ایتالیا برای سایر کشورها حاصل شود، اهمیت رویکردهای سیستماتیک و خطرات راه حلهای ساده است. دولت ایتالیا با صدور یک سری آیین نامه‌هایی به تدریج باعث افزایش محدودیت‌ها در مناطق بحرانی شد، اما اعمال این محدودیت‌ها دیر بود و همین باعث شیوع کووید۱۹ در سراسر این کشور شد.

جمع آوری و انتشار داده‌ها مهم است. به نظر می‌رسد ایتالیا از دو مشکل مرتبط با ارائه آمار رنج می‌برد. در ابتدای شروع بیماری همه گیر، مشکل تنها کمبود داده‌ها بود. به طور خاص، پیشنهاد شد که انتشار گسترده و بدون توجه به ویروس در ماه‌های ابتدایی سال ۲۰۲۰ ممکن است با کمبود قابلیت‌های اپیدمیولوژیک و عدم توانایی در ثبت منظم آمار عفونت غیر عادی در برخی بیمارستان‌ها تسهیل شده باشد.

در یک سناریو ایده آل، داده هایی که شیوع و اثرات ویروس را بر مردم اثبات می‌کند باید تا حد امکان در مناطق و کشورها استانداردسازی شده و از پیشرفت ویروس در سطح کلان و بیمارستان جلوگیری کنند. از طرفی نیاز به داده‌های سطح خرد را نمی توان دست کم گرفت. بحث در مورد کیفیت مراقبت‌های بهداشتی موضوعی حائز اهمیت است.  اغلب اینگونه تصور می‌شود که چون مراکز بهداشتی توسط نهادهای کلان دولتی سازماندهی می‌شود، پس همه این مراکز از نظر کیفیت و کمیت خدماتی که ارائه می‌دهند و قابلیت‌های مدیریتی آنها یکسان است، در حالی که چنین نیست و هر کدام ظرفیت متفاوتی دارند. به جای پنهان کردن این اختلافات اساسی، ما باید کاملاً از آنها آگاه باشیم و براساس این کمبودها، تخصیص منابع محدود خود را برنامه ریزی کنیم. فقط با داشتن داده‌های مناسب در سطح قابل قبولی از تجزیه و تحلیل، سیاست گذاران و پزشکان مراقبت‌های بهداشتی می‌توانند استنتاج‌های مناسبی در مورد اینکه کدام روش‌ها کار می‌کند داشته باشند.

یک رویکرد متفاوت تصمیم گیری

هنوز هم عدم اطمینان عظیمی در مورد آنچه دقیقاً باید برای جلوگیری از شیوع ویروس انجام شود، وجود دارد. چندین جنبه مهم این ویروس هنوز ناشناخته و به شدت مورد بحث قرار گرفته و احتمالاً مدت زمان قابل توجهی همچنان باقی خواهد ماند. علاوه بر این، وقفه‌های قابل توجهی بین زمان عمل و نتایج یعنی هم میزان ابتلا و هم مرگ و میر اتفاق می‌افتد. ما باید بپذیریم که درک صریح و روشن از اینکه چه راه حلهایی ممکن است بحران را کنترل کند وجود ندارد.

با این حال، به نظر می‌رسد دو جنبه از این بحران از تجربه ایتالیا مشخص است. اول، با توجه به پیشرفت نمایی ویروس، وقت تلف کردن خطرناک است و باید به سرعت نسبت به کنترل بیماری اقدام کرد. همانطور که رئیس پروتستان ایتالیایی اظهار داشت، این ویروس سریع تر از بوروکراسی ما است.  دوم، یک رویکرد مؤثر در مورد کووید-۱۹ به لحاظ نیروی انسانی و اقتصادی باید سریعا اتخاذ شود، ضمن اینکه همزمان باید هماهنگی‌های لازم در نقاط مختلف مراقبت‌های بهداشتی صورت گرفته و بسیجی همه‌جانبه مانند شرایط جنگی ایجاد شود.

در کنار اینها، نیاز به اقدام فوری و بسیج گسترده دلالت بر این دارد که یک واکنش مؤثر در برابر این بحران نیازمند یک روش تصمیم گیری منسجم است. اگر سیاستگذاران می خواهند برنده جنگ علیه کووید-۱۹ باشند،باید به سرعت نسبت به شناسایی مبتلایان و جداسازی آن ها اقدام کنند.

As policymakers around the world struggle to combat the rapidly escalating Covid-19 pandemic, they find themselves in uncharted territory. Much has been written about the practices and policies used in countries such as China, South Korea, Singapore, and Taiwan to stifle the pandemic. Unfortunately, throughout much of Europe and the United States, it is already too late to contain Covid-19 in its infancy, and policymakers are struggling to keep up with the spreading pandemic. In doing so, however, they are repeating many of the errors made early on in Italy, where the pandemic has turned into a disaster. The purpose of this article is to help U.S. and European policymakers at all levels learn from Italy’s mistakes so they can  recognize and address the unprecedented challenges presented by the rapidly expanding crisis.

In a matter of weeks (from February 21 to March 22), Italy went from the discovery of the first official Covid-19 case to a government decree that essentially prohibited all movements of people within the whole territory, and the closure of all non-essential business activities. Within this very short time period, the country has been hit by nothing short of a tsunami of unprecedented force, punctuated by an incessant stream of deaths. It is unquestionably Italy’s biggest crisis since World War II.

Some aspects of this crisis — starting with its timing — can undoubtedly be attributed to plain and simple sfortuna (“bad luck” in Italian) that were clearly not under the full control of policymakers. Other aspects, however, are emblematic of the profound obstacles that leaders in Italy faced in recognizing the magnitude of the threat posed by Covid-19, organizing a systematic response to it, and learning from early implementation successes — and, most importantly, failures.

It is worth emphasizing that these obstacles emerged even after Covid-19 had already fully impacted in China and some alternative models for the containment of the virus (in China and elsewhere) had already been successfully implemented. What this suggests is a systematic failure to absorb and act upon existing information rapidly and effectively rather than a complete lack of knowledge of what ought to be done.

Here are explanations for that failure — which relate to the difficulties of making decisions in real time, when a crisis is unfolding — and ways to overcome them.

Recognize your cognitive biases. In its early stages, the Covid-19 crisis in Italy looked nothing like a crisis. The initial state-of-emergency declarations were met by skepticism by both the public and many in policy circles — even though several scientists had been warning of the potential for a catastrophe for weeks. Indeed, in late February some notable Italian politicians engaged in public handshaking in Milan to make the point that the economy should not panic and stop because of the virus. (A week later, one of these politicians was diagnosed with Covid-19.)

Similar reactions were repeated across many other countries besides Italy and exemplify what behavioral scientists call confirmation bias — a tendency to seize upon information that confirms our preferred position or initial hypothesis. Threats such as pandemics that evolve in a nonlinear fashion (i.e., they start small but exponentially intensify) are especially tricky to confront because of the challenges of rapidly interpreting what is happening in real time. The most effective time to take strong action is extremely early, when the threat appears to be small — or even before there are any cases. But if the intervention actually works, it will appear in retrospect as if the strong actions were an overreaction. This is a game many politicians don’t want to play.

The systematic inability to listen to experts highlights the trouble that leaders — and people in general — have figuring out how to act in dire, highly complex situations where there’s no easy solution. The desire to act causes leaders to rely on their gut feeling or the opinions of their inner circle. But in a time of uncertainty, it is essential to resist that temptation, and instead take the time to discover, organize, and absorb the partial knowledge that is dispersed across different pockets of expertise.

Avoid partial solutions. A second lesson that can be drawn from the Italian experience is the importance of systematic approaches and the perils of partial solutions. The Italian government dealt with the Covid-19 pandemic by issuing a series of decrees that gradually increased restrictions within lockdown areas (“red zones”), which were then expanded until they ultimately applied to the entire country.

In normal times, this approach would probably be considered prudent and perhaps even wise. In this situation, it backfired for two reasons. First, it was inconsistent with the rapid exponential spread of the virus. The “facts on the ground” at any point in time were simply not predictive of what the situation would be just a few days later. As a result, Italy followed the spread of the virus rather than prevented it. Second, the selective approach might have inadvertently facilitated the spread of the virus. Consider the decision to initially lock down some regions but not others. When the decree announcing the closing of northern Italy became public, it touched off a massive exodus to southern Italy, undoubtedly spreading the virus to regions where it had not been present.

Further Reading

This illustrates is what is now clear to many observers: An effective response to the virus needs to be orchestrated as a coherent system of actions taken simultaneously. The results of the approaches taken in China and South Korea underscore this point. While the public discussion of the policies followed in these countries often focuses on single elements of their models (such as extensive testing), what truly characterizes their effective responses is the multitude of actions that were taken at once. Testing is effective when it’s combined with rigorously contact tracing, and tracing is effective as long as it is combined with an effective communication system that collects and disseminates information on the movements of potentially infected people, and so forth.

These rules also apply to the organization of the health care system itself. Wholesale reorganizations are needed within hospitals (for example, the creation of Covid-19 and non Covid-19 streams of care). In addition, a shift is urgently needed from patient-centered models of care to a community-system approach that offers pandemic solutions for the entire population (with a specific emphasis on home care). The need for coordinated actions is especially acute right now in the United States.

Learning is critical. Finding the right implementation approach requires the ability to quickly learn from both successes and failures and the willingness to change actions accordingly. Certainly, there are valuable lessons to be learned from the approaches of China, South Korea, Taiwan, and Singapore, which were able to contain the contagion fairly early. But sometimes the best practices can be found just next door. Because the Italian health care system is highly decentralized, different regions tried different policy responses. The most notable example is the contrast between the approaches taken by Lombardy and Veneto, two neighboring regions with similar socioeconomic profiles.

Lombardy, one Europe’s wealthiest and most productive areas, has been disproportionately hit by Covid-19. As of March 26, it held the grim record of nearly 35,000 novel coronavirus cases and 5,000 deaths in a population of 10 million. Veneto, by contrast, fared significantly better, with 7,000 cases and 287 deaths in a population of 5 million, despite experiencing sustained community spread early on.

The trajectories of these two regions have been shaped by a multitude of factors outside the control of policymakers, including Lombardy’s greater population density and higher number of cases when the crisis erupted. But it’s becoming increasingly apparent that different public health choices made early in the cycle of the pandemic also had an impact.

Specifically, while Lombardy and Veneto applied similar approaches to social distancing and retail closures, Veneto took a much more proactive tack towards the containment of the virus. Veneto’s strategy was multi-pronged:

  • Extensive testing of symptomatic and asymptomatic cases early on.
  • Proactive tracing of potential positives. If someone tested positive, everyone in that patient’s home as well as their neighbors were tested. If testing kits were unavailable, they were self-quarantined.
  • A strong emphasis on home diagnosis and care. Whenever possible, samples were collected directly from a patient’s home and then processed in regional and local university labs.
  • Specific efforts to monitor and protect health care and other essential workers. They included medical professionals, those in contact with at-risk populations (e.g., caregivers in nursing homes), and workers exposed to the public (e.g., supermarket cashiers, pharmacists, and protective services staff).

Following the guidance from public health authorities in the central government, Lombardy opted instead for a more conservative approach to testing. On a per capita basis, it has so far conducted half of the tests conducted in Veneto and had a much stronger focus only on symptomatic cases — and has so far made limited investments in proactive tracing, home care and monitoring, and protection of health care workers.

The set of policies enacted in Veneto are thought to have considerably reduced the burden on hospitals and minimized the risk of Covid-19 spreading in medical facilities, a problem that has greatly impacted hospitals in Lombardy. The fact that different policies resulted in different outcomes across otherwise similar regions should have been recognized as a powerful learning opportunity from the start. The findings emerging from Veneto could have been used to revisit regional and central policies early on. Yet, it is only in recent days, a full month after the outbreak in Italy, that Lombardy and other regions are taking steps to emulate some of the aspects of the “Veneto approach,” which include pressuring the central government to help them boost their diagnostic capacity.

The difficulty in diffusing newly acquired knowledge is a well-known phenomenon in both private- and the public-sector organizations. But, in our view, accelerating the diffusion of knowledge that is emerging from different policy choices (in Italy and elsewhere) should be considered a top priority at a time when “every country is reinventing the wheel,” as several scientists told us. For that to happen, especially at this time of heightened uncertainty, it is essential to consider different policies as if they were “experiments,” rather than personal or political battles, and to adopt a mindset (as well as systems and processes) that facilitates learning from past and current experiences in dealing with Covid-19 as effectively and rapidly as possible.

It is especially important to understand what does not work. While successes easily surface thanks to leaders eager to publicize progress, problems often are hidden due to fear of retribution, or, when they do emerge, they are interpreted as individual — rather than systemic — failures. For example, it emerged that at the very early onset of the pandemic in Italy (February 25), the contagion in a specific area in Lombardy could have been accelerated through a local hospital, where a Covid-19 patient was not been properly diagnosed and isolated. In talking to the media, the Italian prime minister referred to this incident as evidence of managerial inadequacy at the specific hospital. However, a month later it became clearer that the episode might have been emblematic of a much deeper issue: that hospitals traditionally organized to deliver patient-centric care are ill-equipped to deliver the type of community-focused care needed during a pandemic.

Collecting and disseminating data is important. Italy seems to have suffered from two data-related problems. In the early onset of the pandemic, the problem was data paucity. More specifically, it has been suggested that the widespread and unnoticed diffusion of the virus in the early months of 2020 may have been facilitated by the lack of epidemiological capabilities and the inability to systematically record anomalous infection peaks in some hospitals.

More recently, the problem appears to be one of data precision. In particular, in spite of the remarkable effort that the Italian government has shown in regularly updating statistics relative to the pandemic on a publicly available website, some commentators have advanced the hypothesis that the striking discrepancy in mortality rates between Italy and other countries and within Italian regions may (at least in part) be driven by different testing approaches. These discrepancies complicate the management of the pandemic in significant ways, because in absence of truly comparable data (within and across countries) it is harder to allocate resources and understand what’s working where (for example, what’s inhibiting the effective tracing of the population).

In an ideal scenario, data documenting the spread and effects of the virus should be as standardized as possible across regions and countries and follow the progression of the virus and its containment at both a macro (state) and micro (hospital) level. The need for micro-level data cannot be underestimated. While the discussion of health care quality is often made in terms of macro entities (countries or states), it is well known that health care facilities vary dramatically in terms of the quality and quantity of the services they provide and their managerial capabilities, even within the same states and regions. Rather than hiding these underlying differences, we should be fully aware of them and plan the allocation of our limited resources accordingly. Only by having good data at the right level of analysis can policymakers and health care practitioners draw proper inferences about which approaches are working and which are not.

A Different Decision-Making Approach

There is still tremendous uncertainty on what exactly needs to be done to stop the virus. Several key aspects of the virus are still unknown and hotly debated, and are likely to remain so for a considerable amount of time. Furthermore, significant lags occur between the time of action (or, in many cases, inaction) and outcomes (both infections and mortality). We need to accept that an unequivocal understanding of what solutions work is likely to take several months, if not years.

However, two aspects of this crisis appear to be clear from the Italian experience. First, there is no time to waste, given the exponential progression of the virus. As the head of the Italian Protezione Civile (the Italian equivalent of FEMA) put it, “The virus is faster than our bureaucracy.” Second, an effective approach towards Covid-19 will require a war-like mobilization — both in terms of the entity of human and economic resources that will need to be deployed as well as the extreme coordination that will be required across different parts of the health care system (testing facilities, hospitals, primary care physicians, etc.), between different entities in both the public and the private sector, and society at large.

Together, the need for immediate action and for massive mobilization imply that an effective response to this crisis will require a decision-making approach that is far from business as usual. If policymakers want to win the war against Covid-19, it is essential to adopt one that is systemic, prioritizes learning, and is able to quickly scale successful experiments and identify and shut down the ineffective ones. Yes, this a tall order — especially in the midst of such an enormous crisis. But given the stakes, it has to be done.

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Gary P. Pisano is the Harry E. Figgie Jr. Professor of Business Administration and the senior associate dean of faculty development at Harvard Business School. He is the author of Creative Construction: The DNA of Sustained Innovation.


Raffaella Sadun is a professor of business administration at Harvard Business School. Her research focuses on the economics of productivity, management and organizational change in the private and public sectosr . She is a faculty research fellow at the National Bureau of Economic Research and a research associate in the Ariadne Labs Program at Harvard T.H. Chan School of Public Health.


Michele Zanini is the managing director of the Management Lab. He is a co-author of Humanocracy: Creating Organizations as Amazing as the People Inside Them (Harvard Business Review Press, forthcoming).

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ارادتمند
فرزاد عباسی
مدرس ، مربی و مشاور توسعه کسب و کار

دوست دارم بجای آرزوی موفقیت برای شما دوست عزیز ، سهمی در برآورده شدن آن داشته باشم . . .

تلفن همراه : ۰۹۱۲۳۵۷۹۴۱۹

تلفن همراه : ۰۹۱۰۰۶۸۸۱۰۰

ایرانسل : ۰۹۳۵۱۵۸۹۴۲۹

سامانه پیامکی ۵۰۰۰۲۰۲۶

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