Preparing Health Systems for Unexpected Crises

On January 1st, Geneva University Hospital (HUG) received a critical call before dawn. Earlier, a devastating fire erupted in a bar at the Swiss resort of Crans-Montana, where New Year celebrations were underway. The tragic event resulted in the death of 40 individuals and injured over a hundred, many suffering severe burns. No single hospital or nation was equipped to handle the crisis alone, leading to patients being transported to burn centers in Lausanne, Zurich, Paris, Milan, and Stuttgart. This incident demonstrated how hospitals across several countries operated collectively without a pre-planned strategy for such a night, highlighting a challenge every health leader faces today: future crises will differ from past scenarios and may include mass-casualty events, cyberattacks, supply chain disruptions, or newly emerging viruses. It is imperative to prepare for any eventuality.

With nearly 30 years of experience with the International Committee of the Red Cross (ICRC), including four years as its director-general, and two years as CEO of one of Europe’s largest university hospitals, I have learned that resilience is essential to governance. Health systems are often evaluated by their preparedness, such as having emergency plans, sufficient beds, and critical supplies. While these factors are important, they do not reveal an organization’s behavior when plans change, as they invariably do. What counts is whether a system can anticipate, decide, mobilize, adapt, and learn under pressure.

Anticipate

Anticipation is not the same as prediction. It involves asking what could happen, what is at stake, and what resources are required before a crisis hits. When G7 leaders met in Evian, France, this potential situation required preparation for large demonstrations that might turn violent. Additional beds were opened, surgeries reduced, and tents set up for tear gas exposure. Cross-border passes were issued for healthcare workers. Although the summit concluded without major issues, the effort was not wasted. It clarified decision-making processes, tested relationships, and revealed unknown gaps. Preparation builds capability, which remains after the risk wanes.

Decide

In crises, information can be fragmented and confusing. Waiting for certainty often leads to poor decisions. At the ICRC, instructions from headquarters were based on clear intent and principles rather than procedures for every situation. Hospitals are similar. Decisions about delegation and central control are crucial, emphasizing that ambiguity remains where crises often strike. Effective leadership involves making sound decisions despite uncertainties.

Mobilize

Technology and infrastructure are vital, but trust and people drive systems forward. Trust is not built amidst crises; it is fostered beforehand. No hospital stands alone. During the Crans-Montana fire, Geneva University Hospital helped colleagues elsewhere by providing medicines and ambulances. Resilience governance requires understanding the whole ecosystem’s vulnerabilities, not just those of the organization itself.

Adapt

Plans meeting reality might reveal shortcomings. For example, during a heatwave in Geneva, some patient rooms were too hot despite having a heat plan. A nurse’s feedback prompted actionable improvements that indicators failed to highlight. Plans need not sit unchanged; they risk irrelevance when not adapted.

Learn

“A back-up that has never been tested is a hope, not a plan.”

In 2017, an IT system failure at the hospital taught a humbling lesson: relying on redundancy without testing proves inadequate. Implementation of security monitoring, paper-based protocols, and regular testing followed. Learning translates plans into reality. Changes, not just debriefs, matter.

Reflecting on a key example from HUG, Professor Didier Pittet’s team developed alcohol-based hand rub to combat infection spread, a solution now adopted globally through the WHO. This exemplifies converting experience into a valuable public health capability.

Finally, a set of vital questions for health systems includes who decides during unexpected times, recognizing critical dependencies, validating collaborations, and examining changes made following crises. Experiences build preparedness for the future’s surprises, readying us to not just withstand, but grow stronger from them.

Robert Mardini is the director-general of Geneva University Hospital and was formerly the director-general of the International Committee of the Red Cross.