Beginning in the late 1990s and lasting through much of the next decade, the Arkansas Department of Health underwent multiple changes to its organizational structure. Part A of "A State of Flux" recounts how, after a brief period in which the director of health replaced traditional hierarchical leadership with team-based management, several findings of administrative shortcomings helped prompt Governor Mike Huckabee and the state legislature to merge the department with the Arkansas Department of Human Services. Supporters of the merger argued that not only would it force the health division to adopt the highly regarded administrative practices of human services, it would also result in substantial cost savings for the state budget. However, the public health community quickly grew frustrated with the new arrangement, arguing that instead of being the marriage of two equals, the merger had resulted in the subordination of health to human services. Soon a movement to end the merger emerged, and Part B of the case explores how public health officials and their political allies rallied both publicly and behind the scenes to reverse course and reestablish a fully autonomous health department. An epilogue to the case portrays the main tasks and challenges public health leaders encountered as they worked to rebuild a reconstituted Arkansas Department of Health after this tumultuous period of organizational change. Case number 2129.0
On October 29, 2012, Superstorm Sandy made landfall near Atlantic City, New Jersey. Sandy's massive size, coupled with an unusual combination of meteorological conditions, fueled an especially powerful and destructive storm surge, which caused unprecedented damage in and around New York City, the country's most populous metropolitan area, as well as on Long Island and along the Jersey Shore. This two-part case study focuses on how New York City prepared for the storm's arrival and then responded to the cascading series of emergencies - from fires, to flooding, to power failures - that played out as it bore down on the city. Profiling actions taken at the local level by emergency response agencies like the New York City Fire Department (FDNY), the case also explores how the city coordinated with state and federal partners - including both the state National Guard and federal military components - and illustrates both the advantages and complications of using military assets for domestic emergency response operations. Case number 2124.0
On April 15, 2013, Dzhokhar and Tamerlan Tsarnaev placed and detonated two homemade bombs near the finish line of the Boston Marathon, killing three bystanders and injuring more than two hundred others. This case profiles the role the Massachusetts National Guard played in the complex, multi-agency response that unfolded in the minutes, hours, and days following the bombings, exploring how its soldiers and airmen helped support efforts on multiple fronts - from performing life-saving actions in the immediate aftermath of the attack to providing security on the region's mass transit system and participating in the search for Dzhokhar Tsarnaev several days later. It also depicts how the Guard's senior officers helped manage the overall response in partnership with their local, state, and federal counterparts. The case reveals both the emergent and centralized elements of the Guard's efforts, explores the debate over whether or not Guard members should have been armed in the aftermath of the bombings, and highlights an array of unique assets and capabilities that the Guard was able to provide in support of the response. Case number 2089.0
This case explores the experiences of three Manhattan-based hospitals during Superstorm Sandy in 2012. Beginning with an overview of how the hospitals prepared in the months and days leading up to the storm, it focuses primarily on decisions made by each institution, as Sandy approached, about whether to shelter-in-place or evacuate hundreds of medically fragile patients -- the former strategy running the risk of exposing individuals to dangerous and life-threatening conditions, the latter being an especially complex and difficult process, not without its own dangers. Ultimately, each of the three hospitals profiled in the case took a different approach, informed by their differing perceptions of risk and other unique circumstances. The case illustrates the very difficult trade-offs hospital administrators and local and state public health authorities grappled with as Sandy bore down on New York and vividly depicts the ramifications of these decisions, with the storm ultimately inflicting serious damage on Manhattan and across much of the surrounding region.
The December 26, 2004, Indian Ocean tsunami caused tremendous damage and suffering on several continents, with Indonesia's Aceh Province (located on the far northern tip of Sumatra Island) experiencing the very worst. In the tsunami's wake - and with offers of billions of dollars of aid coming from all corners of the globe- the Indonesian government faced the daunting task of implementing a massive recovery effort that could meet the expectations of donors and survivors alike. With this in mind, Indonesia's president established in April 2005 a national-level, ad hoc agency -- known by its acronym, BRR -- to coordinate reconstruction activities across the province. This case examines some of the core challenges BRR's leaders encountered as they moved to set up the agency and then proceeded to coordinate and execute a recovery process involving hundreds of domestic and international partner organizations and thousands of independent reconstruction projects. Case Number 2010.0
Following the sinking of the Deepwater Horizon drilling rig in late April 2010, the Obama administration organized a massive response operation to contain the enormous amount of oil spreading across the Gulf of Mexico. Attracting intense public attention and, eventually, widespread criticism, the response adhered to the Oil Pollution Act of 1990, a federal law that the crisis would soon reveal was not well understood - or even accepted - by all relevant parties. This two-part case profiles the efforts of senior officials from the U.S. Department of Homeland Security as they struggled to coordinate the actions of a myriad of actors, ranging from numerous federal partners (including key members of the Obama White House); the political leadership of the affected Gulf States and sub-state jurisdictions; and the private sector. Case A provides an overview of the disaster and early response; discusses the formation of the National Incident Command (NIC), which had responsibility for directing response activities; and explores the NIC's efforts to coordinate the actions of various federal entities. Case B focuses on the challenges the NIC encountered as it sought to engage with state and local actors - an effort that would grow increasingly complicated as the crisis deepened throughout the spring and summer of 2010. Case number 1982.0
Following the sinking of the Deepwater Horizon drilling rig in late April 2010, the Obama administration organized a massive response operation to contain the enormous amount of oil spreading across the Gulf of Mexico. Attracting intense public attention and, eventually, widespread criticism, the response adhered to the Oil Pollution Act of 1990, a federal law that the crisis would soon reveal was not well understood - or even accepted - by all relevant parties. This two-part case profiles the efforts of senior officials from the U.S. Department of Homeland Security as they struggled to coordinate the actions of a myriad of actors, ranging from numerous federal partners (including key members of the Obama White House); the political leadership of the affected Gulf States and sub-state jurisdictions; and the private sector. Case A provides an overview of the disaster and early response; discusses the formation of the National Incident Command (NIC), which had responsibility for directing response activities; and explores the NIC's efforts to coordinate the actions of various federal entities. Case B focuses on the challenges the NIC encountered as it sought to engage with state and local actors - an effort that would grow increasingly complicated as the crisis deepened throughout the spring and summer of 2010. Case number 1981.0
When Indiana State Health Commissioner Dr. Judy Monroe learned of the emergence of H1N1 (commonly referred to as "Swine Flu") in late April 2009, she had to quickly figure out how to coordinate an effective response within her state's highly balkanized public health system, in which more than 90 local health departments wielded considerable autonomy. Over the next several months, she would come to rely heavily on relationships she had worked hard to establish with local health officials upon becoming commissioner -- but she and her senior advisors would also have to scramble to find new ways to communicate and coordinate with their local partners, who represented jurisdictions that varied considerably in terms of size, population demographics, resources, and public health capacity. Case Number 1974.0
In late summer 2005, Hurricane Katrina - the worst natural disaster in U.S. history - wreaked havoc along the Gulf Coast, causing massive loss of life and property damage. (Just a few weeks later, Hurricane Rita would inflict even more suffering across much of the same area.) The evacuation of special needs individuals (e.g., the institutionalized, those with medical conditions, people without access to cars, etc.) from New Orleans was especially problematic, not simply in getting people out of the city but also in tracking who had gone where, letting their families know what had happened to them, caring for them properly in receiving areas, and repatriating them to their homes and loved ones.
In late summer 2005, Hurricane Katrina - the worst natural disaster in U.S. history - wreaked havoc along the Gulf Coast, causing massive loss of life and property damage. (Just a few weeks later, Hurricane Rita would inflict even more suffering across much of the same area.) The evacuation of special needs individuals (e.g., the institutionalized, those with medical conditions, people without access to cars, etc.) from New Orleans was especially problematic, not simply in getting people out of the city but also in tracking who had gone where, letting their families know what had happened to them, caring for them properly in receiving areas, and repatriating them to their homes and loved ones.
The 2009 H1N1 influenza pandemic posed enormous challenges for state health departments across the U.S. This case focuses on the experience of Tennessee - which endured an intense resurgence of the disease in late summer and early fall 2009 - and explores, in particular, how state health officials, working with their partners from local government and the private sector, mobilized in advance of this second wave of the disease. An array of preparedness efforts, such as the development of mechanisms for distributing vaccine, ultimately put the state in a strong position to deal with H1N1 come fall, but health officials still experienced considerable difficulty in several areas, including vaccine delivery, communicating with an anxious public, and managing a surge of patients seeking care.
In the spring of 2009, cases of a previously unidentified strain of influenza began appearing in Mexico and the southwestern U.S. Within just a few months, outbreaks of 2009 Novel H1N1 (commonly referred to as Swine Flu) were so widespread that the World Health Organization declared its first influenza pandemic in over forty years. This case focuses on how state health officials in Texas, which experienced some of the first cases of H1N1, organized a response to the disease in the face of considerable uncertainty regarding its contagiousness, lethality, and geographic spread.