On January 1 this year, Geneva University Hospital received a call just before 5 a.m. Earlier that night, a fire broke out at a packed bar in Crans-Montana during New Year celebrations. Forty individuals lost their lives, and over a hundred suffered injuries, many of them young and burned severely. No single hospital, or even country, could handle all the victims. Patients were quickly transferred to burn centers in Lausanne, Zurich, and further to Paris, Milan, and Stuttgart. For days, hospitals across several countries functioned as a unified system. No plan prepared health leaders for this incident. This highlights a challenging truth: future crises will differ from past ones. They might involve mass casualties, extreme heat, cyberattacks, supply chain disruptions, or new viruses. Potentially, several such events could occur simultaneously.

Lessons Learned

From almost three decades with the International Committee of the Red Cross (ICRC), including four years as director-general, and serving as CEO of one of Europe’s largest university hospitals, I learned a key lesson: resilience is a governance method, not just a plan.

Preparedness and Resilience

Health systems are often assessed by their preparedness levels. Do they have emergency plans? Are beds and critical supplies sufficient? These questions, while necessary, don’t reveal how an organization acts when reality diverges from plans, which it inevitably does.

Five critical actions determine if a system performs under pressure: anticipate, decide, mobilize, adapt, and learn.

Anticipate

Anticipation isn’t about predicting. It’s about asking key questions before pressure mounts. During the G7 summit in Evian, France, potential violence from demonstrations was a concern. Preparations included opening 40 more beds, reducing planned surgeries, setting up tents for tear gas exposure, and issuing over 5,000 cross-border passes for staff. Although no major incidents occurred, the effort wasn’t wasted. It clarified decision-making processes, exposed relationship gaps, and underscored preparation’s role in building lasting capability.

Decide

Information in crises often arrives fragmented. Waiting for certainty can be a poor decision. At the ICRC, remote heads often couldn’t wait for Geneva’s instructions. They received clear intent and firm guidance instead. Similarly, hospitals need explicit delegation of decision-making. Crises target ambiguity, so good leadership manages uncertainty effectively.

Mobilize

People and trust, more than technology or infrastructure, drive system responsiveness. Trust develops beforehand through prior engagement. On the night of the Crans-Montana fire, our hospital received five patients while assisting Lausanne with medicines and deploying ambulances. Resilience governance involves understanding vulnerabilities within the ecosystem beyond just the hospital.

Adapt

Even well-made plans face reality. During summer, Geneva’s heat plan was activated. However, some older buildings reached over 86°F. A nurse highlighted deficiencies, offering solutions. This feedback was more telling than system indicators. Plans require periodic updates to remain relevant.

Learn

In 2017, a crucial IT storage system failed at our hospital. Its designed redundancy didn’t activate. This was a humbling lesson: redundancy on paper differs from actual practice. Thus, we instituted round-the-clock security monitoring, paper-based patient care procedures, and regular system testing. Effective learning results in tangible changes post-crisis.

Approximately 30 years ago, Professor Didier Pittet and his team addressed a hospital-wide issue: infections spread via caregivers’ hands. Their solution, alcohol-based hand rubs, was shared globally through the WHO. This represents experience turned into public capability. Nassim Nicholas Taleb describes this as antifragility, but I view it as adaptive growth.

Moving Forward

Executives and boards should contemplate these questions outside crises:

• Who decides during emergencies, and are they informed?
• Which dependencies could cripple us, and are backups tested?
• Who are our critical contacts, and have we interacted with them?
• When did frontline feedback prompt a plan change?
• What changes did the last crisis prompt?

The answers weren’t improvised on New Year’s morning. They resulted from sustained efforts on ordinary days. Surprises will continue to arise. Our task is to ensure readiness and capitalize on shocks for growth. Robert Mardini is director-general of Geneva University Hospital and a member of the Newsweek CEO Circle.