The Resilient Systems Series, Insight 2

Professional Insights on Healthcare Preparedness, Public Health Leadership, Project Management, and Organizational Resilience

Volume I: Building Resilient Healthcare Organizations

Professional Insight No. 2

The Biggest Mistakes Organizations Make When Conducting Exercises

"Preparedness isn't proven during an exercise—it is strengthened by what an organization chooses to do after the exercise ends."

In This Insight…

Emergency preparedness exercises are among the most valuable tools organizations have to improve their ability to respond to crises. Yet many exercises fall short of their potential—not because they are poorly organized, but because they are designed or evaluated with the wrong objective.

In this insight, we'll explore the most common mistakes organizations make when conducting exercises and discuss practical strategies to transform exercises from annual requirements into catalysts for organizational resilience.

This builds upon Professional Insight No. 1, where we explored why emergency preparedness should be viewed as a project management discipline. Just as successful projects rely on planning, stakeholder engagement, risk management, and continuous improvement, successful exercise programs depend on thoughtful design, honest evaluation, and meaningful follow-through.

Why We Conduct Exercises…

Whether responding to a cyberattack, severe weather event, mass casualty incident, infectious disease outbreak, or infrastructure failure, organizations cannot expect to perform effectively under pressure if they have never practiced working together.

Exercises provide a structured environment to validate plans, strengthen relationships, test decision-making, and identify opportunities for improvement before lives, operations, or critical services are at stake.

National preparedness doctrine emphasizes that exercises are intended to improve capabilities—not simply satisfy regulatory or accreditation requirements. Organizations that approach exercises with a learning mindset consistently build stronger preparedness programs than those focused solely on compliance.

Preparedness is not about predicting every possible emergency. It is about developing adaptable people, processes, and partnerships capable of responding effectively regardless of the situation.

Figure 1. The Preparedness Improvement Cycle

PLAN

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TRAIN

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EXERCISE

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EVALUATE

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IMPROVE

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   └───────────────^

Continuous Learning…

Organizations become more resilient by repeating this cycle—not by completing it once.

Mistake #1: Treating Exercises as a Compliance Requirement

One of the most common pitfalls is viewing exercises as something that must simply be completed each year.

When the primary objective becomes "checking the box," organizations often focus more on documentation than organizational learning.

Exercises should instead answer questions such as:

• Where are our greatest vulnerabilities?

• What assumptions are we making?

• Which partnerships require strengthening?

• How well do our systems function under stress?

Organizations that continuously ask these questions develop stronger capabilities over time because they prioritize improvement over completion.

Mistake #2: Designing Exercises That Are Too Predictable

• Real emergencies are dynamic.

• Information changes.

• Resources become limited.

• Personnel are unavailable.

• Technology fails.

• Competing priorities emerge.

• Exercises should reflect this complexity.

Well-designed scenarios encourage participants to adapt rather than simply follow a written plan. Introducing realistic challenges helps organizations evaluate how they communicate, coordinate, and make decisions when conditions change unexpectedly.

The goal is not to overwhelm participants—it is to create an environment where thoughtful discussion and adaptive problem-solving can occur.

Mistake #3: Limiting Participation

Preparedness is often perceived as the responsibility of emergency management professionals alone.

In reality, healthcare preparedness is an organizational responsibility.

Effective exercises should involve representatives from multiple disciplines, including:

• Executive leadership

• Clinical operations

• Nursing

• Information technology

• Security

• Facilities

• Supply chain

• Human resources

• Communications

• Finance

• Community partners

Every department brings unique expertise and perspectives that contribute to stronger decision-making.

When diverse stakeholders participate together, organizations gain a much clearer understanding of how decisions in one area affect operations across the entire system.

Mistake #4: Mistaking Success for Learning

Many organizations conclude an exercise by asking:

• "Did we successfully complete the objectives?"

While this question has value, a more meaningful question is:

• "What did we learn that we didn't know before today?"

Exercises should uncover:

• Communication challenges

• Policy gaps

• Unclear roles

• Resource limitations

• Decision-making obstacles

• Opportunities for collaboration

Finding these issues during an exercise is a success—not a failure.

Organizations that embrace constructive evaluation become more adaptable and resilient over time.

Mistake #5: Failing to Complete the Improvement Cycle

Perhaps the greatest missed opportunity occurs after the exercise concludes.

• An After Action Report is developed.

• Recommendations are documented.

• Meetings are held.

• Then daily operations resume.

Months later, many of the same issues appear during the next exercise.

Preparedness does not improve because recommendations are written.

It improves because recommendations are implemented.

Every improvement item should have:

• A clearly identified owner

• Defined actions

• Realistic timelines

• Leadership oversight

• Measurable outcomes

Without accountability, valuable lessons are easily lost.

Leadership Lens…

Preparedness exercises are often viewed as operational events.

In reality, they are leadership development opportunities.

Exercises reveal how leaders communicate during uncertainty, make decisions with incomplete information, prioritize competing demands, and build trust across departments.

Perhaps most importantly, they demonstrate whether organizational culture encourages learning or discourages vulnerability.

Leaders who openly acknowledge opportunities for improvement create environments where innovation, collaboration, and continuous learning can flourish.

Preparedness begins with leadership long before an emergency begins.

Figure 2. From Exercise to Organizational Resilience

Exercise

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Lessons Identified

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Corrective Actions

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Leadership Support

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Operational Improvements

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Greater Organizational Resilience

From the Field…

One multidisciplinary preparedness exercise I supported brought together healthcare organizations, public health professionals, emergency management partners, and community stakeholders to work through a rapidly evolving incident.

Early in the discussion, participants focused on finding the "correct" answer to each scenario.

As additional challenges were introduced, however, the conversation changed.

Instead of asking, "What's the right response?" participants began asking:

• Who else should be involved?

• What assumptions are we making?

• What happens if this resource isn't available?

• How would this decision affect our partners?

Those conversations proved to be far more valuable than any individual decision made during the exercise.

Several improvement opportunities were identified, communication pathways were refined, and participants left with a stronger appreciation for the importance of collaboration.

The exercise demonstrated an important truth: preparedness is less about having perfect plans and more about developing organizations that can learn, adapt, and solve problems together.

Practical Actions for Leaders…

To maximize the value of future exercises, consider the following:

• Design scenarios that challenge decision-making rather than test memorization.

• Include multidisciplinary participants and executive leadership whenever possible.

• Foster an environment where honest discussion is encouraged and improvement is celebrated.

• Assign owners and timelines for every corrective action.

• Review progress on improvement items before conducting the next exercise.

Measure success by organizational improvements—not by how smoothly the exercise ran.

Preparedness is strengthened through deliberate practice and continuous refinement.

Key Takeaways…

Exercises are learning opportunities—not performance evaluations.

• Realistic complexity creates more meaningful discussion and stronger preparedness.

• Leadership participation significantly enhances organizational resilience.

• Corrective actions only matter when they are implemented.

• Continuous improvement is the foundation of long-term preparedness.

Reflection Questions…

Consider your own organization:

• Do exercises challenge assumptions or simply validate existing plans?

• Are leaders actively engaged throughout the preparedness cycle?

• Are lessons from previous exercises visibly reflected in current plans and procedures?

• Does your organizational culture reward learning as much as success?

The answers to these questions often reveal the true maturity of a preparedness program.

Looking Ahead…

In Professional Insight No. 3, we'll shift from individual exercises to the broader concept of organizational resilience. We'll explore why resilient healthcare organizations are distinguished not by the absence of crises, but by their ability to adapt, collaborate, and continuously improve in the face of uncertainty.

References…

• Homeland Security Exercise and Evaluation Program (HSEEP), Federal Emergency Management Agency.

• Health Care Preparedness and Response Capabilities for Health Care Coalitions, Administration for Strategic Preparedness and Response.

• Public Health Emergency Preparedness and Response Capabilities, Centers for Disease Control and Prevention.

• Emergency Management Standards, The Joint Commission.

• A Guide to the Project Management Body of Knowledge (PMBOK® Guide), Project Management Institute.

About the Author…

Jessica Skelton, MPH, PMP, CHES, CPH, CEDP, CHEP is a public health and emergency preparedness professional with experience leading healthcare preparedness initiatives, regional collaboration, project management, training and exercises, and organizational resilience efforts across healthcare and public health systems. She is passionate about helping organizations build practical, sustainable capabilities through collaboration, leadership, and continuous improvement.