by NOAA on an hourly basis. Not so with fog. Fog comes and goes quickly, stealthily, and silently. There is no other weather event on the seas during which the safety of your boat and crew is so dramatically dependent on the skills, talent, and actions of other boaters and where captains’ (leaders’) responsibility to other boaters and their passengers can be so great. Fog makes it very difficult to see and be seen. It can arise quickly, making it difficult to keep your bearings and orientation. Fog impacts sound frequencies, making it difficult to understand which direction sound is rising from, thus increasing the risk of collision and running aground with the potential for damage and injury.

The leadership of every healthcare business, organization, practice, and team faces similar moments of restricted visibility - analogous to a fog or being present in a fog that descends and thickens rapidly. The actions of the captain and crew can be like those of the leadership of any organization, especially complex organizations, such as hospitals, health systems, or practices caring for people with complicated illnesses and therapies facing operational challenges that bring even greater complexities and chaos during moments of crisis.

If despite your carefully developed year-end planning and plotting of course you find yourself suddenly in a fog, consider the following:

• Take Time – Slow down to take appropriate time to assess the situation. On a boat, the rule of thumb is to be able to stop within half of the visible distance of an object. Likewise, don’t overact on your initiatives when carefully crafted strategies meet uncertainty. There is no harm to assess rather than change blindly in uncertainty, assuming all will be well.

• Take Care – Take care of yourself and your staff. When in challenging circumstances that are changing rapidly and forcing uncertainty, check on those you care for and make sure the crew and passengers are prepared. Everyone should be wearing a life jacket with communication capabilities. In short, ambiguity of direction and focus are sensed by everyone in challenging times. This necessitates the leadership to prepare in advance for contingencies by having a backup plan for a host of issues such as those in supply chain, staffing shortages, workflows, communication, and monitoring of quality and safety measures.

• See and be Seen – Up your visibility to the staff, passengers, and other crew. Communicate more frequently and be seen and heard in command mode. Make sure your running lights are on – you must be seen.

• Use your Tools and Communicate Frequently – Preparing and being able to use technology and heightened workflow processes during the event is critically important. On a boat, VHF radio monitors NOAA (National Oceanic and Atmospheric Administration) formats during fog conditions and enables communication with other boaters. Dangers around or in proximity can be tracked by radar and AIS (Automatic Identification System) - technology using transceivers on boats/ships that transmit data on vessel identity, location, and closest points of approach; fish finder and sonar to assist in knowing position against charted depths; etc. Analogous modalities exist in healthcare organizations. (Dashboards; CDC; local and state agency tracking and communication; specialty society notifications; etc.)

• Common Sense and Your Previous Experiences – Wisdom is still needed to interpret events and data. Prior experience builds good reflexes and wisdom. Your well-trained team is an asset in these situations as well—tap into their wisdom and prior experiences.

All of the above contribute to vessel (organization) readiness, safety, and successful navigation (workflows and processes) and seamanship (leadership) provided there has been thoughtful planning and training in advance.