MY QUALITY STORY
5 things cruising through a global pandemic teaches you about mitigating risk
by Denise Wrestler
I assumed my nineteenth cruise would be a repeat of my previous 18—an all-you-can-eat ocean paradise, surrounded by college kids and little old ladies on motor scooters. My family and I would sleep in every day, eat ice cream for breakfast and make our way to the lido deck for a round of the electric slide in our swimsuits. I don’t consider myself an expert at much, but I think it’s safe to say that I’m an expert cruiser.
Cruise No. 19 had everything a typical cruise would include, but with one glaring difference—a pandemic was growing just outside of our secluded floating oasis. And we had no idea how bad it would get over the course of our seven days at sea.
Our cruise line made it clear through numerous emails that despite growing concerns over COVID-19, it was taking every precaution to ensure the safety of its cruisers and staff. Common knowledge will tell you a cruise ship is by far one of the most susceptible locations for catching illnesses. They aren’t referred to as floating petri dishes for nothing. But the emails convinced us we would be OK, and my family and I were in the 20% of cruisers who decided not to cancel our vacation—despite warnings from the U.S. government.
I also justified this vacation as a way to gather data on the risk mitigation efforts the cruise line industry was taking to combat the virus and the negative publicity that came with it. Anything for science!
Here are the five risk mitigation strategies the cruise line used:
- Limit the user population
At the port terminal in Miami—after the paperwork, passport checks, security scans and barrage of photo opportunities—was a large man wearing medical gloves and holding a handheld laser thermometer testing every person boarding the ship to determine whether that person was running a fever. If the thermometer alerted, the cruiser was taken to a separate area for further medical evaluation.
Ultimately, the cruise line was selecting the population allowed on the ship through noninvasive forehead scanning. The cruise line’s first line of defense against a respiratory virus spreading on the ship was to remove the biggest variable—people who were already symptomatic.
For most industries, the intended user population dictates where risk mitigation starts. A medical device meant for adults, for example, should not be used on children. Also, prescription drugs contain warnings for individuals whose other medical conditions may interact with the drug. When additional risk mitigation is—or is not—needed, it’s always a good idea to start with the consumer and end user. Limiting the use of your product to a specific group can be a major mitigation for more severe risks.
- Protect users from themselves
The first thing everyone noticed when we boarded the ship was the increased number of handwashing stations and antibacterial hand sanitizer dispensers located throughout the ship. But this increased mitigation apparently wasn’t enough because by day three, crew members were positioned at each station, insisting every cruiser who walked by use them. By day four, their insisting became much more aggressive, and by day seven, debarking cruisers were grumbling about their overly dry hands.
The cruise line mitigated the risk of spreading the virus by first addressing the No. 1 tool used to spread illnesses—hands. The Centers for Disease Control and Prevention recommends washing your hands, or using hand sanitizer when soap and water are unavailable, before eating food.1 Considering a good portion of any cruise involves eating, it seemed the best option was to put handwashing stations and hand sanitizer dispensers near all areas with food. The cruise not only implemented that recommendation, but also reinforced it with a small army.
- Apply user limitations
My family and I like ice cream and will shamefully make several trips to the frozen yogurt and soft-serve machines on the lido deck throughout any cruise. To our surprise, this cruise included dedicated crew members whose sole responsibility was to provide swirled cones for any guest who asked for one, eliminating the need for multiple hands to touch the machines.
What we thought would be a pleasant perk quickly turned into uncomfortable encounters. We had to look away from the workers’ judgmental eyes as we went for our third and fourth cones (for breakfast). We knew which crew members worked which ice cream stations, who made huge ice cream masterpieces—and who did not. The simple act of getting an ice cream cone became a calculated, strategic game.
It wasn’t just the ice cream. There also were dedicated servers for all the buffet items. Now, the black shiny spoons shoved into the vats of potato salad were facing away from the cruisers as we shuffled through the buffet line, and the crew members now dictated how much potato salad went onto our plates.
Like the cruise line industry, it is the responsibility of product designers to ensure the safety and effectiveness of their products. Often, that includes poka-yoking the design to keep consumers safe from themselves. Poka-yoke is a common process analysis tool that uses any automatic device or method that either makes it impossible for an error to occur or makes the error immediately obvious after it has occurred.2 Applying limitations often can serve as a great mitigation tool when others may not be practical or effective.
- Increase your preventive maintenance program
Have you ever been in an elevator and stared at the buttons, wondering how many fingers have pressed them? How often are the buttons cleaned? If they are cleaned, are they also disinfected?
It was on cruise No. 19 that I learned just how many cleaning activities were taking place between 3 a.m. and 6 a.m., when most people were sound asleep. The wands of steam cleaners were swept across elevator buttons and handrails, buckets of overpowering bleach solution were scattered across the hallways and crew members scoured the walls wearing oversized rubber gloves. The activities were far more than any I had observed on cruises one through 18, which mostly included simply hosing off the lido deck and wiping the evening dew off the pool lounge chairs.
The cruise line was fully aware of what a confirmed case of COVID-19 would do to its business. One of the best mitigations it put in place was increasing its already established cleaning activities, thus increasing the preventive measures it already had in place to combat the latest outbreak it was facing. Often, simply increasing the occurrence of already established mitigations is an effective mitigation strategy.
Not only are cruise lines faced with risk mitigation associated with minimizing the spread of a virus, but the industry also is faced with the fallout from negative publicity, and ultimately, decreased sales. To combat the rising number of cancellations, my cruise line offered an onboard cash incentive for keeping and honoring the original booking. My family and I used that extra $400 to buy an internet plan to stay updated with events and school closings, and, of course, fancy drinks served in coconuts with little paper umbrellas. Although we already had committed to keeping our original plans, the extra monetary incentive was enough to keep many other cruisers from canceling their trips.
Incentivizing people as a risk mitigation strategy may be a new idea to many. More common than not, risk mitigation actions are a result of negative risks—they are actions to keep something negative from occurring or recurring. But what about actions that mitigate risks that aren’t even considered risks yet? What about preventive actions that can be put in place to lower the severity of a risk or potential risk? This out-of-the-box thinking can be used as a tool to address risks before they even become an issue.
The day we returned to the Port of Miami also was the day all cruise lines officially suspended operations. Despite all the risk mitigation efforts and implementation, despite the high detection and low occurrence, the severity of some risks is too high to mitigate to an overall acceptable level.
As we headed to the airport and saw the thousands of stranded incoming would-be cruisers struggling to find return flights, we were grateful for the amazing vacation we had, and for coming home safe and healthy.
- Centers for Disease Control and Prevention, “When and How to Wash Your Hands,” https://tinyurl.com/how-to-handwash.
- ASQ, “What Is Mistake Proofing?” https://asq.org/quality-resources/mistake-proofing.
Denise Wrestler is an independent quality assurance/regulatory assurance consultant for CYA Medical Device Consulting in Dallas. She holds a bachelor’s degree in chemical and biomedical engineering from the University of California, Irvine. An ASQ member, Wrestler is an ASQ-certified quality auditor and engineer.