Organizational Adaptation Under Stress: Tracing Communication Processes in Four California County Health Departments During the H1N1 Threat, April 28, 2009, to March 11, 2011

Urgent public health threats present a growing problem for public health surge. This study addresses tensions that occur in organizations as they confront unexpected, urgent demands for performance that exceed their existing allocation of resources and personnel, patterns of adaptation in response, and consequences for continued functionality in their mission. We view the problem through a conceptual lens of complex adaptive systems and distributed cognition to focus on patterns of organizational communication as critical factors in shaping organizational response to crisis operations. We employ a mixed-methods approach to examine communication and coordination patterns in a small-N comparative case study of four California county health departments during the H1N1 threat in late spring–summer of 2009 and the following 24 months. Findings indicate factors that contribute to, or inhibit, the communication process, such as organizational structure, past experiences, exercise of authority, and document the occurrence of defensive routines as a distortion of internal communication practices. Communication and coordination within and among entities engaged in response operations are critical to managing urgent public health threats, indicating that mechanisms which place a cognitive burden on staff exacerbate existing problems in performance