tag:theconversation.com,2011:/institutions/university-of-portland-2556/articlesThe University of Portland2021-11-12T13:35:55Ztag:theconversation.com,2011:article/1677632021-11-12T13:35:55Z2021-11-12T13:35:55ZNurses don’t want to be hailed as ‘heroes’ during a pandemic – they want more resources and support<figure><img src="https://images.theconversation.com/files/430377/original/file-20211104-13-k52yd1.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1024%2C683&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The COVID-19 pandemic has left many nurses feeling burned out, and its long-term effects on the profession are unknown.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/nurse-takes-care-of-a-patient-infected-with-covid-19-in-the-news-photo/1235124543">JEFF PACHOUD/AFP via Getty Images</a></span></figcaption></figure><p>Nurses stepped up to the challenge of caring for patients during the pandemic, and over <a href="https://www.theguardian.com/us-news/ng-interactive/2020/aug/11/lost-on-the-frontline-covid-19-coronavirus-us-healthcare-workers-deaths-database">1,150 of us have died from COVID-19</a> in the U.S. As cases and deaths surge, nurses continue working in a broken system with <a href="https://oig.hhs.gov/oei/reports/oei-06-20-00300.asp">minimal support and resources</a> to care for critically sick patients, many of whom will still die.</p>
<p><a href="https://scholar.google.com/citations?user=ZUV-5awAAAAJ&hl=en">We</a> <a href="https://www.up.edu/academics/faculty-profiles/chloe-littzen.html">are</a> nurses and nurse scientists who <a href="https://repository.arizona.edu/handle/10150/660275?show=full">study nurse well-being</a> during the COVID-19 pandemic. One of our studies, which asks <a href="http://tiny.cc/COVIDDisclosure">health care workers to share voicemails</a> about their experience providing care during the COVID-19 pandemic, is ongoing. What we have found across our studies is that nurses are struggling, and without help from both the public and health care systems they may they leave nursing altogether. </p>
<p>To help you understand their experiences, here are the five key takeaways from our studies on what nursing has been like during the COVID-19 pandemic.</p>
<h2>1. Calling nurses ‘heroes’ is a harmful narrative</h2>
<p>Nurses demonstrated that they will do almost anything for their patients, even <a href="https://khn.org/news/these-front-line-workers-could-have-retired-they-risked-their-lives-instead/">risking their own lives</a>. As of the end of December 2020, <a href="https://www.icn.ch/news/covid-19-effect-worlds-nurses-facing-mass-trauma-immediate-danger-profession-and-future-our">more than 1.6 million health care workers</a> worldwide had been infected by COVID-19, and nurses make up the largest affected group in many countries. </p>
<p>For this, <a href="https://doi.org/10.1016/j.ijnurstu.2021.103887">nurses have been hailed as heroes</a>. But this can be a dangerous label with negative consequences. With this hero narrative, expectations of what nurses should do become unrealistic, such as working with <a href="https://repository.arizona.edu/handle/10150/660275?show=full">inadequate resources, staffing and safety precautions</a>. Consequently, it becomes normalized for nurses to work longer hours or extra shifts without consideration for how this may affect them personally. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="ICU nurse at computer with hand over their masked face." src="https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430510/original/file-20211105-17-w4y8z8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The hero narrative surrounding nurses could exacerbate burnout.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakLouisianaHospital/dbff33d1da064b099139239d6b727dc7">AP Photo/Gerald Herbert</a></span>
</figcaption>
</figure>
<p>This ultimately could result in nurses’ leaving the profession because of burnout. A survey conducted by the American Association of Critical-Care Nurses of over 6,000 ICU nurses found that <a href="https://www.aacn.org/newsroom/hear-us-out-campaign-reports-nurses-covid-19-reality">66% of respondents were considering leaving nursing</a> as a result of their care experiences during the pandemic. Similarly, we found that <a href="http://hdl.handle.net/10150/660275">67% of nurses under 30</a> are considering leaving their organizations within the next two years.</p>
<p>The nurses in our studies put the needs of their patients and society above their own. This is how one young nurse described their experience caring for COVID-19 patients without any safety guidance: “There was a palpable tenseness being there … nobody knew what was going on or what was expected. There was no real protocol yet. If a patient was admitted and you had to take care of one, you kind of felt like you were being thrown to the wolves as an experiment.”</p>
<h2>2. Nurses lack adequate resources or support</h2>
<p>Nurses have cared for patients despite working in <a href="https://www.osha.gov/coronavirus/hazards">hazardous work environments</a>. While some health care organizations have offered <a href="https://www.nbcnews.com/business/business-news/rural-hospitals-losing-hundreds-staff-high-paid-traveling-nurse-jobs-n1279199">increased pay to travel nurses</a>, or contracted temp nurses to address staffing shortages, that offer hasn’t been extended to their full-time staff. Many organizations instead require overtime and don’t provide adequate resources, <a href="https://www.who.int/news/item/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide">such as personal protective equipment</a> or <a href="https://www.wsj.com/articles/high-pay-for-covid-19-nurses-leads-to-shortages-at-some-hospitals-11630253483">support personnel</a>, for safe patient care. This has left many nurses feeling unappreciated, undervalued and unsafe.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Health care workers huddled at an ICU nursing station at night." src="https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430378/original/file-20211104-21790-1sffzjs.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Inadequate institutional support during the pandemic left nurses working long hours in hazardous conditions.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/several-healthcare-workers-working-in-the-icu-of-the-san-news-photo/1306877903">Alvaro Calvo/Stringer via Getty Images News</a></span>
</figcaption>
</figure>
<p>As one nurse from our study explained: “Lack of resources, lack of staffing, lack of getting all our concerns addressed, things like that. Those are very draining, especially when we’re supposed to provide patient care and do a good job. … All the drama from work and things like that, those don’t help. If anything, it just makes the environment more toxic and unbearable, definitely, and at one point, it will start affecting … your mental health and your physical health, even your spiritual health.”</p>
<h2>3. Nurses lost trust in health care organizations</h2>
<p>Nurses said they struggled with <a href="http://hdl.handle.net/10150/660275">rapidly changing policies and procedures</a>. Even when they were given information about these changes, many health care organizations weren’t transparent about the reasons behind them and expected nurses to just roll with the punches. </p>
<p>Even worse, some health care organizations gaslit nurses for being concerned for their own safety. One young inpatient nurse, for example, described frustrations with lack of communication from management: “They just weren’t telling us much of anything. We have three managers and seven clinical coordinators on our unit. There were definitely enough people to be sending emails and to be giving updates, but they were so unsure as well that they just kind of opted for radio silence, which was really frustrating and made the whole situation more challenging. When they were giving us information, a lot of it was, you guys are overreacting. You don’t need to wear N95s all the time.” </p>
<p>The safety sacrifices nurses have made for their organizations and patients has led to severe mental health consequences. In <a href="https://doi.org/10.1097/01.NUMA.0000752784.86469.b9">one study</a> of 472 nurses in California, 79.7% reported anxiety and 19% met the clinical criteria for major depression.</p>
<p>Another nurse in our study had a similar experience: “Our policies were changing so rapidly that oftentimes anesthesia would have a different understanding [of the policy], the doctors and residents would have a different understanding, and nursing would have gotten a different email always within like a half-hour. It was extremely frustrating. It was very, very stressful.”</p>
<h2>4. Nurses experience morally traumatic events</h2>
<p>Nurses have been exposed to a substantial amount of <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp">moral injury</a>, which occurs when they witness, perpetuate or fail to prevent something that contradicts their beliefs and expectations. </p>
<p>Not only have nurses seen a high volume of deaths every day, but they have also been placed in morally difficult situations due to resource shortages, such as <a href="https://www.usnews.com/news/us/articles/2021-08-31/oxygen-supplies-grow-precarious-amid-covid-surge">oxygen supplies</a>, <a href="https://www.miamiherald.com/news/coronavirus/article254289313.html">ECMO machines</a> that support heart and lung function, and <a href="https://www.nytimes.com/2020/11/27/health/covid-hospitals-overload.html">hospital beds and staff</a>. Even more routine aspects of care, such as basic hygiene, <a href="https://dx.doi.org/10.1111%2Fjan.15013">were neglected</a>, further contributing to nurse moral distress.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Nurse hunched over with head in hands." src="https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=513&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=513&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=513&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=645&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=645&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430375/original/file-20211104-22514-1cj1jbk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=645&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The moral injury that nurses sustain can take a toll on their mental health.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakOregon/e91d8625b38846e5869cbbd8b47b557c">AP Photo/Hanin Najjar</a></span>
</figcaption>
</figure>
<p>One nurse in our study described their experience of moral distress in making life support decisions for patients: “We were told very early on … if this person needs a ventilator, they are not going to get it. So, in a way, we were determining code status without really consulting the patient, which to me is very problematic and unethical.”</p>
<h2>5. Nurses are frustrated by the public’s not taking the pandemic seriously</h2>
<p><a href="https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/masking-science-sars-cov2.html">Masks</a> and <a href="https://www.cdc.gov/coronavirus/2019-ncov/variants/delta-variant.html">vaccines</a> are proven to help prevent the spread of COVID-19. Yet some Americans <a href="https://www.bbc.com/news/world-us-canada-53477121">still refuse to mask</a>, and, as of Nov. 1, 2021, <a href="https://www.kff.org/coronavirus-covid-19/issue-brief/latest-data-on-covid-19-vaccinations-by-race-ethnicity/">only 67% of the population</a> has received at least one dose of the vaccine.</p>
<p>According to the CDC, 92% of COVID-19 cases and hospitalizations, and 91% of COVID-19-related deaths, were among individuals who were <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7037e1.htm">not fully vaccinated</a> between April and July 2021. Conversely, only 8% of COVID-19 cases and 9% of deaths were among fully vaccinated individuals. </p>
<p>Nurses care for patients regardless of vaccination status. Unfortunately, what the public may not realize is that their decision to decline vaccination or masking has serious consequences not only for nurses, but also their friends and community members. When hospital systems are overwhelmed with unvaccinated COVID-19 patients, there may be limited staff or resources to help those who need <a href="https://www.wsj.com/articles/hospitals-swamped-with-delta-cases-struggle-to-care-for-critical-patients-11630661403">care for other medical emergencies</a>. This is a frustrating experience for nurses who find themselves unable both to care for every patient in need and to protect people from contracting COVID-19.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="ICU nurse hugging sister of patient who had just died." src="https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/430509/original/file-20211105-10584-ao5cuo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Nurses not only see a large number of COVID-19 deaths firsthand, they may also need to provide comfort for those left behind.</span>
<span class="attribution"><a class="source" href="https://newsroom.ap.org/detail/VirusOutbreakLouisianaHospital/39bcdab213ec4d41a51627e74aa4b3e1">AP Photo/Gerald Herbert</a></span>
</figcaption>
</figure>
<p>A nurse in one of our studies recalled having to chase after an unvaccinated pregnant person with COVID-19 who attempted to leave the ICU against medical advice, despite the risk that she might infect other people: “This was so early [in the pandemic], we didn’t know how far [the virus] would travel. So I’m, like, is she going infect the staff in the lobby? Are there people down there? You know, she’s just going to go home and give this to her newborn. And … her husband looked at me and said, you know, basically Western medicine isn’t real and this isn’t real and I’m, like, OK, this is real. And I’m, like, you’re going to give it to your newborn and your five kids.”</p>
<h2>How you can help nurses</h2>
<p>As the pandemic continues to overwhelm hospitals and communities across the U.S., its effects on nurses need to be carefully considered. Exhausted and demoralized nurses are <a href="https://www.nbcnews.com/health/health-news/u-s-hospitals-hit-nurse-staffing-crisis-pandemic-rages-n1278465">already quitting or retiring</a> at alarming rates.</p>
<p>[<em>Over 115,000 readers rely on The Conversation’s newsletter to understand the world.</em> <a href="https://theconversation.com/us/newsletters/the-daily-newsletter-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=100Ksignup">Sign up today</a>.]</p>
<p>Only time will tell what long-term effects the COVID-19 pandemic will have on the nursing profession. But the public and health care organizations can step up to help nurses now by increasing access to mental health support and providing adequate resources, safe working conditions and organizational transparency during times of immense change. And everyone can help by protecting themselves from COVID-19 through masking and vaccination.</p><img src="https://counter.theconversation.com/content/167763/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jessica Rainbow receives funding from the National Institute of Occupational Safety and Health, National Council of State Boards of Nursing Center for Regulatory Excellence, The University of Arizona College of Nursing, and HRSA. The study described in this piece was unfunded.</span></em></p><p class="fine-print"><em><span>Chloé Littzen receives funding from the Sigma Theta Tau International Beta Mu Chapter of the University of Arizona.</span></em></p><p class="fine-print"><em><span>Claire Bethel does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Exhausted and demoralized nurses are leaving the profession at alarming rates as the COVID-19 pandemic drags on.Jessica Rainbow, Assistant Professor of Nursing, University of ArizonaChloé Littzen, Assistant Professor of Nursing, University of PortlandClaire Bethel, Adjunct Instructor of Nursing, University of ArizonaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/567912016-05-04T10:11:18Z2016-05-04T10:11:18ZCan you imagine a world without Budweiser? We can<figure><img src="https://images.theconversation.com/files/121078/original/image-20160503-17469-13kpvo8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Long live the king?</span> <span class="attribution"><span class="source">Bud beer via www.shutterstock.com</span></span></figcaption></figure><p>Budweiser, the so-called King of Beers, may be on its last kegs.</p>
<p>It may seem odd to picture the demise of the flagship brand of the world’s largest beer company. But Anheuser-Busch – the U.S.-based unit of AB InBev – is following in the footsteps that led to the irrelevance of a host of other once-dominant companies – <a href="http://www.forbes.com/sites/daviddisalvo/2011/10/02/what-i-saw-as-kodak-crumbled/#6727d0e920f5">Eastman Kodak</a>, <a href="http://www.nytimes.com/1997/07/18/business/woolworth-gives-up-on-the-five-and-dime.html">Woolworth’s Department Stores</a>, <a href="http://www.innosight.com/innovation-resources/upload/Disruptive-Innovation-Primer.pdf">Bethlehem Steel</a> and <a href="https://hbr.org/2013/11/blockbuster-becomes-a-casualty-of-big-bang-disruption">Blockbuster Video</a>, to name a few. </p>
<p>While AB InBev <a href="http://fortune.com/2015/10/30/ab-inbev-earnings/">shareholders are cheering</a> each move to boost short-term profitability by snapping up other companies – <a href="http://www.bloomberg.com/news/articles/2016-01-14/ab-inbev-faces-in-depth-u-s-antitrust-review-on-sabmiller-deal">including the US$110 billion takeover</a> of rival SABMiller – CEO Carlos Brito may be unwittingly digging Anheuser-Busch’s grave by ignoring long-term trends. </p>
<p>How could the rational pursuit of profits and growth through acquisition mean the beginning of the end for Anheuser-Busch? </p>
<p>This, we would argue, is a case of <a href="https://hbr.org/2015/12/what-is-disruptive-innovation">disruption theory</a> in action. And the disruptors are the growing ranks of craft brewers that are collectively changing the industry and beer consumption habits as consumers <a href="http://www.businessinsider.com/many-millennials-havent-tried-budweiser-2014-11">increasingly shun Anheuser-Busch and its products</a> – the disrupted – for beers made locally and with a wider variety of higher-quality ingredients. </p>
<p>It’s something we’ve witnessed firsthand, in our own research and through an online community called <a href="http://craftingastrategy.com/">Crafting A Strategy</a> that two of us set up to share knowledge in the beer industry.</p>
<iframe src="https://datawrapper.dwcdn.net/ftDmm/1/" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="450"></iframe>
<h2>New market disruption</h2>
<p>Harvard Business School Professor Clay Christensen coined the phrase “<a href="http://www.claytonchristensen.com/books/the-innovators-solution/">disruptive innovation</a>” in 1995 to describe how a new product or service initially takes root at the bottom of a market and then relentlessly moves upmarket, eventually displacing established competitors.</p>
<p>Eight years later he and Michael Raynor <a href="http://www.claytonchristensen.com/key-concepts/">described three criteria needed for a new market disruption</a> to occur. </p>
<p>Let’s consider each criterion in turn in the case of the beer industry. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=380&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=380&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=380&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=478&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=478&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121091/original/image-20160504-17469-le5ax4.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=478&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Prohibition became the law of the land in 1919.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/cizauskas/23789036064/in/photolist-Cfa2Cd-9bs2sF-obEyZU-dk3poM-ouz5H9-7DeB9p-6Xgo91-ouVAYi-oweSZp-6WUUvH-oddooH-oeYXys-nz4Qm8-ouXWRm-pUqcsJ-qbmZJ6-4ibvW3-5J7PVM-oeY8Ew-ocTPLB-oeXqP4-7DhpHQ-ouzXDg-oeYEFZ-ounf4R-owJPpn-ouyhFi-9bs2r6-oeZcwg-owqsx7-bB1VZX-wk3ubf-ou9B2A-wjPpuY-oeSB9H-9bv9i3-ouvX7n-ouTRU8-ouxyG9-odHtcH-ouAk8P-ov2BRj-osRPBu-hyBGRd-owPV1n-owTmND-ouTCaz-oeS9gf-oeYKMa-of1HHj">Flickr/Thomas Cizauskas</a></span>
</figcaption>
</figure>
<p><strong>1. Large populations of consumers who have not had the means to make the product themselves and have gone without it altogether.</strong></p>
<p>For most of the 20th century, high-quality craft beer was in short supply. </p>
<p>The bigger brewers mass-produced what one <a href="https://books.google.com/books?id=JMVSUEjTCWgC&pg=PA48&lpg=PA48&dq=We+don%E2%80%99t+make+beer;+we+make+flavored+water+for+people+who+don%E2%80%99t+like+beer&source=bl&ots=fw6q7qdsbl&sig=A5XO2jBw5MFH-9ILzTMcmRmP-ro&hl=en&sa=X&ved=0ahUKEwjTlu2p_7PMAhVBqh4KHc8XCFMQ6AEIHDAA#v=onepage&q=We%20don%E2%80%99t%20make%20beer%3B%20we%20make%20flavored%20water%20for%20people%20who%20don%E2%80%99t%20like%20beer&f=false">anonymous Midwest “braumeister” described</a> as “flavored water,” while home brewing <a href="http://www.homebrewersassociation.org/homebrewing-rights/statutes/">was illegal</a> in the U.S. until relatively recently. </p>
<p>In the <a href="http://www.sciencedirect.com/science/article/pii/S0007681304001004">words of Bill Coors, Adolph Coors chairman and CEO,</a> in 1987: </p>
<blockquote>
<p>You could make Coors from swamp water and it would be exactly the same.</p>
</blockquote>
<p>The repeal of Prohibition in 1933 didn’t include home brewing, which meant few people knew how to brew and new brewery start-ups were rare. The <a href="https://eh.net/encyclopedia/a-concise-history-of-americas-brewing-industry/">number of brewers</a> dwindled from several thousand prior to Prohibition to about 100 in the late ‘70’s.</p>
<p>That marked a turning point, as a new federal law finally made home brewing legal again. But other laws remained in force in the '80’s and '90’s that didn’t allow early craft brewers to sell directly to consumers, forcing them to first sell to a wholesaler that would then distribute the beer to a retail grocer or bar. This system meant the only way to make a reasonable profit was <a href="http://beeronomics.blogspot.com/2011/10/on-brewpubs-and-economies-of-scale.html">to go big and leverage economies of scale</a> to ensure your product was featured by distributors. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=458&fit=crop&dpr=1 600w, https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=458&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=458&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=576&fit=crop&dpr=1 754w, https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=576&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/121092/original/image-20160504-22761-1gqhpm8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=576&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Revelers celebrate with a pint after prohibition is repealed.</span>
<span class="attribution"><span class="source">Bar drinking via www.shutterstock.com</span></span>
</figcaption>
</figure>
<p><strong>2. Customers who use the product need to go to an inconvenient, centralized location.</strong> </p>
<p>There were <a href="https://www.brewersassociation.org/statistics/number-of-breweries/">only 89 breweries in America in the late 1970s</a>, and their distribution model meant that consumers had very few choices. In particular, they had inconvenient or no access to craft beer. They generally drank Bud, Pabst, Schlitz, Miller, Coors, etc. By 1981, these brewers <a href="https://eh.net/encyclopedia/a-concise-history-of-americas-brewing-industry/">controlled 76 percent</a> of the U.S. market. </p>
<p>In other words, you had a large population without easy access to well-crafted beer and a system that centralized production and tightly controlled distribution. This created an opportunity for disruption, in the view of <a href="https://hbr.org/2012/12/surviving-disruption">Christensen.</a> The question was, would something change that allowed a larger population to make beer and sell the product more directly to consumers?</p>
<p><strong>3. A technology/business model is developed so that a large population can begin owning and using, in a more convenient context, something that historically was available only in a centralized, inconvenient location.</strong> </p>
<p>In the beer story, that game-changing innovation was the brewpub business model. This became possible after laws began to change in the <a href="http://www.beerhistory.com/library/holdings/chronology.shtml">1980s</a> to allow over-the-counter sales of beer produced in-house. </p>
<p>Yakima Brewing and Malting Inc. opened in Washington state in 1982 and was closely followed by California’s <a href="http://www.californiacraftbeer.com/the-history-of-craft-beer-in-california/">Mendocino Brewing</a> in 1983. The advent of microbreweries coincided with <a href="https://hbr.org/2015/10/why-more-mas-is-a-sign-that-scale-is-no-longer-an-advantage">other industry trends</a> that made it easier to make a profit from small production. There was also growing <a href="http://papers.ssrn.com/sol3/papers.cfm?abstract_id=2620918">ideological opposition</a> to <a href="http://pubsonline.informs.org/doi/abs/10.1287/orsc.2015.1000">the incumbent sector</a>.</p>
<p>Collectively, these changes drove the craft beer revolution in the U.S.</p>
<p>Noted beer historian <a href="https://eh.net/encyclopedia/a-concise-history-of-americas-brewing-industry/">Dr. Martin Stack</a> summed up the innovation this way: </p>
<blockquote>
<p>Microbreweries represented a new strategy in the brewing industry: rather than competing on the basis of price or advertising, they attempted to compete on the basis of inherent product characteristics. </p>
</blockquote>
<p>The result? The number of new breweries has grown exponentially, <a href="http://www.bloomberg.com/news/articles/2016-03-22/i-ll-toast-to-that-u-s-brewery-count-hits-all-time-record">recently surpassing the 1873 U.S. record of 4,131 breweries</a> that now occupy every state. </p>
<h2>Why disruption works</h2>
<p>Disruption works because the initial business models or technologies of the eventual disruptors don’t perform as well as existing ones, so little attention is paid by the incumbents. N. Taylor Thompson <a href="https://hbr.org/2013/09/what-markets-do-and-dont-get-about-innovation/">succinctly summarized</a> new market disruption as: </p>
<blockquote>
<p>a cheaper, more accessible, and worse-performing (business model) that turns non-consumers into customers. </p>
</blockquote>
<p>From a financial perspective, chasing a smaller group of nonconsumers (like craft beer drinkers) who want only beer that costs a lot to make seems like a relatively foolish use of assets. Instead, executives at AB InBev, which is also known for beers including Corona, Stella Artois and Michelob, understood that making light lagers at a <a href="https://finance.yahoo.com/q/ks?s=BUD+Key+Statistics">30 percent to 33 percent operating margin</a> allowed them to earn the most money out of each dollar spent. They ignored craft for so long because craft breweries typically operate on an unattractive 2-5 percent margin. </p>
<p>While being ignored, craft beer producers learned and improved without needing to focus attention on direct competition from the large incumbents, pushing operating margins higher and getting the attention of wholesalers who were keen to the <a href="http://www.mckinseyonmarketingandsales.com/a-perfect-storm-brewing-in-the-global-beer-business">changing buying habits among beer drinkers</a>. As a result, their operating margins soared, even as their scale remained relatively small. Boston Beer Company’s operating margins, for example, <a href="https://finance.yahoo.com/q/ks?s=SAM+Key+Statistics">have crept up to 16.3 percent</a>. </p>
<p>The <a href="https://www.brewersassociation.org/statistics/national-beer-sales-production-data/">numbers say it all</a>: while overall beer sales fell 0.2 percent in 2015, sales of craft surged 12.8 percent. Bigger craft brewers <a href="http://www.npr.org/sections/thesalt/2014/05/28/316317087/big-breweries-move-into-small-beer-town-and-business-is-hopping">are building factories</a> all over the U.S., and <a href="http://jom.sagepub.com/content/40/2/483">pipelines of expertise</a> are flowing toward craft as Anheuser-Busch executives migrate over.</p>
<p>But AB InBev’s response continues to follow the “disrupted” playbook and typical strategy for mature companies: mergers and acquisitions to defend their existing space and to increase average margins through economies of scale.</p>
<p>Most recently, the company agreed to buy fellow behemoth SABMiller, maker of dozens of beers including Leinenkugel’s, Miller Lite and Peroni and another brewer chasing the same high-margin beers American consumers <a href="http://www.wsj.com/articles/budweiser-ditches-the-clydesdales-for-jay-z-1416784086%22%22">increasingly shun</a>. Even attempts by SABMiller’s American division, MillerCoors, <a href="http://www.bloomberg.com/news/articles/2013-08-08/blue-moon-vs-dot-craft-beer-rivals-millercoors-strikes-back">to create “crafty”</a> beers are increasingly dismissed by consumers.</p>
<p>Here’s the irony: this merger <a href="http://craftingastrategy.com/blog/give-me-profitability-and-give-me-death">equates to</a> chasing a 30-33 percent margin on a $2 product (about $0.62) instead of investing in craft processes to make a 16-20 percent margin on a $5 product (about $0.90) that more and more people seem to want. </p>
<p>To make things worse for AB InBev, this craft beer movement seems to be not only spreading all over the U.S. but <a href="http://beergraphs.com/bg/238-where-in-the-world-do-people-drink-craft-beers/">also the world</a>. </p>
<h2>Chasing profits to death?</h2>
<p>Wessell and Christensen suggest that by the time incumbent firms realize a new market disruption is occurring, <a href="https://hbr.org/2012/12/surviving-disruption">it is usually too late</a>. <a href="http://www.reuters.com/article/a-b-i-ma-devilsbackbone-idUSL5N17F43V">Even a recent craft beer company buying spree</a> by Carlos Brito and AB InBev likely cannot stem the tide.</p>
<p>Case in point: its courtship of <a href="http://usopenbeer.com/2015-open/">highly acclaimed Cigar City Brewing</a> fell apart after the Tampa Bay brewer rejected AB InBev’s bid and <a href="https://cigarcitybrewing.com/oskar-blues-ccb/">opted instead</a> in March to become a part of private equity backed brewer Oskar Blues for <a href="http://www.denverpost.com/business/ci_29636788/oskar-blues-buys-cigar-city-brewing-deal-valued">$60 million</a>.</p>
<p>Cigar City likely left tens (perhaps hundreds) of millions of dollars on the table when it walked away from AB InBev. Late last year, for example, wine giant <a href="http://fortune.com/2015/11/16/constellation-brands-ballast-point/">Constellation Brands paid $1 billion</a> for the slightly larger craft brewer Ballast Point from California. </p>
<p>At the time, <a href="http://www.brewbound.com/news/fireman-capital-to-purchase-cigar-city">Cigar City founder Joey Redner said</a>:</p>
<blockquote>
<p>I was almost at the altar with someone else, but it never felt 100 percent right… It was a potentially life-changing opportunity and ultimately, I thought that I wasn’t going to be happy. No amount of money was going to make me happy.</p>
</blockquote>
<p>And his customers, the ones helping drive the trends reshaping the beer industry, must be very pleased, because AB InBev’s strategies are <a href="http://www.bloomberg.com/news/articles/2012-10-25/the-plot-to-destroy-americas-beer">creating a backlash.</a> The fear is that by buying up craft breweries they’ll end up destroying what they represent. </p>
<p>Was Cigar City’s move foolish or wise? Redner opted for less money, a better corporate fit and greater control in brewing the product Cigar City’s customers expect. </p>
<p>Regardless of whether that strategy is successful, we believe this move signals a tectonic shift in the global beer industry. Specifically, craft beer has diminished big beer’s longstanding competitive advantages built on scale, distribution and laws that minimized competition from small-scale brewers.</p>
<p><a href="https://hbr.org/2002/12/the-consolidation-curve">Large breweries have now, it seems, entered a strategic decline</a>, merging and acquiring each other and <a href="http://www.bloomberg.com/news/articles/2012-10-25/the-plot-to-destroy-americas-beer">chasing profits</a> at the expense of future customers.</p>
<p>Chasing higher profitability through <a href="http://www.bloomberg.com/news/articles/2012-10-25/the-plot-to-destroy-americas-beer">lower-quality products</a> and <a href="https://theconversation.com/beer-behemoths-struggle-to-fend-off-craft-brew-craze-47908">acquisitions</a> might please shareholders, but it also fits nicely into disruption theory’s playbook where new technologies, laws, consumer awareness and business models actively work against the long-held advantages of incumbents. </p>
<p>In 20 years, will cracking open a Budweiser on a summer day still be commonplace? Or will it be a relic of times past? If AB InBev stays on its current strategic course, the latter, while tough to imagine now, is the more plausible scenario.</p><img src="https://counter.theconversation.com/content/56791/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Samuel S. Holloway owns Crafting A Strategy, an online business knowledge sharing community for the beer industry. Content from Crafting A Strategy is cited in this article. Sam is a minority percentage owner of Oakshire Brewing, a small batch craft brewery based in Eugene, OR and serves on Oakshire's board of directors as an outside director.</span></em></p><p class="fine-print"><em><span>Mark R. Meckler is co-owner of Crafting A Strategy, an online business knowledge sharing community for the beer industry. Content from Crafting A Strategy is cited in this article.</span></em></p><p class="fine-print"><em><span>Rhett Andrew Brymer does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It may be the world’s largest beer maker, but Anheuser-Busch’s days may be numbered thanks to the rapid rise of craft brewing and a little thing called disruption.Samuel S. Holloway, Associate Professor of Strategy and Entrepreneurship, University of PortlandMark R. Meckler, Associate Professor of Management, University of PortlandRhett Andrew Brymer, Assistant Professor of Management, Miami UniversityLicensed as Creative Commons – attribution, no derivatives.