CrisisCrisis ManagementManagement

A presentation byA presentation by

Bruce HugmanBruce HugmanConsultant to Consultant to the the Uppsala Monitoring CentreUppsala Monitoring Centre

Pretoria, September 2004Pretoria, September 2004

What is a crisis?What is a crisis?

In general?In general? For an For an

organisation?organisation? For government or For government or

bureaucracy?bureaucracy? For a private For a private

company?company? In healthcare?In healthcare? In drug safetyIn drug safety??

TopicsTopics

The nature of crisisThe nature of crisisCrisis management modelCrisis management model

PlanningPlanningRisk assessmentRisk assessmentRisk managementRisk management

Crisis communicationsCrisis communicationsRisk CommunicationsRisk Communications

Key features of a CrisisKey features of a Crisis

Low probabilityLow probabilityHigh impactHigh impactUncertain/ambiguous causes and Uncertain/ambiguous causes and

effectseffectsDifferential perceptionDifferential perceptionss

High level threats:High level threats:

SafetySafetyHealthHealthEnvironmentEnvironmentNational securityNational security

Specific threats to Specific threats to organisation:organisation:

Operational viabilityOperational viabilityReputationReputationCredibilityCredibilityFinancial stabilityFinancial stabilityLegalLegal action action

Consequential effects:Consequential effects:

Uncertainty/ambiguityUncertainty/ambiguityUrgency of responseUrgency of responseStrategic effects of decisionsStrategic effects of decisions

Common features of a Common features of a crisis:crisis:

The situation materialises unexpectedlyThe situation materialises unexpectedly Decisions are required urgentlyDecisions are required urgently Time is shortTime is short Specific threats are identifiedSpecific threats are identified Urgent demands for information are receivedUrgent demands for information are received There is sense of loss of controlThere is sense of loss of control Pressures build over timePressures build over time Routine business become increasingly difficultRoutine business become increasingly difficult Demands are made to identify someone to blameDemands are made to identify someone to blame Outsiders take an unaccustomed interestOutsiders take an unaccustomed interest Reputation suffersReputation suffers Communications are increasingly difficult to Communications are increasingly difficult to

managemanage

Purpose of crisis Purpose of crisis management:management:

PreventionPrevention SurvivalSurvival Successful Successful

outcomesoutcomes

Successful outcomes:Successful outcomes:

Positive balance of success/failurePositive balance of success/failure

- Perpetrator was never identified- Future attempts cannot therefore be precluded

- Swift reactions reinforced Company reputation for integrity- Stakeholders reported high degree of trust- Product did not suffer in long term

TYLENOL TAMPERING

- Long term costs were transferred to public- Delays in implementing clean-up leading to loss of wildlife.- Image management failed to fully recover the Company’s reputation in wider community

- Financial losses were bearable - Costs relating to clean-up were less than pre-emptive costs- Image management recovered the Company’s reputation in business community

EXXON VALDEZ

Failure outcomesSuccess outcomesIncident

Three criteria of success:Three criteria of success:

Has organisational capacity been Has organisational capacity been restored?restored?

Have losses been minimised?Have losses been minimised?Have lessons been learned?Have lessons been learned?

Crisis Management ModelCrisis Management ModelAntecedent conditions

Intrinsic crisisPerceived

crisis

Immature crisis

response

Mature crisis management

Review and Feedback

Existing conditions:Existing conditions:

Open bow doors / Open bow doors /

poor safety culturepoor safety culture

Smoker / poor Smoker / poor cleaning standardscleaning standards

Culture or Culture or

environmentenvironment

Existing conditions:Existing conditions:

Crisis-prepared Crisis-prepared

or crisis-prone?or crisis-prone?

Intrinsic crisis:Intrinsic crisis: Total situation as seen by neutral observer Total situation as seen by neutral observer

with all the factswith all the facts

As seen by all individuals from particular As seen by all individuals from particular viewpointsviewpoints

Perceived crisis:Perceived crisis:

Crisis Management ModelCrisis Management ModelAntecedent conditions

Intrinsic crisisPerceived

crisis

Immature crisis

response

Mature crisis management

Review and Feedback

Immature crisis Immature crisis response:response:

Instant and irrational Instant and irrational (denial/shock/panic)(denial/shock/panic)

Mature crisis management:Mature crisis management:

Grasp of intrinsic crisisGrasp of intrinsic crisis Implementation of plans and Implementation of plans and

proceduresprocedures

Mature crisis management:Mature crisis management:

Technical intelligenceTechnical intelligenceEmotional intelligenceEmotional intelligence

Review and feedback:Review and feedback:

Assessing success and failureAssessing success and failureFeeding learning into future planningFeeding learning into future planning

Crisis Management ModelCrisis Management ModelAntecedent conditions

Intrinsic crisisPerceived

crisis

Immature crisis

response

Mature crisis management

Review and Feedback

Management objective:Management objective:

Ad hoc emergency reaction?Ad hoc emergency reaction?

OROR

Building management capacity to Building management capacity to handle unforeseen events?handle unforeseen events?

End of Part 1End of Part 1

Part 2:Part 2: Planning for Crisis Planning for Crisis ManagementManagement

Integrationof learning

CrisisManagementImplementation

AuthorisationProcedures

TechnicalIntelligence

Crisis ManagementPlanning

Crisis Management ModelCrisis Management ModelAntecedent conditions

Intrinsic crisisPerceived

crisis

Immature crisis

response

Mature crisis management

Review and Feedback

Crisis-preparedculture

EmotionalIntelligence

Gathering intelligence:Gathering intelligence:

Who?Who?What?What?When?When?How?How?

Who for Government?Who for Government?

MinistersMinisters OfficialsOfficials Political partiesPolitical parties SponsorsSponsors VotersVoters International alliesInternational allies

The public in The public in generalgeneral

Tax-payersTax-payers Consumer and Consumer and

lobby groupslobby groups LawyersLawyers The mediaThe media ??

Who for medicine and drug Who for medicine and drug safety?safety?

ManufacturersManufacturers RegulatorsRegulators PoliticiansPoliticians EmployeesEmployees Health Health

professionalsprofessionals PharmacistsPharmacists AcademicsAcademics

The publicThe public PatientsPatients Consumer and Consumer and

lobby groupslobby groups LawyersLawyers The mediaThe media ??

The first goal of crisis The first goal of crisis management is management is

preventionprevention

Intelligence:Intelligence:

Continuous Continuous scanning scanning (networks/media/p(networks/media/ppublic opinion, etc)public opinion, etc)

Outward focusOutward focus CollaborationCollaboration Positive Positive

relationshipsrelationships

Assess risks

Risk assessment is:Risk assessment is:

IdentificationIdentificationdefine and describedefine and describe

EstimationEstimationlikelihood and consequenceslikelihood and consequences

EvaluationEvaluationacceptability of riskacceptability of risk

AcceptableHigh chance that public and media criticism will arise

Recall of a defective batch of medication may lower consumer confidence and take-up rate

Unacceptable

Medium chance leading to severe health problems or death

Medication in question could be mistaken for sweets by young children

EvaluationEstimationIdentification

Priority actions to sensitively withdraw product whilst reassuring honestly and openly

AcceptableHigh chance that public and media criticism will arise

Recall of a defective batch of medication may lower consumer confidence and take-up rate

Product needs to be re-designed to prevent the possibility

Unacceptable

Medium chance leading to severe health problems or death

Medication in question could be mistaken for sweets by young children

PlanningEvaluationEstimationIdentification

Risk management is:Risk management is:

PlanningPlanningResourcingResourcingMonitoringMonitoringControllingControlling

Crisis Planning:Crisis Planning:

Assess risksAssess risks Produce plansProduce plans Define roles and responsibilitiesDefine roles and responsibilities Appoint crisis management teamAppoint crisis management team Draw up communication planDraw up communication plan Produce contact and organisation chartProduce contact and organisation chart Promote crisis-ready culturePromote crisis-ready culture Publish plans and conduct trainingPublish plans and conduct training Test, review and practiseTest, review and practise

End of Part 2End of Part 2

Part 3:Part 3: Crisis Crisis CommunicationsCommunications

Communication plan:Communication plan:

Core elements are:Core elements are: Identifying audiences (Who?)Identifying audiences (Who?) How communication is to take place (How?)How communication is to take place (How?) What messages are to be communicated (What?)What messages are to be communicated (What?)

The core process is:The core process is: Active, two-way communicationActive, two-way communication

WhoWho matters and how will they matters and how will they be contacted?be contacted?

MinistersMinisters OfficialsOfficials Political partiesPolitical parties SponsorsSponsors VotersVoters International alliesInternational allies Tax-payersTax-payers ManufacturersManufacturers PoliticiansPoliticians Health professionalsHealth professionals PharmacistsPharmacists AcademicsAcademics

PatientsPatients ShareholdersShareholders Stock-marketStock-market RegulatorsRegulators Senior executivesSenior executives ExpertsExperts EmployeesEmployees The publicThe public CustomersCustomers Consumer and lobby Consumer and lobby

groupsgroups LawyersLawyers The mediaThe media ??

Dear Consumer Group

You will understand that managing

the nation’s drugs is a complex

business.

From time to time there are scares or

crises which cause much concern to

everyone.

We are keen to discuss the handling

of such events, and to plan jointly

with you and others how we might

best communicate with you in such

circumstances. We’d like to establish

one-to-one contact between a

member of your team and ours…

GatherIntelligence

Complete arisk

assessment

Produceplans to

address risks

Promotecrisis- ready

culture

Publish plansand conduct

training

Test, reviewand practice

Message Options Message Options [What?][What?]

1)1) Full apologyFull apology

2)2) Corrective actionCorrective action

3)3) IngratiationIngratiation

4)4) JustificationJustification

5)5) ExcuseExcuse

6)6) DenialDenial

7)7) Attack the attackerAttack the attacker

What does the world want to What does the world want to see?see?

Acceptance of responsibilityAcceptance of responsibilityWillingness to take positive stepsWillingness to take positive steps

Message Options:Message Options:

1)1) Full apologyFull apology

2)2) Corrective actionCorrective action

3)3) IngratiationIngratiation

4)4) JustificationJustification

5)5) ExcuseExcuse

6)6) DenialDenial

7)7) Attack the attackerAttack the attacker

Critical activities:Critical activities:

Initial responseInitial responseLines to takeLines to take

Initial response:Initial response:

Tell the truth as it is knownTell the truth as it is knownFacts beyond questionFacts beyond questionActions being takenActions being takenAcknowledgement of Acknowledgement of

emotions/psychological needsemotions/psychological needs

Lines to take:Lines to take:

Essential responses plannedEssential responses plannedEach new authorised response is Each new authorised response is

loggedloggedDatabaseDatabaseBookBookWallchartWallchartMessage boardMessage board

Question Is there a specific risk to aged patients from the medicine in question ?

Is the medicine known by any other trade names?

Source / Date

Regional Health Authority secretaryby phone 1/2/02

Feature editor Daily News by phone 2/2/02

Line to take Patients over 65 and of frail health are considered to be high risk

Action to trace other trade marks is urgently proceeding

Source / Date

Professor Changletter dated 2/2/02

Crisis team leaderdocument dated 1/2/02

Media demands Media demands [How?][How?]

Accuracy and simplicityAccuracy and simplicityStatistics which are explainedStatistics which are explainedContext of informationContext of informationComments from highest authorityComments from highest authoritySome controversial elementsSome controversial elementsBoth sides of the issueBoth sides of the issueSpeed, speed and speedSpeed, speed and speed

The ideal spokesperson:The ideal spokesperson:

Polite and patientPolite and patientWell-informed and authoritativeWell-informed and authoritativeAccurate and reliableAccurate and reliableArticulateArticulateAvailableAvailableTrustworthyTrustworthyEvidently committed to the processEvidently committed to the process

Continuing public information Continuing public information and educationand education

‘‘No drug is 100% safe’No drug is 100% safe’Many drugs have potential side-Many drugs have potential side-

effects and adverse effectseffects and adverse effectsComplexity of benefit-harm / Complexity of benefit-harm /

effectiveness-riskeffectiveness-riskRational use of drugsRational use of drugs

Elements increasing media Elements increasing media interest:interest:

Dramatic emotional impact e.g. thalidomide and Dramatic emotional impact e.g. thalidomide and childrenchildren

Large numbers affectedLarge numbers affected Unexpected links e.g. MMR vaccine and autismUnexpected links e.g. MMR vaccine and autism Polarised opinionsPolarised opinions Conflict e.g. health professionals vs. Conflict e.g. health professionals vs.

pharmaceutical companies, or between pharmaceutical companies, or between professionalsprofessionals

Geography e.g. proximity to own country, hospital Geography e.g. proximity to own country, hospital etcetc

Emotive pigeonholes e.g. ‘miracle drug’, ‘poison’Emotive pigeonholes e.g. ‘miracle drug’, ‘poison’ Links to celebritiesLinks to celebrities

XXXWeb Site

XMobile Offices

XEnquiry Desks

XXEmails

XXConferences

XNews Releases

XXInterviews

XHotlines

XXTelephone

AccessTransmission

Primary PurposeMethods

Crisis Management ModelCrisis Management ModelAntecedent conditions

Intrinsic crisisPerceived

crisis

Immature crisis

response

Mature crisis management

Review and Feedback

Integrationof learning

CrisisManagementImplementation

AuthorisationProcedures

TechnicalIntelligence

Crisis ManagementPlanning

Crisis Management ModelCrisis Management ModelAntecedent conditions

Intrinsic crisisPerceived

crisis

Immature crisis

response

Mature crisis management

Review and Feedback

Crisis-preparedculture

EmotionalIntelligence

GatherIntelligence

Complete arisk

assessment

Produceplans to

address risks

Promotecrisis- ready

culture

Publish plansand conduct

training

Test, reviewand practice

End of Part 3End of Part 3

Part 4:Part 4: Communicating RiskCommunicating Risk

Communication of riskCommunication of risk

Very poor public grasp of risk and Very poor public grasp of risk and risk statisticsrisk statistics

Confusion between Confusion between relative/absolute/reference/ relative/absolute/reference/ attributable riskattributable risk

Variable perception/tolerance of Variable perception/tolerance of different kinds of riskdifferent kinds of risk

Fantasy of a ‘safe drug’Fantasy of a ‘safe drug’

Perception of riskPerception of risk

Factors increasing intolerance:Factors increasing intolerance: InvoluntaryInvoluntary - e.g. exposure to pollution rather - e.g. exposure to pollution rather

than voluntary, such as smoking or playing than voluntary, such as smoking or playing dangerous sportsdangerous sports

Unfairly distributedUnfairly distributed - some benefit whilst other - some benefit whilst other suffersuffer

InescapableInescapable - cannot be avoided by one’s - cannot be avoided by one’s personal actionspersonal actions

UnfamiliarUnfamiliar - arising from a novel source - arising from a novel source Man-madeMan-made - from other than natural sources - from other than natural sources

continued…continued…

Perception of riskPerception of risk

Factors increasing intolerance:Factors increasing intolerance: Hidden/irreversibleHidden/irreversible - e.g. effects damaging but - e.g. effects damaging but

concealed for yearsconcealed for years Affects posterityAffects posterity - threatens children, births or - threatens children, births or

future generationsfuture generations Particularly dreadfulParticularly dreadful - e.g. distressing - e.g. distressing

symptoms or social rejectionsymptoms or social rejection Victims identifiableVictims identifiable - e.g. a particular blood - e.g. a particular blood

type or social grouptype or social group Scientifically obscureScientifically obscure - new or rare - new or rare ContradictedContradicted - argued by responsible sources - argued by responsible sources

Problematic issues in drug Problematic issues in drug safety:safety:

Adverse effectsAdverse effectsRisk as a concept in medicineRisk as a concept in medicineBenefit-harmBenefit-harmEffectiveness-riskEffectiveness-riskPublic health versus profitPublic health versus profitAccess to medicinesAccess to medicines

continued...continued...

Problematic issues in drug Problematic issues in drug safety:safety:

Individual patient variation and Individual patient variation and susceptibilitysusceptibility

PolypharmacyPolypharmacy Relationship of allopathic and traditional Relationship of allopathic and traditional

medicinesmedicines ResistanceResistance Diagnostic errorsDiagnostic errors Prescribing errorsPrescribing errors Compliance issuesCompliance issues

Risk Factors for Government Risk Factors for Government OfficialsOfficials

Political expediencyPolitical expediency Culture of secrecyCulture of secrecy AccountabilityAccountability Bureaucracy and inertiaBureaucracy and inertia HierarchyHierarchy Process versus performanceProcess versus performance ComplexityComplexity WorkloadWorkload CorruptionCorruption

SummarySummary

Topics covered:Topics covered:The nature of crisisThe nature of crisisCrisis management modelCrisis management modelPlanningPlanningRisk assessmentRisk assessmentRisk managementRisk managementCrisis communicationsCrisis communicationsLearning from experienceLearning from experience

and good luck!(though luck has nothing to do with good crisis management!)