Crisis Management

A presentation by

Bruce Hugman
Consultant to the Uppsala Monitoring Centre

Pretoria, September 2004

What is a crisis?
 In general?  For an organisation?  For government or bureaucracy?  For a private company?  In healthcare?  In drug safety? safety?

Topics
 The nature of crisis
Crisis management model

 Planning
Risk assessment Risk management

 Crisis communications  Risk Communications

Key features of a Crisis

 Low probability  High impact  Uncertain/ambiguous causes and effects  Differential perceptions perceptions

High level threats:

 Safety  Health  Environment  National security

Specific threats to organisation:

 Operational viability  Reputation  Credibility  Financial stability  Legal action

Consequential effects:
 Uncertainty/ambiguity  Urgency of response  Strategic effects of decisions

Common features of a crisis:

           

The situation materialises unexpectedly Decisions are required urgently Time is short Specific threats are identified Urgent demands for information are received There is sense of loss of control Pressures build over time Routine business become increasingly difficult Demands are made to identify someone to blame Outsiders take an unaccustomed interest Reputation suffers Communications are increasingly difficult to manage

Purpose of crisis management:

 Prevention  Survival  Successful outcomes

Successful outcomes:
 Positive balance of success/failure

Incident
EXXON VALDEZ

Success outcomes
- Financial losses were bearable - Costs relating to clean-up were less than pre-emptive costs - Image management recovered the Companys reputation in business community

Failure outcomes
- Long term costs were transferred to public - Delays in implementing cleanup leading to loss of wildlife. - Image management failed to fully recover the Companys reputation in wider community

TYLENOL TAMPERIN G

- Swift reactions reinforced - Perpetrator was never identified Company reputation for integrity - Future attempts cannot - Stakeholders reported high therefore be precluded degree of trust - Product did not suffer in long term

Three criteria of success:

 Has organisational capacity been restored?  Have losses been minimised?  Have lessons been learned?

Crisis Management Model

Antecedent conditions

Intrinsic crisis

Perceived crisis

Immature crisis response Mature crisis management Review and Feedback

Existing conditions:
Culture or environment

 Open bow doors / poor safety culture

 Smoker / poor cleaning standards

Existing conditions:
CrisisCrisis-prepared or crisis-prone? crisis-

Perceived crisis:
As seen by all individuals from particular viewpoints

Intrinsic crisis:
 Total situation as seen by neutral observer with all the facts

Crisis Management Model

Antecedent conditions

Intrinsic crisis

Perceived crisis

Immature crisis response Mature crisis management Review and Feedback

Immature crisis response:

Instant and irrational (denial/shock/panic)

Mature crisis management:

 Grasp of intrinsic crisis  Implementation of plans and procedures

Mature crisis management:

 Technical intelligence  Emotional intelligence

Review and feedback:

 Assessing success and failure  Feeding learning into future planning

Crisis Management Model

Antecedent conditions

Intrinsic crisis

Perceived crisis

Immature crisis response Mature crisis management Review and Feedback

Management objective:
y Ad hoc emergency reaction? OR y Building management capacity to handle unforeseen events?

End of Part 1

Part 2:

Planning for Crisis Management

Crisis Management Model

Crisis Management Planning Technical Intelligence

Antecedent conditions

Crisisprepared culture Emotional Intelligence

Intrinsic crisis

Perceived crisis Immature crisis response

Authorisation Procedures Crisis Management Implementation Integration of learning

Mature crisis management Review and Feedback

Gathering intelligence:
 Who?  What?  When?  How?

Who for Government?

 Ministers  Officials  Political parties  Sponsors  Voters  International allies  The public in general  Tax-payers Tax Consumer and lobby groups  Lawyers  The media ?

Who for medicine and drug safety?

 Manufacturers  Regulators  Politicians  Employees  Health professionals  Pharmacists  Academics  The public  Patients  Consumer and lobby groups  Lawyers  The media ?

The first goal of crisis management is prevention

Intelligence:
 Continuous scanning (networks/media/ppub lic opinion, etc)  Outward focus  Collaboration  Positive relationships

Assess risks

Risk assessment is:

 Identification
define and describe

 Estimation
likelihood and consequences

 Evaluation
acceptability of risk

Identification
Medication in question could be mistaken for sweets by young children

Estimation

Evaluation

Medium chance leading to Unacceptable severe health problems or death

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

High chance that public and media criticism will arise

Acceptable

Identification
Medication in question could be mistaken for sweets by young children Recall of a defective batch of medication may lower consumer confidence and takeup rate

Estimation
Medium chance leading to severe health problems or death High chance that public and media criticism will arise

Evaluation
Unacceptable

Planning
Product needs to be re-designed to prevent the possibility Priority actions to sensitively withdraw product whilst reassuring honestly and openly

Acceptable

Risk management is:

 Planning  Resourcing  Monitoring  Controlling

Crisis Planning:
 Assess risks  Produce plans  Define roles and responsibilities  Appoint crisis management team  Draw up communication plan  Produce contact and organisation chart  Promote crisis-ready culture crisis Publish plans and conduct training  Test, review and practise

End of Part 2

Part 3:

Crisis Communications

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

The core process is:

 Active, two-way communication two-

Who matters and how will they be contacted?

            Ministers Officials Political parties Sponsors Voters International allies TaxTax-payers Manufacturers Politicians Health professionals Pharmacists Academics              Patients Shareholders StockStock-market Regulators Senior executives Experts Employees The public Customers Consumer and lobby groups Lawyers The media ?

Message Options [What?]

1) 2) 3) 4) 5) 6) 7) Full apology Corrective action Ingratiation Justification Excuse Denial Attack the attacker

What does the world want to see?

 Acceptance of responsibility  Willingness to take positive steps

Message Options:
1) 2) 3) 4) 5) 6) 7) Full apology Corrective action Ingratiation Justification Excuse Denial Attack the attacker

Critical activities:
 Initial response  Lines to take

Initial response:
Tell the truth as it is known  Facts beyond question  Actions being taken  Acknowledgement of emotions/psychological needs

Lines to take:
 Essential responses planned  Each new authorised response is logged
Database Book Wallchart Message 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 Feature editor Daily News by phone secretary 2/2/02 by phone 1/2/02 Action to trace other Patients over 65 and of frail health are considered trade marks is to be high risk urgently proceeding Professor Chang letter dated 2/2/02 Crisis team leader document dated 1/2/02

Line to take

Source / Date

Media demands [How?]

 Accuracy and simplicity  Statistics which are explained  Context of information  Comments from highest authority  Some controversial elements  Both sides of the issue  Speed, speed and speed

The ideal spokesperson:

 Polite and patient  Well-informed and authoritative Well Accurate and reliable  Articulate  Available  Trustworthy  Evidently committed to the process

Continuing public information and education

 No drug is 100% safe  Many drugs have potential side-effects and sideadverse effects  Complexity of benefit-harm / effectivenessbenefiteffectivenessrisk  Rational use of drugs

Elements increasing media interest:

Dramatic emotional impact e.g. thalidomide and children Large numbers affected Unexpected links e.g. MMR vaccine and autism Polarised opinions Conflict e.g. health professionals vs. pharmaceutical companies, or between professionals  Geography e.g. proximity to own country, hospital etc  Emotive pigeonholes e.g. miracle drug, poison  Links to celebrities
    

Methods Telephone Hotlines Interviews News Releases Conferences Emails Enquiry Desks Web Site Mobile Offices

Primary Purpose Transmission X X X X X X X X X X X Access X X X

Crisis Management Model

Antecedent conditions

Intrinsic crisis

Perceived crisis

Immature crisis response Mature crisis management Review and Feedback

Crisis Management Model

Crisis Management Planning Technical Intelligence

Antecedent conditions

Crisisprepared culture Emotional Intelligence

Intrinsic crisis

Perceived crisis Immature crisis response

Authorisation Procedures Crisis Management Implementation Integration of learning

Mature crisis management Review and Feedback

End of Part 3

Part 4:

Communicating Risk

Communication of risk
 Very poor public grasp of risk and risk statistics  Confusion between relative/absolute/reference/ attributable risk  Variable perception/tolerance of different kinds of risk  Fantasy of a safe drug

Perception of risk
Factors increasing intolerance:
 Involuntary - e.g. exposure to pollution rather than
voluntary, such as smoking or playing dangerous sports  Unfairly distributed - some benefit whilst other suffer  Inescapable - cannot be avoided by ones personal actions  Unfamiliar - arising from a novel source  Man-made - from other than natural sources Mancontinued

Perception of risk
Factors increasing intolerance:
 Hidden/irreversible - e.g. effects damaging but
concealed for years  Affects posterity - threatens children, births or future generations  Particularly dreadful - e.g. distressing symptoms or social rejection  Victims identifiable - e.g. a particular blood type or social group  Scientifically obscure - new or rare  Contradicted - argued by responsible sources

Problematic issues in drug safety:

 Adverse effects  Risk as a concept in medicine  Benefit-harm Benefit Effectiveness-risk Effectiveness Public health versus profit  Access to medicines
continued...

Problematic issues in drug safety:

 Individual patient variation and susceptibility  Polypharmacy  Relationship of allopathic and traditional medicines  Resistance  Diagnostic errors  Prescribing errors  Compliance issues

Risk Factors for Government Officials

 Political expediency  Culture of secrecy  Accountability  Bureaucracy and inertia  Hierarchy  Process versus performance  Complexity  Workload  Corruption

Summary
Topics covered:  The nature of crisis  Crisis management model  Planning  Risk assessment  Risk management  Crisis communications  Learning from experience

and good luck!

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