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?

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

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 clean-up leading to loss of wildlife. - Image management failed to fully recover the Companys reputation in wider community

- Swift reactions reinforced TYLENOL TAMPERING Company reputation for

integrity - Stakeholders reported high degree of trust - Product did not suffer in long term

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

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:
Crisis-prepared or crisis-prone?

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:
Ad hoc emergency reaction? OR
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 Authorisation Procedures Crisis Management Implementation

Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback

Crisisprepared culture Emotional Intelligence

Integration of learning

Gathering intelligence:
Who? What? When? How?

Who for Government?

Ministers Officials Political parties Sponsors Voters International allies The public in general Tax-payers 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/p public 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

Estimation

Evaluation
Unacceptable

Medication in question Medium chance leading could be mistaken for to severe health sweets by young children problems or death

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

High chance that public Acceptable and media criticism will arise

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

Estimation
Medium chance leading to severe health problems or death

Evaluation

Planning

Unacceptable Product needs to be re-designed to prevent the possibility

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

Priority actions to sensitively withdraw product whilst reassuring honestly and openly

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 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

Who matters and how will they be contacted?

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

Gather Intelligence

Complete a risk assessment

Produce plans to address risks

Promote crisis-ready culture

Publish plans and conduct training

Test, review and practice

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?

Feature editor Daily News by phone 2/2/02 Action to trace other trade marks is urgently proceeding Crisis team leader document dated 1/2/02

Source / Date Regional Health Authority secretary by phone 1/2/02 Line to take Patients over 65 and of frail health are considered to be high risk

Source / Date Professor Chang letter dated 2/2/02

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 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 adverse effects Complexity of benefit-harm / effectiveness-risk 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 Access

X
X X X X X

X X
X X X 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 Authorisation Procedures Crisis Management Implementation

Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback

Crisisprepared culture Emotional Intelligence

Integration of learning

Gather Intelligence

Complete a risk assessment

Produce plans to address risks

Promote crisis-ready culture

Publish plans and conduct training

Test, review and practice

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

continued

Perception of risk
Factors increasing intolerance:
concealed for years future generations

Hidden/irreversible - e.g. effects damaging but

Affects posterity - threatens children, births or

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 Effectiveness-risk 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!)