Struggling With Internal Crisis Communication

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research-article2015
PRI0010.1177/2046147X15570108Public Relations InquiryHeide and Simonsson
Regular Article
Public Relations Inquiry

2015, Vol. 4(2) 223–255
Struggling with internal crisis © The Author(s) 2015
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DOI: 10.1177/2046147X15570108
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tensions
Mats Heide and Charlotte Simonsson

Lund University, Sweden
Abstract
The aim of this article is to elucidate the complexity of internal crisis communication
by identifying and discussing different paradoxical tensions embedded within a large,
complex, multi-professional organization. This article is based on a qualitative case study
of a university hospital. Internal dimensions of crisis management have long been neglected
within the field of crisis communication research. In the first part of the article, two
theoretical approaches are presented – the functionalist and social constructionist which
are based on different ontological and epistemological assumptions. We take a social
constructionist perspective on crisis communication, which focuses on aspects such as
complexity, sensemaking, and symmetrical relations. In the first part, we also give a brief
overview of the small, but growing research into internal crisis communication. In the
second part of the article, five different paradoxical tensions are identified and discussed:
(1) episodic–emergent, (2) centralized–decentralized, (3) professional–organizational,
(4) planning–improvisation, and (5) external–internal. While the complexity of internal
crisis communication demands a both-and perspective, we have found a tendency to
a simplistic either-or thinking. In the concluding discussions, several explanations of
the one-sided polarization within the tensions are offered. Furthermore, we discuss
various ways of responding to paradoxical tensions. Metacommunication is presented
as important in order to increase organization members’ understanding and thereby
facilitate a more reflexive and broader approach to crisis management.
Keywords
Complex organizations, crisis management, internal crisis communication, paradoxical
tensions, social constructionism
Corresponding author:
Mats Heide, Department of Strategic Communication, Lund University, Campus Helsingborg, P.O. Box 882,
Helsingborg 251 08, Sweden.
Email: Mats.Heide@isk.lu.se
224 Public Relations Inquiry 4(2)
Introduction
There has lately been a growing critique of the one-sided focus on external aspects
within mainstream crisis communication research (e.g. Heide and Simonsson, 2014a;
Johansen et al., 2012; Mazzei et al., 2012; Taylor, 2010). The emphasis on external
communication is quite remarkable since internal communication processes are of
fundamental importance for organizations – organizational members produce and
reproduce an organization through communication and interaction (Putnam et al.,
2009; Weick, 2009). Weick (1995) states, ‘the communication activity is the organization’
(p. 75). Crises do not occur as isolated events, but how and why they occur, and also
how they are managed, are closely related to internal communication processes (cf.
Bechler, 2004; Taylor, 2010). Currently, there is increasing interest among scholars in
internal crisis communication, but there is still a great need for more research. In this
article, we emphasize the complexity of internal crisis communication by focusing on
paradoxical tensions embedded within large, contemporary organizations. Scholars
have paid increasing attention to the irrational side of organizational life and conse-
quently see tensions as a fundamental characteristic of organizations (Ashcraft and
Trethewey, 2004: (editors of a special issue on tensions in Journal of Applied Com-
munication Research); Benson, 1977; Putnam et al., 2014). Thus, the interest in tensions
is a reaction to the tendency of organizational scholars and practitioners to underscore
rationality and the predominant concern of effectiveness (cf. Stohl and Cheney, 2001).
The two research fields of crisis management and crisis communication (cf. Heath,
2010) have traditionally been developed separately. This division can be explained by
the dominating thinking within crisis communication research, that is, a functionalistic
approach (cf. Tyler, 2005). Communication is here understood as a variable of an organi-
zation, not as a precondition for the existence of organizations (Varey, 2000). We take a
social constructionist approach on crisis communication, which implies that communi-
cation is not conceived as a variable, but rather as the very process that produces and
reproduces organizations. Furthermore, we believe there is a close interrelation between
crisis management and crisis communication, since management is impossible without
communication (cf. Gilpin and Murphy, 2008). This interrelationship implies that inter-
nal communication processes cannot be studied as an isolated phenomenon, but must be
understood in the light of the surrounding organizational context. A social constructionist
approach further implies that the complexity and uncertainty of a crisis is underscored,
and the goal is not to find universalistic tools and techniques for damage control (e.g.
Bechler, 2004; Gilpin and Murphy, 2008; Tyler, 2005). Rather than perceiving crisis as a
distinct, punctual, and controllable event, scholars within the social constructionist
approach claim that crisis should be seen as complex, integrated, processual phenomena
that often demand polyvocal responses.
The aim of this article is to elucidate the complexity of internal crisis communication
by identifying and discussing different paradoxical tensions in a large, multi-professional
organization. Related to this aim, we also intend to discuss how organizations can enable
responses to and manage organizational irrationalities such as paradoxical tensions.
The identified tensions comprise two alternatives that seem to be oppositional, that is,
Heide and Simonsson 225
choosing one appears to lead to the negation of the other (cf. Peters, 2012; Smith and
Lewis, 2011). We thus understand these tensions as socially constructed, and more often
than not these contradictions are the two sides of the same coin rather than mutually
exclusive (cf. Lewis, 2000; Luscher et al., 2006; Luscher and Lewis, 2008). With this
article, we would like to inspire other scholars to pay more attention to internal crisis
communication and to also integrate approaches other than the rationalistic approach that
is all too common in public relations (PR) research. A social constructionist approach
opens a wider range of explanations for the complex organizational reality. However, we
hope to not only show the value of a social constructionist approach and theoretically
argue about the complexity of internal crisis communication but also provide increased
knowledge about the character of that complexity in practice.
Furthermore, we would like to inspire practitioners to embrace a broader, more
holistic way to manage internal crisis communication, a way where the traditional and
limiting ‘either or thinking’ is abandoned.
The empirical material that the research is based on comes from a case study of internal
crisis communication in a Swedish university hospital (UH) – a huge organization
with 11,000 employees. One reason for choosing the UH as the case is that hospitals are
complex, multi-professional organizations, which are often in a crisis or chaotic situation
(Fulop and Mark, 2013).
Different theoretical approaches

Crisis is one of the most studied phenomena in the field of PR (Gilpin and Murphy, 2008;
Kent, 2010). PR theory and practice has traditionally been embedded in a functionalistic
thinking associated with modernism and its emphasis on rationality and progress
(Holtzhausen, 2000; Radford, 2012; Toth, 2002). As crisis communication research is
strongly related to PR research, the same functionalistic thinking has also been very
influential in the development of the field (cf. Tyler, 2005), although in recent years there
has arisen an alternative approach, which goes under different labels, for example, late
modern crisis communication (Falkheimer and Heide, 2010), post-modern perspective
(Tyler, 2005), and complexity-based approach (Gilpin and Murphy, 2010). There are of
course some different ideas and assumptions behind these different labels, but they are
all based in the same ontology – social constructionism (see Gergen, 1999). Since ontol-
ogy is the most comprehensive and important characteristic of the different alternative
approaches, we have decided to amalgamate them under the umbrella term the social
constructionist approach. Below we discuss a functionalistic versus a social construc-
tionist approach to crisis communication. This division is, of course, artificial and may
to some extent be regarded as too simplified. Nevertheless, the distinction is rather
common within organization and organizational communication studies (cf. Mumby,
2013), and we think that the division can help to clarify some crucial tenets in the field
of crisis communication research and the theoretical foundation of this article. The dif-
ferent approaches to crisis management and crisis communication embrace different
epistemological and ontological assumptions with clear implications on how crisis and
communication as well as organization and management are defined and understood.
The functionalistic approach

The functionalistic approach is still the most dominant one within social science (Mumby,
2013). An important goal of this approach is to find generalizable claims and laws that
can help organizations to become more efficient and effective in their function. This
approach is also dominant within the research field of crisis communication, and focuses
predominantly on the acute phase, that is, the period after the crisis has occurred (Coombs,
2010; Falkheimer et al., 2009). Consequently, these scholars are mainly interested in
reactive activities and processes such as ‘damage control’ rather than in proactive activities
like detection and prevention (Kent, 2010). The all-embracing goal for crisis communi-
cation scholars within this approach is to help organizations return back to the original
equilibrium with regained or even increased organizational legitimacy. Hence, the aim of
traditional crisis management and crisis communication, based in a positivistic ontology,
is to decrease complexity, and increase control and predictability.
The emphasis on control and planning mirrors a traditional view of rationality,
where managers are believed to have the best prerequisites and knowledge for making
intelligent, well-reasoned decisions. Here, we find a certain kind of managerialism
that privileges managers and their actions, which are understood as vital for the success
of an organization (Alvesson and Sveningsson, 2011). Criticizing crisis management
for being a result of managerialism – with a discourse of instrumentality (Deetz, 1992)
and where management is understood as a technical activity performed by administrative
experts (Mintzberg, 2009) – is almost a tautology (cf. Sturdy and Grey, 2003). Still,
it is important to reflect on the ontology and epistemology behind mainstream crisis
management research, since it affects our understanding and knowledge of organiza-
tions’ management of crises.
The functionalistic approach is further linked to a view of crisis as a discrete event
with an objective, self-evident meaning (Gilpin and Murphy, 2010). Crisis is primarily
seen as coming from the ‘outside’, being the result of external forces and therefore also
requiring a response and communication with external stakeholders. Thus, the idea of
crisis as having an external origin is related to the strong focus on external communica-
tion (Gilpin and Murphy, 2008).
With the functionalistic approach, there follows a transmission-oriented view of
communication (Carey, 2009). Communication is then seen as a tool: skillful and care-
fully planned communication is supposed to mitigate the effects of a crisis and restore
the organization’s reputation. Quite obviously, the lion’s share of crisis research is
sender-oriented and a crisis tends to be treated from the standpoint of an organization
rather than from the standpoint of the stakeholders (Kent, 2010).
The social constructionist approach

In recent years, there has been an increasing criticism of the functionalistic crisis com-
munication approach. Among other things, its opponents claim that the rather one-sided
emphasis on planning and control is unrealistic, since reality is nothing but ordered
(Holtzhausen, 2012). Similarly, simple advice such as ‘Tell it all, tell it fast and tell the
truth’ is questioned, since different individuals and groups often have different under-
standings of the socially constructed reality, while there is no single truth (Tyler, 2005).
One example of a social constructionist view of crisis is given by Coombs (2014),

who argues that ‘if stakeholders believe an organization is in crisis, a crisis does exist,
and stakeholders will react to the organization as if it is in a crisis’ (p. 2). This stands
in contrast to a traditional, functionalistic understanding of crisis that is focused on
‘objective’ and ‘real’ incidents such as a fire, a gas leakage, or an impoverished reputation
after an organization scandal. Gilpin and Murphy (2008), who took a social construc-
tionist perspective on crisis management and crisis communication, claim that an organi-
zational crisis is a situation that is characterized by confusion, there is more information
than can be processed, and the employees do not have control over judgment and
decisions. Such a crisis situation is depicted by Weick (1993) as a cosmology episode,
when employees question essential beliefs and opinions. Weick (1993) explains the con-
cept as a situation:
when people suddenly and deeply feel that the universe is no longer a rational, orderly system.
What makes such an episode so shattering is that both the sense of what is occurring and the
means to rebuild that sense collapse together. (p. 633)
The emphasis on crisis as a perceptual phenomenon associated with ambiguity, confu-

sion, and feelings of disorientation (Maitlis and Sonenshein, 2010) opens up a much
broader approach to what a crisis is and what kind of problems and situations should be
studied. In a similar vein, Kent (2010: 707) urges crisis communication researchers to
expand the traditional focus on natural disasters, product recalls, and catastrophic inci-
dents and also study more mundane events such as employee layoffs, which would imply
that crises happen not only to corporates and their leaders but also other stakeholders.
One implication of this broader crisis view is that change processes can be perceived as
crises from an employee perspective. In a similar vein, Maitlis and Sonenshein (2010)
claim that both crisis and change offer powerful occasions for sensemaking. Another
implication is that small internal problems can also develop into a crisis that influences
external stakeholders (Taylor, 2010).
When it comes to communication, the social constructionist approach implies a sense-
making perspective to communication, that is, there is an emphasis on the complex and
unpredictable character of communication, and that meaning emerges in interaction
between people (Carey, 2009; Weick, 2009). Meanings and understandings of reality
influence people’s thinking and acting. Hence, communication is not only a vehicle or
a tool, but the very means that constitutes and reproduces organizational life (Putnam,
1983; Shotter, 1993).
Advocators of a social constructionist approach to crisis communication emphasize
the complexity of today’s organizations. Gilpin and Murphy (2010) conclude that ‘crisis
managers need to develop a tolerance for looser causality, lighter controls, and limited
predictability’ (p. 685). Too much focus on planning can even do more harm than good,
since it can cause organizations to become locked into fixed routines and acting
(Falkheimer and Heide, 2010). Routine behavior and pre-made plans may work in rather
stable situations, but crises and turbulent situations require the ability to improvise.
But successful improvisation is not possible without expertise and knowledge among
organization members and an organizational culture characterized by trust, flexibility,
and participation (cf. Weick, 1998). In line with the focus on complexity and crisis as a
Table 1. Comparison between the functionalist approach and the social constructionist
approach.
The functionalist approach The social constructionist approach
View of crisis Discrete event with objective, Crisis is a social construction – a

self-evident meaning perceptual view
Crisis phases that are focused Acute phase All crisis phases
Knowledge interest Finding generalizable law-like Increasing understanding of crisis as
results socially constructed
View of management Managerialism, rationality – Complexity and improvisation
plans and checklists
View of communication Transmission-oriented view Sensemaking-oriented view of
of communication communication
Relation to stakeholders Asymmetrical Relational, symmetrical
processual, integrated phenomenon, the systemic nature of crisis is emphasized (Bechler,

2004; Kersten, 2005). There is very seldom a single cause of a crisis. Rather, most crises
are a result of ‘the organizing actions of numerous individuals throughout the system’
(Bechler, 2004: 67).
Another feature of the social constructionist approach is a shift away from an asym-
metrical orientation toward a more relational, symmetrical view that embraces ongoing
communication and interaction with various stakeholders (Kent, 2010). In line with
this, there is a call for focusing not only the power elite, but also to marginalized voices
(Tyler, 2005). One voice that has been more or less neglected in crisis communication
research is that of employees. As mentioned above, a growing interest in internal com-
munication processes can now be seen among crisis communication scholars (Frandsen
and Johansen, 2011; Johansen et al., 2012; Mazzei et al., 2012; Taylor, 2010).
Table 1 summarizes the two different approaches in crisis communication research
and is hopefully helpful to the reader. Using a table that divides the field into two
separate approaches could be perceived as somehow awkward from a social construc-
tionist point of view since it, to some extent, indicates that the world is binary. We
have already emphasized above that this kind of division is factitious and offers a too
simplistic picture of the reality. Nevertheless, we have, for pedagogical reasons,
decided to summarize the two approaches in a table.
In the functionalist approach, crisis is understood as a discrete event with an objective,
self-evident meaning, while scholars in the social constructionist approach apprehend
crisis as something that may have different meanings to different publics (a perceptual
view). Hence, crisis is here understood as a social construction. When it comes to the
different phases of a crisis, functionalists mainly put the acute crisis phase in center, try-
ing to find general and optimal models that explain how a crisis best can be managed.
Social constructionists focus, on the other hand, on all crisis phases, and are predomi-
nantly interested in gaining better understanding of crisis and crisis communication as
social phenomena. In the functionalist approach, leadership is perceived as a rational
activity that privileges plans and checklists (i.e. managerialism), while leadership in the
social constructionist approach highlights complexity and improvisation. Functionalistic
scholars regard communication as a tool and as a transmission process, whereas social
constructionist scholars understand communication as a sensemaking process. Finally,

the functionalist approach emphasizes the organization’s perspective, and relations with
stakeholders tend to be asymmetrical, while the social constructionist perspective
involves a symmetrical relationship with ‘on-going stakeholder interactions to negotiate
how a crisis is interpreted, who is responsible, and what should be done’ (Gilpin and
Murphy, 2010: 683).
These two approaches imply different emphasis when it comes to internal crisis
communication in organizations. The functionalist approach focuses mainly information
distribution to coworkers during the acute crisis, while the social constructionist approach
encompasses a broader crisis spectrum and also includes the pre- and post-crisis phase.
A social constructionist approach also highlights and understands the importance of
interpretation and sensemaking. In the next section, we give a brief overview of research
into internal crisis communication.
On internal crisis communication

As argued in the introduction to this article, the fields of crisis management research and
crisis communication research have developed rather isolated from each other. While
crisis communication research has traditionally had its main focal point on external
dimensions, crisis management research has included internal processes such as
decision-making, organizational learning, and organizational culture (Johansen et al.,
2012). But even if such internal aspects have been studied within crisis management,
a communication perspective has not been used as an analytical lens. In other words,
communication aspects are sometimes discussed but seldom in an explicit way or as a
general analytical approach (e.g. Turner, 1994). This does not mean that research from
the crisis management field is irrelevant for understanding internal aspects of crisis
communication, but we call for more research with a stronger focus on communication.
Internal crisis communication can be briefly defined ‘as the communicative interac-
tion among managers and employees, in a private or public organization, before, during
and after an organizational or societal crisis’ (cf. Johansen et al., 2012: 271). However,
in line with a social constructionist approach, we would like to emphasize that commu-
nicative interactions and processes do not exist in a vacuum, but they are influenced by,
and influence, the organizational context they are a part of. In this article, we therefore
discuss not only ‘pure’ communication aspects, but we also include aspects dealing with
crisis perception, structure, culture, and leadership.
The theory of sensemaking, developed by the American organizational theorist
Weick, is one of the theories of greatest relevance for internal crisis communication. He
has conducted several studies of how organizational members make sense of crisis situ-
ations (e.g. Weick, 1988, 1990, 1993, 2010). Weick’s sensemaking perspective shows
how essential internal crisis communication is to an organization, since employees’
sensemaking of a crisis affects their behavior and action during the crisis (cf. Mazzei
et al., 2012; Weick, 1979, 1995, 2001, 2009). Organization members who have a crisis
perspective at the forefront of their awareness can detect and collect information on
weak signals of changes at an early stage. If empowered, employees can also act and
improvise during a crisis. Internal communication is further crucial after a crisis, since
communication is a prerequisite for learning and resilience (cf. Weick and Ashford,
2001). Weick and Sutcliffe (2001, 2007) distinguish between anticipation – formal
preparedness for the unexpected, focusing on failure, simplification, and operation, and
resilience, which is related to an organization’s ability to learn from a crisis and recover
from it. Both anticipation and resilience are clearly linked to a leadership that under-
stands the value of an open-minded communication climate where coworkers’ voices,
knowledge, and experience are taken seriously (cf. Ulmer, 2012). However, a rather
common problem in many organizations is that middle managers function as ‘commu-
nication subdues’ which hold back some of the negative information flow from coworkers
to the top management (Tourish, 2005; Tourish and Robson, 2006).
Weick has also contributed with important insights of high reliability organizations
(HRO; Christianson et al., 2011; Sutcliffe, 2011; Weick et al., 1999; Weick and Sutcliffe,
2007). HROs are organizations such as high-risk industries, nuclear power plants, and
hospitals that are skilled at mindful signal identification and proactive crisis management
– involving the encouragement of errors and prevailing efforts to learn from near misses
(Weick and Sutcliffe, 2007). In these kinds of organizations, errors and ‘almost errors’
are regarded as an important source for learning how to avoid errors and crisis in the
future. Weick and Sutcliffe (2007) have identified five characteristics of HRO that
are required for organizations to become mindful even in unexpected and equivocal
situations: (1) preoccupation with failure, (2) reluctance to simplify interpretations, (3)
sensitivity to operations, (4) commitment to resilience, and (5) deference to expertise.
In recent years, there have been a few publications where internal crisis communi-
cation has been the main focus. In a conceptual paper, Frandsen and Johansen (2011)
have convincingly argued for the need to focus more on internal crisis communication
and for employees’ needs to be differentiated from those of other stakeholders and
communicated with in a special way. Employees are ‘closer’ to the organization in
terms of stakes, identification, and relationship. Furthermore, employees are not ‘only’
to be seen as receivers, they are also important senders or messengers in relation to
crises – both internally, as they often have vital experience from core operations, and
externally, as they can act as positive or negative organizational ambassadors (cf. also
Johansen et al., 2012; Mazzei, 2010).
Johansen et al. (2012) carried out a survey in more than 450 organizations in Denmark
(both private and public organizations) in order to improve knowledge of how these
organizations perceive, plan, coordinate, and implement internal crisis management and
crisis communication activities. Respondents were persons typically responsible for
crisis-preparedness, which means that the study involved an expert perspective rather
than how employees in general relate to internal crisis management. The study gives a
comprehensive description of several important aspects such as perceptions of employee
reactions, use of communication channels, and how common it is to have a crisis man-
agement plan, a crisis manager, and a crisis management team. The results showed that
the vast majority of the organizations had a crisis or contingency plan and most of these
plans also included an internal crisis dimension.
Mazzei and Ravazzani (2011) studied the effectiveness of internal communication in
Italian companies during the 2008–2009 global financial crisis. The study was based on
interviews with internal communication managers and employees (belonging to different

organizations) and a survey involving internal communication managers. The findings
illustrated the value of building trustful internal relationships between managers and
employees before a crisis occurs. Extensive, well-planned, continuous internal commu-
nication during the crisis was met with misinterpretation and resistance, which was
explained by the lack of trustful relationships between managers and employees before
the crisis occurred. Mazzei and Ravazzanis’ (2011) study also showed that active listening
is crucial for internal crisis communication. Neglected listening may result in a sense of
abandonment and exclusion as well as the loss of important knowledge among employees
(Tourish, 2005).
A third study, conducted by Mazzei et al. (2012), developed one of the aspects men-
tioned above – namely, the relationship between continuous internal communication and
internal communication once a crisis has occurred. The empirical material was based on
a case study of an Italian company where one of the employees had died in a workplace
accident. The authors conducted a document analysis of the website, of presentations of
the internal communication policy and activities, and of monitoring data about internal
communication campaigns dedicated to safety, and so on. They also carried out two
interviews with internal communication referents. The study illustrated that the internal
relationship quality – resulting from years of investment in safety for employees and
continuous efforts on internal communication – was crucial for positive employee com-
munication actions. When coworkers trust and feel pride in their employer, they tend to
act as advocators and not exaggerate management responsibility (Mazzei et al., 2012).
The above-cited studies represent important contributions to a growing body of
knowledge about internal communication processes. As regards the theoretical appro-
aches outlined above, we argue that these studies align with the social constructionist
approach. The studies mentioned tend to embrace a perceptual view of crises and a
sensemaking view of communication; they not only focus on the acute phase, but also
include other phases (especially the pre-crisis phase); they pay attention to the role and
perspective not only of managers, but also of employees; and we can note an emphasis
on ongoing relationship building with employees and other stakeholders. Even so, we
miss a stronger emphasis on the voice of employees. Taylor (2010) is one of the crisis
communications scholars calling for a stronger focus on the internal dynamics of organi-
zations, and also for a wider scope of empirical studies. Taylor argues that too much
crisis communication research is based on studies of PR practitioners and their practices,
which we agree with. In the study presented in this article, we have therefore included
voices from employees in various functions and units, which enhances the possibility
of gaining an understanding of internal communication complexities and dynamics in
relation to crisis management.
Method
The empirical material presented in this article comes from a qualitative case study in a
public UH. In the following, we give a brief description of UH and explain why we chose
to study UH. We also present how the empirical work has been structured.
UH – An extreme case
As mentioned above, UH has 11,000 employees and is a multi-professional, highly
complex organization. The hospital is rather new, founded just a couple of years ago
after a merger between two former UHs in two different cities. The merger was sudden,
heavily debated both internally and in the media, and is still in progress. It should also
be mentioned that UH is part of a bigger public organization that comprises not only
health and medical services, but also areas such as growth and development, public
transport, and culture within a specific geographic region in Sweden. Politicians, who are
elected by inhabitants of the region every 4 years, govern this regional organization.
The sheer size, complexity, and present turbulent situation mean that there are many
kinds of potential and actual crises within UH – patient safety issues, trust crises, internal
conflicts, technical errors, and so on. As a hospital, it is also part of a critical infrastructure
in society, that is, it is one of those organizations the continued functioning of which
is important during an emergency in society. Thus, from a crisis perspective, UH is to
be regarded as an extreme case rather than a typical or average case. Flyvbjerg (2006)
argues that extreme cases are often richer in information on a given problem or phenom-
enon, and we are convinced that an average organization (being in a less turbulent situation,
less critical for society, less complex, etc.) would have involved less opportunity for
the study of the organization’s members’ understanding and experience of crises. And
although our case is an extreme one, insights and knowledge from this study are valid for
other complex, knowledge-intensive organizations in the form of theoretical generaliza-
tions (Tsang and Williams, 2012).
Before presenting how the case study was carried out, we would like to mention a few
words about our case study approach. Case study is very often used within social science,
however, not in a standard way, and some scholars call for a clearer definition (Hammersley
and Gomm, 2009; VanWynsberghe and Khan, 2007), although the most basic core of the
term ‘case study’ is that it refers to research that investigates one or few cases in detail
(Hammersley and Gomm, 2009: 4). Case study does not imply a specific set of methods
– even if it is usually associated with a use of multiple sources of empirical material – and
is not linked to a specific methodology (VanWynsberghe and Khan, 2007). VanWynsberghe
and Khan (2007) argue that case study is transparadigmatic in that it can be used from a
variety of paradigms such as post-positivism, critical theory, and social constructionism.
In line with their reasoning, we do not see case study as a specific methodology, method,
or research design, but rather as an approach or heuristic that takes different forms depend-
ing upon the researcher’s perspective. Following our social constructionist approach, our
case study is characterized by the use of several qualitative methods, closeness to the
natural setting of the organization, and analyses of several units and levels in order to gain
holistic, nuanced, and context-dependent knowledge (see Heide and Simonsson, 2014b).
Multi-methods and sub-studies

The case study was carried out during a period of 3 years (with varying degrees of inten-
sity), and we used several methods in order to get rich, nuanced material. The main
empirical material consists of interviews (both individual and in groups), but we also
used documents as a source of information and made observations of some meetings
and a crisis exercise. The documents we studied consisted primarily of various steering
documents such as crisis plans and policies. Documents can be seen as symbolic repre-
sentations of the social reality constructed by members of an organization (Altheide,
1996), and the documents increased our understanding of the ideas of crisis and crisis
communication constructed within UH. The studied documents also included decisions
and rules, and we were interested in how organizational members related to them (cf.
Hammersley and Atkinsson, 2007). Thus, one rationale for analyzing documents was to
use them as a source of information about rules, roles, and ideas constructed in the organ-
ization. Another rationale was to gain increased background knowledge in order to gain
inspiration for what to ask and look for in interviews and observations (Bowen, 2009;
Patton, 1990). During the 3 years of the project period, we also followed the regional
newspaper reports about UH – not in order to make a systematic analysis of them, but
rather to be able to ask questions about the internal experience of the media picture.
As UH is a very large organization, we were not able to cover the entire organization
with all its divisions and units. Instead, we had to make separate sub-studies focusing on
different actors and units within the organization and on different aspects of internal
crisis communication. Altogether, we made four separate sub-studies.
The first sub-study focused on formal crisis readiness and crisis management at UH,
and how they can be understood from an internal communication perspective. Here,
we mainly interviewed persons with a key role or position within the formal crisis
organization. Several of the interviewees were members of UH’s steering committee
for crises and catastrophes – with positions such as head of emergency department,
communication manager, catastrophe coordinators, security manager, head physician,
and service manager. During this sub-study, we were also able to observe a full-day
crisis exercise, which further enhanced our understanding of the formal crisis manage-
ment organization from an internal communication perspective.
The second sub-study was of the role of communication professionals and their work
in relation to internal crisis communication. We interviewed communication professionals
working in a central department and in various divisions, and we also asked managers
about their ideas of the roles and practices of communication professionals.
The third sub-study focused on error reporting as an important part of the pre-crisis
phase. While errors can cause a crisis, we think there is a clear – but often not outspoken
– link between error management and crisis management. Put differently – closer to crisis
communication terminology – error reporting can be seen as a way of detecting weak
signals (cf. Coombs, 2014). Linked to this part of the case study, we made personal inter-
views and group interviews with managers and coworkers at an emergency department.
The last and fourth sub-study was about how UH dealt with lack of staff and shortage
of patient beds during summer time when many of the employees are on vacation and
the hospital has less capacity. This was not a big, unexpected crisis, but still a recurrent
problem, which has often triggered the first contingency level. Related to this study, we
made a few interviews and observations of two planning meetings and six management
meetings during the summer period.
In total, we conducted 34 individual interviews and 2 group interviews (with three
persons in each group). Using Frey and Fontana’s (1991) distinction between different
types of group interviews, ours can best be described as formal field interviews, that is,
interviews where the researcher gathers a group of interviewees at a location within the
field setting that is free from distractions in order to allow for interpersonal dynamics and
in-depth discussions.
Research process
The individual interviews each lasted 1–1.5 hours and the group interviews about 2 hours
each. Both the individual and the group interviews were semi-structured. We used an
interview guide with prepared questions organized into different themes, but the inter-
viewees were still free to develop relevant sub-themes and their own experiences and
interests influenced what parts in the guide we focused on (cf. Alvesson, 2011). In some
cases – primarily in interviews with senior managers and group interviews – both of the
authors participated in the interview. Most often, however, we chose only to be one inter-
viewer in order to decrease the power asymmetry involved in the interview situation
(Brinkmann and Kvale, 2014). It should also be mentioned that the interview guide
changed and developed as we gained more knowledge and entered into various sub-
studies (cf. Alvesson, 2011). However, in broad terms, the interview guides included one
general part and one specific part with questions linked to the sub-study in hand. The
general part included questions about aspects such as perceptions of what a crisis is,
previous experience of crisis management and crisis communication, opinions of crisis-
preparedness documents and ideas of how internal communication functions in ‘normal’
situations and specifically in times of crisis situations. At the introduction of a new
theme, we often asked open, broad questions, the so-called ‘grand-tour’ questions (Jones,
1996), in order to give room for the interviewees’ spontaneous rich descriptions of what
they perceived as the main aspects of the theme (Brinkmann and Kvale, 2014). One
example of a grand-tour question was the following: ‘Crisis is a word that can be defined
in many ways, what do you perceive as an organization crisis?’ Some subjects gave rich,
nuanced answers to those kinds of open, introductory questions, but in almost all cases,
it was necessary to continue with various follow-up-questions (see Brinkmann and
Kvale, 2014). For instance, we asked interviewees to give concrete examples of crises
they had experienced as employees at UH and to describe how the internal communica-
tion processes had worked during the most recent crisis.
The interviews were recorded and transcribed verbatim (cf. Kvale and Brinkmann,
2009). Observations were not recorded, but documented with careful notes (in most
cases by both of the authors). As noted above, we observed one crisis exercise and
several meetings during the fourth sub-study that dealt with the shortage of staff and
patient beds. Since the observation of crisis exercise was carried out in the beginning
of the empirical work, we chose not to use an observation guide since we thought it
was difficult to select certain topics at that stage of the research process (cf. Hammersley
and Atkinsson, 2007). When doing observations during the fourth sub-study, however,
we used an observation guide with broad questions in order to get more focused notes.
The following are examples of questions in the guide: What kind of motives and argu-
ments are central when making decisions? Which persons or groups dominate during
the meetings? and What is decided to communicate to employees and how is that to be
communicated, through which channels?
Our role as observing researchers was clearly communicated to the staff who partici-
pated in the exercise and the meeting. This, in combination with note-taking being a
‘natural’ activity during meetings, made it possible for us to take extensive and detailed
notes during the actual observations (cf. Hammersley and Atkinsson, 2007). After the
observations, we also always worked through the notes in order to make further develop-
ments and add analytical comments, although we clearly distinguished between notes
that were about our reflections and notes that were direct quotations from the meetings
(cf. Hammersley and Atkinsson, 2007).
Analytical approach
The paradoxical tensions presented in this article were identified after the first initial sub-
study was carried out, but material from the other studies has been used in order to
develop our understanding of the different tensions and the complexity of internal com-
munication processes. In line with a social constructionist approach, we do not think it is
possible to catch the case organization or reality ‘as it is’. Thus, the idea of using several
methods was not to triangulate data in order to seek convergence and corroboration
(Bowen, 2009) and use that as a test of evidence. The idea was rather that there are many
different realities which we tried to grasp by using several methods and a polyphonic
approach by including a variety of different voices and perspectives (Alvesson and
Sköldberg, 2009).
Throughout the research process, we have tried to follow a reflexive approach, that
is, we have viewed the empirical material from different angles and tried to create ‘an
interplay between producing interpretations and challenging them’ (Alvesson, 2011: 7;
see also Alvesson and Sköldberg, 2009). Nevertheless, the analytical process followed
certain basic steps. The first step was to continuously read interview transcripts and
observation notes and code parts of them into different themes. The next step was to
read the material in a horizontal way – find patterns and links between interview state-
ments from different persons and from different occasions of observations (Brinkmann
and Kvale, 2014; Eksell and Thelander, 2014). However, we were looking for patterns
while at the same time also looking for variations (cf. Alvesson and Kärreman, 2011).
The most pervasive pattern was actually a kind of anti-pattern, that is, the paradoxical
tensions showing the complex and ambiguous nature of crisis management and internal
crisis communication.
Paradoxical tensions
Through the analysis of the empirical material, we have identified five different para-
doxical tensions at UH that have clear implications for internal crisis communication.
The five different paradoxical tensions are as follows: (1) episodic–emergent, (2) cen-
tralized–decentralized, (3) professional–organizational, (4) planning–improvisation, and
(5) external–internal. Each tension is constituted of two opposite states that co-exist
in the organization, but there is a strong tendency that either one of the states is stressed
and functions as a point-of-departure. Below we describe these tensions and how they
are manifested in internal aspects of crisis management and crisis communication.
1. Episodic–emergent.
The first paradoxical tension deals with the perception and definition of a crisis. What is
deemed as a crisis is all but a trivial thing since it directs our decisions and practices (Kent,
2010). The formal crisis management plan of UH is one important source of how a crisis is
defined. In the plan, we read the following about the third contingency level catastrophe:
Triggered by a situation where the available resources are inadequate in relation to the urgent
need for care and where the load is so high that normal quality requirements for medical
treatment, despite adequate measures, can no longer be maintained.
This quotation signals a clear focus on patient care and the importance of gathering
enough resources. In broad terms, it could be interpreted as meaning that crisis manage-
ment within UH is about securing patient safety, and that the key to manage that is more
resources. We also met this idea when interviewing managers and employees – words
such as ‘patient safety’, ‘uninterruptable health care’, and ‘insufficient resources’ were
mentioned when we asked about what a crisis is. Examples of crises mentioned in the
plan are bomb threats, fires, water leaks, and problems with elevators. Crises in terms of
reputation, work environment, leadership, and so on are not mentioned in the formal
crisis plan. And even if these aspects actually can cause a situation with problems of
patient safety, they seem to be outside the formal crisis management discourse.
We interpret the crisis management plan and also some of the interview comments as
a reflection of a functionalist approach with a view of crisis as an episodic event. This
crisis perception can also be described as an expression of what Frandsen and Johansen
(2009) call an emergency logic (with clear parallels to the functionalist approach).
Frandsen and Johansen link the emergency logic to an event-oriented approach to crises
and crisis management. Crises are further associated with accidents, disasters, and war
actions damaging people, property, and environment. Frandsen and Johansen oppose the
rather narrow emergency logic, favoring a broader crisis management logic that also
includes strikes, scandals, poor management, and so on and damage to symbolic capital
in terms of trust and reputation.
Interestingly enough, there has never been any severe crisis within UH – at least not
if we adhere to the formal crisis management plan. Three separate contingency levels
or states are identified in the plan: (1) state of staff situation, (2) state of emergency
preparedness, and (3) state of catastrophe. The interviewees agree that UH has never
experienced the second or third states, except once by mistake. On the other hand, the
first level is the more frequently used. A typical situation is when there is a shortage of
hospital beds, occurring almost weekly.
When we talked with employees ‘on the floor’, that is, doctors and nurses close to
core operations, we identified a crisis perception that clearly goes beyond the idea of
crises as distinct episodic events. Some interviewees perceive the hospital as a whole as
being in a crisis and express an experience of a more or less omnipresent crisis:
Crisis is when I can’t fulfil my tasks, and that happens more and more often. (Nurse)
I think we have a crisis at UH right now, because of the cutbacks and fewer hospital beds./…/
But as a manager you do not use the word crisis. You do not want to upset coworkers. (Team
leader)
The perception of being a member of an organization that as a whole is in an enduring

crisis situation stands in strong contrast to the episodic view inherent in the formal crisis
management plan. The perceived organizational crisis is not the result of a sudden or
unexpected event linked to specific actors or occurrences (cf. the functionalist approach),
but is rather a complex, integrated, and emergent phenomenon without a clear beginning
and end (cf. Weick and Quinn, 1999). The experience among the staff at UH of being in
a never-ending state of crisis can be related to the media reporting in Sweden over the
last years. Newspaper articles on crisis in the Swedish healthcare system have been very
common since the 1980s. In recent years, there have also been increased demands from
hospital politicians to reduce costs simultaneously with continued expectations of quality
improvements (cf. Berlin and Kastberg, 2011; Gilmartin and D’Aunno, 2007).
In line with a social constructionist approach, Coombs (2014) has pointed out that if
stakeholders believe that there is a crisis, they will also act as there is a crisis. We can see
clear links between employees’ interpretation of being in a crisis and their actions: during
a period, they carried out weekly demonstrations, they appear quite frequently in the
press on the theme of a stressful work environment, there are media reports about
employees quitting in protest against further cuts, and employees have started a Facebook
group with thousands of members where they put forward strong criticism of the managers
and politicians responsible.
From an internal communication perspective, it is quite interesting to note the final
sentence in the above quote, saying that managers do not want to use the word crisis
since it could worsen the situation. But it could also be the contrary, that is, that silence
or denial of employees’ crisis experience is something that can, if not creating a double-
crisis (Johansen and Frandsen, 2007), at least add to the interpretation of being in a crisis.
In situations of uncertainty and ambiguity, we tend to move away from a habitual way of
making sense to more reflexive, conscious, and active sensemaking (Balogun, 2006;
Chreim, 2006; Weick et al., 2005). Thus, we can expect that the worried employees in
UH actively search for meaning in the current situation, and if their managers do not
communicate with them about their worries and frustration they will fill that vacuum in
other ways, which is also indicated by the above-mentioned activities of starting a
Facebook group and actively approaching external media.
Summing up this first tension, we discerned two different crisis perceptions: the
episodic that focuses on sudden, ‘big’ events that threaten patient safety and that demand
more resources, and the emergent that is not about single events but rather about employ-
ees feeling that they are part of an organization that as a whole is in a crisis. From a
functionalist understanding of crisis, UH has never had any ‘real’ organizational crisis
because the coworkers always have managed the situation, and they have never triggered
the second and third crisis contingency level. However, from a social constructionist
understanding, the importance of various stakeholders’ perception is highlighted and in
that respect UH has definitely had several crises. As mentioned above, Kent (2010)
argues that crisis research needs to be broadened, and include events such as employee
layoffs and moving production units abroad, which clearly indicate that crises not only
happen to organizations and their leaders but also to employees.
2. Centralized–decentralized.
UH is a very large, complex organization, as described above, and it is structured as a

traditional line organization with many hierarchical levels and middle managers. Our
interviews also confirm that a hierarchical decision line is idealized at UH, which could
be explained by the core activity – medical healthcare – that in many situations is dependent
on strict, and almost military, directions and orders. For example, a surgeon has the high-
est status, most power, and responsibility in a surgeon team, and gives clear instructions
to the others in the team. Every member has his or her fixed task and responsibility.
Following a traditional hierarchical management that is typical in the functionalist
approach produces an organization that is highly centralized, with the consequence that
the hospital director and his staff are rather influential in some areas. On the other hand,
a lot of responsibility and decision-making is decentralized to the various medical divi-
sions within the hospital. Some interviewees describe UH as a silo organization with
self-governed papacies. The silo organization is a well-known problem in healthcare
organizations. MacStravic (2007) claims, ‘getting separate departments and functions to
coordinate and integrate their efforts is likened to herding cats. Even getting physicians
in different specialties to work together can be a major challenge’ (p. 108). The division
managers are, according to our interviews, perceived as powerful and rather independent
of the hospital director. One of the interviewees even argues, ‘they do what they like and
do not follow requests from the director’. This paradoxical situation of having both a
strong line hierarch and self-dependent divisions does not necessarily become a problem
for the organization. Perrow (1977) underlines that ‘[t]he efficient organization is both
centralized and decentralized’ (p. 14). A highly specialized, large, complex organization
needs to be decentralized in order to function, but also needs clear rules and values to
function, according to Perrow.
However, when it comes to crisis management at UH, there seems to be no such
balance, since it is organized in a decentralized and loosely coupled manner (cf. Weick,
1976). There are several crisis management functions such as (1) the steering group for
crises and catastrophes, (2) the psychological catastrophe management group, (3)
catastrophe coordinators who work in the emergency department, (4) the risk and vul-
nerability coordinator; and, at some clinical departments, (5) quality coordinators who
are responsible for error reporting. However, our empirical material shows that these
different crisis management functions are rather isolated from each other and are not
included in an integrated, centralized crisis management system. The different func-
tions do cover the three different crisis phases, but are not coordinated. In other words,
there is not an optimal balance between a centralized and a decentralized organization.
Furthermore, there is no crisis manager with an overall responsibility at UH, and some
interviewees claim that the steering group lacks a clear mandate and relationship with
the hospital director:
Part of my role was to be the head of the steering group. My first question was: ‘Where is the
mission statement for the steering group? What am I expected to do?’ But there was no mission
statement, and no one knew. I did not see it as a steering group because it was a gigantic group
with different persons each time. (Manager)
As Ulmer (2012) explains, when crisis management is not a regular issue on the
management board’s agenda, crisis management tends to become fragmented, tactical,
and reactive. An additional crisis management problem at UH is that line managers
are said to have too much responsibility and too many different work tasks. And as a
consequence, some managers have difficulties in finding the time to take care of crisis
management matters such as implementing current crisis plans, facilitating learning
and knowledge sharing, and taking care of early warning signals. Consequently, crisis
management processes tend to lose prioritization in favor of the core activity – medical
healthcare. This finding is naturally related to the next tension professional–organizational
(the professionals tend to set the management agenda), and it is also confirmed by
earlier research (Vogus et al., 2010).
Not very surprisingly, the interviews indicate that the silo organization enhances
vertical communication flow within each division, whereas horizontal communication
between different divisions and departments is hampered. We also think there is a rather
traditional management approach at UH which further strengthens the emphasis on
vertical line communication. According to our interviews, line communication is
interpreted as a kind of ‘sacred cow’ within UH, and it seems to be more or less taken
for granted that the vertical line organization should be, and has to be, the predominant
channel for internal communication. The strong emphasis on line communication is
also linked to a transmission-oriented view of communication where the focus is on
moving ‘information packages’ from A to B. However, the strong emphasis on line
communication can cause problems during a crisis situation. As some interviewees
argue, line communication is far too slow and unreliable when there is a messy crisis
situation that demands fast and efficient communication. A related problem is that ‘it is
not even sure that the manager is at work when something happens’, as one interviewee
pointed out. Another problem is that the strong focus on line communication tends to be
a barrier to communication between organizational members in different departments.
Thus, we can see that learning and communication between different units and profes-
sions seem to be hampered by structural, organizational arrangements. The loosely cou-
pled crisis management functions (cf. Orton and Weick, 1990; Weick, 1976) plus the
silo organization prevent and aggravate internal crisis communication between different
functions and departments, which in turn produces barriers against organizational resil-
ience and learning. It is not that decentralization seems to be the ultimate solution, but
that centralization and decentralization are both needed (cf. Perrow, 1977).
3. Professional–organizational.
UH can be viewed as a professional organization with at least three different players:

medical staff, managers, and administrators. As in many other hospitals, UH is driven by
a medical logic – the norms and values of physicians and nurses tend to override the logic
of different management models (cf. Chreim et al., 2013; Sveiby, 1997). Our interviews
further conform that this dominating logic causes a separation, and sometimes even
conflicts, between different professions within the hospital – especially between the
medical staff, on the one hand, and administrators and managers on the other.
In addition to the dominating logic, the different focuses and identifications of these
two groups explain the divide. In general, employees that belong to strong professions,
such as physician and researchers, are inclined to identify more with their professions
than with the employing organization (Berlin and Kastberg, 2011). Furthermore, pro-
fessionals do mostly put the trade, the profession, in the center of their attention. One
example of this is given during an interview with a physician. The interview took place
in summer time during the intensive holiday period when senior managers and key
persons had regular meetings – so-called 1 pm meetings – in order to discuss possible
problems with lack of staff and shortage of patient beds. The physician being inter-
viewed said that he did not get any information about the outcome of these meetings,
whereupon the interviewer asked if he considered that as a problem:
Interviewer: Would you have liked to know what was said at the meeting or how the
situation was deemed?
Physician: I should not be affected by the current supply of patient beds when I
make my judgment of the patient. So really, I am not interested in that
kind of information. I know that I will be influenced and probably take
bigger risks with the patient’s health if we have a tight situation.
Because in such a situation I know there is a desire to discharge the
patient instead of keeping the patient in the hospital.
This is an example of where the medical assignment is prioritized, while the overall
organizational perspective and other aspects are regarded as secondary (cf. Starbuck,
1992). The same tendency can be found in healthcare organizations in general, and
earlier research (cf. Apker, 2004) confirms our analysis. In contrast, the administrators
(e.g. communication professionals) at UH seem to identify more closely with the hospital
as an organization. This conflict of interests affects cooperation and status between
different categories of coworkers (cf. Fulop and Mark, 2013; Rycroft-Malone et al.,
2004). Sveiby (1997) even suggests that there is a ‘terror balance’ between the admin-
istrative staff and the professionals in professional organizations. In our interviews, it is
mainly administrative staff members who mention a potential terror balance. Some of
them have received pejorative remarks from the medical staff such as ‘What do you
really do? Give us the money instead!’
Our interviews substantiate that professionals at UH are a powerful group and that
they influence the organizational agenda. Physicians represent the most preeminent posi-
tion and they dominate the day-to-day work in hospitals (Sveiby, 1997). It is, for instance,
rather obvious that the official definition of crisis at UH (see above), which is exclusively
related to medical aspects, originates from the strong impact of the professionals. The
one-sided view of crisis within the organization, often to be found in the functionalist
approach, seems to be a strong barrier for alternative and perceptual approaches to crisis.
The strong influence from the medical profession is further mirrored in an emphasis on
the acute phase (rather than the phases before and after the crisis) – also typical of the
functionalist approach. The core organizational activities at UH – medical healthcare –
are in themselves risky and the medical staff are used to handling crisis situations on
a regularly basis. A recurrent pattern in the interview answers is that crisis is an ‘elixir
of life’ for the medical staff. They ‘go at it’ and do their best to handle tricky, equivocal
situations. These are of course vital ingredients in building a safety culture (cf. Reason,
1997), but the interviews also show that the organization is dominated by a ‘here-
and-now-focus’ which reduces the incentive to pay attention to the phases before and
after the crisis (Heide and Simonsson, 2014a).
Thus, the staff from different administrative functions, such as communication,
accounting, and human resources, represents the organizational side in this paradox.
These functions naturally have other goals and interests compared to the professionals
that mainly focus on medical issues. While the medical staff sees issues from a medical
perspective, the organizational side perceives other aspects that are related to crisis man-
agement, for example, security, technique, and communication. Both the communica-
tions director and the deputy underline in the interviews that they experience and witness
a varied degree of understanding for and knowledge in communication. Some managers
have a mature and developed understanding of communication, while others have a more
traditional, instrumental, and transmission-oriented view. The deputy communications
director describes the problem that decisions are not analyzed from a communication
perspective:
We (communication officers) can contribute with knowledge of how a decision will be received
and what possible consequences we can expect – the coworkers will probably […], if we take
this decision it will certainly cause a media debate. And we can hopefully, with this information,
prevent a crisis from evolving.
However, the problem is that the communications director does not have a seat on the
board of directors, and there is also a rather low level of knowledge about the communi-
cation expertise that the department of communications can offer to the organization.
The department of communications stands for a broader understanding than is predominant
in the professional organization that prevails in the medicine aspect of a crisis. A typical
broader understanding of crisis encompasses other aspects such as the effect on the
organizational image and brand, the reputation, and trust among citizens. One can con-
clude that the organizational side takes a broader, holistic, organizational perspective in
the crisis management process. Even if the professional side of this paradox dominates
the understanding of crisis, there are also signs that point toward a somewhat changed
balance. The organizational side is also important when it comes to a holistic approach,
as the communications director emphasizes in the following quote:
You usually don’t take a holistic grip, you solve it locally as soon as something happens, some
form of crisis, and it works rather well. They interact and find a solution, but maybe this
solution could be done even better; there already was an excellent solution in the organization.
So for the individual staff, it is very difficult to have a holistic perspective.
According to the communications director, the UH is a fundamentally sound and

creative organization that promotes improvisation that is excellent when it comes to
handling a crisis situation. But she would also like to see a greater holistic organiza-
tional understanding that demands leadership, structure, and planning.
In sum, the dominance of the medical perspective in UH is reflected in a rather narrow
definition of a crisis and a primary focus on the acute phase. We can also see how the
medical or professional perspective sometimes competes with an overall organizational
perspective that stands for a broader understanding of crisis containing other aspects
such as trust and the brand.
4. Planning–improvisation.
The fourth tension embraces planning and improvisation. Marra (1998) argues that plans
often are overrated, and underlines that ‘crisis communication plans are only part of
what determines excellent crisis public relations practice’ (p. 463). Culture and leader-
ship are often more important predictors of crisis management success compared with a
detailed crisis plan (Marra, 1998, 2004). Along similar lines and linked to the social
constructionist approach, several scholars (Finch and Welker, 2004; Gilpin and Murphy,
2008) argue that improvisation must be encompassed and understood as an effective way
of handling puzzling situations.
With the functionalistic approach on crisis management and crisis communication
that prevails in UH, there follows an emphasis on planning and control. After the merger
of the two UHs had taken place, the director hired an external consultant, in order to
improve the crisis and catastrophe management. One of the first assignments for the
consultant was to integrate the crisis plans at the two former hospitals into one singular
plan. According to the consultant, the content of the two plans were quite similar, but the
hospitals had chosen to organize them differently. Both plans comprised 150 pages each,
and the consultant did not see any point in reducing the bulk of the new crisis plan. The
sheer length of the plans seemed to reflect a functionalistic belief in detailed instructions
as a means to gain predictability and control, although some of the interviewees prob-
lematized their length and stressed the importance of making them shorter and easier to
navigate in. However, efforts were more or less exclusively focused on improving the
plan as an information product, rather than the communication process needed to imple-
ment the plan, that is, how to make it understood and acted upon (cf. Gilpin and Murphy,
2008). Likewise, when we asked how the plans were implemented – communicated and
used – in the organization, we got quite vague answers. Thus, the focus seems to be on
getting the plan as a product in place, not how the plan is understood and used.
This way of handling the situation reflects the management focus that characterizes
the functionalistic approach, emphasizing traditional rationality in the form of plans and
checklists. The managerialism that can be discerned in UH is naturalized and reproduced
when plans and formal procedures are constantly emphasized. An example of this is how
the recurrent problem of the shortage of hospital beds is ‘solved’. Instead of trying to find
new routines or reflect on leadership or communication aspects behind the problem,
the crisis consultant decided to suggest a new contingency level in the plan. Despite
the fact that medical staff has to improvise a great deal in their daily work, we have seen
examples of managers and administrators who criticize employees who do not follow the
formal crisis plan. For instance, during an observation of a large crisis exercise at UH, a
doctor at the emergency department was rebuked when she used her informal network to
receive more information in order to be able to act faster and more reliably. There can of
course be many reasons for such criticism, but it does clearly illustrate the tension
between formal plans and informal improvisation.
In spite of the strong managerialism at UH, we also find an insight among some of the
interviewed coworkers, that plans should only be regarded as a catalyst that facilitate
action taking (Marra, 1998). A nurse told us, ‘The plan is there to set up a level of emer-
gency – especially the emergency department but also other departments. Once the crisis
organization is set, the plan is wasted’. It is also obvious that the medical staff practice
improvisation daily to a larger or lesser extent, and as a consequence, coworkers are well
trained to make quick decisions in order to solve different medical issues that arise. If
they did not improvise and occasionally drop the plan, the consequences could be severe
(i.e. patients could die).
In contemporary crisis management literature, there is a general understanding that
extensive, detailed plans can hinder and make organizational actions slower in times of
crisis (Gilpin and Murphy, 2006; Weick, 1998). As mentioned, we have also met this
understanding among several interviewees. Yet when it comes to crisis management at
UH, plans, line hierarchy, and rational thinking tend to be emphasized. Confidence in
detailed plans, order and scenarios, has a natural explanation in the medical activity
where there are many operation standards and where evidence-based research has high
status. The attraction to plans can also be explained by their visibility and concreteness,
which makes it easier for responsible managers to show what they have achieved.
Another explanation is that producing and developing plans is not that complicated com-
pared with working with long-term aspects such as leadership and organizational culture
(cf. Grint, 2005). One of the interviewed managers argues that crisis management in
complex organizations like UH is a kind of teflon-question: ‘They are so complex, we
don’t know how to handle them. So we keep our focus on what we know instead’.
To sum up, it seems to be easy to get stuck in detailed plans and standard procedures,
while it is much harder to create a crisis awareness culture that encourages improvisation
and flexibility (i.e. an emphasis on resilience rather than anticipation; Weick and
Sutcliffe, 2001, 2007). It is obvious that the functionalist approach is dominant in the
organization since there is an emphasis on crisis plans as products rather than on the
actual use and understanding of them. This understanding is also closely linked to a
transmission-oriented view of communication that prevails in the functionalist approach.
In line with this approach, some interviewees stressed that the main challenge in internal
crisis communication is to secure rapid, reliable transmission of operational instructions.
Questions that are related to a social constructionist approach, such as how informal
communication can provide learning opportunities or how active listening can be used to
build trust and detect early signals of crisis, do not seem to be very high on the agenda
(cf. Mitroff and Anagnos, 2001).
5. External–internal.
Both the interviews and the steering documents we have examined give a clear indication
that external crisis communication (especially media and press contact) is given much
more attention than internal communication. UH has very recently, just a few months
ago, adopted a crisis communications plan. As mentioned above, UH is part of a bigger
organization that comprises all the hospitals within a specific geographic region, and the
crisis plan of UH is built upon the crisis communication plan for the whole region. Press
officers are given a key role in both the local and the regional plan, while the role and
responsibility of communication professionals working with employee communication
is not specified. Some of the communication professionals that we have interviewed are
quite frustrated about this, but also aware that they themselves need to clarify what their
internal crisis role could be
It has to be made clear what the communication department can offer. I was a bit frustrated at
the meeting [after a big crisis exercise]. Everyone was so happy that the press officer is part of
the steering group for crises and catastrophes so that we can reach the media, full stop. I have
met the same attitude on other meetings as well. (Communication professional)
The interviews also indicate a rather narrow view of the internal public in times of
crises. A general pattern seems to be that it is primarily those groups or departments that
are directly influenced by an ongoing crisis that are considered important to reach with
information. Departments and units that are not directly involved seem to be given more
or less the same information as external stakeholders. If the same texts are used for external
and internal purposes, there is of course a risk that the information is not experienced as
meaningful for any of the groups. It is also interesting to note that in the regional crisis
communication plan, there is no distinction between communication objectives for
external stakeholders and for employees. For instance, the text states that the overall
objective is ‘to give enough and correct information internally and externally’. As regards
the local crisis communication plan for UH, no clear communication objectives are for-
mulated at all – neither for external communication nor for internal communication.
As mentioned above, Frandsen and Johansen (2011) present several reasons for distin-
guishing external crisis communication from internal crisis communication. Employees
have, for instance, a contractual, economic relationship, which most external stakeholders
do not have. Another difference is that employees have other – and often higher – stakes
in terms of salary, job security, and working conditions, which affect both their occupa-
tional and private life. Furthermore, employees tend to have a stronger identification than
external stakeholders with the organization, and they act both as receivers and senders in
times of crises. It seems to be quite reasonable to assume that if employees get the same
messages in the same tone of voice as external stakeholders, both their loyalty and their
willingness to act as ambassadors will be decreased. The interviews also give us several
examples of nurses and doctors at UH who are very critical of their employer and who
experience that UH as an organization is in a big crisis situation.
Another troublesome aspect is that internal media cannot compete with the speed of
external media coverage. Several of the interviewees tell us that they often use websites
of regional press and regional radio and television to get the latest information about
what happens within their own organization in times of turbulence and crises (cf. Mazzei
and Ravazzani, 2011). It is also hard to compete with external media when it comes to
the amount of messages and publicity. One of the press officers claimed, ‘the days when
we are not in the paper are almost less than the days we are in the paper’. Most often the
articles are very negative with headlines such as the following: ‘Half of the doctors in the
emergency department are considering quitting’, ‘Operation failed – the surgeon was too
tired’, and ‘Shortage of hospital beds behind deaths of patients’.
The Swedish principle of public access to official documents means that many docu-
ments are accessible for both employees and external stakeholders. This principle, which
creates high expectations of openness, in conjunction with medical staff often being
more loyal to their professions than their employers, seems to have paved the way for a
culture where internal criticism of the hospital management is very strong and tends to
take place in external channels. Social media such as Facebook has intensified this trend.
As mentioned before, there is a Facebook group in which employees make references to,
and cherish, critical media reporting about their own hospital. This is a clear sign of
frustration and reassignment among employees, and also a sign of failure within the
internal communication process. Our point is not that the managers and communication
professionals of UH are to prevent external media coverage, but we can see a need for
commenting on and discussing the external media picture internally. According to the
interviewees, this is not done on a regular basis today. There also seems to be a need for
fostering a culture that facilitates critical upward communication within the organization
(cf. Tourish and Robson, 2003).
Trying to summarize this paradox, we claim that there is a need for a more even
focus between employees and external stakeholders. Employees – not only those
directly involved in a current crisis – need to be given more and special attention. In a
similar vein, UH not only needs press officers but also communication professionals
whose primary role is to support managers and internal communication processes.
Further, the external media coverage is a ‘natural’ part of a big, public organization,
but it is quite problematic if the external media picture is not commented internally and
if much of the internal criticism is taking place externally. From an overall perspective,
the internal crisis communication at UH seems to follow an asymmetrical, functionalist
approach rather than a relational perspective emphasized by the social constructionists.
Previous studies have shown that trustful internal relationships between managers and
coworkers – resulting from investments in continuous internal communication – are
crucial for employees acting as ambassadors and communicating about their employer
in a positive way (Mazzei and Ravazzani, 2011). At UH, there is clearly a lack of such
trustful relationships, and consequently, there are several examples of coworkers acting
as negative ambassadors rather than positive ones. If the practitioners had taken a
social constructionist approach in the internal crisis communication, there would have
been a greater appreciation of sensemaking and the enacting aspects of communication.
Since all human beings produce and reproduce understanding and social constructed
realities through communication, there should be more focus on dialogue and discus-
sions during the pre- and post-crisis phases and during the acute crisis phase if it is
drawn-out. The understanding of coworkers of a crisis situation affects their actions,
and they mediate that picture to a wide range of people, such as customers, citizens,
relatives, and friends.
Concluding discussions
In this article, we focus on internal crisis communication and conclude that it is essential
to an organization, and organizational members are very important in every phase of a
crisis. It is organizational members who can detect early on weak signals of changes that
might lead to a crisis; they are the ones who handle and solve a crisis situation, and their
understanding of the crisis situation is spread to different external groups. After a crisis
has occurred, organizational members discuss and produce new knowledge that, in best
cases, can prevent new crises from occurring, although internal crisis communication
seems to be more or less neglected by practitioners and scholars. Hitherto, external
communication has been the sole focus. Practitioners have mainly been interested in and
have put their energy toward trying to prepare responses to external groups during a crisis,
not at least to the mass media, and recapturing the trust of the external group for the
organization. One reason why scholars, to a large extent, have been interested in external
crisis communication is because most crisis communication scholars have their heritage
in PR that traditionally focus on the external communication of an organization.
With regard to philosophy science, there is little doubt that the functionalistic approach
still dominates PR research (Falkheimer and Heide, in press; Holtzhausen, 2012; Ihlen
and Verhoeven, 2012; Wehmeier and Winkler, 2013) as well as crisis communication
research. A functionalistic approach involves a rather static and unreflected understanding
of the relationship between communication and organization, and that is another expla-
nation for why the internal aspects of crisis communication are neglected. A social
constructionist approach includes an interest in the continuous organizing processes,
since organizations are produced and reproduced through the interactions and communi-
cation of organizational members (Taylor and Van Every, 2000). Hence, an organization
is a product of social relations between organizational members. If crisis communication
scholars take the social constructionist approach seriously they would put the organiza-
tional members in the limelight (cf. Heide and Simonsson, 2011). An additional conse-
quence of the social constructionist approach is dismissing the duality of organizational
phenomenon, such as soft and hard knowledge (Hildreth and Kimble, 2002), stability
and change (Farjoun, 2010), authentic leadership and participative leadership (Nyberg
and Sveningsson, 2014), and control and resistance (Mumby, 2005), which are often
taken for granted. However, life is complex and messy, including organizational life. Our
research has shown that scholars interested in studying internal crisis communication
must understand this messiness and embrace the paradoxical aspects that are always
ubiquitous. We believe that a social constructionist approach is very promising for
the development of crisis communication as a research field since this approach better
captures the complexities of organizational crisis and crisis communication.
In this article, we have argued that the intricacy of internal crisis communication can
be elucidated by five paradoxical tensions within complex, multi-professional organiza-
tions. This data-driven result is based on a qualitative case study at a Swedish UH, and
each tension in the organization is discussed and analyzed from a crisis management and
a crisis communication perspective. We have identified the following five different para-
doxical tensions: (1) episodic–emergent, (2) centralized–decentralized, (3) professional–
organizational, (4) planning–improvisation, and (5) external–internal. The first paradoxical
tension, episodic–emergent, concerns the understanding of crisis per se. An episodic per-
ception of crisis focuses on large incidents that threaten, first of all, the safety of patients.
This understanding reflects a functionalistic understanding of crisis and is believed to be
managed with good planning and sufficient resources. The other understanding of crisis
that is present in the organization is the emergent that is related to a social constructionist
approach. Here the perceptions of stakeholders make up the basis, that is, if organizational
members believe and perceive that a crisis situation is prevalent, they will also act accord-
ingly. The second tension, centralized–decentralized, concerns organizational structure,
management, and communication. To a certain extent, the UH is a rather traditional, hier-
archically structured organization, but at the same time divisions and units are loosely
coupled and decentralized. Both these extremes are important, but the centralized tends to
be emphasized when it comes to crisis management. The third tension, professional–
organizational, is the struggle between two different logics – medical and administrative.
In the UH, the medical side is the dominant, and it influences how crisis is defined, per-
ceived, and managed. The fourth tension, planning–improvisation, contains either a belief
in a traditional, functionalistic crisis management that emphasizes detailed planning and
control or a focus on actions and improvisations, where plans are only regarded as an
initial initiator for further actions. The fifth tension, external–internal, concerns whether
crisis communication is directed to external or internal groups. At the UH, there was a
clear tendency to primarily focus external crisis communication on the mass media, and
organizational members even stated that they searched for information in the local news-
paper during crises in order to be informed.
In this final section, we will discuss various explanations to the tensions and how they
can be managed. The five paradoxical tensions have clear implications on internal crisis
communication and crisis management. The tensions comprise one pole that tend to
draw to the rational, mechanistic, modern perspective of management, that is, a function-
alistic approach on crisis communication, and one pole that pulls to the complex, ambig-
uous, post-modern perspective of management, that is, a social constructionist approach
to crisis communication. We believe that there is a strong bias toward the rational pole in
many organizations. One explanation for this polarization is that ‘the more complex,
diverse, and dynamic organizations become, the more traditional either/or thinking over-
simplifies management practices and demands’ (Lewis, 2000: 769; Mazzei et al., 2012).
Thus, human beings have a tendency to use simple models when reality becomes too
complex, and that is also the case for some aspects of crisis management. Another expla-
nation for the polarization is the dominance of some discourses or logics; in our study,
the medical logic was prevalent with clear links to professional norms and values within
healthcare which also reinforces the orientation toward a rational, narrow management
perspective focusing on plans and instructions rather than a wider perception of crises
management including aspects such as culture, identity, and leadership. This is also
confirmed by earlier research by Vogus et al. (2010). An additional explanation is that
managers in professional organizations tend to be recruited among the professionals. But
being a good, or even excellent, specialist, researcher or clinical doctor, does not per se
mean that this person will be an outstanding manager. Furthermore, the polarization can
be explained by the fact that in turbulent and ambiguous situations, or in a crisis situa-
tion, there often arises a tendency among practitioners to get locked into an either/or way
of thinking instead of embracing a both/and mind-set. The tendency that managers

follow models based on linear and rational problem-solving is nevertheless remarkably
problematic and disadvantageous for the organization (Lewis, 2000: 764). It is a way of
escaping from the problematic, but it often turns out to be counterproductive and could
even fuel the situation. The all too common idea of, and wish, among managers, to control
and predict an organization and its surroundings tends often to develop into ‘stupidity
management’ and ‘functional stupidity’. According to Alvesson and Spicer (2012), func-
tional stupidity involves
[…] a (wilful) lack of recognition of the incompleteness and uncertainty of our knowledge and
the frequently debatable nature of dominant goals and dominant logics. As such, it works as a
doubt-control and uncertainty-coping mechanism. Functional stupidity can help to marginalize
sources of friction and uncertainty. (p. 20)
The study has implications for practitioners in complex, multi-professional organi-

zations who want to support and develop internal crisis communication. Managing
paradoxical tensions is a matter of balancing between extreme poles. From a literature
review, Lewis (2000: 764) concludes that organizational tensions can be managed with
three interrelated means: (1) acceptance, (2) confrontation, and (3) transcendence.
Acceptance is about embracing and learning to live with the existence of paradoxes,
that is, being aware of them and trying not to ignore them (cf. Breit, 2014). Confrontation
means we discuss the paradoxes and try to develop new practices in order to accom-
modate the tensions. The third, transcendence, means we develop a capacity to think
paradoxically. This requires, in turn, a second-order thinking (i.e. self-referentiality
and reflexive thinking – see Bateson, 1972), where organizational members critically
examine the assumptions that lead them to prefer one pole of the paradox. Second-
order thinking could also be a way to reduce some of the functional stupidity (Alvesson
and Spicer, 2012) mentioned above. Hence, an important goal is to ‘challenge simplistic
thinking’ by accepting the tensions and seeing them as natural characteristics rather
than trying to counteract them.
Following Lewis’ advice about the three interrelated means is definitely important
but not a simple thing to do. In organizations dominated by a logic of managerialism, a
culture shift will be required. Lewis’ advice is, in effect, much in line with the prevail-
ing culture in the HRO we mentioned above. However, one way to start challenging
simplistic thinking and using Lewis’ advice is to engage in metacommunication about
organizational tensions (Ashcraft and Trethewey, 2004; Tracy, 2004). Metacommunication
denotes communication about the process of communication (Watzlawick et al., 1967).
Through metacommunication, organizational members can embrace the tensions and
find ways to handle them. In more concrete terms, it may be useful to managers and
coworkers when discussing such questions as:
•• What paradoxical tensions related to crisis communication do we struggle with in

our organizations? In this study, we have identified five different tensions. We
think that many complex, knowledge-intensive organizations might struggle with
the same tensions, but it is, of course, not a complete categorization of tensions.
•• Which tensions are most important for us to confront and transcend? Some ten-
sions might be more urgent to cope with than others. For instance, in the case of
UH, the tension of episodic–emergent reflects the basic perception of crisis, and,
as such, it seems to be very pervasive of the whole practice of crisis management
and internal crisis communication.
•• Each paradoxical tension consists of a continuum with opposed poles – where on
that continuum would we posit our present way of working with internal crisis
communication? And where would it be most optimal for us to be? This is, of
course, not an easy question to find a definite answer to. But the communication
process itself might lead to an increased awareness of current practice and provide
possible alternatives to that.
•• Why have we come to prefer one pole of the tensions – what are the underlying
assumptions that lead us to that? This question is related to Lewis’ concept of
transcendence, and one way of approaching that is to discuss what we measure
and what we reward in our organization. Another relevant question is which
groups and professions are associated with high status. In the case of UH, physi-
cians represent a high-status group, and medical logic is influencing both the idea
of what a crisis is and how it should be handled and communicated.
•• How can we integrate and benefit from including both poles of the tensions? One
of the identified tensions discussed in this article is professional–organizational.
It is quite obvious that physicians, who represent the strongest profession, and
medical logic quite often seem to pull in a direction that is opposed to the organi-
zational perspective imbued with demands from a management perspective.
From an outsider perspective, it seems that the organizational and professional
poles should and can reinforce each other, and there seems to be a great need for
representatives for these two poles to meet and understand each other’s demands
and rationales.
In summary, instead of thinking in terms of either/or, the different tensions need to be

integrated into a both/and perspective (Smith and Lewis, 2011). Both end-states in each
tension are valid and important for the organization and therefore must be cogitated in
the crisis management and crisis communication practices.
Acknowledgements
The authors would like to thank the anonymous reviewers for their valuable comments and con-
structive feedback on earlier versions of this article.
Funding
Work on this article was made possible by a grant from the Swedish Civil Contingencies Agency
(MSB).
References
Altheide DL (1996) Qualitative Media Analysis. Thousand Oaks, CA: Sage.
Alvesson M (2011) Interpreting Interviews. London: Sage.
Alvesson M and Kärreman D (2011) Qualitative Research and Theory Development: Mystery as
Method. London: Sage.
Alvesson M and Sköldberg K (2009) Reflexive Methodology: New Vistas for Qualitative Research.
London: Sage.
Alvesson M and Spicer A (2012) A stupidity-based theory of organizations. Journal of Management
Studies 49: 1194–1220.
Alvesson M and Sveningsson S (2011) Management is the solution: Now what was the problem?
On the fragile basis for managerialism. Scandinavian Journal of Management 27: 349–361.
Apker J (2004) Sensemaking of change in the managed care era: A case of hospital-based nurses.
Journal of Organizational Change Management 17: 211–227.
Ashcraft KL and Trethewey A (2004) Developing tension: An agenda for applied research on the
organization of irrationality. Journal of Applied Communication Research 32: 171–181.
Balogun J (2006) Managing change: Steering a course between intended strategies and unantici-
pated outcomes. Long Range Planning 39: 29–49.
Bateson G (1972) Steps to an Ecology of Mind. Chicago, IL: The University of Chicago Press.
Bechler C (2004) Reframing the organizational exigency: Taking a new approach in crisis research.
In: Millar DP and Heath RL (eds) Responding to Crisis: A Rhetorical Approach to Crisis
Communication. London: Lawrence Erlbaum Associates, pp.63–74.
Benson KJ (1977) Organizations: A dialectical view. Administrative Science Quarterly 22: 1–21.
Berlin J and Kastberg G (2011) Styrning av hälso- och sjukvård [Managing Health Care]. Malmö: Liber.
Bowen GA (2009) Document analysis as a qualitative research method. Qualitative Research
Journal 9: 27–40.
Breit E (2014) Remedy through paradox? Constructions of internal legitimacy in a publicly dis-
credited organization. Management Communication Quarterly 28: 585–608.
Brinkmann S and Kvale S (2014) Interviews: Learning the Craft of Qualitative Research
Interviewing. London: Sage.
Carey J (2009) Communication as Culture: Essays on Media and Society. New York: Routledge.
Chreim S (2006) Managerial frames and institutional discourses of change: Employee appropria-
tion and resistance. Organization Studies 27: 1261–1287.
Chreim S, Langley A, Comeau-Vallee M, et al. (2013) Leadership as boundary work in healthcare
teams. Leadership 9: 201–228.
Christianson MK, Sutcliffe KM, Miller MA, et al. (2011) Becoming a high reliability organization.
Critical Care 15: 1–5.
Coombs WT (2010) Crisis communication and its allied fields. In: Coombs WT and Holladay SJ
(eds) The Handbook of Crisis Communication. Malden, MA: Blackwell, pp.54–64.
Coombs WT (2014) Ongoing Crisis Communication: Planning, Managing, and Responding.
Thousand Oaks, CA: Sage.
Deetz SA (1992) Democracy in an Age of Corporate Colonization: Development in Communication
and the Politics of Everyday Life. Albany, NY: State University of New York Press.
Eksell J and Thelander Å (2014) Kvalitativ analys inom strategisk kommunikation [Qualitative
analysis in strategic communication]. In: Eksell J and Thelander Å (eds) Kvalitativa metoder
i strategisk kommunikation [Qualitative Methods in Strategic Communication]. Lund:
Studentlitteratur, pp.197–214.
Falkheimer J and Heide M (2010) Crisis communicators in change: From plans to improvisations.
In: Coombs WT and Holladay S (eds) Handbook of Crisis Communication. Malden, MA:
Wiley-Blackwell, pp.511–526.
Falkheimer J and Heide M (in press) A reflexive perspective on public relations: On leaving tra-
ditional thinking and uncover the taken-for-granted. In: L’Etang J, McKie D, Snow N, et al.
(eds) Critical Handbook of Public Relations. New York: Routledge.
Falkheimer J, Heide M and Larsson L (2009) Kriskommunikation [Crisis Communication].

Malmö: Liber.
Farjoun M (2010) Beyond dualism: Stability and change as a duality. Academy of Management
Review 35: 202–225.
Finch MR and Welker LS (2004) Informed organizational improvisation: A metaphor and method
for understanding, anticipating, and performatively constructing the organization’s precrisis
environment. In: Millar DP and Heath RL (eds) Responding to Crisis: A Rhetorical Approach
to Crisis Communication. Mahwah, NJ: Lawrence Erlbaum, pp.189–200.
Flyvbjerg B (2006) Five misunderstandings about case-study research. Qualitative Inquiry 12:
219–245.
Frandsen F and Johansen W (2009) Institutionalizing crisis communication in the public sector: An
explorative study in Danish municipalities. International Journal of Strategic Communication
3: 102–115.
Frandsen F and Johansen W (2011) The study of internal crisis communication: Towards an inte-
grative framework. Corporate Communications: An International Journal 16: 347–361.
Frey J and Fontana A (1991) The group interview in social research. Social Science Journal 28:
175–187.
Fulop L and Mark A (2013) Leading in healthcare – Foregrounding context: The theory and prac-
tice of context – Introduction to the special issue. Leadership 9: 151–161.
Gergen KJ (1999) An Invitation to Social Construction. London: Sage.
Gilmartin MJ and D’Aunno A (2007) Leadership research in healthcare. The Academy of
Management Annals 1: 387–438.
Gilpin DR and Murphy P (2010) Complexity and crises: A new paradigm. In: Coombs WT and
Holladay SJ (eds) The Handbook of Crisis Communication. Malden, MA: Wiley-Blackwell,
pp.683–690.
Gilpin DR and Murphy PJ (2006) Reframing crisis management through complexity. In: Botan
CH and Hazleton V (eds) Public Relations Theory II. Mahwah, NJ: Lawrence Erlbaum,
pp.375–392.
Gilpin DR and Murphy PJ (2008) Crisis Communication in a Complex World. Oxford: Oxford
University Press.
Grint K (2005) Problems, problems, problems: The social construction of ’leadership’. Human
Relations 58: 1467–1494.
Hammersley M and Gomm R (2009) Introduction. In: Gomm R, Hammersley M and Foster P (eds)
Case Study Method. London: Sage, pp.1–17.
Hammersley M and Atkinsson P (2007) Ethnography: Principles in Practice. New York:
Routledge.
Heath RL (2010) Introduction. In: Coombs TW and Holladay SJ (eds) The Handbook of Crisis
Communication. Malden, MA: Wiley-Blackwell, pp.1–13.
Heide M and Simonsson C (2011) Putting coworkers in the limelight: New challenges for commu-
nication professionals. International Journal of Strategic Communication 5: 201–220.
Heide M and Simonsson C (2014a) Developing internal crisis communication: New roles and
practices of communication professionals. Corporate Communications: An International
Journal 19: 128–146.
Heide M and Simonsson C (2014b) Kvalitet och kunskap i fallstudier [Quality and knowledge in
case studies]. In: Eksell J and Thelander Å (eds) Kvalitativa metoder i strategisk kommunika-
tion [Qualitative Methods in Strategic Communication]. Lund: Studentlitteratur, pp.215–232.
Hildreth P and Kimble C (2002) The duality of knowledge. Information Research: An Inter-
national Electronic Journal 8. Available at: http://www.informationr.net/ir/8-1/paper142.
html (accessed 15 September 2014).
Holtzhausen DR (2000) Postmodern values in public relations. Journal of Public Relations

Research 12: 93–114.
Holtzhausen DR (2012) Public Relations as Activism: Postmodern Approaches to Theory and
Practice. New York: Routledge.
Ihlen O and Verhoeven P (2012) A public relations identity for the 2010s. Public Relations Inquiry
1: 159–176.
Johansen W, Aggerholm HK and Frandsen F (2012) Entering new territory: A study of internal
crisis management and crisis communication in organizations. Public Relations Review 38:
270–279.
Johansen W and Frandsen F (2007) Krisekommunikation: Når virksomhedens image og omdømme
er truet [Crisis Communication]. Köpenhamn: Samfundslitteratur.
Jones MO (1996) Studying Organizational Symbolism. Thousand Oaks, CA: Sage.
Kent ML (2010) What is a public relations ‘crisis’? Refocusing crisis research. In: Coombs
TW and Holladay SJ (eds) The Handbook of Crisis Communication. Malden, MA: Wiley-
Blackwell, pp.705–712.
Kersten A (2005) Crisis as usual: Organizational dysfunction and public relations. Public Relations
Review 31: 544–549.
Kvale S and Brinkmann S (2009) Interviews: Learning the Craft of Qualitative Research
Interviewing. London: Sage.
Lewis MW (2000) Exploring paradox: Toward a more comprehensive guide. Academy of
Management Review 25: 760–776.
Luscher LS and Lewis MW (2008) Organizational change and managerial sensemaking: Working
through paradox. Academy of Management Journal 51: 221–240.
Luscher LS, Lewis M and Ingram A (2006) The social construction of organizational change para-
doxes. Journal of Organizational Change Management 19: 491–502.
MacStravic S (2007) The other silos in healthcare organizations. Healthcare Financial Management
61: 108–110.
Maitlis S and Sonenshein S (2010) Sensemaking in crisis and change: Inspiration and insights
from Weick (1988). Journal of Management Studies 47: 551–580.
Marra FJ (1998) Crisis communication plans: Poor predictors of excellent crisis public relations.
Public Relations Review 24: 461–474.
Marra FJ (2004) Excellent crisis communication: Beyond crisis plans. In: Millar DP and Heath RL
(eds) Responding to Crisis: A Rhetorical Approach to Crisis Communication. Mahwah, NJ:
Lawrence Erlbaum, pp.311–326.
Mazzei A (2010) Promoting active communication behaviours through internal communication.
Corporate Communications: An International Journal 15: 221–234.
Mazzei A and Ravazzani S (2011) Manager-employee communication during a crisis: The missing
link. Corporate Communications: An International Journal 16: 243–254.
Mazzei A, Kim J-N and Dell’Oro C (2012) Strategic value of employee relationships and com-
municative actions: Overcoming corporate crisis with quality internal communication.
International Journal of Strategic Communication 6: 31–44.
Mintzberg H (2009) Structure in Fives: Designing Effective Organizations. Harlow: Pearson
Education.
Mitroff II and Anagnos G (2001) Managing Crises before They Happen: What Every Executive
Needs to Know about Crisis Management. New York: AMACOM.
Mumby DK (2005) Theorizing resistance in organization studies: A dialectical approach.
Management Communication Quarterly 19: 19–44.
Mumby DK (2013) Organizational Communication: A Critical Approach. Thousand Oaks, CA:
Sage.
Nyberg D and Sveningsson S (2014) Paradoxes of authentic leadership: Leader identity struggles.
Leadership 10: 437–455.
Orton JD and Weick KE (1990) Loosely coupled systems: A reconceptualization. Academy of
Management Review 15: 203–223.
Patton MQ (1990) Qualitative Evaluation and Research Methods. Newbury Park, CA: Sage.
Perrow C (1977) The bureaucratic paradox: The efficient organization centralizes in order to
decentralize. Organizational Dynamics 5: 3–14.
Peters L (2012) The rhythm of leading change: Living with paradox. Journal of Management
Inquiry 21: 405–411.
Putnam LL (1983) The interpretive perspective: An alternative to functionalism. In: Putnam LL
and Pacanowsky ME (eds) Communication and Organization: An Interpretive Approach.
Beverly Hills, CA: Sage, pp.31–54.
Putnam LL, Myers KK and Gailliard BM (2014) Examining the tensions in workplace flexibility
and exploring options for new directions. Human Relations 67: 413–440.
Putnam LL, Nicotera AM and McPhee RD (2009) Introduction. In: Putnam LL and Maydan NA
(eds) Building Theories of Organization: The Constitutive Role of Communication. New
York: Routledge, pp.1–19.
Radford GP (2012) Public relations in a postmodern world. Public Relations Inquiry 1: 49–67.
Reason JT (1997) Managing the Risks of Organizational Accidents. Aldershot: Ashgate.
Rycroft-Malone J, Seers K, Titchen A, et al. (2004) What counts as evidence in evidence-based
practice? Journal of Advanced Nursing 47: 81–90.
Shotter J (1993) Conversational Realities: Constructing Life through Language. London: Sage.
Smith WK and Lewis MW (2011) Toward a theory of paradox: A dynamic equilibrium model of
organizing. Academy of Management Review 36: 381–403.
Starbuck WH (1992) Learning by knowledge-intensive firms. Journal of Management Studies 29:
713–740.
Stohl C and Cheney G (2001) Participatory processes/paradoxical practices: Communication
and the dilemmas of organizational democracy. Management Communication Quarterly 14:
349–407.
Sturdy A and Grey C (2003) Beneath and beyond organizational change management: Exploring
alternatives. Organization 10: 651–662.
Sutcliffe KM (2011) High reliability organizations (HROs). Best Practice & Research Clinical
Anaesthesiology 25: 133–144.
Sveiby KE (1997) The New Organizational Wealth: Managing and Measuring Knowledge-Based
Assets. San Francisco, CA: Berrett-Koehler.
Taylor JR and Van Every EJ (2000) The Emergent Organization: Communication as Its Site and
Surface. Mahwah: NJ: Lawrence Erlbaum.
Taylor M (2010) Towards a holistic organizational approach to understanding crisis. In: Coombs
WT and Holladay SJ (eds) The Handbook of Crisis Communication. Malden, MA: Wiley-
Blackwell, pp.698–704.
Toth EL (2002) Postmodernism for modernist public relations: The cash value and application of
critical research in public relations. Public Relations Review 28: 243–250.
Tourish D (2005) Critical upward communication: Ten commandments for improving strategy and
decision making. Long Range Planning 38: 485–503.
Tourish D and Robson P (2003) Critical upward feedback in organisations: Processes, problems
and implications for communication management. Journal of Communication Management
8: 150–168.
Tourish D and Robson P (2006) Sensemaking and the distortion of critical upward communication
in organizations. Journal of Management Studies 43: 711–730.
Tracy SJ (2004) Dialectic, contradiction, or double bind? Analyzing and theorizing employee reac-
tions to organizational tension. Journal of Applied Communication Research 32: 119–146.
Tsang EWK and Williams JN (2012) Generalization and induction: Misconceptions, clarifications,
and a classification of induction. Mis Quarterly 36: 729–748.
Turner BA (1994) Causes of disaster: Sloppy management. British Journal of Management 5:
215–219.
Tyler L (2005) Towards a postmodern understanding of crisis communication. Public Relations
Review 31: 566–571.
Ulmer RR (2012) Increasing the impact of thought leadership in crisis communication. Management
Communication Quarterly 26: 527–547.
VanWynsberghe R and Khan SM (2007) Redefining case study. International Journal of
Qualitative Methods 6: 80–94.
Varey RJ (2000) A critical review of conceptions of communication evident in contemporary
business and management literature. Journal of Communication Management 4: 328–340.
Vogus TJ, Sutcliffe KM and Weick KE (2010) Doing no harm: Enabling, enacting, and elaborating
a culture of safety in health care. Academy of Management Perspectives 24: 60–77.
Watzlawick P, Beavin JH and Jackson DP (1967) Pragmatics of Human Communication: A
Study of Interactional Patterns, Pathologies, and Paradoxes. New York: WW Norton &
Company.
Wehmeier S and Winkler P (2013) Expanding the bridge, minimizing the gaps: Public relations,
organizational communication, and the idea that communication constitutes organization.
Management Communication Quarterly 27: 280–290.
Weick KE (1976) Educational organizations as loosely coupled systems. Administrative Science
Quarterly 21: 1–19.
Weick KE (1979) The Social Psychology of Organizing. Reading, MA: Addison-Wesley.
Weick KE (1988) Enacted sensemaking in crisis situations. Journal of Management Studies 25:
305–317.
Weick KE (1990) The vulnerable system: An analysis of the Tenerife air disaster. Journal of
Management 16: 571–593.
Weick KE (1993) The collapse of sensemaking in organizations: The Mann Gulch disaster.
Administrative Science Quarterly 38: 628–652.
Weick KE (1995) Sensemaking in Organizations. Thousand Oaks, CA: Sage.
Weick KE (1998) Improvisation as a mindset for organizational analysis. Organization Science: A
Journal of the Institute of Management Sciences 9: 543–556.
Weick KE (2001) Making Sense of the Organization. Oxford: Blackwell Business.
Weick KE (2009) Making Sense of the Organization: The Impermanent Organization. Chichester:
John Wiley & Sons.
Weick KE (2010) Reflections on enacted sensemaking in the Bhopal disaster. Journal of
Management Studies 47: 537–550.
Weick KE and Ashford SJ (2001) Learning in organizations. In: Jablin FM and Putnam LL (eds)
The New Handbook of Organizational Communication: Advances in Theory, Research, and
Methods. Thousand Oaks, CA: Sage, pp.704–731.
Weick KE and Quinn RE (1999) Organizational change and development. Annual Review of
Psychology 50: 361–386.
Weick KE and Sutcliffe KM (2001) Managing the Unexpected: Assuring High Performance in an
Age of Complexity. San Francisco, CA: Jossey-Bass.
Weick KE and Sutcliffe KM (2007) Managing the Unexpected: Resilient Performance in an Age
of Uncertainty. San Francisco, CA: Wiley.
Weick KE, Sutcliffe KM and Obstfeld D (1999) Organizing for high reliability: Process of
collective mindfulness. In: Sutton RI and Staw BM (eds) Research in Organizational
Behavior. Stamford, CT: JAI, pp.81–123.
Weick KE, Sutcliffe KM and Obstfeld D (2005) Organizing and the process of sensemaking.
Organization Science 16: 409–422.
Author biographies
Mats Heide is Professor in Strategic Communication at Lund University. His research interests
are within the field of strategic communication and organizational communication, and he has
especially focused on change communication and crisis communication. Together with Charlotte
Simonsson, he has had a 3-year research project on internal crisis communication. He is author
and co-author of 12 books (in Swedish) and several articles and edited chapters in anthologies
such as Routledge Handbook of Critical Public Relations (2015), The Routledge Handbook of
Strategic Communication (2014), Encyclopedia of Public Relations II (2014), and Handbook of
Crisis Management (2013). Heide is co-editor of Strategic Communication, Social Media, and
Democracy (Routledge, 2015).
Charlotte Simonsson (PhD) is Assistant Professor in Strategic Communication as well as head
of the Department of Strategic Communication at Lund University. Her main research interests
are change communication, crisis communication, leadership communication, and roles and
practices of communication professionals. At present, she is involved in a research project about
communicative organizations focusing on the importance and value of communication.
Simonsson has published several books in Swedish and also published articles in journals such
as International Journal of Strategic Communication and Corporate Communications: An inter-
national Journal. Simonsson has previously worked as a senior consultant.

Struggling With Internal Crisis Communication

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Public Relations Inquiry

Mats Heide and Charlotte Simonsson

Different theoretical approaches

The functionalistic approach

The social constructionist approach

One example of a social constructionist view of crisis is given by Coombs (2014),

The emphasis on crisis as a perceptual phenomenon associated with ambiguity, confu-

View of crisis Discrete event with objective, Crisis is a social construction – a

processual, integrated phenomenon, the systemic nature of crisis is emphasized (Bechler,

constructionist scholars understand communication as a sensemaking process. Finally,

On internal crisis communication

interviews with internal communication managers and employees (belonging to different

Multi-methods and sub-studies

The perception of being a member of an organization that as a whole is in an enduring

UH is a very large, complex organization, as described above, and it is structured as a

UH can be viewed as a professional organization with at least three different players:

According to the communications director, the UH is a fundamentally sound and

of thinking instead of embracing a both/and mind-set. The tendency that managers

The study has implications for practitioners in complex, multi-professional organi-

•• What paradoxical tensions related to crisis communication do we struggle with in

In summary, instead of thinking in terms of either/or, the different tensions need to be

Falkheimer J, Heide M and Larsson L (2009) Kriskommunikation [Crisis Communication].

Holtzhausen DR (2000) Postmodern values in public relations. Journal of Public Relations

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