Crisis Management

Crisis Management A presentation by Bruce Hugman Consultant to the Uppsala Monitoring Centre Pretoria, September 2004 What is a crisis?  In general?  For an organisation?  For government or bureaucracy?  For a private company?  In healthcare?  In drug safety? Topics The nature of crisis Crisis management model Planning Risk assessment Risk management Crisis communications Risk Communications Key features of a Crisis Low probability High impact Uncertain/ambiguous causes and effects Differential perceptions High level threats: Safety Health Environment National security Specific threats to organisation: Operational viability Reputation Credibility Financial stability Legal action Consequential effects: Uncertainty/ambiguity Urgency of response Strategic effects of decisions Common features of a crisis:             The situation materialises unexpectedly Decisions are required urgently Time is short Specific threats are identified Urgent demands for information are received There is sense of loss of control Pressures build over time Routine business become increasingly difficult Demands are made to identify someone to blame Outsiders take an unaccustomed interest Reputation suffers Communications are increasingly difficult to manage Purpose of crisis management:  Prevention  Survival  Successful outcomes Successful outcomes: Positive balance of success/failure Incident EXXON VALDEZ Success outcomes - Financial losses were bearable - Costs relating to clean-up were less than pre-emptive costs - Image management recovered the Company’s reputation in business community Failure outcomes - Long term costs were transferred to public - Delays in implementing clean-up leading to loss of wildlife. - Image management failed to fully recover the Company’s reputation in wider community - Swift reactions reinforced TYLENOL TAMPERING Company reputation for integrity - Stakeholders reported high degree of trust - Product did not suffer in long term - Perpetrator was never identified - Future attempts cannot therefore be precluded Three criteria of success: Has organisational capacity been restored? Have losses been minimised? Have lessons been learned? Crisis Management Model Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback Existing conditions: Culture or environment  Open bow doors / poor safety culture  Smoker / poor cleaning standards Existing conditions: Crisis-prepared or crisis-prone? Perceived crisis: As seen by all individuals from particular viewpoints Intrinsic crisis:  Total situation as seen by neutral observer with all the facts Crisis Management Model Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback Immature crisis response: Instant and irrational (denial/shock/panic) Mature crisis management: Grasp of intrinsic crisis Implementation of plans and procedures Mature crisis management: Technical intelligence Emotional intelligence Review and feedback: Assessing success and failure Feeding learning into future planning Crisis Management Model Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback Management objective:  Ad hoc emergency reaction? OR  Building management capacity to handle unforeseen events? End of Part 1 Part 2: Planning for Crisis Management Crisis Management Model Crisis Management Planning Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback Crisisprepared culture Technical Intelligence Authorisation Procedures Crisis Management Implementation Integration of learning Emotional Intelligence Gathering intelligence: Who? What? When? How? Who for Government?  Ministers  Officials  Political parties  Sponsors  Voters  International allies  The public in general  Tax-payers  Consumer and lobby groups  Lawyers  The media ? Who for medicine and drug safety?  Manufacturers  Regulators  Politicians  Employees  Health professionals  Pharmacists  Academics  The public  Patients  Consumer and lobby groups  Lawyers  The media ? The first goal of crisis management is prevention Intelligence:  Continuous scanning (networks/media/p public opinion, etc)  Outward focus  Collaboration  Positive relationships Assess risks Risk assessment is: Identification define and describe Estimation likelihood and consequences Evaluation acceptability of risk Identification Estimation Evaluation Unacceptable Medication in question Medium chance leading could be mistaken for to severe health sweets by young children problems or death Recall of a defective batch of medication may lower consumer confidence and take-up rate High chance that public and media criticism will arise Acceptable Identification Medication in question could be mistaken for sweets by young children Recall of a defective batch of medication may lower consumer confidence and take-up rate Estimation Medium chance leading to severe health problems or death High chance that public and media criticism will arise Evaluation Planning Unacceptable Product needs to be re-designed to prevent the possibility Acceptable Priority actions to sensitively withdraw product whilst reassuring honestly and openly Risk management is: Planning Resourcing Monitoring Controlling Crisis Planning:  Assess risks  Produce plans  Define roles and responsibilities  Appoint crisis management team  Draw up communication plan  Produce contact and organisation chart  Promote crisis-ready culture  Publish plans and conduct training  Test, review and practise End of Part 2 Part 3: Crisis Communications Communication plan: Core elements are:  Identifying audiences (Who?)  How communication is to take place (How?)  What messages are to be communicated (What?) The core process is:  Active, two-way communication Who matters and how will they be contacted?             Ministers Officials Political parties Sponsors Voters International allies Tax-payers Manufacturers Politicians Health professionals Pharmacists Academics              Patients Shareholders Stock-market Regulators Senior executives Experts Employees The public Customers Consumer and lobby groups Lawyers The media ? Gather Intelligence Complete a risk assessment Produce plans to address risks Promote crisis-ready culture Publish plans and conduct training Test, review and practice Message Options [What?] 1) 2) 3) 4) 5) 6) 7) Full apology Corrective action Ingratiation Justification Excuse Denial Attack the attacker What does the world want to see? Acceptance of responsibility Willingness to take positive steps Message Options: 1) 2) 3) 4) 5) 6) 7) Full apology Corrective action Ingratiation Justification Excuse Denial Attack the attacker Critical activities: Initial response Lines to take Initial response: Tell the truth as it is known Facts beyond question Actions being taken Acknowledgement of emotions/psychological needs Lines to take: Essential responses planned Each new authorised response is logged Database Book Wallchart Message board Question Is there a specific risk to aged patients from the medicine in question ? Is the medicine known by any other trade names? Feature editor Daily News by phone 2/2/02 Action to trace other trade marks is urgently proceeding Source / Date Regional Health Authority secretary by phone 1/2/02 Line to take Patients over 65 and of frail health are considered to be high risk Source / Date Professor Chang letter dated 2/2/02 Crisis team leader document dated 1/2/02 Media demands [How?] Accuracy and simplicity Statistics which are explained Context of information Comments from highest authority Some controversial elements Both sides of the issue Speed, speed and speed The ideal spokesperson: Polite and patient Well-informed and authoritative Accurate and reliable Articulate Available Trustworthy Evidently committed to the process Continuing public information and education ‘No drug is 100% safe’ Many drugs have potential side-effects and adverse effects Complexity of benefit-harm / effectiveness-risk Rational use of drugs Elements increasing media interest:  Dramatic emotional impact e.g. thalidomide and children  Large numbers affected  Unexpected links e.g. MMR vaccine and autism  Polarised opinions  Conflict e.g. health professionals vs. pharmaceutical companies, or between professionals  Geography e.g. proximity to own country, hospital etc  Emotive pigeonholes e.g. ‘miracle drug’, ‘poison’  Links to celebrities Methods Telephone Hotlines Interviews News Releases Conferences Emails Enquiry Desks Web Site Mobile Offices Primary Purpose Transmission X X X X X X X X X X X Access X X X Crisis Management Model Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback Crisis Management Model Crisis Management Planning Antecedent conditions Intrinsic crisis Perceived crisis Immature crisis response Mature crisis management Review and Feedback Crisisprepared culture Technical Intelligence Authorisation Procedures Crisis Management Implementation Integration of learning Emotional Intelligence Gather Intelligence Complete a risk assessment Produce plans to address risks Promote crisis-ready culture Publish plans and conduct training Test, review and practice End of Part 3 Part 4: Communicating Risk Communication of risk Very poor public grasp of risk and risk statistics Confusion between relative/absolute/reference/ attributable risk Variable perception/tolerance of different kinds of risk Fantasy of a ‘safe drug’ Perception of risk Factors increasing intolerance:  Involuntary - e.g. exposure to pollution rather than voluntary, such as smoking or playing dangerous sports  Unfairly distributed - some benefit whilst other suffer  Inescapable - cannot be avoided by one’s personal actions  Unfamiliar - arising from a novel source  Man-made - from other than natural sources continued… Perception of risk Factors increasing intolerance: concealed for years future generations  Hidden/irreversible - e.g. effects damaging but  Affects posterity - threatens children, births or  Particularly dreadful - e.g. distressing symptoms or social rejection  Victims identifiable - e.g. a particular blood type or social group  Scientifically obscure - new or rare  Contradicted - argued by responsible sources Problematic issues in drug safety: Adverse effects Risk as a concept in medicine Benefit-harm Effectiveness-risk Public health versus profit Access to medicines continued... Problematic issues in drug safety:  Individual patient variation and susceptibility  Polypharmacy  Relationship of allopathic and traditional medicines  Resistance  Diagnostic errors  Prescribing errors  Compliance issues Risk Factors for Government Officials  Political expediency  Culture of secrecy  Accountability  Bureaucracy and inertia  Hierarchy  Process versus performance  Complexity  Workload  Corruption Summary Topics covered: The nature of crisis Crisis management model Planning Risk assessment Risk management Crisis communications Learning from experience and good luck! (though luck has nothing to do with good crisis management!)