CrisisCrisis ManagementManagementA presentation byA presentation byBruce HugmanBruce HugmanConsultant toConsultant to thethe Uppsala Monitoring CentreUppsala Monitoring CentrePretoria, September 2004Pretoria, September 2004
What is a crisis?What is a crisis? In general?In general? For an organisation?For an organisation? For government orFor government orbureaucracy?bureaucracy? For a privateFor a privatecompany?company? In healthcare?In healthcare? In drug safetyIn drug safety??
TopicsTopicsThe nature of crisisThe nature of crisisCrisis management modelCrisis management modelPlanningPlanningRisk assessmentRisk assessmentRisk managementRisk managementCrisis communicationsCrisis communicationsRisk CommunicationsRisk Communications
Key features of a CrisisKey features of a CrisisLow probabilityLow probabilityHigh impactHigh impactUncertain/ambiguous causes and effectsUncertain/ambiguous causes and effectsDifferential perceptionDifferential perceptionss
High level threats:High level threats:SafetySafetyHealthHealthEnvironmentEnvironmentNational securityNational security
Specific threats to organisation:Specific threats to organisation:Operational viabilityOperational viabilityReputationReputationCredibilityCredibilityFinancial stabilityFinancial stabilityLegalLegal actionaction
Consequential effects:Consequential effects:Uncertainty/ambiguityUncertainty/ambiguityUrgency of responseUrgency of responseStrategic effects of decisionsStrategic effects of decisions
Common features of a crisis:Common features of a crisis: The situation materialises unexpectedlyThe situation materialises unexpectedly Decisions are required urgentlyDecisions are required urgently Time is shortTime is short Specific threats are identifiedSpecific threats are identified Urgent demands for information are receivedUrgent demands for information are received There is sense of loss of controlThere is sense of loss of control Pressures build over timePressures build over time Routine business become increasingly difficultRoutine business become increasingly difficult Demands are made to identify someone to blameDemands are made to identify someone to blame Outsiders take an unaccustomed interestOutsiders take an unaccustomed interest Reputation suffersReputation suffers Communications are increasingly difficult to manageCommunications are increasingly difficult to manage
Purpose of crisis management:Purpose of crisis management: PreventionPrevention SurvivalSurvival Successful outcomesSuccessful outcomes
Successful outcomes:Successful outcomes:Positive balance of success/failurePositive balance of success/failure
- Perpetrator was never identified- Future attempts cannottherefore be precluded- Swift reactions reinforcedCompany reputation for integrity- Stakeholders reported highdegree of trust- Product did not suffer in longtermTYLENOLTAMPERING- Long term costs weretransferred to public- Delays in implementing clean-up leading to loss of wildlife.- Image management failed tofully recover the Company’sreputation in wider community- Financial losses were bearable- Costs relating to clean-upwere less than pre-emptivecosts- Image management recoveredthe Company’s reputation inbusiness communityEXXONVALDEZFailure outcomesSuccess outcomesIncident
Three criteria of success:Three criteria of success:Has organisational capacity beenHas organisational capacity beenrestored?restored?Have losses been minimised?Have losses been minimised?Have lessons been learned?Have lessons been learned?
Intrinsic crisis:Intrinsic crisis: Total situation as seen by neutral observer with allTotal situation as seen by neutral observer with allthe factsthe factsAs seen by all individuals from particular viewpointsAs seen by all individuals from particular viewpointsPerceived crisis:Perceived crisis:
Management objective:Management objective:• Ad hoc emergency reaction?Ad hoc emergency reaction?OROR• Building management capacity to handleBuilding management capacity to handleunforeseen events?unforeseen events?
Who for Government?Who for Government? MinistersMinisters OfficialsOfficials Political partiesPolitical parties SponsorsSponsors VotersVoters International alliesInternational allies The public in generalThe public in general Tax-payersTax-payers Consumer and lobbyConsumer and lobbygroupsgroups LawyersLawyers The mediaThe media ??
Who for medicine and drug safety?Who for medicine and drug safety? ManufacturersManufacturers RegulatorsRegulators PoliticiansPoliticians EmployeesEmployees Health professionalsHealth professionals PharmacistsPharmacists AcademicsAcademics The publicThe public PatientsPatients Consumer and lobbyConsumer and lobbygroupsgroups LawyersLawyers The mediaThe media ??
The first goal of crisisThe first goal of crisismanagement is preventionmanagement is prevention
Risk assessment is:Risk assessment is:IdentificationIdentificationdefine and describedefine and describeEstimationEstimationlikelihood and consequenceslikelihood and consequencesEvaluationEvaluationacceptability of riskacceptability of risk
AcceptableHigh chance that publicand media criticism willariseRecall of a defective batchof medication may lowerconsumer confidence andtake-up rateUnacceptableMedium chance leading tosevere health problems ordeathMedication in questioncould be mistaken forsweets by young childrenEvaluationEstimationIdentification
Priority actions tosensitivelywithdraw productwhilst reassuringhonestly andopenlyAcceptableHigh chance thatpublic and mediacriticism will ariseRecall of a defectivebatch of medicationmay lower consumerconfidence and take-up rateProduct needs tobe re-designed toprevent thepossibilityUnacceptableMedium chanceleading to severehealth problems ordeathMedication in questioncould be mistaken forsweets by youngchildrenPlanningEvaluationEstimationIdentification
Crisis Planning:Crisis Planning: Assess risksAssess risks Produce plansProduce plans Define roles and responsibilitiesDefine roles and responsibilities Appoint crisis management teamAppoint crisis management team Draw up communication planDraw up communication plan Produce contact and organisation chartProduce contact and organisation chart Promote crisis-ready culturePromote crisis-ready culture Publish plans and conduct trainingPublish plans and conduct training Test, review and practiseTest, review and practise
Part 3:Part 3:Crisis CommunicationsCrisis Communications
Communication plan:Communication plan:Core elements are:Core elements are: Identifying audiences (Who?)Identifying audiences (Who?) How communication is to take place (How?)How communication is to take place (How?) What messages are to be communicated (What?)What messages are to be communicated (What?)The core process is:The core process is: Active, two-way communicationActive, two-way communication
WhoWho matters and how will they bematters and how will they becontacted?contacted? MinistersMinisters OfficialsOfficials Political partiesPolitical parties SponsorsSponsors VotersVoters International alliesInternational allies Tax-payersTax-payers ManufacturersManufacturers PoliticiansPoliticians Health professionalsHealth professionals PharmacistsPharmacists AcademicsAcademics PatientsPatients ShareholdersShareholders Stock-marketStock-market RegulatorsRegulators Senior executivesSenior executives ExpertsExperts EmployeesEmployees The publicThe public CustomersCustomers Consumer and lobby groupsConsumer and lobby groups LawyersLawyers The mediaThe media ??
Dear Consumer GroupYou will understand that managing thenation’s drugs is a complex business.From time to time there are scares orcrises which cause much concern toeveryone.We are keen to discuss the handling ofsuch events, and to plan jointly with youand others how we might bestcommunicate with you in suchcircumstances. We’d like to establishone-to-one contact between a memberof your team and ours…
Message OptionsMessage Options [What?][What?]1)1) Full apologyFull apology2)2) Corrective actionCorrective action3)3) IngratiationIngratiation4)4) JustificationJustification5)5) ExcuseExcuse6)6) DenialDenial7)7) Attack the attackerAttack the attacker
What does the world want to see?What does the world want to see?Acceptance of responsibilityAcceptance of responsibilityWillingness to take positive stepsWillingness to take positive steps
Message Options:Message Options:1)1) Full apologyFull apology2)2) Corrective actionCorrective action3)3) IngratiationIngratiation4)4) JustificationJustification5)5) ExcuseExcuse6)6) DenialDenial7)7) Attack the attackerAttack the attacker
Critical activities:Critical activities:Initial responseInitial responseLines to takeLines to take
Initial response:Initial response:Tell the truth as it is knownTell the truth as it is knownFacts beyond questionFacts beyond questionActions being takenActions being takenAcknowledgement ofAcknowledgement ofemotions/psychological needsemotions/psychological needs
Lines to take:Lines to take:Essential responses plannedEssential responses plannedEach new authorised response is loggedEach new authorised response is loggedDatabaseDatabaseBookBookWallchartWallchartMessage boardMessage board
Question Is there a specific risk toaged patients from themedicine in question ?Is the medicineknown by any othertrade names?Source / Date Regional Health Authoritysecretaryby phone 1/2/02Feature editor DailyNews by phone2/2/02Line to take Patients over 65 and offrail health are consideredto be high riskAction to trace othertrade marks isurgently proceedingSource / Date Professor Changletter dated 2/2/02Crisis team leaderdocument dated1/2/02
Media demandsMedia demands [How?][How?]Accuracy and simplicityAccuracy and simplicityStatistics which are explainedStatistics which are explainedContext of informationContext of informationComments from highest authorityComments from highest authoritySome controversial elementsSome controversial elementsBoth sides of the issueBoth sides of the issueSpeed, speed and speedSpeed, speed and speed
The ideal spokesperson:The ideal spokesperson:Polite and patientPolite and patientWell-informed and authoritativeWell-informed and authoritativeAccurate and reliableAccurate and reliableArticulateArticulateAvailableAvailableTrustworthyTrustworthyEvidently committed to the processEvidently committed to the process
Continuing public information andContinuing public information andeducationeducation‘‘No drug is 100% safe’No drug is 100% safe’Many drugs have potential side-effects andMany drugs have potential side-effects andadverse effectsadverse effectsComplexity of benefit-harm / effectiveness-Complexity of benefit-harm / effectiveness-riskriskRational use of drugsRational use of drugs
Elements increasing media interest:Elements increasing media interest: Dramatic emotional impact e.g. thalidomide and childrenDramatic emotional impact e.g. thalidomide and children Large numbers affectedLarge numbers affected Unexpected links e.g. MMR vaccine and autismUnexpected links e.g. MMR vaccine and autism Polarised opinionsPolarised opinions Conflict e.g. health professionals vs. pharmaceuticalConflict e.g. health professionals vs. pharmaceuticalcompanies, or between professionalscompanies, or between professionals Geography e.g. proximity to own country, hospital etcGeography e.g. proximity to own country, hospital etc Emotive pigeonholes e.g. ‘miracle drug’, ‘poison’Emotive pigeonholes e.g. ‘miracle drug’, ‘poison’ Links to celebritiesLinks to celebrities
Part 4:Part 4:Communicating RiskCommunicating Risk
Communication of riskCommunication of riskVery poor public grasp of risk and riskVery poor public grasp of risk and riskstatisticsstatisticsConfusion betweenConfusion betweenrelative/absolute/reference/ attributablerelative/absolute/reference/ attributableriskriskVariable perception/tolerance of differentVariable perception/tolerance of differentkinds of riskkinds of riskFantasy of a ‘safe drug’Fantasy of a ‘safe drug’
Perception of riskPerception of riskFactors increasing intolerance:Factors increasing intolerance: InvoluntaryInvoluntary - e.g. exposure to pollution rather than- e.g. exposure to pollution rather thanvoluntary, such as smoking or playing dangerous sportsvoluntary, such as smoking or playing dangerous sports Unfairly distributedUnfairly distributed - some benefit whilst other suffer- some benefit whilst other suffer InescapableInescapable - cannot be avoided by one’s personal- cannot be avoided by one’s personalactionsactions UnfamiliarUnfamiliar - arising from a novel source- arising from a novel source Man-madeMan-made - from other than natural sources- from other than natural sourcescontinued…continued…
Perception of riskPerception of riskFactors increasing intolerance:Factors increasing intolerance: Hidden/irreversibleHidden/irreversible - e.g. effects damaging but- e.g. effects damaging butconcealed for yearsconcealed for years Affects posterityAffects posterity - threatens children, births or future- threatens children, births or futuregenerationsgenerations Particularly dreadfulParticularly dreadful - e.g. distressing symptoms or- e.g. distressing symptoms orsocial rejectionsocial rejection Victims identifiableVictims identifiable - e.g. a particular blood type or- e.g. a particular blood type orsocial groupsocial group Scientifically obscureScientifically obscure - new or rare- new or rare ContradictedContradicted - argued by responsible sources- argued by responsible sources
Problematic issues in drug safety:Problematic issues in drug safety:Adverse effectsAdverse effectsRisk as a concept in medicineRisk as a concept in medicineBenefit-harmBenefit-harmEffectiveness-riskEffectiveness-riskPublic health versus profitPublic health versus profitAccess to medicinesAccess to medicinescontinued...continued...
Problematic issues in drug safety:Problematic issues in drug safety: Individual patient variation and susceptibilityIndividual patient variation and susceptibility PolypharmacyPolypharmacy Relationship of allopathic and traditionalRelationship of allopathic and traditionalmedicinesmedicines ResistanceResistance Diagnostic errorsDiagnostic errors Prescribing errorsPrescribing errors Compliance issuesCompliance issues
Risk Factors for GovernmentRisk Factors for GovernmentOfficialsOfficials Political expediencyPolitical expediency Culture of secrecyCulture of secrecy AccountabilityAccountability Bureaucracy and inertiaBureaucracy and inertia HierarchyHierarchy Process versus performanceProcess versus performance ComplexityComplexity WorkloadWorkload CorruptionCorruption
SummarySummaryTopics covered:Topics covered:The nature of crisisThe nature of crisisCrisis management modelCrisis management modelPlanningPlanningRisk assessmentRisk assessmentRisk managementRisk managementCrisis communicationsCrisis communicationsLearning from experienceLearning from experience
and good luck!(though luck has nothing to do with goodcrisis management!)