19b crisis management

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19b crisis management

  1. 1. CrisisCrisis ManagementManagementA presentation byA presentation byBruce HugmanBruce HugmanConsultant toConsultant to thethe Uppsala Monitoring CentreUppsala Monitoring CentrePretoria, September 2004Pretoria, September 2004
  2. 2. 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??
  3. 3. TopicsTopicsThe nature of crisisThe nature of crisisCrisis management modelCrisis management modelPlanningPlanningRisk assessmentRisk assessmentRisk managementRisk managementCrisis communicationsCrisis communicationsRisk CommunicationsRisk Communications
  4. 4. Key features of a CrisisKey features of a CrisisLow probabilityLow probabilityHigh impactHigh impactUncertain/ambiguous causes and effectsUncertain/ambiguous causes and effectsDifferential perceptionDifferential perceptionss
  5. 5. High level threats:High level threats:SafetySafetyHealthHealthEnvironmentEnvironmentNational securityNational security
  6. 6. Specific threats to organisation:Specific threats to organisation:Operational viabilityOperational viabilityReputationReputationCredibilityCredibilityFinancial stabilityFinancial stabilityLegalLegal actionaction
  7. 7. Consequential effects:Consequential effects:Uncertainty/ambiguityUncertainty/ambiguityUrgency of responseUrgency of responseStrategic effects of decisionsStrategic effects of decisions
  8. 8. 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
  9. 9. Purpose of crisis management:Purpose of crisis management: PreventionPrevention SurvivalSurvival Successful outcomesSuccessful outcomes
  10. 10. Successful outcomes:Successful outcomes:Positive balance of success/failurePositive balance of success/failure
  11. 11. - 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
  12. 12. 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?
  13. 13. Crisis Management ModelCrisis Management ModelAntecedentconditionsIntrinsic crisis Perceived crisisImmature crisisresponseMature crisismanagementReview and Feedback
  14. 14. Existing conditions:Existing conditions: Open bow doors /Open bow doors /poor safety culturepoor safety culture Smoker / poor cleaningSmoker / poor cleaningstandardsstandardsCulture orCulture orenvironmentenvironment
  15. 15. Existing conditions:Existing conditions:Crisis-preparedCrisis-preparedor crisis-prone?or crisis-prone?
  16. 16. Intrinsic crisis:Intrinsic crisis: Total situation as seen by neutral observer with allTotal situation as seen by neutral observer with allthe factsthe factsAs seen by all individuals from particular viewpointsAs seen by all individuals from particular viewpointsPerceived crisis:Perceived crisis:
  17. 17. Crisis Management ModelCrisis Management ModelAntecedentconditionsIntrinsic crisis Perceived crisisImmature crisisresponseMature crisismanagementReview and Feedback
  18. 18. Immature crisisImmature crisisresponse:response:Instant and irrationalInstant and irrational(denial/shock/panic)(denial/shock/panic)
  19. 19. Mature crisis management:Mature crisis management:Grasp of intrinsic crisisGrasp of intrinsic crisisImplementation of plans and proceduresImplementation of plans and procedures
  20. 20. Mature crisis management:Mature crisis management:Technical intelligenceTechnical intelligenceEmotional intelligenceEmotional intelligence
  21. 21. Review and feedback:Review and feedback:Assessing success and failureAssessing success and failureFeeding learning into future planningFeeding learning into future planning
  22. 22. Crisis Management ModelCrisis Management ModelAntecedentconditionsIntrinsic crisis Perceived crisisImmature crisisresponseMature crisismanagementReview and Feedback
  23. 23. 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?
  24. 24. End of Part 1End of Part 1
  25. 25. Part 2:Part 2:Planning for CrisisPlanning for CrisisManagementManagement
  26. 26. Integrationof learningCrisisManagementImplementationAuthorisationProceduresTechnicalIntelligenceCrisisManagementPlanningCrisis Management ModelCrisis Management ModelAntecedentconditionsIntrinsic crisis Perceived crisisImmature crisisresponseMature crisismanagementReview and FeedbackCrisis-preparedcultureEmotionalIntelligence
  27. 27. Gathering intelligence:Gathering intelligence:Who?Who?What?What?When?When?How?How?
  28. 28. 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 ??
  29. 29. 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 ??
  30. 30. The first goal of crisisThe first goal of crisismanagement is preventionmanagement is prevention
  31. 31. Intelligence:Intelligence: Continuous scanningContinuous scanning(networks/media/ppub(networks/media/ppublic opinion, etc)lic opinion, etc) Outward focusOutward focus CollaborationCollaboration Positive relationshipsPositive relationships
  32. 32. Assess risks
  33. 33. Risk assessment is:Risk assessment is:IdentificationIdentificationdefine and describedefine and describeEstimationEstimationlikelihood and consequenceslikelihood and consequencesEvaluationEvaluationacceptability of riskacceptability of risk
  34. 34. 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
  35. 35. 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
  36. 36. Risk management is:Risk management is:PlanningPlanningResourcingResourcingMonitoringMonitoringControllingControlling
  37. 37. 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
  38. 38. End of Part 2End of Part 2
  39. 39. Part 3:Part 3:Crisis CommunicationsCrisis Communications
  40. 40. 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
  41. 41. 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 ??
  42. 42. 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…
  43. 43. 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
  44. 44. What does the world want to see?What does the world want to see?Acceptance of responsibilityAcceptance of responsibilityWillingness to take positive stepsWillingness to take positive steps
  45. 45. 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
  46. 46. Critical activities:Critical activities:Initial responseInitial responseLines to takeLines to take
  47. 47. Initial response:Initial response:Tell the truth as it is knownTell the truth as it is knownFacts beyond questionFacts beyond questionActions being takenActions being takenAcknowledgement ofAcknowledgement ofemotions/psychological needsemotions/psychological needs
  48. 48. Lines to take:Lines to take:Essential responses plannedEssential responses plannedEach new authorised response is loggedEach new authorised response is loggedDatabaseDatabaseBookBookWallchartWallchartMessage boardMessage board
  49. 49. 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
  50. 50. Media demandsMedia demands [How?][How?]Accuracy and simplicityAccuracy and simplicityStatistics which are explainedStatistics which are explainedContext of informationContext of informationComments from highest authorityComments from highest authoritySome controversial elementsSome controversial elementsBoth sides of the issueBoth sides of the issueSpeed, speed and speedSpeed, speed and speed
  51. 51. The ideal spokesperson:The ideal spokesperson:Polite and patientPolite and patientWell-informed and authoritativeWell-informed and authoritativeAccurate and reliableAccurate and reliableArticulateArticulateAvailableAvailableTrustworthyTrustworthyEvidently committed to the processEvidently committed to the process
  52. 52. 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 effectsComplexity of benefit-harm / effectiveness-Complexity of benefit-harm / effectiveness-riskriskRational use of drugsRational use of drugs
  53. 53. 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
  54. 54. XXXWeb SiteXMobile OfficesXEnquiry DesksXXEmailsXXConferencesXNews ReleasesXXInterviewsXHotlinesXXTelephoneAccessTransmissionPrimary PurposeMethods
  55. 55. Crisis Management ModelCrisis Management ModelAntecedentconditionsIntrinsic crisis Perceived crisisImmature crisisresponseMature crisismanagementReview and Feedback
  56. 56. Integrationof learningCrisisManagementImplementationAuthorisationProceduresTechnicalIntelligenceCrisisManagementPlanningCrisis Management ModelCrisis Management ModelAntecedentconditionsIntrinsic crisis Perceived crisisImmature crisisresponseMature crisismanagementReview and FeedbackCrisis-preparedcultureEmotionalIntelligence
  57. 57. End of Part 3End of Part 3
  58. 58. Part 4:Part 4:Communicating RiskCommunicating Risk
  59. 59. Communication of riskCommunication of riskVery poor public grasp of risk and riskVery poor public grasp of risk and riskstatisticsstatisticsConfusion betweenConfusion betweenrelative/absolute/reference/ attributablerelative/absolute/reference/ attributableriskriskVariable perception/tolerance of differentVariable perception/tolerance of differentkinds of riskkinds of riskFantasy of a ‘safe drug’Fantasy of a ‘safe drug’
  60. 60. 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…
  61. 61. 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
  62. 62. Problematic issues in drug safety:Problematic issues in drug safety:Adverse effectsAdverse effectsRisk as a concept in medicineRisk as a concept in medicineBenefit-harmBenefit-harmEffectiveness-riskEffectiveness-riskPublic health versus profitPublic health versus profitAccess to medicinesAccess to medicinescontinued...continued...
  63. 63. 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
  64. 64. 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
  65. 65. SummarySummaryTopics covered:Topics covered:The nature of crisisThe nature of crisisCrisis management modelCrisis management modelPlanningPlanningRisk assessmentRisk assessmentRisk managementRisk managementCrisis communicationsCrisis communicationsLearning from experienceLearning from experience
  66. 66. and good luck!(though luck has nothing to do with goodcrisis management!)

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