1. CrisisCrisis ManagementManagement
A presentation byA presentation by
Bruce HugmanBruce Hugman
Consultant toConsultant to thethe Uppsala Monitoring CentreUppsala Monitoring Centre
Pretoria, September 2004Pretoria, September 2004

2. What is a crisis?What is a crisis?
 In general?In general?
 For an organisation?For an organisation?
 For government orFor government or
bureaucracy?bureaucracy?
 For a privateFor a private
company?company?
 In healthcare?In healthcare?
 In drug safetyIn drug safety??

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. 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. High level threats:High level threats:
SafetySafety
HealthHealth
EnvironmentEnvironment
National securityNational security

6. Specific threats to organisation:Specific threats to organisation:
Operational viabilityOperational viability
ReputationReputation
CredibilityCredibility
Financial stabilityFinancial stability
LegalLegal actionaction

7. Consequential effects:Consequential effects:
Uncertainty/ambiguityUncertainty/ambiguity
Urgency of responseUrgency of response
Strategic effects of decisionsStrategic effects of decisions

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. Purpose of crisis management:Purpose of crisis management:
 PreventionPrevention
 SurvivalSurvival
 Successful outcomesSuccessful outcomes

10. Successful outcomes:Successful outcomes:
Positive balance of success/failurePositive balance of success/failure

11. - Perpetrator was never identified
- Future attempts cannot
therefore be precluded
- Swift reactions reinforced
Company reputation for integrity
- Stakeholders reported high
degree of trust
- Product did not suffer in long
term
TYLENOL
TAMPERIN
G
- 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
- 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
EXXON
VALDEZ
Failure outcomesSuccess outcomesIncident

13. Three criteria of success:Three criteria of success:
Has organisational capacity beenHas organisational capacity been
restored?restored?
Have losses been minimised?Have losses been minimised?
Have lessons been learned?Have lessons been learned?

14. Crisis Management ModelCrisis Management Model
Antecedent
conditions
Intrinsic crisis Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback

15. Existing conditions:Existing conditions:
 Open bow doors /Open bow doors /
poor safety culturepoor safety culture
 Smoker / poor cleaningSmoker / poor cleaning
standardsstandards
Culture orCulture or
environmentenvironment

16. Existing conditions:Existing conditions:
Crisis-preparedCrisis-prepared
or crisis-prone?or crisis-prone?

17. Intrinsic crisis:Intrinsic crisis:
 Total situation as seen by neutral observer with allTotal situation as seen by neutral observer with all
the factsthe facts
As seen by all individuals from particular viewpointsAs seen by all individuals from particular viewpoints
Perceived crisis:Perceived crisis:

18. Crisis Management ModelCrisis Management Model
Antecedent
conditions
Intrinsic crisis Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback

19. Immature crisisImmature crisis
response:response:
Instant and irrationalInstant and irrational
(denial/shock/panic)(denial/shock/panic)

20. Mature crisis management:Mature crisis management:
Grasp of intrinsic crisisGrasp of intrinsic crisis
Implementation of plans and proceduresImplementation of plans and procedures

21. Mature crisis management:Mature crisis management:
Technical intelligenceTechnical intelligence
Emotional intelligenceEmotional intelligence

22. Review and feedback:Review and feedback:
Assessing success and failureAssessing success and failure
Feeding learning into future planningFeeding learning into future planning

23. Crisis Management ModelCrisis Management Model
Antecedent
conditions
Intrinsic crisis Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback

24. Management objective:Management objective:
• Ad hoc emergency reaction?Ad hoc emergency reaction?
OROR
• Building management capacity to handleBuilding management capacity to handle
unforeseen events?unforeseen events?

25. End of Part 1End of Part 1

27. Part 2:Part 2:
Planning for CrisisPlanning for Crisis
ManagementManagement

28. Integration
of learning
Crisis
Management
Implementation
Authorisation
Procedures
Technical
Intelligence
Crisis
Management
Planning
Crisis Management ModelCrisis Management Model
Antecedent
conditions
Intrinsic crisis Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Crisis-
prepared
culture
Emotional
Intelligence

29. Gathering intelligence:Gathering intelligence:
Who?Who?
What?What?
When?When?
How?How?

30. 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 lobby
groupsgroups
 LawyersLawyers
 The mediaThe media
 ??

31. 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 lobby
groupsgroups
 LawyersLawyers
 The mediaThe media
 ??

32. The first goal of crisisThe first goal of crisis
management is preventionmanagement is prevention

33. Intelligence:Intelligence:
 Continuous scanningContinuous scanning
(networks/media/ppub(networks/media/ppub
lic opinion, etc)lic opinion, etc)
 Outward focusOutward focus
 CollaborationCollaboration
 Positive relationshipsPositive relationships

34. Assess risks

35. Risk assessment is:Risk assessment is:
IdentificationIdentification
define and describedefine and describe
EstimationEstimation
likelihood and consequenceslikelihood and consequences
EvaluationEvaluation
acceptability of riskacceptability of risk

36. AcceptableHigh chance that public
and media criticism will
arise
Recall of a defective batch
of medication may lower
consumer confidence and
take-up rate
UnacceptableMedium chance leading to
severe health problems or
death
Medication in question
could be mistaken for
sweets by young children
EvaluationEstimationIdentification

37. Priority actions to
sensitively
withdraw product
whilst reassuring
honestly and
openly
AcceptableHigh chance that
public and media
criticism will arise
Recall of a defective
batch of medication
may lower consumer
confidence and take-
up rate
Product needs to
be re-designed to
prevent the
possibility
UnacceptableMedium chance
leading to severe
health problems or
death
Medication in question
could be mistaken for
sweets by young
children
PlanningEvaluationEstimationIdentification

38. Risk management is:Risk management is:
PlanningPlanning
ResourcingResourcing
MonitoringMonitoring
ControllingControlling

39. 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

40. End of Part 2End of Part 2

42. Part 3:Part 3:
Crisis CommunicationsCrisis Communications

43. 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

44. WhoWho matters and how will they bematters and how will they be
contacted?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
 ??

45. Dear Consumer Group
You will understand that managing the
nation’s drugs is a complex business.
From time to time there are scares or
crises which cause much concern to
everyone.
We are keen to discuss the handling of
such events, and to plan jointly with you
and others how we might best
communicate with you in such
circumstances. We’d like to establish
one-to-one contact between a member
of your team and ours…

47. Message OptionsMessage Options [What?][What?]
1)1) Full apologyFull apology
2)2) Corrective actionCorrective action
3)3) IngratiationIngratiation
4)4) JustificationJustification
5)5) ExcuseExcuse
6)6) DenialDenial
7)7) Attack the attackerAttack the attacker

48. 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

49. Message Options:Message Options:
1)1) Full apologyFull apology
2)2) Corrective actionCorrective action
3)3) IngratiationIngratiation
4)4) JustificationJustification
5)5) ExcuseExcuse
6)6) DenialDenial
7)7) Attack the attackerAttack the attacker

50. Critical activities:Critical activities:
Initial responseInitial response
Lines to takeLines to take

51. 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 of
emotions/psychological needsemotions/psychological needs

52. 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

53. Question Is there a specific risk to
aged patients from the
medicine in question ?
Is the medicine
known by any other
trade names?
Source / Date Regional Health Authority
secretary
by phone 1/2/02
Feature editor Daily
News by phone
2/2/02
Line to take Patients over 65 and of
frail health are considered
to be high risk
Action to trace other
trade marks is
urgently proceeding
Source / Date Professor Chang
letter dated 2/2/02
Crisis team leader
document dated
1/2/02

54. 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

55. 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

56. Continuing public information andContinuing public information and
educationeducation
‘‘No drug is 100% safe’No drug is 100% safe’
Many drugs have potential side-effects andMany drugs have potential side-effects and
adverse effectsadverse effects
Complexity of benefit-harm / effectiveness-Complexity of benefit-harm / effectiveness-
riskrisk
Rational use of drugsRational use of drugs

57. 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. pharmaceutical
companies, 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

58. XXXWeb Site
XMobile Offices
XEnquiry Desks
XXEmails
XXConferences
XNews Releases
XXInterviews
XHotlines
XXTelephone
AccessTransmission
Primary PurposeMethods

59. Crisis Management ModelCrisis Management Model
Antecedent
conditions
Intrinsic crisis Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback

60. Integration
of learning
Crisis
Management
Implementation
Authorisation
Procedures
Technical
Intelligence
Crisis
Management
Planning
Crisis Management ModelCrisis Management Model
Antecedent
conditions
Intrinsic crisis Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Crisis-
prepared
culture
Emotional
Intelligence

62. End of Part 3End of Part 3

64. Part 4:Part 4:
Communicating RiskCommunicating Risk

65. Communication of riskCommunication of risk
Very poor public grasp of risk and riskVery poor public grasp of risk and risk
statisticsstatistics
Confusion betweenConfusion between
relative/absolute/reference/ attributablerelative/absolute/reference/ attributable
riskrisk
Variable perception/tolerance of differentVariable perception/tolerance of different
kinds of riskkinds of risk
Fantasy of a ‘safe drug’Fantasy of a ‘safe drug’

66. Perception of riskPerception of risk
Factors increasing intolerance:Factors increasing intolerance:
 InvoluntaryInvoluntary - e.g. exposure to pollution rather than- e.g. exposure to pollution rather than
voluntary, 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 personal
actionsactions
 UnfamiliarUnfamiliar - arising from a novel source- arising from a novel source
 Man-madeMan-made - from other than natural sources- from other than natural sources
continued…continued…

67. Perception of riskPerception of risk
Factors increasing intolerance:Factors increasing intolerance:
 Hidden/irreversibleHidden/irreversible - e.g. effects damaging but- e.g. effects damaging but
concealed for yearsconcealed for years
 Affects posterityAffects posterity - threatens children, births or future- threatens children, births or future
generationsgenerations
 Particularly dreadfulParticularly dreadful - e.g. distressing symptoms or- e.g. distressing symptoms or
social rejectionsocial rejection
 Victims identifiableVictims identifiable - e.g. a particular blood type or- e.g. a particular blood type or
social groupsocial group
 Scientifically obscureScientifically obscure - new or rare- new or rare
 ContradictedContradicted - argued by responsible sources- argued by responsible sources

68. 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 medicines
continued...continued...

69. 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 traditional
medicinesmedicines
 ResistanceResistance
 Diagnostic errorsDiagnostic errors
 Prescribing errorsPrescribing errors
 Compliance issuesCompliance issues

70. Risk Factors for GovernmentRisk Factors for Government
OfficialsOfficials
 Political expediencyPolitical expediency
 Culture of secrecyCulture of secrecy
 AccountabilityAccountability
 Bureaucracy and inertiaBureaucracy and inertia
 HierarchyHierarchy
 Process versus performanceProcess versus performance
 ComplexityComplexity
 WorkloadWorkload
 CorruptionCorruption

71. SummarySummary
Topics 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

74. and good luck!
(though luck has nothing to do with good
crisis management!)