This document discusses crisis management and communication. It defines a crisis, outlines a crisis management model, and discusses planning, risk assessment, and communicating during a crisis. The key points are: - A crisis is a low probability, high impact event that creates uncertainty and demands an urgent response. Successful crisis management aims to restore capacity and minimize losses. - The crisis management model involves antecedent conditions, the intrinsic crisis, response stages from immature to mature, and review/feedback. Planning includes risk assessment, roles, and communication protocols. - Crisis communication involves identifying audiences, determining messaging and methods of engagement. The goal is transparency, acknowledging emotions, and maintaining accurate, timely information flows.

1. Crisis Management A presentation by Bruce Hugman Consultant to the Uppsala Monitoring Centre Pretoria, September 2004

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

3. Topics The nature of crisis Crisis management model Planning Risk assessment Risk management Crisis communications Risk Communications

4. Key features of a Crisis Low probability High impact Uncertain/ambiguous causes and effects Differential perception s

5. High level threats: Safety Health Environment National security

6. Specific threats to organisation: Operational viability Reputation Credibility Financial stability Legal action

7. Consequential effects: Uncertainty/ambiguity Urgency of response Strategic effects of decisions

8. 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

9. Purpose of crisis management: Prevention Survival Successful outcomes

10. Successful outcomes: Positive 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 TAMPERING - 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 outcomes Success outcomes Incident

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

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

15. Existing conditions: Open bow doors / poor safety culture Smoker / poor cleaning standards Culture or environment

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

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

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

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

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

21. Mature crisis management: Technical intelligence Emotional intelligence

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

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

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

25. End of Part 1

27. Part 2: Planning for Crisis Management

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

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

30. Who for Government? Ministers Officials Political parties Sponsors Voters International allies The public in general Tax-payers Consumer and lobby groups Lawyers The media ?

31. Who for medicine and drug safety? Manufacturers Regulators Politicians Employees Health professionals Pharmacists Academics The public Patients Consumer and lobby groups Lawyers The media ?

32. The first goal of crisis management is prevention

33. Intelligence: Continuous scanning (networks/media/ppublic opinion, etc) Outward focus Collaboration Positive relationships

34. Assess risks

35. Risk assessment is: Identification define and describe Estimation likelihood and consequences Evaluation acceptability of risk

36. Acceptable High chance that public and media criticism will arise Recall of a defective batch of medication may lower consumer confidence and take-up rate Unacceptable Medium chance leading to severe health problems or death Medication in question could be mistaken for sweets by young children Evaluation Estimation I dentification

37. Priority actions to sensitively withdraw product whilst reassuring honestly and openly Acceptable High 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 Unacceptable Medium chance leading to severe health problems or death Medication in question could be mistaken for sweets by young children Planning Evaluation Estimation Identification

38. Risk management is: Planning Resourcing Monitoring Controlling

39. 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

40. End of Part 2

42. Part 3: Crisis Communications

43. 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

44. 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 ?

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 Options [What?] Full apology Corrective action Ingratiation Justification Excuse Denial Attack the attacker

48. What does the world want to see? Acceptance of responsibility Willingness to take positive steps

49. Message Options: Full apology Corrective action Ingratiation Justification Excuse Denial Attack the attacker

50. Critical activities: Initial response Lines to take

51. Initial response: Tell the truth as it is known Facts beyond question Actions being taken Acknowledgement of emotions/psychological needs

52. Lines to take: Essential responses planned Each new authorised response is logged Database Book Wallchart Message 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 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

55. The ideal spokesperson: Polite and patient Well-informed and authoritative Accurate and reliable Articulate Available Trustworthy Evidently committed to the process

56. 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

57. 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

58. X X Web Site X Mobile Offices X Enquiry Desks X X Emails X X Conferences X News Releases X X Interviews X Hotlines X X Telephone Access Transmission Primary Purpose Methods

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

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

62. End of Part 3

64. Part 4: Communicating Risk

65. 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’

66. 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…

67. Perception of risk Factors increasing intolerance: Hidden/irreversible - e.g. effects damaging but concealed for years Affects posterity - threatens children, births or future generations 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

68. 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...

69. Problematic issues in drug safety: Individual patient variation and susceptibility Polypharmacy Relationship of allopathic and traditional medicines Resistance Diagnostic errors Prescribing errors Compliance issues

70. Risk Factors for Government Officials Political expediency Culture of secrecy Accountability Bureaucracy and inertia Hierarchy Process versus performance Complexity Workload Corruption

71. Summary Topics covered: The nature of crisis Crisis management model Planning Risk assessment Risk management Crisis communications Learning from experience

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