A crisis is defined as a significant threat to an organization's operations that can have negative consequences if not handled properly. The document discusses various types of crises that can occur in hospitals and provides recommendations for effective crisis management. It emphasizes the importance of planning, prevention, and having emergency response plans, standard operating procedures, and staff training in place. During a crisis, organizations should respond quickly, speak the truth, provide a constant flow of communication, and avoid actions like denial, cover-ups, blaming, and procrastination. After a crisis, root cause analysis and process reviews should be conducted to prepare for future crises. Effective crisis management is an important practice for healthcare organizations to follow.

1. Health Biz India February 2015 39
Strategy
By: Dr. AK Khandelwal
I
t’s every hospital
administrator’s nightmare:
the unexplained death of a
patient who jumped from roof
under the hospital’s care or a
patient that was found dead
and locked in a bathroom or
death of patients in ICU due
to discontinuation of oxygen
supply or a fire resulting in
death of patients.
Put yourself in the place
of the hospital administrator
and think - What are your
top priorities? What message
will you give to the public
and the family? How will you
regain public trust over such
incidents?
What is a crisis?
A crisis is defined here
as a significant threat to
operations that can have
negative consequences if
not handled properly. Three
elements are common to most
definitions of crisis: a threat
to organisation, elements of
surprise, and short of decision
time.
A crisis can create three
related threats: public safety,
reputation loss, and financial
loss.
Types of crisis
Crisis Author Otto Lerbinger
distinguishes seven categories
of crisis:
• Natural crises: Earthquakes,
tornadoes, hurricanes,
storms, volcanic eruptions,
floods, tsunamis, droughts.
• Technological crises:
Machinery failure, software
failure, etc.
• Confrontation crisis: Angry
customers, occupation of
buildings by miscreants,
disobeying by staffs.
• Crises of malevolence:
Tampering with documents
or services kidnapping,
espionage, terrorism,
malicious rumour.
• Crises of skewed
management values: Crises
of deception, crises of
management misconduct,
etc.
• Crises of deception: Crises
of deception occur when
management conceals or
misrepresents information
about itself and its
products in its dealing with
consumers and others.
• Crises of management
misconduct: An act of
fraud, work place violence.
Crisis management
Gonzalez-Herrero and Pratt
created a four-phase crisis
management model (see
figure):
Issue management: A
healthcare organisation
should develop a strategy
on issue management.
Organisations should identify
potential issues by analysing
Crisis Management in a
Hospital
A crisis is defined as a significant threat to operations that can
have negative consequences, if not handled properly
Numerous studies
have revealed that a
very low percentage
of organisations have
a crisis plan in place –
typically around 50%

2. Strategy
Health Biz India February 201540
both internal and external
environmental factors that are
likely to contribute adversely
when crisis do happen. A
large number of crisis are
manmade. Most crisis occur
because organisations have
not communicated potentials
issues to all stakeholders.
Literature has revealed that:
– Issues can be identified
earlier, completely, and
reliably
– Early anticipation widens
the range of options
– Early anticipation permits an
understanding
– Early anticipation permits a
positive orientation
– Early identification identifies
the stakeholders
– Early identification provides
the opportunity for the
organisation to supply
information about the issue
earlier
How to solve issues?
Define the issues, scan the
environment. Thereafter,
measure the issue and see if
prioritisation is required. Find
out the probability of the
occurrence and its impact on
the organisation.
Analysis of an issue – the
5 Whys
• Which stakeholders are
affected?
• Who is responsible for the
issue?
• Who started the ball
rolling? (Past view)
• Who is now involved?
(Present view)
• Who will get involved?
(Future view)
Implementation of
Responses – PDCA
• Formulation is the response
design process
• Implementation is the
action design process
Planning and prevention
Numerous studies have
revealed that a very low
percentage of organisations
have a crisis plan in place –
typically around 50% – and
even fewer have tested the
plan to demonstrate that
it is operational. Ensure
that introducing effective
issue management or crisis
management requires
commitment from the top.
Develop standard
operating procedure:
Manuals are important and
are part of the foundation of
effective crisis management.
Training: Ensure that all
responsible members are
trained. Periodic drill should
be carried out.
Early warning, scanning:
There are many established
tactical mechanisms to
support early warning and
scanning, including leadership
surveys, media content
analyses, public opinion
surveys, legislative trend
analysis, trade association
participation, literature
review, conference attendance,
monitoring key websites, chat-
group analysis.
Issue and risk management:
It includes identification,
prioritisation, strategy
development and
implementation.
So emphasis should be
given to identify problems,
give priority, provide early
and effective management
to reduce the chance of a
problem becoming a crisis.
Emergency response
Needless to say not every
crisis is triggered by an
emergency, but examples are
to suggest that emergencies
badly handled can lead
to crisis. Every healthcare
organisation should have an
emergency response plan,
and should have its own
criteria for identifying when
an emergency might become
a crisis.
Dos of crisis management
Respond quickly: The first
several hours in a crisis are

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Health Biz India February 2015 41
Strategy
the most critical. This is when
the media — both traditional
and online — are framing
their stories and, in effect,
setting the “agenda” for crisis
coverage. Therefore, it is
incumbent on the organisation
enmeshed in the problem
to come out early with a
statement or, at the very least,
establish contact.
Speak the truth: Ensure that
fact should be communicated
to all stake holders.
Provide constant flow of
communication: Develop
a crisis communication plan.
Any organisation can fall
victim to a public relations
crisis, often without warning.
Those who have prepared
for the possibility and have
developed a communication
plan beforehand can emerge
with an enhanced reputation
for integrity. Ensure that
the organisation provides
constant flow of information.
Be flexible: No doubt that
SOP and manuals will guide
you during crisis management.
But a crisis manager should be
prepared for any change, if the
situation demands.
Don’ts of crisis management
Don’t fall apart:Unraveling is
no way to hold things together.
If you become a basket case,
everyone else will, too.
Don’t freeze or become
immobilized: Crisis
management requires action,
not paralysis.
Don’t run away: Physically,
mentally or emotionally. The
initial keys to recovery from
any mishap are presence and
visibility.
Don’t ignore the problem:
Pretending bad things didn’t
happen won’t make them go
away. It will only make you
look like a fool on top of
everything else.
Don’t deny the obvious:
Denial is a form of lying.
Don’t attempt a cover-up:
It usually makes things worse.
Avoid blaming and finger-
pointing:, These are excuses,
not solutions.
Don’t procrastinate
Delaying action only adds to
the problem.
Don’t just keep on doing
what you’ve been doing:
When something goes wrong,
more of the same is not an
antidote.
Don’t give up: Once
you surrender, there is less
possibility for triumph. During
the dark hours, avoiding costly
mistakes can give you a leg up
on an out-lasting disaster.
Post crisis management
Crisis experts emphasise
that the end of every crisis
should be the beginning of
the preparation step for the
next one. They recommend
that in post crisis period,
an organisation should
perform root cause analysis,
management assessment,
process review, and
implementation of change.
In summary
Healthcare institutions of
today are complex matrix
organisations. Crisis is bound
to occur in any complex
human endeavour, and
healthcare is no exception. We
often encounter crisis while
delivering healthcare. Crisis
is more common in areas of
emergency, critical care and
the OT. Crises are ubiquitous
and the costs (human and
financial) are substantial. The
most critical time for your
healthcare organisation is
when a catastrophe, scandal,
or some other negative event
occurs. Things can and do go
wrong in the best managed
organisations. Therefore,
contingency planning for
crises is not only a good
management practice in any
organisation, but also it is a
mandatory practice for any
healthcare organisation.
About the author
Dr. Ashok Kumar
Khandelwal is the
Medical Director,
Anandaloke Hospital &
Neurosciences Centre,
West Bengal. He is a
trained Assessor from
the National Accreditation
Board for Hospital and
Health Care Provider
(NABH). He carries
around two decades of
experience in the hospital
industry and 15 years of
experience as a hospital
administrator.