Crisis Management

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

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Key features of a Crisis

• Low probability
• High impact
• Uncertain/ambiguous causes and effects
• Differential perceptions

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High level threats

• Safety
• Health
• Environment
• National security

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Specific threats to organisation

• Operational viability
• Reputation
• Credibility
• Financial stability
• Legal action

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Consequential effects

• Uncertainty/ambiguity
• Urgency of response
• Strategic effects of decisions

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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

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Purpose of crisis management

• Prevention
• Survival
• Successful outcomes

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Successful outcomes

• Positive balance of success/failure

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Failure outcomes
Success outcomes
Incident
- Long term costs were transferred to public -
Delays in implementing clean-up leading to loss
of wildlife. - Image management failed to fully
recover the Companys reputation in wider
community
- Financial losses were bearable - Costs
relating to clean-up were less than pre-emptive
costs - Image management recovered the Companys
reputation in business community
EXXON VALDEZ
- 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
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Three criteria of success

• Has organisational capacity been restored?
• Have losses been minimised?
• Have lessons been learned?

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

• Culture or
• environment

• Open bow doors /
• poor safety culture

• Smoker / poor cleaning standards

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Existing conditions

• Crisis-prepared
• or crisis-prone?

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Intrinsic crisis
Perceived crisis

• As seen by all individuals from particular
  viewpoints

• Total situation as seen by neutral observer with
  all the facts

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

• Instant and irrational (denial/shock/panic)

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Mature crisis management

• Grasp of intrinsic crisis
• Implementation of plans and procedures

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Mature crisis management

• Technical intelligence
• Emotional intelligence

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Review and feedback

• Assessing success and failure
• Feeding learning into future planning

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

• Ad hoc emergency reaction?
• OR
• Building management capacity to handle unforeseen
  events?

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End of Part 1
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Part 2 Planning for Crisis Management
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Crisis Management Model
Crisis Management Planning
Crisis- prepared culture
Antecedent conditions
Technical Intelligence
Emotional Intelligence
Intrinsic crisis
Perceived crisis
Authorisation Procedures
Immature crisis response
Crisis Management Implementation
Mature crisis management
Integration of learning
Review and Feedback
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Gathering intelligence

• Who?
• What?
• When?
• How?

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Who for Government?

• Ministers
• Officials
• Political parties
• Sponsors
• Voters
• International allies

• The public in general
• Tax-payers
• Consumer and lobby groups
• Lawyers
• The media
• ?

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Who for medicine and drug safety?

• Manufacturers
• Regulators
• Politicians
• Employees
• Health professionals
• Pharmacists
• Academics

• The public
• Patients
• Consumer and lobby groups
• Lawyers
• The media
• ?

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The first goal of crisis management is prevention
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Intelligence

• Continuous scanning (networks/media/ppublic
  opinion, etc)
• Outward focus
• Collaboration
• Positive relationships

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Assess risks
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Risk assessment is

• Identification
• define and describe
• Estimation
• likelihood and consequences
• Evaluation
• acceptability of risk

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Evaluation
Estimation
Identification
Unacceptable
Medium chance leading to severe health problems
or death
Medication in question could be mistaken for
sweets by young children
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
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Planning
Evaluation
Estimation
Identification
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
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
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Risk management is

• Planning
• Resourcing
• Monitoring
• Controlling

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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

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End of Part 2
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Part 3 Crisis Communications
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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

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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
• ?

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Dear Consumer Group You will understand that
managing the nations 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. Wed like to establish one-to-one
contact between a member of your team and ours
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Message Options What?

1. Full apology
2. Corrective action
3. Ingratiation
4. Justification
5. Excuse
6. Denial
7. Attack the attacker

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What does the world want to see?

• Acceptance of responsibility
• Willingness to take positive steps

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Message Options

1. Full apology
2. Corrective action
3. Ingratiation
4. Justification
5. Excuse
6. Denial
7. Attack the attacker

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Critical activities

• Initial response
• Lines to take

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Initial response

• Tell the truth as it is known
• Facts beyond question
• Actions being taken
• Acknowledgement of emotions/psychological needs

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Lines to take

• Essential responses planned
• Each new authorised response is logged
• Database
• Book
• Wallchart
• Message board

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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
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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

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The ideal spokesperson

• Polite and patient
• Well-informed and authoritative
• Accurate and reliable
• Articulate
• Available
• Trustworthy
• Evidently committed to the process

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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

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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

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Primary Purpose
Methods
Access
Transmission
X
X
Telephone
X
Hotlines
X
X
Interviews
X
News Releases
X
X
Conferences
X
X
Emails
X
Enquiry Desks
X
X
Web Site
X
Mobile Offices
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Crisis Management Model
Antecedent conditions
Intrinsic crisis
Perceived crisis
Immature crisis response
Mature crisis management
Review and Feedback
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Crisis Management Model
Crisis Management Planning
Crisis- prepared culture
Antecedent conditions
Technical Intelligence
Emotional Intelligence
Intrinsic crisis
Perceived crisis
Authorisation Procedures
Immature crisis response
Crisis Management Implementation
Mature crisis management
Integration of learning
Review and Feedback
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End of Part 3
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Part 4 Communicating Risk
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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

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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 ones personal
  actions
• Unfamiliar - arising from a novel source
• Man-made - from other than natural sources
• continued

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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

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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...

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Problematic issues in drug safety

• Individual patient variation and susceptibility
• Polypharmacy
• Relationship of allopathic and traditional
  medicines
• Resistance
• Diagnostic errors
• Prescribing errors
• Compliance issues

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Risk Factors for Government Officials

• Political expediency
• Culture of secrecy
• Accountability
• Bureaucracy and inertia
• Hierarchy
• Process versus performance
• Complexity
• Workload
• Corruption

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Summary

• Topics covered
• The nature of crisis
• Crisis management model
• Planning
• Risk assessment
• Risk management
• Crisis communications
• Learning from experience

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