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 perceptions

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 outcomesSuccess outcomesIncident

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 crisisPerceived 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 crisisPerceived 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 crisisPerceived 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. Integration of learning Crisis Management Implementation Authorisation Procedures Technical Intelligence Crisis Management Planning Crisis Management Model Antecedent conditions Intrinsic crisisPerceived 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/p public 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. 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 EvaluationEstimation I dentification

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:  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?] 1)Full apology 2)Corrective action 3)Ingratiation 4)Justification 5)Excuse 6)Denial 7)Attack the attacker

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

49. Message Options: 1)Full apology 2)Corrective action 3)Ingratiation 4)Justification 5)Excuse 6)Denial 7)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. QuestionIs there a specific risk to aged patients from the medicine in question ? Is the medicine known by any other trade names? Source / DateRegional Health Authority secretary by phone 1/2/02 Feature editor Daily News by phone 2/2/02 Line to takePatients over 65 and of frail health are considered to be high risk Action to trace other trade marks is urgently proceeding Source / DateProfessor 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. XXWeb Site XMobile Offices XEnquiry Desks XXEmails XXConferences XNews Releases XXInterviews XHotlines XXTelephone AccessTransmission Primary PurposeMethods

59. Crisis Management Model Antecedent conditions Intrinsic crisisPerceived 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 Model Antecedent conditions Intrinsic crisisPerceived 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. and good luck! (though luck has nothing to do with good crisis management!)