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

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

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

Key features of a Crisis Low probability Low probability High impact High impact Uncertain/ambiguous causes and effects Uncertain/ambiguous causes and effects Differential perceptions Differential perceptions

High level threats: Safety Safety Health Health Environment Environment National security National security

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

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

Common features of a crisis: The situation materialises unexpectedly The situation materialises unexpectedly Decisions are required urgently Decisions are required urgently Time is short Time is short Specific threats are identified Specific threats are identified Urgent demands for information are received Urgent demands for information are received There is sense of loss of control There is sense of loss of control Pressures build over time Pressures build over time Routine business become increasingly difficult Routine business become increasingly difficult Demands are made to identify someone to blame Demands are made to identify someone to blame Outsiders take an unaccustomed interest Outsiders take an unaccustomed interest Reputation suffers Reputation suffers Communications are increasingly difficult to manage Communications are increasingly difficult to manage

Purpose of crisis management: Prevention Prevention Survival Survival Successful outcomes Successful outcomes

Successful outcomes: Positive balance of success/failure Positive balance of success/failure

- 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 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 Failure outcomesSuccess outcomesIncident

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

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

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

Existing conditions: Crisis-prepared or crisis-prone?

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

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

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

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

Mature crisis management: Technical intelligence Technical intelligence Emotional intelligence Emotional intelligence

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

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

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

End of Part 1

Part 2: Planning for Crisis Management

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

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

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

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

The first goal of crisis management is prevention

Intelligence: Continuous scanning (networks/media/p public opinion, etc) Continuous scanning (networks/media/p public opinion, etc) Outward focus Outward focus Collaboration Collaboration Positive relationships Positive relationships

Assess risks

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

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

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

Risk management is: Planning Planning Resourcing Resourcing Monitoring Monitoring Controlling Controlling

Crisis Planning: Assess risks Assess risks Produce plans Produce plans Define roles and responsibilities Define roles and responsibilities Appoint crisis management team Appoint crisis management team Draw up communication plan Draw up communication plan Produce contact and organisation chart Produce contact and organisation chart Promote crisis-ready culture Promote crisis-ready culture Publish plans and conduct training Publish plans and conduct training Test, review and practise Test, review and practise

End of Part 2

Part 3: Crisis Communications

Communication plan: 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: Active, two-way communication Active, two-way communication

Who matters and how will they be contacted? Ministers Ministers Officials Officials Political parties Political parties Sponsors Sponsors Voters Voters International allies International allies Tax-payers Tax-payers Manufacturers Manufacturers Politicians Politicians Health professionals Health professionals Pharmacists Pharmacists Academics Academics Patients Patients Shareholders Shareholders Stock-market Stock-market Regulators Regulators Senior executives Senior executives Experts Experts Employees Employees The public The public Customers Customers Consumer and lobby groups Consumer and lobby groups Lawyers Lawyers The media The media ?

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…

Message Options [What?] 1)Full apology 2)Corrective action 3)Ingratiation 4)Justification 5)Excuse 6)Denial 7)Attack the attacker

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

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

Critical activities: Initial response Initial response Lines to take Lines to take

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

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

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

Media demands [How?] Accuracy and simplicity Accuracy and simplicity Statistics which are explained Statistics which are explained Context of information Context of information Comments from highest authority Comments from highest authority Some controversial elements Some controversial elements Both sides of the issue Both sides of the issue Speed, speed and speed Speed, speed and speed

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

Continuing public information and education No drug is 100% safe No drug is 100% safe Many drugs have potential side-effects and adverse effects Many drugs have potential side-effects and adverse effects Complexity of benefit-harm / effectiveness-risk Complexity of benefit-harm / effectiveness-risk Rational use of drugs Rational use of drugs

Elements increasing media interest: Dramatic emotional impact e.g. thalidomide and children Dramatic emotional impact e.g. thalidomide and children Large numbers affected Large numbers affected Unexpected links e.g. MMR vaccine and autism Unexpected links e.g. MMR vaccine and autism Polarised opinions Polarised opinions Conflict e.g. health professionals vs. pharmaceutical companies, or between professionals Conflict e.g. health professionals vs. pharmaceutical companies, or between professionals Geography e.g. proximity to own country, hospital etc Geography e.g. proximity to own country, hospital etc Emotive pigeonholes e.g. miracle drug, poison Emotive pigeonholes e.g. miracle drug, poison Links to celebrities Links to celebrities

XXWeb Site XMobile Offices XEnquiry Desks XX s XXConferences XNews Releases XXInterviews XHotlines XXTelephone AccessTransmission Primary PurposeMethods

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

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

End of Part 3

Part 4: Communicating Risk

Communication of risk Very poor public grasp of risk and risk statistics Very poor public grasp of risk and risk statistics Confusion between relative/absolute/reference/ attributable risk Confusion between relative/absolute/reference/ attributable risk Variable perception/tolerance of different kinds of risk Variable perception/tolerance of different kinds of risk Fantasy of a safe drug Fantasy of a safe drug

Perception of risk Factors increasing intolerance: Involuntary - e.g. exposure to pollution rather than voluntary, such as smoking or playing dangerous sports Involuntary - e.g. exposure to pollution rather than voluntary, such as smoking or playing dangerous sports Unfairly distributed - some benefit whilst other suffer Unfairly distributed - some benefit whilst other suffer Inescapable - cannot be avoided by ones personal actions Inescapable - cannot be avoided by ones personal actions Unfamiliar - arising from a novel source Unfamiliar - arising from a novel source Man-made - from other than natural sources Man-made - from other than natural sourcescontinued…

Perception of risk Factors increasing intolerance: Hidden/irreversible - e.g. effects damaging but concealed for years Hidden/irreversible - e.g. effects damaging but concealed for years Affects posterity - threatens children, births or future generations Affects posterity - threatens children, births or future generations Particularly dreadful - e.g. distressing symptoms or social rejection Particularly dreadful - e.g. distressing symptoms or social rejection Victims identifiable - e.g. a particular blood type or social group Victims identifiable - e.g. a particular blood type or social group Scientifically obscure - new or rare Scientifically obscure - new or rare Contradicted - argued by responsible sources Contradicted - argued by responsible sources

Problematic issues in drug safety: Adverse effects Adverse effects Risk as a concept in medicine Risk as a concept in medicine Benefit-harm Benefit-harm Effectiveness-risk Effectiveness-risk Public health versus profit Public health versus profit Access to medicines Access to medicinescontinued...

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

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

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

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