Transcript Crisis Management - World Health Organization

Crisis Management
A presentation by
Bruce Hugman
Consultant to the Uppsala Monitoring Centre
Pretoria, September 2004
What is a crisis?
 In general?
 For an organisation?
 For government or
bureaucracy?
 For a private
company?
 In healthcare?
 In drug safety?
Topics
The nature of crisis
Crisis management model
Planning
Risk assessment
Risk management
Crisis communications
Risk Communications
Key features of a Crisis
Low probability
High impact
Uncertain/ambiguous causes and
effects
Differential perceptions
High level threats:
Safety
Health
Environment
National security
Specific threats to
organisation:
Operational viability
Reputation
Credibility
Financial stability
Legal action
Consequential effects:
Uncertainty/ambiguity
Urgency of response
Strategic effects of decisions
Common features of a crisis:
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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
Purpose of crisis
management:
 Prevention
 Survival
 Successful
outcomes
Successful outcomes:
Positive balance of success/failure
Incident
Success outcomes
Failure outcomes
EXXON
VALDEZ
- 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
- 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
- Swift reactions reinforced
TYLENOL
TAMPERING Company reputation for
integrity
- Stakeholders reported high
degree of trust
- Product did not suffer in
long term
- Perpetrator was never
identified
- Future attempts cannot
therefore be precluded
Three criteria of success:
Has organisational capacity been
restored?
Have losses been minimised?
Have lessons been learned?
Crisis Management Model
Antecedent
conditions
Intrinsic crisis
Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Existing conditions:
Culture or
environment
 Open bow doors /
poor safety culture
 Smoker / poor cleaning
standards
Existing conditions:
Crisis-prepared
or crisis-prone?
Perceived crisis:
As seen by all individuals from particular
viewpoints
Intrinsic crisis:
 Total situation as seen by neutral observer
with all the facts
Crisis Management Model
Antecedent
conditions
Intrinsic crisis
Perceived 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
Implementation of plans and
procedures
Mature crisis management:
Technical intelligence
Emotional intelligence
Review and feedback:
Assessing success and failure
Feeding learning into future planning
Crisis Management Model
Antecedent
conditions
Intrinsic crisis
Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Management objective:
 Ad hoc emergency reaction?
OR
 Building management capacity to
handle unforeseen events?
End of Part 1
Part 2:
Planning for Crisis
Management
Crisis Management Model
Crisis
Management
Planning
Technical
Intelligence
Authorisation
Procedures
Crisis
Management
Implementation
Integration
of learning
Antecedent
conditions
Intrinsic crisis
Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Crisisprepared
culture
Emotional
Intelligence
Gathering intelligence:
Who?
What?
When?
How?
Who for Government?
 Ministers
 Officials
 Political parties
 Sponsors
 Voters
 International allies
 The public in
general
 Tax-payers
 Consumer and
lobby groups
 Lawyers
 The media
?
Who for medicine and drug
safety?
 Manufacturers
 Regulators
 Politicians
 Employees
 Health
professionals
 Pharmacists
 Academics
 The public
 Patients
 Consumer and
lobby groups
 Lawyers
 The media
?
The first goal of crisis
management is
prevention
Intelligence:
 Continuous
scanning
(networks/media/p
public opinion, etc)
 Outward focus
 Collaboration
 Positive
relationships
Assess risks
Risk assessment is:
Identification
define and describe
Estimation
likelihood and consequences
Evaluation
acceptability of risk
Identification
Estimation
Medication in question
Medium chance leading
could be mistaken for
to severe health
sweets by young children problems or death
Recall of a defective
batch of medication may
lower consumer
confidence and take-up
rate
Evaluation
Unacceptable
High chance that public Acceptable
and media criticism will
arise
Identification
Estimation
Evaluation
Planning
Medication in
question could be
mistaken for sweets
by young children
Medium chance
leading to severe
health problems
or death
Unacceptable Product needs to
be re-designed
to prevent the
possibility
Recall of a defective
batch of medication
may lower
consumer
confidence and
take-up rate
High chance that
public and media
criticism will arise
Acceptable
Priority actions to
sensitively
withdraw product
whilst reassuring
honestly and
openly
Risk management is:
Planning
Resourcing
Monitoring
Controlling
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
End of Part 2
Part 3:
Crisis Communications
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
Who matters and how will they
be contacted?
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Ministers
Officials
Political parties
Sponsors
Voters
International allies
Tax-payers
Manufacturers
Politicians
Health professionals
Pharmacists
Academics
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Patients
Shareholders
Stock-market
Regulators
Senior executives
Experts
Employees
The public
Customers
Consumer and lobby groups
Lawyers
The media
?
Gather
Intelligence
Complete a
risk
assessment
Produce
plans to
address risks
Promote
crisis-ready
culture
Publish plans
and conduct
training
Test, review
and practice
Message Options [What?]
1)
2)
3)
4)
5)
6)
7)
Full apology
Corrective action
Ingratiation
Justification
Excuse
Denial
Attack the attacker
What does the world want to
see?
Acceptance of responsibility
Willingness to take positive steps
Message Options:
1)
2)
3)
4)
5)
6)
7)
Full apology
Corrective action
Ingratiation
Justification
Excuse
Denial
Attack the attacker
Critical activities:
Initial response
Lines to take
Initial response:
Tell the truth as it is known
Facts beyond question
Actions being taken
Acknowledgement of
emotions/psychological needs
Lines to take:
Essential responses planned
Each new authorised response is logged
Database
Book
Wallchart
Message board
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
Action to trace
other trade marks
is urgently
proceeding
Patients over 65 and of
frail health are
considered to be high
risk
Source / Date Professor Chang
letter dated 2/2/02
Crisis team leader
document dated
1/2/02
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
The ideal spokesperson:
Polite and patient
Well-informed and authoritative
Accurate and reliable
Articulate
Available
Trustworthy
Evidently committed to the process
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
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
Methods
Telephone
Primary Purpose
Transmission
Access
X
X
Hotlines
X
Interviews
X
News Releases
X
Conferences
X
X
Emails
X
X
Enquiry Desks
Web Site
Mobile Offices
X
X
X
X
X
Crisis Management Model
Antecedent
conditions
Intrinsic crisis
Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Crisis Management Model
Crisis
Management
Planning
Technical
Intelligence
Authorisation
Procedures
Crisis
Management
Implementation
Integration
of learning
Antecedent
conditions
Intrinsic crisis
Perceived crisis
Immature crisis
response
Mature crisis
management
Review and Feedback
Crisisprepared
culture
Emotional
Intelligence
Gather
Intelligence
Complete a
risk
assessment
Produce
plans to
address risks
Promote
crisis-ready
culture
Publish plans
and conduct
training
Test, review
and practice
End of Part 3
Part 4:
Communicating Risk
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’
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…
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
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...
Problematic issues in drug
safety:
 Individual patient variation and
susceptibility
 Polypharmacy
 Relationship of allopathic and traditional
medicines
 Resistance
 Diagnostic errors
 Prescribing errors
 Compliance issues
Risk Factors for Government
Officials
 Political expediency
 Culture of secrecy
 Accountability
 Bureaucracy and inertia
 Hierarchy
 Process versus performance
 Complexity
 Workload
 Corruption
Summary
Topics covered:
The nature of crisis
Crisis management model
Planning
Risk assessment
Risk management
Crisis communications
Learning from experience
and good luck!
(though luck has nothing to do with good
crisis management!)