You are called to the CEO’s office with other senior leaders. The father of a newborn in the ICU with a potentially fatal syndrome has met another family with an infant needing a cardiac transplant. The father of the newborn has called a press conference to discuss his plans to donate his child’s heart. How do you respond to this situation, and how should the media be addressed?

Crises come in all forms. However, the response to these crises should generally follow the same pattern. The first response by the leader to a crisis must be to ensure that staff and patients are safe. The second step is to inform key individuals of the crisis, including senior administrators/CEO, senior clinical leaders, risk management, and/or public affairs. While occasionally the need to act may be immediate, most often the third step is to consult a policy that provides guidelines for management of that particular crisis. The temptation is too often for leaders to “wing it”, but leaders are almost always best to strictly follow policy in conjunction with considerable and wide consultation with key individuals such as Quality and Risk, Legal, and Public Affairs.

The appropriate policy, if it exists, should provide a framework for responding to the crisis. However, sometimes a policy doesn’t exist, or the decision is made not to follow the policy. Wide consultation is particularly essential if the leader does not have, or plans to deviate from policy. The response to crises is almost always second-guessed after the event(s) by colleagues, patients, the media, or in the context of litigation. The framework on which the response to the crisis is judged is almost always the policy framework; hence the need to follow the policy, or clearly document why, including documentation of wide consultation, if there has been any policy deviation (for examples of policies that may be useful in a crisis, see my previous posts on Competency and Disruptive Behaviour).

In some crises, the media may be involved, and in many of those cases, the media attention may be hostile. While media training should be part of leadership development, general principles in dealing with media include (i) have a senior (ideally clinical) leader as spokesperson, (ii) provide a sombre, non-defensive and truthful response to the crisis, (iii) focus on the values of organization, (iv) always be well-informed before you speak to media, but if you don’t know the answer, say that you don’t know and commit to getting the answer (v) apologize early if appropriate, and (vi) be seen to take reasonable and immediate action true to the values (and policies) of the organization. Actions often involve outside and independent validation, such as external review(s). Public affairs must be involved and coordinate all media activity. Human Resources, Legal, and Risk Management should also be involved.

In summary, in response to crisis, protect staff-patients, inform all relevant stakeholders, obtain advice and follow policy.