Crisis Management Planning

You know something is going to happen. It always does. What we don't know is the timing, the form or the extent. All we know is that it will be expensive. Life is like that.

So what do we do? We think, we plan and we prepare, maybe. And then we muddle through. But muddling works better when we have some kind of contingency plans to provide a framework for recovery.

For example, I live about one mile from the San Andreas Fault in Silicon Valley. Having lived close to the big shaker in 1989, I have put in some supplies and made some tentative plans with family about establishing contact in the event. Will it be enough? Not a chance. There are too many unknown variables to plan for and that reality also provides rationalization for me to stop worrying once I have done what I can do.

But the principle of identifying a material threat and planning in some way for it is valid for a wide variety of possibilities, from physical catastrophes to financial disasters to interpersonal crises. Whether they’re slightly possible or the "black swan" from left field. That's why we buy insurance of many stripes. That is why we diversify our financial holdings, to reduce risk from any one threat.

There is no absolute protection, as we learned in 2008 when almost all financial sectors tanked at the same time. But diversification did allow many of us to snap back a bit sooner and deeper than those of us who weren't diversified. If you are not comfortable, or knowledgeable, about your current level of financial diversification, please discuss it with your financial advisor. Or if you do not have an advisor, now, at the beginning of a new year, would be a good time to find one that you can trust.

Another real threat to physicians is that of a malpractice claim. That is one reason why we are trained to document clearly and to be both proactive and thorough in our evaluations and treatment plans. Be proactive to prevent a claim and at the same time be ready to defend your decision-making with hard evidence. And that is why most insurance companies who cover such problems send out a steady stream of evidence-based reminders on what to do and what not to do to avoid the kinds of errors that may lead to even the threat of litigation.

Malpractice claims have a considerable emotional and reputation-threatening claim upon you even in the event of dismissal. So prevention is really important. Money may be fungible but peace of mind is hard won, especially the second time.

There are a few general things that you can do in pre-planning for the inevitable crisis event of whatever type when it occurs. First of all, plan for a worst-case scenario. You know, the worst event you can dream up and the worst outcome. Make a detailed response plan; actually write it down. When you do, most other crises will seem less threatening, but many of the same principles of management will still apply. And your perspective will be helped (i.e. "It could be worse!").

Next, if something happens other than a physical catastrophe, plan to stand up. You might feel exposed, but you will gain respect if you do. That includes admitting whatever the truth of the situation is. The truth always comes out. If you made a mistake, man up. Lies and/or denial, even when they buy time, always corrode from within. Just look at the headlines our celebrity and governmental friends generate; the cover-up is worse than the crime. Always.

Lastly, even if you are hit with a real, no fooling, dyed-in-the-wool crisis, realize that in the long run it may also create an opportunity for you. Whether the crisis is external — as in earthquakes or financial melt-downs — or in relationships — malpractice, divorce, sexual harassment or other issue with your staff — it has a way of generating the momentum that can help you address whatever real problems have been uncovered and make changes to help recovery, prevent the next unhappy possibility of occurrence and possibly leave you feeling stronger, even wiser.

Friedrich Nietzsche famously said "That which does not kill us makes us stronger."

I don't know if that always holds, but I will agree with Gilda Radner of 1970's Saturday Night Live fame who ended each rant on her personal disasters with the same plaint; "It's always something!"