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Crisis Leadership – the Single Biggest Mistake

Single Biggest Mistake in a Crisis

As you look around you, I am pretty sure the word ‘crisis’ must go through your mind. We have heard such from an increasing number of increasingly prominent individuals, with words or phrases including train wreck, catastrophe and humanitarian crisis. They aren’t unreasonable choices of words, given the 12-hour waits, the suggestion that these long waiters are actually in the right place, the stopping of day case surgery and the use of paediatric beds for adults. But what goes through your mind when you ask that question about what we need to do? In a crisis, it’s a pivotal moment, or tipping point, that makes the difference between recovery versus disaster. And it’s one we all too frequently get wrong.


Straight to the Mistake

The fundamental mistake is to end up with a mismatch between the magnitude of the response and the true severity of the crisis. It’s easily explained in just two words – Ebola Crisis. Until the response was appropriate to the level of severity, Ebola was in charge. When the magnitude matched up, the corner was turned. The sad fact though, was that there was far more blood on the streets than was necessary. And that’s a real fear in our NHS at this very moment.

So, why do we end up with such a mismatch, when seemingly everybody knows it is a crisis? It’s a myriad of reasons but the critical element is our reptilian mental processing. A crisis requires a calm, thoughtful, swift but not impetuous response and at that very moment our biology pitches us into survival mode, with a good dose of limbic processing. It’s not something I am going to explain in detail because the very crisis we are in requires some brevity and getting to the point. I will offer a brief picture.

Faced with what appears to be a crisis unfolding, leaders need to take decisions and actions, themselves underpinned by thoughts and feelings, which in turn are underpinned by data, information and understanding. When the latter is in place, we calmly develop sensible options, decide and then act. However, in a crisis, by definition, it is a series of unseen, new, scary discoveries taking us into the unknown i.e. we do not have the baseline requirements to either act calmly or to be able to explicitly see what the answer is. And that’s where our neurobiology gets us.

So, we are already hyper-stressed by the situation and now our gut is telling us this is REALLY bad and we need to do something. However, this is survival mode in operation and it is focused on YOUR survival. Consequently, as a leader, you wouldn’t want to be seen to either under- or over-react, which professionally is a threat. The problem is that with a situation continuously unfolding, we can explain away initial under-reaction as just not having the full picture at the time, but over-reaction is seen as far more risky (and likely, even though this is not necessarily so). So, we under-react out of subconscious self-protection and… the crisis stays in charge.


And So To Disaster

Escalate a crisis and you have a disaster. The steps you need to take in a crisis are about preventing this extreme outcome, in which there is always blood on the floor. There are very specific things that need to be done. EVERYBODY (yes, you included) has a role. For some it is to do something specific and for some it is to avoid doing things that are inadvertently unhelpful. But everybody needs to know.

To avoid a disaster is to know what to do in a crisis to prevent it spiralling out of control (and by very definition, a crisis is an uncontrolled situation). Do you know? There’s no question that the right time to be prepared is ahead of the crisis. The second-best time is RIGHT NOW. You might be saying “but the NHS copes well with a crisis” and there is an element of truth in this, as long as it unfolds as planned. Let me illustrate.

I want you to imagine a plane crashes into the suburbs surround your hospital (by the way, the unnecessary loss of life from this is likely to be far, far less than what this winter produces, just before you write off the analogy as extreme). Your mind will be thinking, there’s an escalation plan, a distinct protocol and it all kicks in. Your probably right. We do it well. But this isn’t that kind of crisis, which is finite, involves a limited number of casualties and in which you can draw on support from the surrounding hospitals. I want you to imagine now that the plane crashes into your hospital. You have just transitioned from being part of the solution to thoroughly part of the disaster… and that escalation plan is now going to seem just a bit tame.


Lead Well

Suddenly, all hell breaks loose. Every action seems both extreme and yet inadequate. You have to tend to the ‘physical’ casualties whilst leading and managing the ‘emotional’ and ‘psychological’ ones. At every turn, something new or unpredictable emerges. Everybody is in the moment and thinking “what now” rather than “what’s next and where do we need to go”. If you already knew the answers to the latter (called crisis or disaster preparation), then the plan can kick in. If don’t, your biggest challenge will be the mistakes and accidents people engage in, at a crucial moment.

You need to know what to do and appreciate, whether you are a leader or a participant, you are part of the answer, or part of the problem. Let me repeat that – you need to know what to do and appreciate, whether you are a leader or a participant, you are part of the answer, or part of the problem.


Offering a Life Ring

Just prior to Christmas, when we saw this coming, we took our programme Leading Services in and through a Crisis or Disaster and reduced the price from £90 + VAT to £30 + VAT. There are LOTS of people who took that up. However, after a further two weeks and a deepening of the crisis, in the interests of time and the right support, we have moved that programme into one of our packages, called Crisis Leadership, still priced at £30 + VAT (which was a level hovering around cost – that was our Christmas gift). This approach allows me to address individual questions and provide support through the platform discussion forums. Let’s call it informal coaching.

That coaching is designed to help individuals with circumstances or decisions that are scary or seem risky because of insufficient information. Sometimes, a detached opinion is worth a million pounds. In this instance, it costs just £30 and you get CPD points for it too!

There will be cynics amongst you. No problem, just don’t bother with it. For the rest, I hope to see you on the inside so that we may preserve and protect what in crisis terms we’d call ‘the other side’.



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2 responses to “Crisis Leadership – the Single Biggest Mistake

  1. Dear Andrew, Just wondered what your view is of today’s announcement by Prof Willett’s on behalf of NHS England on “winter pressures plan”?

    1. Hmmnnn… I think I am about to disappear from a Christmas Card list…

      It feels like denial at the deepest of levels. By starting with “the NHS is not in a crisis” he speaks volumes about the level of denial but also perhaps the lack of understanding of WHAT the crisis really is. It appears it is viewed as a short term demand spike, which a bit of deferral will solve. In reality it is people in corridors, all beds full and even a huge injection of emergency money won’t solve the element of underlying cause – workforce (a combination of a failure to keep it in track with demand and the slow ruination of good will, tolerance and thus retention and attraction) – which has a 7+ year solution horizon. They’ve broken it and the mayhem at the moment is NOT the crisis, it’s a symptom of the crisis. However, a bit like an MI being a symptom of blocked arteries, you only get to deal with root cause if you actually survive the sympton. My biggest concern is that when you throw out statements like “we’re not in a crisis” they risk causing under-reaction and thus under-treatment of the symptoms… until there are far more bodies around.

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