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Medicina Academica Integrativa, 2024; Vol. 1, No. 1 Review
© University of Mostar
CRISIS COMMUNICATION IN HEALTHCARE
Zoran Tomić, Vladimir Vegar & Miro Radalj
University of Mostar, Mostar, Bosnia and Herzegovina
received: 16.06.2023; revised: 04.10.2023; accepted: 11.12.2023
SUMMARY
The paper explores the key role of crisis communication in addressing the growing number of crisis situations in
healthcare. It examines and analyze dierent forms of crises in healthcare, encompassing nancial and ethical dimensions,
emphasizing that the eective management of crisis communication is integral to overall crisis management and thus,
helps preserve the reputation of the organization and sometimes ensures its survival, threatened by crises. The signicance
of preparedness and the timely identication of potential crises emphasizes the crucial responsibilities of communicators,
particularly in the contemporary era marked by swift and ecient modern communication techniques and tools. The
text highlights the imperative requirement for two-way symmetrical communication with the media and all stakeholders
before and during a crisis. The conclusion is that successful crisis management depends on crisis planning, simulations,
and comprehensive training across all crisis management processes, inclusively and with a specic emphasis on crisis
communication.
Keywords: crisis; healthcare; crisis management; crisis communication; communication; planning; communication
models, public, crisis stages, COVID-19.
* * * * *
INTRODUCTION
Due to the increasing number of accidents and crises, crisis
communication has had a strategic place in the life of orga-
nizations in the last few years. Experts warn that the crisis
can appear in various forms. The most sensitive branches
for the outbreak of crises are certainly activities and pro-
cesses related to the production and processing of food,
beverages, and medicines, followed by air and maritime
transport, railways, the chemical industry, nuclear power
plants, oil rening and transportation, oil and gas pipelines,
power plants, mining, construction, etc. However, these are
not the only areas of possible crises. Crises can also arise
in sports organizations, clubs, state institutions, political
parties, societies, associations, in fact in all areas of human
activity. There is also a personal crisis. When we talk about
crisis, then, in addition to accidents related to endanger-
ment or loss of life, we also mean nancial crises, man-
agement crises, crises of results, ethics, etc. (Tomić 2016).
It is evident from the above that the management of cri-
sis relations with the public is one of the most critical
areas of modern communication. Eective management
of crisis situations protects companies and their reputa-
tion, and sometimes can aect their endangered surviv-
al. Therefore, the key assumption of crisis management
is preparedness, as well as recognizing a crisis before it
occurs. In today’s age of information and communica-
tion, it is crucial, when a crisis occurs, to understand
the role of the communicator (Novak 2001). But rst of
all, the question of what a crisis is should be answered.
The structure of the work consists of an introduction,
the rst chapter with a synthesis of basic concepts and
the most important theoretical knowledge about crisis
communication, the second chapter dealing with crisis
management, the third chapter which refers to develop-
mental-situational crises and communication models,
while the fourth chapter deals with the target audience in
a crisis. The fth chapter refers to the crisis communica-
tion plan and the team, and the sixth chapter deals with
the three stages of the crisis. The seventh chapter deals
with the crisis caused by the COVID-19 pandemic, and
the eighth chapter with the crisis as an opportunity and a
threat. The ninth chapter presents the research results, fol-
lowed by the conclusion and the list of literature at the end.
KEY TERMS OF CRISIS
COMMUNICATION
For a better understanding of the work, it is necessary to
point out the most important denitions of crisis, crisis man-
agement, and crisis communication, as well as to dene what
constitutes the term healthcare and a healthcare institution.
1. Dening the crisis
There is no consensus on the denition of crisis. A cri-
sis can generally be dened as an emerging risk. It has
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Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
already been recognized and valued before, or it was not
noticed at all, so it appeared completely out of the blue.
The London School of Public Relations (LSPR) denes a
crisis as “a serious incident that aects human safety, the
environment, products or the reputation of an organiza-
tion. Usually such an incident is characterized by a hos-
tile attitude of the media towards it” (Novak 2001). Some
authors dene a crisis as an unplanned and unwanted
process that lasts for a certain period of time, which can
only be partially inuenced and can end in various ways.
At the individual level, crises represent a change in a per-
son’s normal functioning. This includes increased tension,
psychological burden, exposure to stress, and dicult ori-
entation in time and space in the decision-making process.
At the social level, crises are manifested through threatening
social situations in political, economic, social and cultural
systems. The Greek word krisis (κρίσις) - krís and krísis
means choice, decision, turn, danger, discernment, decision.
Plenković states “Dangers and crises are sudden and un-
desirable situations that can aect individuals, families,
groups, parties, economy, society, local self-government,
settlement, village, city, state or international commu-
nity” (Plenković 2015). Sunara and Jeličić (2013) state
that the common characteristics of all crisis situations are
“unexpected circumstances, the speed and escalation of
events, the presence of panic, the tendency to act irratio-
nally and hastily due to strong emotions, chaos in internal
communication, even when the company has an elabo-
rate communication plan for crisis situations, the ubiqui-
ty of the media is a threat to the company’s reputation.”
Other scholars describe a crisis as “a major event with a po-
tentially negative outcome that aects both the organization
and its publics, services, products and/or its name” (Fearn-
Banks 2001). It interferes with the normal operations of the
organization and, in the worst case, threatens its survival. A
crisis is an unplanned and unwanted process that lasts for
a certain period of time, which can only be partially inu-
enced and can be ended in various ways (Ašanin Gole 2001).
Given that the crisis most often aects corporations, the
term corporate crisis in the literature means “unplanned and
undesirable processes of limited duration and the possibility
of inuence with an ambivalent outcome” (Krystek 1987).
So, for an organization, a crisis is a circumstance in which
it is no longer possible to operate normally. It interferes
with routine activities, causes uncertainty and stress, and
threatens the long-term survival of the organization. Al-
though the crisis may not have such dramatic eects at
rst glance, its negative impact on the image and repu-
tation of the organization can be very large and prevent
further development and survival of the organization.
Not all crises are complete failures. “A crisis is a turn-
ing point, not necessarily burdened with irrepara-
ble negativity, but characterized by a certain degree
of risk and uncertainty” (Tomić & Milas 2007). From
this, we can conclude that during a crisis situation, it
is still possible to turn regular activities for the better.
A crisis can be seen as a turning point in the life of an or-
ganization and an opportunity to improve its reputation. It
is the perfect opportunity for the management of a com-
pany to introduce the necessary organizational changes,
change the way of thinking, establish new departments,
or introduce a new organizational culture. A crisis is a
threat, but it is, rst of all, a challenge and a possible new
beginning: a challenge as a quality check of the plan for
defense against the crisis, and a new beginning as an op-
portunity for the organization to rise even stronger like
a phoenix. Therefore, we can conclude that for a certain
organization, a crisis is both a threat and an opportunity.
2. Healthcare and healthcare institutions
Healthcare and healthcare institutions are key compo-
nents of every society because they take care of the health
of individuals and the community. This sector is essen-
tial for the preservation and improvement of human life,
as well as for the economic stability and development of
society as a whole. Healthcare institutions include vari-
ous organizations, institutions, agencies and experts that
provide medical services, take care of disease prevention,
diagnosis, treatment and rehabilitation. This includes hos-
pitals, clinics, pharmacies, laboratories, health centers, spe-
cialized medical centers and other organizations. The term
“public health” appears in the middle of the 19th century in
the USA. Strictly translated into Croatian, this would mean
javno zdravlje, however, in our country this term was trans-
lated and thus adopted as javno zdravstvo. (Ropac 2001).
The rst denition of public health (health) was given
in 1920 by Winslow. According to this denition, public
health is the science and art of preventing disease, pro-
longing life and promoting health through organized ef-
forts and informed choices by society, public and private
organizations, communities and individuals. (Ropac 2001).
For now, there is no single universally accepted denition
of global health. (Beaglehole & Bonita 2010). The deni-
tion proposed by Koplan et al. (2009) states: “Global health
is a eld of research and practice that emphasizes improv-
ing health and achieving health equity for all people around
the world. Global health highlights transnational health
issues, determinants, and solutions; includes many disci-
plines within and outside healthcare and promotes interdis-
ciplinary collaboration; it is a synthesis of population-based
prevention and clinical care at the individual level.”
Beaglehole & Bonita (2010) compiled a shorter and some-
what clearer denition based on the previous one, which
reads: “Global health is collaborative transnational re-
search and action to promote health for all.” It is important
to note that the word global in “global health” indicates the
extent of the problem, not its location (Koplan et al. 2009).
In order to ensure the eciency and quality of health-
care, it is necessary for health institutions to be well or-
ganized, transparent, accessible and adapted to the needs
of the community. In many countries, healthcare is part
of the public sector and is nanced from public sources,
taxes and contributions from citizens. However, there are
also private healthcare institutions that provide services
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against payment or on the basis of private insurance.
The key goals of the healthcare system include improv-
ing the health of the population, preventing disease, prop-
er treatment of diseases, ensuring aordable and quality
healthcare for all citizens, as well as education on health
topics in order to raise awareness of the importance of a
healthy lifestyle. Healthcare management is a complex pro-
cess that requires cooperation and coordination between
dierent levels of government, healthcare workers, pa-
tients and the wider community. Continuous improvement
of the healthcare system is important in order to respond
to the changing needs and challenges of modern society.
CRISIS MANAGEMENT
Crisis management can be dened as a series of fac-
tors organized to deal with a crisis situation, the main
goal of which is to reduce its negative eects, i.e.,
damage to the organization. Put simply, crisis man-
agement seeks to prevent or reduce the negative con-
sequences of a crisis from possible damage and thus
protect the organization, stakeholders and the entire in-
dustry in which the organization operates (Coombs 2012).
It is possible to approach the denition of crisis manage-
ment in a dierent way and highlight what it is not, as
opposed to what it is. First of all, crisis management is
not synonymous with bad management. Due to their own
inappropriate or inadequate planning or the complete ab-
sence of a planning approach, organizations are often put
in the situation of reacting to crisis situations only when
they escalate. However, without clearly dened priorities,
managers of organizations rarely know which situations
require their increased and urgent attention and which
do not. In such crisis situations, management cannot al-
ways react eectively, which is a classic example of bad
management, but not crisis management. True and ef-
fective crisis management therefore implies a systematic
approach to managing crisis situations that enables the
normal functioning of the company (Littlejohn 1983).
The importance of organizational crisis management
is reected in the fact that the public treats organiza-
tional crises signicantly dierently from public crises,
considering them either a problem or an opportunity for
organizations. This is a question that managers of orga-
nizations should deal with internally. Crisis situations
are at the same time an opportunity for the stakeholders
of each organization to assess the capabilities of the man-
agers of the organizations themselves (Darling 1994).
Some theoreticians and experts in public relations (Fink
2002) equate crisis management with crisis planning
and point out that crisis management is the art of re-
moving risk and uncertainty with the aim of achiev-
ing a higher degree of control over one’s own destiny.
As a rule, organizations view crises as completely isolated
events that can be analyzed through a total of four elements:
1) Causes ─ include immediate mistakes that activate the
causes of the crisis situation and encourage already exist-
ing problems and deciencies that allowed the mistakes to
actually happen;
2) Consequences ─ can have immediate and long-term ef-
fects;
3) Caution ─ imply the inclusion of measures taken to pre-
vent or minimize the eect of a potential crisis;
4) Response ─ implies measures taken to suppress a crisis
that has already occurred.
In its essence, crisis management enables the company to
formulate a systematic and orderly response to crisis sit-
uations. That response is the foundation that allows the
organization to continue day-to-day operations while si-
multaneously managing the crisis. At the same time, what
distinguishes a successful and systematic crisis manage-
ment system from a less successful one is the establishment
of a system for early detection of a crisis. Namely, it is
possible to prevent many crises or create a more favorable
position for mitigating their negative eects, by planning
in which it is desirable to include, i.e., use the expertise
of individuals from suitable sectors of the organization’s
management (Shrivastava 1993).
CRISIS COMMUNICATION
Crisis communication can be dened as a dialogue be-
tween an organization and its public immediately before
a negative event, during a negative event and after a nega-
tive event. This dialogue implies the creation of strategies
and tactics with an aim to minimize damage to the image
of the organization. In this context, it is important to un-
derstand the relationship between crisis management and
crisis communication, given that eective crisis manage-
ment also implies crisis communication, which can not
only mitigate and eliminate the crisis, but in some cases can
also bring the organization a more positive reputation than
it had before the crisis. (Banks 2011). At the same time,
crisis communication and public relations are inextricably
linked, whereby public relations deal with the publics, that
is, specic audiences: employees, clients, shareholders,
members of the local community, board members, unions
and retired employees of the organization. In this context,
proactive public relations programs can signicantly im-
prove the relationship between organizations and their au-
diences and thus prevent crises, but at the same time make
these audiences their allies during a crisis (Banks 2011).
Some authors name crisis communication as crisis pub-
lic relations and point out that crisis public relations are
one of the most critical aspects of modern communica-
tions as a whole (Langford 2009). Crisis communica-
tion involves identifying internal and external recipients
who necessarily need to receive information during a
crisis, and crisis communication managers must under-
stand, create and disseminate messages to both inter-
nal and external recipients and at the same time prepare
to receive feedback from these groups (Zaremba 2010).
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
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Crisis communication is crucially important for successful
overcoming of crisis situations. The key element in com-
munication during a crisis is the speed of communication.
In the “old days” of crisis communication, it was common
to wait 24 hours after a crisis event for an organization to
address the public. Today, 24 hours is simply too long to
wait. Every crisis, regardless of its nature, also represents
a crisis of information. The inability to control such an in-
formation crisis inevitably results in the inability to con-
trol the entire crisis (Crandall, Parnell & Spillan 2014).
Crisis communication can also be dened as “a continu-
ous process of creating shared meaning between groups,
communities, individuals and organizations, all with the
aim of preparing, limiting and responding to risks and pos-
sible damage” (Sellnow & Seeger 2013). This denition
refers to the diversity of communicators involved in this
communication, senders of messages and their recipients,
as well as instrumental and functional elements of com-
munication during a crisis situation. This denition should
be viewed in the context of the fact that communication
processes imply a sense-making methodology that en-
ables individuals, groups, communities and organizations
to co-create frameworks for understanding activities in
situations that imply a high level of uncertainty, demands
and threats. Such events strongly shake the fundamen-
tal sense of stability and predictability that most people
count on in their daily lives. In this context, the fact that
crisis communication processes are signicantly more
complex is highlighted due to the diversity of the public,
cultures, background events, experiences and new tech-
nologies that then inuence the forms of crisis situations.
In such cases, eective communication can be a matter of
life and death, so understanding the communication pro-
cess in such moments is crucial (Sellnow & Seeger 2013).
Crisis communication undoubtedly implies the urgent for-
mation of a communication team and its inclusion in the
communication process. This process implies a quick start
of communication with the involved stakeholders and the
public, which strengthens the organization’s credibility and
builds trust in their eyes. The content of that communication,
that is, the messages that the organization sends out, must
satisfy the needs of all involved groups of stakeholders and
the public, and at the same time provide them with the tone
and context of all messages. At the same time, one should
take into account the fact that the goal and key messages
must be consistent, and the details regarding the way of their
communication may vary depending on the stakeholders
and groups of the public (Crandall, Parnell & Spillan 2014).
1. Developmental-situational crises
The ability to respond to public health risks requires a
system that enables rapid detection, response, preven-
tion and communication with the wider community about
health risks. It is necessary to strengthen vertical and hor-
izontal communication in crisis public health situations
through a common platform, which automatically acti-
vates the relevant factors. Crisis public health situations
are conditioned by transitive processes in the world, such
as a strong epidemiological transition (change in dis-
ease patterns), pandemics and emergence of new infec-
tious diseases (new viruses), migrant crisis, then natural
disasters (oods, earthquakes, res), etc. (FMZ 2022).
Developmental crises in healthcare represent long-term
and deep-rooted challenges that signicantly aect the
stability and eciency of healthcare systems. One of the
key factors contributing to these crises is nancial pres-
sure. The lack of adequate nancial resources limits the
ability of health systems to keep up with technological
innovations, improve infrastructure and ensure sucient
salaries for health personnel. This lack of investment can
result in a reduction in the quality-of-service provision
and hinder access to healthcare. In addition, the global
shortage of health professionals, doctors, medical techni-
cians, demographic challenges further deepen the crisis.
With adequate funding, investment in the education and
training of health personnel, and changes in policies and
management of health systems, long-term improvements
in the quality and access to healthcare can be achieved.
Situational crises in healthcare represent unexpected and
extraordinary events that signicantly aect the pro-
vision of healthcare. These crises often require urgent
measures and adjustments in the work of health systems.
Examples of such situational health crises include pan-
demics, accidents and disasters, mass injuries, equipment
and resource shortages, biological threats, and techni-
cal failures. Management of situational crises in health-
care requires good preparation, coordination between
dierent levels of healthcare systems, quick decisions
and cooperation with other sectors. Rehearsing and up-
dating emergency plans regularly are essential to ensure
that systems are ready to respond to unexpected events.
The basic function of every crisis plan is to dene proce-
dures and human and material resources, and to inform
and guide participants towards the execution of the plan.
Aware of the fact that no crisis manager can prepare us
for all possible crisis situations, recognition of their role
in the healthcare system is unquestionably important for
getting to know a wide range of crisis and emergency sit-
uations that can occur in healthcare institutions and en-
able us to develop analytical skills (Lujanac et al. 2018).
2. Communication models during times of crisis
Healthcare institutions, like all other organizations, com-
municate with their internal and external publics daily and
continuously. Some of these organizations have an orga-
nized approach to communication strategy and on the other
hand, they have formal documents named Communication
Strategy. Among other things, communication models are
dened in the strategy. The most capable organizations
have highly trained communication personnel who are
able to communicate two-way and symmetrically. Thus,
two-way symmetrical communication of the organization
with the internal and external public becomes the most im-
portant and key model of communication (Tomić 2013).
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
15
Many organizations apply two-way communication with
their strategic public, but this communication is more asym-
metric. The asymmetrical two-way model is proving to be
the most common model of communication between orga-
nizations and their stakeholders. This model has its aws.
Organizations that apply one-way communication with their
public, including the media, nd themselves in a dicult sit-
uation when a crisis breaks out. Such an organization does
not have the capacity or personnel to establish fast two-way
symmetrical communication. Such a turn only in times of
crisis will not be approved by the media and other audiences.
From the above, it is understandable that the preferred
communication model of healthcare organizations is a
two-way-symmetrical model. Such a model will give the most
results at the time of communicating the organization’s crisis.
TARGET AUDIENCES
(STAKEHOLDERS) IN CRISIS
Dening the audiences in a crisis is another import-
ant task of management. An audience is a homogeneous
group of people who inuence the corporation through
their actions and vice versa. Its success and long-term
survival depend on how successfully and eciently the
corporation manages its relations with the public. In or-
der for a corporation to communicate successfully even
during a crisis, it must dene in advance its key audi-
ences that could be involved in the crisis, directly and
indirectly. There are multiple audiences that dier from
each other and depend on the type of crisis or disaster.
1. Public health institutions
A signicant segment in public health is communication.
It takes place in several directions. First of all, experts in
the eld of public health must communicate with indi-
viduals, population groups, groups of vulnerable persons
or the entire population to which the implementation of a
certain public health activity relates. (Ropac 2011). Pub-
licity of healthcare institutions refers to the transparency,
accessibility and information of citizens about the work,
policies, services and results of healthcare organizations.
This is a key aspect of a democratic society, where citi-
zens have the right to be informed about matters concern-
ing their health and the healthcare system. The importance
of public health institutions includes several key aspects.
First, transparency of information is crucial. Healthcare
institutions should ensure openness and access to infor-
mation about their work, costs, treatment results, quality
of services and plans and policies. This enables citizens to
better understand how the healthcare system is managed
and how to access the services they need. Second, citizen
participation in the decision-making process is important.
Citizens have the right to participate in decision-making on
the policies of health institutions that concern them. This
may include participation in advisory committees, making
suggestions and comments on planned changes, and partic-
ipating in the evaluation of the work of health institutions.
Third, educating and informing the public is extremely
important. Health institutions should educate the public
about the importance of disease prevention, healthy life-
style, available services and patients’ rights. Informed
citizens can make better decisions about their own health
and actively participate in preserving their well-be-
ing. Fourth, patients have the right to information about
their health and treatment. This includes access to your
medical records and detailed explanations of your di-
agnosis, treatment plan, risks and alternative options.
The health system should conduct an analysis of its envi-
ronment and listen to the voice of the public. It is neces-
sary to understand what patients and citizens want, how
they perceive the current policy of the health system,
identify their dissatisfactions, recognize key health in-
stitutions that deserve special attention, and investigate
potential problematic cases. On the website of the Min-
istry of Health of the Republic of Croatia, there is a sec-
tion entitled “Consultations with the interested public”
which means “consultations and engagement of all those
concerned in adopting laws and other regulations is to
collect information about their interests, views, sugges-
tions and interests concerning a specic public policy
but also detecting previously undetected weaknesses and
negative impacts of the public policy that need to be cor-
rected as soon as possible” (Ministry of Health 2019).
It is very important to provide mechanisms for feed-
back and complaints. The public has the right to ex-
press its opinion about the quality of services provided
by healthcare institutions, as well as to le complaints
if they are not satised with the care provided. These
mechanisms enable continuous monitoring and improve-
ment of the quality of healthcare and contribute to build-
ing trust between patients and healthcare institutions.
CRISIS COMMUNICATION PLAN
Management of corporations, management of institutions
and organizations must be aware of possible crises in their
system. In this regard, they must start planning for emer-
gency situations. This includes organization and making as
many decisions as possible before a crisis occurs. Pre-crisis
planning gives people enough time to consider all options,
to think things through, consider the merits of dierent
courses of action, and test readiness for action. Each of
these important tasks is easier to do well in normal times,
but very dicult and stressful when a crisis breaks out.
Crisis communication experts point to ve steps that can
help to design an eective plan (Ministry of Health 2019):
First step – assemble a planning team; second step – as-
sess the scale of the problem; third step – make a plan;
fourth step – test the plan; fth step – update the plan.
British scientist S. Black points to six stages of the crisis
plan. According to him, these are (Tomić & Sapunar 2006):
Analyzing possible causes of crises. It is necessary
to assess possible diculties, either external or in-
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
16
ternal. It is often impossible to predict all possi-
ble crises. However, when the causes are assessed,
they should be listed and given an ocial character.
Preparation of the plan. The plan should in-
clude pre-crisis communication planning, cri-
sis communication and post-crisis communication.
Selection of personnel. When creating the plan, the corpo-
rate administration should make a list of persons who would
be available at the time of crisis. The most important role of
that team is answering media calls and phone calls. When
such team lists are made, they must be covered 24 hours a day.
Communication capacities. From the technical aspect,
the problem of the load on permanent communica-
tion lines should be carefully planned when creating the
plan. Let us remember, at the time of the demolition of
the buildings of the World Trade Center in New York,
the entire city was in a communication blockade. This
problem should be given great importance and antici-
pated. On the other hand, one must know who makes up
the crisis communication group and what their tasks are.
Training. In order for the persons involved in the cri-
sis plan to know their obligations, it is necessary to
organize education and training. This will help en-
sure that sta are ready to act when a crisis occurs.
Simulation of a crisis situation. Once the crisis plan is
set, it is necessary to simulate the crisis situation several
times, at dierent time intervals, unannounced. The sim-
ulation will give an answer as to how the sta behaves
in relation to the crisis and the crisis plan. Of course, it
is an opportunity to eliminate all possible shortcomings.
1. Crisis Communication Team
In an organization aected by a crisis, it is impossible
for everyone to decide, coordinate and know everything
about everything to the same extent. For this reason, a
crisis team composed of the leading people of the orga-
nization is established, i.e., it must include all individuals
who can contribute to the solution of the crisis in a pro-
fessional manner. This means that the team should include
the chief executive ocer (CEO), the head of the public
relations department, the vice president of the organi-
zation, the general manager of the area where the crisis
broke out, the head of protection, the organization’s law-
yer and anyone who could in some way shed light on the
situation. Contacting the crisis team should be the starting
point from which we begin to resolve the resulting crisis.
The team’s rst task is to come up with a crisis resolution
plan and appoint a spokesperson. It is important to note
that, although an organization may have a pre-prepared cri-
sis plan, each crisis is specic and requires adaptation of the
plan or the creation of a completely new one in view of the
predicted or expected situation. One person should be desig-
nated as the main spokesperson who will represent the com-
pany, make ocial statements and answer questions from
the media during the crisis. A deputy spokesperson should
also be appointed so that he can be replaced if necessary.
In addition to spokespersons and replacements, it is expect-
ed that others involved in the crisis - police, reghters,
health ocials - will also have spokespersons. It is import-
ant to know the identity of these persons as soon as possible
so that all statements and contact with the media can be
aligned with them whenever possible. According to the de-
nition, a crisis communication team is “a cross-functional
group of people within an organization” (Coombs 1999).
In crisis situations, a quick and decisive reaction
is required. The main burden is taken by the cri-
sis team. Since the crisis team will not be able to ful-
ly satisfy the public’s curiosity due to its tasks, the
next task is to organize a crisis information center.
THREE STAGES OF THE CRISIS
There are several approaches to the life cycle and develop-
ment stages of crisis situations. In this regard, we know the
three-stage model, four-stage, ve-stage and even six-stage
model of crisis development. Respecting dierent theoret-
ical approaches, we will consider the crisis and crisis com-
munication in three stages, which is the most common model
and approach to organization and implementation of crisis.
I. STAGE - PREPARATION FOR THE CRISIS
In the rst stage of the crisis, the crisis is dened, as well
as the causes and types of the crisis. An important aspect
of this stage is the segmentation of the public in a crisis.
In order to manage a crisis, it is necessary to create a cri-
sis communication plan and a crisis communication team.
1. Causes of the crisis
If we look at the crisis as an unplanned process, the question
arises as to what are the causes of crises in organizations. Al-
though the causes are dierent, in modern literature they are
generally divided into external and internal. (Novak 2011).
External causes, as the word itself suggests, arise out-
side the organization in the environment. It is consid-
ered that the organization has no signicant inuence
on these causes. Among the external causes of crisis to-
day, we can count natural disasters and accidents, po-
litical and social changes, economic crises, reces-
sions, changes in the market, security environment, etc.
Crises often arise within an organization. Such crises
are often not visible. These include: poor organization
of work, damaged interpersonal relations, incompetence
and immorality of management, corruption, sick rival-
ry, lack of corporate culture, poor working conditions,
unrealistic union goals, lack of communication, etc.
If crises are viewed from the perspective of natural and
social phenomena that can cause crises, the causes can
be divided into three large groups (Zvonarević 1989):
1. natural phenomena - can be divided into two subgroups:
a) geophysical phenomena such as earthquakes, oods,
weather disasters, etc.,
b) biological phenomena such as large epidemics
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(Covid-19)
2. technical factors - they are related to the technical and
technological development of human civilization (major
trac accidents, major res and explosions, nuclear acci-
dents)
3. social phenomena (wars, armed conicts, economic cri-
ses, mass hunger, etc.).
2. Research - types of crises
We have seen that the causes of crises can be di-
verse. When we try to classify all these crises into
groups, we can get certain types of crises (Novak 2011):
1. Types of crises with regard to the environment in which
they originate (crises of a physical nature, crises of public
opinion, crises due to administrative errors, crises of the
economic and political environment)
2. Types of crises with regard to warning time (sudden cri-
ses/accidents and deaths and covert crises/audits, internal
factors)
3. Types of crises with regard to the ways of experiencing
them (unusual crises and perceptual crises).
Other scientists state the causes of possible crises: acci-
dents and natural events, health and environmental crises,
technological incidents, economic and market forces, em-
ployees out of control (Luecke 2005).
II. STAGE - CRISIS COMMUNICATION
The second stage is marked by the course of the cri-
sis, i.e., the behavior of key publics during the crisis,
workers and external publics. For this period, it is im-
portant to point out the relations with the media in crisis.
1. The course of the crisis
American crisis management expert P. McCue present-
ed the course of the crisis. He described the beginning as
“a special interest group (active public) that sends neg-
ative information to the public and thereby activates the
alarm” (Regester & Larkin 2011). In the continuation of
the explanation of the course of the crisis, it is said that the
media play an extremely important role with their report-
ing on the event and regularly create a feeling of general
danger. A company hit by a crisis responds with a state-
ment based more on facts than on feelings. The public is
increasingly beginning to avoid questionable products
from companies aected by the crisis due to negative me-
dia coverage. In such conditions, product sales fall. The
crisis instigators (a special interest group) in the public
intensify the negative campaign against the aected or-
ganization, with the media more inclined to report on ev-
erything that the crisis instigators declare. The aected
company tries with all its might to ght the crisis and in-
crease sales, and in these conditions, for a while, everyone
forgets about the real problem of the crisis (Novak 2011).
After some time, things become clear, the organiza-
tion gathers strength for further work, and the media is
looking for a new player aected by the crisis situation.
2. Implementation of the crisis
Manager of the Century in the USA Jack Welch,
CEO of General Electric Company, in the book Win-
ning, points out ve assumptions that should be
kept in mind when a crisis occurs. (Welch 2005).
1. Always assume that the problem is more dicult than
it seems at rst glance. Crises rarely remain as small as
when they rst appeared. Most often, they are much bigger
and more serious than you could have imagined when you
received that rst call. In addition, it will last longer than
you expect and will become more and more uncomfortable
over time. It will aect more people than you think, more
lawyers will stick their noses into it, and more awful things
will be said and published than you could ever imagine.
Adapt in time! Approach any crisis with the assumption
that the worst has happened somewhere in your organi-
zation and, just as importantly, that solving the resulting
problem is entirely your concern. Go so far as to assume
that your organization has made a mistake and that it is
your duty to correct that mistake. Always start from the as-
sumption that you have a big problem in front of you and
that it is your duty to solve it.
2. Assume that there are no secrets in the real world and
that eventually everyone will nd out everything. In times
of crisis, your lawyers will advise you to say as little as
possible. As a rule, this advice is not wrong. And yet, don’t
take it as gospel. Get your lawyers to let you say as much
as possible. You just have to make sure that everything you
say is the bare truth, without any gray shadows. The more
openly you talk about the problem, its causes and solutions,
the more people will trust you, both inside and outside the
organization.
3. Assume that the media will portray you personally, as
well as the way your organization will handle the crisis,
in the worst possible light. There are industries in which
the measure of success is the size of the market share, in
some it is an increase in income, the number of concessions
obtained in a year or gures that speak of greater consum-
er satisfaction. In journalism, success is measured by the
number of empires destroyed and emperors exposed. Pub-
lic defamation is hard to bear. But no matter how innocent
you feel and no matter how convinced you are that your
organization is handling its diculties very well, that is
completely irrelevant. A journalist’s job is not to interpret
your view of the situation, their job is to present opportu-
nities as they see them. Sometimes you may want to back
out, but you must not. Along with publishing all aspects
of the problem, clearly explain your own attitude towards
the newly created situation and present your proposals for
overcoming it. If you do not, your lack of clarity will be in-
terpreted as an admission of guilt. True, not all crises reach
the public. In this case, the same principles apply: openly
discuss the situation, state your position, explain why the
problem arose, explain how you intend to solve the prob-
lem.
4. Assume that after the crisis, changes will follow, both in
processes and in personnel. Most crises end with some kind
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of settlement - nancial or legal. Then comes cleaning, and
cleaning implies changes. Processes are usually the rst to
be hit, although the problem may not only be in the process,
but also in people who do not follow existing guidelines.
Crisis situations require changes. This is why there are few
crises that end without blood being spilled.
5. Assume that your organization will not only overcome
the crisis, but will emerge from it even stronger. There is
no such crisis from which you cannot learn something, al-
though, of course, you hate them all the way. Every time a
crisis period ends, you will feel the need to forget it as soon
as possible and not to mention it again. Learn from crises
and don’t miss any opportunity to share your experiences
with others.
3. Information gap
As we have seen through the review of crisis relations
activities with the media, it is very important to react
immediately to the public. Even if not all information is
collected, the spokesperson, general manager or person
authorized to communicate with the media must respond
to press inquiries to avoid an information gap. The infor-
mation gap is the time that ows from the emergence of
a crisis to communication with the media. In case the me-
dia do not get quick information, they will have to inform
the public, usually based on rumors or partial information.
Experts and professional literature indicate that a quick
response within 24 hours is required. But today, in the
digital age and the age of new media, you don’t need to
think about 24 hours. It is “eternity”. It is necessary to re-
act as soon as possible, some will say - immediately. It is
important to keep in mind that a quick reaction must not
come at the expense of accuracy and verication of data.
We need to react immediately when we know what to say.
Communications sta have to think about a number of is-
sues when it comes to the possibility of a crisis. One such
question reads: “What if communication channels are de-
stroyed in a crisis?” R. Luecke answers this question as
follows: “People in the developed world take modern elec-
tronic communication for granted. In fact, our dependence
on fax, e-mail, Internet, telephones, radio and television
in mutual communication is enormous. We only become
aware of this dependence when the electricity goes out or
when our internet service or company server crashes. For-
tunately, such accidents usually do not last more than a few
minutes. Crisis managers must be aware that major natural
or human-made disasters can disrupt electronic communi-
cations for days or weeks and limit their ability to com-
municate with employees and the public” (Luecke 2005).
4. Tools in crisis public relations
In communication with the media, the communi-
cation team has at its disposal communication chan-
nels such as statements, press releases, press confer-
ences, company information, interviews, briengs, etc.
Key communication tools for mediating informa-
tion are public statements. With them, the manage-
ment of the company explains the main informa-
tion about the event, expresses its regret and other
feelings. In crisis situations, public statements often need
to be supplemented as soon as new information arrives.
An eective communication tool in crisis situations is de-
nitely a press conference that allows the administration to
announce information to all journalists at the same time.
Conferences give companies the opportunity to tell their
story live and clarify any misunderstandings. The princi-
ple for holding press conferences in crisis situations should
be kept in mind: they should not be limited, as this can
give the impression that something is being covered up.
Brieng. Most often, the analysis of the crisis and the
rst meeting with the crisis phenomenon begins with
the rst, urgent brieng. The brieng is intended as a
communication tool in the campaign plan. According to
the plan, the people participating in the brieng are de-
ned. This is where the situation is analyzed and mea-
sures and ways of responding to crises are agreed upon.
Interviews with management representatives or a spokes-
person are suitable communication tools. With the help of
interviews, company management can explain events in
more detail and remove possible ambiguities. It would be
desirable to do an interview exercise where the interviewee
would face potential questions and prepare answers to them.
A press release is also often used in media rela-
tions. Press releases help to present the position of
the management, new details and maintain continu-
ous communication with the media and the public.
Background information is also a common tool of crisis pub-
lic relations. This is the most important information about
the organization, its history, composition of the board, or-
ganization, successes, photos and everything that could be
of interest to journalists as an addition to the current story.
Journalists are not always able to come to the scene, so
communication tools and special telephone lines are nec-
essary. Media calls should be answered by members of
the crisis communication team who must be equipped
with all the necessary information and materials about
the crisis situation. Members of the crisis communica-
tion team should be able to answer any question asked.
III. STAGE - POST-CRISIS COMMUNICA-
TION
A crisis is a turning point in the life of a company, and at the
same time an opportunity to gain a greater reputation. After
the end of the crisis, the organization must return to normal
business as soon as possible and the motivation to restore
and improve the reputation of the organization. Unfortu-
nately, most organizations do not learn from their mistakes
that led them to the crisis and after the crisis they do business
the same as before. B. Novak points out that “the biggest
mistake is to forget the crisis. Experiences can be instruc-
tive only if they are thoroughly analyzed” (Novak 2011).
After the crisis, the management must analyze what
worked in the crisis and what did not. If the manage-
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ment worked according to the crisis plan, it should be
determined which parts of the crisis plan were well exe-
cuted and which were poorly executed. It is necessary to
determine whether and how the crisis could have been
avoided. The main purpose of the analysis is to im-
prove the action plan in crisis situations, which is never
nal. Analysis of the crisis should start after its end, but
no longer than 30 days, because then new tasks appear.
1. Consequence analysis
Analysis of the consequences of the crisis and crisis com-
munication is the last stage of the crisis. The corporation
or institution will consider all elements of the crisis, draw
conclusions and lessons, and try to return to everyday life
as quickly as possible. One of the biggest mistakes can be to
quickly forget the crisis. Therefore, it is not for nothing that
it is said that lightning can strike twice in the same place.
The analysis should include internal and external publics,
i.e., all employees who were involved in the crisis, volume
of sales, public opinion, publications in the media, material
damage, possible lawsuits for compensation. It is desirable
to keep records and notices of events during a crisis, so
that the administration can more successfully deal with
future similar crisis situations. If the analysis manages to
determine the causes of the crisis and the responsible per-
sons, the management can prevent such crises in the future.
2. Solving the crisis
This crisis is a story in itself, J. Welch (2005) be-
lieves. Some are related exclusively to the internal
problems of the organization and for them the solu-
tion is usually found quickly. But there are crises that
grow into media sensations of enormous proportions
and with the most diverse legal consequences. Precise-
ly because of the specicity of each individual crisis, it
is dicult to establish common rules for solving them.
As we have already mentioned, there are ve as-
sumptions that you must take into account
when solving a crisis in your organization:
1. Always assume that the problem is more dicult than it
seems at rst glance.
2. Assume that there are no secrets in the real world and
that eventually everyone will know everything.
3. Assume that the media will portray you personally, as
well as the way your organization will handle the crisis, in
the worst possible light.
4. Assume that after the crisis there will be changes both in
processes and in personnel.
5. Assume that your organization will not only overcome
the crisis, but will emerge from it even stronger.
It is a typical phenomenon that companies, having over-
come the crisis, go to the other extreme. They arm them-
selves with various regulations and determine some pro-
cedures in order to be ready to ght the enemy who has
already managed to break through their ranks once (Welch
2005).
CRISIS CAUSED BY THE PANDEMIC
COVID 19
The COVID-19 crisis in the world represented a seri-
ous challenge. At the end of 2019 and the beginning of
2020, the rst case of an unknown viral disease was de-
tected in the Chinese city of Wuhan. Scientists quick-
ly determined that it was the SARS-CoV-2 virus, i.e.,
the coronavirus, which causes the disease COVID-19.
In humans, this virus causes pneumonia and the ap-
pearance of certain symptoms such as malaise, fever,
diculty breathing and a dry cough. The coronavirus
belongs to the group of zoonotic viruses, and is transmit-
ted between humans and animals (Žmuk & Jošić 2021).
The health system was faced with an increased number of
patients, a lack of resources and the risk of infection of health
workers. State governments have implemented measures
such as movement restrictions, wearing masks and physical
distancing to curb the spread of the virus. These measures
had a signicant impact on everyday life and the economy.
Due to the very rapid spread of the virus, the World
Health Organization declared a pandemic threat on
March 11, 2020. The rst cases that spread outside of
China were detected in Thailand on January 13, 2020.
A year later, the coronavirus spread to 191 countries
and caused all activities to be restricted (Džidić 2021)
Vaccination has played a key role in the ght against the
pandemic, but challenges have emerged in vaccine distri-
bution and access. The psychological and social impacts
of the pandemic were also signicant, with isolation, job
loss and uncertainty weighing on citizens’ mental health.
Community solidarity was also key in meeting these chal-
lenges. This crisis required the joint eort of everyone to
overcome the challenges and enable a quick recovery of
the community. The World Health Organization (WHO)
declared the long-awaited end of the global emergen-
cy due to the COVID-19 pandemic on May 5, 2023.
CRISIS AS AN OPPORTUNITY OR A
THREAT?
The leading man of one of the largest technological
companies in the world, Intel, once said the following:
“Bad companies are destroyed by crisis. Good companies
survive them. Great companies are improved by them.”
The crisis often arouses divided reactions, some per-
ceive it as a danger that threatens stability, while others
nd an opportunity for innovation and growth. How we
understand a crisis can have a profound impact on our
ability to face challenges and adapt to change. Accord-
ing to (Bedenik 2003), successful crisis management in-
cludes anticipatory, i.e., preventive action to prevent the
arrival of a crisis, crisis identication, and reactive crisis
management, which implies mastering the crisis situa-
tion, which implies, among other things, remediation.
From an opportunity perspective, many see the crisis as
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an opportunity for positive change. Crises stimulate the
need for innovation, adaptation and restructuring in or-
der to avoid similar situations in the future. Organizations
that manage to adapt to crises can identify new opportu-
nities for improvement and development. Crises also pro-
vide an opportunity to build resilience, learn from chal-
lenges, and identify weaknesses that can be addressed
to make systems more resilient to future challenges.
From the point of view of threat, the crisis can bring real
threats to our stability. Financial, health or other crises can
lead to serious disruptions in society, cause insecurity and
fear and cause a loss of trust in institutions. In addition,
crises impose challenges in resource management, health-
care and other key sectors, requiring urgent interventions to
mitigate negative consequences. Remediation aims to save,
heal the company so that it continues to survive, but not nec-
essarily in the same market or industry. On the other hand,
liquidation shuts down the business when it is noticed that
there are no longer any realistic prospects for continuing
operations because identied weaknesses and threats are
greater than strengths and opportunities (Bedenik 2003).
Crisis management not only requires immediate measures,
but also the ability for long-term planning. Through crises,
organizations and societies have the opportunity to change
priorities, to recognize the importance of certain aspects
such as public health, economic stability or sustainability.
Many leaders and innovators have successfully used chal-
lenges to improve and transform their environments. This
dual perspective provides an incentive to seek solutions and
nd room for progress even in the most challenging times.
RESEARCH
The subject of the research is the type of crisis in health
institutions in the world with regard to the environment,
time and experience. The goal of the research is to de-
termine which forms of crisis dominate in healthcare in-
stitutions and how to inuence favorable outcomes by
managing crises in the interest of both the public and the in-
stitutions. The purpose of the research is to provide recom-
mendations and concrete instructions on the best model of
communication in times of crisis in healthcare institutions.
The work explores the following crises:
1. with regard to the environment in which they originate
(crises of a physical nature, crises of public opinion, crises
due to administrative errors, crises of the economic and po-
litical environment)
2. with regard to warning time (sudden crises/accidents and
death and covert crises/audits, internal factors)
3. with regard to the ways of experiencing them (unusual
crises and perceptual crises).
Hypotheses:
H1: In the world’s most recognized health institutions, the
crisis is caused by internal factors, i.e., the human factor,
such as management and doctor errors, lack of sta and
poor internal and external communication.
H2: The crisis in healthcare institutions is caused by nan-
cial conditions.
H3: The economic and political conditions in society aect
crises in healthcare institutions.
H4. Crises in the environment in which they originate,
strikes and crises of public opinion are a threat to health
institutions.
H5. More and more frequent crises are crises related to the
mental health of healthcare workers.
The scientic methods used in the preparation of this pa-
per are the analysis of the content of the websites of health
institutions, the analysis of the content of the literature, the
concretization method, the comparative analysis of previ-
ous research and theoretical knowledge about crisis com-
munication, and the synthesis for the creation of conclu-
sions.
The research covers healthcare organizations from North
America, South America, Africa, Europe, Asia, Australia
and the Southeast European countries of Bosnia and Herze-
govina, Serbia, Croatia and Montenegro. The research was
conducted in October and November 2023.
1. Research results
North America
According to the source of the best 250 hospitals in
the world, the sample included Mayo Clinic, Roches-
ter, New York and Cleveland Clinic, Cleveland, Ohio
(Newsweek , World’s Best Hospitals 2023, https://www.
newsweek.com/rankings/worlds-best-hospitals -2023 ).
1. Mayo Clinic, Rochester, New York
According to the types of crises, the crises that happened
at the Mayo Clinic in New York are mainly salary cuts,
strikes, however, on November 15 of this year, a doctor
sued the clinic for the right to free speech, which raised a
lot of dust.
Types of crises: crises due to management errors (cri-
sis with regard to the environment from which they
originate ) (Taylor, 2023, https://www.beckershos-
pitalreview.com/legal-regulatory-issues/physician-
sues-mayo-clinic-over-free- speech-rights.html ) .
2. Cleveland Clinic, Cleveland, Ohio
The biggest crisis to hit the Cleveland Clinic is related to
accusations of racism.
Types of crises: economic-political environment crisis and
internal factor (Huntsman, 2021, https://www.ideastream.
org/health-science/2021-06-22/how-can-cleveland-hospi-
tals-address-racism-as- a-public-health-crisis ).
South America
In South America, Hospital Israelita Albert Einstein, Sao
Paulo from Brazil and Fundación Valle Del Lili, Cali from
Colombia were investigated.
1. Hospital Israelita Albert Einstein, Sao Paulo, Brazil
At the Hospital Israelita Albert Einstein in Sao Paulo, I
would mention the crisis when a 17-year-old girl died due
to a medical error.
Types of crises: death of a patient (cri-
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21
sis regarding warning time) (Globo.com,
2007, https://g1.globo.com/Noticias/SaoPau-
lo/0,,MUL9165-5605,00-HOSPITAL+DE+SP+E+CON-
DENADO+POR+ERRO+MEDICO.html ).
2. Fundación Valle Del Lili, Cali, Colombia
At the Fundación Valle Del Lili Hospital, Cali, Colombia,
a medical malpractice crisis emerged when a young girl
died. The crisis in this case began in 2012 when doctors
allegedly unknowingly treated a teenage girl.
Types of crises: death of a patient (crisis regarding warning
time) (90 minutos noticiero, 2020, https://90minutos.co/
cali/familia-denuncia-muerte-joven-cali-dio-aparente-neg-
ligencia-medica-17-01-2020/ ) .
Europe
In Europe, two clinics that are considered the most pres-
tigious in their practice were investigated. These are: Kar-
olinska Universitetssjukhuset, Solna from Sweden and
Charité - Universitätsmedizin Berlin, Berlin from Germa-
ny.
1. Karolinska Universitetssjukhuset, Solna, Sweden
The largest university hospital in Sweden and one of the
best in the world has been struggling with debt and poor
management for years. In 2019, Björn Zoëga, the direc-
tor of the Karolinska University Hospital in Stockholm,
announced the termination of employment for 250 doctors
and 350 nurses, which led to an outcry from both doctors
and residents, both in Stockholm and throughout Sweden.
Types of crises: crisis of public opinion. (crisis with
regard to the environment from which they orig-
inate) (SM 2019, https://www.index.hr/vijesti/
clanak/stotinama-lijecnika-najvece-svedske-bol-
nice-prijete-otkazi-ovo-je-presedan/2130259. aspx ).
2. Charité - Universitätsmedizin Berlin, Berlin, Germany
Hospitals in Berlin entered a crisis situation due to a lack
of sta in key departments, as well as poor management.
Types of crises: internal factors. (a crisis with regard to
warning time (Hasel, 2016, https://www.tagesspiegel.de/
gesellschaft/die-zustande-in-der-kinderonkologie-sind-un-
ertraglich-2777605.html ).
Africa
On the African continent, the most important health in-
stitutions are institutes. Groote Schuur Hospital, Cape
Town from South Africa and University Teaching Hos-
pital, Lusaka from Zambia were included in the analysis
(Scimago, institutions rankings, 2023, https://www.scima-
goir.com/rankings.php?country=Africa§or=Health ).
1. Groote Schuur Hospital, Cape Town, South Africa
Hospital from South Africa is most exposed to nancial
problems, internal and problems related to the econom-
ic-political environment.
Types of crises: nancial problems, management mistakes
and external factors. (Crisis of a physical nature, crises of
public opinion, crises due to management errors, crises
of the economic-political environment) (Daniels, 2023,
https://www.iol.co.za/news/south-africa/groote-schuur-
suers-major -cash-crisis-94955 ).
2. University Teaching Hospital, Lusaka, Zambia
Financial conditions are the most common crisis situations
of hospitals in Lusaka, Zambia. Also the crisis caused by
the strike (2009).
Types of crises. Workers’ strike. (Crises of a physical na-
ture, crises of public opinion, crises due to management
errors, crises of the economic-political environment) (Lu-
kastimes, 2009, https://www.lusakatimes.com/2009/06/10/
situation-at-the-university-teaching -hospital-uth- worri-
some-mangani/ ).
Asia
Two health institutions were investigated in the area of
Asia. Singapore General Hospital from Singapore and She-
ba Medical Center, Ramat Gan from Israel.
1. Singapore General Hospital, Singapore
A medical worker at a hospital in Singapore committed sui-
cide, causing a crisis due to the poor mental health of other
hospital workers.
Types of crises: Death and mental health crisis. (Types of
crises in terms of warning time - sudden crises/accidents and
fatality and covert crises/audits, internal factors) (Zheng,
2021, https://mothership.sg/2021/12/sgh-nurse-karunyah/ ).
2. Sheba Medical Center, Ramat Gan, Israel
Israeli Health Minister Uriel Busso took oce following
the October 7 Hamas attack on southern Israel. The minis-
ter pointed out the large number of cases of mental health
crisis.
Types of crises: Mental health crisis. (Types of crises with
regard to their experience - unusual crises and perceptual
crises) (JNS, 2023, https://www.jns.org/israel-faces-the-
worst-mental-health-crisis-in-its-history/ ).
Australia
In Australia, the Royal Prince Alfred Hospital, Camper-
down and The Alfred in Melbourne were investigated.
1. Royal Prince Alfred Hospital, Camperdown, Australia
The investigation into the cover-up of the deaths of pa-
tients, which according to experts could have been prevent-
ed, caused a crisis situation.
Types of crises: Death. (Types of crises in terms of warning
time - sudden crises/accidents and fatality and covert crises/au-
dits, internal factors) (Fellner, 2022, https://www.smh.com.
au/national/nsw/doctors-demand- end-to-culture-of-cover-
up-after-string-of-patient-deaths-20220702-p5ayj0.html ).
2. The Alfred, Melbourne, Australia
The appearance of pests in hospital wards has led the Al-
fred Hospital in Australia to a crisis. Pests, mice, rats and
snakes disrupted the regular work of doctors and nurses
and other hospital sta. The doctors of this hospital said in
their statements that the nancial crisis is the biggest cause
of this.
Types of crises: nancial crisis, management error crisis.
Types of crises with regard to their experience - unusu-
al crises and perceptual crises) (Attanasio, 2023, https://
au.news.yahoo.com/horrifying-discovery-patients-hospi-
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
22
tal-beds-melbourne-the-alfred-071416593.html ).
Southeast Europe
Given that there are no ranking lists of hospitals in South-
east Europe, we take the 10 most common crisis situations/
crises in hospitals in Southeast Europe, specically in Bos-
nia and Herzegovina, Croatia, Serbia and Montenegro.
1. The work of clinical centers and large hospitals in Bosnia
and Herzegovina is burdened with enormous debts for taxes,
contributions, utilities and medicines. Research conducted in
2015 showed that only hospitals in Mostar, Sarajevo, Bihać,
Zenica, Goražde, Banja Luka, Bosanska Gradiška and East
Sarajevo owed a total of an enormous 213.7 million BAM.
(Dnevni avaz, 2015, https://avaz.ba/vijesti/163905/dugovi-
velikih-bolnica-u-bih-dosegli-213-7-miliona-km ).
2. Financial crisis and lack of resources in the UKCS: In 2016,
the UKCS had a debt of close to 50 million euros, which deep-
ened the crisis with a shortage of medicines and medical sta.
(Al Jazeera, 2016, https://balkans.aljazeera.net/news/bal-
kan/2016/6/13/pokusava-se-naci-izlaz-iz-krize-ukcs ).
3. Lack of proper care of an infected patient in SKB
Mostar: At the beginning of the COVID-19 pandem-
ic in Bosnia and Herzegovina, failures in the care of an
infected patient caused a crisis situation in SKB Mostar.
(Soldo, 2020 , https://www.dw.com/hr/mostar-tragiko-
medija-u-doba-korone/a-52855867 ).
4. The nancial crisis of 2013 did not spare healthcare in
Bosnia and Herzegovina. There was not enough money,
medical sta complained that they were poorly paid, and
employers paid contributions irregularly. In the BiH enti-
ty Republika Srpska, dozens of health institutions were in
debt, including the Clinical Center in Banja Luka, where
most patients were treated. (Aljazeera, 2013, https://bal-
kans.aljazeera.net/news/balkan/2013/2/5/zdravstvo-repub-
like-srpske-na-udaru-krize ).
5. Mistakes in the medical intervention in Metković: A
nine-year-old patient died of sepsis after a failure in the
medical intervention in Metković, where he was sent back
home twice before being transported to the KBC Split.
(Apple TV, 2018, https://www.jabuka.tv/metkovic-gabri-
el-umro-zbog-propusta-lijecnika/ ).
6. Unavailability of medicines in Montenegro: The Amer-
ican Chamber of Commerce in Montenegro expressed
concern about the lack of medicines and continuous
treatment, especially for patients with serious diseases.
(Janković, 2022, https://www.slobodnaevropa.org/a/
crna-gora-novac-zdravstvo-lijekovi-oprema/32056295.
html ).
7. Poisoning with carbonated drinks in Croatia: A scan-
dal with questionable carbonated drinks in Croatia caused
injuries to patients at KBC Rijeka and KBC Zagreb.
(Kovačević Barišić, Bičak, 2023, https://www.vecern-
ji.hr/vijesti/sire-se-uznemiravajuce-poruke-o-trovan-
ju-sokom-i-mineralnom-cekaju-se-sluzbene-informaci-
je-1722201 ).
8. Suspicions of organ tracking in KBC Zagreb: An in-
spection by the Ministry of Health revealed irregularities
in organ transplants at KBC Zagreb, raising suspicions of
organ tracking (PN, 2022, https://www.novilist.hr/novo-
sti/trgovanje -organs-in-kbc-in-zagreb-kidneys-did-serbi-
an-and-kosovar-transplantation-temporarily-prohibited/ ).
9. Problems with sta at the Clinical Center of Ser-
bia: The new building of the Clinical Center of Serbia
faced problems with the recruitment of medical sta,
with minimal salaries and poor working conditions.
(Marković, 2022, https://nova.rs/vesti/drustvo/ministre-
u-novom-klinickom-centru-nema-ko-da-radi-svi-su-u-
nemackoj/ ).
10. Theft of organs at the Clinical Center of Montenegro: A
vascular surgeon at the Clinical Center of Montenegro was
accused of stealing organs and removing parts of the hu-
man body from the institution (Srbija danas, https://www.
sd.rs/vesti/region/horor-u -Montenegro-surgeon-stole-pa-
tient’s-organs-carried-out-the-body-parts-in-jars-from-the-
clinic-center-2023-09-17 ).
Types of crises: crises of a physical nature, crises of public
opinion, crises due to management errors, crises of the eco-
nomic-political environment, sudden crises/accidents and
deaths and covert crises/audits, internal factors, unusual
crises and perceptual crises.
CONCLUSION
In a dynamic global environment, constant threats,
whether caused by nature or human factors, make it inev-
itable for any institution or organization to be immune to
crises. Crisis management therefore becomes one of the
most important competences of the president of the board
as well as of the entire team, i.e., the management of the
organization. Also, a prominent and necessary competence
is the knowledge and ability to communicate internally
and to external audiences (externally). The ability to deal
with crises is conditioned by crisis planning. The best or-
ganizations have their own crisis communication plans and
crisis communication teams. The plans foresee possible
types of crises and the protocol that will be used to manage
crisis communication. All this is simulated and rehearsed.
In addition to employees and patients (internal public),
the media is one of the most important stakeholders in
the life of a healthcare organization, whose special im-
portance comes to the fore in times of crisis. In times of
crisis, there is no other approach in cooperation with the
media than the approach of daily familiarity and commu-
nication with them. Healthcare organizations must strive
for a two-way symmetrical model in communication with
the internal and external public, especially the media.
The media write and report on crises in healthcare insti-
tutions, serving the public but also helping the healthcare
organization to better respond to crisis situations and chal-
lenges. By analyzing the media, it is possible to identify
numerous crises that exist in almost all healthcare insti-
tutions. Following the news as an indicator, the types of
crises in the world’s most prestigious hospital systems,
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
23
ranked according to quality criteria, have been explored.
The study has investigated crises based on their origin,
the time of warning, and the ways they are experienced.
In relation to the initial hypotheses, it was established
that in the world’s most recognized health institutions,
the crisis is caused by internal factors, i.e., the human
factor such as errors of doctors and management, lack of
sta and poor internal and external communication. This
conrms hypothesis H1. The research showed that cri-
ses in healthcare institutions are caused by numerous -
nancial conditions, which conrms hypothesis no. 2.
Hypothesis H3 was also conrmed, which points out that
crises in healthcare institutions are inuenced by eco-
nomic and political conditions in society. The research
also conrmed the H4 hypothesis that crises, the envi-
ronment in which they originate, strikes and crises of
public opinion are a threat to health institutions. More
and more frequent crises are crises related to the mental
health of healthcare workers, conrming hypothesis H5.
The research was conducted on a smaller sample of
health institutions in the world. With the new research,
it is possible to expand the sample and apply oth-
er research methods and methodology in order to in-
vestigate other types of crises that are not listed here.
Acknowledgements:
We would like to thank professor emeritus Miro Jakovljević
for his contribution to this article.
Conict of interest: None to declare
Contribution of individual authors:
Zoran Tomić, the author, played a key role in designing the
theoretical part of the work, ensuring that the methodology
corresponds to the set research goals. His participation
extended to extensive analysis and interpretation of the
collected theoretical part. His inuence is especially visible
in the writing of clear and concise conclusions within the
work.
Vladimir Vegar, the second author, made a signicant
contribution to the design of the research, ensuring that the
research relies on solid and up-to-date scientic knowledge.
His eorts were crucial in identifying and synthesizing the
relevant sources that formed the foundation of the research.
Miro Radalj, the third author, was responsible for the
statistical analysis, leveraging his expertise in quantitative
methods to guarantee the reliability of our conclusions
through statistical processing.
Collaboratively, all authors engaged in the research
conceptualization, oering critical analyses and valuable
suggestions that greatly enhanced the paper’s quality and
depth. Furthermore, each author played an active role in
deliberating the results and their implications, contributing
signicantly to the nalization of the paper.
References
1. Al Jazeera, (2016). Pokušava se naći izlaz iz krize UKCS-a.
<https://balkans.aljazeera.net/news/ balkan/2016/6/13/
pokusava-se-naci-izlaz-iz-krize-ukcs>. Accessed: 1/11/2023
2. Al Jazeera, (2013). Zdravstvo Republike Srpske na udaru
krize. <https://balkans.aljazeera.net/news/balkan/2013/2/5/
zdravstvo-republike-srpske-na-udaru-krize>. Accessed:
3/10/2023
3. Attanasio, (2023). Horrifying discovery in patients’ beds at
busy Melbourne hospital. <https://au.news.yahoo.com/hor-
rifying-discovery-patients-hospital-beds-melbourne-the-al-
fred-071416593.html. > Accessed: 25/11/2023
4. Zaremba A: Crisis Communication: Theory and Practice. M.
E. Sharpe, New York, 2010
5. Ašanin Gole P: Komuniciranje u kriznih in koniktnih oko-
liščinah. Gradivo za delavnico IABC. In: Novak B: Krizno
komuniciranje. Binoza Press, Zagreb, 2001
6. Banks K: Crisis Communications: A Casebook Approach.
Routlege, New York, 2011
7. Beaglehole R & Bonita R: What is global health?. Glob
Health Action. [Internet]. 2010 Apr 6; 3. doi: 10.3402/gha.
v3i0.5142 Available from: https://pubmed.ncbi.nlm.nih.
8. gov/20386617/https://pubmed.ncbi.nlm.nih.gov/20386617
9. Bedenik O N: Kriza kao šansa. Školska knjiga, Zagreb, 2003
10. Clawson, S. S. K. Crisis Communication Plan: A PR Blue
Print. <https://www3.niu.edu/newsplace/crisis.html>. Ac-
cessed: 2/11/2023
11. Coombs T: Ongoing Crisis Communications. Sage Publica-
tions, Los Angeles, 2012
12. Coombs T: Ongoing Crisis Communication: Planning, Man-
aging, and Responding. Sage Publications, Los Angeles,
1999
13. Crandall W, Parnell J & Spillan J: Crisis Management in
the New Strategy Landscape. Sage Publications, Thousand
Oaks-London, 2014
14. Darling J: Crisis management in international business:
keys to eective decision making. Leadership Org Dev J,
1994 ; 15(8) 3-8
15. Daniels, (2023). Groote Schuur suers major cash crisis.
<https://www.iol.co.za/news/south-africa/ groote-schuur-
suers-major-cash-crisis-94955>. Accessed: 5/11/2023
16. Dnevni avaz, (2015). Dugovi velikih bolnica u BiH doseg-
li 213,7 miliona KM!. <https://avaz.ba/vijesti/163905/du-
govi-velikih-bolnica-u-bih-dosegli-213-7-miliona-km>. Ac-
cessed: 29/11/2023
17. 90 minutos noticiero, (2020). Familia denuncia que muerte
de joven en Cali se dio por aparente negligencia médica.
<https://90minutos.co/cali/familia-denuncia-muerte-jo-
ven-cali-dio-aparente-negligencia-medica-17-01-2020>/.
Accessed: 30/10/2023
18. Fearn-Banks K: Crisis Communications: A Review of Some
Best Practices. In: Handbook of Public Relations. Heath R
L(ed.). Sage Pub., International Education and Professional
Publisher, Thousand Oaks-London, 2001
19. Development Programming Institute. Enhancement of ac-
tions in public-health crisis situations. Communicating in a
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
24
Crisis. <https://fzzpr.gov.ba/ bh/mjere/unapreenje-djelovan-
ja-u-kriznim-javnozdravstvenim-situacijama>.
20. Fellner, (2022). Doctors demand end to ‘culture of cover
up’ after string of patient deaths. <https://www.smh.com.
au/national/nsw/ doctors-demand-end-to-culture-of-cover-
up-after-stringof-patient-deaths-20220702-p5ayj0.html>.
Accessed: 27/11/2023
21. Fink S: Crisis Management: Planning for the Inevitable. Au-
thors Guild Backinprint, Cincinnati, 2002
22. Globo.com, 2007. Hospital de SP é condenado por
erro médico. <https://g1.globo.com/Noticias/SaoPau-
lo/0,,MUL9165-5605,00-HOSPITAL+DE+SP+E+CON-
DENADO+POR+ERRO+MEDICO.html>. Accessed:
04/10/2023
23. Hasel, (2016). Kritik an Berliner Charité: “Die Zustände
in der Kinderonkologie sind unerträglich”. <https://www.
tagesspiegel.de/gesellschaft/die-zustande-in-der-kin-
deronkologie-sind-unertraglich-2777605.html>. Accessed:
23/09/2023
24. Huntsman, (2021). How Can Cleveland Hospitals Address
Racism As a Public Health Crisis?. <https://www.ideas-
tream.org/health-science/2021-06-22/how-can-cleveland-
hospitals-address-racism-as-a-public-health-crisis>. Ac-
cessed: 18/09/2023
25. Jabuka tv, (2018). Metković: Gabriel umro zbog propusta
liječnika. <https://www.jabuka.tv/metkovic-gabriel-um-
ro-zbog-propusta-lijecnika/>. Accessed: 28/09/2023
26. Janković, (2022). Manjak lijekova i opreme vode zdravstvo
Crne Gore ka kolapsu. < https://www.slobodnaevropa.org/a/
crna-gora-novac-zdravstvo-lijekovi-oprema/32056295.
html>. Accessed: 25/09/2023
27. JNS, (2023). Israel faces the worst mental-health crisis in
its history. <https://www.jns.org/israel-faces-the-worstmen-
tal-health-crisis-in-its-history/>. Accessed: 22/09/2023
28. Kovačević Barišić, Bičak, (2023). Četvrti slučaj trovan-
ja, još jedan mladić primljen u KBC Zagreb; Policija na
zagrebačkom PMF-u. <https://www.vecernji.hr/vijesti/
sire-se-uznemiravajuce-poruke-o-trovanju-sokom-i-min-
eralnom-cekaju-se-sluzbene-informacije-1722201>. Ac-
cessed: 19/11/2023
29. Krystek U: Unternehmenskrisen: Beschreibung, Vermei-
dung und Bewältigung überlebenskritischer Prozesse in Un-
ternehmungen. Gabler, Wiesbaden, 1987
30. Langford M: Crisis Public Relations Management. In:
Exploring Public Relations. Tench R, Yeomans L. (eds.).
FT-Printice Hall, Harlow, 2006
31. Langford M: Upravljanje kriznim odnosima s javnošću. In:
Otkrivanje odnosa s javnošću. Tench R i Yeomans L (ed).
HUOJ, Zagreb, 2009
32. Littlejohn R F: Corporate Crisis Leaders: A Team Approach.
American Corporate leaders Association, New York, 1983
33. Lujanac D et al: Krizni menadžment zdravstva. J. appl.
health sci 2018;4 (1): 115-120.
34. Lukastimes, (2009). Situation at UTH worrisome, Man-
gani. <https://www.lusakatimes. com/2009/06/10/sit-
uation-at-the-university-teaching-hospital-uth-worri-
some-mangani/>. Accessed: 9/11/2023
35. Marković, (2022). Ministre, u novom kliničkom centru
nema ko da radi, svi su u Nemačkoj. <https://nova.rs/vesti/
drustvo/ministre-unovom-klinickom-centru-nema-ko-da-ra-
di-svi-su-u-nemackoj/>. Accessed: 25/09/2023
36. Ministry of Health (2019). Public consulting. <https://
zdravlje.gov.hr/>. Accessed: 02/11/2023
37. Newsweek, World’s Best Hospitals 2023. <https://www.
newsweek.com/rankings/worlds-best-hospitals-2023>. Ac-
cessed: 4/11/2023
38. Novak B: Krizno komuniciranje. Binoza Press, Zagreb, 2001
38. Nurmi R & Darling J: International Corporate leader-
ship: The Primary Competitive Advantage. International
Business Press, New York, 1997
39. Plenković M: Krizno komuniciranje. Media, culture and
public relations 2015; 6: 113-118.
40. P. N., (2022). Trgovanje organima u KBC-u Zagreb?
Bubrege dali Srbin i Kosovar, privremeno zabranjeno pre-
sađivanje. <https://www.novilist.hr/novosti/trgovanje-org-
anima-u-kbc-u-zagreb-bubrege-dali-srbin-i-kosovar-privre-
meno-je-zabranjeno-presadivanje/>. Accessed: 13/10/2023
41. Luecke R: Upravljanje kriznim situacijama. Harvard Busi-
ness Essentials Zgombić & Partneri, Zagreb, 2005.
42. Regester M & Larkin J: Risk Issues and Crisis Management.
St Ives plc: Great Britain, Clays Ltd, 2001
43. Ropac D: Javno zdravstvo. Inter-Ing, Zagreb, 2011
44. Soldo, (2020). Tragikomedija u doba korone.
<https://www.dw.com/hr/mostar-tragikomedija-u-do-
ba-korone/a-52855867). Accessed: 23/10/2023
45. Scimago, institutions rankings, (2023). <https://www.scima-
goir.com/rankings.php?country=Africa§or=Health>.
Accessed: 27. 9. 2023.
46. Sellnow T & Seeger M: Theorizing Crisis Communication.
Wiley – Blackwell, Oxford, 2013.
47. Shrivastava P, Hu A & Dutton J: Advances in Strategic
Management. JAI Press, Stamford, CT, 1993
48. Srbija danas. HOROR U CRNOJ GORI! Hirurg krao organe
pacijenta, delove tela iznosio u teglama iz Kliničkog centra.
<https://www.sd.rs/vesti/region/horor-ucrnoj-gori-hirurg-
krao-organe-pacijenta-delove-tela-iznosio-u-teglama-iz-
klinickog-centra-2023-09-17>. Accessed: 24. 9. 2023.
49. Sunara Ž & Jeličić S: Organizacijsko komuniciranje u tur-
izmu. Zbornik radova Međimurskog veleučilišta u Čakovcu
2013; 4:89-93
50. S. M. (2019). Stotinama liječnika najveće švedske bolnice
prijete otkazi: “Ovo je presedan”. < https://www.index.hr/
vijesti/clanak/ stotinama-lijecnika-najvece-svedske-bol-
nice-prijete-otkazi-ovo-je-presedan/2130259.aspx>. Ac-
cessed: 28/10/2023.
51. Taylor, (2023). Physician sues Mayo Clinic over free speech
rights. <https://www.beckershospitalreview.com/legal-reg-
ulatory-issues/physician-sues-mayo-clinic-over-freespeech-
rights.html>. Accessed: 21/09/2023
52. Tomić Z: Odnosi s javnošću: Teorija i praksa. Synopsis, Za-
greb – Sarajevo, 2016
53. Tomić Z: Teorije i modeli odnosa s javnošću. Synopsis, Za-
greb- Sarajevo, 2013
54. Tomić Z: Enciklopedijski rječnik odnosa s javnošću. Synop-
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
25
Zoran Tomić, Vladimir Vegar & Miro Radalj: CRISIS COMMUNICATION IN HEALTHCARE
Medicina Academica Integrativa, 2024; Vol. 1, No. 1, pp 11-25
Correspondence:
Vladimir Vegar
University of Mostar
Trg hrvatskih velikana 1
88000 Mostar, Bosnia and Herzegovina
E‒mail: vladimir.vegar@sum.ba
sis, Zagreb – Mostar – Sarajevo, 2023
55. Tomić Z &Milas Z: Strategija kao odgovor na krizu. Politič-
ka misao 2007; 44: 137–149
56. Tomić Z & Sapunar J: Krizno komuniciranje. HUM: journal
of the Faculty of Humanities and Social Sciences of the Uni-
versity of Mostar 2006;1: 298-310
57. Welch J: Kako pobijediti. Naklada Zadro, Zagreb, 2005
58. Zheng, (2021). SGH nurse’s passing sparks concerns over
healthcare workers’ mental well-being. <https://mothership.
sg/2021/12/sgh-nursekarunyah/>. Accessed: 03/10/2023
59. Zvonarević M: Socijalna psihologija. Školska knjiga, Za-
greb, 1989
60. Žmuk B & Jošić H: Godina dana bolesti COVID-19 u Repub-
lici Hrvatskoj: Pogled s kvantitativne perspektive. Zbornik
Ekonomskog fakulteta u Zagrebu 2021;19 (1): 223-241.
