The crisis communications plan nobody has actually rehearsed
Most hospital groups have a crisis communications plan and have never rehearsed it. The document describes who should speak; it does not produce a spokesperson who can speak, under pressure, in the first hour. This piece looks at what a real first sixty minutes demands and how to close that gap.
I have read a lot of crisis communications plans. Almost all of them are competent documents — a RACI table, an escalation ladder, a list of approved spokespeople, a template holding statement with brackets where the specifics go. Almost none of them have ever been run. The plan exists as proof that planning happened, filed on a shared drive next to the disaster recovery policy and the data retention schedule, reviewed once a year by whoever owns compliance, and never once acted out by the people whose names are on it. This is the gap I want to spend this piece on, because it is the single most predictable failure mode I see in hospital communications, and it is almost entirely fixable.
The document is not the plan
A crisis communications plan is not, in any meaningful sense, a document. The document is a record of decisions that were made in advance so they do not have to be made under pressure — who convenes the room, who speaks externally, what gets said before the facts are confirmed, how internal communication and external communication are sequenced so staff do not learn about their own organisation from a news alert. Those decisions are only real if the people who have to execute them can execute them without consulting the document in the moment, because in the moment there usually is not time to consult it.
This is the distinction between a plan and a reflex. A plan is written knowledge. A reflex is what is left when the writing has been converted, through repetition, into something a person can do under stress without stopping to think about the steps. Crisis response has to be a reflex, because the conditions it operates under — incomplete information, external pressure, internal panic, a clock that is already running before anyone in leadership has been told — are precisely the conditions in which written knowledge is hardest to retrieve and apply.
What the first sixty minutes actually demands
I want to be specific about this, because the abstraction is where most plans fail — they describe roles and escalation paths without describing what actually happens, minute by minute, when something goes wrong. Note that what follows applies to any category of incident a hospital group might face — an adverse event under review, a data security lapse, a public complaint that goes viral, a regulatory notice — and deliberately does not describe any specific clinical scenario. The process is the same regardless of what triggered it, which is exactly why it is worth rehearsing as a process rather than as a response to one imagined trigger.
The first call
Somebody outside the communications function is almost always the first to know something has happened — a department head, a front-desk supervisor, someone in the contact centre fielding an unusual number of calls. The plan’s first job is making sure that person knows exactly who to call, has that number memorised or one tap away, and calls within minutes rather than routing the information up through a normal management chain that was not built for speed. In an unrehearsed organisation, this step alone can consume the first thirty to forty minutes, because the person who noticed the problem does not know they are supposed to escalate immediately, or escalates to their direct manager instead of to the crisis contact, and the information takes a slow, hierarchical path to the people who need it fast.
The holding statement
A holding statement is not a defence and not an explanation. It is an acknowledgement that something is being looked into, delivered fast enough that the organisation is not silent while the story forms without it. The mistake I see most often is treating the holding statement as something that has to wait for facts to be confirmed, which guarantees it arrives too late to matter — by the time facts are confirmed, the narrative has usually already been set by whoever spoke first, and that is rarely the hospital. A holding statement can and should go out saying only that the organisation is aware, is looking into it, and will share more when it can. Getting comfortable with saying that little, that fast, is a skill, and it is one that has to be practised, because the instinct under pressure is almost always to say either too much or nothing at all.
The spokesperson question
Almost every plan names a spokesperson. Almost no plan has confirmed that the named spokesperson is actually available, briefed and capable of standing in front of a camera or a phone call within the window that matters, on the specific day a crisis happens to occur. Spokespeople travel, take leave, change roles, and the plan is rarely updated in step. A rehearsal surfaces this immediately, because a drill forces the organisation to actually reach the named spokesperson and have them actually perform the role, rather than simply confirming their name is still correct on a document. I have seen a drill reveal that the named spokesperson had left the organisation eight months earlier and nobody had updated the plan — a fact that would otherwise have been discovered for the first time during an actual crisis.
Sequencing internal and external communication
Staff should never learn what is happening in their own organisation from an external news alert or a message forwarded from a patient’s family member. This sounds obvious and is violated constantly, because internal communication is treated as a lower priority than external communication under time pressure, when it needs to be sequenced just ahead of it — a brief internal note, even a short one, before or at the same moment as anything goes external. The reason this matters beyond morale is practical: staff who hear about an incident externally before internally will often speak to media, patients or on their own social accounts without guidance, multiplying the number of uncontrolled narratives the organisation is now managing.
Why plans go unrehearsed
Nobody sets out to leave a crisis plan unrehearsed. It happens because rehearsal has no natural sponsor. Writing the plan has an obvious owner and an obvious deliverable — a document, reviewed and signed off, that satisfies a governance requirement. Rehearsing the plan produces no artefact anyone is required to file, competes for calendar time with people whose actual jobs are running departments and treating patients, and surfaces uncomfortable gaps — an unavailable spokesperson, an escalation contact who has left, a holding statement template nobody can find in under ten minutes — that are easier to leave undiscovered than to fix. The plan sits in its finished, unrehearsed state because finishing it felt, to everyone involved, like the job was done.
There is also a discomfort specific to hospitals. Rehearsing a crisis scenario means rehearsing bad news, and healthcare organisations, reasonably, are cautious about anything that could be read internally as suggesting bad outcomes are expected or normalised. The way through this is to be explicit, every time, that the drill is about the communications process and never about the clinical or operational specifics of any imagined event — the scenario used in a drill should be abstract enough (a generic adverse event under review, a generic data incident, a generic viral complaint) that nobody in the room experiences it as a rehearsal for a particular bad outcome. The process being drilled is identical regardless of the trigger, so there is no need for the scenario to be specific or realistic in clinical terms at all.
What a drill actually looks like
A tabletop exercise does not require a consultant, a simulated newsroom or a full day. The minimum version that produces real learning is two hours, a facilitator, a deliberately vague scenario prompt, and the actual people named in the plan — not their deputies, not a stand-in, the actual spokesperson, the actual first-call contact, the actual person who approves external statements. The facilitator introduces the scenario, gives the room limited and incomplete information exactly as a real incident would arrive, and then asks the room to actually do each step: who is being called, what the holding statement says, who is briefing staff and when, what gets sent externally and by whom. The value is entirely in forcing people to produce the actual artefacts — an actual draft statement, an actual sequence of calls — rather than describing what they would do.
The debrief afterward matters as much as the exercise itself. Every gap the drill surfaces — a contact who did not answer, a statement that took forty minutes to draft when it needed to take ten, a disagreement about who has final sign-off — should become a specific, owned action item with a deadline, not a general note that the plan “needs updating.” Plans that get vaguely noted as needing updates do not get updated. Plans with three specific, assigned fixes due in two weeks usually do.
Who has to be in the room for the drill
The drill fails if it is run only by the communications team, because the communications team already knows the plan. The value comes from including the people who are not natural communicators and who would, in a real event, be operating far outside their comfort zone — a clinical lead, a facility administrator, someone from the contact centre, ideally someone reasonably senior who has never had to do this before. Their confusion during the drill is the most useful data point it produces, because their confusion is exactly what would happen for real, and it is far cheaper to discover during a two-hour exercise than during an actual incident with media already calling.
After the drill: what actually changes
A drill that changes nothing was not worth running. The output of a good drill is a short list of concrete fixes — an updated contact who actually answers, a holding statement template pre-approved by legal so it does not need fresh sign-off mid-crisis, a clearer rule about who is authorised to post on the organisation’s own social accounts in the first hour — plus a firm date for the next drill. I recommend drilling at least twice a year, with the scenario varied each time, because a plan rehearsed once and never again drifts back toward being a document within a year as roles change and people move on.
If you are building or rebuilding this plan
- Confirm the named spokesperson is actually available, briefed and has done this before — not just named on the document
- Pre-approve a holding statement template with legal so it does not need fresh sign-off during an actual incident
- Give the person most likely to notice a problem first a single, memorised escalation contact, not a management chain
- Sequence a short internal note just ahead of or alongside anything that goes external
- Run a two-hour tabletop drill with a deliberately abstract scenario, using the actual named people, not deputies
- Turn every gap the drill surfaces into a specific, owned fix with a deadline, and schedule the next drill before the room disperses
A plan nobody has rehearsed is a hope, formatted to look like a plan. The rehearsal is the plan. Everything before it is preparation for writing one.
Questions people ask
Why isn’t a written crisis communications plan enough on its own?
A written plan records decisions made in advance — who speaks, who escalates to whom, what gets said before facts are confirmed — but those decisions only work if the people responsible can execute them without stopping to consult the document, because a real incident rarely allows time for that. Written knowledge and the ability to act under pressure are different things; the gap between them closes only through repetition, which is what a drill provides and a document, however well written, cannot. Most crisis plans I have reviewed are genuinely competent as documents and have simply never been converted into something the responsible people can actually do quickly under stress.
What does the first hour of a hospital crisis actually require?
Four things in fast sequence: the person who first notices the issue reaching a single, memorised crisis contact within minutes rather than routing it up a normal management chain; a holding statement — a brief acknowledgement that something is being looked into — going out fast rather than waiting for full facts; the named spokesperson being genuinely available and briefed, not just named on a document; and internal communication to staff being sequenced just ahead of or alongside anything sent externally, so staff never learn about their own organisation from a news alert. In an unrehearsed organisation, even the first of these can take thirty to forty minutes it should take five.
What is a holding statement and why does it matter so much?
A holding statement is a brief, fast acknowledgement that an organisation is aware of a situation and looking into it — it is not an explanation, a defence, or an admission, and it does not require confirmed facts. Its value is speed: if the organisation stays silent while waiting for full facts, the narrative usually gets set by whoever speaks first, which is rarely the hospital. Getting comfortable saying only “we are aware and looking into it” quickly, without adding unconfirmed detail or over-explaining, is a specific skill people under pressure tend to get wrong in one of two directions — saying too much, or saying nothing — and it needs to be practised, not just written down.
Why do crisis communications plans usually go unrehearsed?
Writing the plan has a clear owner and a clear deliverable — a document that satisfies a governance or accreditation requirement. Rehearsing it produces no artefact anyone is required to file, competes for the calendar time of people whose actual jobs are running departments and treating patients, and tends to surface uncomfortable gaps, like an unreachable spokesperson or a missing template, that are easier to leave undiscovered than to fix. There is also a specific discomfort in healthcare around rehearsing bad-news scenarios at all. The fix is treating the drill explicitly as a rehearsal of a communications process, using a deliberately generic scenario, never a rehearsal of any specific clinical outcome.
How do you run a crisis communications drill without it taking over a full day?
The minimum useful version is about two hours: a facilitator, a deliberately vague and generic scenario prompt, and the actual named people from the plan — not deputies or stand-ins. The facilitator releases limited information the way a real incident would arrive, and the room has to actually produce the artefacts a real crisis would require — an actual draft holding statement, an actual sequence of calls, an actual decision about who briefs staff and when — rather than describing in the abstract what they would do. The value comes almost entirely from forcing real execution under time pressure, not from the realism of the scenario itself.
Who should be included in a crisis communications drill?
Not just the communications team, who already know the plan and will run it smoothly regardless. The value comes from including people who would be genuinely outside their comfort zone in a real incident — a clinical lead, a facility administrator, someone from the contact centre, ideally someone senior who has never done this before. Their confusion during the drill is the most useful output it produces, because it mirrors exactly what would happen in a real event, and surfacing it during a two-hour exercise is far cheaper than discovering it for the first time while media are already calling and the clock is already running.
How often should a hospital group rehearse its crisis communications plan?
At least twice a year, with the scenario category varied each time — an adverse event under review in one drill, a data security lapse or a viral public complaint in the next — so the process is tested against different starting conditions rather than the same imagined trigger. A plan rehearsed once and never again tends to drift back toward being a document within a year, as named spokespeople change roles, contact details go stale and staff who were in the original drill move on. Regular, moderate-effort drills beat a single elaborate one, because the goal is keeping the reflex current, not producing one impressive exercise.
What is the biggest gap a crisis drill usually reveals?
Most commonly, that the named spokesperson is not actually reachable, briefed or practised at the role — they may have changed positions, left the organisation, or simply never been asked to perform the role out loud since being named on the document. A close second is an escalation contact that goes unanswered, because the plan lists a role rather than a person with a working number someone has actually dialled recently. Both gaps are invisible on paper and only surface when a drill forces the organisation to actually attempt the sequence, which is the core argument for rehearsing rather than only reviewing and re-signing the document annually.
How does internal communication fit into the first hour of a crisis?
It has to be sequenced just ahead of, or at the same moment as, anything sent externally — never after. If staff learn what is happening in their own organisation from a news alert, a social media post, or a message forwarded by a patient’s family member, they will often speak to media, patients or on their own accounts without any guidance, which multiplies the number of uncontrolled narratives the organisation then has to manage. Even a short internal note — acknowledging the situation is being handled and asking staff to direct enquiries to the communications team — dramatically reduces this risk, and it takes only a few minutes to draft if a template already exists.
What should happen immediately after a crisis communications drill ends?
Every gap the drill surfaces should become a specific, owned fix with a deadline before the room disperses — an unreachable contact gets corrected, a slow-to-draft statement gets a pre-approved template, an unclear sign-off gets a named decision-maker. A debrief that produces only a general note that “the plan needs updating” tends not to result in any actual update. A debrief that produces three named fixes due in two weeks usually does. The date of the next drill should also be set at this point, rather than left to be scheduled later, because plans without a scheduled next rehearsal are the ones that quietly go a year or more without one.
Can a crisis drill be run without describing a specific clinical scenario?
Yes, and it should be. The communications process being rehearsed — escalate fast, issue a holding statement, confirm the spokesperson, sequence internal ahead of external — is the same regardless of what triggered it, so the drill scenario only needs to be abstract: a generic adverse event under review, a generic data incident, a generic complaint going viral. There is no need for clinical specificity for the exercise to be useful, and keeping the scenario generic avoids the legitimate discomfort of rehearsing anything that could be read as normalising a particular bad outcome. The process, not the trigger, is what is being drilled.
What is the difference between a crisis plan and a crisis reflex?
A plan is written knowledge — decisions made in advance and recorded in a document. A reflex is what that knowledge becomes after enough repetition that a person can act on it under stress without pausing to retrieve and interpret the written version. Crisis response has to operate as a reflex because the conditions it happens under — incomplete information, external pressure, a clock already running before leadership has even been told — are exactly the conditions in which reading and applying a document is hardest. Rehearsal is the only mechanism that converts a written plan into a reflex; review and re-signing the same document annually does not.
