When Crisis is Out of the Box: Leading Through the Unexpected
The hardest crises to manage are the ones no one planned for when silence feels safer than speaking, and every decision carries a human weight.
Most organizations have a crisis management plan. Fire drills, natural disasters, pandemics. We know the steps, even if the execution feels overwhelming in the moment. But what happens when the crisis is not in the handbook, when it feels almost apocalyptic , like the headlines we see today.
A suicide.
A racial incident.
A political flashpoint that divides your institution.
These are the moments where most programs freeze. Not one of negligence, but because there is no script. Leaders whisper behind closed doors. Emails are drafted and redrafted. Meanwhile, the very people who need reassurance: students, residents, and faculty are left navigating uncertainty and pain on their own.
Out-of-the-Box Crises
Unlike natural disasters of public health emergencies, these moments demand not just logistics but humanity. They strike at the heart of identity, belonging, and trust. And because there is no playbook, the default often becomes silence or worse, rushed worlds that land without empathy.
The Cost of Unpreparedness
When institutions don’t know how to respond:
Students and trainees feel abandoned- as though their struggles are invisible.
Faculty lose trust in leadership’s ability to stand firm in difficult times.
Communities fracture, and the wounds linger long after the incident fades through the news cycle.
Silence or missteps in these moments carry more weight than we sometimes realize.
Leadership Imperatives in Unscripted Crises
In my years in medical education leadership, I’ve seen what works and what doesn’t. The difference often comes down to three things:
Transparency: Say something. Silence creates its on narrative.
Timeliness: Every hour of hesitation chips away at trust.
Humanity: Policies matter, but people come first. The words chosen should reflect care, not just compliance.
Building a Framework for the Unimaginable
If the pandemic taught us anything, it’s that preparation is never wasted. The same applies here. Leaders should be building:
Crisis communication protocols that go beyond natural disasters.
Mental health and DEI perspectives integrated into response teams.
Training for faculty and staff in real time, human-centered decision-making.
Case Examples
Suicide of a trainee: Acknowledge the loss. Provide immediate mental health resources. Allow space for grief while protecting privacy.
Racial Incident: Address it openly. Commit to accountability and systemic reflection. Invite dialogue, not defensiveness.
Political disruption: Reaffirm the institution’s mission. Protect learning spaces while recognizing diverse voices.
Each of these requires courage tot step into discomfort. But silence is never neutral. It always sends a message.
From Reaction to Preparedness
The question is not whether crises will happen, but whether we will be ready to lead through them. Institutions that thrive in the face of the unimaginable are the ones that normalize hard conversations in advance, empower leaders at every level, and remind their communities that people come before policy.
Closing Reflection
What if the next crisis isn’t in the handbook? Will your institution be ready to lead, or only to react?
It’s time for leaders in medical education, and beyond, to ask that question honestly and prepare for the unexpected with courage, clarity, and compassion.