As a health care executive, you know the importance of communication during high-stress events. But if you have executive presence, or EP, you will maximize the impact of your communication. Leaders with EP take charge with credibility, develop trust with their audience and act as a guide as an event develops.


National data indicate that executives in the public and private sectors, including health care, increasingly face negative exposure. For example, 42 percent of executives have been subject to government inquiry or investigation while 24 percent have experienced data loss, security breaches and natural disasters. Concurrently, media coverage of reputation has more than doubled in the past five years. In addition, 60 percent of blame is attributed to the executive in charge. (See Pillsbury Winthrop Shaw Pittman's Crisis Management Team and Levick Strategic
Communications. 2011 Crisis Preparedness Survey Results. New York: Pillsbury Winthrop Shaw Pittman LLP.)

During crisis situations, executives must balance promises (what they say they will do), performance (what they actually do), perceptions (what the public believes they are doing) and expectations (what the public believes they should be doing). Effective EP can close the gap between reality and perception. As an executive, how well you express the following 10 indicators can profoundly affect the public's acceptance of your message in a crisis:

  • authenticity
  • ability
  • mindset
  • information
  • reputation
  • compassion
  • consequences
  • opportunity
  • visuals
  • connection

Authenticity involves being real and honest, as well as conveying strength and compassion. The golden rule in any crisis is to put people first. Authenticity is the hallmark of EP; the audience will not believe the message without it. Conveying authenticity requires practicing self-acceptance: I'm not perfect, but I'm handling this situation as best I can. I accept my leadership role in this terrible crisis. You should express empathy without letting negative emotions overwhelm you.

To maximize EP, a spokesperson must be coachable. Rehearsing your answers to the toughest possible questions aloud will enhance your ability to face the media. Related to ability — and a critical element of demonstrating EP — is vocal tone. In his verbal and nonverbal communication research, Dr. Albert Mehrabian showed that vocal tone is responsible for 38 percent of the impression a speaker makes. Tone is not the verbal content, but rather the way a person speaks.


A negative mindset can create fear, ultimately undermining EP. Conversely, a positive mindset can instill confidence and motivate action. While you verbally answer questions, you also communicate nonverbally. Not only did Apple's Steve Jobs perfect the words and images for Apple product launch presentations, he was also a master of body language. Jobs assured his audiences that Apple's products mirrored their desires and values. To achieve a positive mindset, hear yourself confidently communicating your message. Visualize yourself already on the other side of the crisis.


Communicate concise, accurate and actionable messages. Before facing your audience, understand your message. What you say — and how you say it — can become either your golden hour or your darkest one. Your first message must be framed in clear terms. Add facts as they become available.

When critical information is lacking, provide the processes you are using to obtain it. Acting decisively helped Johnson & Johnson successfully navigate a 1982 nationwide Tylenol recall. Although the company was not responsible for the deadly product tampering, it assumed responsibility. Johnson & Johnson was able to position itself as an industry leader with new tamper-resistant packaging. (See Lazare, Lewis. "Crisis triggered brilliant PR response." Chicago Sun Times, Sept. 29, 2002.) More recently, however, a series of missteps have damaged the company's once stellar reputation.


In a crisis, the organization's reputation — and your own — are on the line. A simple yet powerful messaging template can help safeguard reputations. First, stop the wrong. In the first three minutes to three hours, take clear, decisive action that is specific and measurable. Next, right the wrong. Explain what the audience can expect from you. Finally, remove the potential for wrong. Tell the audience how you will ensure that it will not happen again. Stay focused and head off personal attacks. This is not the right forum to respond to personal attacks. We are focused on the situation. EP involves building credibility — with those asking questions, and with the audience for which the message is intended.


People may not remember your exact words, but they will remember how you made them feel. Consider the 2010 Chilean mine disaster. Though the mining company had been cited for numerous violations before the cave-in, during rescue operations the company brought families to the site, established communications and disseminated critical information about rescue plans. The compassion with which company officials handled the situation helped ameliorate the negligence that originally led to the cave-in.


From a "present-future" perspective, frame the situation with three potential outcomes: best possible, most probable and worst possible. During the mining disaster, in the best possible scenario, the miners would have been rescued within 24 hours. In a most probable scenario, it would have taken about a week. In the worst-case scenario, all rescue attempts would have failed. A three-part outcome gives the audience wider latitude in thinking about possible outcomes. It prevents the organization from getting boxed in. The outcome is shared risk, responsibility and result.

While urgent events may present risk, they also present opportunity. Uncovering opportunities allows you to go beyond the danger of the immediate situation to potential benefit and reward. It is important to redirect attention from what went wrong to what can prevent it from happening again. Analyzing contingencies ahead of time enables a quick reaction when the worst happens.


A considerable body of research shows that most people believe what they see in preference to what they hear (for further reading, see below). If the spokesperson says that everything is under control yet appears nervous and upset, the audience does not believe the verbal message and responds to the lack of control they visually perceive. Leaders can be proactive and control the visuals. Relevant graphics, interviews, podcasts and the like help you shape the story.

There is a very real difference between simply communicating and truly connecting with the audience. To create the desired connection, be open, speak with integrity and share as much information as possible. In effect, be the host of the crisis. Delivering a clear message helps calm an anxious public and focuses attention on what the organization is doing to help. In particularly challenging environments, always put people first. Engage with the families. Share information about casualties immediately to avoid damaging your credibility and that of your organization.

A Critical Delivery

Communicating effectively with your audience is vital for health care executives during an urgent or emergent event. People may not remember your exact words, but they will remember how you made them feel. Your connection, compassion and authenticity will maximize your message's impact. We believe effective leadership is the gateway to overcoming a crisis, and EP is the key to unlocking it.

Timothy Tinker, Dr.P.H., is a senior associate and program lead for Booz Allen Hamilton's Risk & Crisis Communications Capability. Bettina Gregory, Ph.D., teaches oral communication at the University of Maryland's Robert H. Smith School of Business and is a former ABC News correspondent.

Further reading:

Bitterman, M.E., V.M. LoLordo, J.B. Overmier and M.E. Rashotte. Animal
Learning: Survey and Analysis (1979). New York: Plenum Press.

Colavita, F.B. "Human sensory dominance." Perception & Psychophysics (1974) 16:409–12.

LoLordo, V.M., and D.D. Foree. "Transfer of Control of the Pigeon's Key Peck
from Food Reinforcement to Avoidance of Shock." Journal of the Experimental
Analysis of Behavior (1974) 22(2):251–59.

Meltzer, D., and M.A. Masaki. "Measures of stimulus control and stimulus
dominance." Bulletin of the Psychonomic Society (1973) 1:28–30.

Shapiro, E.S., J.J. McGonigle, and T.H. Ollendick. "An analysis of self-
assessment and self-reinforcement in a self-managed token economy with
mentally retarded children." Applied Research in Mental Retardation (1980) (1):227–