In this thought paper, Blair Sadler and Kevin Stewart draw on experiences from their roles as chief executive of a children’s hospital in San Diego, California and as chief medical officer of a general hospital trust in the south of England.

They review the management of serious clinical crises in the United States, lessons learned from other industries, the experience of the Mid-Staffordshire crisis in the NHS and the subsequent reports by Robert Francis and Don Berwick. They look at legal and media barriers to effective action, review lessons learned from the ‘second victim’ literature and provide recommendations for action for both organisations and leaders.

The power of transparency emerges as a core theme from all this work. Leaders who promote and model transparent behaviours and instil a transparent culture in their organisations can use crises as learning and improvement opportunities. Those that don’t may be destined to recurrent failure.