You are working as a Chief Executive Officer of a large teaching hospital and 2 months ago, surveys on patient satisfaction, employee opinion, and culture of safety were sent out to patients and employees of the institution. Survey scores were very low in all areas. In fact, these scores were considered a “crisis”, and unprecedented in the history of the institution that you are leading.

What would be the internal and external causative factors for the decline in survey scores?
Explain the role of crisis in the change process and identify the elements of crisis management.