Crisis Communications in Health Care:Developing Plans That Work

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Crisis is part and parcel of health care. From medical device manufacturers to public health departments, health care organizations deal with people going through personal crises everyday: one patient receives a breast cancer diagnosis, another gets a new hip implant, a family sits by the bedside of a terminally ill loved one.

Less frequently but just as predictably, health care organizations face their own crises. In addition to the universal risks all businesses face, health care organizations encounter challenges unique to their industry, like malpractice suits, drug and device recalls, and Health Insurance Portability and Accountability Act (HIPAA) violations. Whether a crisis ultimately creates goodwill or leads to bankruptcy depends on how an organization handles and communicates the situation.

Some health care organizations—hospitals for example—are required by regulation to develop crisis plans that guide them in their responses to natural and manmade disasters.1 Once or twice a year, they test them during simulated plane crashes or bioterrorism attacks. But crisis communication planning and practice must not stop there, because

communication crises occur more often and with more variety than do public disasters.

This paper provides tips and insights on developing usable communication plans that take into account the health care industry’s specific challenges—and that won’t end up in the circular file when crises hit.

Assess Risk

Research is the first step in any planning process. When developing a crisis communication plan, research means assessing risks that could affect perceptions among key audiences.

Organizations cannot predict every scenario that might become a crisis, and they shouldn’t necessarily try. But knowing as much as possible about potential problems can help in addressing and preparing for them. It can even prevent crises from happening in the first place. Involving people throughout the organization in the risk assessment process often identifies and solves operational problems before they balloon into public crises of confidence. As the University of California–Los Angeles (UCLA) Medical Center’s patient records

snafu illustrates, inadequately assessing, mitigating, and communicating about risk can cause big headaches later (see UCLA sidebar).

In some cases, executives and communications personnel within an organization may be too close to the trees to see the forest. Therefore, the risk assessment phase is a good time to call in outside attorneys, accountants, and communications consultants who can look at risks and opportunities objectively. Forming relationships with these key consultants in advance will enable them to activate quickly and effectively should a crisis strike.2

Define and Assign

Risk assessment is important, but a crisis plan that tries to address response to specific situations in minute detail won’t be useful during an actual crisis. Chances are the reality of the situation will be completely different than the one simulated in the last disaster drill.

American Airlines serves as one dramatic example. The airline finished revamping its crisis communication plan in the summer of 2001. It took into consideration contingencies such as

Preparation and transparency enable health care organizations to survive—even thrive—during and after organizational crises. Using relevant case studies and examples, this report outlines the characteristics of useful communication plans that will not be discarded when crises hit:

• Risk assessment • Defining and assigning critical functions • Protecting patient privacy

• Relationship building • Practice drills • Developing and delivering transparent messages

Executive Summary

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plane crashes and old-school hijackings. September 11 quickly forced American to abandon its new plan, partly because the Federal Bureau of Investigation (FBI) assumed control of all communication about the American jets used in the terrorist attacks.3

Sunnybrook and Women’s College Health Sciences Centre in Toronto learned a similar lesson in March 2003, shortly after admitting its first patients suffering from what came to be called SARS. The hospital’s crisis communication plan anticipated medical-liability issues that could be addressed by apologizing for errors and correcting them. It did not consider a full-blown public health panic involving infected employees and quarantined departments. Sunnybrook’s PR team responded promptly and effectively by positioning its infectious disease expert as an official spokesman and instituting enhanced employee communications tactics, but those initiatives went far beyond the bounds of its pre-SARS crisis communications plan.4

But by the same token, a plan that assumes the next health care crisis will involve bird flu and outlines exact action steps for that particular situation has a small chance of being useful. Crisis management experts argue that attempting to follow rigid, proscriptive plans can be ineffective or even harmful.5 The same holds true for crisis communication plans. Instead, a useful plan

• identifies what functions will need to be performed during a crisis,

• defines procedures to ensure the identified functions will be carried out,

• assigns the functions to specific roles, and

• identifies the people who will assume the roles when a crisis happens.

Working through the define-and-assign process gives organizations the

opportunity to identify who will likely serve as spokespersons during a crisis and to make sure these people receive media training in advance. This is also the time to make contingency plans for developing and maintaining employee and Web communications.

Patient Privacy

Protecting patient information is good business and good communications strategy for health care organizations. Failing to secure patient data from

external hackers or internal snoops can erode public confidence, and failing to notify patients when breaches occur can cause even greater damage.

HIPAA codified some of these principles in legislation intended to protect sensitive health information and give patients more control over its use and dissemination. Health care insurance companies, clinics, drug researchers, pharmacies, and all other official health care organizations that handle protected health information must ask

UCLA Medical Center: Secrecy Doesn’t Pay

Continued on page 3

Farah Fawcett’s son found out his mother’s cancer had returned from a headline in the National Enquirer. The California Department of Public Health learned of patient privacy problems at the University of California–Los Angeles (UCLA) Medical Center from an article in the Los Angeles Times. The first example illustrates the immense challenges health care organizations face in keeping information about famous patients confidential. The second demonstrates the risks businesses take when they don’t fully disclose problems to key audiences.

Fawcett, a star of the 1970s TV hit “Charlie’s Angels,” raised concerns in May 2007 after the Enquirer reported her cancer diagnosis within forty-eight hours of UCLA Medical Center physicians breaking the news to her. Hospital officials checked calls and e-mails a single employee made from workplace systems only and later claimed they had no reason to believe the staff member had shared Fawcett’s information with the media. However, they did not notify state regulators or other affected patients of the complaint or the internal investigation.

In sum, UCLA failed to thoroughly assess its HIPAA risks, took few if any steps to mitigate them, and chose not to notify affected patients or regulators. If it had done so, it could have avoided the problems that came later.

Word of UCLA’s patient privacy shortcomings became a hot public topic eight months later when celebrity Britney Spears was admitted into the psychiatric unit. Within six weeks, the Los Angeles Times wrote that the medical center was firing more than a dozen employees for improperly accessing Spears’ patient records. Fawcett soon publicly weighed in.

Executives initially tried to paint the culprit as a “rogue” employee, and the medical center issued statements stressing the confidentiality agreements staff members sign. But within weeks, a Department of Health investigation instigated in response to media attention revealed that dozens of people affiliated with UCLA Medical Center—from volunteers to physicians—had accessed the records of thirty-two other high-profile patients and nearly as many lesser knowns.

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patients to sign release forms giving them permission to process claims, compile research data, or otherwise use and release information. To meet these stringent requirements, the health care industry spent billions of dollars preparing for HIPAA’s implementation.

Protecting patient privacy is a laudable goal but one that can be difficult to achieve in the information age. Technology continues to evolve faster than privacy regulation. Therefore, communication leaders within health care organizations should be familiar with and prepared to communicate appropriately about data security contingencies. They should know the answers the following questions:

• How will we respond to an unintended release of personal health information?

• How will we protect patients’ health information in a crisis?

• How will we communicate with the press and patients about HIPAA issues?

The last question illustrates one unintentional consequence of HIPAA legislation: the law can make health care organizations appear obstructionist in the eyes of the press and public.6,13 Reporters who routinely received detailed information from emergency room nursing managers about car crash victims before HIPAA took effect now get only one-word condition reports, and then only if they can provide the first and last names of the patients. In 2008, shelters and hospitals couldn’t confirm the locations of Hurricane Ike survivors in the Houston metropolitan area because of privacy laws, according to the Laura Recovery Center. Normally dedicated to missing children, this organization set up a hotline and Web page to help find missing people after the storm.13

Direct health care providers, such as hospitals and physician offices, can also find themselves at a communications

(UCLA continued)

Among them was California first lady Maria Shriver.

Several other health care institutions across the country have faced similar issues in recent years. Federal legislation has placed greater emphasis on patient privacy, but electronic medical records make information easier and more tempting to access. In such an environment, problems are bound to arise. Health care organizations that acknowledge this challenge and demonstrate sincere and continuing efforts to secure information may not be permanently associated with privacy breaches. But by attempting to minimize this serious issue, UCLA Medical Center may have unintentionally made itself a poster child.

More than 34,000 complaints have been filed under HIPAA, but only a handful of violators have faced criminal prosecution. One of them is former UCLA Medical School administrative clerk Lawanda Jackson, who was indicted by a federal grand jury in April 2008 on charges of selling Fawcett’s medical information to the National Enquirer.

Unfortunate Quotes

The following were printed were in the Los Angeles Times between March and April of 2008:

• UCLA treats celebrities “all the time and you never hear about this.”

— Jeri Simpson, director of human resources at Santa Monica–UCLA Medical Center, where Britney Spears’ first child was born in 2005. Several employees were fired for accessing Spears’ records.

• “Not to my knowledge.”— Response of UCLA chief compliance

officer Carole A. Klove when asked if any other celebrities’ records had been compromised. State regulators would later find that information on thirty-two high-profile patients had been inappropriately accessed.

• “As this becomes more public, that may change our minds.” — UCLA Hospital System chief

executive Dr. David Feinberg, discussing the medical center’s decision not to notify patients affected by privacy breaches.

• “We will do everything possible in the future not to be accused of that.” — Feinberg’s response to questions

about staff members being internally punished more harshly than physicians for HIPAA violations.

• “It is my personal belief that Lawanda Jackson is most guilty of being a pawn. She worked in a hospital system that did not provide strong enough deterrents to stop their employees from breaching their patients’ medical records—which made it all the easier for the tabloids to financially induce…her to invade my privacy as well as the privacy of many others.” — Farah Fawcett, in a letter to U.S.

Attorney Thomas P. O’Brien.

Sources: Selected issues of the Los Angeles Times and written statements issued by UCLA Medical Center.

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disadvantage when patients involved in high-profile incidents decline to allow the release of information. Police departments aren’t legally constrained from telling reporters the names of crime, accident, or disaster victims and where they are taken for treatment. But because of HIPAA, hospitals may be legally unable to confirm what the press already knows. The best way to avoid HIPAA-related image problems with the media is to educate reporters about the law’s constraints as a part of crisis preparation activities.

Despite such challenges, a health care organization’s first priority is to care for and protect patients. That includes protecting their privacy.7 Institutions that fail to do so will face much greater long-term public perception problems than the ones that refuse to disclose information as directed by specific patients and as required by law (see UCLA sidebar).

Make Friends

No crisis occurs in a vacuum, especially in the health care industry. Any problem that affects a health care organization also affects patients and physicians—and possibly clients and vendors. It also very likely involves a regulatory agency or public health authority. Social service groups, medical schools, law enforcement agencies, and business partners will probably be affected as well. If relationships with key partners have not been cultivated before a crisis hits, recovery efforts can quickly disintegrate.

Boston Scientific’s experience with a series of high-profile recalls in 2004 illustrates the value of establishing positive relationships with business partners and customers. The recalls involved drug-eluting stents, or tiny metal scaffolds that prop open clogged arteries and are coated with medications that prevent scar tissue from reblocking the vessels. A manufacturing problem prevented balloons used to deploy the stents from deflating in a small number of cases.8

Before Boston Scientific launched its Taxus stent in March 2004, Johnson & Johnson’s Cypher was the only stent available in the United States. American cardiologists had a hard time getting the Cypher, and hospital administrators complained of the cost. Many rejoiced when the amply-supplied and less-expensive Taxus hit the market, and Boston Scientific reinforced physician relationships by regularly delivering presentations and research papers at cardiology conferences.9, 10 Even after the recalls, cardiologists defended the Taxus in postings on www.angioplasty.com, and Boston Scientific retained more than a 50 percent share of an increasingly competitive market at least through 2007.11,12

But when positive relationships such as these aren’t established in advance, crises can quickly devolve into blame games, jurisdictional squabbles, power struggles, and misunderstandings. Creating a foundation of familiarity and trust in advance removes such barriers.

Two Rutgers professors observed both ends of this spectrum when they studied how four jurisdictions in New Jersey handled anthrax attacks and scares in 2001.13 Overall, the researchers found that differences among law enforcement and public health organizations’ missions, procedures, and cultures hindered effective communication. This trend was noted more acutely among federal agencies and where no previous relationships existed.

Postal facilities in Florida and New Jersey processed anthrax-contaminated letters on October 12. Employees in Florida began receiving treatment immediately, and some tested positive for the disease the next day. Meanwhile in Hamilton, New Jersey, a sincere but misguided state epidemiologist, after conferring with the U.S. Centers for Disease Control and Prevention (CDC), told postal workers they faced an “infinitesimal” risk for contracting the disease. The facility stayed open another six days, and workers didn’t receive antibacterial drugs until

October 19. In response to confusion and ineffectiveness among federal and state agencies, the town’s mayor stepped in and took charge of setting up a clinic to distribute antibiotics to postal workers. Postal union leaders, who felt misled, assumed responsibility for informing workers about the need for treatment.

On the other hand, the Rutgers study found communication and coordination to be much more effective, albeit informal, in another New Jersey county. The county’s sole health officer knew he would need help in a crisis, so he formed a bioterrorism task force in 1999. When a local bank closed because of a white-powder scare, physicians, emergency personnel, police, and public health officials knew each other and knew what do to. One law enforcement officer noted, “[People] were getting one message. They weren’t calling the police department and getting one message, the fire department and getting another, and then the health department and getting another message.”

The Rutgers authors summarized, “Informal social networks, it seemed, provided a mechanism of trust building among professionals and goal alignment among organizations.”

Depending on the type of health care organization, developing networks may be much more formal and even compulsory than the Rutgers team described in its paper. Communications team members, among others, may be required to participate in incident command system (ICS) drills and training. These systems provide an organizational structure for response to natural or manmade disasters through which health care communications personnel may be called upon to act as or assist official information officers. Participating in local ICS activities can provide valuable insights in addition to networking opportunities.14

What is true for communication and operational partners also pertains to the media: making friends before a crisis hits

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can help an organization bounce back afterward. Building positive relationships with reporters and editors mitigates the risk of negative coverage.

Such relationships are built on trust, and maintaining trust with the press, public, and business partners during a crisis can call for thinking that might seem counterintuitive at other times. As Modern Healthcare pointed out following the CDC’s report on state-by-state disaster preparedness, health care organizations’ business missions must sometimes take a back seat to collaboration during crises that affect public health.15 The same is true for communications strategies. Natural impulses to withdraw or defend can be mitigated when relationships based on mutual trust exist.

For example, a drug manufacturer facing a recall must not only put patient safety ahead of financial concerns, it may also need to work with physicians, pharmacists, competitors, government agencies, and industry associations to make sure patients stop taking the recalled medication and have access to alternative treatments. In the cautionary Vioxx tale, Merck instead took competitors and other industry institutions down with it by choosing to maintain an aggressive and defensive legal posture (see sidebar).

Cultivating relationships internally will also pay off in a crisis. The crisis plan development process can be a great opportunity for an organization’s communications leaders, top executives, communications consultants, and attorneys to get to know each other. By educating corporate leaders about crisis communication and setting realistic expectations, the communications team can earn trust and respect that will be vital to the crisis plan’s success.

Practice and Preparation

Once the overarching goals of a crisis communication plan have been identified, with critical tasks defined and assigned, preparation activities turn to educating

staff and making sure they will have the resources they need to be successful.

Conducting media training with executives who will likely serve as spokespeople is one important step. Experts generally recommend putting one consistent and authoritative face out front, so preparing the CEO is crucial. However, the top executive may need

backup, and he or she might not be the best spokesperson for a local crisis. Those with technical or specialized expertise the CEO lacks may be called upon to answer some questions. And while the CEO may stand in front of cameras, he or she will not answer every media call. Communications staff should be prepared to speak on the record as necessary.

Vioxx: Recall without Remorse?

Merck was once a business and pharmaceutical darling. Known for its scientific rigor, the company topped Fortune’s Most Admired list no fewer than seven times in the 1980s.

Its decision to voluntarily withdraw the popular Vioxx arthritis pain drug in September 2004 was initially seen as a responsible act intended to protect patients. Then-CEO Ray Gilmartin established this position in the recall announcement:

“We are taking this action because we believe it best serves the interests of patients. Although we believe it would have been possible to continue to market Vioxx with labeling that would incorporate this new data, given the availability of alternative therapies, and questions raised by the data, we concluded that a voluntary withdrawal is the responsible course to take.”

But within weeks, reports began to surface that Merck officials knew years earlier that Vioxx increased cardiovascular risks.

Academic researchers who later analyzed Merck’s crisis messaging found that the company’s strategy diverged from generally accepted practices. They classified the Vioxx

issue as a “transgression,” or a crisis in which an organization knowingly takes actions that are inappropriate and harmful. Effective communication following a transgression generally requires a “highly accommodative response” that includes apology and corrective action. Instead, the researchers found that Merck took steps to rectify the issue (by withdrawing the drug) but never accepted responsibility for harm to patients (by apologizing). Since the messaging study only analyzed Merck’s communication for the first few months after Vioxx’s withdrawal, the authors drew no conclusions about the results of this strategy.

The approach arguably paid off in the courtroom. Merck’s attorneys adopted a very aggressive legal stance. In the first few cases tried, appeals court judges ultimately reduced damage awards or overturned blockbuster jury verdicts against Merck. The payout for eventual settlement of patient suits was also much lower than some industry prognosticators had forecast.However, Merck could hardly claim victory in the court of public opinion. The Vioxx taint spilled out of Merck’s reputational reservoir and onto the pharmaceutical industry in general:

Continued on page 6

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Executives aren’t the only team members who need to prepare for a crisis. Support will be needed from employees at all levels; administrative, technological, and customer service staff will be involved in addition to communications team members and outside consultants. All personnel who will be involved need to understand the plan and their roles within it.

A comprehensive crisis plan will also include an equipment and supply checklist. Make sure an emergency communications kit is available and well stocked with phone and e-mail lists, note pads, HIPAA release forms, communications equipment, and everything else that will be needed during a crisis.

Practice is one way to ensure a communication plan is effective and practical. Drills may be announced in advance or sprung as surprises. They may use only internal staff or involve outside communications partners. However an organization decides to approach drills, conducting them regularly and using the results to refine the plan is vital. Practice sessions will also help educate staff and executives about the crisis plan, increasing the likelihood that they will actually follow it when needed.

Case studies abound that illustrate how effective planning and practice can help organizations weather crises. One of the most compelling comes from the National Cattlemen’s Beef Association (NCBA).16 The organization began developing a crisis framework for bovine spongiform encephalopathy (BSE), or mad cow disease, in 1997. Planning began shortly after the British government admitted a link between the cattle ailment and human Cruzfeldt-Jacob disease and during the cattle industry’s widely publicized beef with Oprah Winfrey. When the first case of BSE was reported in the United States in December 2003, the NCBA’s communications team sprung into action, activating the plan to maintain demand and consumer confidence. As a result, American beef

demand rose 7.74 percent in 2004, and consumer confidence in beef safety increased from 88 percent to 93 percent.

Developing and Delivering the Message

If an organization is lucky, the crisis that hits will be one its executives and communications team anticipated. That rarely happens. More often, communicators must gather information and develop messaging quickly.

Executive engagement and participation is vital to this process, but a crisis is not the time to communicate by committee. Taking control of a crisis means communicating early and often, and a statement that plods through a lengthy, multilayer approval process may be irrelevant by the time it is issued. An effective plan should include a streamlined framework for approvals. Depending on the crisis, the truth may be painful for some of the organization’s

• Esteemed medical journals, including the New England Journal of Medicine, questioned their own policies. Editors took drug makers to task for paying ghostwriters to draft studies, then persuading clinical researchers to list themselves as lead authors.

• Direct-to-consumer advertising came under fire, and several drug companies agreed to voluntarily delay campaigns touting new drugs.

• Federal lawmakers pushed for the U.S. Food and Drug Administration to continue studying drug side effects after medications receive approval.

Perhaps most troubling for Merck, a survey conducted by Forrester Research in the first quarter of 2006 found that 70 percent of doctors were more worried about drug safety, and 68 percent preferred to prescribe medications that had been on the market at least ten years. These statistics show a significant erosion of confidence among Merck’s most important audience—doctors who prescribe new drugs to patients.

In the face of these challenges, some might interpret Merck’s first-ever corporate image campaign, launched in 2005, as reactive.

References:

Vlad, Ion; Sallot, Lynne M.; Reber, Bryan H. “Rectification Without Assuming Responsibility:

Testing the Transgression Flowchart With the Vioxx Recall.” Journal of Public Relations Research. 2006, Vol. 18, No. 4, pp 357-379.

Other sources: Selected issues of Medical Marketing & Media, Fortune, The Wall Street Journal,

Advertising Age, The San Francisco Chronicle, PRWeek US and UK editions, Reuters, and The Denver Post.

Vioxx (continued)

Vioxx by the Numbers

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$� billion total sales

$�0� million total advertising budget

$�1 million spent on an “independent investigation” to clear Merck executives

$�8 million settlement paid to states for suits related to misleading direct-to-consumer advertising

$�.8� billion in settlements paid

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leaders or constituents. But as the business world has learned over the past decade, transparency is good medicine. The same is true for health care. Providing timely, accurate information to affected audiences isn’t just the right thing to do. Studies have shown that it can save money for health care organizations by reducing malpractice costs (see “The Value of Apology” sidebar).

Because of their training and education, an organization’s well-intentioned attorneys often cloud the communications team’s attempts for transparency. As The Sorry Works! Coalition points out, physicians and their lawyers often fall back on the “deny and defend” strategy, assuming it limits legal liability. When management convenes to assess crisis and response, communications professionals should listen to the wise counsel of attorneys, especially where legally sensitive and complicated issues such as labor unions are concerned. However, some of the greatest public-image gaffes occur when attorneys dictate communication policy.

The example of retired baseball pitcher Roger Clemens provides a cautionary tale. An investigative report released by former U.S. Senator George J. Mitchell in December 2007 implicated eighty-nine Major League Baseball players in a scandal involving illegal performance-enhancing drugs. Within six months, the media seemed to have forgotten many of the players, including Clemens’ former teammate Andy Pettitte, who readily admitted and apologized for briefly using human growth hormone.

Yet no one who even peripherally follows professional sports can forget Clemens. Instead of seeking communications counsel, he let his attorney, Rusty Hardin, speak to the press. Hardin is one of the most successful and tenacious defense lawyers in Houston, and his public comments might have been effective if delivered before a jury box instead of a microphone. But in Clemens’ case, Hardin took “deny and defend” to the media—and to a whole new level.

“Roger Clemens did not take steroids, and anybody who says he did had better start looking for a hell of a good lawyer,” Hardin said in one written statement. Later, a judge admonished Hardin for telling the New York Times, in reference to a federal investigator, “If he ever messes with Roger, Roger will eat his

lunch.” Amid all this, Clemens released a clandestinely recorded telephone conversation with his former trainer, appeared on “60 Minutes,” and even drew his wife into the scandal. When the dust finally settled, it didn’t really matter whether Clemens used steroids. The damage to his

The Value of Apology

Traditionally, physicians and the malpractice lawyers who represent them considered the words “I’m sorry” as potentially very expensive. To them, admitting fallibility meant admitting liability.

Many people in the health care field still feel that way, but an alliance of doctors, lawyers, payers, and patient advocates hopes to change that mindset by showing how apologies actually save money. The Sorry Works! Coalition strives to educate stakeholders about the value of apology while organizing the full-disclosure movement and advocating laws that remove legal liability for health care providers who say “I’m sorry.”

The movement has its roots in Lexington, Kentucky, where a Department of Veterans Affairs (VA) hospital decided to part with tradition and practice full disclosure in notifying patients and their families about medical errors. A decade later, its average malpractice payout had dropped to $16,000 per settlement, compared to the nationwide VA average of $98,000.

The new policy ultimately halved the number of pending malpractice lawsuits for the Lexington VA hospital and for several others that followed suit, including the University of Michigan Health System and Children’s Hospitals and Clinics of Minnesota. One payer—COPIC

Insurance of Denver—achieved similar results in a pilot program involving low-value cases, and it reduced settlement expenses by 25 percent.

When internal investigations reveal harmful errors, the Sorry Works! Coalition encourages providers to follow these five steps:

1. Apologize2. Admit fault3. Explain what happened4. Explain what will be done

to prevent similar errors in the future

5. Offer fair compensation

The organization stresses that this process works regardless of the legal climate, but it encourages legislatures to pass so-called “apology laws.” So far, thirty-five states have adopted them.

References:

Wojcieszak, Doug; Banja, John, M.D.; Houk, Carole, J.D.; The Sorry Works! Coalition: Making the

Case for Full Disclosure. The Joint Commission Journal on Quality and Patient Safety. June 3 2006, Vol. 32, No. 6.

http://www.sorryworks.net/lawdoc.phtmlLauer, Charles S. “To err is human.” Modern Healthcare, May 24, 2004, Vol. 34, No. 21.

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About the Author

Editorial manager Sherri Deatherage Green brings to FrogDog high-intensity writing, editing, crisis communication, and health care experience. Her two-decade career has included media relations positions with Memorial Hermann Healthcare System and the Texas Department of Public Safety. As a freelance writer, Green served as a regional correspondent for PRWeek and wrote health care articles for the Houston Chronicle, Houston Community Newspapers, Texas Medicine, and the University of North Texas.

About FrogDog Communications

FrogDog Communications is a marketing communications consultancy that helps businesses bring ideas to market and achieve their goals through strategy development, marketing, advertising, public relations, media relations, design, and more. The firm has clients throughout the United States. For more

information, visit www.frog-dog.com.

reputation has been inflicted by his own combative defensiveness.

By contrast, Pettitte’s approach serves as a model of how to salvage reputation in a crisis. He admitted his mistake, apologized, and expressed regret. In the health care setting, mistakes can affect or harm other people, so a couple of extra steps must be added to the tried-and-true formula Pettitte used: organizations must express sincere concern for the people affected and outline the steps they will take to prevent such mistakes from happening in the future.

Despite the proven effectiveness of transparency and truth, attorneys may not be the only ones whose first impulse is to withdraw or offer less-than-candid explanations. A communications director advocating openness can feel pretty lonely sitting at the proverbial C-suite table. An objective, external communications consultant can be valuable at this time. An outside advisor may be in a better position to raise the tough issues that need to be addressed.

As some of the examples discussed here illustrate, telling the truth helps companies get back on track more quickly and surely than defensiveness or the eventual discovery of an unfortunate secret.8, 11, 12, 13

This is especially true in the health care industry, where laws that require public reporting of errors to government agencies can make secrets impossible to keep.7

Transparency doesn’t have to derail an organization’s marketing efforts, and will most likely serve to salvage or bolster them. Crisis messaging should support the company’s goals as much as possible, even if disseminating information vital to public health and safety temporarily trumps marketing priorities.

In the case of the Toronto SARS outbreak, this meant providing the public and media with helpful information about the disease and with resources that didn’t always carry Sunnybrook branding, according to the hospital’s public affairs director. For example, Sunnybrook’s communications team recognized that quarantines meant the press couldn’t see what was happening inside hospitals. So its audio-visual staff shot generic, unbranded B-roll video and photos and gave these to media. The materials didn’t convey messages about Sunnybrook—or even display logos—but the institution gained credibility with reporters, and images of calm professionalism within a hospital likely helped ease public anxiety.3

Last but not least, messages delivered during a crisis must take emotions into account. Health care organizations must be especially attuned to emotional appropriateness. People whose health care has been affected or who have lost loved ones may be experiencing any stage of the grief process, so messages should be delivered with sincerity, compassion, and empathy.

Conclusion

That emotional and highly personal element sets health care crises apart from crises affecting most other industries. Emotions can run high internally as well as externally. Experienced outside communications counsel can offer objective perspectives less colored by the emotional investment any engaged communications director or CEO brings to a crisis situation. Executives will be more likely to accept the advice of outside consultants and other professionals they know and trust, so facilitating these relationships during the process of developing a crisis communication plan will help ensure its success when activated.

For an organization to survive and thrive after a crisis, its crisis communication plan must incorporate sound risk analysis, well-defined crisis communications functions assigned to appropriate staff, patient privacy considerations, ongoing outreach to a broad range of communications partners, and messaging that is truthful and compassionate. Training executives and staff with regard to their crisis roles, and conducting regular drills to test and refine the plan, will build familiarity with the crisis communication strategy so that internal stakeholders feel comfortable implementing it when crisis inevitably strikes.

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9www.frog-dog.com

References:

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