Ten Steps for Handling Healthcare Crisis Communications

/ South Florida Hospital News / By

Published in South Florida Hospital News –

Healthcare Organizations Provide Fertile Ground for a Crisis

Healthcare organizations are inherently complex.  Consider the milieu in which healthcare transactions typically occur.  Medicine itself is an inexact science, and hospitals are often multi-million dollar institutions with thousands of employees and non-employee agents (physicians, volunteers, vendors, to name few); a diverse and often international workforce and patient population, bringing innate language and cultural barriers; new electronic information systems subject to staff and physician learning curves (and, unfortunately, sophisticated hackers); and, all too often, arcane processes still fraught with waste and the possibility of human error.  The sheer volume of interactions between staff, patients, and families in a typical community hospital probably runs into the hundreds of thousands, if not millions, of encounters.  The myriad of steps taken in a typical patient encounter—registration and acquisition of sensitive patient demographic and insurance data, a medical history and physical, documentation of drug allergies, diagnosis of the illness with may itself involve multiple laboratory tests, imaging scans, invasive or non-invasive procedures, and the sharing of the most personal of details—almost guarantee the possibility, if not the likelihood, of a medical mishap sometime in the organization’s history.

Aside from medical mishaps, there are innumerable other critical situations which may flare up to become crises:  untoward regulatory findings, patient privacy breaches, unanticipated financial takebacks or penalties, negative employee or agent interactions, clinical or regulatory compliance violations, labor disputes, governance or management issues, and many, many more.  The crisis itself can take many forms.  It might be precipitous or it might develop slowly with a gradual crescendo until it erupts into a full-blown media event or until appropriate crisis communications brings it to a conclusion. 

Obviously the best intervention in a crisis is preventing the incident from ever happening in the first place.  Most healthcare institutions have carefully developed over time a set of institutional procedures, human resources policies, and clinical protocols, care paths and guidelines, which, if religiously followed, can minimize the likelihood of an adverse event occurring.  However, even the best-managed, most-automated, most sophisticated institution can experience a crisis.  The fact remains that the delivery of healthcare is essentially a series of actions by human beings which, at its core, introduces the possibility of an untoward incident which could develop into a crisis.

So, even if the likelihood of a crisis can be minimized, it is improbable or impossible that it will be entirely eliminated.  Fortunately, however, the outbound communication around the crisis can and should be managed.  The effective healthcare CEO will surround himself or herself with a talented coterie of executives who will need to act as a cohesive team to identify and address the issues leading to the crisis, to develop and communicate the response to the crisis situation, and to rally and inspire the workforce in the face of unwanted publicity, difficulty, and stress.  The team, led by the CEO, must be prepared for action and must remain nimble, flexible and focused in its remediation and crisis communication efforts. What are the steps, then, in handling the communication surrounding a crisis?  What follows are some basic guidelines for the CEO to consider and to adapt to his or her particular situation.

The First 5 Steps in Crisis Communications

  1. First of all, become fully informed about what happened and commit to being forthright and transparent with all involved parties.
  2. Patient safety is paramount.  Once you’ve identified the precipitating issue, take all necessary steps to “stop the bleeding.”  This may involve conducting a complete root cause analysis as to how the event occurred and should include a plan on how to remedy the situation and how to prevent the adverse event from re-occurring.  Although most events are triggered by human intervention, refrain from taking rash personnel actions.  Obviously, actions caused by criminal intent, malfeasance, or gross neglect must be immediately addressed.  Consider, however, that many events are caused by inadequate training, faulty systems, or poor communications among well-meaning parties, not necessarily by bad people or poor performance.  In any event, take swift, but well-considered, action if necessary to remediate the situation and restore patient safety and confidence.
  3. Apologize personally and privately to the patient, family, or affected party.  A public apology may also be necessary but start with a private one. The chance of forgiveness by the aggrieved party may be optimized, or, at least, the possibility of the event not mushrooming into a full-fledged media event will be greatly reduced, if the aggrieved person or party believes that the organization and its representatives have been honest, forthright, compassionate, and remorseful.  The apology should be delivered by the person committing the error and in the presence of the institutional representative with whom the aggrieved party has the closest relationship.  For an event involving multiple aggrieved parties, the likely person to deliver to an apology will be the CEO.
  4. Develop the message points to be communicated to internal and external publics.  These are the points you want to convey to your constituents—staff, physicians, media, investors, regulatory agencies, etc.  There should be no more than 3-5 key points, particularly to the media.  Members of the administrative and public relations teams must fully comprehend these points and must be consistent in the delivery of these messages.  These message points usually acknowledge the incident itself, specify that remedial action has been taken, and express compassion, regret, and remorse to the affected individuals.
  5. Ensure that the organization commits enough resources to address the crisis.  This means dedicating enough operational personnel to functionally address the event and its aftershocks and enough public affairs personnel to develop messages, to identify and coach spokespersons, and to reach out to constituents.  In a true crisis, inquiries can from anywhere—the media, regulatory authorities, Board members, community agencies, worried family members, and even from your own employees.  Now is not the time to skimp on resources.  Inform your senior staff that “all hands on deck” will be needed.  Call in outside assistance if necessary; your public relations counsel or advertising agency can likely provide resources or point you in the right direction.  Insure, however, that communications and messaging do not become clouded or frayed by too many well-meaning advisors weighing in on the development of the message points.  The CEO will need to display confident leadership and should set up clear lines of approval of public messages, press releases, and other organizational statements.

The Last 5 Steps in Crisis Communications

  1. Be proactive and beware of legal landmines.  Legal counsel is imperative to avoid running afoul of laws and regulations, but legal counsel is not a substitute for public relations counsel.  Institutional lawyers are often very conservative and may advise against releasing crisis-related information.  Recognize, however, that, more than likely, patient information, regulatory actions or provider names are already in the public domain by the time the organization receives the media call.  Remember:  Be honest, transparent and forthright.  If there are legitimate issues of privacy or confidentiality, honor the aggrieved party’s or family’s wishes.  Otherwise, don’t hide behind legal arguments.
  2. Select the right external spokesman for the situation.  Many organizations make the mistake of having a low-level PR spokesperson communicate with the media when the situation could likely be better addressed by an alternate subject-matter expert.  However, the CEO does not need to be the media face for every situation.  In fact, conventional wisdom suggests that the CEO should make a public (on-camera) statement only in the top or bottom 5% of good or bad situations.  The organization should consider the nature of the crisis and choose the most appropriate spokesperson for the type of crisis.  For example, a physician (usually a physician in the specialty precipitating the issue or dealing with the crisis) might be considered for delicate clinical situations.  If the critical situation is politically charged, deals with governance issues or needs to create stability in the event of an abrupt CEO departure, the Board chair might be considered.
  3. In written statements—press releases, letters to the editor, advertorials, etc.—always be professional, compassionate and remorseful.  Reassure the public that appropriate operational remedies have already been implemented.  Don’t try to do battle with or in the press; refrain from complaining about media hype and excessive scrutiny.  Do not be combative or defensive; take the high road and remind the public about the organization’s serious and clear mandate and its overriding focus on delivering quality and compassionate care to its community.
  4. In verbal statements, stick to the message points.  Don’t get rattled or be led astray by inflammatory questions or conjecture on the part of the reporter.  Make sure that the on-camera spokesperson has been coached on how to bring the conversation back to the key message points.  Be truthful and concise in the interview and avoid being led into speculation.  If you don’t know the answer to a question, don’t be evasive.  Acknowledge the question itself and promise to get the answer if you can.  Reporters may encourage you to keep talking by nodding and leaving what may seem to be excessive silence or wide open spaces in the conversation.  Don’t bite, however.  Make your points, stop, and wait for the next question.
  5. Let the organization get back to business.  The fact of the matter is that most organizations go through crisis-related peaks and valleys and, sooner or later, a critical issue is likely to come your way.  But an effective CEO can control or at least temper the unwanted hype by thoughtful, calm and collected leadership and true organizational integrity and transparency.  Don’t beat yourself up, don’t focus on the negatives, and realize that this, too, shall pass. Redouble your efforts to be visible in order to reassure your staff and your constituents that your leadership, your command of the situation, your transparency and your empathy will once again bring calm waters and mission focus to the organization.  Your leadership will likely be tested but will definitely be honed as you navigate through tough adverse situations.   The CEO’s job is to manage the event itself, minimize the reputational fallout, reassure the public and other key constituents, and inspire the team members to get back to the business of delivering extraordinary healthcare.