CPR: How to Crisis-Proof Your HCO

Wisconsin HPRMS ConferenceSept. 13, 1007

Kathleen L. LewtonPrincipal, Lewton,Seekins&Trester

Duke 2003

“A Death at Duke“In the future, we can expect more publicity after major errors in medical care, especially when communication breaks down and trust is lost.”

NEJM 3/20/03“Ms Santillan’s plight also tarnished to some degree

the reputation of one of the nation’s most renowned hospitals.”

NY Times 2/22/03

Mt. Sinai New York 2002-03

“On top of the fiscal mess came the death of a man who had donated part of his liver in January 2002 . . . . .a state investigation found “woefully inadequate care . . . . Violations occurred in 80 of 195 complaints patients had brought . . . . .The sum of it all has been a crisis of spirit.”

“Today, most worrisome are the occupancy numbers.”

New York Times

Johns Hopkins 2001

“Hopkins officials reacted with outrage to the suspension of research, calling the action unwarranted, unnecessary, paralyzing and preciptious.”*

NYTimes

*Three days after accepting “full responsibility” for the death of a young woman in a clinical trial

Cleveland Clinic 2003

“But the Cleveland Clinic Foundation is struggling these days . . . . Nearly $500 million of its wealth has vanished.

“Dr. Loop did not return several calls seeking comment.”

NY Times

Crises will happen

Surviving them means having a reputation and relationships that can weather the storm

And then managing the crisis effectively• If the goodwill bank is empty, survival is difficult• If the crisis is not managed effectively, the bank

account is overdrawn

First, let’s define “crisis” A crisis in a healthcare organization is NOT

an external disaster that the HCO must respond to• That’s by-the-book and you can plan and drill for

it – and it’s not “your” crisis A crisis is something that happens within

the hospital that can damage reputation• And it’s something that happens unexpectedly,

vs. a long-simmering issue that can be managed

Such as:

MedRel Advanced:CPR

It’s not “if” a crisis happens – it’s when and how soon• Medical errors are inevitable• Patients/families now understand why and how

to take their stories public• HCOs still seem to be caught off guard, to

respond with arrogance and reinforce pre-existing negative stereotypes

And CPR is needed because:

It’s life or death• Media coverage is instant• Web coverage is instant-er

The outcomes are critical• Litigation• Damage to reputation• Loss of confidence among patients, physicians

and EMPLOYEES• Loss of productivity• Undercut all your marketing efforts

When the crisis comes, it is a CRISIS

Crisis PR may be only 2% of a PR job, but it can often be make or break• Reputation can be irrevocably damaged – not by

the medical or institutional mistake, but by how the institution reacts and responds

• The public WILL forgive mistakes – but NOT dishonest, disingenousness, arrogance

Some make CPR sound simple

But it’s not• No cookie cutter approach that works in every

case• A plan is only a piece of paper without

institutional buy-in• Situations can be anticipated, but real life can be

different• It‘s about people – unpredictable people – and in

health care, it’s about life/death

It begins with a mindset

Strategic communications process in place Full buy-in of senior management CPRO part of senior management team Detailed operational plan Pre-existing conditions: strong credibility

and good relationships with media

And also requires:

Effective internal and stakeholder communications channels already in place and fully road tested

Spokespersons already trained and tested• One MUST be an MD, ideally not the CEO

And a full account in the goodwill bank

The Basics: The Team Established in advance – crisis is no time for saying

“Should we call XXX” or answering “But what about ME?”• CEO• HR• Legal• Operations• Risk management• IT possibly• Security• PR• Others PRN

Establish chain of command and tie-breaker

The Basics: The Plan

Must be in sync with HCO values, mission Detailed P&P to insure that potential crises are

reported!• And make sure employees are oriented and trained

Detailed info on who does what when• For example, when senior manager hears about a crisis

situation – who gets called FIRST? CEO? PR? Lawyer? Figure it out now.

Implementation instructions Resource and contact info – updated weekly

The Basics: The Essential Info

Master list of all key audiences • Contact database

Allies database Systems – phones, pagers, Blackberries• With fall-back plans when systems crash

Media logistics Fact sheets already printed “Dark” section on website, ready to go

The Basics: Pre-Screened Spokespersons

SpokespersonS must be:• Credible• Mediagenic• Coachable, trainable• Constantly available• Calm, calm, calm – unemotional, ego-free• Stamina

Weigh the merits of CEO, COO, MD, PR TRAIN, train, train, and train

Testing 1, 2, 3, 4 -- Checklist

The Basics: Anticipate and Rehearse

Issues anticipation • The predictable and generic• The “that could be US” opportunities

Routinely (at least quarterly) put the team through a crisis drill with a scenario “torn from the headlines”

Scenario Drills

“Working” these issues provides ideal time to:• Kill the “no comment” mentality• Try out spokespersons and decision-makers –

role play• Confront the “WE DON’T MAKE MISTAKES

LIKE THAT” mentality• Thrash things out with legal in advance

Scenario Drills

Allows for:• Assessing probability• Identifying potential audiences by scenario• Assessing severity and risks• Determining – in advance – what the answer to

the first question

Scenario drills also:

Allows you to show CEO et al examples of good CPR and bad• Start with the classics -- Nixon, Exxon vs.

Iacoccoa, Tylenol• Then use current/recent hospitals

Allows you to road test your team, your plan, spot any inbred issues and deal with them

And provides time to teach your team the RULES

CPR: The Cardinal Rules

Never, ever, ever lie – the truth will ALWAYS COME OUT• The “You Tube” generation• Any employee can dial NY Times

And never speculate • Educated guesses that turn out to be wrong –

look like lies to the public• “I don’t know” can’t come back to bite you like a

lie or speculation can Respond quickly and calmly

CPR: When the crisis happens, the first pulse to take is your own

Bring in outside counsel• Internal staff simply cannot be objective and

callous• Outside counsel can confront CEO, MDs, angry

Board chairman, et al

CPR: The crisis is upon us

ID and prioritize the affected audiences• Employees and closest in audiences are always

first, usually forgotten– Employees in an info vacuum = rumors– Employees receiving bad or misleading info = critics– Employees receiving frequent updates and info =

community info representatives• Validate your statements to media• ID and counter rumors• Able to be productive and do their jobs

• Then – who else is affected???

CPR: The crisis is upon us

Get the facts – divide up the work if needed Assess the damage potential

• Overreaction is dangerous – poll if needed

• But in a 24/7 news environment, with patients/advocates who see the role coverage can play, assume it will go public sooner rather than later

Frame the messages FIRST, before obsessing about channels• Do NOT write by committee!

CPR: The crisis is upon us

The message must:• Focus on the harmed party – NOT “we”• Be utterly candid – “I don’t know that now” is OK,

no comment is not• Begin with statement of compassion

– Know how to apologize or at least express regret

• Accept blame if an error has been made– Assume there WILL be a lawsuit someday– Worry about court of public opinion NOW

CPR: The crisis is upon us

The message must also SHOW as well as say• Prove it! • What steps are you going to take?• What steps have already been taken?

CPR: The crisis is upon us

Get to your internal audiences BEFORE they see the coverage and stay in touch• Employees• Board, governance• Physicians• KEY community opinion leaders• Patients, past patients

Stay below radar – e/vmail, CEO phone calls, employee meetings – but assume everything will go public

USE your website!!!!

CPR: The crisis is upon us

Monitor media coverage – correct rumors or misinformation

Monitor public opinion, formally and informally

Know when to go back to “normal” mode Make sure management is still flying the

plane!

Case in Point: Let’s Practice CPR

Case in point: The Duke Disaster

Looking from the outside in – which is precisely the perspective of the institution’s key audiences

CORE PROBLEM was how caregivers managed (not) relationship with patient’s family• “Conflict between caregivers and the patient’s

supporters” -- Dr. Davis• The story “suddenly” became public – should not

have been a surprise

Duke

Let situation fester and worsen Did not bring in professional PR counsel Initial comments bad – “We do hundreds of

these, we don’ t make mistakes, this is a tragedy for US”

Spokespersons not charismatic WW syndrome

• “Patient’s supporters” (they are a FAMILY)• “These things happen”

Duke

Did things by the book, but didn’t seem to comprehend how that plays to public• Refused second opinion on brain death

Never seemed to get it together• After Jessica died, spokesperson said “he could

not confirm” whether 2nd opinion was requested• Doctors and admins “not available for comment”• ’60 Minutes’ not bad – until the end, when

surgeon said ‘these things happen’ – sounding cold, irresponsible

Duke is not an isolated case

HCOs generally tend to believe they are infallible• “This could not have happened”• “We do not make mistakes like this”• “We have procedures in place and followed

them” The public thinks: It did. You did. So

what?

It’s now a brand new world

The medical error issue will not go away, even without cases like Jessica

“Inappropriate” deaths are inevitable and unavoidable, as are all kinds of other errors

Media smell blood in the water HCOs that are deficient in good patient

relationship skills increase the likelihood of family going public

So the next Duke could be you

Have the conversations, the scenario planning, the bitter fights over who will speak, what will be said – NOW

AND strengthen and refine reputation building program so that the goodwill bank will be as full as possible when the crisis hits!