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CPR: How to Crisis-Proof Your HCO
Wisconsin HPRMS ConferenceSept. 13, 1007
Kathleen L. LewtonPrincipal, Lewton,Seekins&Trester
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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
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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
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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
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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
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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
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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
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Such as:
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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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Testing 1, 2, 3, 4 -- Checklist
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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”
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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
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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
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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
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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
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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
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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???
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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!
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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
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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?
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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!!!!
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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!
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Case in Point: Let’s Practice CPR
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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
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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”
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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
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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?
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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
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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!