Taming a Hospital Crisis: 7 Rules Of the Road

Managing a crisis is a major test for any hospital executive.

A hospital crisis, by definition, is unexpected and unpleasant. No organization seeks it out. No CEO yearns to face one.

While crises can come in a variety of flavors — natural disasters, lawsuits, white collar crime, massive layoffs, medical errors, personal tragedies, etc. — the "do's and don'ts" in handling crisis rarely vary.
Following are seven rules of the road for efficacious crisis management.

1. Do be flexible. Certainly, it is important to "be prepared" for crisis. Crisis manuals, role simulations, emergency preparedness checklists and the like are valuable tools.

But anyone who has lived through a crisis understands that sometimes, you can't even find the crisis manual, much less follow it! Therefore, you have to be ready to move quickly.

Lawyers, concerned about what might be put on the record now and brought back in court later, invariably counsel to add little to the public discourse, until the organization has had time to assess the full body of evidence.

That's a sensible philosophy, but often impractical in the real world of 24/7 communications, in which uncorrected allegations and innuendoes become facts. Today, with the Internet, social media, cable TV, radio and other media continuously reporting on rapidly changing developments, a smart hospital must keep its crisis options open and not be tied to a rigid response plan.

Consider the situation at a Missouri hospital when the anesthesiology group walked out after acrimonious contract talked failed.

Charges were flying back and forth as interim coverage was being provided by new anesthesiologists (one a Locum) and eight certified registered nurse anesthetists. Then an obese 40-year-old patient died during what was supposed to be routine foot surgery. One doctor promptly branded it an "anesthesiology death."  Two other doctors delivered an audiotape to the news media. Their message: "Surgery here may not be safe right now."

No crisis manual could have predicted that scenario.

2. Do answer early. The first several hours in a crisis are the most critical.

This is when the media — both traditional and online — are framing their stories and, in effect, setting the "agenda" for crisis coverage. Therefore, it is incumbent on the organization enmeshed in the problem to come out early with a statement or, at the very least, establish contact.

For instance, when a Life Flight helicopter carrying patients or crew crashes anywhere during a mission, hospital spokespeople must make themselves available immediately at headquarters to try to handle the media onslaught. Meanwhile, personnel are simultaneously dispatched to rush to the crash site.

3. Do speak with one voice. The media prefer lots of spokespeople. They want access. And as a general communications premise, candor and openness should be the rule.

But in a crisis, multiple communications channels must be shut down. The institution must speak with one voice.

It is important in crisis to communicate a sense of confidence and control and coordination. There are few things more embarrassing — or damaging — to credibility than one spokesperson having to "correct" on the evening news, the comments of a previous spokesperson quoted earlier in the day.

This was the problem that plagued Humana years ago, when it engaged in the first artificial heart efforts, pioneered by Dr. Robert Jarvik and Dr. William DeVries. With media clamoring for daily insights into patient status, Humana spokesman regularly tripped over themselves as patient conditions changed frequently. 

Therefore, channels of communication in crisis must be closed. Any hospital response, of course, must be "blessed" by all pertinent parties — executive, legal, human resources, financial, etc.

In most cases, the best spokesperson is a public relations professional.

By keeping the conflict at the public relations spokesperson level, it suggests that the organization doesn't consider the crisis of "life or death" consequence. On the other hand, once the CEO appears as spokesperson, the crisis can never be "deescalated" from the highest level.

Obviously, if the hospital has been involved in massive layoffs or deaths, it is difficult not to have the CEO serve as standard-bearer. But if at all possible, it is often much better for the organization to initially send out a public relations officer — knowledgeable, hopefully attractive, but most of all experienced in the idiosyncrasies of today's "journalism," which too often is a synonym for "show biz."

4. Do be prepared to move without all the facts. Sure, the lawyers get antsy if you speak up quickly. And certainly, there is always a risk of saying too much, too soon.

But there is often a greater risk of remaining silent. If you sit still too long, you could still be sitting there as the media spew out uncorrected negative assertions about you and brand you "guilty as charged."

We see this over and over.
  • "We're studying the allegations."
  • "We haven’t seen the court papers yet."
  • Or worst of all, "No comment."
What's wrong with saying, "No comment?" The words themselves aren’t damning. Rather, it's the impression they give. 

Consider what happened when a research firm asked 500 Americans this question: “If a company spokesperson declines to comment, does this mean the company is guilty of some wrongdoing?”  65 percent answered, "Yes."

In a rapidly changing situation at a mid-Atlantic hospital, management had to move without all the facts  when a once-respected surgeon took a walk on the wild side. Before he was dismissed, the physician had been surfing X-rated websites at hospital computers, in plain view of coworkers. He also admitted to intentionally miscoding billing codes for patient services, and was 10 months behind in maintaining patient medical records. Then, the surgeon and his teenaged daughter were arrested for shoplifting.

But his loyal patients held protest rallies over his dismissal, roiling the community. And a handful of renegade physicians pushed publicly to have their colleague reinstated, and lobbied privately for a "No Confidence" vote against the CEO.

As crisis counselors and strategists, we worked with outside legal counsel and provided day-to-day advice for this evolving affair, drafting specific communications vehicles and training a hospital spokesperson to communicate with each significant constituency as events unfolded.

Hospitals, of course, must be sensitive to patient privacy, peer review and other matters of confidentiality. But the point is there are many eager to anonymously impugn the hospital in public forums, especially if you don't quickly put them on notice, that your organization will fight back.

5. Do squawk if you're wronged. Henry Ford used to say, "Never complain, never explain." But that's bad advice in a crisis.

In a crisis, you must fire back if the hospital is accused unfairly, or if information reported is flat out wrong. Most organizations don't correct the record, and that's a tragedy.

Reporters don't necessarily write the truth. The write what people tell them is the truth. And sometimes, what they tell them simply isn't true. So it's your job to set the record straight.

How do you complain?

You always go, first, directly to the source of the story — the reporter. After all, you wouldn't want someone going to your boss about a problem with your work, until they've spoken with you first. Too many hospital CEOs want to take their case "straight to the publisher," thus alienating the beat reporter in the process.

If you get no satisfaction — meaning a correction or clarification from the reporter — then tell him you plan to go to a "higher court." And do it.

An example: One rural hospital was minding its own business when the city's only newspaper, a weekly, launched a frontal assault. The editor, a notorious muckraker who thrived on making life difficult for the town's established institutions, seized on state data about hospital performance issues in specific clinical areas. The editor transformed these dated data into a full-scale, multi-week attack on hospital management.

We were called in to create a media relations strategy and response in the wake of the article series. While management and board, obviously angered, favored a "take no prisoners" counter-attack, we recommended a more moderate course based on one simple reality: The hospital needed to coexist with the editor, so alienating him wouldn't be prudent.

Management and board acquiesced. The CEO met with the editor, clarified areas where he had been mistaken, updated him on developments since the publication of the state data, and offered to keep him apprised of developments.
As a result, later articles in the series were more benign — even favorable — toward the hospital.

6.  Do say, "We're sorry." The public understands that mistakes can happen. But they want more than a dispassionate, clinical explanation. They want to know there are human beings and human feelings at your institution.

In Seattle, a gentlemen underwent surgery for a brain aneurysm and was mistakenly injected with a highly toxic antiseptic solution. He died after amputation and other extreme attempts failed to keep him alive.

"We're just so sorry and so devastated this happened," said the hospital's medical director. "It’s a very unfortunate error that we all feel horrible about."

Lawyers may get apoplectic when an error is admitted, but caregivers must think first and always about expressing "humanity."  And significantly, laws in some states now allow physicians to apologize for mistakes without fear of having those words resurface in malpractice lawsuits.

7. Do seek out your allies.
Too often in crisis, organizations clam up. They circle the wagons. They drop off the radar screen.

The operative communications posture is one of withholding rather than disclosing. Companies refer to this as learning on a "need to know basis." Government refers to this as "for your eyes only."

Whatever it's called, it's often bad advice in crisis.

In times of crisis, hospitals need all the goodwill and support they can muster. They need their employees, doctors, patients, families, suppliers and all the other constituent publics who believe in what they do and how they do it.

The cornerstone of the practice of public relations is "third party endorsement" — getting someone else to talk about how good you are. Accordingly, in crisis, the more you share with key publics, the more third party support you can generate.

Again, this may seem counter-intuitive, but that doesn't mean the hospital shouldn't do it. The fact is, the more external support that can be generated, the quicker the crisis will go away.

And make no mistake, the only "good crisis" is one that's over.

Steve Rivkin and Fraser Seitel are partners in Rivkin & Associates LLC, a management and communications consulting firm that specializes in crisis counseling for healthcare institutions. They have handled assignments for more than 90 hospitals and healthcare systems.

More Articles on Hospital Crisis Management:

5 Hospital Crisis Scenarios and How to Overcome Them
3 Best Practices for Communicating During a Crisis

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