calm in a crisis

With all the planning in the world, some crisis situations—from natural disasters to medical errors—cannot be avoided. It’s how you handle them that matters, writes HRMR.

The 2012 fungal meningitis outbreak in the US, which affected 772 patients in 20 states and claimed 50 lives, is an example of the kind of crisis situation every healthcare provider dreads.

In this instance the meningitis was traced to contaminated steroid injections, and a media storm erupted. Healthcare providers faced the task of fielding enquiries from the media while contacting patients who may have been infected. Michelle Foster Earle and her colleagues at Omnisure Consulting Group were called in to help some of their clients deal with this complex and challenging task.

“Some of our clients had to inform their patients that they had been exposed,” she says. “Instead of sending letters they called us and we were able to review their communications strategy and offer some tips on how to handle it. We were able to help them change their form letter to meet their needs and in some cases we recommended that rather than sending a letter they actually call the patient.

“Imagine if you were a patient who’d been exposed to fungal meningitis—wouldn’t you much prefer a human being on the other end of the line?”

Earle says that in the face of a crisis it is important to resist the urge to make up a story or try to find somebody to blame. While it is a natural human reaction to want allocate blame, healthcare executives need to make sure they look at the events from every possible angle and consider the feelings of the patients, the employees and the community. Good communication is vital.

“You need to create a safe place for people to know that they can trust you and resist the urge to speculate or point fingers,” she advises.

SAYING SORRY

Amanda Budak, executive director of SE Quality Consulting, agrees. Her organization promotes full disclosure and the power of saying “I’m sorry”.

“If a patient has an adverse event, even if it’s an error such as a retained sponge in a surgical procedure, it’s important to disclose to the patient what happened, how it happened and most importantly what is being done to prevent it happening again in the future,” she says. “We really strongly believe that that can help prevent a patient from taking it further and seeking any kind of lawsuit.”

The ideal situation is to avoid a crisis occurring in the first place. With this in mind, it is essential to ensure that adequate safeguards are in place in order to protect patient safety. Budak and her colleagues work with hospitals and physician practices to assess what processes, policies and procedures are in place in order to avoid problems such as medication errors.

“We also work with the hospitals and the physicians to ensure they have their appropriate documentation and processes in place and that they are educating the patient of the risks, to avoid any complication becoming a malpractice claim,” she says.

Even the best planning cannot totally rule out the chances of a crisis occurring. Beth Berger, national director, healthcare practice for Arthur J Gallagher, recommends having an internal plan that gives designated people certain responsibilities for when trouble strikes.

“You need to decide who is going to communicate, how they are going to communicate and what your message is, and how you’re going to deal with the media,” she says. “The big thing is having a plan up front, having people responsible to execute it and then usually, depending on the actual crisis, we advise consulting with legal counsel. You can’t anticipate everything but you need to know who’s responsible for making those decisions, for communicating, for working through the crisis.”

LEARN FROM MISTAKES

When the crisis is over, another process begins: understanding what lessons can be learned. Berger advises a thorough investigation in order to establish what the issues were so that you can adjust your risk plan to accommodate your findings. According to Earle, this is the positive side of a crisis: it brings people together and encourages them to explore how to improve the care they provide.

“Crises help us improve situations, make patient care more safe, ensure the same thing won’t happen again. There’s always an upside to the crisis if you’re willing to look and do the hard work of determining what we can take away from this that’s positive.”

When juggling the needs of the many people who get caught up in a crisis, it is important to spare some sympathy and care for the person or people whose errors caused the situation. A recent case in the UK, when a nurse inadvertently put through a call which resulted in confidential information about a member of the royal family being revealed during a crank phone call from an Australian radio station, is a case in point: in the wake of her mistake, and amid ravenous media attention, the nurse responsible committed suicide.

“We sometimes forget that we have an obligation to the human being who made the mistake as well,” says Earle. “It’s very important for healthcare executives to make sure there is a system in place to tend to the emotional needs of whoever it is that made an error.”

Media attention has the power to intensify a crisis but used properly, the media can be a powerful tool. Berger points out that it is a far more complex issue than it was in the past, because of the ease with which information—and opinions—can be published on social media sites. With this in mind, she recommends getting a media coach to help you formulate your response.

“You need to be honest, you need to communicate but you have to watch what you communicate and be proactive,” she says. “The last thing you want is to have the media or others spin it for you—they can take the most negative view. You don’t want to be defensive: you want to use all your media area—the press, the news, social media, to keep people informed.

“You do have to be careful of what you say but at the same time if there really is a problem you don’t want to deny it, only for it to come out a month later that you lied. Trying to cover things up and sweep them under the rug doesn’t work any more; it’s better to admit that an event has happened and to say that you are investigating it.”

Effective crisis media management can be an opportunity to improve your reputation. Earle believes that how you respond in a crisis is much more important than the fact that you had a crisis. “Everybody knows that unexpected events occur,” she says.

“How you respond to that and how you use it can actually be a form of marketing. People can remember that you were on TV and that you handled this crisis very well, and they know you’re not going to make that mistake again. A crisis can be tackled in a way that turns out to be very positive.”