REPUTATION MATTERS!
Building, Sustaining and Crisis-Proofing
Reputation and Market Share
Lewton,Seekins&Trester
(Kathy, Steve & Ken)
14th National Forum
on Customer-Based Marketing Strategies
February 4, 2009 Las Vegas
Reputation is real – so are crises!
Both matter & can be managed

Today we’re going to look at:
• How reputations are built, nurtured and
managed
• How a crisis can impact reputation
• And how a strong reputation helps an
organization survive a crisis
First, a sampler of crises past and present. . .
Mt. Sinai New York 2002
“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 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
Tenet 2003
“Amid widespread media coverage, Tenet said
patient volume had declined 20 to 30%
since the start of the investigation.”
Modern Healthcare
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.”
New England Journal of Medicine 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
And in just past six months . . .

$13.5 awarded in hospital death; Jury faults
doctors at Dana-Farber (Boston Globe)
• “Dana-Farber did not issue an apology”

Immigrants Facing Deportation by U.S.
Hospitals (New York Times)
• “Sister Margaret McBride, vice president for mission
services at St. Joseph’s in Phoenix, which is part of
Catholic Healthcare West, said families were rarely happy
about the hospital’s decision to repatriate their relatives.
But, she added, “We don’t require consent from the
family.”
And . . . . . .

Top Psychiatrist Didn’t Report Drug Makers’
Pay (New York Times)
• “Repeatedly assured by Dr. Nemeroff that he
had not exceeded the limit, Emory did nothing.”
And (truly) that just skims the surface
Reputation matters
“If you lose money for the firm, I will be very
understanding. If you lose reputation for
the firm, I will be ruthless.”
Warren Buffett
to Salomon Brothers employees
Warren Buffet
To Salomon Brothers employees
Reputation has broad impact






Affects employee recruitment, retention,
performance and morale
Ditto physicians, faculty
Drives donations, grants, alumni support
Attracts partnerships and alliances
Supports or undercuts promotional efforts to build
market share (Good service/bad hospital vs halo)
Plays a role in decisions by managed care
companies, foundations and more . . . . .
Reputation can be managed



Every organization HAS a reputation, even
if no one knows what it is or tries to manage
it
Reputations can be created and nurtured,
repaired and restored, managed and
monitored
And reputations can be damaged by poorly
managed crises
The Reputation Equation
Reputation = Perception
Perception = Reality + Awareness
Reality = E2
Personal Experience +
Trusted Endorsements
In healthcare, E2 rules
because reality reigns

Promotion aside, the truth is that reality (as
interpreted by personal experience and trusted
sources) dictates patients’ choice in healthcare

Latest Center for Studying Health System
Change survey of 13,500 adults:
• Choosing PCP: 50% F&F word of mouth, 38% MD recs
• Choosing specialist: 69% PCP rec, 20% F&F, 18% another
MD
• Choosing hospital for procedure: 74% specialist rec, 14%
another MD, 10% F&F

Promotion can build awareness and amplify the
reputation, but it can’t override nor create reality
The HCO reputation
management track record: C




HCOs have the prerequisites for positive
reputation given their lifesaving work
Always assumed favorable reputations as a
“given”
Many did not actively work to sustain
reputation based on performance
Many focused more on promotion
HCOs prone to crises
• And many high profile crises have been handled
badly

Tarnish has affected the entire category
Flash forward to 2009:


All health care, all the time – and clearly
Obama intends to keep it front & center
Every sector is seen as a villain or potential
villain (MDs, Rx, HMOs and yes, HCOs)
• And we all provide enough fodder to make the
concerns realistic


The transition from white hat to black hat
continues (nurses are tarnish exempt)
And the public doesn’t know who or what to
trust
This is significant because
without trust . . .


The bond that is essential for human service
organizations broken
The impact can be massive
•
•
•
•

From clinical outcomes
To philanthropic support
To over and re-regulation
To patients not trusting caregivers
So the time for reputation management and
crisis protection is now!
A good reputation
is like money in the bank


A solid reality-based reputation means the
HCO has full account in the goodwill bank
So when crises occur, as they will and do,
the HCO’s reputation destroyed
• But if the goodwill bank is empty, damage can
be lethal

Managing the crisis effectively will keep that
reputation and the bank account intact
• Alternatively, if the crisis is not managed
effectively, even a big bank account can be
overdrawn
A closer look at building and
protecting reputation
Part One:
Building a Reality-Based Reputation
Building & Burnishing
Reputation:The Basics
1.
2.
3.
4.
5.
An integrated process
Audience identification
Audience research
Message development
Key strategy: Building reputation via
performance and relationships
•
•
•
•
With all of our customers, especially patients
With our employees
With our physicians
With the communities we serve
Building & Burnishing
Reputation:The Basics
1. An integrated process
2.
3.
4.
5.
Audience identification
Audience research
Message development
Key strategy: Building reputation via
performance and relationships
•
•
•
•
With all of our customers, especially patients
With our employees
With our physicians
With the communities we serve
1. A complex universe with many players
Donors, grantors
Prospective
employees,
faculty
Patients
Families/
Visitors
Government
Consumers
Employees
Management
Reputation
Customer
Focus
Faculty
Students
Volunteers
Community
Media
And precisely because there
are many players . . . . .

Managing reputation requires an integrated
approach involving multiple functions:
•
•
•
•
•
•
•
PR
Marketing
Alumni
Development
Employee relations
Physician relations
And . . . . .
Integration does not mean
a single control point

It does require a collaborative, inclusive
team approach
• Get the right people at the table – someone has
to make the first move
• Focus on institutional objectives
• Agree on master audience list
• Use research data to:
– Identify current communications channels
– Identify appropriate messages
– Shape strategies and tactics
AND then . . . . .
Develop a comprehensive plan





With core messages
And messages tailored by audience
Clearly identified tactics, many that will
reach multiple audiences
Implementation responsibilities based on
expertise, experience and interest
And make this planning process part of the
regular strategic plan process for the entire
institution so that “they” buy-in
And execute
(the plan, not each other)




Goal is to ensure no audience is overlooked
or ignored
And that there’s no duplication of effort
Build in monitoring and benchmarking
Keep the team together to track, make midcourse corrections, evaluate, revise plan
Building & Burnishing
Reputation:The Basics
1. An integrated process
2. Audience identification
3. Audience research
4. Message development
5. Key strategy: Building reputation via
performance and relationships
•
•
•
•
With all of our customers, especially patients
With our employees
With our physicians
With the communities we serve
2. Audiences:
Who ARE those guys?



Before we can decide which audiences matter the
MOST when it comes to building, enhancing a
reputation, we first need the complete list
HCOs have a tendency to overlook some key
audiences (or not even realize they exist)
Those audiences that are on the radar screen are
often viewed too broadly, as large, homogenous
groups (“physicians”), when in reality they are
comprised of many subsegments
Start with:

Employees
• Current, retirees, past,
families

Physicians
• Faculty, voluntary
attendings, referrers,
potential referrers

Patients
• Current, former, families


Governance
Payors






Medical students,
residents, fellows
Med school alums
Donors, grantors
Non-MD referral
sources
Media
Community
• Civic, business leaders;
neighbors,
organizations
And don’t forget:



Volunteers
Vendors
UNIVERSITY
• Faculty, staff,
students/families, alumni



PETA et al
KOLs nationally
Associations

“Consumers”
• Many may be part of
another audience already
and thus are getting your
messages
• Important to consider
differences between
segments (age, ethnicity,
income/ education,
diagnosis, attitudes,
healthstyles, gender) and
when/how to segment
even further (not all
“women” share same
concerns, issues, needs)
While all audiences matter . . . .

Some are either lethal weapons or can be your
advanced life support when it comes to reputation,
especially in crises, because they speak from
personal experience
•
•
•
•
•
•
•
•
Employees
Patients
Physicians
Employees
Patients
Employees
Physicians
Employees . . . . . .
Key audiences must not only
know you . . . . .
But also must love you (or at least like or
respect you)
 That means building relationships
 And that process begins with understanding
the audience
 And that means research
Building & Burnishing
Reputation:The Basics
1. An integrated process
2. Audience identification
3. Audience research
4. Message development
5. Key strategy: Building reputation via
performance and relationships
•
•
•
•
With all of our customers, especially patients
With our employees
With our physicians
With the communities we serve
3. Reputation planning
research helps us discover:




Who are our stakeholders (audiences) that
can impact or be impacted by our
reputation?
What do they know and feel about us now?
What do we need to tell them to build
awareness, credibility, support (message)?
How do we reach and motivate them
(strategies and tactics)
Audience research is the core
of reputation management

You can’t start creating messages without
knowing what stakeholders
•
•
•
•
•
•
Know
Believe
Feel
Want/ don’t want
Need
Value
Once you have this data, you
can do the classic gap analysis


Identify gaps between current and desired
reputation
And set out to fill those gaps
Research has special role
in HCO setting . . . . .



Because the decision-makers are data
driven (H1)
Because it provides a benchmark against
which to measure
Because it provides a road map for each
stakeholder group
• What messages work, don’t work
And the core research program
should also include:
Employee attitude/opinion studies
 Ditto for physicians/faculty
 Routine consumer awareness/preference
benchmarks as well as major studies
 Referring physician/provider surveys
 Community/opinion leader perception audits
 Multi-faceted patient satisfaction program
And all of this data helps us develop
MESSAGES!!!

Building & Burnishing
Reputation:The Basics
1. An integrated process
2. Audience identification
3. Audience research
4. Message development
5. Key strategy: Building reputation via
performance and relationships
•
•
•
•
With all of our customers, especially patients
With our employees
With our physicians
With the communities we serve
4. Oh, yeah, the MESSAGE
(we’ll get to that after we decide on ads vs. Twitter vs.
stadium signage)
The reason many communications
campaigns fail is simply because the
message doesn’t work, for one of four
basic reasons:
•
•
•
•
They don’t understand it (Comprehension)
They don’t believe it (Credibility)
They don’t care about it (Relevance)
It doesn’t touch their emotions (Resonance)
C2, R2
Comprehension –
do they get it?

HCOs are huge abusers of jargon
• Acronyms, science terms, insider info (Magnet)


And we pile on the FACTS, FACTS, FACTS
And we often rely on print channels when
the “average” consumer audience includes:
•
•
•
•
Illiterates
Semi-literate
Anti-literate
Poor vision, hearing
Credibility –
do they believe it?




Overpromising, directly or indirectly
Overendorsing
Overqualifying
Overhyping things that have no inherent
credibility to the average consumer
• Ratings, rankings
• Awards
• Credentials that are unintelligble to the
consumer (FANA, FACHE, CRRRRRRT, etc.)
Relevance –
does it matter to THEM?

Do they care about:
• Service or product or procedure they figure
they’ll never ever need or use
• Who manufacturers anesthesia equipment
• Lots of high tech terms
• Hospital that’s two hours away
• We, us, our . . . . . . . all about YOUR assets
rather than their real-life needs and how they will
benefit
Resonance –
does it touch their feelings?

For a message to move audience to action,
it has to touch heads and hearts
• Real people with real stories
• Showing rather than telling
• Don’t be afraid of what we think of as the same
old types of words and visual images IF they
resonate with your audience
Only one way to ensure
messages will work

Test, test, test
• In your market(s)
• With your target audienceS
• With a talented moderator/interviewer who can
play word games
An even closer look at reputation:
performance & relationships
Building & Burnishing
Reputation:The Basics
1.
2.
3.
4.
An integrated process
Audience identification
Audience research
Message development
5. Key strategy: Building reputation
via performance and relationships
•
•
•
•
With all of our customers, especially patients
With our employees
With our physicians
With the communities we serve
We must focus on performance




Reputation is built on reality (remember the
equation)
And reality means how we perform, how we do our
work, how we take care of and build relationships
with our core stakeholders: patients, employees,
physicians and community
Promotion is an important part of burnishing
reputation because it builds awareness – but the
foundation is performance
So marketing/PR must be integrally involved in
organizational performance, not just relegated to
promotion or communications
5. Key strategy: Building reputation
via performance and relationships




With all of our customers, but especially
patients
With our employees
With our physicians
With the communities we serve
Patient satisfaction
(still a work in progress according to HCAPS)



Patients are “expert endorsers,” and their opinions
are based on their experiences
Thus, their satisfaction is essential in terms of
shaping reputation
Management of function requires group effort
• PR/marketing should support/staff the function to ensure
that data is translated into action

Requires coordination with all operating units –
rarely does a problem have a single owner
Patient satisfaction is a
mission, not a program



A question of culture
It starts with the “quest for excellence”
Quality care and optimal outcomes require
satisfying patients.
• There are strong correlations between patient
satisfaction and clinical performance, and patient
satisfaction and outcomes
The marketing/public relations
role begins at the top


Marketing/PR officer often needs to help make the
case for culture change
First, the CEO; then tackle the rest of the gang:
• Bring data
–
–
–
–
–
Ongoing phone surveys (core benchmarking tactic)
Quick response feedback system
Focus groups
Expectation/gap analysis
Print survey, primarily for good will
• Bring strategy, models and tools


If you have a crisis, leverage it
If you don’t have a crisis
• Lead by inspiration
• Model the competition
The marketing/public relations
role also includes:



Culture management
Keep the platform burning
Provide measurement tools
• Manage the survey
• Shoppers
• Other feedback mechanisms (Web, callbacks)

Spread the message
• Successes AND failures/challenges
• Metrics outcomes and benchmarks

Keep it on top management’s agenda
Make it stick - even if you’re
big, complex & decentralized


Clear vision, definitions and standards
New processes to support new cultures
• HR policies and practices critical
• Reliable tracking systems
• Accountability mechanisms

Disciplined, methodical rollout plan with
standardized communications
The Ritz-Carlton Formula




Make management visible
Imprint the standards
Lineups: everyday, everyone (more on that)
Put employee satisfaction first
5. Key strategy: Building reputation
via performance and relationships




With all of our customers, especially
patients
With our employees
With our physicians
With the communities we serve
Employee relations

Foundation of reputation program
• Employees can support or undercut all
messages to other stakeholders
• Employee behavior drives patient satisfaction,
market share (and quality, cost containmnet,
etc.)
• Too important to be left to HR
• Can be managed collaboratively with HR
Employee communications

Requires multiple channels
• Education/literacy variations
• Employee preferences
• Repetition important

Face to face with supervisor remains #1
preferred channel
• Publications, e-mail, videos, etc., can be used to
reinforce, explain details
The Huddle: A breakthrough
communications tool


Systematic process for assuring
group discussions every day
Case in point: Oakwood Healthcare,
Detroit MI
Guiding principles





Simplicity: 5 to 10 minute meeting
Consistency: everyone, everyday, every
shift
Interactivity: discuss Service First!
Standards
Motivational: reinforce personal values
Fun: engender team spirit
Do you rely on huddles
for information?
Patient loyalty scores:
cause and effect?
Other major gains
Pre
Post
Change
Consumer Top-of-mind
Awareness
36.3%
44.2%
 7.9
Consumer Preference
31.2%
41.6%
 10.4
Market Share
35.3%
38.9%
 3.6
-2%
1%
3pts
Profitability
Chain of success starts
with satisfied employees
The VanRinsven
formula for victory




Hire right
Do “onboarding” by top leadership in person
Create “emotional engagement”
Show employees AND physicians that an
environment of engagement is in THEIR
best interest
5. Key strategy: Building reputation
via performance and relationships




With all of our customers, especially
patients
With our employees
With our physicians
With the communities we serve
Physician relations matter



Physician opinion vital in maintaining
reputation
AND REMEMBER THE STUDY: They
DELIVER the patients
HCOs often take a pieces/parts approach to
HD relationships: very fragmented in terms
of responsibility for managing
• Many people can be involved, but someone has
to own responsibility for the process
Physician relationships




Must be based on MDs #1 concern:
RESPECT
Must be driven from the top down
Walking the talk is critical
Most MDs, when asked carefully, will admit
don’t want ultimate, total control – but they
absolutely DO want input, to be listened to
Physician communications 10.0




Brutally brief
Actionable
RELEVANT
In the format THEY choose
• Maybe combination of email, blast FAX and yes, even
snail mail
• We NEED them to get the info



Peer to peer is critical for credibility
And they still want the respect of face to face time
with admins
And the old standby – repetition – is absolutely
critical with this audience
5. Key strategy: Building reputation
via performance and relationships




With all of our customers, especially
patients
With our employees
With our physicians
With the communities we serve
• An area long ignored by most HCOs because
it seems “old-fashioned”
• It isn’t Twitter but it is critically important in
times of shrinking resources
• So we want to spend extra time here
It’s back to our roots



“Hospitals exist with the tacit permission of
the communities they serve”
And the only force that ever stopped the
WalMart juggernaut was organized
community opposition
So it’s time for total immersion in the
community, building trust by being there,
being credible and demonstrating caring
Back to the very basics

Relationships put a face on the organization, we
personalize it
• It’s harder to dislike organizations where you know the
people
• And in crises, people who know you tend to believe you


CR should be seen as a primary PR function – NOT
as an add on to someone else’s job
Not budget intensive when compared to other
functions, but it does take staffing
• Takes commitment from senior management – personal
time commitment
CR 101 begins with the basics

Advisory Boards are foundational strategy
• IF you use them effectively
–
–
–
–
–
–
Have a role and goal
Cast a broad net
Create a solid structure
Listen – and then respond
Make them “insiders”
Use them as loyal advocates
And the old stand-bys
still work!

The All NEW Speakers Bureau
• Give it a jazzy name, a logo, a brochure, a
champion and you’ve got SB for a new decade
• HCOs have what consumers want: nice smart
people who know a lot about health care and
community organizations podium, audiences
– Seek out platforms that match marketing strategy
– Prep and train speakers, send out with HCO’s core
messages
– Evaluate and monitor
– Seize the day – breaking news
And the old stand-bys
still work!




Bring ‘em in – HCOs fascinate the public
And there are other ways to get the
consumers into you facility
Offer free meeting space – and tack on a
mini-tour to one of your hot service lines
For target audiences, supplement the (well
trained and monitored) tour guide with a
physician in a hot specialty
Outsiders IN:
The Influentials Program

Invite the right people -- create a powerful
database
• Yes, the usual suspects (mayor, council, C of C,
biz CEOs) BUT go further
• Look at ALL segments of your community
(education, arts, social services, labor unions,
minority groups, etc.) and do the research to find
the leaders
• Who are people who can influence several
hundred other people?
– Clergy, activists, Junior League president, etc.
Insider influencers



Treat influentials like the special people they are:
private, first-class dinner hosted by CEO, chairman
of the Board
Exciting presentation by compelling physician on a
hot or timely topic
After the party’s over . . . . . the work has just begun
• Frequent personal updates from CEO (letters, one-onones, etc.)
• “Insider” status – they hear the news FIRST
• Find ways to involve them based on their needs
• Mini-internships or “go alongs” can be very effective
Insiders Out:
The Ambassadors Program

Community liaisons can be the best
communications channel ever!
• Takes time and careful management, but pays
huge dividends


The true value of this program becomes
evident when you have a crisis and need to
get truth to the community
OR when you have an issue and need to
build grassroots support
Outside ambassadors

Find the people in your HCO who know the
people out in the community
• Begin with audit of who’s involved in what – and
don’t just ask management

Invite participation, outline role clearly,
provide incentives
• Most important incentive is feeling of
“contribution”
• “Ambassador” title and a plaque also help!
Outside ambassadors

Liaisons’ primary role: LISTEN
• Early warning system for emerging issues or
anti-HCO sentiment
• Need easy mechanism for getting info and
feedback to PR
• Personalized facet of environmental scanning, to
add real life reality to the data

When needed, liaisons can also deliver
messages – but must be done without
compromising their status in the group
Inside and Outside:
Partnerships

Sponsorships -- $$ in return for a logo (one
among many) on a 5K Walk T-shirt
• ROI negligible

Partnerships – long-term side-by-side
commitment that builds trust and
relationships
• You’re OUT THERE, being visible and credible
• Your people work side by side with other
community leaders
• The ultimate win/win
The Partnership Paradigm:
It takes hard work





“Mission” goes real-time
Begin with the community’s need (not the
HCO’s agenda)
You may need to lead the community needs
assessment (which is a great position)
ID problems which can be solved at local
level
Focus on healthy communities
Partnership principles

Pick the problems that you are most suited
to address
• The HCO can provide brains, or brawn or bucks
– or all three

Find one or more appropriate partners
(generally local, but other sources can
support with funding – i.e., RX companies)
• Media outlets can be great partners – just be
equitable

Manage the partnership like a business –
measurable objectives, biz plan, monitoring
and evaluation
And make sure the Board is
involved, too

Board members are from and of the
community – built-in credibility
• Board CR Committee should take the lead
– Opinion leader visits, briefing lunches/breakfasts
• All Board members should have briefing cards
and info updated regularly

And finally – don’t neglect health
education/prevention programs
• Whether inside out, or outside in, they impact
reputation and market share
PART TWO:
Managing a Crisis
to Protect Reputation
Media relations:
Last step in building reputation,
first step in protecting it


Once the foundation programs are in place, and
relationships strengthened, a proactive media
program is a valuable tool
The upside of media coverage:
– Credibility, reach (broad and narrow), cost effectiveness

The downsides:
• Lack of control (timing, full story, accuracy)
• Contradictory messages may be included
• Frequency – only one hit per outlet – although multiple hits
create bandwagon effect
Today’s media environment:





Is incredibly intense
24/7 means there is no “down time”
Incredibly competitive
Sensational sells (“If it bleeds, it leads”)
Reporters are cranky, harried, tired,
underpaid, feel unloved
• Pushed around by editors and news directors
Media Relations 1 and 2.0

Commitment to honesty, candor, access
• Commitment from senior management is
essential first step

Designated media relations function
• Protocols and policies
• Full-time manager and staff
• TRAINED spokespeople
Media Relations 1 and 2.0

Healthcare is STILL a hot topic – we’ve got the
human interest, the drama, the politics, the costs
• Great fodder for coverage – good and not so





Reporters, editors, producers NEED sources and
resources
Desksides, e-mail access help lay groundwork,
build relationship
Stay in touch without expecting coverage
Controlled vehicles (SMTs, RMTs, VNRs, ANRs,
etc.) can help deliver the story to national audience
Social media – despite the hype, the jury is STILL
out
• Powerful channels, yes; for HC messages . . . . .?
Two kinds of interviews:
risky and risky


A crisis or negative story has built-in risks
But even “normal” interviews can get out of
control
“It’s always a risk to speak to the press; they
are likely to report what you say”
Hubert Humphrey
To stay in control:

Preparation is ESSENTIAL
• What do you want readers/listeners to know,
think, feel
• What are your messages and proof points
• Get it down on paper
• Avoid JARGON
• Simplify, simplify, simplify
To get your message across:

Think in headlines
• Do NOT begin at the beginning --- use pyramid
approach.
• Then comes key fact, supporting facts and proof
points.

Anticipate what questions reporter will ask –
positive and negative.
“If you dread it, you’ll get it”
During the interview:


If you don’t know the answer, say so and
promise to get the information.
Don’t get provoked, don’t fake answers and
DON’T LIE or say “No comment.”
• Explain why you can’t answer – patient
privacy,legal restrictions, etc.


Don’t overanswer – answer and then stop
talking.
ALWAYS put the patient and family first.
Express sorrow and compassion.
A crisis only exacerbates risk

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:

Any nominees?
CPR =
Advanced media relations

It’s not “if” a crisis happens – it’s when and
how soon and how BAD is it
• 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 preexisting 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
Jack Welch and Fraser Seitel on
crisis management – the wrong
way
1.
2.
3.
4.
5.
6.
7.
Ignore the problem as it festers, or deny it
once it happens
Containment – give it to someone else to
solve
Tell half truths or LIE
Let bad news dribble out
Assign blame
MEA CULPA x 10
Paralysis
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
What organizations want from
PR: The 4 C’s

Companies in Crisis want Calm Counsel
from their in-house team and consultants
• Our collective wisdom abased on accumulated
experience
• Our third party objective viewpoint –
unemotional, providing clear guidance based on
expertise
• Arms, legs and warp speed communications
counsel and tactics that can turn things around
Companies in Crisis
want Calm Counsel

So we must provide that counsel
• Sometimes they may act on it sometimes they
may ignore it
• Even if our advice is not heeded, we still have go
do our ultimate best to help the organization
survive and ideally, move on to propser
• But above all else, what’s needed is calm . . . Or
the illusion of calm
What’s expected

Team that is THERE 24/7, on site, with no
whimpers
• Energy, realism, optimism
• A team that sees the BIG picture
– All the audiences
– The real issues and the IMPACT
• A team that’s one step ahead
What’s needed

A team that will help management
• Moderate their emotional responses, so anger,
fear or bitterness don’t drive decisions
• Face facts with straight talk, even if it’s not what
senior management wants to hear
• Keep all the balls in the air – remember the
things they may forget
• Put out the fire AND keep the plane in the air
and headed to its destination
Crises come in two varieties


The true surprise – urgent, big blow up,
trains JUST collided
Smoldering – the homegrown train wreck
• Been creeping up for months but was ignored or
denied
• Started as something manageable but wasn’t
managed, so it just grows and grows like the
bread dough in Lucy’s oven
And there are two responses to
managing crisis comms:


Utopia: there’s a plan, and the crisis fits
the plan
Reality: the crisis is a unique little firestorm
.....
BUT the institution is prepared with all the
tools in place AND has rehearsed via
scenario drills
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
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 deliver

“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 deliver

Allow 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:

Allow 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


Allow you to road test your team, your plan,
spot any inbred issues and deal with them
And provide 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: The crisis is NOW


When the crisis happens, the first pulse to
take is your own
Bring in outside counsel
• Internal staff simply cannot be objective and
immune to emotion
• Outside counsel can confront CEO, MDs, angry
Board chairman, et al
CPR: The crisis is NOW

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 NOW


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 NOW

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 NOW

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 NOW

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!!!!
The Crisis Interview





GET THE FACTS ASAP
Know the first question they will probably
ask and have your answer ready
Begin with expression of sympathy if
appropriate
Admit the error if there was one (you’re
going to settle anyway)
Remember who’s listening
•
•
•
•
Patient, family
Employees, physicians
Referring physicians
Community, potential patients
CPR: The crisis is NOW




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:
The Duke situation


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
Tried to use in-house staff to manage
emotional, angry physicians
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 (especially academic medical
centers) 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 that
performance-centered, reality-based
reputation building program so that the
goodwill bank will be as full as possible
when the crisis hits!
Bonus Points:
Legislative Relations
as an Extension of CR
Legislative relations is a
natural extension of CR
 Make it a priority
• Needs to be a clearly designated role of member of
management team (with responsibilities ranging from
ongoing legislative interactions to internal
briefings/training and legislative databases)
• Translate the hospital’s legislative position on national
issues for local press and editorial boards
• Make a government relations report a standing agenda
item at Board and management staff meetings
Legislative relations . . . .
 Make it a priority
• Involve trustees and management staff in setting
the policy agenda
• Take trustees and key managers on legislative
visits to the state and national capitols
• Regularly brief all members of the “family”
— employees, physicians, volunteers,
vendors/suppliers, patients. Don’t wait until
they’re needed to write letters or make calls.
Legislative relations . . . .
 Building real relationships with legislators
and staff
• Know the health care organization’s legislators
— federal, state, and local
• Identify “who knows whom” — which people in
the HCO (not just management) have personal
relationships with legislators and can serve as
intermediaries and endorsers
Legislative relations . . . .
 Building relationships
• Set up ROUTINE meetings with the CEO and
the health care organization’s legislators and city
officials
• Get to know the legislators’ staff members —
field reps at their local offices and administrative
assistants in the statehouse and federal offices
Legislative relations . . . .
 Building relationships
• Be helpful — offer legislators the chance to
address the HCO’s employees, medical staff ,
board members, or other influential gatherings
• Make sure your trade association keeps you
posted on the key issues and positions of your
state and federal representatives
• Consider establishing key contact programs,
modeled after those used by corporations
Legislative relations . . . .
 Continue the relationship
• Conduct briefings for legislators at the health
care organization at least yearly — and
– Make your schedule fit theirs.
– Provide updates on changes and achievements, and
share your position on pending or potential issues
• Take the lead in getting HCO competitors to
work together on key issues
Legislative relations . . . .
 Instread of focusing your message on what
the HCO needs – instead focus on how
what you want will affect people – the voters
 “Pre-qualify” potential partners and
advocates
• Through issues management function, identify
supporters
• Build relationships before they’re needed –
through CR 101