Communication & Crisis Mgmt in Vaccine PV
[dropdown_box expand_text=”What is Crisis?” show_more=”” show_less=”Less of” start=”hide”]What is a crisis?
Any event that comes to public notice and threatens the health or safety of individuals or groups, or the reputation or stability of a programme or organisation. Crises usually erupt suddenly and dramatically; they require rapid and effective response and communications (see section on crisis communications below for more on this).
Management of a crisis requires not only resolution of the crisis event, but also very skilled management of the often intense emotions and outrage that the public may feel.[/dropdown_box]
[dropdown_box expand_text=”Unexpected or Not?” show_more=”” show_less=”Less of” start=”hide”]Unexpected or not?
Crises are generally regarded as sudden and unexpected, but many arise from conditions where there has been a history of neglect, carelessness or poor safety management; where warning signs and vulnerabilities have been ignored. Many crises were long in the making and were waiting to happen; many of these could have been prevented or the damage they caused reduced through early awareness, planning and action.[/dropdown_box]
[dropdown_box expand_text=”The purposes of crisis management” show_more=”” show_less=”Less of” start=”hide”] The purposes of crisis management
- To prevent crises happening
- To manage crises that do happen rapidly and effectively, minimising damage to all parties, resolving problems and recovering stability and credibility.
[dropdown_box expand_text=”Prevention” show_more=”” show_less=”Less of” start=”hide”] Prevention
Every system and organisation has actual or potential weaknesses and vulnerabilities arising from internal and external sources. Every aspect of management and safety systems, transport, storage, communications, data collection; staff motivation, knowledge and commitment; quality control, supplier management, and so on, needs to be examined for any potential failures, weaknesses or problems that might lead to future crisis: what could possibly go wrong and how can it be anticipated and prevented?
The second aspect of prevention is being in a high state of alert for early, maybe weak signals of problems: a handful of AEFI or ADR reports; a newspaper report of patient injury; new safety concerns emerging in another country; unexplained failure of treatment; anything that could escalate over time into a major crisis. Bureaucracies tend to stifle dissent and minor signs of possible trouble, sometimes leading to explosive problems later on: when, as so often, there were early signs of problems, how can an organisation hold up its head and convincingly explain its neglect of them?
The third element of crisis prevention is reputation. An organisation that has open communications with its audiences, conscientiously explains what it is doing at all times, is known and trusted, will suffer far less in crisis than one that is regarded as remote and secretive. This is especially true for public health, where interventions are sometimes controversial and a great deal of preparatory work may be necessary to ensure there is acceptance and goodwill when vaccination or other interventions actually take place. A regulator or ministry of health that has thoroughly and openly communicated about the risks of medicines and its activities will be subject to much less criticism than one that has been defensive and distant; indeed some crises arise simply because patients, or the media, or health professionals have been kept in the dark about what is going on and are angry and hostile when the facts eventually emerge. All organisations need to be actively communicating with their audiences at all times, especially target populations and the media; when crises emerge, a familiar voice is more likely to be trusted, even forgiven.
[dropdown_box expand_text=”Expecting the worst” show_more=”” show_less=”Less of” start=”hide”]Expecting the worst
In preparing a crisis plan, the very worst possibilities in every aspect of an organisation’s business need to be reviewed:
- Core business: major accidents, injuries, deaths for staff/customers/patients/the public at large/the environment
- Facilities: explosions, toxic leaks, fires, theft, robbery, cold-chain or storage failure
- Technology: data corruption or loss, data theft, system outages, power supply, hacking
- Management and personnel: sickness, death, fraud, theft, corruption, carelessness, laziness; succession planning, availability and deputising
- Systems, including quality and safety systems: out-moded, fragile, inconsistent, disregarded; unsupervised or poorly enforced; lack of staff training
- Reputational: public challenges about ethics, practices, professionalism, secrecy
- Natural disasters: earthquakes, tornadoes, floods, tsunamis
These lists may seem to cover dramatic and unlikely events, but they are happening to all kinds of organisations all over the world every day. These lists do not include kidnapping, hostage-taking, shootings and other exceptional events, but some organisations should be preparing for these too (schools, banks and embassies, for example).[/dropdown_box]
[dropdown_box expand_text=”Identifying and assessing risk” show_more=”” show_less=”Less of” start=”hide”]Identifying and assessing risk
Every organisation needs to review its entire range of operations and relationships to identify and assess the risks:
- What could go wrong?
- How likely is the problem?
- How serious would it be?
- The first priority is to discover the most likely and the most serious risks and:
- Investigate how the likelihood can be reduced (prevention)
- Plan for managing the impact and reducing its seriousness in the event of a crisis
[dropdown_box expand_text=”Familiar example: Fire” show_more=”” show_less=”Less of” start=”hide”] A familiar example: Fire
Fire is a familiar, common risk and a frequent cause of injury, death and financial loss. We’ll examine this as a useful and simple illustration of the entire set of principles. Having identified the risk of fire as moderate, at least, and the consequences as potentially very serious, the responsible crisis manager will:
- Eliminate all fire hazards, such as dodgy electrical wiring, dangerous cooking practices, smoking or naked flames in vulnerable areas
- Ensure that inflammable or combustible materials are stored securely and safely
- Provide fire-detection equipment such as smoke-detectors
- Provide fire suppression measures, fire extinguishers, hoses, and so on
- Ensure there are safe and accessible fire escapes for staff and visitors
- Establish and communicate details of evacuation procedures, management responsibilities, assembly points, roll-calls, to everyone
- Brief and regularly train everyone in emergency procedures with live practice
So, here, we can see the whole crisis management process:
- The risk is identified
- The risk is assessed as serious
- Preventive measures are installed
- Procedures and equipment are put in place for dealing with emergencies
- Everyone is informed and rehearsed in what to do in an emergency
We know, only too tragically, what happens when these steps are not followed in offices, clubs and homes. (Do you have an evacuation plan for your family and children?)[/dropdown_box]
[dropdown_box expand_text=”A sudden batch of unexpected and serious AEFIs or ADRs” show_more=”” show_less=”Less of” start=”hide”] A sudden batch of unexpected and serious AEFIs or ADRs
This is one of the commonest causes of crisis in pharmacovigilance for which every programme manager and PV centre should plan. The issues and relationships and communications are more complex than in the case of fires, but the basic crisis management process is exactly the same:
- Identify the risk: unexpected injury to vaccination subjects and consequent public outrage
- Assess the risk: probable and serious
- Initiate preventive measures: a constant state of high alert and attention for any evidence or allegation, however seemingly weak, from any source, of unexpected injury or death or other problems
- Establish procedures for rapid investigation, review, analysis and decision-making about problems when they do occur, and for communication with all stakeholders (this may require, for example, immediate access to pre-designated technical experts to be sent out into the field; see Crisis Communications section below).
- Review and rehearse procedures prior to crisis erupting
[dropdown_box expand_text=”Crisis-prone organization” show_more=”” show_less=”Less of” start=”hide”]
Some organisations are much more likely to experience crises than others, especially those that are not aware of or are careless about the intrinsic and extrinsic risks in their everyday operations. Over-worked or poorly motivated staff represent a risk that any organisation needs to address if it wishes to avoid crisis; inadequate safety systems or a cavalier attitude to them frequently explain erupting crises; deafness to dissenting opinions, or dismissal out of hand of rumours, anecdotes or media stories can be fatal mistakes.
The best organisations have a crisis-prepared culture: while constantly trying to reduce risk in their operations they also ask frequently, what could go wrong? and they react by minimising risk and preparing for the inevitable occasion when something will go seriously wrong. Risk can never be reduced to zero; crises can never be eliminated, but measures can be taken to reduce potential damage.[/dropdown_box]
[dropdown_box expand_text=”Management planning” show_more=”” show_less=”Less of” start=”hide”]Management planning
Crisis planning requires seriousness, constant discussion and review, and investment. Someone needs to be responsible for an organisation’s crisis planning, the larger the organisation, the more senior the person. Everyone in the organsiation must be involved in identifying and assessing risks and in agreeing to collective action to reduce risk and prepare for crisis. Everyone needs to know what to do at the first sign of a crisis erupting and what to do while it is in progress. Separate plans for every kind of crisis need to be prepared. The whole process needs to be live and active with review and practice at least twice a year.
[dropdown_box expand_text=”Crisis communication overview:” show_more=”” show_less=”Less of” start=”hide”]Crisis communications overview:
A crisis is likely to be a very public event, with journalists, maybe politicians, and certainly the general public paying intense attention to it. There must be an effective communications plan in place:
- Designated spokesperson and deputy, available at all hours during a crisis
- Established contacts and channels of communication for major audiences
- Facilities for rapid electronic, telephone or personal communication with critical audiences
- Effective means of keeping staff and key affiliates in the picture
An organisation must have a policy about its crisis communications, ideally including a commitment to rapid and open information about what is happening and what is being done to manage the crisis. Organisations should pay attention to the suffering, anxiety or outrage being felt and expressed in public, and respond to them with credible, empathetic and serious messages. Distance, coolness, secrecy are disastrous tactics in almost all crisis situations. The priority is for frequent communication, even if it is only to describe what is being done to resolve the crisis. Never, ever say, ‘No comment,’ to enquiries; it will just make everyone think you have some dark secret to hide.
Many organisations (like PV centres) are more or less invisible to the public most of the time; it is only at a time of crisis that they are thrust onto the public stage. Great public relations benefits at all times, but especially during crises, accrue to organisations that have an established level of public profile and credibility throughout the course of their normal business. An organisation that is known and trusted is likely to suffer much less damage at a time of crisis than one that is unfamiliar and not trusted. An active media relations programme will benefit most organisations all the time, and especially during crises.[/dropdown_box]
[dropdown_box expand_text=”The fallacy of denial” show_more=”” show_less=”Less of” start=”hide”]The fallacy of denial
‘It won’t happen to us,’ is a common response to discussion about the risk of crises happening. It belongs to the same category of human thinking as those, in risk-prone areas, who do not insure their houses against floods or earthquakes, or cancel their insurance when memory of the last disaster fades. That there has never been a crisis does not mean there won’t be one tomorrow. The risk is ever present; low probability does not mean it won’t happen. In Vaccine PV and patient safetyeverywhere, the probability of crisis is moderate to high, and plans must be in place to manage it.
Crisis Communications are dealt with in much greater detail in the section below.[/dropdown_box]
[dropdown_box expand_text=”Summary” show_more=”” show_less=”Less of” start=”hide”]Summary
- All organisations are at risk of crises of one kind or another
- The most likely and the most serious potential crises need to be identified and their risks assessed
- Specific crisis plans need to be made for each identified crisis, including both preventive measures where possible, and details of how the actual crisis would be managed
- Everyone in the organisation needs to be familiar with the plans and know exactly what to do when a crisis strikes
- A plan for internal and external crisis communications is essential
Organisations with a crisis-prepared culture, including extensive planning, will be less vulnerable to crises and will manage them much better when they occur.[/dropdown_box]
Expecting the Worst is a full-length crisis management manual produced by Uppsala Monitoring Centre specifically for organisations involved in pharmacovigilance and patient safety, hospitals, public health programmes and the pharmaceutical industry. Enquiries: firstname.lastname@example.org
There are also immense resources available on the internet that simple searches will provide access to.
[Crisis communications section follows…]
This is a much condensed version of material that appears in the UMC’s crisis management manual, Expecting the Worst
[dropdown_box expand_text=”Introduction” show_more=”” show_less=”Less of” start=”hide”]
Objective: To provide guidance, advice and skills that will enable personnel in vaccine and other public health programmes to plan and implement effective communications through traditional and modern media to prevent crises and to manage them positively when they occur.
Planning for communications in crisis is one element of a full crisis management plan that includes:
- An active crisis management planning group
- Risk assessment
- Risk mitigation and management planning
- Detailed planning for the management of all aspects of all possible, probable crises, including the vital element of internal and external communications.
Few crises are actually sudden, unpredictable events. There are very often antecedent conditions that contribute to the likelihood of a crisis; very often early warning signs that, if noticed and dealt with, might have prevented later disaster. Weaknesses in cold-chain transport, poor staff training, or inadequate community preparation are, for example, frequent causes of major public health programme problems. Good crisis management will anticipate and deal with such issues before they become dangerous. All staff, especially front-line and field staff, often see weaknesses or risks that worry them; good crisis management ensures that there are open lines of communication so that these concerns are rapidly shared with senior managers before they threaten safety. Huge disasters like the Gulf of Mexico oil-spill and the 1986 US Space Shuttle explosion might have been prevented if the views of junior staff on safety issues had been given serious attention. Such open lines of communication and attention to small issues are essential parts of mature crisis management and prevention.
Communication is an essential element in planning for crisis management and the actual management of real episodes. This section of the Toolkit summarises best practice in creating or reviewing the communications aspects of crisis plans, and provides some guidance for action. The principles and suggestions will inevitably need to be varied in the context of different organizations, cultures and languages, but the core messages are universally applicable.
This material is relevant to the management of crisis in general (fire, flood, system failure and so on), as well as crises specific to the field of healthcare, vaccines and patient safety in general. In this section the emphasis is on crises relating to vaccine safety issues, but the principles and guidance apply equally to all other types of crisis.[/dropdown_box]
[dropdown_box expand_text=”Communication Skills” show_more=”” show_less=”Less of” start=”hide”]
Not a game for amateurs!
Communication is a highly skilled and specialist activity.
It requires knowing and understanding the hearts and minds of audiences and very good methods for finding out what effect communication has had (see Communications Section of the Vaccine Pharmacovigilance Toolkit).
Effective communications should not be confused with the corruptions of the many methods of avoiding or manipulating the truth, commonly known as ‘spin’. Inevitably, the truth will emerge in due course, and the spinners are revealed for what they are; at best, purveyors of half-truths, at worst, deceivers and liars.
Every organization will hope to portray itself in a positive light. That may well require the discomfort of admitting error, for by admitting it, in the long run, reputation will be enhanced and will attract respect. Disguising error is a recipe for disaster. All organizations can greatly enhance their reputations by handling even culpable crises well, especially by showing compassion for those who have suffered.
A great deal can be learnt about crisis management and crisis communications by watching politicians, officials and businesspeople actually managing crises in real life, when many of them so often perform so badly.
All the principles of good communication, outlined in the Communications chapter in this Toolkit, are relevant to managing crises.
[dropdown_box expand_text=”Golden Practice” show_more=”” show_less=”Less of” start=”hide”]
Some or all of the following types of response and behaviour will give you the best chances of communicating effectively and being viewed positively when there are problems or crises. More details appear later in this section.
- Respond quickly
- Acknowledge that there is a problem
- Express concern for those who may have suffered
- Acknowledge and take account of the emotions generated in the crisis and respond to them
- Tell the truth as far as it is known
- In ambiguous or uncertain conditions be frank about unknowns
- Explain what you are doing to take effective action to investigate or resolve the problem, or to prevent its effects spreading
- Keep in constant touch with your audiences through as many channels as possible
- Promise regular updates and keep the promise
- Encourage contact; promote your hotlines, websites and other channels
- Acknowledge and accept responsibility when you are fault, apologise
- Welcome and embrace journalists and media people
[dropdown_box expand_text=”Communicating Risk & Uncertainty in Vaccine programmes” show_more=”” show_less=”Less of” start=”hide”]
Communicating Risk and Uncertainty in vaccine programmes
Communicating risk and uncertainty are complex matters. Please refer to the material in the Communications chapter, Risk Communication section here [link], for more discussion of this.
Best practice in communicating risk issues is summarized in these points from Covello and the US National Research Council. In general, risk communication should:
- relate the message to the audience’s perspectives, emphasizing information relevant to any practical actions that individuals can take, be couched in clear and plain language or be represented in appropriate visual materials, respect the audience and its concerns, and seek strictly to inform and enlighten them
- clearly state the existence of uncertainty
- avoid risk comparisons which trivialize the concern (road accidents and vaccine injuries are not usefully comparable, for example)
- ensure completeness, including the nature of the risk and harm, the nature of the benefits that might be affected if the risk were reduced, the available alternatives, acknowledging uncertainty in knowledge about risks, harms and benefits
- be balanced and honest (framing of risk)
- focus on the specific issue of public concern (which may or may not be a direct vaccination issue)
- pay attention to what the audience already knows, assumes or believes
- tailor the message to the specific needs of the audience
- place the risk in appropriate context (risk of disease, risk of immunisation, risk to individual and community, and so on)
- messages should contain (at least) the specific information needed to resolve the decisions that members of the audience face, with more available for those that want it
- material should be hierarchically organized so that people who only want general answers can find them quickly, and people who want details can also find them
- be respectful in tone and recognize that people have legitimate feelings as well as thoughts (technical and emotional intelligence)
- be honest about the limits to scientific knowledge and the probability of disagreement over some issues even among experts
- consider and address the broader social dynamics in which risks are embedded (rumour, scares, cultural or religious issues, for example) and,
- be subjected to careful empirical evaluation, feedback and refinement through persistent questioning and testing in interaction with others
[dropdown_box expand_text=”The Crisis Communication Plan” show_more=”” show_less=”Less of” start=”hide”]
The Crisis Communication Plan
The communication plan has one main objective: to ensure effective communication with all audiences during crisis to reduce damage and speed solution.
It is necessary to remember at all times that communication is reciprocal, a two-way process. An organization which becomes fixed on transmitting messages only will miss vital incoming intelligence and frustrate those who whish to enquire, protest or seek information. Creating genuinely two-way channels will give confidence not only that messages are being broadcast, but most importantly, they are being understood, and that there is a channel for active contribution. Listening is not always the natural behaviour for officials or big organisations, but it is often likely to be more productive than talking, especially when other parties have very strong feelings and much they want to say.
The plan needs to cover these aspects of the communication process:
- Identifying the targets for communication (WHO)
- Identifying the methods for communicating (HOW)
- Identifying the contents of the communications (WHAT)
- Identifying the timescale and priorities (WHEN)
In section 6 below, we identify the range of target audiences we may have to communicate with. We stress that a relationship should be built up with representatives of each of these audiences in advance of an incident so that effective lines of contact and communication are already in place. Ideally a named member of the Crisis Management Team should have a specific responsibility for each audience.
Knowing WHO is to be the target for communications goes a long way towards deciding the HOW. Programme personnel may expect to receive information, for example, via email or team meetings, whilst the media will expect to get printed or email press releases, have telephone access and opportunities for personal briefing and interview. Each specific audience has specific requirements which they can tell you about. The Plan should address these needs in advance and have prepared actions and channels which swing into operation when an incident occurs.
News and opinions move round the modern world at fantastic speed. While TV and radio remain important, the role of printed media is declining, though their web-based services are increasingly popular. News channel websites and their widespread links to social networking media are very influential.
The electronic social networks (Twitter, Facebook, YouTube, and many more) are increasingly the media of choice for tens of millions of individuals. Organizations concerned about their reputation and keen to respond effectively when things go wrong will be tuned into these networks as part of their intelligence-gathering activities, and using them proactively when they want to reach large audiences (more below).
Again, in an ideal world, the target audience, or at least their representatives should be involved in the design of these communication processes, (journalists and consumer groups are obvious examples), as a matter of routine and long before any crisis emerges. That way they will display some ownership of the actual process in operation. Some of the issues specific to particular audiences are covered later in this section, but first let us address the purpose of the communication. As well as knowing who we are communicating with and how, it is vital we understand our objective, the WHAT, as this too will have a fundamental bearing on design and implementation. [/dropdown_box]
[dropdown_box expand_text=”Quality of Response” show_more=”” show_less=”Less of” start=”hide”]
Quality of Response
The golden practice pointers above set the standard for good crisis communications. Two elements need further discussion: first the attitude and emotional tone of public communications which will determine the second, the initial response.
Coombs identifies ten possible responses which govern the content and cultural aspects of an organization’s actual crisis communications. This is a modified version of his list:
- Full Apology – taking full responsibility, asks forgiveness and promises remedial action and possibly compensation for the victims.
- Active empathy – for victims and compassion for their suffering without necessarily accepting responsibility for their cause.
- Corrective Action – the organization does not necessarily assume blame but repairs the damage and guards against repeat occurrence.
- Ingratiation – emphasizing and publicising its previous good record to shift attention from crisis; praising or appreciating stake-holders.
- Justification – attempting to minimize the crisis by, for example, citing similar mistakes by others or showing how impossible anticipation and prevention would have been.
- Excuse – evading responsibility by citing forces beyond its control; by implicating others (scape-goating).
- Denial – contradicting the scale or impact of the events, or that a crisis exists.
- Attack the accuser – defending by blaming the media, the victims or others for the crisis.
- Victim Status – explaining that the organization is also a victim of the crisis.
The key influence in each of these is the extent to which an organization is willing to accept responsibility and wishes to take positive steps to recover. Responses 4 to 9 are unattractive because they carry with them the probability that they will in fact make the crisis worse by provoking further conflict and increased mistrust, even if there is a grain of truth in the claims.
Response 4 may have some value, but not on its own. It may do no harm to emphasize a good safety record, but it may not impress the actual victims, or resolve the immediate problem unless accompanied by a fuller response.
This suggests that responses 1, 2 and 3, or a combination of them, will most often be the best response, dependent upon the establishment of responsibility. An apology does not necessarily mean taking responsibility: it can be an expression of sorrow that the event has occurred or that people have suffered. An apology is a sign of strength, not weakness. Apart from a basic response which encourages confidence, all audiences want speed and openness – crucial qualities for an organization that is going to come well out of crisis.
Within this overall framework of positive response the communication plans have to be built to ensure:
- all stakeholders’ concerns are understood and catered for (empathy)
- communications will be adapted to the specific needs of those audiences with particular regards for speed and the appropriateness of media (tailoring)
- a priority order is established to determine the sequence in which messages will be processed (priority)
- communication considerations are included in all the actions and reviews undertaken during and after the incident; little or nothing happens behind closed doors (integration)
Crisis Communication Plans should begin with preparing for the initial response. This should be rapid, honest and empathetic. Once an alarm is raised leading to the initiation of crisis management procedures, the organization must be seen and heard to act quickly, purposefully and consistently. This requires the early and authoritative articulation of an acceptable response and the choice of the speediest and most appropriate media.
The table below provides samples of positive approaches (here, assuming a senior manager is speaking, when the cause is uncertain or unknown)
The initial response needs, therefore, to have the authority of the crisis management team, or at least its leader to ensure that the entire public management of the crisis heads in the correct direction. One way of facilitating this is to have a model response agreed at the planning stage. Different formulae for responses can be developed from the conclusion of the risk assessment and for each crisis scenario.
Planned responses could be the basis of a live interview, news release, web page, press advertisement or a letter to consumer organizations, or a communication to any other audience, if such actions were judged necessary.
Once the response has been published or broadcast, all members of the organization dealing with external contacts need to have copies of it and to be disciplined in sticking to that formula in the short-term (until new developments take place), or the organization will appear incoherent and inconsistent, and risk misrepresentation. Programme staff cannot be free to express their personal views in public, though they should have every opportunity to inform their managers of their opinion about the crisis and its causes; field staff often have unique and relevant comments to make.
The standard for the initial response is that it Tells The Truth as we know it. It should establish only those facts which are beyond question, it should never involve speculation and it should always describe the actions taking place as a response. If applicable it should also address any emotional issues (not least latent or evident outrage) without necessarily accepting the blame unless liability is manifest. ‘We don’t know’ is a reasonable response in the first instance, no matter how strong the pressure for details becomes. However, convincing descriptions of what actions have been taken to gain knowledge are imperative to support the initial stance. (The delay caused by searching for an airplane’s black box is commonly understood: finding the ‘black box’ of vaccine safety intelligence or data requires the same explanation and patience. This also requires having an expert team standing by to begin immediate investigation; that needs planning.)
One issue that needs constant attention and management is the popular assumption that two events that take place close in time must be causally related. This is especially true when, for example, a child falls ill shortly after vaccination with symptoms that may or may not be scientifically attributable to the vaccine. Any tendency for programme managers or the public to jump to unsound conclusions has to be managed and resisted.
Though things will change, the requirement to be consistent remains. One way of achieving this is to manage the flow of communication via a database of Lines To Take.
Lines to take
Whether the database is a sophisticated affair held on a computer, or simply wall-charts or message boards the principle is the same: each time a response is authorized it is logged as an approved Line to take. All new requests for information, questions or challenges are then checked against the database. If the request repeats an earlier one then the line to take can be reproduced. If not, authority needs to be sought for a new response – assisted by reference to the growing database. The lines to take can be modified and adapted for a specific audience, but the central response needs to be consistently maintained or deviance will undermine the coherence and impact of the communication plan.
An example of a database extract is shown in the table below.
|Question||Source/date of enquiry||Line to take||Source/Date of response|
|Is there a specific, known risk to children from this vaccine?||Programme staff, enquiry taken by phone 1/2/13||Up to 10% of children may have mild headache, slight fever or tiredness for up to 24 hours; 1 child in about 240,000 may have more serious symptoms that require medical attention||Professor Chang fax dated 2/2/13|
|Has any child died as a direct reaction to this vaccine?||Feature editor Daily News by phone 2/2/13||Nowhere in the world has this happened, to the best of our knowledge||Crisis team leader document dated 3/2/13|
Table: Lines to take
The database needs to be reviewed daily (hourly in fast-moving crisis) to update information and actions and to initiate follow-up activity.[/dropdown_box]
[dropdown_box expand_text=”Audiences” show_more=”” show_less=”Less of” start=”hide”]
Particular audiences all require that their specific concerns are addressed and that communication is adapted to their own requirements. Some of the general principles are covered below.
Please see the material in the Media Relations section, in the Communications chapter [here] for a fuller treatment of these issues.
Journalists are human beings and will pay respectful attention to those who have made the effort to get to know them and communicate openly with them. It is up to us to take the initiative and build relationships with these vital intermediaries long before crises happen.
First signs of sudden crises will often come from media stories or enquiries from journalists. (These days, they may also come from electronic social networks, blogs or other internet sources).
Key players in any crisis, journalists have the power to communicate with very large numbers of people very quickly. If our early responses are not quick and to the point, credible and authoritative, we may lose control of the public perception of the crisis, and be fighting a rear-guard action throughout.
Media priorities will not always be the same as ours, nor will journalists always endorse on perspective, nor report on us without adverse criticism, but without them we face an uphill struggle.
The use of consistent spokespersons, able to build a real rapport with media representatives, will facilitate improvements in the relationship.
We cannot emphasise strongly enough the vital importance for all public health programmes and organizations of having a long-term media relations strategy and of establishing sound, working relationships with key journalists, publications and broadcast media, irrespective of crisis situations.
A log of media contacts, questions and the replies to them should be kept on a separate database, or incorporated with Lines To Take.
A note on ‘No Comment’
Nothing will antagonize journalists (and the public) or raise suspicions of defensiveness or cover-up more than this panic-stricken and unprofessional response. Every media contact or opportunity should be used productively for saying something, ideally something which defuses some aspect of the crisis or, at other times, which provides positive information about the organization.
The initial responses above show how it is possible to make no comment on a particular event without appearing to close the doors on communication, If there’s nothing to say, then we must explain why and what is being done to gather information so that a comment can be made. NEVER say, ‘No comment’.
All employees and programme staff have the potential to be useful and to act as goodwill ambassadors during a crisis, or they can undermine the organization’s good efforts – consciously or unconsciously. No assumptions should be made about the level of information among the workforce who may be as mystified, angry or shocked as the public. They need rapidly to feel informed and secure. They need to be disciplined regarding speculation and rumour and alive to opportunities to spread useful information. In a crisis-prepared environment, people feel secure and positive – and want to help.
Involvement and inclusion will do most to secure the support of employees. They will be looking to their leaders for clear and authoritative direction. Good planning and early implementation of internal communications will be based on a desire to reach all employees as quickly as possible with the core messages as they emerge. Methods of mass-notification need to be on stand-by.
It’s particularly important that, if at all possible, employees do not learn about their own organization’s problems from media (a very common experience).
Consumers & patients
Consumers (the general public) and patients in general or specific groups will often react on a predominantly emotional level rather than a rational level to a perceived crisis. For the reasons outlined in the section on risk (Communicating Risk, here), people in general find it challenging to assess risk coolly and very quickly tend to apportion blame. They may also be alarmed at the possible implications of the crisis for them or their loved ones. These factors taken together mean that it is vital that information is imparted to consumers quickly and sensitively, through channels that reach them effectively, in ways they can process easily, and which address their feelings.
Pharmaceutical Companies/Vaccine suppliers
Companies have their own needs which may be at variance with the agency or facility that needs their urgent collaboration. They view all information through specific restraints, especially commercial and legal. Commercially they need to protect their assets and retain profitability, and legally they are bound by regulatory guidelines and codes, and concerns about liability.
Effective collaboration with companies at times of crisis is only likely when the relationship respects these factors. Some information may need to be protected within commercially confidential forums, without being made freely available. Such a situation needs very careful handling as withholding of information or sources can give rise to damaging suspicions of cover-up or special-pleading. As far as possible, suppliers and manufacturers must pursue a policy of complete openness and disclosure.
Communications which seem to be primarily concerned with protecting an organization from litigation or reducing liability will lead to public criticism, if they area not balanced by more generous considerations and information. Recent years have seen pharmaceutical companies lose credibility and public trust by not being quick and open in their responses, so crisis communications become even more demanding. Programme staff need to have lines of communication with manufacturers and suppliers open and active before any crisis emerges; they should share and agree those aspects of their crisis planning that are relevant.
The range and volume of materials available to health professionals makes it impossible for them to be up-to-date with all information and means that even critical communications may be missed or lost. Very efficient and effective systems of communication need to be in place for notifying programme staff as well as doctors and pharmacists of any crisis or controversy. Major problems have been caused in the past when patients or journalists have had information about drug or vaccine problems before staff on the ground. A general sense of disillusionment and anger can quickly flourish in such circumstances. A range of different methods and channels is essential to ensure reasonably comprehensive coverage.
Programme staff may feel implicated personally in any crisis incident and their own emotional reactions will require attention. They may feel caught between the competing demands of emotional patients, harassed officials and remote managers. Their emotional needs may be as great as those of patients or the general public.
Effective processes for communication with large numbers of people need to be in place. Broadcast email and fax are obvious methods, with postal back-up as an essential safety-net. These have the disadvantage of possibly being lost in the mass of communications received by professionals, and more targeted and effective methods are also needed, including SMS, telephone, personal messenger and social networks where links and contacts are established.
Personalized contact seems to offer greater hope of influence than mass mailings and emails. While such individually-targeted communications have great resource implications, they have potential for much greater impact.
The influence of lawyers is often concealed, but experience of other crises and fear of legal action may colour many of the actions and decisions taken by stakeholders.
Wording of advice and warning notices, reluctance to share information, denial of responsibility are among the issues often attributed to legal necessity, and many organisations will deny that they have discretion in such matters which may be of acute public importance. ‘Subject to commercial confidentiality’ or ‘in the hands of our lawyers’ can be as damaging as ‘no comment’ if such pronouncements are not explained with great care and imagination. This is a further example of the need to be able to convey information about context rapidly and convincingly, similar to issues regarding vaccine safety in general. Waiting for legal advice, even following it sometimes, may not always be in an organization’s best interest.
Politicians and Government Bodies
These players can be very influential. They may wield immense control over the public agenda. Understanding their viewpoint and appreciating their constituency will enable quality communication to take place. Much can be gained by inviting them into the process, so that they identify with the solutions as well as the perceived problems. As allies, with the potential to use their power to influence other stakeholders, politicians are likely to be much less understanding and supportive if they have had no knowledge of a programme or organisation prior to a crisis, or have unrecognised prejudices about it.
Political agendas, however, may put politicians in conflict with regulatory authorities or other public bodies, and freedom to determine the outcome of a crisis may be compromised by considerations quite outside the medical or scientific arena. Politicians, like the public, have a tendency to want instant and complete answers and solutions. They will sometimes have an irrational ‘knee-jerk’ reaction on matters they really do not understand or make the dishonest and impossible promise that they will take action ‘to make sure this never happens again.’ Here the skills of the communications team may be strenuously tested. Decisions or communications that might lead to unrealistic public expectations or negative public responses must be resisted.
Pressure groups cover a range from responsible, conscientious consumer groups, cultural and religious communities, to quirky, fringe activists. The crisis management team needs to bring together previously-gathered intelligence about the nature of these groups and their motives, and to activate new or established channels of communication. If a community has doubts about vaccination on the basis of their religious principles, then a lot of preliminary work has to be done to ensure that there is not a damaging public outcry when a programme is implemented.
All over the world there is increasing pressure for greater patient-involvement in medical therapy and policy. A thriving international network of patient organisations means that there are many individuals who are extremely well-informed about vaccines and safety matters, as well as many who are knowledgeably-critical of how public health programmes are conducted.
Collaborative groups can be treated like other stakeholders, but critical or hostile groups need sensitive and expert handling, and long-term familiarisation. It’s particularly important to remember that those implacably opposed to vaccination on the basis of their personal values or faith will not be impressed by safety data; their position is based on quite different and profound emotional and moral issues that must be addressed directly. An expert individual contact within the communications team maybe an essential provision.
Other important audiences
The crisis management planning process should have identified other important audiences including, for example, expert external consultants (who may be needed urgently to analyse obscure events or data) or hospital directors round the country or agencies in other countries who are dealing with a similar crisis. The needs of these audiences and methods of contacting them need equally meticulous advance planning.[/dropdown_box]
[dropdown_box expand_text=”Methods” show_more=”” show_less=”Less of” start=”hide”]
Knowing your audience and planning the communication content are important, but the appropriateness and effectiveness of the methods for communication are also vital.
In a world stuffed to bursting with information, advertising and communications of all sorts, there are three essential principles to remember:
- amidst the noise and busyness and clutter of the world it’s extremely difficult to get and hold anyone’s attention at all, let alone for any length of time. Attention spans are short.
- one-way communication is no communication; we must know what effect our communications are having and what our audiences are thinking. Retrieving significant feedback requires at least as much skill as making the initial communication. The communications loop must be completed.
- One communication is no communication: repetition is what makes a mark with preoccupied human beings. For each audience, we must identify the various channels through which they may be reached and use several of them so that the probability of the message bring noticed is increased as it arrives from various directions, several times.
Below we discuss some of the common methods of communication during a crisis.
Whenever a short message needs to be sent numbers of people – employees, citizens in a community or metropolis, all doctors, or pharmacists and so on, an automated mass notification, by text message, phone, email or social network, is the most effective and efficient method. This requires the setting up of a comprehensive database of all possible contacts, coded in relation to all possible emergencies. Implementing mass notification (though not control of the contents of the database or the message) can be outsourced.
Large audiences can be reached through printed and broadcast media, of course, and through intermediaries, such as local village heads, teachers, community pharmacists and many others.
Dark Websites and related channels
Many organisations have one or more fully functional, up-to-date dark website/s which remain inactive and inaccessible until required in an emergency. These may include such elements as:
- Crisis communications contacts for the programme or the organisation
- Hotline numbers
- Draft news release or public statement templates
- Outline of corporate activities, standards, products and services (‘Who are we?’)
- A range of safety guidelines relating to known and potential problems
- Links to other sources of information, expert opinion and so on (including the organisation’s main website).
It is also possible to use the main website as a communications tool in a crisis, especially posting regular updates on the homepage, or activating passive pages with the kind of information that might otherwise be on the dark site.
There should be the possibility of visitor interaction and comment. This is taken to a more sophisticated level if the CEO or spokesperson has a blog or a presence on one of the social network channels. RSS feeds and podcasts should be considered too.
The purpose of all this is to ensure the largest possible numbers of concerned people have access to the latest information and that channels of communication in both directions are as open and available as possible. Such channels provide unique intelligence about external perception and, therefore, the possibility of much greater refinement of outward information.
Hundreds of millions of people worldwide belong to electronic social networks which have the capacity to send news and pictures round the world instantaneously*. Businesses are waking up to the huge potential of these networks and nowhere are they more valuable than at a time of crisis. If your organisation or a personality within it has an established and popular presence on any of these networks, invaluable opportunities will present themselves during a crisis when brief updates can be given along with redirection to phone numbers or URLs. If this is new territory for you, do find someone with the talent and experience to advise you and get you started.
Depending on the nature of the incident and the available resources, telephone hotlines are often chosen as the first line of access communication. When used in conjunction with a database for lines to take, as detailed above, they are very effective at responding and getting good quality information out quickly.
Hotlines can have a profoundly negative effect if the demand is underestimated and they are perceived to be (or actually are) constantly engaged. Hotlines are a passive method of communication (waiting for contact) rather than proactive, but an essential tool amongst the others. They reach only individuals, of course, but they matter, however huge the actual audience.
Key players, and certainly journalists will demand interviews.
Any potential spokesperson should have media training in advance so that they are confident and competent when called upon to perform in front of a microphone or camera. There is a checklist in the Media Relations section covering the main points to be addressed [here].
Telephone interviews for TV or radio may be requested or foisted upon staff. If it’s the first occasion during the particular crisis, it is prudent to ask if you can call back after (say) ten minutes to allow you to gather your thoughts, after asking what questions the journalist wants answered. Everyone must be prepared to be on air without notice. Promises to call back must be strictly honoured.
Whether preparing an in-depth interview or responding to a media ambush the Lines to take will provide a secure foundation for most answers.
News releases are often regarded by journalists as bland and uninformative. They are an important means of communication, but, of course, may not be effective in a crisis where events are moving rapidly. They can be a useful mechanism of recording and communicating the latest events and developments, especially for programmes or publications which are not daily. A release of information may take the form of an updating statement, issued by someone of appropriate authority.
(See media relations section, in the Communications chapter.)
A very important communication tool, conferences need to be professionally organised. They must be seen to be serious attempts to communicate and avoid appearing to be a superficial public relations exercise. Conferences are opportunities for stakeholders and the media to put the organisation under the microscope.
Presentations should be snappy, simple and supported by quality images. Facilities for the media are important (phones, internet and computer connections, refreshments). Question and answer sessions should be given sufficient prominence, and taken very seriously.
Above all it is necessary to remember at all times that communication is a two-way process and that there is no point in promoting a conference unless there’s a conscientious intention to engage actively with guests. If there is no such intention, don’t call people in, send them something in writing.[/dropdown_box]
[dropdown_box expand_text=”Conclusion” show_more=”” show_less=”Less of” start=”hide”]
Planning communications should take place alongside the other planning processes. Training, practice, rehearsal are essential.
Without robust and effective communications all other crisis planning will come to nought. We do not want to end up being driven to fulfil Mark Twain’s eternal adage: When all else fails – tell the truth – when telling the truth clearly and effectively would have been the wisest strategy in the first place. If the vision and priorities are firmly established in advance, at least the crisis will not be deepened by amateurish communications, and effective communications may bring greater benefits than you might think, long after the crisis has receded.[/dropdown_box]
Expecting the Worst (2nd edition, 2010). See ‘Publications’ at: www.who-umc.org
[dropdown_box expand_text=”Introduction” show_more=”” show_less=”Less of” start=”hide”]
Effective media relations are an essential aspect of the communications activities of any organisation dealing with issues of social and political interest, especially in high-profile fields like vaccine safety and public health.
Effective media relations do not guarantee that there will never be negative or critical stories in the news media, nor that the message will always appear in the form we wished or intended. An organisation with an active media relations policy – in contrast to one with no policy at all, or a ‘keep them at bay’ mentality – can, however, be pretty sure of these benefits:
- Fairer coverage of stories
- More extensive and thorough coverage
- More likelihood of consultation prior to publication
- More likelihood of comment or correction being published
- More understanding of the programme or organisation and commitment to supporting its activities, if not uncritically.
[dropdown_box expand_text=”The Essence” show_more=”” show_less=”Less of” start=”hide”]
As with communications in general, there are whole libraries of books on media relations. Here we can do nothing but skim the surface.
People in the news media are another of our audiences and, if we wish them to take us seriously, we must deal with them as conscientiously as we would with any other audience – doctors, patients, whoever. Most of the problems organisations have with editors and journalists result from the neglect to which these vital, external partners are subjected.
Here are some of the essential truths about media relations:
- Basically the news media owe us nothing; we have to earn their attention
- Editors and journalists are under no obligation to print what we want, how we want it, uncritically or at all
- The publication of news is largely a commercial activity: it is, inevitably, driven by winning and keeping viewers, listeners and readers, so news-values drive most content
- There are thousands of column inches and broadcast hours to be filled every day; the news media are hungry for good stories
- At the same time, there can be severe competition for space and news value priorities may not include our story, however vital we regard it
- To gain attention, we must be sure that our stories are presented in ways that give them news-value
- Publishers and broadcasters are interested in exclusives which give them the edge over their competitors. They are likely to give much more time and space to a story they have exclusively in advance of others
- News media work to very short deadlines – print or broadcast schedules – and need rapid responses
- With the exception of those in some sectors, editors and journalists are people with principles – honesty, accuracy, balance, the public interest, at least
- Most editors and journalists will respect the ‘off-the-record’ convention; it’s in their interests to respect it: they know that if they don’t they won’t get privileged information a second time
- Most editors and journalists strongly prefer a collaborative relationship, though not conceding their right to independence of judgement
- It is the business of the news media to investigate and expose dishonesty, manipulation, incompetence, misuse of resources
- Silence or ‘no comment’ will frustrate, irritate, anger journalists and (naturally enough) predispose them to a negative view or to the suspicion of cover-up
- If ‘no comment’ is the policy, then some explanation should be offered in either diplomatic or off-the-record form
- Journalists cannot be expected to understand the intricacies of our world unless we make conscientious efforts to inform them; people change jobs quite frequently in the news media, so the process of keeping staff up-to-date is a continuous one
- Journalists cannot be expected to take us seriously if we appear every so often demanding that they do take us seriously; we cannot expect them to take our crises seriously if we are never in contact with them between times and they do not understand the ordinary conduct of our everyday work
- As with members of any audience, familiarity and trust are essential: these come only through the cultivation of personal relationships with significant editors and journalists on a regular basis
- Almost all news media have specialist journalists for areas like health and science. These should be identified and cultivated
- Beyond the news desk, many publishers and broadcasters have other departments of interest, including features, business, society, environment, health and welfare, and so on. They make documentaries, write in-depth pieces on specialist subjects and may be valuable contacts, and we may be useful information resources for them from time to time
- Many print news media offer the facility of ‘advertorials’: by buying a certain area of advertising space, you have a similar area for your own copy, photographs, charts or whatever. This method, along with the simple expedient of buying straight advertising space, are the only ways you can guarantee that what you want to say will be printed exactly as you wrote it
- Organizations need to have a serious schedule of media relations activities, including personal contact; briefings and visits (in both directions), news conferences, information packs, background briefings, regular news release and other information output.
[dropdown_box expand_text=”News Releases ” show_more=”” show_less=”Less of” start=”hide”]
The subject of news releases deserves its own check-list:
- The regular issue of news releases ensures that the organisation´s existence and activities are at least known by editors and journalists
- Information about the ordinary, everyday activities of an organisation is acceptable and useful
- They should always include some measure of background information about the
- organisation and contextual information about the issue in hand
- They should always carry a named contact with communications details and hours of availability. At times of crisis, availability of contact 24 hours a day should be provided
- As with off-the-record, an embargo time is likely to be respected by most editors and journalists: those who don´t respect it know they won’t be likely to get advance information a second time
- A news release is a briefing for the recipient and should not be written in the form it might be expected to appear in the paper or on-air: that´s the journalist´s or sub-editor´s job
- While evidence of wit and originality in news release headlines is not unacceptable, such details are properly the sub-editor´s job
- News releases are sometimes printed more or less verbatim and, for reasons of space, are likely to be edited (cut) from the bottom, in the printed media – so all the critical information should appear very early on
- Journalists are very busy people and are likely to skim the dozens or hundreds of news releases on their desk each day to identify the really interesting ones: a summary statement of the entire release should appear in the first paragraph to ensure yours is not binned
- The structure of a news release should be: summary; exposition of argument;
- supporting evidence; elaboration; conclusion
- It is always helpful if a quote from a named source – as senior and/or relevant as possible – is included: this adds life and authenticity to any story. Such a quote may well be followed up for elaboration
- News releases should never be more than about two A4 pages or equivalent. They should have wide margins and line-spacing so that they can be easily edited by hand if required
- Good photographs or graphics (tables, charts) will enhance the appeal of a story (check editors’ preferred formats before sending)
- Some publications and broadcasters will be pleased to receive your information by fax or e-mail.
Aspects which will increase media interest in a story:
- Dramatic emotional impact
- Large numbers affected
- Unexpected links
- Polarised opinions
- Conflicting views
- Geography (proximity to own country, hospital etc)
- Emotive tags (eg ‘miracle drug’, ‘poison’)
- Links to celebrities
What the media appreciate:
- Accuracy and simplicity
- Statistics which are explained
- Context of information
- Comments from highest authority
- Some controversial elements
- Both sides of the issue
- Speed, speed and speed
The ideal spokesperson will be:
- Polite and patient
- Well-informed and authoritative
- Accurate and reliable
- Evidently committed to the process
[dropdown_box expand_text=”Conclusion” show_more=”” show_less=”Less of” start=”hide”]
The most successful businesses and organisations almost always have an active and energetic media relations policy as part of their overall marketing and communications strategy. (The development of a marketing and communications strategy is, of course, another fundamental activity of organisations hungry for influence and success. That overarching aspect of internal and external communications is beyond the scope of this piece.)
Individuals or organisations who are suspicious, hostile or neglectful in their attitudes to the news media, possibly as the result of seemingly negative treatment in the past, fail to understand that the negative treatment may result precisely from their hostility, suspicion or neglect, and that the remedy is within their hands, subject only to their imagination and initiative. They completely fail to grasp the enormous potential for their benefit in exploiting the power and influence of the printed and spoken media to reach specialist and mass audiences. News media people cannot ultimately be controlled, but they can be engaged in a mutually beneficial collaboration which, though it has its risks like all communications activities, can be rich and productive when managed skilfully.[/dropdown_box]
A postscript on the importance of social media
Social media and networks are the means through which tens of millions of people share opinion and gather information. They are far more influential and powerful than traditional media for enormous segments of populations everywhere. Having an effective presence on social media requires knowledge, skill and considerable resources, but it is now almost essential for any organisation that wants to increase its profile and influence.