02 April 2008

Healthcare Crisis Public Relations - what makes a crisis?

While the specific details of a crisis may be unique, the fact that crises occur and need to be properly managed is a well accepted notion.

Many organizations have some sort of emergency or crisis plan for certain types of events and the literature on the public relations aspects of crisis management is wide. These tend to focus on natural disasters like fires or floods and in more recent times, organizations have become aware of the potential for manmade disasters like terrorist attack.

Oddly enough, there are more than a few organizations  - especially government ones - that seem to miss the examples of policy-related or similar crises and realize they fall in the same general category.

But if one considers the typical definition of a crisis from the crisis management literature, it gets pretty clear the problems at Eastern Health in 2005 fit the bill.  Take for example, the definition of "crisis" contained in Crisis communications in healthcare: managing difficult times effectively, a 2002 publication of the American Hospital Association's Society for Healthcare Strategy and Market Development.
A healthcare crisis is anything that suddenly or unexpectedly has adverse effects on a healthcare organization or its patients, staff or community. (p.7)
The book also contains a useful tool for assessing the type of crisis.  It's not an absolute system but it gives some idea of what the problem is and, as the book subsequently lays out, the sort of responses that experience shows work more effectively to:
  • respond to the crisis;
  • maintain or restore public confidence; and,
  • restore normal operations.
The following table is adapted from the assessment tool with some wording changes to save space.

Assessing the severity of a crisis
Level 1
Level 2
Level 3
Geographic scope/duration
Single facility or location
Affects more than one location but for short period
Affects org. or region for indefinite period
Impact on operations
Temporary. Confined to one dept. Normal operations restored within 24 hrs
Significant. Routine operations may shut down temporarily.
Extremely serious. Affected organization may be closed or operate indefinitely at fraction of normal capacity
Employee Involvement
Handled without many problems.  May divert from normal routine
Employees require support from senior management and may require external resources.
Level 2 + Total workforce involved. May need support of healthcare professionals from other organizations.
Regulatory, accreditation,law enforcement impact
Minimal concern.  Phone call or written report may be required.
Appropriate agencies will investigate and may sanction/fine. Sanctions are minimal to moderate.
Sanctions are serious: closure of unit etc.
Public Concern
Limited to parties directly involved in situation
Some public anxiety. Relatives of patients, community residents and others may contact hospital for information on an urgent basis.
Substantial public anxiety. Volume of calls strains normal capacity of organization.
Likely media coverage
Maximum publicity limited to one day of local news coverage.
Regional press plus trade publication.
National and/or international media interest. major newspapers, television, radio, magazines cover issue.
This table is by no means exhaustive nor is it complete.  There is some possibility for overlap from one crisis level to another, however, it is intended purely as a rough guide.  It doesn't have to be perfect.

For our purposes, though, it's interesting to take the evidence from the Cameron Inquiry to date and apply what was known in July 2005 by government officials to this matrix.

There's no question that what occurred at Eastern Health was a crisis.

Geographic scope and duration:  Level 3.  The laboratory problems themselves were confined to one site but their impacts involved patients from the whole province. While the start date for problems was identified as possibly being 1997, there was no indication of how long the problems might last into the future.

Impact on Operations:  Level 2.  The whole hospital wasn't shut but that section of the laboratory was.  Several departments were affected by the situation.

Employee Involvement:   Level 2.  External resources were required - outside labs - and there is no question that senior management assistance was needed in several ways to cope with the incident.

Regulatory, Accreditation, Law Enforcement:  Level 2/3.  There's not enough information to judge the potential impact of these problems on Eastern health's accreditation.  if we add to this section the potential for litigation from affected parties, this one becomes a Level 3 crisis.  A minimum of 100 people seriously affected, all of whom may become party to a lawsuit raises the potential of legal costs stretching into the hundreds of millions of dollars.

Public Concern: Level 2 - Eastern Health clearly anticipated some anxiety and a volume of telephone calls from patients and relatives that may affect operations.  In practice, Level 3 - the incident caused significant public anxiety over a prolonged period.

Likely media coverage:  Level 3.  A story involving breast cancer, testing problems and hundreds of people couldn't be kept local if money changed hands.  It's big and everyone knew it was big from the outset.

Now that we've established that fairly obvious point, in our next posting in this series, let's look at a typical set of crisis responses and compare them to what senior officials at Eastern Health and the provincial government decided to do.