REPUTATION MATTERS! Building, Sustaining and Crisis-Proofing Reputation and Market Share...

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 BuffetTo Salomon Brothers employees

Warren Buffettto 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 specialistChoosing 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 reputationis 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. 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


1. An integrated process2. Audience identification3. Audience research4. Message development5. 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

Reputation

Donors, grantorsDonors, grantors

Consumers

Consumers

MediaMedia

CommunityCommunity

GovernmentGovernment

EmployeesEmployees

CustomerFocus

CustomerFocus

FacultyFaculty

ManagementManagement

StudentsStudents

Prospective employees,

faculty

Prospective employees,

faculty

VolunteersVolunteers

Families/Visitors

Families/Visitors

PatientsPatients

1. A complex universe with many players

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 meana 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 mid-

course corrections, evaluate, revise plan



2. Audience identification3. Audience research4. Message development5. Key strategy: Building reputation via


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


1. An integrated process2. Audience identification

3. Audience research4. Message development5. Key strategy: Building reputation via


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 rolein 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 programAnd all of this data helps us develop MESSAGES!!!


1. An integrated process2. Audience identification3. Audience research

4. Message development5. Key strategy: Building reputation via


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



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

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


With all of our customers, especially patients


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?

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

Profitability -2% 1% 3pts

Other major gains

Chain of success starts with satisfied employees

The VanRinsvenformula 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

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




• 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-bysstill 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-bysstill 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-on-ones, 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 pre-existing 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. Ignore the problem as it festers, or deny it once it happens

2. Containment – give it to someone else to solve

3. Tell half truths or LIE

4. Let bad news dribble out

5. Assign blame

6. MEA CULPA x 10

7. 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


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???


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!


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


The message must also SHOW as well as say• Prove it! • What steps are you going to take?• What steps have already been taken?


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


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 Relationsas 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.


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


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


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


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


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

REPUTATION MATTERS! Building, Sustaining and Crisis-Proofing Reputation and Market Share...

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Transcript of REPUTATION MATTERS! Building, Sustaining and Crisis-Proofing Reputation and Market Share...