At a Glance

Action steps hospitals and health systems should take to prepare for a public relations (PR) crisis include the following:

  • Develop a plan for dealing with PR crises that establishes a central incident command center and sets forth clear lines of authority and responsibility.
  • Provide the name, phone number, email address, and other contact information for a knowledgeable person who can respond to media inquiries.
  • Act fast—within a couple of hours—to explain the facts.

Legal and regulatory issues can lead to a public relations (PR) crisis for hospitals and health systems at any moment. For example, Stanford Hospital, Palo Alto, Calif., was hit with sudden media scrutiny in 2011 when 20,000 emergency department patients’ names and diagnosis codes were discovered on a commercial website. The media jumped all over the story for a while and then moved on to other things—that is, until a second breach less than a year later reignited their interest. 

A more recent example is the story of an 87-year-old Bakersfield, Calif., “nursing home” resident in apparent cardiac arrest who died despite the pleas of a 911 operator for someone to help her. One headline read: “Dramatic 911 Tape Reveals Dispatcher’s Fight to Save Patient; Nurse Refuses to Help.” The local media were all abuzz for a few days: The evening news replayed the tape of the 911 call, and some national outlets picked up the story as well. Although much of the reporting was wrong, the well-respected retirement community got a bad name from the negative publicity. 

These are just two examples of the kind of PR crises that can flare up when interest is fueled by traditional media (television, radio, and newspapers). Furthermore, the ubiquity of social media today makes organizations more vulnerable than ever to bad PR. “An Internet crisis can erupt in mere seconds if someone has a bad experience with your organization,” says Gini Dietrich, CEO of Arment Dietrich, a Chicago-based communications firm. 

How can healthcare organizations mitigate the risks associated with a crisis that is made public? Dietrich offers the following advice.

Preparing for a PR Crisis

“Given the life-and-death nature of what you do, healthcare organizations are especially fertile ground for sensationalism in media,” Dietrich says. “The nuances of a situation like the one in Bakersfield can get lost in the six o’clock newscast.” 

For example, here are some of the facts about the Bakersfield case that did not make the news: The woman resided in an independent living facility, not a nursing home. Her family said she would not have wanted CPR. Plus, she suffered a serious stroke (not a heart attack), so CPR would not have saved her. In fact, CPR itself might have been fatal in a woman her age, as detailed in an article by Jennifer Black, MD (“What You Think You Know About CPR Is Probably Wrong,” Compassion & Choices, published online, March 9, 2013).

Most interesting of all, perhaps, was the fact that family members were fully satisfied with the care the woman received and said they had no intention “to seek legal recourse or to try to profit from what is a lesson we can all learn from,” according to an article on Bakersfield Now.com (Ferguson, C., “Family OK with Glenwood Gardens; Many Still Question CPR Call,” March 5, 2013). This point was generally lost on the public and was mentioned only in passing during the final 10 seconds of a five-minute news report on a Bakersfield TV station. 

Given that the media cannot be relied on to report matters accurately, what can hospitals and health systems do to prepare? The work of Dietrich and other crisis management experts suggests the following action steps can help healthcare organizations successfully respond to a PR crisis.

Have a plan. Every healthcare provider has an emergency incident command system. There should be a similar plan for dealing with PR emergencies. The PR emergency plan should establish a central incident command center and set forth clear lines of authority and responsibility for senior executives and others. 

Each organization should structure its systems in a way that makes sense for its own circumstances while ensuring that one person is given the lead role in directing the organization’s response and that everyone knows who is in charge in any given PR situation. Dietrich suggests assigning PR incident command responsibility to the hospital leader who handles the communications unit under the Hospital Emergency Incident Command System (HEICS) plan. 

Empower your team through practice. The organization’s response to PR incidents should be rehearsed, just as the organization rehearses its HEICS plan. There are plenty of examples of ways to simulate and train for a PR crisis, and they can form the basis of some interesting in-service training. An online search for “privacy breaches in health care” or “PR crisis case studies” is one way to identify such resources. 

Act fast to explain the facts. Have a communications expert on the management team (or on speed dial) so the organization can respond the day the incident comes to light. Tell the facts about what happened. “The media and the public will speculate and make guesses that are only partly accurate if you don’t immediately tell your story and tell it truthfully,” Dietrich says.

Provide a knowledgeable contact person. There will always be follow-up questions, especially if the crisis concerns patients or breaches of patient privacy. Identify a knowledgeable person who can deal with those questions, and provide that person’s name, phone number, email address, and other contact information to the media and to other interested parties. Make sure the questions are dealt with promptly—within an hour or two at the most.

Include physicians in the plan. If the crisis implicates the physician-patient relationship—for example, if it involves inaccurate lab results, as has sometimes occurred—physicians will get questions from their patients regarding what the situation means for them. Be sure the physicians have the facts so they can speak knowledgeably with their patients and patients’ families.

Respond where the crisis is occurring. This advice does not mean healthcare leaders should respond in the geographic location where the crisis has occurred (although that’s important too); rather, it refers to the need to respond by using the same medium that is carrying the message. If the incident is being reported on TV and radio news, for example, hold a news conference. If it’s in the newspaper, issue a press release. If news of the incident has gone viral on social media like Facebook and Twitter, respond there as well. 

Be prepared to respond in all types of media at all times. Dietrich suggests that you even include internal media, such as your website and your internal email. And remember to squelch the rumor mill. Rumors of a crisis, whether they be true or not, can be as bad as a real crisis. “The rumor is itself a crisis,” she says.

If necessary, apologize. There are at least five types of apology:

  • Expressing regret (“We are sorry.”)
  • Accepting responsibility (“We were wrong.”)
  • Making amends (“We want to make it right.”)
  • Genuinely repenting (“We won’t do that again.”)
  • Requesting forgiveness (“Please forgive us.”)

Not all of these apologies are appropriate for every crisis, and each one may have legal implications, so check with counsel first before providing an apologetic response. Whether an apology is best made publicly or privately will depend on the situation, but the main point is that it’s usually best to say you’re sorry if something actually did go wrong. 

“If you do apologize, you have to mean it,” Dietrich says. “Don’t say ‘I’m sorry, but …,’ and don’t sound like you’re only sorry that you got caught.” 

Change what needs to be changed. If the organization’s previous policy or practice has been wrong or is based on a double standard, reassess the policy, and be prepared to change it. This is just good management. As Ralph Waldo Emerson famously wrote, “A foolish consistency is the hobgoblin of little minds.” Persisting in a practice that the organization knows is in need of improvement will only make matters worse.

Honesty Is the Best Policy 

Honesty reveals character: the character of the individual and the organization. So express honest concern, honest regret, and honest responsibility. Discuss the facts honestly, without equivocation or shading the truth. And display an honest willingness to bring the matter to a successful resolution. 


J. Stuart Showalter, JD, is a contributing editor to HFMA’s Legal & Regulatory Forum.

Interviewed for this article: Gini Dietrich is CEO, Arment Dietrich, and the author of the blog spinsucks.com.

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