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At the height of the discovery of anthrax cases in Washington, DC, a hospital public relations staff member created a stir by reporting to the news media that one of the people exposed to the bacteria at Senate Majority Leader Tom Daschle’s office was a newspaper reporter who had only been in the hallway outside the senator’s suite.
The report turned out to be untrue, but the damage had been done. People in the Capitol area panicked — believing that a person had been infected simply by passing by a room in which the bacteria had been discovered.
The situation is representative of the problems that can occur when organizations haven’t developed clear plans about communicating with the public during crisis situations, says Philip S. Cogan, a disaster and crisis management expert and executive vice president of Bernstein Communications Inc. in Springfield, VA.
"The Washington Post reported that while it was true the woman was a reporter, she had never even been in that building," Cogan says. "When someone at the hospital asked her, she stated she was a reporter who worked on Capitol Hill. She had never in her career been in the building. The PR person pieced information together from what had been given to him."
In the never-ending quest to satisfy the "24-hour news cycle," hospitals can get caught up in the media frenzy for "updates" and "the latest information" and lose sight of the purpose of sharing information with the public, he says.
"A lot of information provided sometimes appears to be information for information’s sake," Cogan explains. "You need to follow a principle that journalists were taught a long time ago: Give people information they can use."
People charged with providing information to the public in crises need to go a step beyond ensuring that the information is factually correct, he says. The public is entitled to information it needs to take steps to protect itself. It is not, however, entitled to any available information, all of the time. "I think they need to ask themselves, Is providing this information going to help? Is it going to be information that people can base decisions upon after they analyze the information? Or is it going to contribute to the problem? Is it just going to lead to more questions?’"
During crisis situations, it is important that the public hear correct and consistent information, says Mohammed Akhter, MD, MPH, executive director of the American Public Health Association in Washington, DC. "We have seen with the anthrax cases how multiple people were providing information: the Justice Department was saying one thing, the Centers for Disease Control was saying something else, and the local health department was saying another thing.
"As a result, a certain level of mistrust developed in the community and the country," he says.
That kind of vague distrust results from "cognitive dissonance," says Cogan. "Basically, if you give people information that is variant with other information that they receive, they are left with trying to decide what to believe. And that only results in a population that is confused, upset, and maybe even angry."
Medical information providers especially need to realize that they are not islands, even when they are a primary focus in a disaster situation. They are providing information in concert with other health care providers, other hospitals, and government officials.
"All of these other entities are capable of either supporting or undermining the information that you are providing," he explains. "The health care system needs to look at coordinating information activities with governments and among itself, rather than trying to go it alone."
Akhter recommends electing a single voice to deliver updates to the public. He served as state health director for Missouri in the 1980s and as health commissioner for the city of Washington, DC. During his tenure in the nation’s capital, he had to contend with contamination of part of the city’s water supply. "I had to order that water be boiled for a certain number of people living in this area," he recalls. "I had to talk to the public every morning and every evening: what we were doing, when the results would come back, and when we would make a decision about when they could stop boiling the water. It was very important for people to get information from one source only."
When information comes from a single, medically qualified source, the public knows that it can trust the information, and people don’t hear conflicting information that is confusing, he says.
However, having one source of information is often not feasible or practical, especially during a national disaster such as the recent terrorist attacks, Cogan says.
"People in Alabama or California are not going to be seeking reassurance from some official in Washington, DC. They want reassurance from their local public health director, their local hospital administrator, probably even more so from their private physician," he says.
The key is for all sources to speak together, providing information that conforms with what other officials are saying, he says. "When discrepancies exist, it is not necessarily because someone is wrong, but because they are out of sync. A hospital administrator at one facility may give out information that may have been accurate at a certain point in time, but because they are not linked into a system, it appears to be at variance with something that later is true. Discrepancies also do not always reflect that a certain organization does not know what it is doing, only that it is not working together with other organizations."
Cogan recommends planning for a "joint information center," where representatives from all involved entities will get together to coordinate the release of information. "You all have access to phones and ties back to the original organizations and, when you speak, you speak together and are able to synchronize what the known facts are at particular points in time."
Coordinating the release of information to the public also removes some of the pressure to speculate or predict or otherwise make vague statements that can be damaging later, Cogan adds. "Reporters will always want you to speculate, and deal with hypotheticals. Never make assumptions and never deal in hypotheticals."
If only a limited amount of information is known at a particular time, the communicator has a responsibility to say that he or she has no more information to share.
"Your responsibility is not to intentionally hide information that can be useful, but on the other hand, to not simply provide information in the hopes that the public can make sense out of something the experts are having trouble making sense out of," Cogan says.
Establishing set times for providing information updates also helps alleviate pressure to feed the news cycle, says Akhter. "You need to communicate with the public on a regular, ongoing basis — not a sporadic thing. During the water crisis, I gave updates each day, once in the morning and once in the evening." It’s important to give some kind of update, even when there is not much to report, he adds. "If you don’t give out some kind of information, that is when the rumors take over."
You have to go out and regularly speak to the public, even to say, "We don’t have anything new to report, we just wanted to let you know, we haven’t forgotten about you," Cogan agrees.