When a Patient Becomes a Cause

Chart a Course of Compassion, Professionalism

The recent, heartbreaking story of Charlie Gard, the U.K. infant whose parents battled to keep him on life support and seek experimental treatment for his genetic disorder in the U.S., over the objection of his doctors, highlights an issue that all healthcare organizations need to think about.

“What happens when our patient becomes a cause célèbre?”

Wikipedia defines “cause célèbre” as “an issue or incident arousing widespread controversy, outside campaigning, and heated public debate. The term is particularly used in connection with celebrated legal cases.” Sometimes, the célèbre part becomes literal, with celebrities voicing opinions on one side or the other.

In the case of little Charlie, everyone from Donald Trump to Cher to Pope Francis weighed in to either offer assistance to the family or implore the hospital to bend to the wishes of the parents. There was massive public pressure on an institution that sincerely believed they were making the best medical decision given the circumstances – and which was no doubt concerned about their legal liability should the baby die when removed from their premises.

This kind of wellspring of sentiment, public opinion and media coverage is, fortunately, rare. But even stories that don’t generate words from world leaders or pop icons can become maelstroms at the local or regional level should word get out that a patient or their family is being “denied” free will or certain rights by a hospital, particularly where end-of-life is concerned. And usually, it’s the family – or one member – purposely trying to support their cause when they clash with the hospital or another relative. Telling your tale of perceived oppression to a TV reporter can be a powerful way to influence public opinion…and exert pressure on the other party.

When the “Correct” Thing isn’t the Popular Thing

When this happens, healthcare organizations need to tread lightly. Aside from navigating HIPAA rules on patient confidentiality, communications staff must deal with the natural human belief that we all have final authority over our personal health, or that of our children. Then there’s the legal aspect: doing the morally “correct” thing may be in opposition to legal requirements. For example, the compassionate move may be to take a patient who is virtually brain dead off life support, but the patient may have an advance directive prohibiting it, or in the absence of one, family advocates opposing it.

In the case of Terri Schiavo, the Florida woman who was in a persistent vegetative state, her husband and legal guardian sought to remove her from life support while her parents fought to prolong her life artificially. Prolonged legal battles, with the hospital and Schiavo’s doctors as key witnesses, caused a seven-year delay before her feeding tube was ultimately removed in 2005. Her name remains a flash point for patient and spousal rights.

The Eye of the Storm

So what to do when there’s a clash among family, or between family and hospital that becomes public? While each case will be different, here are some basics to bear in mind:

  • Designate a single spokesperson for the hospital or organization, but be careful in your choice. An executive might come off as more concerned with preserving reputation than the good of the patient or family, while the treating physician can credibly fall back on what’s best clinically in the circumstances. Think long and hard before trotting out a lawyer to speak for the organization.
  • Remember HIPAA. Talking specifics of a particular patient’s care is a no-no, even if the family is going in front of every reporter they can find. Limit comments to policy, protocol, and information already published elsewhere.
  • Expect fallout, and be ready for it. One of the best ways to defend your organization amid a public hue and cry is to demonstrate that you are adhering to standard procedures and protocols, and there’s nothing different or personal in the case at hand. The public needs to see that your organization acts legally and professionally, even if they disagree with your stance.
  • Be available. Despite the heat, offer opportunities for the media to have their questions answered, either one-on-one or during a press conference. Don’t bury your head in the sand.
  • Stay off social media. There’s little to be gained, and much to lose with a misstep, by posting or tweeting in a sensitive situation. However do share any public statements you’ve issued after you’ve disseminated them by other, more traditional means.
  • Know when to fold ‘em. Sometimes, a story will wane after a news cycle or two, or when the public gets consumed by something else. Don’t proactively reignite it through unsolicited statements. If courts are involved, don’t go out with news of even favorable rulings, but be prepared with a statement if the media seek you out.

Things can get highly charged when a controversial patient comes through your door or emotion clashes with clinical care. No institution wants to be in a volatile situation, but if a patient does become a cause, level heads and a reliance on existing protocols will keep you on the high ground.

When Employees Behave Badly

Avert Crisis with Preparedness

There’s an old saying that the only things that are absolutely certain are death and taxes.

Close behind is the reality that forms the basis for Murphy’s Law: sooner or later, despite our best efforts, something is going to go wrong, and we’ll have to answer for it, or at least explain it in a satisfactory manner.

Bad online reviews can dampen business, and should be dealt with promptly (as covered in a previous blog) to mitigate the ill effects. A significant error or lawsuit can become a major news story, depending on the circumstances.

Then there’s the human factor. Employees saying things they shouldn’t under the auspices of the organization, or worse, physicians or employees behaving badly. Whether it’s a misguided social media post, a verbal smack-down or physical altercation caught on camera, or a criminal act, you need to act quickly to minimize the impact on the organization and move toward mending public perception.

People Behaving Badly

Take the case of a national home care agency, with thousands of employees offering wonderful, compassionate care to their clients and making a difference in thousands of lives each day. Alas, like every industry, there are a few employees who shouldn’t be in their roles, who lack integrity, or don’t respect the trust they’ve been given.

When news broke that an employee – or in this case an independent contractor working as a caregiver – had stolen cash and jewelry from a client’s home, SPRYTE had to dust off the crisis communications playbook. The arrest, including perp walk, made local television news in the city where it occurred, and had the potential to spread beyond, as negative news often does. The franchise office which contracted the caregiver was facing blowback, and even other nearby franchises that had nothing to do with the incident were fielding calls of concern from clients and were asking for help.

Have a Plan, Then Work It

Every organization should have a crisis communications plan, with some basic steps. Of course, these will evolve or change with specific circumstances, but generally, you’ll want to designate a single spokesperson, develop talking points, and establish a means of providing timely, accurate information to those affected and other contingencies. Here are some specific steps to think about when the crisis involves the actions of an employee:

  • Assess the situation. See how it is being reported, and how widely. Is it a one-and-done story or does it have “legs” to carry it through more than a single news cycle? Are other outlets picking it up? Is the incident ranking high in online searches of the company name? In our sample case, we learned one television station ran the story on air and on its website, and that was the extent of it. It appeared near the top of a Google News search, but was several pages down on a general Google search.
  • Create talking points for various audiences. Limit this to the facts you know, and include mitigating information if there is any. SPRYTE learned that the victim of the theft didn’t even want to report her suspicions to the police because she liked the caregiver so much, and that it was the agency itself that encouraged her to contact the authorities. This kind of proactivity shows the company is ethical and trustworthy, even if the employee wasn’t. Also, we included the point that this was a 1099 contractor, not a regular employee, while acknowledging that to the public and clients, that distinction is meaningless.
  • Empower your managers. Since this was a local-level story, we briefed the franchise owner on how to answer questions that might come up, from either the media or clients’ families. Essentially, she was prepped to be the front-line representative for the company. We also shared separate talking points with neighboring offices.
  • Brainstorm all scenarios. Come up with a list of “what-ifs” addressing all eventualities so you or your front-line staff are ready for them. In this case, we created a table with the headings “If this happens” and “We’ll do this” and listed potential issues and how to react. Sometimes, the response was as simple as “refer the reporter to the corporate office, which will respond per the talking points.”

 

As Gene Kranz, the NASA flight director immortalized in Apollo 13, memorably said, “Let’s work the problem. Let’s not make things worse by guessing.” Take the time to gather all the relevant information, then monitor the situation and respond with facts, not conjecture. By being transparent, and addressing the concerns of your publics in a timely and accurate manner, you’ll go a long way toward minimizing the damage to your organization’s reputation.