Dealing with SARS: Toronto Hospital learned to survive beyond the crisis communication plan.When SARS hit Canada this past spring, Sunnybrook and Women's College Health Sciences Centre was on the receiving end. Early morning 14 March, the head of the infectious diseases infectious diseases: see communicable diseases. department at Sunnybrook & Women's, an acute-care teaching hospital affiliated with the University of Toronto Research at the University of Toronto has been responsible for the world's first electronic heart pacemaker, artificial larynx, single-lung transplant, nerve transplant, artificial pancreas, chemical laser, G-suit, the first practical electron microscope, the first cloning of T-cells, , informed the public affairs Those public information, command information, and community relations activities directed toward both the external and internal publics with interest in the Department of Defense. Also called PA. See also command information; community relations; public information. office that a patient with a new form of "community acquired atypical pneumonia atypical pneumonia n. See primary atypical pneumonia. atypical pneumonia Chest medicine A clinically 'atypical' form of pneumonia, which lacks the classic signs and Sx of pneumonia Types Chlamydia pneumonia, " had been admitted overnight. Less than 12 hours later, health care in the city would be changed forever when a hurried news conference was held that Friday night to tell Toronto and the rest of the country that three hospitals were caring for family members who had Canada's first cases of this mysterious illness and that there may be others who were unknowingly infected in·fect tr.v. in·fect·ed, in·fect·ing, in·fects 1. To contaminate with a pathogenic microorganism or agent. 2. To communicate a pathogen or disease to. 3. To invade and produce infection in. . Communication was needed to help contain the spread of what was thought to be a potentially fatal pneumonia (the virus had not yet been identified as SARS, severe acute respiratory syndrome Severe Acute Respiratory Syndrome (SARS) Definition Severe acute respiratory syndrome (SARS) is the first emergent and highly transmissible viral disease to appear during the twenty-first century. ). Though there was some concern among health care workers, there was no widespread public panic. But a week later, the real threat surfaced when health care workers caring for SARS patients developed similar symptoms and entire hospitals were forced to close their doors to contain the illness. Toronto started to draw international attention as a SARS hotbed hotbed, low, glass-covered frame structure for starting tender plants. It differs from a cold frame only in that the soil is heated—either artificially as by underground electric wiring or steampipes, or naturally with partially fermented stable manure, which . In the three months that followed, Sunnybrook & Women's treated about 75 SARS patients, including 11 of its own staff members (all of whom have been treated and released). At the height of the outbreak, the hospital was also screening up to 100 citizens dally. A SYSTEM IN CRISIS SARS was a different kind of crisis. This situation didn't fit traditional crisis management strategies where organizations apologize a·pol·o·gize intr.v. a·pol·o·gized, a·pol·o·giz·ing, a·pol·o·giz·es 1. To make excuse for or regretful acknowledgment of a fault or offense. 2. To make a formal defense or justification in speech or writing. for an error or problem and then correct it. Health care organizations had to do their best to protect their staff and the people who look to them for help. Sunnybrook & Women's, like many other hospitals in Toronto The following is a list of hospitals in Toronto:
tr.v. par·a·lyzed, par·a·lyz·ing, par·a·lyz·es 1. To affect with paralysis; cause to be paralytic. 2. To make unable to move or act: paralyzed by fear. , communication technologies were vastly different, health care workers were not developing symptoms of the illnesses and large numbers of people were not being thrown into quarantine quarantine (kwŏr`əntēn), isolation of persons, animals, places, and effects that carry or are suspected of harboring communicable disease. . In many ways, SARS challenged and redefined the role of the public affairs department at Sunnybrook & Women's. Almost all communication or public relations public relations, activities and policies used to create public interest in a person, idea, product, institution, or business establishment. By its nature, public relations is devoted to serving particular interests by presenting them to the public in the most departments have crisis communication plans, and being home to Canada's largest trauma centre, Sunnybrook & Women's also has a rather extensive plan that can be put into action at any time. But the department quickly discovered that even the best plan one that establishes a communication infrastructure between the PR department and the crisis management team gets you through only the first few hours of a serious situation. After that, you really are on your own, and you have to become resourceful re·source·ful adj. Able to act effectively or imaginatively, especially in difficult situations. re·source  ful·ly adv. and look for
opportunities to leverage your organization's strengths in a
confused system.
Sunnybrook & Women's was able to do this by positioning its internationally renowned in-house infectious disease Infectious disease A pathological condition spread among biological species. Infectious diseases, although varied in their effects, are always associated with viruses, bacteria, fungi, protozoa, multicellular parasites and aberrant proteins known as prions. experts as official spokesmen with the media and, more important, internally with staff. In a systemic crisis, where multiple agencies are involved, it is important to recognize your organization's strengths early on. An obvious strength for Sunnybrook & Women's was its unique ability to respond quickly to crises at all levels of the organization, from doubling the capacity of isolation rooms literally overnight to working to contain the spread of the illness through strict adherence to infection control protocols. The role of the public affairs department was to highlight these wins early and often through every available communication vehicle with internal and external audiences. This helped reassure our public that the hospital was well in control of the situation and instilled confidence among staff that they were safe. By establishing a sense of control, positioning experts and highlighting wins throughout the organization, we built confidence internally and externally and banked credibility for future inevitable challenges. But as other hospitals began closing their doors, it seemed that it was just a matter of time before Sunnybrook & Women's would have to do the same. Over the long Easter weekend--five weeks after we received our first ease of SARS--several staff members who had been involved in clearing the airway airway /air·way/ (-wa) 1. the passage by which air enters and leaves the lungs. 2. a device for securing unobstructed respiration. of a SARS patient started to show symptoms of the disease. As a result, 11 staff were hospitalized for about a month and more than 200 other staff members were quarantined quar·an·tine n. 1. a. A period of time during which a vehicle, person, or material suspected of carrying a contagious disease is detained at a port of entry under enforced isolation to prevent disease from entering a country. for 10 days. Even though the quarantine affected only three departments, leaving the remainder of the hospital open, this crisis within a crisis reverberated throughout the organization, causing further concern among staff and the public. SETTING GOALS FOR AN UNKNOWN OUTCOME Despite the complexity of a crisis situation, the goals and objectives you set for your department should be relatively short term and simple. They have to be flexible enough to withstand a constantly changing environment and measurable to achieve results quickly and offer some moral victories for your team. The goals we set for dealing with this outbreak were fairly obvious: * Provide accurate and timely information to our most affected audiences as soon as information becomes available. * Wherever possible, work to reduce rumour and correct misinformation mis·in·form tr.v. mis·in·formed, mis·in·form·ing, mis·in·forms To provide with incorrect information. mis . * Ensure that the public has confidence in our ability to manage this outbreak effectively and protect the safety of our staff, patients and their families. It is extremely important to stick to your goals or basic principles for communication throughout a crisis. As you get deeper into it, you can begin to question your rationale. Remember that you were probably thinking more clearly at the outset than at some exhausted point along the way. Caring for its own staff forced Sunnybrook & Women's to make a decision about how to communicate the situation. After some internal discussion, the decision was made to keep people informed about the condition of the hospitalized staff members through a daily broadcast e-mail newsletter. Even providing somewhat vague updates continued to reassure other personnel that the information they were getting was better than what they were hearing in the press and helped position the organization as an honest communicator. UNDERSTANDING THE AUDIENCE Defining who needed to be communicated with and when was normally issue specific, but it became dear early on that the majority of our communication efforts had to be focused on our hospital staff. To instill in·still v. To pour in drop by drop. in  stil·lation n. a sense of calm, special care had to be taken to position the
organization and its experts internally as a credible and caring voice
of reason.
Communicating with the media was also important, and experts were offered to explain this illness just as they had been at the beginning of the outbreak. Nevertheless, it became increasingly difficult for spokespeople not to get caught between reporters who were growing impatient with the government's response to this crisis and a public that wanted reassurance. This did not mean that media activity was restricted entirely The hospital continued to provide infection control experts to comment on issues such as how the disease was being contained and the types of precautions precautions Infectious disease The constellation of activities intended to minimize exposure to an infectious agent; precautions imply that the isolation of an infected Pt is optional, but not mandatory. being taken and protective equipment being used. We also began to provide the media with useful information that did not overtly benefit Sunnybrook & Women's. At the time, all media and visitor access to hospitals in Toronto was essentially restricted. Nobody (except hospital staff in the trenches) really knew what it looked like on the inside. So Sunnybrook & Women's' audio visual department provided background or "library" video footage and photographs of what was happening behind the hospital's closed doors. Photos and video of our SARS unit and operations meetings were appearing in daily newspapers and evening news broadcasts locally and internationally None of this footage openly identified the hospital It was purposely pur·pose·ly adv. With specific purpose. purposely Adverb on purpose USAGE: See at purposeful. Adv. 1. kept generic so that any media outlet could use it. Although it was Important to ensure that the organization's message was reaching its intended audiences, it was equally important to bank some credibility with the public when they needed it most and least expected it. Though it took a little bit of extra time, providing this footage showed that the hospital was not simply self-promoting the good work it was doing, which strengthened our relationship with the media. TUNE OUT THE ENVIRONMENT, TURN UP INTERNAL CREDIBILITY Assuring staff that if they meticulously me·tic·u·lous adj. 1. Extremely careful and precise. 2. Extremely or excessively concerned with details. [From Latin met used proper precautions and protective equipment they would be safe was a simple but difficult point to get across. Especially when the media were reporting that health care workers were getting sick despite using the same precautions we were prescribing. Essentially, it had to be communicated that there were wide variations in how precautions were being applied and that Sunnybrook & Women's was home to some of the country's leading experts in infection prevention and control and the use of precautions to contain outbreaks. We validated this point by highlighting the appearance of our exports in the media and making sure these people were highly visible in targeted briefings with staff. We also ran interviews with them in e-newsletters, and we highlighted their relationships with impartial Favoring neither; disinterested; treating all alike; unbiased; equitable, fair, and just. third parties such as the provincial and federal governments and international organizations such as the Centers for Disease Control and Prevention Centers for Disease Control and Prevention (CDC), agency of the U.S. Public Health Service since 1973, with headquarters in Atlanta; it was established in 1946 as the Communicable Disease Center. in the U.S. and the World Health Organization in Geneva Geneva, canton and city, Switzerland Geneva (jənē`və), Fr. Genève, canton (1990 pop. 373,019), 109 sq mi (282 sq km), SW Switzerland, surrounding the southwest tip of the Lake of Geneva. . DEBUNKING de·bunk tr.v. de·bunked, de·bunk·ing, de·bunks To expose or ridicule the falseness, sham, or exaggerated claims of: debunk a supposed miracle drug. THE SINGLE SPOKESPERSON MYTH Crisis communication literature will tell you to use one spokesperson to keep consistency of message, and this role usually falls to the CEO (1) (Chief Executive Officer) The highest individual in command of an organization. Typically the president of the company, the CEO reports to the Chairman of the Board. . But challenging the notion of one contact can boost the integrity of your message and ensure that a diverse voice reaches what is inevitably a diverse public, whether it is staff or members of the community. Sunnybrook & Women's was able to do this internally and externally In dealing with the media, multiple staff members were allowed to communicate with reporters and relay their experiences in managing the disease. This seemed to resonate res·o·nate v. res·o·nat·ed, res·o·nat·ing, res·o·nates v.intr. 1. To exhibit or produce resonance or resonant effects. 2. with a vastly heterogeneous viewing public in Toronto. Everyone from our housekeepers and administrative staff to nurses, social workers and surgeons was encouraged to tell the world their stories. In messaging internally with staff at open forums and through other vehicles, the hospital's infectious disease experts were positioned alongside the CEO and allowed to offer opinions and in some cases cut,duct the entire forum. The CEO was positioned as the person clearly at the helm leading our response to the crisis, but he would call on members of the SARS management team to answer staff questions about everything from human resources The fancy word for "people." The human resources department within an organization, years ago known as the "personnel department," manages the administrative aspects of the employees. , physical plant and even financial issues to more common questions about the proper use of protective equipment. It is Important to have a wide variety of people communicating and carrying a similarly themed message--multiple faces add credibility when communicating with multiple audiences. TACTICAL APPROACH Strategically, Sunnybrook & Women's did everything most organizations do in a crisis to communicate with internal and external audiences. We used a combination of existing communication vehicles and others created specially for the crisis, such as internal and external web sites, broadcast voice mail and staff forums with video conference technology, along with daily e-mail updates, to ensure that the messages were being received frequently. We also tackled issues head on, often in open staff forums, which were held whenever the situation seemed to be getting acute--for example, when our staff contracted SARS or whet new government directives were issued regarding infection control protocols. During the three month crisis, there were 11 staff forums, daily e-mail newsletters sent to all staff (sometimes seven days a week), news postings on internal and external web sites, staff and patient information phone lines, and 11 news releases. Frequent, clear communication gave our message credibility and helped to reduce rumour and misinformation. But more important, it helped to keep a workforce that was being inundated in·un·date tr.v. in·un·dat·ed, in·un·dat·ing, in·un·dates 1. To cover with water, especially floodwaters. 2. with conflicting news in the media and public gossip reassured of its safety and confident in the organization. LEARNINGS Whether you are dealing with a crisis or planning for one, start by building strong relationships with your public and banking as much credibility as possible. Nurture relationships with the media and other external audiences just as you would with your staff. It will pay dividends when you need them most. It can sometimes be difficult to see the end of a storm when you are caught in its eye, so look for milestones along the way and keep the internal public motivated and informed. Throughout this crisis, Sunnybrook & Women's did everything it could to reward staff publicly (gift certificates, free tickets to events, etc.) and share public appreciation for a job well done. In our daily SARS e-mail newsletter, we published letters of thanks received from other hospital CEOs and some heartwarming heart·warm·ing or heart-warm·ing adj. 1. Causing gladness and pleasure. 2. Eliciting sympathy and tender feelings: a heartwarming tale. Adj. 1. messages written by students at a local school. Never wait to communicate all of the facts--you may never have them, and it is OK to communicate the process you make to reach a decision. You may find that you get some great suggestions from unsuspected places. You do not want the distance between the discussion of an issue and the final decision and ultimate implementation to be measured in rumour Communicate intermittently in·ter·mit·tent adj. 1. Stopping and starting at intervals. See Synonyms at periodic. 2. Alternately containing and empty of water: an intermittent lake. and often. Tell your public what the organization is considering and the rationale for your actions. It is also important to realize early on that the PR department is not the only area in an organization responsible for communication. Mid to senior-level leaders must assume a communicator's role and help fan out messages internally and externally. The role of the PR department is to provide the common denominator common denominator n. 1. Mathematics A quantity into which all the denominators of a set of fractions may be divided without a remainder. 2. A commonly shared theme or trait. on which more targeted and specific communication can occur. If your PR department is not at a level within the organization (i.e., reporting to the chief executive) where it can ensure that people are communicating with their subordinates, do whatever you have to do to get there. Finally, a crisis is an opportunity for the PR department to really shine and show what it can do to navigate the tricky waters of an uncertain situation. In a crisis, strong communication makes the difference between success and failure, but there is no magic bullet (jargon) magic bullet - (Or "silver bullet" from vampire legends) A term widely used in software engineering for a supposed quick, simple cure for some problem. E.g. "There's no silver bullet for this problem". or special formula that can ensure that you do this properly. What works in one organization may not work in yours, but be sure to seize the crisis as an opportunity, recognize that you will make mistakes, learn from others who may be involved in the same situation (call your fellow IABC IABC International Association of Business Communicators IABC Indo-Americans for Better Community members) and remind yourself that no matter how bad the situation gets, every story has a beginning, a middle and an end. SARS TIMELINE March 13 Sunnybrook & Women's admits its first patient infected with SARS, then referred to as "atypical atypical /atyp·i·cal/ (-i-k'l) irregular; not conformable to the type; in microbiology, applied specifically to strains of unusual type. a·typ·i·cal adj. community acquired pneumonia." March 15 The World Health Organization (WHO) issues an emergency travel advisory regarding a pneumonia that has reached Canada, China, Hong Kong Hong Kong (hŏng kŏng), Mandarin Xianggang, special administrative region of China, formerly a British crown colony (2005 est. pop. 6,899,000), land area 422 sq mi (1,092 sq km), adjacent to Guangdong prov. and several Asian countries Noun 1. Asian country - any one of the nations occupying the Asian continent Asian nation country, land, state - the territory occupied by a nation; "he returned to the land of his birth"; "he visited several European countries" . March 17 Health Canada Health Canada (French: Santé Canada) is the department of the government of Canada with responsibility for national public health. Health Canada's goal is to improve Canadian life by improving Canadian longevity, lifestyle and use of public healthcare. announces 11 suspected cases of SARS in Canada including nine in Ontario. March 23 The first hospital in Toronto closes in an effort to contain SARS. March 26 Ontario Premier Ernie Eves Ernest Lawrence Eves (born June 17, 1946) was the twenty-third Premier of the province of Ontario, Canada, from April 15, 2002, to October 23, 2003. Beginnings Ernie Eves was born into a working class family in Windsor, Ontario, in 1946. declares SARS a provincial emergency after three SARS-related deaths. March 27 Visits to hospitals in Toronto are severely restricted. March 31 Hong Kong reports 530 probable eases of SANS, including 213 people who live in the same apartment complex. April 7 Health Canada reports approximately 226 cases of SARS in Canada. April 8 Almost 200 employees and visitors at Hewlett-Packard's Toronto office are placed under quarantine after an employee, who broke an isolation directive and went to work, developed SARS-like symptoms (the employee later dies). April 14 All 500 members of a Roman Catholic sect in Toronto are placed under quarantine after 10 members develop probable cases and another 19 develop suspect cases. Two physicians also become infected after treating members of the group. April 17 Before the long Easter weekend, Sunnybrook & Women's takes its first step to ease restrictions by no longer requiring masks to be worn by employees who are not involved in patient care. April 19 Staff members at Sunnybrook & Women's involved in a procedure to manage the airway of a SAnS patient earlier in the week develop symptoms. As a precaution, the hospital closes its critical care units, quarantines more than 200 staff and admits 11 employees with symptoms consistent with SARS. April 20 Local daily paper, the Toronto Star The Toronto Star is Canada's highest-circulation newspaper, though its print edition is distributed almost entirely within Ontario. It is owned by Toronto Star Newspapers Ltd., a division of Star Media Group, a subsidiary of Torstar Corporation. , publishes a story incorrectly suggesting that everyone who had visited Sunnybrook & Women's in the past week must be quarantined. The hospital switchboard is flooded with calls from thousands of concerned patients. The hospital reacts quickly by updating phone lines, web sites, etc., and manages to get a new story published in the newspaper the next day. April 23 Sunnybrook & Women's sets up a "concierge service" to help quarantined staff members and their families with daily chores and to provide food and whatever else the isolated staff members need to cope. April 27 The number of suspected and probable SARS cases in Toronto drops to 267, prompting health officials to express cautious optimism that the outbreak is under control. April 29 After 10 days without a new case of SARS, Sunnybrook & Women's reopens its quarantined units. WHO lifts its warning against travel to Toronto. Other advisories affecting Hong Kong, Beijing and two regions of China remain in place. May 15 Canada is removed from WHO's list of SARS-affected areas. China threatens to execute anyone who ignores quarantine orders. May 17 Ontario Premier Ernie Eves lifts the provincial emergency on SARS. He announces that Toronto and Ontario "are safe places to live, work and visit." May 21-22 Feeling cautiously optimistic op·ti·mist n. 1. One who usually expects a favorable outcome. 2. A believer in philosophical optimism. op that the outbreak may be over, Sunnybrook & Women's holds large "thank-you" forums for staff on all campuses. May 22 Four new suspected cases of SARS surface in a Toronto rehabilitation hospital Hospital devoted to the rehabilitation of patients with various neurologic, musculoskeletal, orthopedic and other medical conditions following stabilization of their acute medical issues. . This news comes after nearly a one-month lull in new reported cases. As the second outbreak begins, hospitals are once again placed under serious restrictions. July 5 WHO announces that the worldwide SARS crisis has ended. Sunnybrook & Women's has treated about 75 patients with only one death. One patient remains in intensive care at Sunnybrook & Women's, and hospitals continue to operate under restrictions. Sources include Canadian Television Canadian television may refer to:
SARS WEB SITES Centers for Disease Control and Prevention www.cdc.gov/ncidod/sars World Health Organization www.who.int/csr/sars/en/index.html Health Canada http://sars.gc.ca Ontario Ministry of Health and Long-Term Camera www.health.gov.on.ca Toronto Public Health www.city.toronto.on.ca/health Craig DuHamel is director or public affairs for Sunnybrook and Women's College Health Sciences Centre a Canadian acute-care teaching hospital affiliated with the University of Toronto He can he reached at craig.duhamel@sw.ca |
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