Micerc a guide for Developing Crisis Communication Plans Office of Public Health Preparedness




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Marie Milkovich MS LLP, Risk Communication Coordinator


Office of Public Health Preparedness

Michigan Department of Community Health

milkovichm@michigan.gov


Introduction:

The Michigan Crisis and Emergency Risk Communication (MICERC) manual synthesizes and adapts many principles of risk and crisis communication for the Michigan public health community. A wide variety of resources for crisis and emergency risk communication are available. This includes a substantial body of research, principles from corporations, businesses, and the public relations field, and manuals and materials developed by the Centers for Disease Control and Prevention. The CDC has developed two sets of materials specifically for crisis communication and public health. This includes the Crisis and Emergency Risk Communication manual and training (Reynolds, 2001) and the CDCynergy Emergency Risk Communication CD. These resources provide detailed and sophisticated materials for crisis communication. We strongly recommend that you print out, in advance of a crisis, any of the CDCynergy templates or check sheets that you think are essential to your organization. This can save valuable time.


The MICERC materials found in this manual synthesize and integrate many of these resources. The materials and principles are presented in an accessible way for the local public health and healthcare professionals. In addition, the resources and conditions within Michigan are described. The principles outlined below will help public health communicators develop a basic crisis communication capability.


It is important to point out that the MICERC manual is not a crisis plan, although there are many sections that could be included in a crisis communication plan. It is very important that each local health department and healthcare agency develop its own crisis plan. An outline of a crisis plan as well as some specific suggestions about how plans can be adapted to specific circumstances are presented at the end of the MICERC manual.


There are several other sections of this manual that are designed to facilitate effective communication during a crisis or emergency. Described are the principles of crisis communication, the core values and standards for informing decisions about crisis and emergency risk communication, and the crisis development process, which is based on the CDC’s crisis and emergency risk communication model. Also included are lists of probable audiences, guidelines and worksheets for communicating with them, guidelines and suggestions for working with local media, descriptions of media processes, and suggested methods for interacting with the media. Several basic message templates and examples of messages are included as well as structures and guidelines for how to prepare press releases, media statements, and speeches. Also included are guidelines and checklists for spokespersons, press events, press conferences, and interviews.


In the appendix of this manual are a variety of lists for purposes of coordination and notification during a crisis. This includes lists for the Michigan public health community, Michigan hospitals, Michigan media outlets, Michigan State Police and Emergency Management as well as the Michigan Department of Community Health. These lists may be used by local health departments and healthcare agencies to develop their own personalized contact lists to include in a crisis plan. It is very important that these lists be maintained and updated so that in a crisis, they are current. The most frequent mistake organizations make is failure to maintain an updated media contact list. It is imperative that you continually update this list. This critical task is essential for a quick, effective crisis communication plan.


Finally, the appendix also includes a number of references to other materials on crisis and emergency risk communication. These will be helpful in continued development of a crisis and emergency risk communication capacity.


Section One


Principles of Crisis Communication


Principles of Crisis Communication


Described below are core values and principles for informing decisions about crisis and emergency risk communication. In the absence of specific communication plans or standards, or when a situation is developing in an entirely unexpected way, it is appropriate to follow these general recommendations. When developing more specific and detailed plans, it is also helpful to keep these standards in mind.


There are few hard and fast rules in crisis and emergency risk communication. Crises and disasters are inherently uncertain circumstances and effective communication often requires a balance between competing standards and values. You must use your own best judgment in deciding what to communicate, when, to whom, and through what channels.

These standards will be helpful, however, in making those judgments.


Honesty: In general, effective crisis and emergency risk communication is as honest and forthright as the circumstances allow. Honesty is important to empowering audiences and building credibility. It is also the right of communities to have information about the risks that they face.


The primary justification for withholding information from the public during times of crisis has been based on a belief that the public might panic. Fifty years of research demonstrates that people seldom panic in the wake of a catastrophe. The studies were conducted around the globe, in moderate to extreme circumstances, and the findings have been scrutinized by many. One example is the 1918 flu pandemic, which in 2 years killed about 40 million people world wide. This is more than the Black Plague in the Middle Ages, yet despite tremendous health problems and severe resource shortages, there was no panic or revolt. People remained remarkably cool and cooperative. The interesting thing that needs to be stressed about the 1918 pandemic is that at the time of the crisis the U.S. was at war, and in fact some irresponsible parties suggested that the Germans had introduced the pandemic as a form of bioterrrorism, (a claim that is totally unfounded). Even given that climate there was no panic.


People are confused and concerned, agitated and afraid, but only in very rare circumstances do they actually panic. During the collapse of the World Trade Center, most people evacuated in a very calm and orderly manner. Confusion and concern is best addressed by providing honest and forthright information about the situation and about the risks the public faces.


Lack of complete honestly has the potential to seriously damage credibility. It is very likely that dishonest or misleading statements will later be discovered and may be reported in the media. In these cases, the motives of the source are usually questioned and the credibility of the source is reduced.


At the onset of a crisis, leaders are often inclined to make reassuring statements prematurely. This well-meaning stance can backfire. Downplaying danger when it’s extent is not yet fully known will make a leader or an agency’s subsequent statements suspect, particularly if the peril is real and even greater than anticipated.


Maintaining an honest response when the facts of the situation are unclear will be one of the largest challenges. In these cases, it is appropriate to say “I don’t yet have that information”, or “The situation is unclear and we do not yet have confirmation of all the facts,”or “We are still gathering information and do not yet have a clear picture of the situation.” Provide clear descriptions of what steps are being taken to obtain a better picture of the crisis.


Openness: Openness means being accessible and willing to communicate. Openness relates directly to frequency of communication and enhances the impression that audiences have the latest up to the minute information about a situation. Being open also creates the impression that officials are being responsive to the needs and concerns of the public. The impression of openness is sometimes compromised, by the feeling that there is nothing new to communicate. Scheduling regular news conferences, briefings and updates during an emergency and simply being accessible to the media will enhance the impression of openness.


During the early stages of the 9/11 World Trade Center disaster, Mayor Guliani held news conferences twice a day. Answering questions also enhances the impression of openness. If you do not have an answer, say so and indicate that you will find the information as soon as possible. Be sure to carry through on this commitment. During a crisis, news conferences may need to be scheduled every few hours to ensure that openness is maintained.


Immediacy: During a crisis or disaster, speed of response is important. Slow responses have enhanced the harm during many crisis events. Often, during a crisis, emergency officials are reluctant to respond quickly because the circumstances of the crisis or risk have not yet been confirmed. While accurate information is very important during a crisis, it should not significantly slow the speed of a response. If a critical piece of information cannot be confirmed, the public should be told that the information is unconfirmed, using phrases like, “Based on an unconfirmed report . . .” or “The limited information we currently have access to indicates . . .” Remember that during a crisis, established channels of communication are often cut off and actual confirmed information is rare.


In general, the media outlets in Michigan are very professional and will work with you in getting your message out quickly. In addition, the Emergency Alert System through the county Emergency Management Offices disseminates warnings and alerts very quickly.


Equivocal: Crises and emergencies are by definition uncertain and unclear. Emergency officials and spokespersons, however, sometimes believe they must be very certain in all their comments in order to avoid panic. When the situation turns out to be different than was presented by the spokesperson, credibility is lost. There are many cases where harm has been enhanced by an inappropriately certain statement about what is inherently an uncertain circumstance.


Too much reassurance and certainty about a disaster may also actually enhance the level of public concern. In those cases where the situation changes and turns out to be different than expected, credibility may also be seriously damaged.


Avoid being overly certain about a crisis or disaster. Use phrases like “Based on what we currently know . . .”, “The situation is changing, but our current understanding is . . .” and

“While we expect to have more information soon, we believe . . .” The CDC’s recent response to the SARS outbreak used these strategies and as a consequence was much more successful than their response to anthrax. In most of their statements, the CDC acknowledged that SARS was a new disease and not enough was known about the disease to make certain predictions about how it would develop.


Empathy and support: While it is important not to over reassure, it is important to express concern, empathy, and support for anyone harmed by a crisis. Use phrases like “Our concern and support goes out to the victims and their friends and family . . , and we express our deepest sympathy to those harmed by the event and we will do everything possible to help them . . .” , “Our hearts go out to those who have lost family and friends in this tragedy . . .” or “Our first priority is to be supportive to those who have been harmed or who have lost property as a consequence of this disaster”. These kinds of supportive and reassuring statements demonstrate your good intentions. Large-scale incidents do have the capacity to unnerve people. Demonstrations of emotion are not necessarily problematic, and in the case of bioterrorism, it may be prudent that the public remain concerned and cautious. Rather than dismiss expressions of fear, public health leaders should acknowledge peoples sense of vulnerability and ask them to bear the risk and work toward solution. As a general rule, empathy and support should be the first public statements made following a disaster.


Consistent/Redundant: Consistency of message is one of the hallmarks of good emergency and crisis communication. Consistency promotes credibility and certainty.

Consistency can be achieved by appointing designated spokespersons and by maintaining openness. If the media cannot access formal sources, they will find others to speak about the event. In these cases, control over the message will be lost and many inconsistent statements will be made. In the anthrax episode, more than 80 government spokespersons were featured in the media. This significantly enhanced the level of confusion.


Part of being consistent is being redundant. By repeating the same core message again and again, you help ensure that the message is heard and retained. Remember that not everyone heard the first message or warning, or was listening at the beginning of the press conference. Do not be afraid to repeat the critical information. By having key points that are repeated and emphasized, you will also stay “on message.” Make sure that the key message is also featured in subsequent messages such as flyers, web sites, press releases, or on hotlines. This will help achieve consistency. Also, make sure that key staff members also know the core message so that they can repeat it.


Simple: Simplicity is another hallmark of effective crisis and emergency risk communication. In general, audiences have a hard time retaining more than three key points. During a crisis, the ability of an audience to process complex messages may be further reduced by the stress and uncertainty of the situation. Messages that are limited to two or three main points and that are targeted to about a 6th grade comprehension level are more likely to be understood and retained.


An effective message would likely feature the three following key points:



  1. What is happening/what should I do? What is the nature of the event? Is it a toxic spill, an infectious disease outbreak, a radiological incident or some other threat? In general, until the public has some basic understanding about the nature of the event, they cannot begin to take any action. Answering the questions about what to do, helps the public regain some control of the situation. This may be as simple as closing windows and turning off fans, air conditioners, or furnaces in the case of a toxic spill, or wearing insect repellant in the case of West Nile virus. In other cases, you may simply want to tell the public to monitor the media for further developments. Whatever you suggest the public do, be sure that it is a meaningful activity. If the public perceives the activity as trivial or meaningless you will forfeit some degree of trust and reinforce the feeling that the public is not involved.



  2. Am I at risk? How will this affect my family or me? Answering the question “Am I at risk?” is difficult during a crisis because the information is often very sketchy and incomplete. In general, indicate the types of risks being faced and give some specific recommendations for various groups i.g., those living downwind of a spill, individuals with compromised immune system in the cases of some infectious disease, those who have eaten certain kinds of foods in the cases of food borne illness. By indicating who is at risk, you may limit the number of “worried well”. This will help alleviate the number of people flooding emergency rooms because of their fear and uncertainty.



  3. It is also important to tell those people who are at risk what to do. If symptoms develop, for example, should they seek medical advice? Should they call the local health department or go to the local emergency room? Where can they get more information? A final part of many effective emergency risk messages is to indicate where more information is available. This may be the CDC or the Michigan Department of Community Health web site. It may be a hotline where they can call in. You may wish to refer them to their local physician.



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