What happens when something goes horribly wrong at an organization that has been entrusted with the care and safety of a vulnerable population? When Penn State was accused of failing to protect children, the way its leaders handled the crisis had a profound and potentially lasting impact. The well-known case study contains invaluable lessons for hospital leaders, as a hospital has a similar responsibility toward its patients.


How Not to Handle a Crisis

When retired Penn State assistant football coach Jerry Sandusky was arrested on charges of child sexual abuse, he was still closely identified with the university. Therefore, what started as one man's alleged transgressions quickly became the school's crisis.

The hours and days immediately after a crisis occurs are crucial. Unfortunately for Penn State, two things quickly became apparent: Its leaders had failed to act when they first knew there was a problem, and they had no crisis communication plan in place once it hit the public eye.

In the days following Sandusky's arrest, Penn State faced a barrage of public criticism that was magnified by around-the-clock news coverage and a tidal wave of social media attacks. After issuing a single initial statement, school leaders retreated behind a stone wall. Penn State lost valuable ground in a messaging battle that had profound implications for its brand name.

When university leaders finally acted, their attempts at swift, definitive action backfired. They fired both the president and legendary football coach Joe Paterno without explaining their rationale, and they failed to immediately designate a senior spokesperson, leaving the school without an effective representative. Ultimately, two key audiences — the student body and the broader Penn State community of donors and supporters — were left in the dark as rumors and misinformation ran rampant. The damage to Penn State will be severe and long-lasting.

Better Crisis Management

While there is no foolproof approach to crisis management that's guaranteed to protect your organization's reputation, there are certain cardinal rules that will help keep intact the trust you've worked so hard to earn among your employees, physicians, patients and community — often through decades of service.

Develop a crisis communication plan. Any organization can fall victim to a public relations crisis, often without warning. Those who have prepared for the possibility and have developed a communication plan beforehand can emerge with an enhanced reputation for integrity. Identifying a lead messenger, key audiences and best practice tactics can make identifying the right message much easier when a crisis hits the fan.

Know when to apologize. The practice of apologizing for medical errors was pioneered by the Lexington VA Medical Center in Kentucky 20 years ago and since has been demonstrated to prevent PR problems and, actually, to reduce malpractice costs. Sincerely apologizing to and, when appropriate, compensating an aggrieved party can save a world of unwanted trouble, expense and exposure.

Stay true to your values. Every organization should have a set of values that guide behavior and decision-making. The commitment to integrity should be a guiding beacon at all times — never more so than in a time of crisis. When James Burke, then-CEO of Johnson & Johnson, called his team together during the early moments of the Tylenol poisoning crisis, he gave them each a copy of the J&J credo. With the first tenet — that the health and safety of their patients and customers trumps every other business consideration — as a guide, they made decisions that cost millions in the short run but created billions of dollars' worth of goodwill in the long run.

Tell it first. A wait-and-see approach will almost always keep you in a reactive mode. Reluctance to speak first can destroy trust you've worked hard to build with the stakeholders who matter to you. When a patient at Griffin Hospital in Derby, Conn., was diagnosed with inhalation anthrax back in the anxiety-ridden days after 9/11, the FBI warned hospital CEO Patrick Charmel to remain silent. Concerned that the criminal investigation would be impeded and that rumors would percolate and mutate in the dark, he quickly informed the hospital staff, the media and the community what was going on and kept them informed throughout the incident, preventing an epidemic of panic.

Tell it all. Convincing yourself that you can keep a problem secret is dangerous and naive. When Saint Thomas Health in Nashville, Tenn., recently became the subject of a reporter's story about a two-year-old medical error involving a child, the leaders had a choice — clam up and weather the reputation hit, or engage the reporter and openly discuss the issue. Leaders chose the latter course, arguably the riskier path. They were quick to take responsibility, to be completely transparent and to use the story as an opportunity to share all the thoughtful patient safety measures they've taken since the incident. Saint Thomas' confident response and clear compassion was commended by community leaders and has enhanced the organization's reputation for quality.

Tell it yourself. People trust other people, not a faceless institution. Your doctors, employees and patients want to hear from you. Not from a lawyer. Not from a PR person. Not from a nameless statement. In times of crisis, they want to hear from the leaders responsible for addressing the issue. It is also essential that this leader receive coaching from an appropriate expert in advance. The politically tone-deaf performance of former BP CEO Tony Hayward following the Deepwater Horizon oil spill is a great example of just how disastrously an un-coached media presence can damage an organization's reputation.

Get others to tell it. Internal stakeholders — physicians, employees and even patients — can be strong advocates for an organization if they are informed, inspired and asked to help. When Dave Carroll's “United Breaks Guitars” video went viral, thousands of people posted comments. Unfortunately, none of them were United's employees. Although there are plenty of loyal and dedicated people working at United, the company's leaders failed to mobilize them in a damage control effort, resulting in what is already a business school case on how not to react to customer service failures.

Communication doesn't stop when the crisis has passed. A reputation can be destroyed in one day, but it takes years to rebuild, if it can be salvaged at all. Communication — internally and externally — should be ongoing following a crisis. After HCA settled Medicare fraud charges for $2 billion in 2000 and 2002, the company adopted, and widely communicated, one of the most stringent ethics and compliance programs in the health care industry. As a result of this and other measures, last year the Ethisphere Institute named HCA one of the world's most ethical companies for the second year in a row.

Building a Culture of Preventing and Handling Crises

Of course, none of these cardinal rules is a stand-alone strategy. Rather, they should be woven into the cultural fabric of an organization. Fostering a culture of ownership, where every employee feels a personal responsibility to prevent crises and to help their organization tell a positive story in the event of a crisis, is an important leadership responsibility.

People rarely dwell on the crisis, but they long remember how an organization handled it. By embracing and operationalizing these cardinal rules, hospitals can minimize damage and even turn a crisis to their advantage.

Anne Hancock Toomey is a partner with Jarrard Phillips Cate & Hancock Inc., a health care public affairs firm with offices in Nashville and Chicago. Joe Tye, M.H.A., M.B.A., is the CEO of Values Coach Inc., a health care consulting and training firm in Solon, Iowa. He is also a member of Speakers Express.