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Healing an Image

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Healing an Image

An Analysis of the 2014 Ebola Crisis at Texas Health Presbyterian Hospital, Dallas

MARY TAYLOR RENFRO

KEALIA OHAI

11.25.14

An Analysis of the 2014 Ebola Crisis at Texas Health Presbyterian Hospital, Dallas MARY TAYLOR RENFRO

Table of Contents

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OVERVIEW

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INTRODUCTION

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HISTORY OF TEXAS HEALTH PRESBYTERIAN HOSPITAL, DALLAS

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FOUNDATION

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REPUTATION AND PATIENT SATISFACTION

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RECENT ISSUES

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SITUATION ANALYSIS

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EBOLA VIRUS

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TIMELINE

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KEY PUBLICS

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SWOT ANALYSIS

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STRENGTHS

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WEAKNESSES

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OPPORTUNITIES

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THREATS

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STRATEGY ANALYSIS

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ISSUES

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TACTICS

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#PRESBYPROUD CAMPAIGN

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LETTER TO THE COMMUNITY

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MINUTES INTERVIEW WITH NURSES

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SETTLEMENT WITH DUNCAN FAMILY

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ANALYSIS

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#PRESBYPROUD CAMPAIGN

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LETTER TO THE COMMUNITY

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MOVING FORWARDADVERTISEMENTS

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MINUTES INTERVIEW WITH NURSES

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SETTLEMENT WITH DUNCAN FAMILY

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CONSISTENCY ISSUES

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LESSONS LEARNED

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SUMMARY

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RECOMMENDATIONS FOR THE FUTURE

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FOCUS ON MOVING FORWARD

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COMMUNITY RUN

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WINTER ILLNESS PREVENTION CAMPAIGN

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ONE MEDIA CONTACT

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CONCLUSION

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APPENDIX

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SOURCES

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I. OVERVIEW

Introduction

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When Thomas Eric Duncan became the first person to be diagnosed with the contagious Ebola virus in the United States in October 2014, concern about the possibility of an outbreak in the U.S. proliferated the news media as well as the public, sparking international attention. At the center of the situation was Texas Health Presbyterian Hospital, Dallas, the hospital responsible for treating the patient and containing the virus.

After several significant missteps, the hospital became the target of heavy scrutiny. Much of the criticism involved the hospital’s lack of preparedness before the patient with Ebola arrived as well as its lack of transparency after his initial misdiagnosis. As a result, the hospital saw a 25 percent loss of revenue and a 50 percent decline in patient admissions through its emergency department.

To combat the negative press surrounding the hospital in the wake of the crisis, Texas Health Presbyterian Hospital, Dallas launched a public relations campaign highlighting the compassion and integrity of its staff members and their unrelenting pride in the hospital. The campaign featured authentic messages from hospital workers declaring their support for the company. Messages were spread through hashtags on Twitter and Facebook, a promotional video series uploaded to YouTube, an advertisement published in a Dallas newspaper, an interview on a national news program, and a press conference. By launching a full-fledged campaign drawing upon many public relations tactics, administrators at Texas Health Presbyterian Hospital, Dallas hoped to reestablish the respected reputation the hospital held within the community prior to the Ebola crisis.

History of Texas Health Presbyterian Hospital, Dallas

Foundation

During a sermon at Highland Park Presbyterian Church in the early 1960’s, Dr. William M. Elliott Jr. was struck with the idea to build a hospital in Dallas affiliated with the church (“About Us”). With support from members of the religious community, Texas Health Presbyterian Hospital was opened in Dallas in 1966 (“About Us”).

The company has since grown in size and prominence along with the Dallas community it serves. It is now the flagship location of one of the largest healthcare entities in the state, Texas Health Resources (Loftis et al.). According to the American Hospital Directory, Texas Health Presbyterian Hospital Dallas (THPH) generated $600 million in revenue and $40 million in net profit in 2013 (Loftis et al.).

Reputation and Patient Satisfaction

Since its establishment, the hospital has created a positive reputation for itself within the Dallas community. In 2013, US News & World Report ranked THPH fifth in Dallas and fifteenth in Texas (“Texas Health…”). With nearly 900 beds, THPH has been recognized as one of the country’s best

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hospitals for its digestive disorders, neurology and neurosurgery, and orthopedics departments (“About Us”). The hospital also made headlines in 2013 for being the location where former president George W. Bush received treatment for an artery blockage (Loftis et al.).

A 2013 poll showed that THPH served over 83,000 patients in its emergency department (ED) each year

and had extremely high approval ratings (“Texas Health”). Seventy-four percent of patients ranked the hospital “very high” overall, and 61 percent of patients felt they always got help from the staff as quickly as they needed (“Texas Health”) 1 . Seventy-nine percent of patients said they would recommend the hospital to friends and family. Along with the public satisfaction, THPH’s nursing staff was ranked among the top 3 percent in the country (“Texas Health”).

Recent Issues

THPHS’s approval ratings have dropped drastically in recent months. The company’s problems began on September 25, 2014 when hospital staff dismissed Thomas Duncan from the ED after he showed signs of Ebola, causing the public to lose trust in the hospital (Scientific American Global RSS). Later, two nurses who had cared for Duncan became infected after wearing gear that didn’t fully protect them from exposure (Scientific American Global RSS), further damaging the reputation of the hospital and increasing public unease. By the end of October, the hospital’s revenue had dropped 25 percent (“Texas Health”), and Moody’s Investor Service had changed the long-term debt rating of Texas Health Resources from “positive” to “developing” (Loftis et al.).

II. SITUATION ANALYSIS

Ebola Virus

With a mortality rate ranging from 53 to 88 percent, Ebola virus disease (EVD) is considered one of the most deadly viruses to humans and primates (“Ebola Virus”). It was first discovered in remote areas of Zaire and Sudan in 1976, and led to an outbreak that infected 284 people before it was contained (“Ebola Virus”). Its highly infectious nature requires that research on the virus be performed in a Biosafety Level 4 laboratory – the highest security level for laboratories (“Ebola Virus”). Because of the strict regulations surrounding it, testing on Ebola has been very limited historically, so it is not well understood relative to other viruses (Baylor College of Medicine). It is known, however, that Ebola is spread to humans through contact with the bodily fluids of infected animals including primates and fruit bats, and that it has an incubation period of 2-21 days in humans (“Ebola Virus”). Once infected with the virus, common symptoms include fever, diarrhea or bloody stool, vomiting and a skin rash (“Ebola Virus”). There is currently no licensed vaccine to treat the virus, but two drugs are currently undergoing trial (“Ebola Virus”).

In order to thwart the spread of the virus, community perceptiveness and engagement is paramount.

Contact tracing, surveillance, well-equipped facilities and safe burial practices are also necessary to contain Ebola (“Questions…”).

Timeline of Crisis 2

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On September 25, 2014, 42-year-old Liberian national Thomas Eric Duncan was sent home after visiting the emergency room at Texas Health Presbyterian Hospital in Dallas (Buchanan et al.). Duncan had been in the United States for a little more than a week when he arrived at the hospital (Buchanan et al.). He had travelled from Liberia, and sought medical attention the day after he started experiencing a fever, abdominal pain and nausea (Drago 3 .).

Three days later, Duncan was admitted to the same hospital after his symptoms worsened (Lupkin). At that point, his full travel history was revealed to health care officials and he was put in an isolative care unit and tested for Ebola (Lupkin). On Tuesday, September 30, Duncan tested positive for Ebola. Two days later, THPH released a statement saying Duncan was originally sent home due to a flaw in the hospital’s digital collection of patient health history known as the electronic health record, or EHR (“Can Texas…”). Shortly after that, media probing revealed the mistake was caused by a human error, not a technical glitch as the hospital’s statement claimed (“Can Texas”). The next day, THPH released a second statement retracting its original claim and clarifying that there was no flaw in the EHR (“Can Texas”). After this, many people blamed the hospital for not coming forward and admitting that its staff had made a mistake.

Less than a week later, on October 8, Duncan died in the hospital (Lupkin). The next day, THPH’s staff launched a social media campaign called #presbyproud in an effort to express their solidarity as a medical team despite the tragic and precarious situation regarding Duncan’s diagnosis and subsequent death (“Can Texas”).

Two days later on October 11, THPH nurse Nina Pham was admitted to the hospital and tested positive for Ebola after caring for Duncan the previous week (Lupkin). Four days later, Amber Vinson, another THPH nurse who had also cared for Duncan, tested positive for Ebola (Lupkin). The same day she was confirmed to have the virus, Vinson was flown to Atlanta to receive care at one of the few hospitals fully equipped to treat Ebola patients in America (Lupkin). The next day, Pham was flown from Dallas to Maryland to receive treatment at a similar facility (Lupkin).

On October 19, two days after Pham was transported, a letter of apology from Texas Health Resources CEO Barclay Berdan was published in the Dallas Morning News Sunday paper (“Can Texas”).

Finally, on October 22, THPH released a financial statement revealing that the hospital had suffered a 25 percent decline in revenue, and 50 percent fewer patients were seen in the ER during the month of October than September (“Can Texas”).

Key Publics

Given the prevalence of the topic of Ebola in media coverage during September 2014 as well as the threat of an American outbreak occurring if the virus reached the U.S., key publics in this case include

2 See appendix: Figure 2 3 See appendix: “Timeline Given to the Congressional Committee”

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not just the patient, his loved ones and the THPH staff, but also the Dallas community, the larger American community, media outlets, and public health officials around the world.

SWOT Analysis

Strengths

THPH had several significant strengths during the Ebola crisis. The hospital had a strong reputation within the community and extremely high patient satisfaction. Employee morale among the hospital’s staff was also very strong and remained strong throughout the situation as it unfolded. Finally, the hospital had a superior nursing team which had been recognized among the top 3 percent in the country.

Weaknesses

Before Duncan arrived at THPH, the hospital was not fully equipped to treat Ebola. Though it did have training programs in place, the programs were not fully developed, and the staff was not entirely educated on the Ebola virus and proper techniques for treating it.

Opportunities

The amount of national attention THPH received gave the hospital the opportunity to receive access to resources. Organizations could lend support that otherwise wouldn’t be available. Similarly, since THPH was the first hospital to diagnose a patient with Ebola in the U.S., it could establish itself as a model for others, elevating its reputation worldwide.

Threats

One threat THPH faced was that it could not look to other U.S. hospitals to learn how to handle the Ebola situation. Because it was the first hospital to diagnose an Ebola patient in America, there was no example to follow, making it difficult to know exactly which steps to take. Another threat to THPH came from the heavy media coverage of the situation: every decision the hospital made was analyzed and published, which made it vulnerable to widespread criticism after any mistake was made.

III. STRATEGY ANALYSIS

Issues

The first main issue in this case was one of consistency. In this situation, the hospital needed to deliver one clear message to the public to begin to reestablish its reputation of adeptness in the community. It was important that all public relations tactics fit together cohesively.

Another main issue was one of transparency. Initially, the hospital did not explain that Duncan was first released on account of a human error. Similarly, Texas Health Resources CEO Barclay Berdan did not release any information about Nina Pham and Amber Vinson in his letter to the community. He stated

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that he was unaware of specific details. Without transparency it is extremely difficult for the public to trust an organization.

A third issue for the hospital was containment of information. Because of the high-profile nature of the

case, it was difficult to manage the information released by the media. The hospital should have had one

media outlet to send all questions and inquiry.

Finally, timeliness was an important issue in this case. Because of how dangerous and threatening the situation was, THPH should have been quick and efficient with all messages to the public. With lives on the line, timeliness is vital for a successful public relations campaign.

Tactics

“We wanted to cut through the media sensationalism with a message that humanized and personalized the hospital,” said Paul Szablowski, senior vice president of communications and image for Texas Health Resources (Santamour).

THPD responded to the Ebola crisis by implementing a public relations strategy that broadcasted the commitment and pride of the hospital’s staff for the work they do. It aimed to start an authentic conversation about the laudable efforts of the staff and thereby increase the brand value of the hospital within the Dallas community.

#PresbyProud Campaign

On October 9, THPH launched the #PresbyProud campaign in an attempt to regain public trust (“Can

Texas”). The campaign used social media, a rally and a video series entitled “Employee Perspectives” to show the community that the staff was proud to be part of the organization. THPH used hospital workers

as spokespeople in order to create an authentic and emotional tone.

Using Twitter, Facebook and YouTube, THPH turned to social media to create buzz and raise campaign awareness. Spiking on October 18, the hashtag #PresbyProud was used close to 250 times per day (Topsy). Though the number pales in comparison to those garnered by hashtags promoted by larger social movements, such as the Ferguson protest’s #HandsUp, most of the #PresbyProud posts came from hospital accounts, staff members, or friends and family of hospital workers, which established an authentic tone for the campaign.

Additionally, a hospital rally was held on October 17 to show support for Nina Pham and Amber Vinson. Several dozen hospital workers exited through the emergency room doors holding signs with messages including “We Heart Presby” and “I am Presby Proud”. They chanted cheers of encouragement for Pham and Vinson and prayed for Ebola victims worldwide. The rally immediately received international media coverage.

On the same day the rally was held, THPH released the “Employee Perspectives” video series on its website. The short clips featured staff members who worked with Duncan during his stay expressing

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their commitment to the hospital and their pride in the THPH team. The videos emphasized that employee morale remained high and progress was a priority at the hospital.

Letter to the Community

Eleven days after Duncan’s death, Texas Health Resources CEO Barclay Berdan published a letter in The Dallas Morning News addressing the community. 4 In the letter, Berdan admitted the hospital’s Ebola training and education programs had not been fully developed when the patient arrived. He also stated that the hospital made a mistake when it did not correctly diagnose Duncan.

Berdan’s letter did not provide any information about the status of the two nurses who became sick after caring for Duncan. “Our focus is on the facts and we are determined to get all of the answers and soon as we can,” he wrote. Berdan also promised that the hospital was improving its Ebola response programs and doing everything in its power to ensure hospital workers’ safety.

“Moving Forward” Advertisements

On October 24, five days after the CEO’s letter to the community was published in Dallas Morning News, THPH released an advertisement entitled “Moving Forward” (“Moving Forward…”). The ad featured nurses, doctors, and other staff members at THPD looking directly into the camera and saying “thank you” to the Dallas community for standing by them over the previous few weeks as the Ebola situation unraveled. While the theme was consistent with the hospital’s other public relations tactics in that it featured employees of the hospital trying to convey an authentic tone, the message in this advertisement was completely new. The hospital had never said “thank you” to the public before – up until this point, its message had been “we are proud of our hospital despite our mistakes.”

60 Minutes Interview with Nurses

On October 26, 60 Minutes aired an interview with four of the nurses who treated Duncan at THPH (Pelley). In it, they expressed their pride in the hospital, their concern for Duncan while they cared for him, and revealed several key facts about the situation that had previously not been made known to the public.

First, they cleared up allegations made by the media by stating that the hospital never breached CDC protocol during Duncan’s treatment (Diamond). They clarified that the CDC’s guidelines were unclear when they were treating Duncan, and that was what ultimately led to the infection of Nina Pham and Amber Vinson (Pelley). They also said that after 48 hours of treating Duncan, the hospital moved to equip its staff with protective gear that covered the neck (Pelley). This decision came three weeks before the CDC implemented new protocol that required the same gear (Pelley).

The nurses also revealed that when Duncan tested positive for Ebola, the hospital informed its entire staff of the news and gave all of its health care providers the choice to opt out of treating him (Pelley). Because of this, all of the staff members who cared for Duncan were volunteers. This fact had not been made clear to the public before the interview (Diamond).

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Finally, the THPH nurses addressed the question of how Duncan had been sent home upon his initial visit to the hospital’s emergency room. The nurses clarified that Duncan had mentioned only that he had been to Africa, not West Africa or Liberia specifically, which would have been red flags for the health care workers who saw him (Pelley). Also, he had specifically said that he had never come in contact with a person infected with Ebola, which turned out to be untrue – he had actually helped a sick pregnant woman into a car to go to the hospital in Liberia (Diamond). All of this, they explained, coupled with the fact that he only showed a 100.1° temperature when he arrived and no other symptoms of Ebola at the time, legitimized the hospital’s decision to release him (Diamond).

Settlement with the Duncan Family

The final tactic THPH used in its attempt to reshape its image involved contacting Duncan’s family and reaching a private settlement to compensate for the initial misdiagnosis (Moyer). The hospital also established a charity in Duncan’s name dedicated to combatting the spread of Ebola in his home country of Liberia (Moyer).

Josephus Weeks, Duncan’s nephew, spoke about the settlement during a press conference on November 12 (Moyer). Weeks had previously appeared on various cable news outlets accusing the hospital of denying his uncle the care he deserved because he was black, poor and without insurance (Moyer). During the press conference he gave on November 12, however, Weeks spoke about the admiration he had for the hospital to correct its mistakes and added that he himself wouldn’t hesitate to go there for treatment (Moyer).

Analysis

#PresbyProud Campaign

The #PresbyProud campaign successfully relayed personal and real-life perspectives from hospital workers, which made significant progress towards regaining the trust and support of the community.

Although the social media campaign did not garner widespread, passionate involvement from people outside the hospital community, the hashtag did have a large reach. According to Topsy, #PresbyProud was used about 850 times during the month of October, but most of the posts came directly from hospital accounts and THPH staff (Topsy). Though it was used less than 900 times, the hashtag made 1.3 million impressions (Topsy). The broad reach of the initiative made it successful at altering the conversation surrounding THPH in the wake of the Ebola crisis.

The hashtag was used most on October 18 (Topsy). The peak of the social media activity surrounding #PresbyProud combined with the recent release of the “Employee Perspectives” videos made the third week of October particularly significant in the hospital’s public relations efforts. Though the use of the hashtag peaked on October 18, it was used in a positive context only 19 times. It was used negatively 79 times and neutrally 115 times. 5 However, it should be noted that many of the 79 negative uses were repetitive messages from the same accounts; that is, the negative sentiment associated with

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#PresbyProud was not expressed by 79 unique individuals (Topsy). Furthermore, the majority of the 115 neutral uses of the hashtag came from news organizations reporting about the campaign, and the 19 positive uses came almost exclusively from the THPH account or the accounts of employees at the hospital (Topsy). Although the hashtag was used in a negative context, the media was most receptive to the positive uses coming from the THPH community, so the majority of the impressions made during the campaign cast the hospital in a positive light.

One challenge to the #PresbyProud campaign was inconsistent messaging sent by hospital workers to the public. While many hospital employees shared feelings of pride in the wake of the crisis, several others displayed a different sentiment to the media. One anonymous physician told The Dallas Morning News, “It’s difficult to be proud to work here right now. Suffice it to say, morale is low” (Loftis et al.). Briana Aguirre, a nurse who treated Nina Pham at THPH, shared similar feelings during an interview with Matt Lauer on the “Today Show.” “I can no longer defend my hospital,” she said (Aguirre). “Knowing what I know, I would try everything and anything to refuse to go there to be treated…. I would feel at risk by going there. If I don’t actually have Ebola, I may contract it there. I would do anything to refuse to go there,” (Aguirre).

These comments were particularly harmful to the hospital’s efforts to reestablish its reputation because they came from employees – the same people who were filmed expressing their supposed solidarity in the “Employee Perspectives” videos. Aguirre’s remarks about the safety of the hospital were especially damaging because they fed into and legitimized the fear about the hospital which already existed in the mindset and which THPH was fighting to overcome. Also, the publication of negative employee attitudes regarding the hospital debased some of the authenticity with which the positive sentiment had previously been viewed.

Although the #PresbyProud initiative was successful in shaping the conversation surrounding the hospital and reaching more than 1 million people through social media, the campaign could have been more influential if there had been complete solidarity among the hospital’s employees.

Letter to the Community

Berden’s letter was largely unsuccessful at reshaping the hospital’s image in the wake of its Ebola crisis. Though Berden made it clear that the hospital assumed responsibility for the mistakes made during Duncan’s treatment, the response was not made in a timely manner. Issued 11 days after Duncan’s death and after two THPH nurses had become infected themselves, the letter seemed less sincere than it would have if it had been released immediately after the patient passed away.

Though it was released to an appropriate target audience—the Dallas community—the letter was also an ineffective tactic because it did not provide a way for members of the public to engage in a conversation with the brand. Unlike digital initiatives, which are conducive to viewer engagement through likes, shares, replies, and comments, promotional print material does not encourage any response. In this situation, it was imperative for the hospital to regain the close relationship it once had with the community; one of the simplest ways it could have begun to do that is by fostering meaningful conversation with the Dallas community, but the CEO’s letter did not take advantage of that opportunity whatsoever.

“Moving Forward” Advertisements

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The “Moving Forward” advertisement effectively addressed the Dallas community, which was an appropriately targeted audience, and contained a clear and simple message, but ran into issues of timeliness.

The timing of the advertisement’s release was problematic because it occurred the day before the hospital produced financial data revealing it had suffered a 25 percent decline in revenue during the crisis. While the advertisement was saying “thank you” to the public for remaining supportive, the financial report showed that the public was actually avoiding the hospital. Given the amount of attention THPH was receiving from the media, it should have anticipated the publication of such significant losses by a variety of news outlets. Had it done so, it could have delayed the release of the advertisement until the public was showing some degree of demonstrable support for the hospital.

60 Minutes Interview with Nurses

The interview with THPH nurses on 60 Minutes was an effective public relations tactic because it gave the public an opportunity to see the nurses who treated Duncan and hear their side of the story, which had previously been lost in the media hailstorm surrounding the Ebola subject.

The interview clearly showed that the nurses were all deeply affected by their experience of caring for Duncan. Their emotional recounting of the situation made the public see that the hospital’s staff was genuinely concerned for the patient’s well-being and those treating him tried their best to help him recover. Though the statements in the interview were undisputedly genuine, they were also an effective messaging tactic for the hospital. By letting the public see the faces of the people who cared for Duncan and hear their voices as they recounted the last moments spent with him, the interview humanized the situation and made it easier for people to understand Duncan’s death and the infection of Pham and Vinson as tragic but accidental outcomes that could have happened at any hospital across the country.

The interview was also an important tactic for the hospital because it gave the nurses a chance to reveal several key facts that dispelled rumors about negligence at THPH.

Before the interview, many news outlets were publishing articles alleging that a breach of protocol at THPH led to Pham and Vinson’s subsequent diagnoses with Ebola 6 . During the interview with 60 Minutes, the nurses directly disputed those allegations, saying the hospital had always adhered to the guidelines of the CDC, but the guidelines themselves were inadequate. The nurses helped to redeem the image of the hospital by publicly setting the record straight about this point.

The nurses made other significant clarifications during the interview as well. Duncan’s withholding of significant information about his travel history and exposure to Ebola patients upon his first visit to the hospital made it easier to understand how the misdiagnosis occurred without assuming the hospital had been careless or negligent. It was also helpful to highlight the policy of volunteerism that prevailed during Duncan’s treatment. The fact that there was a team of nurses and doctors who chose to care for a

6 See Sources: Jervis and Bacon; Nolan and Rosenberg; Goldling

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patient with such a contagious and serious disease shows the character of the staff at THPH. Before the interview, that fact had not been made clear to the public.

Overall, the 60 Minutes interview with the nurses at THPH was an extremely successful way of capturing the attention of the public and shifting the tone of the conversation surrounding the crisis to have a more favorable conception of the decisions on the part of the hospital (Diamond). However, the interview was not as successful as it could have been because it was released on October 26 -- more than three weeks after Duncan had died. Since the nurses revealed such key facts that worked in the favor of the hospital, the interview should have been arranged either several weeks sooner to communicate the facts of the situation in a timely manner, or the hospital should have used a different tactic to release the facts the nurses revealed. By the 26, the situation was no longer developing so there was much less attention on the details of the events as there had been the preceding weeks.

Settlement with Duncan Family

Though the abrupt change in Weeks’ tone following the settlement with the hospital ran against the authenticity THPH was trying to create in its campaigns, the decision to reach out to Duncan’s family was a good one. Since Weeks had made such inflammatory comments directed towards the hospital in the past, there was a decent chance that he would have moved to sue the hospital for malpractice. Though the case would have been extremely difficult to make for the Duncan family, since they would have had to prove that the health care workers who treated Duncan were aiming to cause him harm, there would have been a frenzy of press surrounding the ordeal and engulfing the hospital in scandal once again (Moyer). In this situation, it was better for the hospital to foresee this and act proactively to make reparations with the family ahead of time rather than deal with more bad press down the road.

Consistency Issues

Starting with the #PresbyProud campagin, THPH’s message to the public was simple:

“we are proud”. The hashtag, video series and rally were all ways to show the public that employee morale was high and that staff members had unified as one. This quickly shifted with the release of the CEO letter when Berdan changed the tone to apologetic. “We are sorry” was now the message to the public. This changed yet again when THPH released the “Moving Forward” advertisement that stated, “thank you”. Each tactic they used differed greatly. It became confusing and hard to understand what exactly they were trying to say. It seemed as if they would say anything to regain public trust and didn’t know what they were trying to say. THPH should have created a more consistent, cohesive campaign. In order to remain credible they needed to communicate clearer and more consistently.

Lessons Learned

Several lessons can be learned from THPH’s public relations campaign in response to the Dallas Ebola crisis. Firstly, critical information must be released in a timely manner during a crisis, especially when lives are at stake. If information is withheld or its release is delayed, the speaker risks a serious loss of credibility.

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Secondly, a public relations campaign must contain one clear, consistent message throughout. By staying on message, an organization can establish a voice for itself that cuts through the static, but if it attempts to say too much or does not communicate clearly, the force of its communication will be lost.

Also, there must be complete solidarity among the group given the microphone during a campaign. If a company chooses to communicate its message through its employees, it must be sure they all stand behind the effort before it uses them to help repair its image. A negative statement released to the public from just one member of the group can cause significant harm to the authenticity of the entire campaign.

Finally, it is important for an organization involved in a crisis to take the time to evaluate the situation as it unfolds and consider each potential course of action. By predicting the reactions and consequences of each possible action, an organization can anticipate future challenges and act proactively to minimize them.

IV. SUMMARY

Recommendations for the Future

Focus on Moving Forward

Another tactic THPH should use going forward is to further communicate its focus on moving forward in the wake of the crisis. Its messaging should not disregard the situation it endured, but should place an emphasis on the lessons it learned and experience it gained as it centers its focus back to the patients and their health. By concentrating on what it can control, THPH can have a much greater influence on the conversation surrounding its brand as media coverage of the Ebola crisis fades.

Community Run

After refocusing its sights on the future, the hospital will need the support of the Dallas community to regain the reputation it had before the crisis. One helpful tactic THPH could employ to win back the community’s support is to sponsor a community run, such as a 5k or half marathon, which would benefit the charity established by the hospital in Duncan’s memory.

Instead of continuing to release statements and video messages affirming its dedication to the public, THPH would be going a step further and showing its commitment to community involvement through the run. Furthermore, it would give the hospital a chance to demonstrate that it did not merely establish the charity in Duncan’s name to appease his family and avoid going to court, as some critical reporters conjectured, but that the charity works to advance a cause that truly matters to THPH. On a more nuanced level, it would also give attendees a new, positive experience to associate with the hospital -- an experience completely detached from and contradictory to the negative images that still dominate the public’s conception of the hospital. This is a crucial step in overcoming the loss of reputation the hospital experienced since people will not be inclined to renew support in a brand with a damaged image until they begin to conceptualize their understanding of the brand in a new way.

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A community run benefitting Duncan’s charity is the perfect platform for the hospital to use to show the

public that they have not forgotten the situation they were involved in or belittled the tragedy that

resulted from it, but that they are also deeply concerned with actively re-engaging with the Dallas community and making efforts to move forward.

Winter Illness Prevention Campaign

In order to fully recover from the Ebola crisis, THPH needs to become a voice of authority rather than a

target of scrutiny. It can use its position as the one American hospital to have treated an Ebola patient unexpectedly to widely disseminate information on the virus for public awareness.

As winter approaches, more people will become infected with viruses and bacteria such as the common cold and the flu, but in the wake of the Ebola crisis, more people will also be on alarm about the disease since it has received significant attention in the media.

An effective tactic THPH could employ to reposition itself as a trustworthy hospital involves aggressively disseminating information to the public about signs and symptoms of common winter illnesses and contrasts them with symptoms of Ebola. The information could also include instructions regarding recommended medical care for each condition. This tactic would benefit the hospital because it would diminish public fear of Ebola through education about the virus, and would re-establish the hospital as a source of medical authority.

One Media Contact

The containment of information has been an issue for THPH since Duncan first tested positive for Ebola. Because of the severity of the case, a media frenzy quickly erupted causing the dissemination of inconsistent information. This only increased nationwide fear and further harmed THPH’s image.

Moving forward, the hospital should direct all media inquiries to a single contact at a single outlet, such

as The Dallas Morning News, and communicate directly with that organization alone. This tactic would allow THPH to more efficiently contain and monitor what is released, ensuring more consistent, accurate publication of information across outlets.

Conclusion

The THPH response to the Ebola crisis was in some ways successful, but could have improved several executions. The hospital excelled in creating an authentic tone. Using its staff members as spokespeople, they communicated their message to the public from an authentic perspective in a relatable, human voice. THPH also handled the lawsuit with Duncan’s family successfully by anticipating future criticism and settling proactively.

However, THPH could have improved its campaign by ensuring employee solidarity before communicating largely through its staff. When frustrated workers went to the media to voice complaints about the hospital, the authenticity of the #PresbyProud campaign was severely jeopardized.

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Timeliness was another important issue in the campaign. Given the gravity of the situation, information should have been released as quickly and efficiently as possible. Both Barclay’s letter to the community and and the 60 Minutes interview with the nurses would have been more successful if the public had received them sooner.

In the future, THPH should continue to focus on moving forward after headlines surrounding the crisis die down and media clamor involving the hospital quiets. It should keep up its vigorous efforts to communicate its dedication to the Dallas community and stress patient care as its top priority in order to reshape the conversation around its brand. To further demonstrate its commitment to the health of the community and support for its patients, the hospital could also sponsor a community run to benefit Duncan’s charity. A Winter Illness Prevention Campaign would also help the hospital reposition itself as a voice of medical authority in the community while framing its experience with Ebola as an advantage. Lastly, THPH should take steps to ensure consistent and accurate press coverage by communicating with one media outlet exclusively and directing all inquiries to that source. Though it has begun to rebuild its brand in the wake of the Ebola crisis, it still has a considerable portion of the public’s trust to reclaim, and each of these tactics could speed up that healing process for the hospital.

APPENDIX

APPENDIX Figure 1: Patients’ overall approval rating, U.S. News and World Report Healing an Image 17

Figure 1: Patients’ overall approval rating, U.S. News and World Report

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TIMELINE GIVEN TO CONGRESSIONAL COMMITTEE

Published By: Mike Drago

Notable Elements of Mr. Duncan’s Initial Emergency Department Visit

Thursday night, September 25 – Friday morning, September 26

10:37 p.m. Mr. Duncan arrives in Emergency Department (ED)

· Patients presenting to the ED are treated in order of priority based upon a screening tool used widely around the country.

· Information obtained from Mr. Duncan and his companion during intake was limited to his chief complaint, a date of birth, gender, and first and last name.

· Based on these initial symptoms, Mr. Duncan returned to the waiting room to await triage. 5-10 patients at the time were waiting for beds in the ED treatment area.

11:36 p.m. Triage starts

· A triage nurse again asks Mr. Duncan the reason for his presentation and records Chief complaint identified as “abdominal pain, dizziness, nausea and headache (new onset).”

· She records a temperature of 100.1F.

· His other vital signs were unremarkable.

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· Obtaining the patient’s travel history was not a part of the triage nurse’s process on September 25,

2014.

12:05 a.m. Mr. Duncan is brought back to a room in the ED treatment area

12:27 a.m. First physician interaction with the EHR

· The EHR shows the physician accessed the triage nurse’s report, along with other elements of the record, which at this time did not include the travel history. These included:

· Visit Navigator Template

· ED Triage [twice]

· THR Template MD Assessment

· ED Patient History

· Flow Sheet ED PTA Home Meds

· Allergies

· ED First Provider Contact

The physician visited the patient but did not begin his examination

12:33 – 12:44 a.m. RN assessment

· The primary ED nurse continues the assessment.

· She identifies his complaints as “sharp, intermittent epigastric/upper abdominal pain; sharp, frontal headache; dizziness; lack of appetite”

· She asks about Mr. Duncan’s travel history.

· The nurse documents that Mr. Duncan “came from Africa 9/20/14”

· RN states she recalls the discussion because of how long the plane flight was.

experience with very long plane fights). Attached no further significance to this travel history.

(She had personal

· This information was not verbally communicated to the physician, as prompted by the EHR

12:52 – 1:10 a.m. ED physician begins evaluation of Mr. Duncan

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· The ED physician accesses the EHR again. A review of the EHR shows that the physician, on

several occasions, accessed portions of the EHR where the travel history was now available including:

o

ED Lab Results Screen

o

ED Triage [twice]

o

ED Rad Results

· The record does not show which information the physician read, only which information was available.

· Additionally, the EHR review shows that the physician gathered personal history and health data directly from Mr. Duncan and his companion.

· These data, as reflected in the EHR, reveal that Mr. Duncan and his companion advised that he was

a “local resident”, that he had not been in contact with sick people, and that he had not experienced nausea, vomiting or diarrhea.

· The patient’s physical examination was remarkable only for nasal congestion and a runny nose along with mild abdominal tenderness.

·

The physician views several more locations in the EHR including:

o

ED Lab Results Screen

o

Visit Navigator Template

o

Related Encounters

o

Flow sheet

o

Allergies

o

PTA Home Meds

o

ED Patient History

1:10 – 3:37 a.m. Physician ongoing evaluation and treatment

· Over the next two hours, the physician accesses the EHR several times to review laboratory results, radiology results, response to treatment, review of vital signs, and medications.

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· On several occasions, the physician reviewed this information in locations within the EHR that

included Mr. Duncan’s travel history, as documented by the primary ED nurse. Again, the record does not show which information the physician read, only which information was available.

·

The patient is given Extra Strength Tylenol at 0124 and Intravenous Normal Saline is started

·

Lab results are reviewed at 0109 and include:

o

WBC – 3.08 L (low end of ‘normal range’ 3.98)

o

Platelets – 92 L (low end of ‘normal range’ 130)

o

Glucose – 180 H (high end of ‘normal range’ 100)

o

Creatinine – 1.41 H (High end of ‘normal range’ 1.25)

o

AST – 94 H (‘normal’ <34); can reflect abnormalities in liver function or muscle tissue

·

Radiology results reviewed at 0128 and included:

o

CT scans Abdomen & Pelvis- “no acute disease” and Head - “unremarkable”

·

The patient’s temperature was documented as 103.0F at 3:02 a.m.

·

The patient’s temperature was documented as 101.2F at 3:32 a.m.

3:37 a.m. Patient discharged

· The discharge diagnosis was sinusitis and abdominal pain. At the time of discharge, the ED physician documented that “patient is feeling better and comfortable with going home.”

·

Physician makes final views of patient record including:

o

ED Lab Results

o

ED Rad Results

o

Visit Navigator Template

o

Allergies

o

ED Triage

o

ED PTA Home Meds

o

Visit Diagnosis

o

THR Discharge MD ED

o

Discharge Instructions

o

ED Disposition

o

Flow sheet

o

Inpatient DC Instruction Writer

o

Communication Management Section

o

ED AVS PHD RTF

o

ED Orders

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· Discharge instructions were recorded in the EHR advising the patient to take medication as directed, return for increased pain, fever, vomiting or other concerns. Follow up with your doctor or the recommended doctor tomorrow for a recheck. Rest and drink plenty of fluids. Specific instructions for abdominal pain, dizziness and sinusitis gave additional instructions and advice when to seek immediate care.

additional instructions and advice when to seek immediate care. Figure 2: Timeline of events during Ebola

Figure 2: Timeline of events during Ebola crisis in Dallas

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Healing an Image 22 Figure 3: THR CEO Barclay Berdan’s letter to the Dallas community

Figure 3: THR CEO Barclay Berdan’s letter to the Dallas community

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Healing an Image 23 Figure 4: #presbyproud usage for Oct. 18 on public Twitter accounts, compiled

Figure 4: #presbyproud usage for Oct. 18 on public Twitter accounts, compiled manually

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