American Journal of Infection Control 43 (2015) 368-9
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Handling Europe’s first Ebola case: Internal hospital communication experience Margarita Mosquera MD, PhD, MPH a, *, Victoria Melendez PhD b, Pello Latasa MD, MPH a a b
Preventive Medicine Department, Alcorcón University Hospital Foundation, Madrid, Spain Internal Communication Department, Alcorcón University Hospital Foundation, Madrid, Spain
Key Words: Ebola virus Communications media Public health
Europe’s first Ebola virus disease (EVD) case was diagnosed in our hospital. There was an unjustified panic in the population because of an imbalance of credibility assigned to the media as opposed to scientific information. A reinforcement of hospital internal communication was needed to keep health care workers informed with up-to-date scientific EVD information. The proactive management of information flow to both internal and external actors is required to reduce unjustified fear within the public. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
In public health crises, network news, newspapers, and social media communication become particularly important. Europe has recently experienced different situations, such as food alerts (mad cow disease), terrorism (Madrid 3/11, London bombings), and pandemics (influenza A H1N1), where social media has played a crucial role in shaping public response and crisis management.1,2 Experts in health, risk, and scientific communication suggest that managers in charge of crises should handle a public health emergency by the principle of “an informed population is a safe population.” Fast, timely dissemination of accurate and appropriate information to the population is one of the main tools that governments have to address these situations. Because misinformation can create unnecessary fear, international, national, and local institutions should be prepared to coordinate an effective communication flow to manage public health crises, including institutions’ internal communication. However, are we prepared? The Alcorcón University Hospital Foundation is a tertiary care hospital near Madrid, Spain, with 382 beds. Our hospital has an internal communication plan developed by the internal communication department and approved by the steering committee in 2012, which recognizes the importance of strong internal hospital communication. This plan includes different ways to communicate important events (Intranet, e-mails, screensavers, meetings, employee feedback suggestions) to ensure a continuous flow of information between managers and professionals (up and down)
* Address correspondence to Margarita Mosquera, MD, PhD, MPH, Unidad de Medicina Preventiva, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, Alcorcón 28922, Madrid, Spain. E-mail address: [email protected] (M. Mosquera). Conflicts of interest: None to report.
and between professionals (horizontal). From initiation, the plan includes daily monitoring of all instances of internal communication. A monthly report of comparative data to measure the impact of this communicative activity is performed. The first case of Ebola virus disease (EVD) contracted outside Africa was diagnosed in Alcorcón University Hospital Foundation. A 44-year-old female assistant nurse came to our emergency department reporting that she had had contact with an EVD patient. She had previously taken care of a patient with EVD transported from Sierra Leone to Spain on September 22, 2014. She was immediately transferred to an isolation room, and protective measures were used in caring for the patient (personal protective equipment, segregation of regulated medical waste, etc). A quantitative polymerase chain reaction test for Ebola virus was reported as positive and confirmed after 11.5 hours. A transfer to a designated hospital for the care of patients with EVD was arranged.3 Our health care workers took care of the patient for 20 hours. The outbreak news was spread worldwide in a few minutes. Examples of poor media communication regarding the hospital’s EVD crisis management played an important role on public opinion. Media published images of the isolation zone that conveyed a false picture of reality.4 The patient was in an isolation room in the emergency department but the photo of the screen and sticky tape that isolated the corridor prior to the isolation room was interpreted as the only physical barrier that existed between the patient and health care staff. In fact, unjustified fear within the population resulted in a >50% reduction of emergency department patients the following day (Fig 1). Patients cancelling their programmed surgeries, an important decrease in outpatient visits, fewer visitors to inpatients, employees at the information desk wearing surgical gloves, and an
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.015
M. Mosquera et al. / American Journal of Infection Control 43 (2015) 368-9 350
369
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Fig 1. Comparison of emergency department patients in October (2013e2014).
Fig 2. Internal communication actions annual comparison (2013e2014).
empty hospital coffee shop were the hospital picture for almost a week. Panic is harder to contain than the spread of the disease itself.5 Because of the need of keeping professionals informed about what happened inside the hospital, in the period after the EVD admission, a significant increase of 200% in the activity of internal communications was observed (Fig 2), 75% because of Intranet information. Therefore, an increase of information meetings, updating protocols, training programs, and publications on the hospital Intranet were performed. In particular, during the days after the EVD admission, we reinforced information meetings open to all health care workers. In those meetings, medical staff from preventive medicine, internal medicine, and occupational health departments tried to explain and clarify certain aspects of the misinformation disseminated by social media and networks. Messages to health care workers were focused on science-based and understandable6 information about EVD. This experience provides us with the opportunity to analyze the consequences of the impact of the information offered by media and social networks not only on the general population but also on our own health care workers. Actually, in spite of the increased efforts from the hospital to maintain staff up to date, there was a lack of confidence in the internal hospital communications because of social media coverage. There was an imbalance of credibility assigned to the media as opposed to scientific information provided internally. This introduces a new scenario which is a challenge in the management of communication and information in and out of institutions in a crisis outbreak. Uncertain information with poor scientific rigor in the media and in some emerging social networks in the first hours of a crisis has an effect on the professionals who are involved in patient care.
In scenarios such as these it is necessary to strengthen internal communication with hospital staff to counteract social media information, which can cause confusion and fear among health care workers. They are the benchmarks for the rest of the population in such difficult times, and a reaction of fear or safety may influence the image that people have of a health crisis, its severity, its evolution, and its consequences. Health care organizations’ crisis managers should act proactively and lead7 the information from social networks to prevent the spread of information that causes unnecessary concern. Because of the high influence of the media in public opinion, up-todate scientific information should be available to them in the first hours of the crisis, and they should act responsibly to convey accurate and appropriate information to the general public.
References 1. Lowrey W, Evans W, Gower KK, Robinson JA, Ginter PM, McCormick LC, et al. Effective media communication of disasters: pressing problems and recommendations. BMC Public Health 2007;7:97. 2. Ungar S. Hot crises and media reassurance: a comparison of emerging diseases and Ebola Zaire. Br J Sociol 1998;49:36-56. 3. Parra JM, Salmerón OJ, Velasco M. The first case of Ebola virus disease acquired outside Africa. N Engl J Med 2014;371:2439-40. 4. The Telegraph. Spanish Ebola case: screen and sticky tape to protect against virus. Available from: http://www.telegraph.co.uk/news/worldnews/ebola/ 11148196/Spain-Ebola-case-Screen-and-sticky-tape-to-protect-against-virus. html. Accessed February 12, 2014. 5. Bonneux L, Van Damme W. An iatrogenic pandemic of panic. BMJ 2006;332: 786-8. 6. Ratzan SC, Moritsugu KP. Ebola crisisecommunication chaos we can avoid. J Health Commun 2014;19:1213-5. 7. Gostin LO, Friedman EA. Ebola: a crisis in global health leadership. Lancet 2014; 384:1323-4.
Contents lists available at ScienceDirect
American Journal of Infection Control
American Journal of Infection Control
journal homepage: www.ajicjournal.org
Brief report
Handling Europe’s first Ebola case: Internal hospital communication experience Margarita Mosquera MD, PhD, MPH a, *, Victoria Melendez PhD b, Pello Latasa MD, MPH a a b
Preventive Medicine Department, Alcorcón University Hospital Foundation, Madrid, Spain Internal Communication Department, Alcorcón University Hospital Foundation, Madrid, Spain
Key Words: Ebola virus Communications media Public health
Europe’s first Ebola virus disease (EVD) case was diagnosed in our hospital. There was an unjustified panic in the population because of an imbalance of credibility assigned to the media as opposed to scientific information. A reinforcement of hospital internal communication was needed to keep health care workers informed with up-to-date scientific EVD information. The proactive management of information flow to both internal and external actors is required to reduce unjustified fear within the public. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
In public health crises, network news, newspapers, and social media communication become particularly important. Europe has recently experienced different situations, such as food alerts (mad cow disease), terrorism (Madrid 3/11, London bombings), and pandemics (influenza A H1N1), where social media has played a crucial role in shaping public response and crisis management.1,2 Experts in health, risk, and scientific communication suggest that managers in charge of crises should handle a public health emergency by the principle of “an informed population is a safe population.” Fast, timely dissemination of accurate and appropriate information to the population is one of the main tools that governments have to address these situations. Because misinformation can create unnecessary fear, international, national, and local institutions should be prepared to coordinate an effective communication flow to manage public health crises, including institutions’ internal communication. However, are we prepared? The Alcorcón University Hospital Foundation is a tertiary care hospital near Madrid, Spain, with 382 beds. Our hospital has an internal communication plan developed by the internal communication department and approved by the steering committee in 2012, which recognizes the importance of strong internal hospital communication. This plan includes different ways to communicate important events (Intranet, e-mails, screensavers, meetings, employee feedback suggestions) to ensure a continuous flow of information between managers and professionals (up and down)
* Address correspondence to Margarita Mosquera, MD, PhD, MPH, Unidad de Medicina Preventiva, Hospital Universitario Fundación Alcorcón, Calle Budapest, 1, Alcorcón 28922, Madrid, Spain. E-mail address: [email protected] (M. Mosquera). Conflicts of interest: None to report.
and between professionals (horizontal). From initiation, the plan includes daily monitoring of all instances of internal communication. A monthly report of comparative data to measure the impact of this communicative activity is performed. The first case of Ebola virus disease (EVD) contracted outside Africa was diagnosed in Alcorcón University Hospital Foundation. A 44-year-old female assistant nurse came to our emergency department reporting that she had had contact with an EVD patient. She had previously taken care of a patient with EVD transported from Sierra Leone to Spain on September 22, 2014. She was immediately transferred to an isolation room, and protective measures were used in caring for the patient (personal protective equipment, segregation of regulated medical waste, etc). A quantitative polymerase chain reaction test for Ebola virus was reported as positive and confirmed after 11.5 hours. A transfer to a designated hospital for the care of patients with EVD was arranged.3 Our health care workers took care of the patient for 20 hours. The outbreak news was spread worldwide in a few minutes. Examples of poor media communication regarding the hospital’s EVD crisis management played an important role on public opinion. Media published images of the isolation zone that conveyed a false picture of reality.4 The patient was in an isolation room in the emergency department but the photo of the screen and sticky tape that isolated the corridor prior to the isolation room was interpreted as the only physical barrier that existed between the patient and health care staff. In fact, unjustified fear within the population resulted in a >50% reduction of emergency department patients the following day (Fig 1). Patients cancelling their programmed surgeries, an important decrease in outpatient visits, fewer visitors to inpatients, employees at the information desk wearing surgical gloves, and an
0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.015
M. Mosquera et al. / American Journal of Infection Control 43 (2015) 368-9 350
369
90 80 70 60
250 2014 2013 200
Number
Number
300
50
2014 2013
40 30
150
100
20 10 01 03 05 07 09 11 13 15 17 19 21 23 25 27 29 31
Days
0
January
March
May
July
September
November
Month
Fig 1. Comparison of emergency department patients in October (2013e2014).
Fig 2. Internal communication actions annual comparison (2013e2014).
empty hospital coffee shop were the hospital picture for almost a week. Panic is harder to contain than the spread of the disease itself.5 Because of the need of keeping professionals informed about what happened inside the hospital, in the period after the EVD admission, a significant increase of 200% in the activity of internal communications was observed (Fig 2), 75% because of Intranet information. Therefore, an increase of information meetings, updating protocols, training programs, and publications on the hospital Intranet were performed. In particular, during the days after the EVD admission, we reinforced information meetings open to all health care workers. In those meetings, medical staff from preventive medicine, internal medicine, and occupational health departments tried to explain and clarify certain aspects of the misinformation disseminated by social media and networks. Messages to health care workers were focused on science-based and understandable6 information about EVD. This experience provides us with the opportunity to analyze the consequences of the impact of the information offered by media and social networks not only on the general population but also on our own health care workers. Actually, in spite of the increased efforts from the hospital to maintain staff up to date, there was a lack of confidence in the internal hospital communications because of social media coverage. There was an imbalance of credibility assigned to the media as opposed to scientific information provided internally. This introduces a new scenario which is a challenge in the management of communication and information in and out of institutions in a crisis outbreak. Uncertain information with poor scientific rigor in the media and in some emerging social networks in the first hours of a crisis has an effect on the professionals who are involved in patient care.
In scenarios such as these it is necessary to strengthen internal communication with hospital staff to counteract social media information, which can cause confusion and fear among health care workers. They are the benchmarks for the rest of the population in such difficult times, and a reaction of fear or safety may influence the image that people have of a health crisis, its severity, its evolution, and its consequences. Health care organizations’ crisis managers should act proactively and lead7 the information from social networks to prevent the spread of information that causes unnecessary concern. Because of the high influence of the media in public opinion, up-todate scientific information should be available to them in the first hours of the crisis, and they should act responsibly to convey accurate and appropriate information to the general public.
References 1. Lowrey W, Evans W, Gower KK, Robinson JA, Ginter PM, McCormick LC, et al. Effective media communication of disasters: pressing problems and recommendations. BMC Public Health 2007;7:97. 2. Ungar S. Hot crises and media reassurance: a comparison of emerging diseases and Ebola Zaire. Br J Sociol 1998;49:36-56. 3. Parra JM, Salmerón OJ, Velasco M. The first case of Ebola virus disease acquired outside Africa. N Engl J Med 2014;371:2439-40. 4. The Telegraph. Spanish Ebola case: screen and sticky tape to protect against virus. Available from: http://www.telegraph.co.uk/news/worldnews/ebola/ 11148196/Spain-Ebola-case-Screen-and-sticky-tape-to-protect-against-virus. html. Accessed February 12, 2014. 5. Bonneux L, Van Damme W. An iatrogenic pandemic of panic. BMJ 2006;332: 786-8. 6. Ratzan SC, Moritsugu KP. Ebola crisisecommunication chaos we can avoid. J Health Commun 2014;19:1213-5. 7. Gostin LO, Friedman EA. Ebola: a crisis in global health leadership. Lancet 2014; 384:1323-4.
