Crisis Management By Doctors: Strategies For Crisis Communication In Health Sector
“Coronavirus: India doctors’ spat at and attacked'”
“Doctors attacked in Indore”
“Doctor attacked by mob speaks with press”
And many more articles of a similar nature crowd the front-space of media reporting. The first question that comes to mind: is this pandemic a one off instance in which patients have lost mental stability? Is the attack on doctors a reflection of panic? Even before we delve into these questions in the current situation, scholarship on the healthcare sector reveals that doctors have been subjected to such incidents over the past many years. Researchers postulate that similar crises, though in other sectors, can be mitigated through effective communication.
Increasing indignities against the medical community prompted us to probe into the applicability of crisis communication strategies in the healthcare sector. We decided to conduct a study to explore causative factors leading to a crisis, challenges faced by doctors and strategies adopted to mitigate the crisis impact and conducted a study in the month of September/October 2019. A survey questionnaire was circulated both by hand and email to doctors in hospitals in Ahmedabad, Kanpur and Delhi. We collected data from a little over 100 doctors across India. This report is a summary of the findings in the study.
After collecting the data, when we began the analysis, the clock hit January 2020 and the pandemic intensified the attack against doctors. Based on our analysis do we then propose a primer for crisis communication? No! Our attempt in this study is to help our medical saviours understand the antecedents to crisis in the medical profession and design suitable responses. This report, we hope, will help comprehend strategies for mitigating negative consequences of patient interaction.
The ‘Why?’
Crisis will hit, there is no escape from the situation - Doctors are no exception. The causes for the same are multiple as dissatisfaction with the treatment, high medical costs, delay in recovery etc. In this study we tried to find out the challenges faced by doctors in the execution of their duties and responsibilities. Interestingly, the response of doctors was surprising. They reported that it was their own management/staff who posed the biggest challenge (34.48%), followed by patients (27.59 %), security (24.14 %) and mob (13.79%). Some of the responses covered issues as unwillingness to cooperate in moments of distress, raising multiple queries related to health, not being present to save the situation and use of coalition and force to pressurize doctors.
Narrowing down the emphasis to the source of communication challenges faced by doctors, 32.3% mentioned patients themselves which often aggravated the crisis situation. This was followed by a significant 21 % from relatives and 15 % from management. The difficulty for the doctors arose from the fact that the patients were all in a denial mode. There were too many questions, major expectations from the patients and their relatives, little understanding of the risks involved, desire to listen to only positive news, external interference (political), related high costs and linked insurance coverage. Finance related issues and style of communication also impeded the connect with the patient.
Almost all doctors agreed that these challenges had increased and intensified over the years. The major contributors to this upward move were patient expectations (34 %) followed by surprisingly doctors themselves (30 %). Some of the reasons attributed for this enhanced negativity, linked patient expectation to doctor’s competency, professionalism, knowledge base, communication, and time constraint. The contribution of doctors to this negativity stemmed from huge bills, unethical practices, long wait, ineffective use of internet, unsavoury odours in the hospital/clinic.
On most occasions the doctors were the face of the hospital addressing crisis situations. However, on other occasions it was the management, administrative staff or medical superintendent. It was agreed upon by most of the respondents that the presence of the attending doctor helped mitigate the crisis in an effective manner. Appeasement of the patients from management personnel, or administrative staff or medical superintendent often aggravated the situation.
What was critical in the research was the deployment of strategies to arrest crisis situations faced by doctors. As discussed above, intervention by other doctors (24.5 %) was perceived to be the most relevant technique followed by summoning the police (20.8 %) and security (20.8 %). Often other team members (paramedics), staff or bouncers were requisitioned on the spot for addressing mob frenzy. The responses in the questionnaire suggested that in crisis situations the expectation from doctors was to inform and share information, counsel patients, show empathy and stay calm. They were expected to not talk negative, appease the patients and minimize perceived threat to health. A point that clearly emerged in this communication was a need to understand the financial implications of the treatment. Similar strategies were not expected from other service providers in the hospitals. For instance, from the police and security, the expectations were of providing relevant information concerning the issue. An interesting strategy suggested by doctors was the presence of bouncers when information was being provided to the patients
Considering the increasing number of violent attacks on doctors, have hospitals devised a crisis preparedness plan (e.g., staff training) to prevent such situations? There was an almost equal number of responses on both sides of the question. While a section of doctors agreed to the fact that security cover was being provided to the doctors, staff mock drills, and training programs were being conducted, the other section of doctors presented a contrarian viewpoint. Additionally, the interference of political or antisocial elements aggravated the already tense situation in the healthcare sector.
The ‘How’
Based on the analysis, we can highlight certain communication strategies to abate a crisis situation.
Sender credibility – Developing competency and professionalism
Compliance – With hospital rules and norms
Economic Logic: Costs and financials to be commensurate with the treatment
Counselling – Patients and relatives –allay fears and negativity
Interactivity – With patients and their relatives
Emotional connect – Building an emotional connect with patients and their relatives for ease of operations
Reciprocity – Be nice to the patients and their relatives which is sure to find an echo in their response.
Strategies to be avoided:
Coalition: Avoid meeting the patient with a large team
Interventions: Prevent media or other party (NGOs or political) interventions
The question now is: Will the same work in the current situation?
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