7.1. Communication strategies for interacting with the public

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The response of the general public that is potentially affected by a crisis, or could be helpful in resolving a crisis, has an impact on the outcome of the crisis response work. Therefore, organizations need to develop and implement communication strategies for Interacting with the public that can help facilitate beneficial responses to crises and crisis response efforts. Communication and interaction with the public during a crisis will be facilitated if daily communication strategies and regular interaction with the public is already well established. The recommendations presented here are aimed at both public and private entities at all levels that are involved in crisis management, in particular crisis managers and roles within the organizations related to design, development and evaluation of communication plans and strategies. Even though not all personnel involved during a crisis or incident needs to communicate directly with the public, being aware of communication strategies aimed at the public and the need of communication competencies can be of use.

Implementation

Introduction

There are several considerations to explore and investigate in order to achieve the full potential of effective communication with the public that are applicable to all phases of crisis management and everyday operations.
These considerations have been formulated in terms of triggering questions that can be used within the organization, in the context of workshops, focus groups involving communication strategists and other domains experts, to check the effectiveness of the communication strategy that the organization is adopting. The triggering questions are different depending whether we are Before, During or After a crisis or emergency situation.

Healthcare implementation - Introduction

Building public engagement and trust in healthcare authorities requires long-term actions. Crises in healthcare in the last decade (e.g. disease outbreaks) showed that the public’s noncompliance with the government measures taken to contain the crisis (e.g. vaccination campaigns), the lack of trust between the public and national authorities on one hand, and between the public and international organizations on the other hand, are the consequence of a deficit of theoretical and applied knowledge in the area of risk communication and public inclusion through social media (TELL ME, 2014a).

In order to implement effective risk communication and to overcome these deficits in case of pandemics, some relevant questions have to be taken into account by institutions in charge of managing the crisis, across the different phases:

• How can the general population be persuaded through public health communication to take effective preventive actions?
• What are the most appropriate communication methods to deal with the complexity, uncertainty, misinformation, and fake information?
• What are the best communication strategies to maximize compliance with vaccination, and to assist health professionals and agencies to cope with vaccine-resistant groups? (TELL ME, 2014a)

In the case of a pandemic, the stages to implement the communication strategy are identified in the four pandemic phases (Inter-pandemic, alert, pandemic, transition) that correspond with the new approach to the WHO Influenza Threat Index (TELL ME, 2014c).

Before a crisis

The triggering questions BEFORE are meant to stimulate organizations to assess their communication strategies in order to increase their preparedness and capability to respond in the face of a crisis or emergency situation.
When planning for crisis response, it should be taken into account that the public can be helpful both in the prevention phase and during the actual occurrence of the crisis. Therefore, it is important to give proper value to this opportunity through adequate messages. To be able to benefit from resources and assistance provided by the public there is a need for proper organization, planning, education, and training.

Triggering questions

Adequacy of the Plan

• Do we have a communication strategy or crisis communication plan that gives guidance on who and how to communicate?
• Are relevant roles aware of their responsibilities with regard to communication?
• Is our communication plan sufficiently coordinated with other relevant authorities/organizations?
• Do we have mechanisms to prevent misalignment or conflicts regarding communication among both different organizations and/or different parties of the same organization (e.g. through an appointed common spokesperson)?

Capability to guide effective crisis response by the public

• Does the communication plan include adequate information on how to guide crisis response by the public?
• Are we making sure the information shared with the public does not cause unnecessary alarm or distress?
• Does the communication plan include information to the public on how to avoid using resources that may be needed by others during a crisis?
• Do we provide information on crisis management also during normal/ordinary situations?
• Have we prepared standard public messages or information blocks for use during crises?
• How do we communicate the individual responsibility to increase public preparedness, avoiding an overreliance on authorities?

Communication Channels

• Through what kind of channels are we able to communicate?
• Do we use communication channels that people already use every day?
• Are the communication channels sufficiently up-to-date?
• Does the selection of our communication channels take into account the needs or routines of the public in target?
• Is there a risk of our communication channels being overloaded?

Adequacy of Competencies

• Are we proficient at using the available communication channels?
• Are relevant roles trained, educated, and exercised using this strategy/plan?
• Are we using the appropriate terminology for communication with the public (consider, for instance, different demographics)?
• Do we have access to the appropriate competences (subject matter experts, domain experts etc.) while developing communication strategies/plans?
• Does the communication officer/s have the appropriate (technical) domain knowledge in order to understand, and respond to, information requests from the public (and thus have the ability to work independently)?

Clarity and Accessibility

• Are people aware of where they can access the information?
• Have we considered in which languages the information needs to be communicated?
• What processes or routines do we have to fact-check/quality-assure before we communicate it?
• Do we clearly communicate responsibilities of individuals, as well as of the agencies involved in crisis management?

Acceptability and Trustworthiness

• Does our communication strategy adequately encourage trust and acceptance by the public?
• Is our information presented in a way or place that makes it trustworthy?
• Is our communication avoiding any expression of blame culture, which could be seen as unhelpful or counterproductive scapegoating?
• Are we adequately communicating the benefits of being prepared in case of crisis and not just prescribing how to be prepared?

Prevention of Misinformation

• Do we have procedures to monitor and react to misinformation spread by non-official communication channels?
• Do we have a strategy to counter misinformation and rumors?
• Do we have adequate technical information security in order to prevent misuse or manipulation of our social media/web channels (i.e. prevent hacking and spoofing in order to distort or change official information)?

Ability to listen and collect feedback

• Are we able to engage with the public in order to understand and recognize the diversity of local communities, the local needs, and the available or lacking resources? How?
• Are we able to integrate information from the public or other sources into our communication? How?
• How do we seek feedback from the public?
• What capability do we have to respond to information requests or other interactions with the public?
• How do we communicate the need for people to be self-reliant to a certain degree?

Capability to trigger public engagement

• Does our communication strategy/plan facilitate public participation? How?
• How do we ask for help/resources that corresponds to actual needs?
• Are we prepared to communicate in a timely manner (i.e. do we have prepared messages, websites or other forms of communication)?

Healthcare implementation - Before

The development of a communication plan and strategy is relevant to every phase of the crisis. The plan should comply with the specific objectives and the public in target during each phase (e.g. inter-pandemic, alert, pandemic, transition). Setting-up strategic communication means getting a targeted, goal-driven message out at the opportune time through the appropriate channel.

When developing the communication plan, some actions are relevant in healthcare:

• Including Healthcare Professionals (HCPs) in the planning stage. This can be done by involving HCPs in workshops where they can express their concerns, or by means of an e-learning platform providing a two-way channel between HCPs and national and international health organizations. This action allows HCPs to be familiar with the plan and effectively apply it when dealing with patients. Because of their role as ‘trusted translator’ between health agencies and patients, their recommendations are the major influencers for patients’ decisions (Tell ME, 2014a, 2014b).
• Public segmentation. Priority groups need to be identified through profiles in order to enable mutual communication, in terms of understanding risk perceptions and responsiveness. Profiles should be identified by taking into account many variables (e.g. origin, gender, language, age, religion, culture, education, perception, etc.) (Tell ME, 2014a).
• Identifying specific indicators to assess the communication plan. Evaluating the strategy helps identify weaker areas which need to be addressed and strengthened.

See in addition Tools 1.1, 1.2, 2, 3, 4 and 5 in the Healthcare Practices, Methods and Tools section.

Air Traffic Management implementation - Before

• In the Air Traffic Management (ATM) context, a good level of Safety Culture and Just Culture is fundamental in order to guarantee, at all levels of the organization, the right sensibility to handle the information: "transparency and honesty always pay".

• "Preventive communication" is important to protect the organization against contradictory, incorrect or ambiguous messages. In this case it is important to "interpret the signals from outside" before an event happens.

During a crisis

The triggering questions DURING can be used to assess and adjust the communication strategies employed by the crisis management team or communications strategist in order to continually tune communications to the most appropriate form and content during crisis management.
Issues such as management of acceptance and trust, collection and sharing of relevant and accurate information, as well as the prevention of misinformation, should be constantly monitored as the crisis develops.

Triggering questions

Adequacy of the Plan

• Do we need to coordinate our current communication with other authorities/organizations?
  
• Do we need an appointed common spokesperson to manage the communication towards the public and the media (to avoid misalignment or conflicts among both different organizations and/or different parties of the same organization)?

Capability to guide effective crisis response by the public

• Are we communicating the information required to avoid being affected by the consequences of a crisis?
• Is our communication informing the public on how to avoid using resources that may be needed by others or interfere with our response?

Communication Channels

• What communication channels are we using (i.e. websites, media, social media)?
• Are we using relevant communication channels that people already use every day?
• Are the communication channels sufficiently up-to-date?
• Is there a risk our communication channels are overloaded?

Adequacy of Competencies

• Are we proficient at using the available communication channels?
• Are we using the appropriate terminology for communication with the public (consider, for instance, different demographics)?
• Do we have access to the appropriate competencies (for instance, a communications officer on duty)?

Clarity and Accessibility

• Is the public in target able to understand the information (e.g. use of complex probabilistic models, language barriers etc.)?
• Is our information sufficiently accessible to the public?
• Is our communication adequate to meet the actual needs of the public/media?
  

Acceptability and Trustworthiness

• Are we communicating in a way to lessen the psychological impacts of people involved and to avoid them feeling a sense of isolation?
• Does the public perceive our communication as trustworthy?
• Do we need to disclose more information and be more transparent to increase acceptance and trust by the public?
• Are we communicating the benefits of following our communication or adhering to our advice?
  

Prevention of Misinformation

• How do we check if misinformation is spread by non-official communication channels?
• Do we know if the public is ill-informed or diverted by rumours and misinformation?
• How can we counter and mitigate the effects of misinformation (and rumours)?
• How can we redirect the public to official channels for trusted information?
• How are we responding to information needs of the public, to avoid making them look for answers elsewhere?
• How are we checking the accuracy of our information?
  

Ability to listen and collect feedback

• How are we using the public as a partner in the crisis?
• Are we giving the public sufficient opportunities to help in gathering and spreading relevant information?
  

Capability to trigger public engagement

• Does our plan include guidance for the public on how to contribute with resources/capabilities to the management of the crisis?
• How are we recognizing and reinforcing supportive behaviours by the public?
• Does our communication encourage the public to provide support to us?
  

Healthcare implementation - During

During a crisis, it is important that public health authorities communicate in time with the public, in an open and reliable way, addressing their specific needs. In particular, local health authorities play an important role in planning, activating and assessing communication activities. The main goal is to help people – also including public health workers - by steering their fears and concerns towards acknowledgement of the situation and appropriate level of vigilance (see tools 1.3 and 2 in the Healthcare Practices, Methods and Tools section below).

• A public survey to assess risk perception of the public should be carried out. In case the risk perception is difficult to be estimated. This, for instance, for a new emerging or unknown infectious disease (see tool 1.1). In fact, there is a linear correlation between the epidemic curve and the public’s compliance with the public health authorities' recommendations (i.e. higher is the risk perception, higher is the public’s liability to follow recommendations).
• Timing of communication, target groups and manner and scale of communication should be assessed and identified (TELL ME, 2014a). Specific tools can be used for this purpose (see tools 1.3 and 2 in the Healthcare Practices, Methods and Tools section). In particular, the use of social media accelerates the speed of communication during public health emergencies or outbreaks (see Practice 2 and Tools 4, 5 in the Healthcare Practices, Methods and Tools section) (ECDC, 2016).

Air Traffic Management implementation - During

According to the International Air Transport Association (IATA) Guidelines (IATA, 2016) an "integrated, consistent and authentic communication response to an accident is essential, using all available channels to engage with its internal and external stakeholders". Before the introduction of the social media, there was the so-called "Golden Hour", now it has been literally zeroed. Actually if before ATM Communication experts were "information providers", now with social media, they are "information certifiers". It is noteworthy that real-time communication cannot be translated in rigid procedures, it depends on the type of crisis and on the experience of the communicators. Several activities and related timelines are suggested as follows:

• T+15 mins: Release first “tweet” acknowledging initial reports. Update regularly with short posts as new information is confirmed.
• T+60 mins: Issue longer summary of information confirmed to date, via multiple channels and posted on website. Release new summaries hourly, or as key developments are confirmed, while maintaining regular flow of short updates.
• T+60 mins: Change branding to monochrome/remove promotional images and messaging from all online platforms. Dark Site activated (i.e. a pre-made website to be activated in the event of a crisis or emergency). Ensure consistent messages/information appears on every online platform, with simultaneous updates.
• T+3 hrs: First media appearance/statement by most senior executive to arrive at location where families, media, and authorities are congregating (usually at/near the accident scene or arrival/departure airport).
• T+6 hrs: First in-person press conference with CEO or most senior executive available (may be at HQ, departure/arrival airport or accident location).
• T + 6-24 hrs: Further statements, media interviews and press conferences as relevant information is confirmed (may be done jointly with emergency services, response agencies, airport operator, government representatives or investigating body).

During a crisis it is fundamental also to:

• Monitor online conversations (“social listening” on Twitter, Facebook, etc.) about the event and company itself and decide whether to answer/reply to the conversations or not.
• Pay particular attention to the use of technical language.

After a crisis

Conducting post-event learning in relation to the way the communication was managed during the crisis, can improve the readiness for future crisis events. This may be done as part of analysis, after-action review in the context of workshops and focus groups, using the triggering question AFTER.

Triggering questions

Adequacy of the Plan

• Was our communication plan sufficiently coordinated with other relevant authorities/organizations?
• Can we derive lessons-learned, which are worth documenting and feeding into future plans?
• How can these lessons learned be captured into communication strategies/policies (see also 6.1 Systematic management of policies)?
  

Capability to guide effective crisis response by the public

• Was the information on guiding crisis response by the public included in our plan adequate?
  

Communication Channels

• Were the communication channels used during the crisis sufficiently up-to-date?
• Was the selection of our communication channels adequate to the public in target?
• Did we experience an overload of our communication channels during the crisis?
  

Clarity and Accessibility

• Did people experience difficulties in accessing our information source during the crisis?
• Was the necessary information communicated in a language, or in different languages, understandable by the public in target?
• Were the responsibilities of individuals, as well as of the agencies involved in crisis management properly communicated?
  

Adequacy of Competences

• Do we need to acquire new available communication channels?
• Are relevant roles trained, educated, and exercised using this strategy/plan?
  

Acceptability and Trustworthiness

• Did the public perceive our communication during the crisis as trustworthy?
  

Prevention of Misinformation

• Were we successful in counteracting misinformation and rumours?
  

Ability to listen and collect feedback

• Did we adequately engage with the public during the crisis to understand and recognize different needs, due to local specificities and diversity of the involved communities?
• Were we able to integrate information from the public with other sources of information in an effective manner?
• Were we able to respond to information requests by the public in a timely manner?
  

Capability to trigger public engagement

• Did the rescuers involve the public in an appropriate way?
• Was the involvement and interaction with the public useful?
• How did the public experience the crisis and their involvement in the response/relief efforts?
  

Healthcare implementation - After

After the crisis, assessment of the communication plan and strategy is highly recommended to analyse data and information gathered from the public, and to gain inputs for improving the plan. A methodological road map to analyse lessons learnt, should be set-up. An example of methodology used in the healthcare domain is found in the KAP Survey Model (Knowledge, Attitudes, and Practices) (see in addition Method 1 in the Healthcare Practices, Methods and Tools section).

Air Traffic Management implementation - After

After the crisis an issue, not mentioned in the generic field, could be related to the decision on when start the transition back to the normal promotional branding on the website. Particular attention must be paid to the synchronization with other communications and marketing activities.

Understanding the context

Detailed objectives

A major part of crisis management is managing people – the people involved in the response and the public, both the people directly affected and the people that are at risk of being affected. The response of the public is a contributor and in some situations a decisive factor to the outcome of a crisis. In a sense, the public may become part of the response. Therefore, organizations need to develop communication strategies that facilitate interactions with the targeted public and increase the probability of public responses that are beneficial for the management of a crisis.

A relevant distinction between different groups of the public is here between those who are currently affected by or helping to resolve (e.g. on-site) a crisis and those who are at risk of becoming affected by a crisis or could potentially help (e.g. a current or anticipated crisis). The aim of this capability card is to support development of communication strategies directed towards the public, including those potentially affected by, or could be helpful, in a crisis.

The three main goals of the communication strategies are to guide the public that are potentially affected by the crisis or that could be helpful in crisis, to:

• Avoid being affected by the consequences of a crisis.
• Avoid using resources more needed by others, or to otherwise interfere with the response.
• Contribute resources/capabilities to the response.

The rationale for these goals are the limited resources available to organizations, which mean a need for collaboration and cooperation. The high-level means of achieving these goals are:

Achieve wide information dissemination and negate disinformation
The public needs correct and relevant information to enable informed personal choices. The public needs to have the opportunity to verify information.

Encourage specific behaviour by the public
The organization should see a benefit in encouraging/directing the public to act in a way that is not interfering with relief efforts or worsening the crisis.

Receive off-site resources from the public
The public can offer private resources to help the disaster management, e.g. shelter refugees in their home.

This card is highly relevant for Public_involvement_in_resilience_management. While, not all personnel involved in crisis management communicate directly with the public, communication is an important aspect of crisis response operations, and a vital part of Establishing common ground between collaborating organizations as well as Establishing networks, and Understanding roles and responsibilities.

Targeted actors

The actors that are concerned by this capability card are public and private entities with tasks and roles related to dealing with emergencies and disruptions. The capability card relates to 1) crisis managers that see the need to interact with the general public to avoid, affect, or stimulate their involvement in the crisis, and 2) those who design, review, validate and sign off communication strategies/policies in these organizations, such as managers in general, or specific information, communication, or media officers/strategists.

Indirectly affected actors: formal and informal leaders, and individual citizens of the general public potentially affected by, or helpful in, crises (including those not yet directly affected by or engaged in the response).

The scope of the capability card is response operations during all types of emergencies and disruptions.

Healthcare actors

Specific actors/stakeholders can be engaged in the risk communication, according to the different types of crises in public health.

In the Outbreak Risk Communication domain, a new Framework Model was developed within the TELL ME project (TELL ME, 2014a).

The Framework Model emphasizes the interactive nature of outbreak communication among several groups of actors (TELL ME, 2014a) as follows:

• Government/ policy/ institutional actors (IAs). Political structures and organizations, competent public authorities, regulatory standards bodies, funding agencies and advisers responsible for design and implementation of communication strategies in the case of major infectious disease outbreak. IAs operate on different levels (see the table below): international (transnational, European), national and local (see: http://www.tellmeproject.eu/sites/default/files/ST3.2.3-Document-Spreads.pdf).
  • Transnational level: World Health Organization (WHO); International Organization for Migration (IOM); World Organisation for Animal Health (OIE); United Nations Children's Fund (UNICEF); United Nations World Tourism Organization (UNWTO); World Trade Organization (WTO); World Bank.
  • European level: European Centre for Disease Prevention and Control (ECDC); European Directorate for the Quality of Medicines (EDQM); European Medicines Agency (EMA)/ex European Agency for the Evaluation of Medicinal Products (EMEA); European Commission (DG SANCO, DG ENTR, DG RTD, etc.).
  • National level: Ministry of Health; National (Surveillance) Public Health Institutes; Medicine Regulatory Agency; other Ministries.
  • Local level: Local Public Health (LPH) agencies; LPH authorities (e.g. Regions); Prefectures (Public Health Division); Local political parties.

• Pharmaceutical industry and commerce: manufacturers, suppliers, distributors, exporters involved in liability issues.

• Community-based public institutions and infrastructures as schools, hospitals, day care centres, clinics and public transport.

• Civil society organizations at the national level: Non-Governmental Organizations (NGOs), foundations and charities. At local level: community-based organizations, faith-based groups, etc.

• Public sphere is the heart of the model, where the public opinion rules. It includes:
  • Public is at the centre of the communication process. In order to effectively communicate with it, priority groups need to be identified by means of segmentation.
  • Health workers possess high accessibility by the population and hold high levels of credibility and trust from the public. They often have a personalized relationship with patients and are able to target communication to at-risk groups. They have a crucial role in activities for prevention. Among them: general practitioners (family physicians), nurses and midwives (both hospital and community based) play a special role.
  • Media and social media include broadcast, print, mobile, Internet. Social media are represented by different channels, including internet forums, social blogs, weblogs, wikis, podcast, social networking, video/photo sharing. Each of them has different features and audiences. However, during a crisis they have to be dealt with as one monolithic entity.
  • Opinion leaders comprise trustworthy members of peoples' social networks whose identification - especially at local and social media levels – is relevant to effectively mediate communication.
  • Research entails building public profiles through qualitative and quantitative studies pinpointing different subpopulations and identifying different trends in public discourse, or the public sphere.

The framework aims at reversing the typical top-down model in which the information flow is unilateral (from the health authorities to the public), in favour of a perspective that sees the public as a partner, by means of communication technologies that allow accessible and immediate public participation (see http://www.tellmeproject.eu/node/314).

Air Traffic Management actors

During a crisis, several actors are involved, in a greater or lesser degree. They have to provide timely information to the news media and public. They are:

• Airlines (including codeshare or franchise partners, third-party contractors)
• Emergency services
• Investigating body
• Government agencies
• Arrival and departure airports
• Air Navigation Service Provider
• Aircraft and engine manufacturers (including suppliers of key systems or components)

Expected benefits

A suitable communication strategy has the expected benefits of:

• Reducing the number of people that are affected by consequences of a crisis.
• Reducing the strain on resources needed on-site during a crisis.
• Increasing the attainable and manageable resources and capabilities, which can aid the relief effort.

Overall, the expected benefit is thus a more resource-efficient and flexible response and management of a crisis.

Relation to adaptive capacity

Facilitate resource mobilization, sharing, and balancing.

Relation to risk management

The interactions between the public and organizations are to a large extent neglected.

Illustration

Following the 2005 hurricane Katrina, the White House commissioned a review of the Federal response during the event. "Public communications" is one of the critical challenges identified by the report on lessons learned from this review. While the dissemination of weather and hurricane tracking information preceding its landfall is one of the success stories of the management of the event, the report mentions two essential areas in which communication to the public was not sufficiently effective:

• The lack of a mechanism for officials to communicate disaster information and instructions at the Federal, State, and local levels. The review notes that setting up the structure, processes and resources for public communication, lacking at the beginning of the event, took several weeks.
• As a result, uncoordinated, and sometimes contradictory, information provided by officials caused confusion. In addition, uncorroborated information provided continuously by the media interfered with emergency response efforts. According to the report, inadequate and ineffective communication fed the public's perception of government sources lacking credibility.

Some cases describe experiences from government - civil society partnership. (Chen, Chen, Vertinsky, Yumagulova, & Park, 2013).

Healthcare illustration

Lack of communication strategies and coordination between policy makers and first responders in case of healthcare emergencies. The successful management of health emergencies requires the involvement of the public by means of clear communication strategies between policy makers and local first responders (healthcare professionals). The importance of such coordination is illustrated by the 2009 H1N1 - flu pandemic. During this event, many Italian regions got a poor response due to lack of communication with the public. First, disagreements were reported to occur among the Ministry of Health and some regional health authorities. Then, local health authorities bemoaned the absence of centrally defined guidelines about how to inform the population. Eventually, great uncertainty grew from the people about the social groups that had to be vaccinated. Also controversial messages by the Ministry of Health and other ministries released by media were not aligned. The media initially released alerting claims about the consequences of the disease, while later reassured about possible dangerous effects. Also, the communication departments of different ministries did not pursue a coordinated response to the population, acting on singular basis. On the other hand, a few regions (e.g. Emilia Romagna) with an established communication plan developed by the regional health authority, supported coherent communication from the top to the bottom. These regions were effective in countering misleading messages arriving from the media. However, during this crisis, a new data mining tool to collect information from the public on its health status was included in the integrated epidemic surveillance system managed by the local health authorities. It allowed to enhance data promptness and richness for epidemiological surveys. During H1N1, contradictory messages were communicated not only at national, regional and local levels, but also among countries and international agencies. The illustrative case underlines how these differences generated confusion among citizens about whose advice to follow. Therefore, information sharing and cooperation among all professionals, institutions and healthcare services involved in risk management is a prerequisite for coordinated planning of activities, as well as it simplifies the communication process with the public and thus allows for responsible and informed communication with the community.

Air Traffic Management illustration

In the International Air Transport Association (IATA) guidelines (IATA, 2016), the following examples are reported:

• "After the Asiana Airlines OZ214 accident at San Francisco in July 2013, the first photo was posted on Twitter in less than one minute, by a passenger waiting to board another flight. Once ignited, the social media “firestorm” spread so quickly that it generated more than 44,000 tweets within the next 30 minutes."
• "Coverage of Malaysia Airlines MH370 led the prime-time evening news on all three major US TV networks (ABC, CBS and NBC) for 11 consecutive nights in March 2014 – an unprecedented level of domestic interest when only three American citizens were among the 239 people on board."

Implementation considerations

Challenges

Organizations need to see the potential contribution of the general public. Further important enablers are creating functioning networks of volunteers and leaders during non-crisis periods, development of two sided communication, and taking into account the cultural characteristic of the public. When developing communication strategies and plans it is important to consider cultural and technical backgrounds of those involved and to include experts with different and relevant backgrounds in the process.

Communicating information to the public during a crisis is always a balancing act between being transparent and establishing a relationship of trust but at the same time knowing what information to disclose, when, and how, in order to not disrupt the crisis management efforts.

Implementation cost

No information

Healthcare implementation considerations

Associated challenges

Some conditions could affect the effectiveness of the communication strategies involving and addressed to the public:

• The absence of a communication plan and a strategy shared among the stakeholders, that causes confusion of roles and responsibilities, lack of coordination, inappropriate time to communicate, loss of institutional credibility and acknowledgment.
• The self-reference of the healthcare system. In this domain the one to one communication (i.e. healthcare worker to patient) is at the basis of the healthcare culture. In particular family physicians “hold the power” to communicate (by deciding how, when, and what) with patients, by influencing their health beliefs and practices.
• The unawareness of the institutional actors of the local communities’ approaches to healthcare that have not to be a priori contrasted but understood and integrated in the communication strategy addressed to specific groups.

Minimum Viable Solution

The first action to be undertaken is the setup of a communication plan and strategy. This requires a budget allocation for a minimum number of human resources including a communication expert in social media/two way communication channels. Their fundamental tasks should be:

• Establishing connection with institutional actors, local healthcare agencies research organizations, and priority groups in the public (identifying Point of Contacts, PoCs).
• Participating to round tables with stakeholders (at least to answer the triggering questions related to the before-a–crisis section but also to discuss the contents of the plan and to define roles and responsibilities).

Air Traffic Management implementation considerations

The International Air Transport Association (IATA) in its Crisis Communications in the digital age a guide to “Best Practices” for the aviation industry (IATA, 2016) "Aviation accidents and serious incidents are extremely rare. Despite the almost exponential increase in passenger numbers and flights operated since the start of the jet age, the rate at which hull loss accidents occur has steadily improved. Most communication professionals working within the industry (indeed, most airline employees) will therefore never face the unique and emotionally stressful experience of responding to an aviation disaster. Unfortunately accidents do still happen, and the challenges of planning and managing an effective response have never been more complex. Profound – and accelerating - changes to the business, political, social and media environment have created pressures and expectations which did not exist even a decade ago. The proliferation of social media channels, and the exponential growth in mobile smartphone use, have ensured that “breaking news” of an accident or major incident will usually appear first on Twitter, Facebook or Weibo. Photos, commentary and even streaming video may be available, in real time, to a vast global audience before the companies involved are fully aware of what happened. Flight tracker websites will allow anyone to see the aircraft’s last known position, heading, speed, altitude and other parameters, including the history of the aircraft concerned, the service history of the aircraft type and any issues related to the operations of the airline. The first opportunity to define the event, and to shape the unfolding narrative, will belong to the people who experienced it, those who saw it, and those affected by it. The airline may be left struggling to make its message heard above the cacophony created by citizen journalists, politicians, government agencies, celebrities, “experts” and self-publicists eager to share their opinions."

Relevant material

Relevant Practices, Methods and Tools

Practices

Examples of practices regarding guidance of effective crisis response by the public:

• In Australia several emergency management authorities have implemented education programs delivered through the school system. The aim is to increase the community resilience by making the communities “ready, willing and able to do what is necessary” to prepare for or respond in the event of a crisis (Dufty, 2009).

• Texas 2-1-1 is a state program that presents accurate and attainable information from official health and human services to the public. The program applies several communications methods, telephone, web, and physical centres, to create a disaster communication hub between individuals with unmet needs and community services. The information hub is available not only during crises and disasters but at all times and also covers a broad range of every-day issues regarding health care and human services. This means that the place to find information and support in the case of a crisis is the same as in normal cases.

Examples of responses initiated and managed by the public to respond to crisis:

• After Hurricane Katrina there was public engagement to supply shelter/refuge to affected people who lost their homes, e.g. “open your home”-campaigns. Non-profit organizations set up webpages communicating information and guidance to the public on how to support the crisis response.
• Universities accepted students from affected areas and initiated campaigns to supply housing.
• While airline cooperations can help in evacuations bona fide, also individuals donated their frequent flyer-miles to evacuate affected people away from the crisis area.

Methods

There are different ways of communicating with the public, either face-to-face or through different communication channels. The main types of communication during crisis management are more or less one-way communication such as one-to-one and one-to-many, where for instance the crisis response management communicates a message to the one or more people in the general public. There are also methods and tools for the crisis management to gather and receive information from/about the public, for instance localizing people through mobile networks and geographical tagging if different types.
The EU-project Driver’s short paper presented at ISCRAM 2016: “Interaction with Citizens Experiments: From Context-aware Alerting to Crowdtasking” (Havlik, Pielorz, & Widera, 2016) presents the results of an evaluation of four selected crisis management tools: DEWS (Distant Early Warning System sending out alerts based on user profiles and their geographic position), Safe Trip (aimed at tourists, giving safety information etc.), GDACSmobile (facilitates self-organisation of volunteers) and AIT CrowdTasker (supporting communication between crisis response personnel and pre-registered volunteers). The method used to evaluate the tools included a series of experiments with volunteers and professionals within the Driver project.

Tools

Communication channels:
Information regarding crisis management can be communicated by a broad range of channels such as: officials on site or local leaders, word of mouth, letters, notices, one-way radio, two-way radio, telephone, TV, notice boards, internet, and social media.

Examples of one-way communication tools:

• Texas 2-1-1 (http://www.211texas.org) represents a governmentally controlled and information supplied information sink reach through internet, telephone or information centres. The aim is to inform the public.
• In a coastal area (Sunshine Coast, Australia), that is a popular tourist destination, public warning systems for warning of natural and manmade disasters, was according to a workshop with experts, considered as a factor contributing to resilience (Singh-Peterson, Salmon, Baldwin, & Goode, 2015).
• DEWS (Distant Early Warning System) (Esbri, Esteban, Hammitzsch, Lendholt, & Mutafungwa, 2010) is a system developed for tsunami warnings is used to distribute alerts based on user profiles and their geographical positions.

Examples of two-way communication tools:

• Recovers.org is a company-run internet-based framework that can be applied to a specific crisis at the time of need. The framework supports a way to request assistance, donate supply/money and sign up as a volunteer. It can also work as a platform to spread information from “organizers”.
• Safe Trip (http://www.hkv.nl/en/products/apps/231-apps.html) is a mobile application that based on location gives travellers and tourists within Europe relevant safety information. The application can also be used by citizens to inform national authorities of their location, needs and conditions.
• AIT CrowdTasker (http://crowdtasker.ait.ac.at) is a mobile application for targeted one-to-many communication for crisis coordination with volunteers. With the tool crisis management professionals can interact with preregistered volunteers by sharing information and assigning tasks to unaffiliated volunteers, as well as collect structured responses from the public.
• Social media platforms allow both authorities and the public to share information and comments. See the following article for detailed guidance on “incorporating social media in risk and crisis communication” (Veil, Buehner, & Palenchar 2011):
• GDACSmobile facilitates self-organisation of volunteers and aims to improve situation awareness of citizens by sharing an easy-to-understand overview of the situation. See Link et al. 2015 for further details.
• I-REACT is a European-wide platform under development (release Oct, 2018) that aim to integrate emergency management data, including social media. The development is funded by the European Commission (see http://www.i-react.eu).

Healthcare Practices, Methods and Tools

Practices

Practice 1. The Norwegian Institute of Public Health (NIPH) started using social media in 2010 and strengthened its social media work considerably in early 2014, after it became evident that the institute needed to reach a larger target audience. During their initial listening and engagement activity, NIPH focused on Facebook and Twitter because they were the most popular channels in Norway for their target audience and therefore offered the greatest engagement opportunity (80% of the population had a Facebook account). Twitter also became an important part of NIPH’s social media strategy because it could be used to communicate with health professionals, the media, policymakers, politicians and stakeholders. NIPH also embraced other platforms such as LinkedIn, YouTube, Vimeo and Instagram (ECDC, 2016).

Practice 2. The Facebook page of Public health emergency (PHE.gov) provides updates on Zika spreading. Public Health Emergency.gov is a web portal held by the US Department of Health and Human Services and its cross-governmental partners to serve as a single point of entry for access to public health risk, and situational awareness information. Declared disasters and emergencies are some of the contents populating the US Public Health Emergency website. Besides the pages dedicated to disaster response and to agents, diseases, and other threats, involving the public is a key feature of the portal, either by social media profiles or by constant information and news updating. An outstanding example is about the fervid activity delivered by the Public Health Emergency.gov in updating its Facebook page with posts, maps, infographics of Zika spreading (ASSET, 2017) (see https://www.facebook.com/pg/phegov/about/?ref=page_internal)

Practice 3. In the field of public health, an excellent example of social media management comes from the Centers for Disease Control and Prevention (CDC). Their page dedicated to social and digital tools is a valuable source of information, conceived to encourage people to participate and share information provided by the organization. CDC has many different Twitter accounts: three are national profiles, one is dedicated to the emergencies, and other 23 are related to specific health topics like hepatitis or tuberculosis. They also implemented a Twitter account for their Morbidity and Mortality Weekly Report (@CDCMMWR). On the website, a series of guidelines and best practices can be found, through which CDC “encourages the strategic use of Twitter to disseminate CDC health information and engage with individuals and partners”. Something similar is also available for Facebook, in a page dedicated to social media tools, guidelines and best practices. Which also includes two documents of great interest: the Social Media Toolkit and the CDC’s Guide to Writing for Social Media. [...] In 2014, CDC launched the Public Health Nerd online campaign to mobilize people who are passionate about public health, in order to promote awareness about CDC’s work, and to encourage learning and increase knowledge about health topics. The main motto of the campaign was “You are a Public Health Nerd if you…”, and most of the pictures and tweets (with the hashtag #PHNerd) contained questions and sentences aimed to boost conversation, not just to give information in a strict top-down approach (Bellone, 2017)(see http://www.asset-scienceinsociety.eu/news/features/public-engagement-and-trust-building-social-media)

Methods

Method 1. The KAP Survey Model (Knowledge, Attitudes, and Practices) is a quantitative method (standardized questionnaires) that provides access to quantitative and qualitative information. KAP surveys reveal misconceptions or misunderstandings that may represent obstacles to the activities that we would like to implement and potential barriers to behaviour change. KAP survey essentially records opinions, what was said, but there may be considerable gaps between what is said and what is done (see http://www.medecinsdumonde.org/fr/node/9575)

Tools

1. The toolbox (ECOM EU project - Effective Communication in Outbreak Management: development of an evidence-based tool for Europe) consists of different products that form an evidence-based behavioural and communication package for health professionals and agencies throughout Europe, in case of major outbreaks of infectious disease (available at: [1]). It includes tools regrouped into three areas:

1.1 Tools to Assess public perception and anticipate behaviour:

• Assessing Disease & Public Characteristics - Checklist Risk Communication helps to assess the urgency of risk communication and to decide whom you want to reach, how, and on what scale, for a timely and consistent information that does not cause distress.
• Assessing risk perception of the public - Standard questionnaire on risk perception of an infectious disease outbreak measures public risk perception (i.e. knowledge, perception of severity/ susceptibility, anxiety, self-efficacy and efficacy of preventive measures, intention to carry out these measures, motivating/ hindering factors and information needs).
• Conducting focus group discussion is a guideline aiming at facilitating end-users when preparing a focus group to gain insight on public behaviour regarding future pandemic outbreaks and vaccination.

1.2 Tools to review the preparedness:

• Identifying your option - Communication and Persuasion Intervention Mix Tools describe some possible types and forms of intervention (by means of an Intervention Matrix) that can be used to influence the behaviour of citizens and professionals prior to, during, and after a pandemic. It should be used in the pre-preparation phase and managed by those responsible for developing communication and behavioural influence programs.
• The STELa planning framework is a guide to the key stages, tasks, and activities that are required when planning delivering, managing, and evaluating an intervention designed to influence health-related behaviour.
• Specifying the Objectives – Setting SMART Objectives Tool helps identifying and addressing behavioural targets in pandemic communication and marketing programs.

1.3 Tools to communicate with the public:

• Recommendations for Communication gives general and country-specific recommendations how to communicate with the public during influenza pandemics.
• Journey through a flu-pandemic is a poster designed as a printed and interactive version that clarifies the phases of a pandemic and gives basic action directives. This helps health officials to give a better understanding to the public in terms of the progress of a pandemic.
• The Pila Smartphone App is a prototype of the app ‘Pandemic Information & Life Assistant’ that teaches the public about the pandemic and how to protect themselves. It will help people to assess their personal risk during a pandemic, based on personal and geographical information.
• ECOM Animation Movies include main suggestions for policy makers on Effective Communication in Outbreak Management.

2. TELL ME Communication Kit (TELL ME EU project – Transparent communication in Epidemics: Learning Lessons from experience, delivering effective Messages, providing Evidence). It supports public health officials in the development of a communication strategy within the wider framework of a national or international preparedness and response plans for major infectious disease outbreaks. It also addresses health communicators and healthcare professionals who are required to communicate risk and uncertainties to the general public. The communication kit provides a spectrum of practical recommendations and tools to support the development of evidence-based messages, tailored for different sub-populations and target groups across various cultural contexts with the aim of minimizing deviations between perceived and intended messages in the communication process. It comprises four different guidance documents:

• New communication strategies for healthcare professionals and agencies
• New communication strategies for working with different subpopulations/at-risk group
• New communication strategies for institutional actors
• New communication strategies for preventing misinformation (see TELL ME, 2014b)

3. ASSET Tool Box (ASSET EU project -Action Plan on Science in Society Related Issues in Epidemics and Total Pandemics) (ASSET, 2016) consists of eight tools mainly meant for pandemics (but adaptable also to other healthcare domains). They are learning modules (e.g. Reporting health issues by journalists), checklists (e.g. Checklist for patient and public involvement in research along with checklist for basic research considerations), glossaries and guidelines (e.g. How to organize citizen participatory meetings). In general, the tools aim at: increasing awareness in the health workers who have direct contact with patients to assess their knowledge, attitude, and willingness to facilitate their preventive activities; facilitating communication, avoiding linguistic misunderstandings with so many different disciplinary, geographical, and cultural backgrounds; including citizens in decision making; and training journalists in health reporting. Among them, Citizen Participatory Meetings, enhance a participatory governance approach. They aim at including citizens in decision making processes that have implications for their wellbeing, by understanding their point of views and learning from their everyday experiences (The Asset Tool Box is available at: http://www.asset-scienceinsociety.eu/outputs/deliverables/asset-tool-box)

4. European Centre for Disease Prevention and Control (ECDC) guidelines for a social media strategy development in public health communication. The guide provides public health organizations and practitioners with a practical approach to strengthening the integration of social media into their overall communication activities. In particular it focuses on identifying effective ways to use social media in communicable disease prevention and control (ECDC, 2016).

5. ECDC guidelines for building trust on communication on immunization. The guide aims at supporting Member States in planning and implementing communication initiatives on vaccination, by presenting an overview of the main issues that public health institutions need to consider in relation to building and maintaining trust (ECDC, 2012).

Air Traffic Management Practices, Methods and Tools

• On the company's official website: activate Dark Site, change branding to monochrome, remove inappropriate images and messaging, publish a “blog” from the CEO, launch a “live blog” with rolling updates.

Regarding information channels:

• Determine which social media channels (i.e. Facebook, Twitter, YouTube, etc.) are already used by the organization, and who manages them.

Regarding information adequacy of competencies:

• Exercise the crisis communication plan (ECDC, 2012) "at least once per year, conduct an exercise to test the plan and to ensure that everyone understands their role, and the purpose of the plan. An exercise may be a simple table-top or a full-scale input-response exercise run by a control team".

Regarding information adequacy of competencies, communications exercises also should include:

• Notification exercise: Check contact numbers are valid and key players can be reached quickly.
• Slow walk-through: Take a potential scenario and ask a series of questions of your team. Check whether your current plan provides the answers.
• Tabletop: Run through a simple scenario and test one aspect of the plan – for example, developing updated press statements.
• Input-response exercise: Test the entire communication plan by using an exercise control team to provide “inputs” via phone calls, emails, social media posts and “news reports”.

References

• Artman, H., Brynielsson, J., Johansson, B. J. E., & Trnka, J. (2011). Dialogical Emergency Management and Strategic Awareness in Emergency Communication. In Proceedings of the 8th International ISCRAM Conference 2011.
• Chen, J., Chen, T. H. Y., Vertinsky, I., Yumagulova, L., & Park, C. (2013). Public–private partnerships for the development of disaster resilient communities. Journal of contingencies and crisis management, 21(3), 130-143.
• Dufty, N. (2009). Natural hazards education in Australian schools: How can we make it more effective? The Australian Journal of Emergency Management, 24(2), 13-16.
• Esbri, M. A., Esteban, J. F., Hammitzsch, M., Lendholt, M. and Mutafungwa, E. (2010). DEWS: Distant Early Warning System-Innovative system for the early warning of tsunamis and other hazards, Jornadas Ibéricas de Infraestructuras de Datos Espaciales (JIIDE), Lisbon, Portugal.
• Havlik, D., Pielorz, J., & Widera, A. (2016). "Interaction with citizens" experiments: From context-aware alerting to crowdtasking. In Proceedings of the International ISCRAM Conference 2016.
• Kenney, C. M., & Phibbs, S. (2015). A Māori love story: Community-led disaster management in response to the Ōtautahi (Christchurch) earthquakes as a framework for action. International Journal of Disaster Risk Reduction, 14, 46-55.
• Link, D., Widera, A., Hellingrath, B., de Groeve, T., Eidimtaite, G. & Kumar, L. M. (2015). GDACSmobile - An IT Tool Supporting Assessments for Humanitarian Logistics. The International Emergency Management Society (TIEMS) 2015 Annual Conference, Rom, Italy.
• Madni, A. M., & Jackson, S. (2009). Towards a conceptual framework for resilience engineering. IEEE Systems Journal, 3(2), 181-191.
• Singh-Peterson, L., Salmon, P., Baldwin, C., & Goode, N. (2015). Deconstructing the concept of shared responsibility for disaster resilience: a Sunshine Coast case study, Australia. Natural Hazards, 79(2), 755-774.
• Veil, S. R., Buehner, T., & Palenchar, M. J. (2011). A work‐in‐process literature review: Incorporating social media in risk and crisis communication. Journal of contingencies and crisis management, 19(2), 110-122.

Healthcare references

• ASSET (2016). Deliverable D3.4 Asset Tool Box. Available at: http://www.asset-scienceinsociety.eu/outputs/deliverables/asset-tool-box
• ASSET (2017). Pandemic Preparedeness and Response Bulletin, Issue 5. Available at: http://www.asset-scienceinsociety.eu/outputs/bulletins/asset-pandemic-preparedness-and-response-bulletin-issue-5-share-and-move
• Bellone, M. (2017). Public engagement and trust building on social media. Asset Editorial July 26, 2017. Available at: http://www.asset-scienceinsociety.eu/news/features/public-engagement-and-trust-building-social-media
• ECDC (2012). Communication on immunization - building trust Available at: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/TER-Immunisation-and-trust.pdf
• ECDC (2016). Social media strategy development. A guide to using social media for public health communication. Available at: http://ecdc.europa.eu/en/publications/Publications/social-media-strategy-guide-for-public-health-communication.pdf
• D'Ambrosio, L., Huang, C. E., & Kwan-Gett, T. S. (2014). Evidence-based communications strategies: NWPERLC response to training on effectively reaching limited english-speaking (LEP) populations in emergencies. Journal of Public Health Management and Practice, 20(SUPPL. 5), S101-S106.
• Roy, N. (2006). The asian tsunami: Pan-american health organization disaster guidelines in action in india. Prehospital and Disaster Medicine, 21(5), 310-315.
• TELL ME (2014a). D3.1. New framework model for communication. Available at: https://www.tellmeproject.eu/sites/default/files/D3.1%20-%20New%20Framework%20Model%20for%20Outbreak%20communication.pdf
• TELL ME (2014b). D3.2. TELL ME communication kit. Available at: http://www.tellmeproject.eu/content/d32-tell-me-communication-kit
• TELL ME (2014c). New Communication Strategies for Institutional Actors (ST3.2.3). Available at: http://www.tellmeproject.eu/sites/default/files/ST3.2.3-Document-Spreads.pdf

Air Traffic Management references

IATA (2016). Crisis communication in the digital age - A guide to "best practice" for the aviation industry. Available at: [2]

Terminology

• Organization
  "Person or group of people that has its own functions with responsibilities, authorities and relationships to achieve its objectives Note The concept of organization includes, but not limited to, sole trader, company, corporation, firm, enterprise, authority, partnership, charity or institution, or part or combination thereof, whether incorporated or not, public or private" (Source: ISO22300)
  




• Crisis
  "Situation with high level of uncertainty that disrupts the core activities and/or credibility of an organization and required urgent action" (Source: ISO22300)
  




• Competence
  "Demonstrated ability to apply knowledge and skill to achieve intended results" (Source: ISO22300)
  




• Governance
  Governance describes structures and processes for collective decision-making involving governmental and non-governmental actors (Source: Nye and Donahue (2000)).
  




• Needs
  A condition or capability needed by a user to solve a problem or achieve an objective (Source: Hallberg, Jungert, & Pilemalm, 2014)
  

Navigate in the DRMG

• Parent theme: Involving the public in Resilience Management

• Resilience abilities
  • Contributes to: Monitor, Respond and Adapt
  • Supported by: Learn and Evolve
• Categories: Collaboration, Communication, Resources, Planning, Procedures
• Functions of crisis management: BEFORE, Preparation, Plan for crisis, DURING, Damage control and containment, Short-term recovery, Execute and revise plan, AFTER, Learning, Revise crisis management processes, Assess performance