Trust in H1N1: Uncertainty

Earlier this year, the scholarly journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Research published an extremely interesting article entitled Exploring communication, trust in government, and vaccination intention later in the 2009 H1N1 pandemic: results of a national survey. If you know someone who has access to that journal, I highly recommend you read the article. And if you don’t know someone, I’ve pulled out three of the biggest points from the article, and plan to talk about it all week in a series I’m calling Trust in H1N1. You can find links to the other two posts on this article following today’s post.

Today we’re talking about uncertainty.

Uncertainty is a strange thing. In emergencies, like a pandemic, the only thing that you can be completely sure of, is that things will change. The situation, the recommendations, the guidance, the response, the players. Some, or all, of it will change. Change breeds uncertainty. Uncertainty about a situation leads to doubt, unfocused response, questions and recriminations. Uncertainty is a capital “B” Bad Thing.

But if it’s a constant in emergencies, why is it so bad? Well, it’s bad for the response for obvious reasons. When you don’t know what’s going to happen next, it’s tough to plan, but there is another reason, and it has to do with trust.

Many response communicators worry that if you keep changing the message, you’ll ruin your credibility. And that’s not completely untrue. A communicator that constantly changes their message will appear scattershot, unfocused and unbelievable. But in an emergency, by the very nature of the emergency, things will change and what we’re saying will have to change. So what do we do?

The article we’ve been reviewing deals with this idea of uncertainty and trust, quoting no less than former CDC Director Dr. Richard Besser during the H1N1 response:

I want to acknowledge the importance of uncertainty. At the early stages of an outbreak, there’s much uncertainty, and probably more than everyone would like. … We’re moving quickly to learn as much as possible and working with many local, state and international partners to do so. … I want to acknowledge change. Our recommendations, advice, approaches will likely change as we learn more about the virus and we learn more about its transmission.

The research showed that the openness shown by government officials was greatly appreciated by the public.

By addressing uncertainty early in the crisis, it appears the government was able to influence the public’s acceptance of future changes in understanding and behavioral recommendations. In our results, we saw over 90% agreement with the item, “I understand that information about swine flu will change as scientists learn more about the virus.”

The problem isn’t that we have to change our messages. The problem is that we aren’t being honest with our publics. We still think we can get in front of them, tell them what’s what and that we’re in charge. We’re not being open and honest and letting them know that, hey, we’re not positive, we’re not perfect, but dammit, we’re working hard and we’ll keep you in the loop because you’re important and vital and we want you on our team.

That’s what Dr. Besser was talking about. Openness, honesty, transparency. These aren’t just hallmarks of a twenty-first century communications system, they are vital parts to mounting an effective emergency communications campaign. They are vital to success. As we’ve said before, a poorly executed information campaign can sink any response. Not being trusted, not being believed is item 1A in the definition of a failed response. Not dealing with uncertainty early is one of the best ways to destroy that trust.

Trust in H1N1: The Messenger
Trust in H1N1: Building Trust


Trust in H1N1: Building Trust

Earlier this year, the scholarly journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Research published an extremely interesting article entitled Exploring communication, trust in government, and vaccination intention later in the 2009 H1N1 pandemic: results of a national survey. If you know someone who has access to that journal, I highly recommend you read the article. And if you don’t know someone, I’ve pulled out three of the biggest points from the article, and plan to talk about it all week in a series I’m calling Trust in H1N1. You can find links to the other two posts on this article following today’s post.

Today we’re talking about building trust.

Trust is a central component to almost everything we do. It is what allows government to operate. Trust is our currency and our charter. Without trust, why would anyone listen to us? Why would the public not revolt and overthrow us? Trust is the only thing keeping our society together. And yet, we haven’t been great stewards of the public’s trust. One needs only to look at the Edelman Trust Barometer to see how poorly government the world over is trusted. But that doesn’t mean that all hope is lost. Our article today talks about trust: who is trusted and how to build trust.

First, who is trusted? Research from H1N1 showed that, in a pandemic, public health officials were the most trusted:

… CDC officials as the most trusted, followed by state and local public health officials and Secretary Sebelius. Interestingly, while elected officials were typically less trusted than public health authorities, President Obama was the next most trusted after the HHS Secretary.

Local and state elected offiicals did not fare as well as trusted spokespersons either eiarly or in the midst of the pandemic.

This passage raises an interesting point. First, research is showing that subject matter experts are who our messengers should be. Elected officials maybe shouldn’t be. So how do you tell the elected officials that they should probably avoid the limelight?

But where does that trust come from? Why experts and not electeds? The article hints that the reason might be the actions taken. Subject matter experts and public health officials are the ones leading a pandemic response, so they’ve got some background in the topic. Elected officials may come off as opportunistic. But what comes first, the action of protecting the public’s health engendering trust, or being trusted to implement the public health response?

Selective exposure theory posits that people’s choice of information exposure in a pandemic will confirm their preexisting beliefs and predispositions and that whether someone chooses official sources in a pandemic may be determined well in advance of the event.

But the last sentence in that passage is what I want to really point out:

This speaks to the importance of building trust in and loyalty to official sources as well as educating people about what to do in a pandemic (e.g., hygiene, vaccination, social distancing, etc.) in advance of a pandemic.

So how do you do that?! (If only there was a blog about emergency risk communication, government communication and crisis communication to help you walk through that kind of thinking…) Well, the answer is to look at the current state of things (see the Edelman Trust Barometer link again) and ask if that really is good enough. If not, then something needs to change. Think about what makes you trust something: openness, availability, history, track record of success. Do you do those things? Is that what you’re known for? If not, maybe that’s where you should start.

Trust in H1N1: The Messenger
Trust in H1N1: Uncertainty

Trust in H1N1: The Messenger

Earlier this year, the scholarly journal Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Research published an extremely interesting article entitled Exploring communication, trust in government, and vaccination intention later in the 2009 H1N1 pandemic: results of a national survey. If you know someone who has access to that journal, I highly recommend you read the article. And if you don’t know someone, I’ve pulled out three of the biggest points from the article, and plan to talk about it all week in a series I’m calling Trust in H1N1. You can find links to the other two posts on this article following today’s post.

Today we’re talking about the messenger.

Very often, when we talk about government emergency communication, we talk about the message. We plan for what we’ll say. We have message maps and approved talking points, templated press releases and FAQs, dark sites and empathetic Facebook messages. We don’t lack for what to say in many planning areas. (I’m willing to bet that no other disaster has had as many potential messages written about it as has an aerosolized anthrax attack, and this is due solely to the CDCs Cities Readiness Initiative funding and program.) We write messages all day, and some of us even pilot test them, get them approve and practice turning the templates into real messages. Boy, we are ready to go.

Unfortunately, that’s only part of the equation. As anyone who has ever taken a media relations course or some sort of in-front-of-camera training will tell you, up to eight percent of the audience’s comprehension comes from non-verbal cues. But where in our planning documents does it tell folks not to read in a monotone voice, or not to shuffle their feet, or strive to make eye contact with the cameras (or media folks), not to fidget and to turn off your cell phone? It doesn’t, and that’s a huge problem because if you put the wrong person up there, it could do as much to derail your messaging as not having pilot tested your messages. While the research is extremely nascent in this particular topic, there is some interesting anecdotes and correlations that support that who says something is almost as important as what they say (hm, sounds almost like the tagline for this blog that I know…).

There is growing consensus that, as Larson and Heymann remind us, “It is not only the ‘what’ that matters [with regard to what is communicated], but ‘who’ is conveying the information or concerns and ‘how’ it is communicated.

While trust scales are being developed to give us a way to model trustworthy speech, real life messengers are demonstrating how things should be done. Folks like Governor Frank Keating and Mayor Rudy Giuliani have shown, in the worst possible situations, how the right person saying the right thing at the right time can make all of the difference:

It may behoove them to adopt the “Giuliani model,” based on then-Mayor Giuliani’s behavior after the 2001 anthrax attacks: He conveyed empathy, compassion, and grasp of the complex situation and made excellent use of his team of experts, each speaking to his or her specific area of responsibility.

But sometimes, even saying the right thing isn’t enough. It’s demonstrating that the messenger really truly believes in what they’re saying, and are willing to prove it. Read about President Barack Obama’s decision to publicly vaccinate his daughters against H1N1:

[I]t appears the president’s [sic] actions to vaccinate his children may have transcended typical political divisions and allowed the public to see him as a parent making decisions on behalf of his family. This suggests that having highly visible role models may be an effective communication strategy, particularly as it may reflect the emphasis on fiduciary responsibility and fairness as a critical component of trust in the context of vaccination decisions.

Our findings are consistent with a report from the United Kingdom that asserted that then-Prime Minister Tony Blair’s unwillingness to disclose the vaccination status of his young son during the controversy over the MMR vaccine undermined the government’s own message about the safety of the vaccine.

So, by all means, continue to plan your messages out. But don’t, for one second, believe that your work is done. Choosing the right spokesperson to deliver those messages might be just as important. And something that can easily be practiced today. A less well-known facet of Mayor Giuliani’s performance in the days following the 9/11 attacks was that much of what he said was planned, practiced, tweaked and updated. His executive team regularly practiced not only disaster drills, but what to say to the media and the public following the disaster. He helped the public start to move on from the attack, but it was less about him as a person and more about his exceptional team and comprehensive pre-planning that was more than a dusty old binder.

Trust in H1N1: Building Trust
Trust in H1N1: Uncertainty

Your Next Job Will Be Your Life

When we talk about social media around these parts, we talk about how your agency should do it, or how your executive should do it. Unfortunately, I don’t get around to talking about something that’s equally (or more!) important than either of those things: how you use social media.

Cause you do. You are. Right now, actually.

And if thinking about you using social media isn’t scary yet, read this:

The NMC’s decision to suspend Allison Marie Hopton for comments she posted on Facebook will make sobering reading for some nurses.

It is nice to think our work and private life are separate but social media blurs the boundaries and – as the NMC rightly points out – if you identify yourself as a nurse your behaviour has to uphold the standards of the profession.

I often see anonymous comments on our own website that make me anxious about how others will view our profession – not only in terms of the language used but the attitude nurses sometimes adopt towards each other.

I get asked about this type of thing regularly when speaking at conferences. And my answer isn’t very satisfying: the courts are working it out–slowly. And in the meantime? Folks are posting things online and dealing with the aftermath.

So be careful out there. But, don’t go hiding from social media, because there are real benefits, as this blog post about how to hire great candidates:

When I researched them online, I found them engaged in repeated professional conversations
This indicated that they cared enough about what they were doing that they were engaged in it outside of their nine to five jobs. They sought out situations to discuss aspects of their chosen profession both with other professionals and with their clients.

This is why Twitter, message boards, websites, and even Facebook can both prove valuable for professionals. It provides a clear way to demonstrate professional behavior and passion for a topic while also connecting with peers and potential clients.

And now for some personal perspective. Nothing–NOTHING–has been better for my career than my social media work. Not my degrees, not my day-to-day, not how I dress or how late I stay at work. I’ve been invited to speak at conferences across the country, I’ve made friends at health departments, emergency management agencies, government agencies from coast to coast. I can reach out to public health and government heroes that I’ve read about and they not only hear me, but they answer: Laurie Garrett, Dr. Rich Besser, Jack Herrmann, Scott Becker, Wendy Harman.

The risk is real, but the benefits are life-changing. Take hold of it and see how it will change your career, and life.

Human Beings in Communication

Gerald Baron had a great post the other day about a study that said that Facebook was found to be a useful tool in a crisis. He reviewed the conclusions and was less than impressed (and rightfully so). Apparently, the researchers took what is good communications work and put it next to poorer communications work and then ascribed the good work to the medium through which it was transmitted. Gerald came away with the following key message:

Direct messages sent in a human voice that provide in-depth information are effective in a crisis.

This shouldn’t surprise anyone who reads me, though, because I regularly talk about being a real person when communicating (from bears to About Us pages).

The thing is, we’re still not very good at it. So when I see stories about a government agency that are all impressed with a minor effort to seem human, I get a huge kick out of it. Like, we’re still learning this?

There are some folks, though, that have taken that engagement, that being human, to another level. They’re no longer including, “Be sure to empathize,” on their checklist of how to deal with the public. The classic example of this is the Los Angeles Fire Department’s @LAFDTalk Twitter account, but a bit closer to home, there’s another success story:

SEPTA has an @SEPTA Twitter account for alerts regarding the whole system. Then there is the Twitter account for SEPTA buses, one for each regional rail line, an account for the Broad Street Line and one for the Market Frankford Line, a Twitter account for each trolley line and one for the Norristown High Speed Line. Each of these shoots out updates about the given line.

The one that is turning heads, though, is the @SEPTA_Social account. Run by the customer service team, @SEPTA_Social is all about engaging with customers, having actual conversations, and at times, even being a little sarcastic.


Now, Monday through Friday from 7 a.m. to 7 p.m. and Saturday and Sunday from 8 a.m. to 6 p.m., these customer service reps watch what’s happening on Twitter. They respond to inquiries, complaints and praise directed to the @SEPTA_Social account and watch what people are saying about SEPTA.

The rationale?

“When you think about a traditional call center, that’s me talking to you,” Heinle said. “That works, but social is me talking to you and maybe 500 other people, so the impact or the potential impact, both good and bad, is significantly more.”

What this means is so much more than an “Attaboy!” for SEPTA (though they do deserve one). This is more about your agency. SEPTA is setting the bar for interaction and openness and approach-ability. After the public has a great experience with SEPTA then turns to your agency, are they going to be disappointed? Usually, that’s not a terrible thing. As Ms. Heinle says above, usually it’s just one-to-one; I had a bad experience and now I’m going to stew.

But now? Are they going to be more likely to talk with their friends about their experience with you? Is their unhappiness going to be shared with 500 people or more?

And just think: all of this can be avoided for the low, low cost of being a human being. Dropping the “government automaton” voice, getting over yourself and actually respecting your publics.

Holding Back the Tides

04hajj-395Interesting times make for interesting posts, apparently. If you haven’t been following the flu blogosphere, MERS-CoV has been kicking up again in the Middle East (machine-translated gobbledygook). MERS-CoV is something that public health professionals are watching very closely for two reasons. First, our experience with SARS. While MERS-CoV is not SARS, that doesn’t mean that the 2003 outbreak can’t be learned from. Second, we’re concerned about where the outbreaks are taking place due to the upcoming religious pilgrimage in Mecca, in the Kingdom of Saudi Arabia. Lots of people from all over the world crowded together, while an infectious agent floats (?) around, and then dispersing to the winds, potentially infecting their home populations. (One only needs to look at the importation of cases to the UK, France and Italy.)

Well, the flu blogosphere is in a bit of a tizzy right now over the most recent release of information from the Kingdom over cases. Apparently, there have been a few reports of hospitals asking people not to go to hospitals due to cases already in the hospitals and unannounced outbreaks. (Caution: more machine translation.) In a country that controls the media and information releases as strongly as the Kingdom, this is a HUGE deal.

The Saudi government has openly prosecuted bloggers and dissidents, maintains strict control over internet content, and in 2012 was listed by the CPJ (Committee to Protect Journalists) as number 8 in the 10 Most Censored Countries. And just this week, KSA passed a law to combat cybercrime, which includes a broadly worded provision to outlaw `the dissemination of ideas that could affect public order or morality.’

The inimitable Mike Coston goes on later:

Whatever the truth is regarding these reports, the fact that they are appearing at all in mainstream Arabic media suggests growing concerns over MERS (and a loss of confidence in the MOH) by the public, and by the media.

I’ve talked about this before, when I was describing the internet rumor mill that surrounded the H7N9 cases in China, and wondered aloud if something similar would ever pop up in Saudi Arabia:

Now imagine the value that a rumor mill like Weibo could be in Saudi Arabia. How much better we all might be protected.

As we talked about yesterday, all it takes is one clever person with a smartphone and a social media account and that secrecy that the Kingdom is so famous for will be as useful as an ice cream cone stand there.

Bruce Schneier, when talking about the Snowden case, details a secondary problem to lies coupled with secrecy, not just the original problem, but something much more dreadful:

All of this denying and lying results in us not trusting anything the NSA says, anything the president says about the NSA, or anything companies say about their involvement with the NSA. We know secrecy corrupts, and we see that corruption. There’s simply no credibility, and — the real problem — no way for us to verify anything these people might say.

It’s a perfect environment for conspiracy theories to take root: no trust, assuming the worst, no way to verify the facts. Think JFK assassination theories. Think 9/11 conspiracies. Think UFOs. For all we know, the NSA might be spying on elected officials. Edward Snowden said that he had the ability to spy on anyone in the U.S., in real time, from his desk. His remarks were belittled, but it turns out he was right.

How will we learn to trust the Saudis again if they’re hiding this? How will the Saudis be able to trust the Kingdom? And while not all rumors are true, in today’s world, all it takes is one rumor to slip out and all hell could break loose. Trying to stop it? Like holding back the tides.

The Opposite of Transparency

If the last few months of American politics and national security news have done anything, it’s proving that secrets rarely are. We live in a time when people debate, openly and in a completely non-absurdist way, whether or not information wants to be free. I say that information doesn’t want anything. People want power and in today’s world, information is power. Releasing withheld information is a play to shift power as much as withholding information is a play to maintain power.

The super-smart security expert Bruce Schneier believes that secrets are getting harder and harder to keep these days:

[I]t is possible to build a career in the classified world of government contracting, but there are no guarantees. Younger people grew up knowing this: there are no employment guarantees anywhere. They see it in their friends. They see it all around them.

Many will also believe in openness, especially the hacker types the NSA needs to recruit. They believe that information wants to be free, and that security comes from public knowledge and debate.

We live in a world where information is currency, but it is a currency that has a shelf-life measured in minutes. The five seconds it takes to tweet a piece of previously-secret information is all it takes for it to be completely worthless. Everyone has access to it now due to viral messaging. But that wasn’t always the case. Secrets-holders used to be able to put the genie back in the bottle. Through delaying, denying and denigrating, the powerful could make those scoops go away. Could wait it out until the media became interested in something else.

Today though? Just ask Anthony Weiner about putting the genie back in the bottle. Once information is released, it is released. Full stop.

The problem with this, and the reason for today’s post is because some crisis communications folks still think that they can unring bells. That they can delay, deny and denigrate until the story has blown over. Today we’re talking about our friends at Star Alliance, and this picture:

thai airlines

It’s an image taken after a Thai Airlines jet had a problem landing at an airport in Bangkok, Thailand. Things went wrong, as they sometimes do, and 14 people ended up in the hospital. No big deal, right? Now look at the jet, and try to find the Thai Airlines logo. If you look at the jet in the air behind it, you’ll see the logo, up front, above the windows. But not on our crashed jet. According to a spokesperson:

Thai Airways official Smud Poom-On said that “blurring the logo” after an accident was a recommendation from Star Alliance known as the “crisis communication rule,” meant to protect the image of both the airline and other members of Star Alliance.

And this is what I mean by secrets aren’t for very long. All it took was one person to see the absurdity of the situation and snap a picture of a similarly-colored and painted jet in the background to demonstrate how useless an effort covering up the logo of the airlines was.

That was supposed to be the end of the story, but writing this made me think about if I’d seen this before. I never had (some crisis communication rule, eh?), even in plane crashes of other Star Alliance airlines, like United or US Air or, I don’t know, Asiana Airlines (and their very recognizable and definitely not painted over logo). Why the difference in tactics?