Corporate case study: Healthy media reputation aids Duke's crisis recovery

Though Duke Health System's reputation took a devastating hit following an ill-fated transplant in February, its long-standing open relationship with the media helped repair the damage.

Though Duke Health System's reputation took a devastating hit following an ill-fated transplant in February, its long-standing open relationship with the media helped repair the damage.

The Duke University Health System is a healthcare network comprising three hospitals (Duke University Hospital, Durham Regional Hospital, and Raleigh Community Hospital), Duke University School of Medicine, Duke University School of Nursing, a biomedical research enterprise, and several physician practices. It is the largest employer in Durham County, NC, and the third-largest private employer in the state. In total, approximately 16,000 people work for the system. Vicki Saito, associate vice chancellor of communications, oversees all PR efforts for the health system. There is an internal relations department and an external communications operation, which is also referred to as the Duke University Health System News Office. The news office's 10 staffers, who are led by director Jeffrey Molter, disseminate about 200 press releases per year, and maintain a robust website, The team has what Molter calls a "very proactive relationship with the media," and has become quite familiar with handling reporters under controversial circumstances. "When you're dealing with cutting-edge medicine, as Duke does, sometimes things don't always go the way you want," Molter says. "A lot of high-risk operations go on, where the outcomes can draw a great deal of media scrutiny." Responding to a media maelstrom As familiar with handling media inquiries as the news office might have been, no one was fully prepared for the spotlight Duke would occupy when it found itself at the center of one of the biggest healthcare stories of 2003. But it was a telling moment for the current state of healthcare communications, as well as how it needed to change. On February 7, surgeons from one of the health system's member organizations, Duke University Hospital, gave Jesica Santillan a heart and lung transplant from a deceased donor with blood type A. The 17-year-old girl's blood type was O - a mismatch that led to what has since been called one of the worst mistakes in medical history. After receiving another unsuccessful transplant on February 20, Santillan died on February 22. "On average, we'll have about 1,000 media placements per month," tells Molter. "In February, we had about 5,800." He recalls getting paged by reporters "22 hours straight for days" during the "tsunami of media activity." During the first week, from February 7-14, Molter says Duke's communications team had an agreement with the Santillan family and its advocate, Mack Mahoney, not to disclose that the mismatch had occurred. "One of the most important principles in our business is to adhere to the family's wishes," explains Molter. "Jesica's parents didn't want the mismatch to be made public because they wanted attention focused on getting her a second set of organs." The news office, according to Molter, helped the family with media relations so that they could tell reporters their daughter was rejecting the organs, without talking about the unmatched blood types. On February 14, unbeknownst to Duke's news office, the Santillan family decided to reveal to reporters that their daughter had received organs of the wrong blood type. However, it was not until the following Monday, February 17, that the communications team met with Duke Hospital's CEO, Dr. William Fulkerson, to discuss plans to deal with the mistake publicly. Citing severe weather in the Durham area over the weekend, Molter reluctantly admits, "In retrospect, we probably should have had a better response time, since we knew the story was breaking on Friday [February 14]." Approximately one week before Jesica received the second transplant, Duke called upon Burson-Marsteller to offer crisis communications counsel. The hospital does not retain a regular PR firm, but has hired external help in the past to assist with "special circumstances," according to Molter. Duke also enlisted Burson in 1999, when the health system experienced problems with some of its clinical research. The agency is currently still retained to help the hospital with its recovery efforts. Past reputation helps reparation Fortunately for Duke, the Jesica Santillan incident "occurred on its good foundation," says Sylvia Wrobel, associate VP of communications at Emory University's Woodruff Health Sciences Center. "Duke had been known for dealing with the media well, so they were able to recover from this by reminding people what a great institution they were. You can't start from square one the day after a crisis. You must already have your reputation in place." Since Santillan's death, the hospital has been working to repair relationships with the media outlets that became frustrated with Duke's silence in the early stages of the story. Molter says, "We've essentially opened our doors to reporters." In March, the surgeon who performed the transplants, Dr. James Jaggers, and Fulkerson were interviewed on 60 Minutes. "That interview made you realize there were remorseful human beings behind this, and not just a cold institution," says Wrobel. Stories about the way Duke handled the situation also appeared in Forbes and US News & World Report. The communications team developed an outreach program through which it goes out and talks to people in the news media and the medical profession. Their goal is to obtain feedback on how constituencies think the hospital handled the organ mismatch, and what could have been improved. "We've learned the importance of having more available spokespeople, better response time, and talking openly about what steps we've taken to tighten internal procedures," says Molter. Based on the lessons learned, he notes that a quicker media plan and greater number of spokespeople were prepared when Duke recently had a potential SARS case at one of its facilities. Duke's openness after the fact allowed it to uphold its reputation, according to Wrobel, but "it has also been helpful to the entire PR profession." She explains, "Rather than just letting the organ mismatch be an event of the past, they have actively gone out and told their story. By doing that, they've demonstrated how useful it is to get people to really understand how medicine works. One of the main reasons people get so angry at institutions is that they don't understand them." Prioritizing patients' interests The challenge of keeping audiences informed about what an institution does is particularly sensitive at an organization like Duke Health System. High-profile patients, such as celebrities or top executives, and experimental therapies are everyday occurrences at Duke. Olympic athlete Marion Jones, for example, recently had a baby at Duke University Hospital, but she did not want to reveal to the media that she was there until after the baby was born. Duke's news office deferred all media inquires to Jones' PR people until she was ready to make her whereabouts public. "There are some patients that welcome publicity, and others that don't. In the case of celebrities, that sometimes means our media relations people work with their media relations people," Molter explains. "Their needs are our main concern, so we have to work to protect their privacy no matter what." Wrobel adds that the first priority of a medical institution's communications department has to be the same as that of everyone at the organization. She says, "We always have to act in the interest of the patient. Sometimes it goes against what the press wants, but if it's not best for the patient, we won't do it." While Molter admits that Duke could have been more revealing in the initial stages of the Santillan tragedy, he maintains that the hospital always acted in the best interest of its patient, adding, "[Jaggers] was not initially put out there as a spokesperson because he was too busy taking care of Jesica." ----- PR contacts Associate vice chancellor of communications Vicki Saito Director, Duke University Health System News Office Jeffrey Molter Associate director, Medical Center & Health System News Office Richard Puff

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