Forging an Internal–External Approach for Communicating Medical Truth

The ordeal of the COVID-19 pandemic was exacerbated by the groundswell of misinformation and disinformation that flourished during it. For the communications team at University of Utah Health Sciences, the challenge of the pandemic crystallized around one notion: Be a trusted source of medical truth.

Speaking at the SHSMD 2023 Connections annual conference, held last September in Chicago, Kathy Wilets, MPA, the senior director of media relations and content marketing at the University of Utah Health, and Paul Gadd, MBA, its director of internal communications, reviewed the approach they developed that served to integrate external and internal communications into a cohesive team—while attending to the trial-by-fire known as the pandemic.

University of Utah Health, the sole academic medical center in the state, is a large health system, encompassing five hospitals, 12 community health centers and several specialty medical centers. The health care system’s 24,000 employees oversaw 2.2 million patient visits in 2022. The catchment area, the largest of any hospital system in the United States, is larger than many countries, and includes Utah, Idaho, Wyoming, Montana, western Colorado, and most of Nevada. The system’s expenses exceed $5 billion annually.

The vastness of the health system is one of the reasons why internal and external communications were historically separate teams. However, even before the pandemic, events conspired to blur the separation between the two. Wilets and Gadd discussed two events from 2017 that prompted the internal and external teams to rethink their approach.

As Wilet explains: “There was a police officer who came to the hospital who wanted to draw blood from a patient who was in critical condition. The nurse taking care of the patient said, ‘No, you can’t do that; he is in critical condition and you need a warrant.’ But the policeman insisted and ended up arresting the nurse, all of which was caught on tape.”

Employees of the medical center were not happy about this because a security guard had been standing by the whole time and had not intervened.

“The nurse felt that the university wasn’t backing her up,” Wilets says, and as a result many employees were upset. The story was picked up by national and international media. “I answered my phone and heard, ‘You are live on the BBC, in 5, 4, 3, …’”

The second issue was a protracted institutional crisis in which the CEO of University of Utah Health and the president of the University of Utah disagreed over funding for the Huntsman Cancer Institute. The dispute pitted two highly respected leaders against one another and created internal tensions, with protests and picketing.

The story about the arrested nurse was both an internal and external story, so both communications teams worked to consider the best way to address it. In the end the CEO held a press conference, Wilets explains.

“He said, ‘Look, the buck stops here. We are responsible and we are going to take care of our own,’” she recalls.

The statement served to calm down employees who were upset with the situation.

The institutional crisis was another matter.

“It was the hardest thing I had ever gone through as a communications person because we were not allowed to comment,” Wilets says. Still, there was a desire to do something, so the internal and external teams came up with a series of joint talking points that underscored the values of the institution.

“We created a vision statement, which gave us a road map, and this set the stage for us as a team to deal with misinformation and crisis situations in the future,” Wilets continues.

The communications teams didn’t realize it at the time, but they had set the first cornerstone for their approach to addressing the communications needs of the future pandemic.

Communications Challenges of the Pandemic

The key to communicating in stressful times is to be as transparent as possible, starting with your internal audiences. An example of this approach came very early in the pandemic, in March 2020.

“Senior leadership had decided to set up blue medical tents at University Hospital,” Gadd recalls. “These are emergency negative pressure medical tents that are used in the event of a natural disaster or mass casualty incident. At the time, there were no cases of COVID-19 in Utah, but they decided to set these up in anticipation of patients.”

There was enough anxiety about the pandemic, however, that the communications team wanted to tamp down speculation, so it was decided to alert employees first through the hospital intranet.

“Keep in mind, people were scared,” Gadd says. “We decided to say what we were doing and be open and honest. Yes, we are setting up these tents and here’s why, and we stressed that University of Utah Health is prepared to treat anybody who needs it.”

Meanwhile, Wilets and the external communications team put out a press release about the tents but also invited media to come take a look.

“That resulted in some local and national coverage, and we realized we had the opportunity to be the source of truth during this difficult situation,” Gadd says. “Why can’t we be the ones providing information to our internal and external audiences and combat the misinformation that was going around?”

“We had to be the source of truth,” Wilets adds, noting that her team employed their established communications tool kit to get the word out. “We used our podcast to do interviews with front-line clinicians. We had our blog, we created videos, and we did almost daily press conferences.”

There was also a daily livestream on the intranet that kept employees abreast of information—made especially important when a 5.7-magnitude earthquake hit in the first week of the pandemic, setting anxieties to a new high.

In addition, the CEO of University of Utah Health, Michael L. Good, MD, took to YouTube to deliver “Chalk Talks,” where he would present the latest scientific information on COVID-19. The concept of transparency was key, and being the source of trusted medical information proved vital. The role of leadership in this type of situation is paramount.

“One of the things we appreciated is the willingness of leadership to step up every day to be the voice of information,” Gadd says. “Our leadership agreed that they needed to be on the front line of communication and let people know that the information they are getting is coming from a trusted source.”

If a leader is reluctant to take on this role, it is OK to prod them to agree to do it, he adds: “We need you at this moment to communicate this information.”

Identify the spokespeople you want to spotlight and train them, if necessary, Gadd advises.

Dissemination of Information

How information is disseminated within a large organization needs to be carefully considered. It is important to get information out to internal audiences first.

Wilets and Gadd have settled on a stepped approach for leadership announcements, wherein the senior vice president’s office, the hospital board and trustees are all notified first; followed by department and division leadership and their affiliated staff; then the entire organization; and, finally, the general public and news media. Employees should never hear important hospital information first from the general media.

Whereas Wilets and Gadd have specific expertise in their areas of communication, they stressed that it is important to cross-train so that each can step into the other’s role if circumstances require. They told the story of a credible bomb threat at the hospital where Wilets was not able to meet the media outside the hospital but Gadd was, and so he did interviews on air to discuss the situation.

“We had identified cross-training as important because you never know when you are going to need it,” Gadd recalls. “In this case, we needed it badly.”

The internal and external communications teams meet about four times yearly to learn the systems and processes used by the other team.

Finally, Wilets and Gadd emphasized the importance of the full spectrum of employees, not just top leadership. These employees then become your ambassadors.

“Your employees can be some of the greatest assets in your organization when it comes to controlling misinformation,” Wilets says.

“At the end of the day, employees go home from work and talk to friends and neighbors, so our attitude is let’s arm them with the most accurate information we can,” Gadd adds.

Lessons Learned in a Crisis

Be as transparent as possible.

Disseminate information internally and then externally.

Use leadership and hospital spokespeople to communicate.

Arm employees with information and recognize their potential as ambassadors.

Cross-train internal and external teams and know relevant systems and processes.

Project your organization as being the source of accurate information.