Often when I’m training on how to deal with online comment, criticism and abuse I feel a drawbridge go up.
It’s the job of social media, I tell people, to be the canary in the mine when it comes to criticism. Screen shot it and play it back to the decision makers. Avoid the temptation to always dismiss those who have not had a happy experience.
This week, I heard a remarkable interview with on BBC Radio 4’s Today programme with Dr Bill Kirkup, who led a damning report into East Kent NHS Trust’s maternity service that concluded that 15 babies died who may have lived had their treatment been better.
You can hear the interview with Dr Kirkup on BBC Sounds here from around 1:53:40 onwards.
The interview led me to Dr Kirkup’s full report ‘Reading the Signs: Maternity and neonatal services in East Kent – the Report of the Independent Investigation.’ After reading it, if you’re public sector comms – but particularly NHS comms – I recommend you get up to speed with it.
The need to re-think reputation management
Reputation management emerged strongly first in the 1990s as a strategic aim. Good branding is part of it and so it maintaining a reputation with partners and others.
Ralph Tench and Stephen Waddington’s ‘Exploring Public Relations Management’ talk of the evolutions of how this is dealt with.
But Kirkup’s report is harshly critical of the way reputation management implemented across East Kent NHS Trust had closed down the need to listen and reflect. There was a sense, the report says, across the organisation that all criticism is bad and must be shut down.
Now, I have to stress that the comms team at East Kent is not singled out for particular criticism in the report. I’m sure they have talented staff who do really good work. I’m also consistently impressed at the quality of so much of wider NHS comms. In the report, reputational management went far wider than communications and dictated individual teams’ responses to grieving members of the public.
“What made this more than just a clinical issue,” Kirkup said on his Today interview, “was the singling out of reputational management as one of the problems. Lessons couldn’t be learned.”
Looking through the report there is much for clinicians and leaders to be concerned with over a bullying culture and poor leadership.
But it is the passages on reputation management that really sting:
The default response of almost every organisation subject to public scrutiny or criticism is to think first of managing its reputation, as is evident from a great many instances within the NHS and much more widely. Many risk registers will identify reputational damage in several contexts as something to be mitigated. If this were only a single part of a more complete response that was based on identifying failure and learning from it then it might be considered reasonable. But repeated experience says that it is not.
On the contrary, the experience of many NHS organisational failures shows that it is the whole basis of the response in many cases. Further, it has clearly led to denial, deflection, concealment and aggressive responses to challenge, in the Trust as elsewhere. Not only does this prevent learning and improvement, it is no way to treat families, who are heartlessly denied the truth about what has happened when something has obviously gone wrong, compounding the harm that they have already suffered. Refusal of scrutiny may extend to the manipulation of information for the CQC, and misrepresenting deaths (for example, as “expected”) to avoid inquests.
The balance of incentives for organisations needs to be changed. The need for openness, honesty, disclosure and learning must outweigh any perceived benefit of denial, deflection and concealment. The current small risk to an organisation does not match the risk of loss of public confidence in one of its vital services.
These passages really chime with the conversations I’ve had in training.
Sometimes when I’m telling people that listening to issues on social media is one of the important tasks I’m struck with a lukewarm enthusiasm.
Why do I raise this? Well, I’m from Stafford. My local hospital was Mid Staffordshire Hospital. In 2013, it drew a critical report and a conclusion that as many as 1,200 people died because of neglicence. My timeline in the week of its publication was filled with people I know who had been directly been affected by the deaths of loved ones.
In some NHS circles, this probably means I’m outside of the wagon train. I don’t really care about that. But I do care about the NHS and I do care that its run well. It’s the one service we’ll all use at some point in our lives and I’m keen in training that people are trained to the highest possible standards.
The role of Hillsborough in all this
The Hillsborough disaster of 1989 saw 97 people killed at a televised football match because of systemic incompetence made worse by the peverse refusal from several key organisations not to accept blame.
The incident raised a debate about the need for transparency from public bodies so they can learn from mistakes rather than being made to learn from mistakes.
Kirkup’s report takes the issue of openness a step further. New legislation is needed, he says, to compel public organisations as this is far wider than one NHS Trust.
To quote the report:
Unfortunately, these problems are far from restricted to East Kent. Indeed, reputation management could be said to be the default response of any organisation that is challenged publicly. When the end result is that patient safety is being damaged, unrecognised and uncorrected, however, it is especially problematic. At present, the benefits of inappropriate and aggressive reputation management outweigh the meagre risks to an organisation of behaving in this way. This balance must be addressed.
The problems of organisational behaviour that place reputation management above honesty and openness are both pervasive and extremely damaging to public confidence in health services. A legal duty of truthfulness placed on public bodies has been proposed as one of the responses to the Hillsborough disaster. It seems that NHS regulation alone is unable to curtail the denial, deflection and concealment that all too often become subsequently clear, and more stringent measures are overdue.
So, one key recommendation to Government from Kirkup is for the need to bring forward legislation ‘placing a duty on public bodies not to deny, deflect and conceal information from families and other bodies.’
It also requests that Trusts be required to re-think their approach to reputational management. In other words, it sets out a legal requirement not to deny and deflect. That could have a profound impact not just on NHS but all public sector communicators.
The act of even raising it as a recommendation in a significant report should start forward thinking NHS communicators to rethink their strategies.
The need for good internal comms
Internal comms specialists will no doubt take a great deal from this report, too.
The organisational culture of East Kent NHS Trust, according to the report, failed to celebrate things done well.
If ever you’ve wondered what the value of staff stories of success on the intranet or online or through staff awards then this report deserves reading.
What comms can do
Speaking truth to power is sometimes a requirement of communications. It can sometimes be a hard task to complete. But what this report does is set out in black and white on the need to re-think reputational management for the whole organisation. This isn’t just an issue confined to professional communicators.
Constructive criticism can often be a chance for the organisation to learn and if that means avoiding babies dying this has to be a good thing.
I’d be reading the report and using it as a Trojan horse to talk to senior leadership as a way to change the culture of the organisation. Quote it liberally. You’ll be doing the leaders a favour.
Experienced directors of communications Sarah Pinch and Bridget Aherne this week at Firepro ran a compelling session on the need to influence upwards. They talked impressively on putting a foot in the door with senior management and to keep it there. This feels like an issue that feels like both would be being pro-active with.