Risk Communication & Risk Perception: Legionellaworcesterhealth.info/files/Legionella OC2016Risk Comm_Cheung_Final... · Risk Communication & Risk Perception: Legionella Hung Cheung,

Risk Communication & Risk Perception: Legionella

Hung Cheung, MD, MPH, FACOEM

Cogency Environmental

November 7, 2016

Protecting your people, your purpose and your reputation.

Found On Social Media Legionella? I received a letter from _________ letting me know the condo building we rent from has recently been tested positive for legionella bacteria after two people tested positive after a recent stay. They want is [sic] to sign a waiver for their responsibility in the case anyone gets sick. Since the filtration system and 6 months worth of testing won't be complete until after our scheduled vacation . We don't know what to do ... Anyone have any experience with this?


Another Post from Social Media

The appearance of Legionella at the ______ comes just about eight months after the most recent reported case in Ocean City last fall. Last October, the presence of Legionella was confirmed in the water system of the _______ after at least six individuals who had stayed at the hotel during the late summer months was [sic] diagnosed with the disease. One of the victims, an elderly out-of-state guest at the hotel, later succumbed to the disease.


Credits

• Dr. Syd Havely, UPenn & Havely Consulting, Inc.

• Dr. Phil Lewis, UPenn & Former Corporate Medical Director, Rohm & Haas

• Dr. Peter Sandman, Rutgers & Author, Responding to Community Outrage

• Dr. Vincent Covello, Founder and Director, Center for Risk Communication

• Michelle Fransen, MPS, MPH, Environmental/Technical Specialist, Cogency

• Emily Cheung, Supplier Contracts & Ex-Im Financing, Elpac China, Inc


Learning Objectives

• What is Risk Communication

• How risk is perceived/ perception theories

• Trust, credibility and perception calculus

• Seven cardinal rules of risk communication

• Seven deadly don’ts

• Message mapping

• Audience ID (culture, context & concerns)

• Community interactions


What is Risk Communication?

• Late 1980’s – you are at the shore with your children.

• Medical waste is floating up onto the shore and your child steps on a syringe.

• Your immediate response?

• Your expectations?

• What are the dangers?


Risk Communication

• NJ DEP – “Stuff is not dangerous”


Risk Communication

• RI Commissioner of Health: “This is an outrage; this is unacceptable. The people of RI will not, and should not, tolerate any hypodermic needles washing up on our shores. We are going to do absolutely everything in our power to stop it, even though the hazard from it is essentially nonexistent… We are going to turn budget upside down if we have to. We will put a stop to it no matter what it will take and not matter how much it costs.”


Medical Waste Scenario

• So what happened in NJ vs. RI?

– Which approach demonstrated more:

• Concern

• Empathy

• Credibility

• Trustworthiness

– Who listened?

– Which approach was more cost effective and efficient to resolve?


Listening

• Very important to risk (or any) communication

• How the other half thinks:

– I don’t care what you know unless I know how much you care.


https://www.youtube.com/watch?v=-4EDhdAHrOg

https://www.youtube.com/watch?v=-4EDhdAHrOg

Case Scenario 1

You and your family drove 200 miles to Hotel X in Ocean City for a week’s vacation. Upon arrival,

the you overheard that someone got sick with Legionnaire’s disease after staying at this hotel

last month.


Exercise

• Your immediate response?

• What are the dangers?

• What do you want to know?

• What are your expectations?

• What do you do?

(Write down your answers on a piece of paper)



Risk Communication

AKA:

Alerting the Apathetic &

Reassuring the Hysterical

(Dr. Peter Sandman)


Risk Communication

• Science-based approach for communicating effectively in situations that are:

– High concern

– High stress

– Emotionally charged, or

– Controversial


Risk Communication Challenges

“Spin”

Vs.

“Ethical Communication”



Spin:

“…making things appear to be that

which are not.”



What does Ethical

Communication

look like?


Ethical Communication

To inform with three primary goals:

• Knowledge and understanding

• Trust and credibility

• Dialogue to resolve disagreement


Correlation?

• Why is Risk Communication necessary?

• Make a list of hazards/ conditions/ activities

– Driving, obesity, swimming pools, mountain climbing, skydiving, plane crashes, waste disposal facilities, mold, etc.


Correlation?

• Rank them two ways:

1. How upsetting are they to lay people

2. Scientifically, according to injuries and illnesses


Emotions Influence Perception

We are sensitive to possibility rather than probability when greeted with strong

positive or negative events (Lowenstein et al. 2001; Rottenstrech & Hsee, 2001)

Strong emotions makes one insensitive to probability


Mega Million Jackpot/ Powerball


High Emotions


Risk Communication

• There are many risks that make people furious though they cause little harm, while others kill many without making people mad.

• Risk communication is the discipline that confronts this conundrum.

• Risk communication can be used to calm people down or generate a sense of urgency.


Risk Communication

• Why is there a gap? Is it purely scientific?

• What makes something appear to the average individual to be more or less harmful/ hazardous compared to valid scientific data?

Risk = Hazard + “Outrage*”

*Dr. Peter Sandman


Outrage Components


Safe Risky

Voluntary Coerced/ imposed

Natural Industrial

Familiar Foreign/ exotic

Not memorable Memorable

Not dread Dreaded

Chronic Catastrophic

Knowable Unknowable

Individually controlled Controlled by others

Fair Unfair

Trustworthy source Untrustworthy source

Morally irrelevant Morally relevant

Responsive process Unresponsive process

Case Scenario 1

You and your family drove 200 miles to Hotel X in Ocean City for a week’s vacation. Upon arrival,

the you overheard that someone got sick with Legionnaire’s disease after staying at this hotel

last month.


Exercise

• Make a list of all the outrage factors in this scenario.

• How might you can move it or them (if any) from the perceived risky side to the safe side?

(Write these on a piece of paper)


Risk Perception

• How does the human brain processes information relevant to risk?

– Mental Noise Theory

– Trust Determination Theory

– Risk Perception Theory

• Understanding risk perception substantially improves the communication of risk to the public and helps you do your job.


Risk Perception

Mental Noise Theory

• When people are stressed or upset, they have difficulty:

– Hearing information

– Understanding information

– Remembering information


Risk Perception

Trust Determination Theory

• When people are stressed or upset, they often distrust that others are:

– Listening, caring, empathetic

– Honest, open

– Competent, expert


Risk Perception

Less afraid and less outraged when we:

Trust

Feel prepared

Feel in control


Trust Determination Factors

Insert Pie chart


Trust Ladder in Risk Perception • High

– Health professionals (e.g., nurses, physicians) – Safety professionals (e.g., fire, police, PH) – University scientists

• Medium – Environmental professionals – Media – Activist groups

• Low – Industry – Paid external consultants


Risk Communication Approaches

1. When hazard is high but outrage is low – Precautionary advocacy

2. When hazard is low but outrage is high – Outrage management

3. When hazard is high and outrage is high – Crisis communication


Seven Cardinal Rules

About Communicating Risk

To the Public

(Dr. Vincent Covello)



1. Accept and involve the public as a partner—Your goal is to produce an informed public.

2. Plan carefully and evaluate your efforts—Different goals, audiences and media require different actions.



3. Listen to the public's specific concerns—People often care more about trust, credibility, competence, fairness, and empathy than about statistics and details.

4. Be honest, frank, and open—Trust and credibility are difficult to obtain; once lost, they are almost impossible to regain.



5. Work with other credible sources—Conflicts and disagreements among organizations make communication with the public much more difficult.

6. Meet the needs of the media—The media has a job to do.



7. Speak clearly and with compassion—Never let your efforts prevent your acknowledging the tragedy of an illness, injury, or death. People can understand risk information, but they may still not agree with you; some people will not be satisfied no matter what you say.


Seven Deadly Don’ts



Trainers and risk communicators all share the view that there are certain “don'ts” in communicating in public that will ruin your:



1. Lose your temper

2. Attack the interviewer or questioner personally

3. Repeat the

negative allegation

in your response



4. Indulge jargon as a way of confusing or defusing the question 5. Make promises you can't keep or speak "off the record“ 6. Indulge "what ifs“



7.


Message Mapping


Message Mapping

• Visual aid – provides glance at organization’s message for high concern/ controversial issues.

• Should contain detailed, hierarchically organized responses to anticipated questions and concerns.

• Provides consistency in your message at all levels.


Message Mapping Steps

1. Identify potential stakeholders

2. Anticipate stakeholder questions and concerns

3. Organize your thoughts and develop prepared messages

4. Develop key messages and supporting information in a clear, concise, transparent manner, in an accessible framework


Message Mapping

5. Promote open dialogue about messages both inside & outside the organization

6. Provide user friendly guidance to spokesperson

7. Ensure central repository of consistent messages

8. Encourage the organization to speak with one voice


Message Mapping

Rule of Three’s

• Three key messages (3/9/27)

• Repeat message three times

• Three supporting facts or credible sources for each key message

(see handouts for examples)


Message Mapping Exercise

Question:

1. Key Message 1

1. Supporting information 1:



2. Key Message 2 (3 supporting information)

3. Key Message 3 (3 supporting information) (use handout for this exercise)


Audience Identification

Includes: – Customers/guests

– Board of Directors

– Co-workers, vendors

– Area residents

– Health care providers

– Media

– Travel consultants/agents

– Government officials/regulators


Culture, Context & Cognition

• Health threat concerns

• Attitudes, cultural beliefs and levels of literacy

• Financial concerns & level of inconvenience

• Current vs. future desired behaviors


Culture, Context & Cognition • Relationship

– Casual or long term

• History – Previous involvement, results, past patterns, on-

going issues, health ramifications

• Reasons for interest – Health, safety, environment, economics,

esthetics, fairness, process, legalities surrounding the issue


Community Interactions and Platforms


Community Interactions

1. Provide a forum for people to air their feelings.

2. Listen to people when they express their values and feelings.

3. Acknowledge and authenticate people's feelings about an issue.


Community Interactions

4. Respond to people's emotional concerns appropriately by showing empathy and caring, rather than with just data.

5. Demonstrate dedication and commitment to addressing and resolving their issues and health concern.


Communications Plan


Good Communications Plan

1. Identify what needs to be done preventively before a crisis, and what to do during and post-crisis (BDA).

2. Seeks to protect people, purpose, and reputation to prevent tailspin.

3. Who is responsible/accountable for what aspects(BDA)?


Good Communications Plan

4. Who will speak on the issues (internal & external)?

5. Who will be in charge of incident command center, including what outside agencies/consultants will help resolve issues?

6. Introductions, co-training and rehearsals.


Learning Objectives

• What is Risk Communication

• How risk is perceived/ perception theories

• Trust, credibility and perception calculus

• Seven cardinal rules of risk communication

• Seven deadly don’ts

• Message mapping

• Audience ID (culture, context & concerns)

• Community interactions


Questions?

[email protected]

or

1(888) 361-8882


Risk Communication & Risk Perception: Legionellaworcesterhealth.info/files/Legionella OC2016Risk Comm_Cheung_Final... · Risk Communication & Risk Perception: Legionella Hung Cheung,

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