Repeating Milgram: Endoscopy Staff Behavior

In 1963, Stanley Milgram gave the world a glimpse into obedience by publishing the results of his experiment in the Journal of Abnormal and Social Psychology. I learned about the study in college.

The experiment, conducted at Yale University, tested how much pain one participant would inflict on another, provided the participant inflicting the pain would relinquish responsibility to the person they perceived as an authority.

Although the experiment was staged (the person enduring the pain was a actor) and no one was injured, Milgram found that 65 percent of participants would administer an electric shock of what they believed to be 450 volts. Even more surprising, not one participant refused to administer shocks before the 300-volt level, despite several switches clearly marked “danger: severe shock” and the actor complaining of chest pain, banging on the wall, or dropping silent.

With light to moderate prodding, an authority figure in the experiment was able to convince the participant to deliver electric shocks. Some would protest, but continue to “shock” the actor nevertheless.

Understanding Obedient Staff Behavior.

Understanding Milgram’s experiment was followed by strip search prank call several years ago. It was not an experiment. It involved a caller claiming to be the police and instructing fast food managers to strip search employees. In more than 70 reported cases, managers surrendered personal responsibility to an authority figure, becoming like a puppet, and demanded employees remove their clothes.

By comparison, the notion that staff at the Endoscopy Center of Southern Nevada would blindly follow the instruction of administrators to reuse vials of single-dose medicine would likely take less surrendering of responsibility to a higher authority, especially one who had served on the board of the Nevada Board of Medical Examiners.

Why? Proximity to the authority figure. Perceived level of authority. Assurances of a minimal risk. Other nurses already practicing the procedure. And on. And on.

It the only answer for people still wonder why they didn’t stop the practice at the Endoscopy Center of Southern Nevada. Objectivity was sacrificed in favor of perceived acceptance. As one CDC officer reported it: the center’s practices to be so obviously dangerous that it was like “driving the wrong way down the freeway.”

I feel the same way about the center's crisis communication plan. It's like watching a horror show of a horror show, where you watch the next victim stumble up stairs with a flashlight.

The latest update: The Las Vegas Metropolitan Police Department and county prosecutors opened a preliminary criminal investigation. These investigations join inquiries by the FBI and the Nevada attorney general’s office.

Add to all this news an endless stream of sources being tapped by the media, including a very telling and almost incoherent interview with the center’s recently hired third-party crisis expert. Somebody forgot to tell her she wasn't a spokesperson.

Employees Need To Learn To Say No.

Comedian George Carlin includes it in his bit. He says people are too fat and happy to question authority. He's right. It happens all the time.

Even on social networks, it's obvious people blindly follow perceived authority figures, sometimes even participating in a “pile ons” just to be accepted. There is no concern for facts. Most online diatribe can be traced back to obedience and acceptance. It happens everywhere in places all over the world, places just like the Endoscopy Center.

There is only one lesson, and more employees could learn it:

• Th nurses could have complained to the administration that the practices were unsafe, refused to perform them, and demanded correction.
• Upon administrative insistence, the nurses could have told the center to correct its practices or report the incident to county health officials.
• Upon insistence or further inaction, the nurses could have resigned and immediately reported the infractions to county health officials.

Three simple steps could have protected thousands of people from being at risk of hepatitis B, hepatitis C, and HIV. Unfortunately, no one was up to the task. In all the world, only a mere 10-25 percent of people would have been willing to step up to the plate, depending on the country where they were raised.

Skirting Apologies: Endoscopy Center Not So Sorry

On Friday, the Las Vegas Review-Journal reported that the city of Las Vegas shut down the Endoscopy Center of Southern Nevada. After waiting until six patients had completed treatment, all employees were asked to leave the building and the doors were locked.

As mentioned last week, the Endoscopy Center of Southern Nevada was using single dose vials of medication, some of which had become infected with hepatitis C, a potentially fatal blood-borne virus, more than once. Hepatitis C is not the only potential infection that could have been spread; some fear hepatitis B and HIV could have also infected patients, some as far back as 2004 or earlier.

In what appears to be an effort to "control communication," the Endoscopy Center of Southern Nevada, which has declined to comment to any media outlet, did not seem short on words this Sunday. They ran a full-page advertisement in the Las Vegas Review-Journal.

The advertisement, designed to mimic an "open letter to the public" with the headline “Open Letter to Our Patients and the People of Southern Nevada,” smacks as a near-exact carbon copy of an ill-advised communication disaster attempted by Jack in the Box several years ago. Somebody must have missed that case study. It did not work then. It will not work today.

Dr. Dipak Desai offers sympathy but no apology.

“Recent events at the Endoscopy Center of Nevada of Southern Nevada are causing great concern to our patients and the community at large.”

This opening line says it all. It is so obviously written to mask where the responsibility might reside. This was not an accident. The responsibility lands squarely on the medical director and presumed "letter writer" of the advertisement.

In fact, according to the Las Vegas Review-Journal story referenced above, clinic staff has already told health investigators that they knew this technique fell well below accepted medical practices and was dangerous. However, they say they were ordered by administrators to engage in the practice anyway. So they did. The ad continues…

”First, I want to express my deepest sympathy to all our patients and their families for the fear and uncertainly that naturally arises from this situation. The trust we have spent for years building in this community has been challenged by the discovery that some of our patients may have been exposed to blood-borne diseases at our facility. In cooperation with the Southern Nevada Health District and other health agencies and officials, we have carefully reviewed our procedures and implemented the changes they recommended.”

Despite the near admission in the third sentence, there is no direct admission (despite mounting testimony) or any apology whatsoever. Clearly, the aim is an ill-advised attempt to position the crisis as an accident while once again attempting to leverage "trust" that patients placed in the clinic while they were "unknowingly" placed at risk by what seems to be a very "knowing" staff. The ad continues…

“We are also working with third party payers to be sure all our patients who need to be tested are, and that the costs are completely covered.

For those who are uninsured, a foundation is being set up to cover the cost associated with their tests. You will learn more about this in the days to come.”

It amazes me that any company or organization would attempt to promote the argument of denial, despite the fact that the clinic is already proven responsible for the infection of several patients. In addition, the attempt to portray itself as a good public citizen by setting up a foundation reminds me of post-crisis measures employed by Jack In The Box, which they only implemented after sustaining a loss of $20 to $30 million.

The ad continues with another paragraph, first thanking the health district for bringing the problem to the Endoscopy Center of Southern Nevada’s attention and continued clarification that the clinic did not spread the disease to patients one way as has been reported, but another erroneous way all together. As if that matters. The ad closes…

"At the same time and without making excuses, I think it’s important for the public to know that the chances of contracting an infection at our center from 2004 though June 2007 were extremely low. Of the six cases reported, it appears one exposure took place in July 2007 and five on Sept. 21, 2007. Regardless, if you were a patient at our facility, I encourage you to get tested.

Thank you for allowing me to share these thoughts with you.”

The six cases mentioned were those that prompted health officials to conduct an investigation, and not the results of 40,000 tested. Worse, this closure attempts to use the number of confirmed infections as a tool toward exoneration, as if six patients who have been confirmed infected are less significant when compared to the 40,000 that have yet to be tested.

What it also neglects to mention is that health officials are also concerned, however, that even more patients could have been infected prior to 2004 when the clinic operated under a different name. Not everyone is taken by these controlled statements. As expected, one local law firm, Craig P. Kenny & Associates, ran a full-page advertisement in the same section. Its advertisement encourages patients to contact the firm to discuss legal action.

While heroes are seldom found during a crisis, there is one clear hero in Las Vegas. Quest Diagnostics, which is completely unaffiliated with the Endoscopy Center, is the first business to offer to test patients for free. The offer from Quest Diagnostics to provide this community service came after the Endoscopy Center was slow to offer the same and after another health care provider, one that sent overflow patients to the Endoscopy Center, shrugged off any responsibility.

As shocking as it seems, the Endoscopy Center of Southern Nevada has not made any mention of how it intends to compensate those patients who have been infected nor has there been any comment that seems to demonstrate remorse or empathy. So far, it seems they are content to play the numbers and control an uncontrollable message.

Causing Crisis: Health Clinic Spreads Virus

Sometimes a crisis communication checklist is not enough. The Endoscopy Center of Southern Nevada is attempting to apply some practices, but the message is failing to resonate. I’m not surprised.

This is the largest hepatitis C scare in the history of the country.

The Endoscopy Center of Southern Nevada was reportedly using single dose vials of medication, which had become infected with hepatitis C, a potentially fatal blood-borne virus, through their initial use and were used again. Hepatitis C is not the only potential infection that could have been spread.

The Southern Nevada Health District is asking some 40,000 patients who had procedures requiring injected anesthesia at the clinic between March 2004 and January 11, 2008, to contact their primary care physicians or health care providers to get tested for hepatitis C as well as hepatitis B and HIV. Given the transient nature of Las Vegas, it is nearly impossible to tell how many of these patients have moved out of the area or have been living with an infection for years.

The reality and gravity of the situation is severe enough that the statement released to the media by the Endoscopy Center of Southern Nevada fails to exhibit even a basic understanding of crisis communication, considering the severity of the issue.

“On behalf of the Endoscopy Center of Southern Nevada, we want to express our deep concern about this incident to the many patients who have put their trust in us over the years. As always, our patients remain our primary responsibility and we have already corrected the situation.”

Obviously not. If patients were the primary responsibility, this would have never happened. How could anyone even think such a statement was appropriate to include as a patient care message during a press conference that addressed wrongdoing of the worst kind — reusing single dose vials is widely known to pass infection.

The statement goes on to say things like “In addition to our corrective actions, we are on a mission to maintain the trust our patients have had in us during our years of service to southern Nevada.” They must be joking. And, unbelievably, they attempted to play the legal counsel card — pending class action suits already being organized and a criminal investigation — to limit their comments and refuse to take reporters’ questions. Unbelievable.

If you break off communication with the media during a severe crisis, they will have no alternative but to seek other sources. Every media outlet covering the story is doing exactly that.

According to the Las Vegas Sun today, several doctors unaffiliated with the Endoscopy Center of Southern Nevada have surmised that the clinic appeared to put profits ahead of patient care, directing staff to cut corners in order to accommodate the high volume of patients. The procedures were performed by certified nurse-anesthetists, with apparently no one at the practice willing to step up and say what they were doing was wrong.

These practices continued until the Southern Nevada Health District identified six cases of hepatitis C, five of which stemmed from the Endoscopy Center of Nevada. While the center continues to stress that the actual risk of anyone being affected by this is extremely low, it seems to be little consolation for the individuals. Elected officials are already calling for the removal of the clinic’s license.

This crisis has already been mishandled to the point of no return.

In such extreme cases, one might ask if the clinic is worth saving. While this could be debated endlessly, I’d rather focus on what they did wrong from a communication standpoint, which made this unrecoverable.

They are attempting to apply a truncated crisis communication formula frequently employed by public relations professionals who have little real world experience. Worse, they are being selective in which ones they are using — the statement doesn’t even include an apology, possibly for fear of admitting criminal negligence.

Look, crisis communication is a process and not a formula. You can come forward, apologize, explain the incident, address corrective measures, seek outside consult, promise it will never happen again, and perhaps demonstrate some measure of empathy (I was told the owner appeared empathetic at the press conference) all you want. But it won’t change gross negligence.

What the crisis communication team needed to consider.

• The clinic needed to come forward sooner and explain precisely what occurred and why it occurred, regardless of potential civil and criminal cases. If the crisis was caused by placing profits before patients as some speculate, an admission is appropriate.

• The clinic needed to apologize, at minimum, to the five people likely infected with hepatitis C by its procedures and offer immediate restitution. It further needed to voluntarily pay for a proactive location and testing of all 40,000 patients as well as family members that may have been affected as a result.

• The clinic needed to maintain an open door policy to address all concerns and questions from the media and other stakeholders, regardless of personal jeopardy, as personal and public safety remain at risk.

• The clinic needs to verbalize empathy, sympathy, and embarrassment over its procedural practices without any trite statements revolving around preserving patient trust and promises that it will never happen again. It would seem more logical for the clinic to voluntarily dedicate 100 percent of its resources to the crisis.

• Dipak Desai, medical director and majority shareholder in the practice, needs to step forward as his own spokesperson and promise to step down immediately after overseeing restitution to the victims. Desai also needs to fully cooperate with all investigations and help determine which doctors and nurses were engaged in these procedures or knew about the procedures but neglected to speak up.

All this should have already happened. However, it did not. Given the severity of the crisis and the initial handing, it’s likely this will be unrecoverable. And frankly, despite placing it in the living case study slot, maybe that is for the best if it does not recover.

Bridging Online And Physical Space: The Recruiting Roadshow

As is often the case, I came away from speaking at John Sumser’s Recruiting Roadshow with more knowledge than I could ever hope to present yesterday.

For starters, it truly gave me an understanding just how far behind communication-related fields — advertising, marketing, public relations, communication, etc. — are from other industries. Yes, I pay attention when various colleagues on the marketing speaking circuits consistently report how few communication professionals are active — only 10-20 percent of their audience is engaged in social media, they often report.

Engaged communicators are ahead, but the industry is behind.

My experience was amazingly different. When I asked an audience of hundreds, primarily consisting of recruiters and human resource directors, how many were engaged in social media, the answer was amazingly different.

• 90 percent of the audience participate online
• 75 percent are members of at least one social network
• 50 percent are active members of one or more social networks
• 15 percent of the audience lead a social network or maintain a blog

Interesting. There doesn’t seem to be an online social media bubble for others, as communicators insist while they continue to argue about the validity of social media. As I’ve said before, social media exists. And therefore, it cannot be ignored, especially by communication-related fields.

Is it any wonder why more companies implemented internal communication programs in 2007, programs managed by human resources departments as opposed to corporate communication? According to Watson Wyatt’s 2007-2008 Communication ROI study, 53 percent of employers used communication to increase enrollment in benefits programs, up from 25 percent in 2003. As other departments continue to expand their roles and actively participate in social media, communicators may find themselves asking the same questions over and over again — how do we get a seat at the table?

Ridiculous. This reoccurring question is only asked by people who missed their opportunity to set the table in the first place.

We must erase the notion that online - offline networks are different.

After taking the spontaneous room survey, I pointed out that 100 percent of the people in attendance were members of a social network — the room, for a few hours — was a social network, indistinguishable from any online community.

Several hundred people registered to attend, filled a space, and then randomly met each other based on nothing more than a nametag and proximity of their seat. Funny. For all the discussions about whether to “friend” strangers online, not one person in attendance refused to shake hands with a stranger when a hand was extended. Online, people present much more than a nametag. Many of us present complete resumes, profiles, and years of thought on blogs.

We might as well be walking around with sandwich boards outlining who we are and what we do. So why do communicators remain skeptical?

Sometimes network exercises reveal more than intended.

One of the first exercises presented by Sumser and his team was an ingenious one designed to simulate an organic search. They had passed out little pieces of paper, each with one word written on them.

Then, he instructed the room to find five other people with the same word and introduce themselves to simulate an organic search. As chaos broke out in the room with people converging toward the middle, one person created a sign with his word and held it above his head. Others quickly followed suit, each holding signs above their heads.

“Did you notice how quickly others adopt innovation?” Sumser asked. “This is exactly the way innovation is adopted online.”

But there was something else, I noticed. The people who held signs above their heads may have expedited the exercise, but in doing so, met fewer people. And once people had found the word they were looking for, they felt gratified, forgetting to fully engage themselves in the sub-group they had created.

It reminded me of many online social networks. Sometimes the speed in which tasks are performed — such as attempting to increase the quantity of connections or increase traffic — undermines our own ability to truly engage people in any meaningful relationship. It’s quality of engagement, not quantity of engagement, that counts, online or off.

I worked some observations of the exercise into my presentation, remembering some great advice I had gleaned from Chris Brogan and Jeremiah Owyang. When you’re engaging in social networking activities, you don’t want to be the person with a sign on their head and megaphone as much as you want to be the person who joins the party and engages people on their terms.

This also presents a challenge in teaching people how to engage in social networks. I know many people who keep putting together bullet points for advice, but relatively few who remind people to ask the right question on the front end. What do you hope to accomplish?

For recruiters, I suggested they abandon the notion that social networks are technologies. It makes more sense to think about social networks as physical spaces much like the room where we had all assembled, with an emphasis on meeting people that may deliver mutually beneficial relationships.

• If you want to know more about the recruiting industry, join a recruiting network like RecruitingBlogs.com.
• If you want to engage prospective clients, invest more time in social networks around niche industries you specialize in, whether it’s health care, education, or whatever.
• If you want to engage job candidates, find social networks that consist of people within those specific industries or develop your own network within a larger network, much like people do every day on Twitter.

Above all, never discount online relationships as less than those you make physically. It’s the number of engagements with people, sometimes across many social networks, that deepens a relationship, much like life. Except online, you often have a greater chance to know about someone well beyond the nametags that decorated everyone’s apparel around the room.

Canceling Campaigns: Pfizer Says It’s Your Fault

After more than $258 million spent in advertising, the long-running advertising campaign that primarily employed Dr. Robert Jarvik as spokesperson for Lipitor, according to The New York Times today.

Pfizer announced yesterday that it would cancel the advertisements featuring Dr. Jarvick. Pfizer offered up a release that primarily focuses on a 3-paragraph statement from Ian Read, president of worldwide pharmaceutical operations. Here are two...

“Nevertheless, the way in which we presented Dr. Jarvik in these ads has, unfortunately, led to misimpressions and distractions from our primary goal of encouraging patient and physician dialogue on the leading cause of death in the world — cardiovascular disease. We regret this. Going forward, we commit to ensuring there is greater clarity in our advertising regarding the presentation of spokespeople.

“Raising awareness of the dangers of cardiovascular disease in the U.S. remains an urgent public health priority. Only half of all Americans who have high LDL cholesterol are even diagnosed, and just half of those are being treated. Future Lipitor campaigns, to be launched in several weeks, will continue to stress the critical importance of patients talking to their doctors so they can make informed choices about their treatment options.”

In other words, Pfizer regrets that the “misimpressions and distractions” led to the cancellation of the advertisement as opposed the misrepresentation of the spokesperson as an avid rower. Dr. Jarvick does not row and a body double appeared in advertisements.

The release goes on to reinforce the benefits of statins such as Lipitor in treating heart disease are validated in clinical guidelines. Lipitor represents $12.7 billion in sales for Pfizer.

According to The New York Times, the decision to withdraw the advertisements will have no bearing on the investigation led by U.S. House of Representatives Committee on Energy and Commerce. The committee is still collecting documents from several sources and plans to meet with Dr. Jarvik.

One of the other complaints about the advertisement came from three former colleagues of Dr. Jarvik. They said the ads erroneously identified Dr. Jarvik as “inventor of the artificial heart” as opposed to the inventor of the “Jarvik artificial heart.” Other medical professionals also complained that Dr. Jarvik does not hold a license to practice any type of medicine.

Communicating To Employees: Obvious But Overlooked

Last Thursday, Joanna Blockey, ABC, communication analyst for Southwest Gas Corporation, help put the crossover impact of external and internal communication into perspective as a guest speaker in my Writing For Public Relations class at the University of Nevada, Las Vegas.

While Southwest Gas Corporation has a well-defined program, she pointed out that many companies do not. Some employers still believe that "providing a paycheck" is the company’s only obligation to employees.

“We communicate to approximately 3,200 employees and retirees at Southwest Gas Corporation,” said Blockey. “It would be a mistake to discount them because they are one of our most important publics. Every day, employees go home with a message about the company.”

And then what happens? They talk to friends and family.

Considering some studies place the average person’s number of friends somewhere between 25 and 35, one internal impression about a company can travel considerable distance. At Southwest Gas Corporation for instance, 3,200 employees and retirees could deliver 96,000 impressions about the company. If these friends pass that impression on to even half of their friends, the impression count suddenly reaches 1.5 million people. It doesn’t end there nor does it consider the number of employees who communicate online.

It didn’t seem like it in January, but Yahoo has learned this lesson the hard way. More than one employee has made their layoff public. This communication, which started with 87 connections on Twitter, has since circled the globe and been picked up by the media. That's just one person.

It's something we alluded to back in Jaunary. Employees don’t like the uncertainty created at Yahoo, a message reinforced by Jerry Yang, chief executive, when he botched the balance between being empathetic for the 1,000 employees to be laid off, which started last week, and being bullish on streamlining the company for non-internal shareholders.

Add up employee impressions alone and you'll discover Yahoo is struggling against the weight of more than 3 million low morale impressions per day, which doesn’t even count that some employees have hundreds or thousands of connections online. Suddenly, this seems to make the recently added "padded" severance packages, for employees and top executives in the event of an acquisition, not all that comforting. In fact, the idea of a Yahoo buyout doesn’t even seem very comforting to Microsoft employees either.

All communication overlaps, inside and out.

Seattle Times reporter Benjamin Romano recently published part of one Microsoft internal communication sent by Kevin Johnson, president of the platform and services division at Microsoft.

"While some overlap is expected in any combination of this size," it said, "we should remember that Microsoft is a growth company that has hired over 20,000 people since 2005, and we would look to place talented employees throughout the company as a whole."

It then when on to shed light on just how important advertising has become to Microsoft executives: "Respect for both the creative and analytical aspects of advertising is core to both companies, along with recognition that advertising is an industry that represents opportunity and growth."

The full communication seemed to have several purposes. In addition to fending off growing concerns that a Yahoo acquisition could lead to Microsoft layoffs, it’s a message to internal Microsoft shareholders (meaning employees). It’s also a message to Yahoo employees (who are also Yahoo shareholders). And, it's carefully written in case it might land someplace else like, um, the Seattle Times.

Communication doesn’t happen in a vacuum.

Watson Wyatt, a global consulting firm, released some key findings to consider about employee communication in its 2007/2008 report: Communication ROI Study
Secrets of Top Performers: How Companies With Highly Effective Employee Communication Differentiate Themselves.

• Effective employee communication is a leading indicator of financial performance.
• Effective employee communication translates into a 15.7 percent increase in the market value of a company.
• Effective employee communication increases employee engagement, which translates into better relationships.

The reasons are simple. There has never been a barrier between internal communication and external communication, except for the delusional beliefs of some executives. Simply put, if you cannot get the employees to buy into the company, then how you can expect customers to buy into its products and services?

People, like some companies, make the same mistakes.

The mistake in attempting to apply spatial barriers onto non-spatial ideas, as if things don't overlap, is not limited to business communication. It's an idea that keeps being transposed onto social media and social networks over and over again.

People attempt to define themselves like companies define themselves. They talk in terms that make the company-individual seem like it is the center of the universe with various social networks hovering around them like little planets, not at all different from the geocentric system debunked by Galileo.

Ergo, social networking is better represented by people orbiting an unknown center. On the Internet, they don't orbit a network but rather pass through networks much like they pass through networks in life. Their orbit takes them through this industry, that industry, work, home, friends, etc. Along the way, they leave little bits of communication.

Sure, I know this may seem terribly philosophical to some, but it’s the truth. Human nature is not all that different than nature, which is why employers need to ask themselves what they are communicating and where that communication will be left as their employees go about their daily lives. And then, where will that communication go from there?

Had Yahoo asked these questions months ago, I bet they would have considered a different communication strategy all together. You think?