D 2.2 Mapping of weakness, strengths and competences of target groups

Transcription

1 Improving Crisis Communication Skills in Health Emergency i D 2.2 Mapping of weakness, strengths and competences of target groups WP2 Identification of target groups training needs and competences European Hospital and Healthcare Federation (HOPE) 27 September 2013 Project Number: LLP PT-LEONARDO-LMP

2 Improving Crisis Communication Skills in Health Emergency ii Partners: Project Coordinator: INOVAMAIS Serviços de Consultadoria em Inovação Tecnológica Azienda Sanitaria Locale della Provincia di Brescia HOPE European Hospital and Healthcare Federation Ludwig-Maximilians-Universität München Aarhus Social and Healthcare College Artica Telemedicina

3 Improving Crisis Communication Skills in Health Emergency iii D 2.2 Mapping of weakness, strengths and competences of target groups WP2 Identification of target groups training needs and competences European Hospital and Healthcare Federation (HOPE) 27 September 2013

4 Improving Crisis Communication Skills in Health Emergency iv Contents 1- Introduction Objectives and Methodology Global SWOT analysis Respondents profile SWOT Analysis SWOT Matrix SWOT analysis by country Denmark Germany Italy Portugal Spain Conclusions Annexes Annex I - Health C survey Annex II Summary of data... 71

5 Improving Crisis Communication Skills in Health Emergency 1 1- Introduction The mapping of weaknesses, strengths and competences of the target groups (SWOT analysis) presented in this report is the final step of WP2, dedicated to the identification of the target groups training needs and competences. The main objective of the SWOT analysis is to serve as guidelines for the development of a training course on communication in emergency situations and the respective training materials, including a toolkit, which represent the overreaching objective of the Health C project. Data for this report have been collected through a survey 1, which ran at European level from July 5 th until August 16 th 2013, obtaining a total of 431 responses. The report is divided into three sections: 1) the first section clarifies the objectives of the survey and the methodology used for the analysis of the replies relevant to this report; 2) the second section presents a global SWOT analysis; 3) in the third section SWOT analysis are developed for the countries part of the Health C consortium (i.e. Denmark, Germany, Italy, Portugal and Spain). At the end of the second and third sections, a SWOT Matrix provides a short summary of the analysis, illustrating the top three weaknesses, strengths, threats and opportunities identified. 1 See Annex I

6 Improving Crisis Communication Skills in Health Emergency Objectives and Methodology The Health C project aims at supporting health authorities staff in the development of the competences required for managing communication in emergency situations caused by a health crisis in a scenario of transnational emergencies. The main results will include the development of a training course in communication in emergency situations and the respective training material, including a tool-kit. The SWOT analysis presented in this report is a fundamental step in this direction, since it serves as guidelines for the development of the training course in a way that it can give response to the weaknesses identified, take into account the opportunities detected, foster the strengths and look for solutions to avoid potential threats affecting health crisis communication. In this way, it will help the project to focus on the real existing gaps and the target groups needs. In order to collect the data useful for the SWOT analysis, three questions (7, 8 and 9) were inserted in a common survey for WP2 and WP3 (Annex I). The survey ran at European level from July 5 th until August 16 th 2013, obtaining a total of 431 responses. It was administered electronically, sent by by the Health C partners to the target groups identified in their respective countries and with the European Hospital and Healthcare Federation (HOPE) addressing its network at EU level. In particular, the target groups addressed were health authorities (health managers as well as communication managers) and health professionals (hospitals managers as well as health care personnel). The survey was translated in English, Danish, German, Italian, Portuguese and Spanish. The objective of these three specific questions was to obtain an overview of the strengths and weaknesses of the target groups, in order to have a better understanding of their competences and needs, and receive a feedback on opportunities and threats having the potential to contribute or hamper an effective crisis communication. For each question, a list of factors was pre-indicated, with the possibility for the respondent to add others if needed. Questions and the list of factors were defined taking into account the inputs and preliminary results of three focus groups carried out between March and May 2013 in Germany, Italy and Portugal, as well as using previous knowledge partners acquired through literature review. A brainstorming session also took place during the first consortium meeting (held on 16 th May 2013) in order to better define the structure of the questionnaire. A five-point scale was used to identify the need for improvement in relation to the proposed factors considered as strengths/weaknesses in crisis communication and the degree of importance of potential threats and opportunities. Participants were asked to respond according to their view and experience and responses were treated anonymously. After having provided a complete overview of the replies obtained for each question, to draw the SWOT analysis and identify weaknesses, strengths, opportunities and threats, the following

7 Improving Crisis Communication Skills in Health Emergency 3 methodology has been adopted: we considered as weaknesses, opportunities and threats the factors that obtained the highest scores in the top two boxes (i.e. the highest rating points on the scale, corresponding to need to improve and much need to improve or important and very important ). Inversely, we considered as strengths the factors that obtained the highest scores in the bottom two boxes (i.e. the lowest rating points on the scale, corresponding to no need to improve and little need to improve ). Furthermore, to facilitate the analysis and the interpretation of results, factors have been grouped under four main categories for weaknesses and strengths (Standards & processes; Ways of communication; Involved stakeholders & target groups; Media) and three categories for threats and opportunities (Economic factors, Political factors and Social & Cultural factors). A detailed summary of responses is also available in Annex II.

8 Improving Crisis Communication Skills in Health Emergency Global SWOT analysis This section presents a global SWOT analysis of the target groups strengths and weaknesses, with a focus also on opportunities and threats. The analysis is based on the total 431 responses received. In the global SWOT analysis, it was decided to take into account replies received not only from the countries of the partnership but also from other countries, so to have a wider overview of target groups competences and needs at European level. In this way, the training course and the toolkit will have the potential to be used in the future by the target groups in countries other than those represented in the Health C consortium Respondents profile Country Responses were received from participants working in different countries but mainly from those represented in the Health C consortium: Italy (21,8%), Germany (19,3%), Spain (13,9%), Portugal (9,7%) Denmark (9,5%) and Belgium (3%). Fig. 1 Partners working country 22,7% 3,0% 9,5% 13,9% 19,3% Belgium Denmark Germany Italy Portugal Spain Other, please specify 9,7% 21,8% A significant number of responses was received from participants working in other countries: Malta (2,6%), Greece (2,6%), United Kingdom (2,3%), Finland (2,1%), Sweden (1,9%), Austria (1,6%), the Netherlands (1,6%), Slovenia (1,4%), Switzerland (1,4%), France (1,4%), Serbia (), Poland (0,7%) and Bulgaria, Estonia, Hungary, Latvia, Lithuania and Romania (2,1%).

9 Improving Crisis Communication Skills in Health Emergency 5 Fig. 2 Other countries Partners countries Austria Finland 0,7% 1,6% 1,4% 1,9% 1,4% France Greece Malta 77,3% 22,7% 2,6% 2,3% Netherlands Poland 2,1% Serbia 2,6% 1,4% 2,1% 1,6% Slovenia Sweden Switzerland United Kingdom Bulgaria, Estonia, Hungary, Latvia, Lithuania, Romania Type of organization The majority of the respondents to the Health C survey work for hospitals, medical care centers and medical practices (45,9%) and for governmental and health authorities (34,1%). The remaining work for research and education organizations (5,8%), health professionals or medical associations (4,4%), voluntary associations (1,6%) and insurance companies (). Besides, 5,3% of respondents indicated to work for other types of organizations not present among the proposed items. These include: - physicians and doctors associations; - foundations; - public corporations in the health sector; - consumers and patients organizations; - health offices; - health emergency departments; - primary health care centers; - NGOs,; - hospital associations; - local health departments; - fire department; - civil protection.

10 Improving Crisis Communication Skills in Health Emergency 6 Fig. 3 Type of organization 5,3% 1,6% Governmental and health 1,6% authorities 5,8% Hospitals, medical care centers, medical practices 34,1% Health professional or medical 4,4% associations Insurance companies Research & education organizations Voluntary Associations Other, please specify Not replied 45,9% Working area The majority of respondents work in the medical/health care (34,3%) and management (26,5%) areas. The rest declared to work in the communication (Press Department/Public Relations) (13,9%), administration (9,7%), training (3,5%) and research (3,5%) areas. Also, 6,3% of respondents work in an area which was not present among the proposed items. These include: - health/healthcare management; - emergency and disaster medicine; - health education; - policy; - consulting; - social work; - Information and Communication Technologies (ICT) and Information Technologies (IT); - quality and safety; - nursing care; - public health; - supporting services; - risk management. Respondents were also asked about the number of years they worked in the professional area mentioned in question 2. Responses show that the average years worked in the professional area is 15,20 years.

11 Improving Crisis Communication Skills in Health Emergency 7 Fig. 4 Working area 9,7% 3,5% 6,3% 2,3% Communication (Press 13,9% Department/Public Relations) Medical/health care Research Management Administration 26,5% 3,5% 34,3% Training Other, please specify Not replied Operational level Respondents were also asked to state at which operational level they work. Almost half of participants work at local level (46,9%), the remaining working at regional (30,6%), national (18,8%) European () and worldwide (1,6%) levels. Fig. 5 Operational level 1,6% 0,9% 18,8% Local (city, town, county) Regional (federal state, region) 46,9% National (country) Europe Worldwide Not replied 30,6%

12 Improving Crisis Communication Skills in Health Emergency SWOT Analysis Overview of replies (Weaknesses and Strengths) In question 7 the target groups were asked to rate several factors related to crisis communication, in accordance with their view and experience. The chart below provides an overview of the obtained answers. An in-depth summary of data is also provided in Annex II. Fig. 6 Question 7: Considering these factors again, according to your view and experience, how much do these factors need to be improved in order to achieve effective crisis communication? Knowledge of the target groups and how they get their information Maintenance of trust in health authorities Monitoring and evaluation of communication activities Quick provision of information Involvement of voluntary organizations in the communication process Identification and use of suitable media channels Sense of responsibility of the media to provide adequate information Consistent and reliable information in all communication channels Disclosure of uncertainties Understanding the news production process Use of external communication experts Communication competence of health authority staff and health experts Availability of designated spokespersons Establishment of a standardized communication procedure (guidelines) within an organization Involvement of health professionals (e.g. physicians, nurses) in the communication process Involvement of local organizations in the information exchange process Regular cooperation between all stakeholders involved in the crisis communication process A common understanding and definition of health crisis 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No need to improve Little need to improve Medium need to improve Need to improve Much need to improve Don't know Not replied n.a. At the end of the question, respondents had the possibility to mention other factors and to rate them using the same five-point scale. Several factors were listed and rated as much need to improve : - disaster exercises; - direct contacts between the administrative and political levels; - communication of uncertainties; - transparency; - knowing to wait before to speak; - Information technologies (ITs);

13 Improving Crisis Communication Skills in Health Emergency 9 - knowledge of lobby groups; - dignity of participants; - motivation of participants. Other factors were listed and marked as need to improve. These include: - a corporate Communications Team to manage strategy and process. - confession of "ignorance". - inclusion of independent organizations; - promote the Citizens participation throughout the Complains Office/Department. One factor was indicated and marked as medium need to improve : - SBAR (Situation, Background, Assessment, Recommendation). Finally, two factors were indicated by the survey participants but not rated: - the ability to generate certainties in a climate of clear uncertainty for the population; - increased involvement of professionals, increased staff to take over administration from core health professionals to enable working with information. Weaknesses and Strengths Global results underline a general need for improvements in all the factors proposed in question 7, apart from use of external communication experts. Despite this general trend, response rate allows to distinguish between factors that need to be prioritized and require a particular attention and consideration (weaknesses) and others that do not need to be urgently addressed and can therefore be treated less in-depth by the Health C training course and the relative materials (strengths). The most important weakness highlighted by respondents is the communication competence of health authority staff and health experts (70,3%). This result confirms that the Health C project is a timely initiative based on a real need: the necessity to set up a training course in order to improve and create adequate skills and competences in health crisis communication. Beside this, the sense of responsibility of the media to provide adequate information is an element that, according to the opinion of 69,2% of respondents, need or much need to be improved. This demonstrates the urgency to strengthen the relation and cooperation between actors involved in health crisis communication and the media so to avoid mistrust. The establishment of a regular cooperation between all the stakeholders involved in the crisis communication process (65,7%) was also recognized as a priority as well as the establishment of standardized communication procedures such as guidelines within an organization (63,1%). Looking into strengths, the one that most of respondents highlighted is the use of external communication experts (35,1%). This is also the unique factor clearly recognized as a strength rather than a weakness. This is followed by the involvement of voluntary organizations in the communication process (26,9%) and the availability of designated spokespersons (18,3%).

14 Improving Crisis Communication Skills in Health Emergency 10 In general, it is possible to notice that weaknesses are more concentrated under structural factors related to the standards & processes category, while relatively less present for certain aspects related to ways of communication (i.e. use of external communication experts and availability of designated spokespersons) and the involvement of stakeholders such as voluntary and local organizations. Fig. 7 Weaknesses (Percentage of replies obtained under the categories need to improve and much need to improve ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Communication competence of health authority staff and health experts Sense of responsibility of the media to provide adequate information Regular cooperation between all stakeholders involved in the crisis communication process Establishment of a standardized communication procedure (guidelines) within an organization Maintenance of trust in health authorities Involvement of health professionals (e.g. physicians, nurses) in the communication process Monitoring and evaluation of communication activities A common understanding and definition of health crisis Quick provision of information Disclosure of uncertainties Knowledge of the target groups and how they get their information Identification and use of suitable media channels Consistent and reliable information in all communication channels Understanding the news production process Availability of designated spokespersons Involvement of local organizations in the information exchange process 70,3% 69,2% 65,7% 63,1% 62,6% 60,8% 60,5% 58,7% 58,0% 56,4% 54,9% 53,6% 53,2% 49,8% 46,8% 45,0% Involvement of voluntary organizations in the communication process Use of external communication experts 27,2% 31,8% Standards & Processes Ways of communication Involved stakeholders & target groups Media

15 Improving Crisis Communication Skills in Health Emergency 11 Fig. 8 Strengths (Percentage of replies obtained under the categories little need to improve and no need to improve ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Use of external communication experts Involvement of voluntary organizations in the communication process Availability of designated spokespersons Understanding the news production process Consistent and reliable information in all communication channels Involvement of local organizations in the information exchange process Identification and use of suitable media channels Disclosure of uncertainties Quick provision of information Knowledge of the target groups and how they get their information Involvement of health professionals (e.g. physicians, nurses) in the communication process A common understanding and definition of health crisis Monitoring and evaluation of communication activities Maintenance of trust in health authorities Establishment of a standardized communication procedure (guidelines) within an organization Sense of responsibility of the media to provide adequate information Communication competence of health authority staff and health experts Regular cooperation between all stakeholders involved in the crisis communication process 35,1% 26,9% 18,3% 16,3% 16,0% 15,3% 12,1% 11,4% 11,1% 9,8% 9,5% 8,8% 8,6% 8,4% 7,9% 7,7% 5,3% 5,4% Standards & Processes Ways of communication Involved stakeholders & target groups Media Overview of replies (Threats and Opportunities) Question 8 listed ten factors considered as potential threats to effective crisis communication, asking the respondents to indicate their importance on a five-point scale. The chart below provides an overview of responses received. An in-depth summary of data is also provided in Annex II.

16 Improving Crisis Communication Skills in Health Emergency 12 Fig. 9 Question 8: Below you find a list of potential threats to effective crisis communication. How strongly, do you think, do these factors affect crisis communication? Increasing mobility of individuals across borders Unforeseen reactions on the part of the public/media/other stakeholders Neglect of health crisis situation due to different political priorities Different knowledge backgrounds Different administrative backgrounds Different legal backgrounds Insufficient collaboration at European level Social, cultural and linguistic diversity in Europe Increasing importance of social media in the society Economic crisis situation in Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not important at all Little importance Medium importance Important Very important Don't know Not replied n.a. The question ends with the possibility for the respondents to indicate other factors constituting possible threats to crisis communication and to rate them using the same fivepoint scale. Participants indicated the following threats as very important : - lack of staff in the press offices; - lobbying; - self-proclaimed experts; - too big impact of some medical lobbies, creating policy of hermetic communication; - personal fears; - poor cultural share of information; - to cure "ignorance" as a serious disease; - truth telling; - try to hide ignorance; - no communication of uncertainties; - general doubting any kind of expert; - unwillingness of public employees to work overtime; - dependence from technologies; - organisational change and shifting priorities being made in isolation without consulting and involved partners; - consensus about very important things in health care system; - neglecting all the necessary criteria for effective communication in times of peace; - lack of competence in communication techniques by health professionals;

17 Improving Crisis Communication Skills in Health Emergency 13 One threat was rated as important : - - manipulation of media to reach business purposes. Other threats that have been indicated but not rated: - insufficient agility and knowledge in communication; - economic goals of companies or government. The survey also explored potential opportunities for effective crisis communication, according to the view of the respondents. Question 9 listed six factors and asked participants to indicate their importance in a five-point scale. A general overview of responses is provided in the chart below. An in-depth summary of data is also provided in Annex II. Fig. 10 Question 9: Here is a list of important societal developments that can provide opportunities for effective crisis communication. How strongly, do you think, do these developments contribute to a more effective crisis communication? Increasing mobility of experts across borders Placing crisis communication higher on the political agenda Transnational coordination Learning from each other's experiences in the EU Increasing role of social media in our society Economic crisis as an opportunity to do things differently 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less important Little importance Medium importance Important Very important Don't know Not replied n.a. At the end of the question, the respondents had again the possibility to indicate other factors representing in their opinion an opportunity for effective crisis communication. The following opportunities were listed by respondents and marked as very important : - higher demand for risk minimization; - transnational coordination already exists through the civil protection mechanism; - the real and substantial attention from the institutions of the criteria and the complex process of effective communication. Improving planning and reporting skills; - transnational communication; - establishment of jointly supported communication; - engage local and social structures.

18 Improving Crisis Communication Skills in Health Emergency 14 One opportunity (internet) was also added and marked as important. Other opportunities that have been listed but not rated: - task forces for rapid analysis of new media on the coordination authorities; - increased mobility can be dealt with virtually. Threats and Opportunities Almost all ten potential threats listed in the survey were considered by more than half of the respondents as important or very important and therefore having the potential to negatively affect effective crisis communication. According to responses, the most important threat to crisis communication is represented by the neglect of a health crisis situation due to different political priorities (70,3%). Besides this, respondents highlighted social and cultural factors such as the increasing importance of social media in the society (69,1%), indicating a possible diffidence towards social media and their use, and different knowledge backgrounds (65,4%). The economic factor (economic crisis situation in Europe), although it has been recognised as a potential threat by 48,3% of respondents, comes only at the penultimate place, being considered less important in comparison to political, social and cultural factors. Also, among other factors cited by respondents, economic factors (lack of staff in the press office; economic goals of companies or government) are less present than others. Regarding opportunities, all six societal developments listed in question 9 were considered by more than half of the respondents as opportunities for a more effective crisis communication. However, the possibility to learn from each other's experiences in the EU (78,9%) was particularly highlighted by participants. This recognition is particularly important since the Health C project has among its objectives the fostering of collaboration and sharing of best practices in health crisis communication and therefore has the potential to seize this opportunity and use it to overcome weaknesses identified and mitigate threats such as the insufficient collaboration at European level (highlighted by 51,7% of respondents). Other opportunities identified include the placing of crisis communication higher on the political agenda, which comes at second place (66,4%), followed by the transnational coordination (65,4%). The economic factor (economic crisis as an opportunity to do things differently), received the lowest, although considerable, score of 55,9%. Similarly to threats, we can also notice the absence of economic factors in the other items suggested by the respondents, demonstrating the prevalence, in the opinions of participants of political, social and cultural factors as major opportunities for effective crisis communication.

19 Improving Crisis Communication Skills in Health Emergency 15 Fig. 11 Threats (Percentage of replies obtained under the categories important and very important ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neglect of health crisis situation due to different political priorities Increasing importance of social media in the society Different knowledge backgrounds Unforeseen reactions on the part of the public/media/other stakeholders 70,3% 69,1% 65,4% 65,2% Different administrative backgrounds Different legal backgrounds Social, cultural and linguistic diversity in Europe Insufficient collaboration at European level Economic crisis situation in Europe Increasing mobility of individuals across borders 55,2% 53,6% 52,9% 51,7% 48,3% 46,4% Economic Political Social & Cultural Fig. 12 Opportunities (Percentage of replies obtained under the categories important and very important ) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Learning from each other's experiences in the EU 78,9% Placing crisis communication higher on the political agenda 66,4% Transnational coordination 65,4% Increasing role of social media in our society 64,9% Increasing mobility of experts across borders 56,8% Economic crisis as an opportunity to do things differently 55,9% Economic Political Social & Cultural

20 Improving Crisis Communication Skills in Health Emergency SWOT Matrix The SWOT Matrix below provides a summary, indicating the top three strengths, weaknesses, opportunities and threats. Use of external communication experts Fig. 13 SWOT Matrix Top three Strengths, Weaknesses, Opportunities and Threats Top 3 - Strengths Top 3- Weaknesses Communication competence of health authority staff and health experts Involvement of voluntary organizations in the communication process Sense of responsibility of the media to provide adequate information Availability of designated spokespersons Regular cooperation between all stakeholders involved in the crisis communication process Learning from each other's experiences in the EU Top 3 - Opportunities Top 3 - Threats Neglect of health crisis situation due to different political priorities Placing crisis communication higher on the political agenda Increasing importance of social media in the society Transnational coordination Different knowledge backgrounds

21 Improving Crisis Communication Skills in Health Emergency SWOT analysis by country This section analyses the replies received from participants working in the countries part of the Health C consortium. These national maps will help the partners to adapt the training course to their national contexts so that it can give response to the weaknesses identified, take into account the opportunities detected, foster the strengths and look for solutions to avoid possible threats to an effective health crisis communication in their specific countries Denmark This section presents a SWOT analysis of strengths, weaknesses, opportunities and threats based on the responses of the participants to the Health C survey working in Denmark. The analysis is based on 41 replies out of the 431 total received. Respondents profile Type of organization The majority of respondents work in hospitals, medical care centers and medical practices (85,4%), the rest working for governmental and health authorities (9,8%) and research and education organizations (4,9%). Fig Type of organization. (Danish Overview) 4,9% 9,8% Governmental and health authorities Hospitals, medical care centers, medical practices Research & education organizations 85,4% Working area Respondents mostly work in the management area. Other areas include medical and health care (26,8%), administration (9,8%), research (7,3%) and training (). Participants were also asked to provide information on the number of years they spent working on the professional area stated in question 2. Responses show that the average years worked in the professional area is 17,09 years.

22 Improving Crisis Communication Skills in Health Emergency 18 Fig.15 Working area. (Danish Overview) 9,8% 26,8% 7,3% Medical/health care Research Management Administration Training Not replied 5 Operational level Findings from this question show that more than half of the participants exercising their profession in Denmark carry out the work mainly at regional level (63,4%), while the remaining work at local (26,8%) and national level (7,3%). Fig. 16 Operational level. (Danish Overview) 7,3% 26,8% Local (city, town, county) Regional (federal state, region) National (country) Not replied 63,4%

23 Improving Crisis Communication Skills in Health Emergency 19 SWOT Analysis Overview of replies (Weaknesses and Strengths) Question 7 asked the target groups about strengths and weaknesses related to crisis communication, in accordance with their view and experience. The chart below provides an overview of the responses for Denmark. An in-depth summary of data is also provided in Annex II. Fig. 17 Question 7: Considering these factors again, according to your view and experience, how much do these factors need to be improved in order to achieve effective crisis communication? (Danish Overview) Knowledge of the target groups and how they get their information Maintenance of trust in health authorities Monitoring and evaluation of communication activities Quick provision of information Involvement of voluntary organizations in the communication process Identification and use of suitable media channels Sense of responsibility of the media to provide adequate information Consistent and reliable information in all communication channels Disclosure of uncertainties Understanding the news production process Use of external communication experts Communication competence of health authority staff and health experts Availability of designated spokespersons Establishment of a standardized communication procedure (guidelines) within an organization Involvement of health professionals (e.g. physicians, nurses) in the communication process Involvement of local organizations in the information exchange process Regular cooperation between all stakeholders involved in the crisis communication process A common understanding and definition of health crisis 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No need to improve Little need to improve Medium need to improve Need to improve Much need to improve Don't know Not replied n.a. It must be noticed that 21,7% of participants on average selected the reply don t know. A possible explanation might be that participants lacked of information or personal experiences related with these factors and therefore were not able to provide their opinion. The 68,3% of replies was not available for the factor maintenance of trust in health authorities, which was therefore removed from the further analysis of weaknesses and strengths.

24 Improving Crisis Communication Skills in Health Emergency 20 Weaknesses and Strengths If compared with the results of the global SWOT analysis, findings highlighted a lower need in Denmark to improve the factors presented in question 7. According to responses, the communication competence of health authority staff and health experts (43,9%) is the factor that requires the major improvements. This is followed by one factor under the media category, namely the sense of responsibility of the media to provide adequate information (41,5%) and in the third position by the necessity to have consistent and reliable information in all communication channels (39,1%). It can also be noticed that the first two weaknesses identified in Denmark coincide with those highlighted by the global SWOT analysis. Several factors were clearly identified as strengths such as the involvement of voluntary organizations in the communication process (36,6%), followed by the involvement of local organizations in the information exchange process (31,8%) and the use of external communication experts (29,3%). Fig. 18 Weaknesses. (Percentage of replies obtained under the categories need to improve and much need to improve - Danish Overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Communication competence of health authority staff and health experts Sense of responsibility of the media to provide adequate information Consistent and reliable information in all communication channels A common understanding and definition of health crisis Regular cooperation between all stakeholders involved in the crisis communication process Quick provision of information Knowledge of the target groups and how they get their information Understanding the news production process Establishment of a standardized communication procedure (guidelines) within an organization Involvement of health professionals (e.g. physicians, nurses) in the communication process Disclosure of uncertainties Monitoring and evaluation of communication activities Identification and use of suitable media channels Availability of designated spokespersons Involvement of local organizations in the information exchange process Use of external communication experts Involvement of voluntary organizations in the communication process 43,9% 41,5% 39,1% 36,6% 36,6% 34,1% 31,7% 31,7% 31,7% 26,9% 26,8% 24,4% 21,9% 17,0% 14,6% 12,2% 12,2% Standards & Processes Ways of communication Involved stakeholders & target groups Media

25 Improving Crisis Communication Skills in Health Emergency 21 Fig. 19 Strengths. (Percentage of replies obtained under the categories little need to improve and no need to improve - Danish Overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Involvement of voluntary organizations in the communication process Involvement of local organizations in the information exchange process Use of external communication experts Disclosure of uncertainties Sense of responsibility of the media to provide adequate information Identification and use of suitable media channels Understanding the news production process Availability of designated spokespersons Monitoring and evaluation of communication activities Knowledge of the target groups and how they get their information Communication competence of health authority staff and health experts Regular cooperation between all stakeholders involved in the crisis communication process Involvement of health professionals (e.g. physicians, nurses) in the communication process A common understanding and definition of health crisis Quick provision of information Establishment of a standardized communication procedure (guidelines) within an organization Consistent and reliable information in all communication channels 36,6% 31,8% 29,3% 26,9% 24,4% 21,9% 21,9% 19,5% 17,1% 17,0% 14,7% 14,6% 14,6% 1 12,2% 9,8% 9,7% Standards & Processes Ways of communication Involved stakeholders & target groups Media Overview of replies (Threats and Opportunities) The table below provide an overview of replies to question 8, in which respondents were asked about potential threats to crisis communication. An in-depth summary of data is also provided in Annex II.

26 Improving Crisis Communication Skills in Health Emergency 22 Fig. 20 Question 8: Below you find a list of potential threats to effective crisis communication. How strongly, do you think, do these factors affect crisis communication? (Danish Overview) Increasing mobility of individuals across borders Unforeseen reactions on the part of the public/media/other stakeholders Neglect of health crisis situation due to different political priorities Different knowledge backgrounds Different administrative backgrounds Different legal backgrounds Insufficient collaboration at European level Social, cultural and linguistic diversity in Europe Increasing importance of social media in the society Economic crisis situation in Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not important at all Little importance Medium importance Important Very important Don't know Not replied n.a. Participants were also asked about societal developments having the potential to contribute to a more effective crisis communication. The table below provides an overview of replies to question 9 for Denmark. An in-depth summary of data is also provided in Annex II. Fig. 21 Question 9: Here is a list of important societal developments that can provide opportunities for effective crisis communication. How strongly, do you think, do these developments contribute to a more effective crisis communication? (Danish Overview) Increasing mobility of experts across borders Placing crisis communication higher on the political agenda Transnational coordination Learning from each other's experiences in the EU Increasing role of social media in our society Economic crisis as an opportunity to do things differently 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less important Little importance Medium importance Important Very important Don't know Not replied n.a.

27 Improving Crisis Communication Skills in Health Emergency 23 Threats and Opportunities Respondents found in the neglect of a health crisis situation due to different political priorities the top threat to effective crisis communication (63,4%), in accordance with the results from the global SWOT analysis. Besides this political factor, the other two most important identified threats are of social and cultural nature, with the existence of different knowledge backgrounds coming at second place (58,6%) and the third place occupied by the unforeseen reactions on the part of the public/media/other stakeholders (56,1%). The economic crisis situation in Europe comes at the last place with only 26,9% of the respondents considering it as an important or very important threat to effective crisis communication. This coincides with the global results, where the same factor is in the penultimate position in the list of potential threats, although with an higher score of 48,3%. Regarding the opportunities identified, all six factors were considered by more than half of the respondents as important or very important and therefore having the potential to contribute to a more effective crisis communication. 70,8% of respondents stated that learning from each other s experiences in the EU is an important or very important opportunity, surpassing quite considerably the other factors. Interestingly, the economic crisis as an opportunity to do things differently occupies the second position (58,6%), obtaining the same score as the placing of crisis communication higher in the political agenda (58,6%) and followed by transnational coordination (56,1%). Fig. 22 Threats. (Percentage of replies obtained under the categories important and very important - Danish Overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neglect of health crisis situation due to different political priorities Different knowledge backgrounds Unforeseen reactions on the part of the public/media/other stakeholders Social, cultural and linguistic diversity in Europe Increasing importance of social media in the society Increasing mobility of individuals across borders Insufficient collaboration at European level Different administrative backgrounds 63,4% 58,6% 56,1% 53,6% 48,8% 43,9% 39,0% 36,6% Different legal backgrounds Economic crisis situation in Europe 31,7% 26,9% Economic Political Social & Cultural

28 Improving Crisis Communication Skills in Health Emergency 24 Fig. 23 Opportunities. (Percentage of replies obtained under the categories important and very important - Danish Overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Learning from each other's experiences in the EU 70,8% Economic crisis as an opportunity to do things differently 58,6% Placing crisis communication higher on the political agenda 58,6% Transnational coordination 56,1% Increasing role of social media in our society 53,7% Increasing mobility of experts across borders 48,8% Economic Political Social & Cultural

29 Improving Crisis Communication Skills in Health Emergency 25 SWOT Matrix The SWOT Matrix below provides a summary, indicating the top three strengths, weaknesses, opportunities and threats for Denmark. Involvement of Fig. 24 SWOT Matrix Top three Strengths, Weaknesses, Opportunities and Threats (Danish Overview) Top 3 - Strengths Top 3- Weaknesses voluntary organizations in the communication process Communication competence of health authority staff and health experts Involvement of local organizations in the information exchange process Sense of responsibility of the media to provide adequate information Use of external communication experts Consistent and reliable information in all communication channels Top 3 - Opportunities Learning from each other's experiences in the EU Top 3 - Threats Neglect of health crisis situation due to different political priorities Economic crisis as an opportunity to do things differently Different knowledge backgrounds Placing crisis communication higher on the political agenda Transnational coordination Unforeseen reactions on the part of the public/media/other stakeholders

30 Improving Crisis Communication Skills in Health Emergency Germany This section presents a SWOT analysis of strengths, weaknesses, opportunities and threats based on the responses of the participants to Health C survey working in Germany. The analysis is based on 83 replies out of the 431 total received. Respondents profile Type of organization According to the survey results, the majority of the German participants work for governmental and health authorities (62,7%). The rest of respondents exercise their profession in hospitals, medical care centers, medical practices (12%), insurance companies (6%), research and education organizations (3,6%), health professionals or medical associations () and voluntary associations (). 9,6% indicated other types of organizations. These encompass: doctors associations; foundations; consumers and patients organizations and health offices. Fig. 25 Type of organization. (German overview) 3,6% 6,0% 12,0% 9,6% 62,7% Governmental and health authorities Hospitals, medical care centers, medical practices Health professional or medical associations Insurance companies Research & education organizations Voluntary Associations Other, please specify Not replied Working area The majority of respondents work in the areas of communication (Press Departments/Public Relations) (32,5%), management (20,5%), medical/health care (15,7%), administration (15,7%), research () and training (). Other areas mentioned by respondents include healthcare management; emergency and disaster medicine; health education; policy and consulting. Respondents were also asked to provide additional information on the number of years they spent working in the professional area stated in question 2. Responses for Germany show that the average years worked in the professional area is 11,6 years.

31 Improving Crisis Communication Skills in Health Emergency 27 Fig. 26 Working area. (German overview) 15,7% 7,2% 32,5% Communication (Press Department/Public Relations) Medical/health care Research Management Administration Training 20,5% 15,7% Other, please specify Not replied Operational level Participants working in Germany carry out their work mainly at national level (37,3%), followed by the regional level (34,9%) the local (25,3%) and European level (). Fig. 27 Operational level. (German overview) 25,3% 37,3% Local (city, town, county) Regional (federal state, region) National (country) Europe Not replied 34,9%

32 Improving Crisis Communication Skills in Health Emergency 28 SWOT Analysis Overview of replies (Weaknesses and Strengths) Question 7 asked the target groups about strengths and weaknesses related to crisis communication, in accordance with their view and experience. The chart below provides an overview of the responses for Germany. An in-depth summary of data is also provided in Annex II. Fig. 28 Question 7: Considering these factors again, according to your view and experience, how much do these factors need to be improved in order to achieve effective crisis communication? (German overview) Knowledge of the target groups and how they get their information Maintenance of trust in health authorities Monitoring and evaluation of communication activities Quick provision of information Involvement of voluntary organizations in the communication process Identification and use of suitable media channels Sense of responsibility of the media to provide adequate information Consistent and reliable information in all communication channels Disclosure of uncertainties Understanding the news production process Use of external communication experts Communication competence of health authority staff and health experts Availability of designated spokespersons Establishment of a standardized communication procedure (guidelines) within an organization Involvement of health professionals (e.g. physicians, nurses) in the communication process Involvement of local organizations in the information exchange process Regular cooperation between all stakeholders involved in the crisis communication process A common understanding and definition of health crisis 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No need to improve Little need to improve Medium need to improve Need to improve Much need to improve Don't know Not replied Respondents also mentioned other factors, rating them as need to improve or much need to improve, and that can therefore be considered as weaknesses. Factors identified and rated as much need to improve were: disaster exercise; transparency; knowledge of lobby groups. Other factors were listed and marked as need to improve. These include: confession of "ignorance"; inclusion of independent organizations.

33 Improving Crisis Communication Skills in Health Emergency 29 Weaknesses and Strengths The chart below shows that there is a general need to improve almost all factors presented in question 7. The top weakness identified by respondents working in Germany is the sense of responsibility of the media to provide adequate information (68,7%). This is followed by the regular cooperation between all stakeholders involved in the crisis communication process (63,9%) and at the third position by the need for consistent and reliable information in all communication channels (59%). These three weaknesses would appear to be strongly correlated since the need to improve the sense of responsibility of the media might be the result of an insufficient cooperation between media and target groups, either in the news production process or in the delivery of consistent messages to the population. The need to improve the communication competence of health authority staff and health experts comes in the fifth place, although being recognised as a weakness by more than half of the respondents (57,9%). This result is slightly different if compared to the global analysis, where this factor corresponds to the top weakness (70,5%). Finally, about half (47%) of the respondents answered that the use of external communication experts does not need to be improved, constituting clearly a strength in the German crisis communication process or an element which the respondents believe do not need to be further improved in order to reach an effective crisis communication. Other strengths include factors belonging to the involved stakeholders & target groups category, namely the involvement of voluntary organizations in the communication process (37,3%) and the involvement of local organizations in the information exchange process (28,9%).

34 Improving Crisis Communication Skills in Health Emergency 30 Fig. 29 Weaknesses. (Percentage of replies obtained under the categories need to improve and much need to improve - German overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sense of responsibility of the media to provide adequate information Regular cooperation between all stakeholders involved in the crisis communication process Consistent and reliable information in all communication channels Maintenance of trust in health authorities Communication competence of health authority staff and health experts Establishment of a standardized communication procedure (guidelines) within an organization A common understanding and definition of health crisis Quick provision of information Involvement of health professionals (e.g. physicians, nurses) in the communication process Disclosure of uncertainties Identification and use of suitable media channels Monitoring and evaluation of communication activities Knowledge of the target groups and how they get their information Availability of designated spokespersons Understanding the news production process 68,7% 63,9% 59,0% 57,9% 57,9% 56,6% 53,7% 51,8% 50,6% 50,6% 48,1% 46,9% 43,3% 42,2% 38,5% Use of external communication experts 27,7% Involvement of voluntary organizations in the communication process Involvement of local organizations in the information exchange process 18,1% 16,8% Standards & Processes Ways of communication Involved stakeholders & target groups Media

35 Improving Crisis Communication Skills in Health Emergency 31 Fig. 30 Strengths. (Percentage of replies obtained under the categories little need to improve and no need to improve - German overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Use of external communication experts 47,0% Involvement of voluntary organizations in the communication process Involvement of local organizations in the information exchange process Understanding the news production process Identification and use of suitable media channels Disclosure of uncertainties Availability of designated spokespersons Quick provision of information Monitoring and evaluation of communication activities Knowledge of the target groups and how they get their information Consistent and reliable information in all communication channels Involvement of health professionals (e.g. physicians, nurses) in the communication process Maintenance of trust in health authorities A common understanding and definition of health crisis Establishment of a standardized communication procedure (guidelines) within an organization Communication competence of health authority staff and health experts Sense of responsibility of the media to provide adequate information Regular cooperation between all stakeholders involved in the crisis communication process 37,3% 28,9% 27,7% 22,9% 21,7% 20,4% 19,3% 19,3% 19,3% 18,1% 16,9% 16,9% 14,4% 13,2% 10,8% 10,8% 8,4% Standards & Processes Ways of communication Involved stakeholders & target groups Media Overview of replies (Threats and Opportunities) Question 8 presented ten factors considered as potential threats to effective crisis communication, asking the respondents to indicate their importance on a five-point scale. The chart below provides an overview of responses received. An in-depth summary of data is also provided in Annex II.

36 Improving Crisis Communication Skills in Health Emergency 32 Fig. 31 Question 8: Below you find a list of potential threats to effective crisis communication. How strongly, do you think, do these factors affect crisis communication? (German overview) Increasing mobility of individuals across borders Unforeseen reactions on the part of the public/media/other stakeholders Neglect of health crisis situation due to different political priorities Different knowledge backgrounds Different administrative backgrounds Different legal backgrounds Insufficient collaboration at European level Social, cultural and linguistic diversity in Europe Increasing importance of social media in the society Economic crisis situation in Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not important at all Little importance Medium importance Important Very important Don't know Not replied n.a. Respondents also mentioned other factors, rating them as important or very important, and that can therefore be considered as a potential threat according to the respondents view. Participants indicated the following threats as very important : lack of staff in the press offices, lobbying and self-proclaimed experts, personal fears; try to hide ignorance; no communication of uncertainties; general doubting of any kind of expert. The table below provides an overview of replies to question 9, in which respondents were asked about societal developments having the potential to contribute to a more effective crisis communication. An in-depth summary of data is also provided in Annex II.

37 Improving Crisis Communication Skills in Health Emergency 33 Fig. 32 Question 9: Here is a list of important societal developments that can provide opportunities for effective crisis communication. How strongly, do you think, do these developments contribute to a more effective crisis communication? (German overview) Increasing mobility of experts across borders Placing crisis communication higher on the political agenda Transnational coordination Learning from each other's experiences in the EU Increasing role of social media in our society Economic crisis as an opportunity to do things differently 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less important Little importance Medium importance Important Very important Don't know Not replied n.a. At the end of the question, it was given again the possibility to mention other opportunities not present among the proposed items and to rate them using the same five-point scale. The following opportunities were considered as important or very important : higher demand for risk minimization, transnational communication, and establishment of jointly supported communication. Another opportunity was indicated but not rated: task forces for rapid analysis of new media on the coordination authorities. Threats and Opportunities Respondents highlighted the existence of different knowledge backgrounds (78,3%) as the main threat among the ones proposed in question 8. The increasing importance of social media in the society (77,1%) is also cited by the large majority. The fact that social media are perceived as a threat might be explained by the absence of specific training courses on the use of social media 2 in health crisis communication. Thus, the target groups would be not sufficiently familiar or/and would not know how to properly use these new communication channels. Finally, respondents stated that the unforeseen reactions on the part of the public/media/other stakeholders is the third major threat to effective crisis communication (69,8%). As illustrated in the chart below, the major opportunity in the opinion of respondents is the increasing role of social media in the society (68,7%). This result is particularly interesting if compared with the one obtained in question 8 (threats), where 77,1% of respondents said the increasing importance of social media in the society represents an important or very important 2 See Background report, Health C project, 6 June 2013, pp

38 Improving Crisis Communication Skills in Health Emergency 34 threat. Although for respondents social media represent more a threat than an opportunity, these results highlighted at the same time a sense of confidence and diffidence in social media. The second most important opportunity recognized by respondents is learning from each other s experiences in the EU (65,1%) while at the third place comes the placing crisis communication higher on the political agenda (60,3%). Fig. 33 Threats. (Percentage of replies obtained under the categories important and very important - German overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Different knowledge backgrounds Increasing importance of social media in the society Unforeseen reactions on the part of the public/media/other stakeholders Different administrative backgrounds Different legal backgrounds Neglect of health crisis situation due to different political priorities 78,3% 77,1% 69,8% 60,3% 57,8% 55,4% Social, cultural and linguistic diversity in Europe Insufficient collaboration at European level Increasing mobility of individuals across borders Economic crisis situation in Europe 43,4% 43,3% 37,3% 31,3% Economic Political Social & Cultural Fig. 34 Opportunities. (Percentage of replies obtained under the categories important and very important - German overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Increasing role of social media in our society 68,7% Learning from each other's experiences in the EU 65,1% Placing crisis communication higher on the political agenda 60,3% Transnational coordination 53,0% Increasing mobility of experts across borders 45,8% Economic crisis as an opportunity to do things differently 26,5% Economic Political Social & Cultural

39 Improving Crisis Communication Skills in Health Emergency 35 SWOT Matrix The SWOT Matrix below provides a summary, indicating the top three strengths, weaknesses, opportunities and threats for Germany. Use of external Fig. 35 SWOT Matrix Top three Strengths, Weaknesses, Opportunities and Threats. (German overview) Top 3 - Strengths Top 3- Weaknesses communication experts Sense of responsibility of the media to provide adequate information Involvement of voluntary organizations in the communication process Regular cooperation between all stakeholders involved in the crisis communication process Involvement of local organizations in the information exchange process Consistent and reliable information in all communication channels Increasing role of social media in our society Top 3 - Opportunities Different knowledge backgrounds Top 3 - Threats Learning from each other's experiences in the EU Increasing importance of social media in the society Placing crisis communication higher on the political agenda Unforeseen reactions on the part of the public/media/other stakeholders

40 Improving Crisis Communication Skills in Health Emergency Italy This section presents a SWOT analysis of strengths, weaknesses, opportunities and threats based on the responses of the participants to Health C survey working in Italy. The analysis is based on 94 replies out of the 431 total received. Respondents profile Type of organization The majority of the respondents work for governmental and health authorities (54,3%). The remaining work for hospitals, medical care centers, medical practices (28,7%), health professional or medical associations (4,3%), voluntary association (2,1%) and research and education organizations (1,1%). 7,4% of participants indicated local health departments under other, please specify. Fig. 36 Type of organization. (Italian overview) 7,4% 2,1% 1,1% 4,3% 28,7% 2,1% 54,3% Governmental and health authorities Hospitals, medical care centers, medical practices Health professional or medical associations Research & education organizations Voluntary Associations Other, please specify Not replied Working area Most of respondents work in the medical/health care area (63,8%). The remaining work in the areas of communication (Press Department/Public Relations) (11,%), management (11,7%), administration (4,3%), training (2,1%) and research (1,1%). Other areas indicated by 7,4 % of participants are: quality and safety and risk management. Respondents were also asked about the number of years they worked in the professional area mentioned in question 2. Responses show that the average years worked in the professional area is 21,7 years.

41 Improving Crisis Communication Skills in Health Emergency 37 Fig.37 Working area. (Italian overview) 4,3% 1,1% 2,1% 4,3% 11,7% 1,1% 11,7% Communication (Press Department/Public Relations) Medical/health care Research Management Administration Training Other, please specify Not replied 63,8% Operational level The large majority of respondents work at local level (79,8%), followed at the second place by the regional level (11,7%),. A minority of respondents work at national level (5,3%) and worldwide level (1,1%). Fig. 38 Operational level. (Italian overview) 1,1% 2,1% 5,3% 11,7% Local (city, town, county) Regional (federal state, region) National (country) Worldwide Not replied 79,8%

42 Improving Crisis Communication Skills in Health Emergency 38 SWOT Analysis Overview of replies (Weaknesses and Strengths) Question 7 asked the target groups about strengths and weaknesses related to crisis communication, in accordance with their view and experience. The chart below provides an overview of the responses for Italy. An in-depth summary of data is also provided in Annex II. Fig. 39 Question 7: Considering these factors again, according to your view and experience, how much do these factors need to be improved in order to achieve effective crisis communication? (Italian overview) Know ledge of the target groups and how they get their information Maintenance of trust in health authorities Monitoring and evaluation of communication activities Quick provision of information Involvement of voluntary organizations in the communication process Identification and use of suitable media channels Sense of responsibility of the media to provide adequate information Consistent and reliable information in all communication channels Disclosure of uncertainties Understanding the new s production process Use of external communication experts Communication competence of health authority staff and health experts Availability of designated spokespersons Establishment of a standardized communication procedure (guidelines) w ithin an organization Involvement of health professionals (e.g. physicians, nurses) in the communication process Involvement of local organizations in the information exchange process Regular cooperation betw een all stakeholders involved in the crisis communication process A common understanding and definition of health crisis 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No need to improve Little need to improve Medium need to improve Need to improve Much need to improve Don't know Not replied Respondents also mentioned other factors that can be considered as weaknesses, since they were rated in the five-point scale as need to improve or much need to improve. These factors are: direct contacts between the administrative and political levels, communication of uncertainties, dignity and motivation of participants. Finally, one additional factor was mentioned but not rated: the ability to generate certainties in a climate of clear uncertainty for the population. It can also be observed that 17% of respondents replied don t know when asked about the factor consistent and reliable information in all communication channels. A possible interpretation for this result is that respondents might not be aware of the quality of the information available in all communication channels or they are not familiar with them all.

43 Improving Crisis Communication Skills in Health Emergency 39 Weaknesses and Strengths Findings demonstrate that almost all the factors presented in question 7 need to be improved. However, the top weakness is constituted by the maintenance of trust in health authorities (77,6%). In coherence with this result, the second aspect cited by respondents is the communication competence of health authority staff and health experts (76,6%). Both weaknesses would seem to be linked since the lack of trust in health authorities might be the consequence of an insufficient communication competence of the authorities itself. This top weakness might be also explained by the involvement of many different levels in the management of an emergency situation 3, with a multiplicity of actors responsible for crisis communication, a possibility which is confirmed by the third weakness identified by the survey respondents: the regular cooperation between all stakeholders involved in the crisis communication process (73,4%). The factor disclosure of uncertainties also received the same score with 73,4% of replies. Two factors were particularly considered as elements not requiring a particular need for improvement in Italy: the use of external communication experts (40,4%) and the need for consistent and reliable information in all communication channels (37,3%). Other two items which gathered around one-fifth of responses were the availability of designated spokespersons (21,3%) and the involvement of voluntary organizations in the communication process (20,3%), although these factors were considered more a weakness than a strength by respondents. 3 See Background report, Health C project, 6 June 2013, pp

44 Improving Crisis Communication Skills in Health Emergency 40 Fig. 40 Weaknesses. (Percentage of replies obtained under the categories need to improve and much need to improve - Italian overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Maintenance of trust in health authorities Communication competence of health authority staff and health experts Regular cooperation between all stakeholders involved in the crisis communication process Disclosure of uncertainties Sense of responsibility of the media to provide adequate information Involvement of health professionals (e.g. physicians, nurses) in the communication process Quick provision of information Understanding the news production process Establishment of a standardized communication procedure (guidelines) within an organization Monitoring and evaluation of communication activities Identification and use of suitable media channels A common understanding and definition of health crisis Involvement of local organizations in the information exchange process Knowledge of the target groups and how they get their information 77,6% 76,6% 73,4% 73,4% 71,3% 68,1% 64,9% 64,9% 63,9% 62,8% 62,8% 61,7% 61,7% 60,6% Availability of designated spokespersons 5 Involvement of voluntary organizations in the communication process 39,3% Consistent and reliable information in all communication channels Use of external communication experts 20,2% 25,5% Standards & Processes Ways of communication Involved stakeholders & target groups Media

45 Improving Crisis Communication Skills in Health Emergency 41 Fig. 41 Strengths. (Percentage of replies obtained under the categories little need to improve and no need to improve - Italian overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Use of external communication experts Consistent and reliable information in all communication channels 40,4% 37,3% Availability of designated spokespersons Involvement of voluntary organizations in the communication process 21,3% 20,3% Establishment of a standardized communication procedure (guidelines) within an organization Involvement of local organizations in the information exchange process Involvement of health professionals (e.g. physicians, nurses) in the communication process Identification and use of suitable media channels Disclosure of uncertainties Quick provision of information Monitoring and evaluation of communication activities Maintenance of trust in health authorities Understanding the news production process Sense of responsibility of the media to provide adequate information Knowledge of the target groups and how they get their information A common understanding and definition of health crisis Communication competence of health authority staff and health experts Regular cooperation between all stakeholders involved in the crisis communication process 9,6% 7,5% 7,5% 6,4% 5,4% 5,3% 5,3% 5,3% 4,3% 4,3% 4,3% 3,2% 2,1% 1,1% Standards & Processes Ways of communication Involved stakeholders & target groups Media Overview of replies (Threats and Opportunities) Question 8 lists ten factors considered as potential threats to effective crisis communication asking the respondents to indicate their importance on a five-point scale. The chart below provides an overview of responses received for Italy. An in-depth summary of data is also provided in Annex II.

46 Improving Crisis Communication Skills in Health Emergency 42 Fig. 42 Question 8: Below you find a list of potential threats to effective crisis communication. How strongly, do you think, do these factors affect crisis communication? (Italian overview) Increasing mobility of individuals across borders Unforeseen reactions on the part of the public/media/other stakeholders Neglect of health crisis situation due to different political priorities Different knowledge backgrounds Different administrative backgrounds Different legal backgrounds Insufficient collaboration at European level Social, cultural and linguistic diversity in Europe Increasing importance of social media in the society Economic crisis situation in Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not important at all Little importance Medium importance Important Very important Don't know Not replied Respondents also indicated other threats, rating them as very important : to cure "ignorance" as a serious disease, the unwillingness of public employees to work overtime, the neglecting of all the necessary criteria for effective communication in times of peace; lack of competence in communication techniques by health professionals. One threat was mentioned and rated as important : manipulation of media to reach business purposes. The survey also explored potential opportunities for effective crisis communication, according to the view of the respondents. Question 9 listed six factors asking the respondent to indicate their importance in a five-point scale. A general overview of answers for Italy is provided in the chart below. An in-depth summary of data is also provided in Annex II.

47 Improving Crisis Communication Skills in Health Emergency 43 Fig. 43 Question 9: Here is a list of important societal developments that can provide opportunities for effective crisis communication. How strongly, do you think, do these developments contribute to a more effective crisis communication? (Italian overview) Increasing mobility of experts across borders Placing crisis communication higher on the political agenda Transnational coordination Learning from each other's experiences in the EU Increasing role of social media in our society Economic crisis as an opportunity to do things differently 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less important Little importance Medium importance Important Very important Don't know Not replied n.a. Another opportunity was identified as very important : the real and substantial attention from the institutions of the criteria and the complex process of effective communication. Threats and Opportunities In general, it can be noticed that all proposed threats were considered as having the potential to strongly or very strongly affect crisis communication, the only exception being represented by the increasing mobility of individuals across boarders, which received less than half of responses (44,7%). The neglect of a health crisis due to different political priorities largely represents, according to the view of the respondents, the major threat for an effective crisis communication (80,8%), followed by the unforeseen reactions on the part of the public (73,4%) and the increasing importance of social media in the society (66%). These results are very close to the ones presented in the global SWOT analysis. Also, coherently with the global results, the major opportunity highlighted by the large majority of the respondents working in Italy is learning from each other s experiences in the EU (85,1%). The increasing role of social media in the society comes at the second place (70,2%), demonstrating a certain confidence in the possibilities opened by the use of these new communication channels, followed by transnational coordination (67%). The increasing mobility of experts across borders, although important or very important for the 51,1% of

48 Improving Crisis Communication Skills in Health Emergency 44 respondents, does not fall into the factors that most are believed to have the potential to positively affect crisis communication, in line with the result also emerged for threats. Fig. 44 Threats. (Percentage of replies obtained under the categories important and very important -Italian overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neglect of health crisis situation due to different political priorities Unforeseen reactions on the part of the public/media/other stakeholders Increasing importance of social media in the society Different knowledge backgrounds Social, cultural and linguistic diversity in Europe Economic crisis situation in Europe Insufficient collaboration at European level Different administrative backgrounds Different legal backgrounds Increasing mobility of individuals across borders 80,8% 73,4% 66,0% 59,6% 58,5% 56,4% 56,4% 52,2% 52,1% 44,7% Economic Political Social & Cultural Fig. 45 Opportunities. (Percentage of replies obtained under the categories important and very important - Italian overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Learning from each other's experiences in the EU 85,1% Increasing role of social media in our society 70,2% Transnational coordination 67,0% Placing crisis communication higher on the political agenda 64,9% Economic crisis as an opportunity to do things differently 61,7% Increasing mobility of experts across borders 51,1% Economic Political Social & Cultural

49 Improving Crisis Communication Skills in Health Emergency 45 SWOT Matrix The SWOT Matrix below provides a summary, indicating the top three strengths, weaknesses, opportunities and threats for Italy. Use of external Fig. 46 SWOT Matrix Top three Strengths, Weaknesses, Opportunities and Threats. (Italian overview) Top 3 - Strengths Top 3- Weaknesses communication experts Maintenance of trust in health authorities Consistent and reliable information in all communication channels Communication competence of health authority staff and health experts Availability of designated spokespersons Regular cooperation between all stakeholders involved in the crisis communication process Disclosure of uncertainties Top 3 - Opportunities Learning from each other's experiences in the EU Top 3 - Threats Neglect of health crisis situation due to different political priorities Increasing role of social media in our society Unforeseen reactions on the part of the public/media/other stakeholders Transnational coordination Increasing importance of social media in the society

50 Improving Crisis Communication Skills in Health Emergency Portugal This section presents a SWOT analysis of strengths, weaknesses, opportunities and threats based on the responses of the participants to Health C survey working in Portugal. The analysis is based on 42 replies out of the 431 total received. Respondents profile Type of organization Most of participant for Portugal work for research and education organization (31%) and for hospitals, medical health care centers and medical practices (28,6%). Other respondents declared to work for governmental and health authorities (19%), health professional or medical associations () and voluntary associations (). Some other areas not present among the options available were identified. These include: primary health care centers; hospital associations; fire department and civil protection. Fig. 47 Type of organization. (Portuguese overview) 9,5% 19,0% 31,0% 28,6% Governmental and health authorities Hospitals, medical care centers, medical practices Health professional or medical associations Research & education organizations Voluntary associations Other, please specify Not replied Working area As illustrated in the chart below, the majority of replies indicated as area of work the medical/health care one (28,6%). This is followed by the areas of training (19%) communication (Press Department/Public Relations) (11,9%), and research, management and administration all receiving 7,1% of replies. Finally, other working areas were also indicated. These include the social work; risk management; quality and safety; emergency. Respondents were also asked about the number of years they worked in the professional area selected in question 2. Responses show that the average years worked in the professional area is 14,5 years.

51 Improving Crisis Communication Skills in Health Emergency 47 Fig. 48 Working area. (Portuguese overview) 11,9% 14,3% Communication (Press Department/Public Relations) Medical/health care Research 19,0% 28,6% Management Administration Training Other, please specify Not replied 7,1% 7,1% 7,1% Operational level More than half of the respondents work at local level. The rest work at national (26,2%), regional (14,3%), worldwide () and European level (). Fig. 49 Operational level. (Portuguese overview) 26,2% 5 Local (city, town, county) Regional (federal state, region) National (country) Europe Worldwide 14,3%

52 Improving Crisis Communication Skills in Health Emergency 48 SWOT Analysis Overview of replies (Weaknesses and Strengths) Question 7 asked the target groups about strengths and weaknesses related to crisis communication, in accordance with their view and experience. The chart below provides an overview of the responses for Portugal. An in-depth summary of data is also provided in Annex II. Fig. 50 Question 7: Considering these factors again, according to your view and experience, how much do these factors need to be improved in order to achieve effective crisis communication? (Portuguese overview) Knowledge of the target groups and how they get their information Maintenance of trust in health authorities Monitoring and evaluation of communication activities Quick provision of information Involvement of voluntary organizations in the communication process Identification and use of suitable media channels Sense of responsibility of the media to provide adequate information Consistent and reliable information in all communication channels Disclosure of uncertainties Understanding the news production process Use of external communication experts Communication competence of health authority staff and health experts Availability of designated spokespersons Establishment of a standardized communication procedure (guidelines) within an organization Involvement of health professionals (e.g. physicians, nurses) in the communication process Involvement of local organizations in the information exchange process Regular cooperation between all stakeholders involved in the crisis communication process A common understanding and definition of health crisis 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% No need to improve Little need to improve Medium need to improve Need to improve Much need to improve Don't know Not replied Other two items were mentioned by respondents in the free space other, please specify. These were Information Technologies (ITs) which was rated much need to improve and promote the citizens participation throughout the Complains Office/Department qualified as need to improve. Weaknesses and Strengths Responses for Portugal highlight a particularly urgent need for improvements in all the 18 factors listed in question 7. The large majority of respondents (83,3%) cited the sense of responsibility of the media to provide adequate information as the factor that most needs to be improved.

53 Improving Crisis Communication Skills in Health Emergency 49 Structural aspects also need to be improved in Portugal. Other main weaknesses highlighted are factors under the category standards & processes, namely the communication competence of health authority staff and health experts (81%), and the monitoring and evaluation of communication activities, together to the need for a common understanding and definition of health crisis (73,8%). Although all items were considered by respondents more as weaknesses than strengths, it is nevertheless useful to draw attention on the aspects that received the highest score such as the use of external communication experts (31%), the availability of designated spokespersons (14,3%) and disclosure of uncertainties (11,9%). These factors do not necessarily constitute a strength but something that is less urgent to improve and therefore can be treated less indepth by the Health C training course. It is also important to notice that three factors (i.e. regular cooperation between all stakeholders involved in the crisis communication process, sense of responsibility of the media to provide adequate information and monitoring and evaluation of communication activities) obtained no responses under the points no need to improve or little need to improve. Fig. 51 Weaknesses. (Percentage of replies obtained under the categories need to improve and much need to improve - Portuguese overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Sense of responsibility of the media to provide adequate information Communication competence of health authority staff and health experts A common understanding and definition of health crisis Regular cooperation between all stakeholders involved in the crisis communication process Monitoring and evaluation of communication activities Involvement of health professionals (e.g. physicians, nurses) in the communication process Consistent and reliable information in all communication channels Maintenance of trust in health authorities Establishment of a standardized communication procedure (guidelines) within an organization Involvement of local organizations in the information exchange process Quick provision of information Understanding the news production process Availability of designated spokespersons Knowledge of the target groups and how they get their information Identification and use of suitable media channels Disclosure of uncertainties Involvement of voluntary organizations in the communication process 83,3% 81,0% 73,8% 73,8% 73,8% 71,4% 69,0% 69,0% 66,7% 64,3% 64,3% 64,3% 59,5% 57,1% ,6% Use of external communication experts 35,7% Standards & Processes Ways of communication Involved stakeholders & target groups Media

54 Improving Crisis Communication Skills in Health Emergency 50 Fig. 52 Strengths. (Percentage of replies obtained under the categories little need to improve and no need to improve - Portuguese overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Use of external communication experts 31,0% Availability of designated spokespersons Disclosure of uncertainties Involvement of voluntary organizations in the communication process Understanding the news production process Knowledge of the target groups and how they get their information Identification and use of suitable media channels Involvement of local organizations in the information exchange process Involvement of health professionals (e.g. physicians, nurses) in the communication process Establishment of a standardized communication procedure (guidelines) within an organization Quick provision of information Maintenance of trust in health authorities Consistent and reliable information in all communication channels Communication competence of health authority staff and health experts A common understanding and definition of health crisis Regular cooperation between all stakeholders involved in the crisis communication process Sense of responsibility of the media to provide adequate information Monitoring and evaluation of communication activities 14,3% 11,9% 11,9% 9,5% 7,1% 7,1% Standards & Processes Ways of communication Involved stakeholders & target groups Media Overview of replies (Threats and Opportunities) Question 8 lists ten factors considered as potential threats to effective crisis communication asking the respondents to indicate their importance on a five-point scale. The chart below provides a summary of responses received for Portugal. An in-depth summary of data is also provided in Annex II.

55 Improving Crisis Communication Skills in Health Emergency 51 Fig. 53 Question 8: Below you find a list of potential threats to effective crisis communication. How strongly, do you think, do these factors affect crisis communication? (Portuguese overview) Increasing mobility of individuals across borders Unforeseen reactions on the part of the public/media/other stakeholders Neglect of health crisis situation due to different political priorities Different knowledge backgrounds Different administrative backgrounds Different legal backgrounds Insufficient collaboration at European level Social, cultural and linguistic diversity in Europe Increasing importance of social media in the society Economic crisis situation in Europe 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Not important at all Little importance Medium importance Important Very important Don't know Not replied n.a. The potential threat of poor cultural share of information was also mentioned and rated as very important. The survey also explored potential opportunities for effective crisis communication, according to the view of the respondents. Question 9 listed six factors asking the respondent to indicate their importance in a five-point scale. A general overview of responses for Portugal is provided in the chart below. An in-depth summary of data is also provided in Annex II.

56 Improving Crisis Communication Skills in Health Emergency 52 Fig. 54 Question 9: Here is a list of important societal developments that can provide opportunities for effective crisis communication. How strongly, do you think, do these developments contribute to a more effective crisis communication? (Portuguese overview) Increasing mobility of experts across borders Placing crisis communication higher on the political agenda Transnational coordination Learning from each other's experiences in the EU Increasing role of social media in our society Economic crisis as an opportunity to do things differently 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Less important Little importance Medium importance Important Very important Don't know Not replied n.a. Another opportunity was mentioned and rated as very important : the engagement of local and social structures. Threats and Opportunities As shown in the chart below, the neglect of a health crisis situation due to different political priorities is considered the top threat by the large majority (83,3%) of respondents. Another relevant threats is represented by the existence of different knowledge backgrounds (71,4%), followed by the economic crisis situation in the EU (66,7%). This threat is much more important in Portugal, if compared with the results obtained for other countries like Denmark (26,9%) and Germany (31,3%) and also if compared with the global results where this factor occupies the penultimate position (48,3%). Regarding the opportunities, the large majority of respondents (85,7%) consider the possibility to learn from each other s in the EU the most important factor having the potential to positively affect crisis communication. In line with this first result, transnational coordination (76,2%) is the second factor highlighted by respondents, followed by placing of crisis communication higher on the political agenda (73,8%) which obtained the same score as the economic crisis as an opportunity to do things differently (73,8%).

57 Improving Crisis Communication Skills in Health Emergency 53 Fig.55 Threats. (Percentage of replies obtained under the categories important and very important - Portuguese overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Neglect of health crisis situation due to different political priorities 83,3% Different knowledge backgrounds Economic crisis situation in Europe Different legal backgrounds Unforeseen reactions on the part of the public/media/other stakeholders Increasing importance of social media in the society Social, cultural and linguistic diversity in Europe Increasing mobility of individuals across borders Insufficient collaboration at European level Different administrative backgrounds 71,4% 66,7% 64,3% 64,3% 61,9% 59,5% 59,5% 57,1% 57,1% Economic Political Social & Cultural Fig. 56 Opportunities. (Percentage of replies obtained under the categories important and very important - Portuguese overview) 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Learning from each other's experiences in the EU 85,7% Transnational coordination 76,2% Economic crisis as an opportunity to do things differently 73,8% Placing crisis communication higher on the political agenda 73,8% Increasing mobility of experts across borders 66,7% Increasing role of social media in our society 57,1% Economic Political Social & Cultural

58 Improving Crisis Communication Skills in Health Emergency 54 SWOT Matrix The SWOT Matrix below provides a summary, indicating the top three strengths, weaknesses, opportunities and threats for Portugal. Use of external Fig.57 SWOT Matrix Top three Strengths, Weaknesses, Opportunities and Threats. (Portuguese overview) Top 3 - Strengths Top 3- Weaknesses communication experts Sense of responsibility of the media to provide adequate information Availability of designated spokespersons Communication competence of health authority staff and health experts Disclosure of uncertainties Involvement of voluntary organizations in the communication process Top 3 - Opportunities Learning from each other's experiences in the EU A common understanding and definition of health crisis Regular cooperation between all stakeholders involved in the crisis communication process Top 3 - Threats Neglect of health crisis situation due to different political priorities Transnational coordination Different knowledge backgrounds Economic crisis as an opportunity to do things differently Economic crisis situation in Europe Placing crisis communication higher on the political agenda