title: Disclosing large scale adverse events in the US Veterans Health Administration: lessons from media responses.
abstract: OBJECTIVE
  We examined print, broadcast and social media reports about health care systems' disclosures of large scale adverse events to develop future effective messaging.
  
  
  METHODS
  Directed content analysis.
  
  
  METHODS
  We systematically searched four communication databases, YouTube and Really Simple Syndication (RSS) feeds relating to six disclosures of lapses in infection control practices in the Department of Veterans Affairs occurring between 2009 and 2012. We assessed these with a coding frame derived from effective crisis and risk communication models.
  
  
  RESULTS
  We identified 148 unique media reports. Some components of effective communication (discussion of cause, reassurance, self-efficacy) were more present than others (apology, lessons learned). Media about 'promoting secrecy' and 'slow response' appeared in reports when time from event discovery to patient notification was over 75 days. Elected officials' quotes (n = 115) were often negative (83%). Hospital officials' comments (n = 165) were predominantly neutral (92%), and focused on information sharing.
  
  
  CONCLUSIONS
  Health care systems should work to ensure that they develop clear messages focused on what is not well covered by the media, including authentic apologies, remedial actions taken, and shorten the timeframe between event identification and disclosure to patients.
authors.affiliation: Center for Healthcare Organisation and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA, USA. Electronic address: Elizabeth.maguire@va.gov.
authors.forename: E M
authors.initials: EM
authors.lastname: Maguire
authors.affiliation: Center for Healthcare Organisation and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA, USA; Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA.
authors.forename: B G
authors.initials: BG
authors.lastname: Bokhour
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Healthcare System, 3801 Miranda Avenue, Menlo Park, CA, USA; School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, USA.
authors.forename: S M
authors.initials: SM
authors.lastname: Asch
authors.affiliation: Center for Innovation to Implementation, VA Palo Alto Healthcare System, 3801 Miranda Avenue, Menlo Park, CA, USA; Health Economics Resource Center, VA Palo Alto Healthcare System, 3801 Miranda Avenue, Menlo Park, CA, USA; School of Medicine, Stanford University, 291 Campus Drive, Stanford, CA, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Wagner
authors.affiliation: Center for Healthcare Organisation and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA, USA; Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA.
authors.forename: A L
authors.initials: AL
authors.lastname: Gifford
authors.affiliation: School of Medicine, University of Washington, 1959 N.E. Pacific St., Seattle, WA, USA.
authors.forename: T H
authors.initials: TH
authors.lastname: Gallagher
authors.affiliation: Office of Public Health, Clinical Public Health Program, 810 Vermont Avenue, NW, Veterans Health Administration, Washington, DC, USA.
authors.forename: J M
authors.initials: JM
authors.lastname: Durfee
authors.affiliation: Office of Public Health, Clinical Public Health Program, 810 Vermont Avenue, NW, Veterans Health Administration, Washington, DC, USA; School of Medicine, Yale University, Cedar Street, New Haven, CT, USA.
authors.forename: R A
authors.initials: RA
authors.lastname: Martinello
authors.affiliation: Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 South Huntington Ave, Jamaica Plain Campus, Boston, MA 02130, USA; Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, USA.
authors.forename: A R
authors.initials: AR
authors.lastname: Elwy
mesh_terms: D003142:Communication; D030881:Disclosure; D006801:Humans; D008402:Mass Media; D011369:Professional-Patient Relations; D061108:Social Media; D014481:United States; D014493:United States Department of Veterans Affairs
keywords: Crisis and risk communication; Disclosures of large scale adverse events; Media analysis