834

Abstract

Introduction: A February 2012 front page newspaper article cited higher than average infection rates in the ICUs of several metropolitan Atlanta hospitals. Hospital staff at the first hospital cited, Emory University Hospital Midtown, were incensed, feeling that the article was misleading. This study explores how Emory Healthcare and other institutions facing negative press can partly use adversity to their advantage. In its wake, the newspaper article has created a dialogue between the ICU’s frontline staff and the hospital system’s CEO. Together they are increasing teamwork in the ICU, decreasing public concern about medical error, and creating a model for other hospitals seeking to revolutionize the structure of critical care. Hypothesis: We hypothesized that Emory Healthcare’s forward-leaning response to recent adversity would initiate crucial behavioral changes in critical care. Methods: Two ICU directors/intensivists, one chief affiliate, one nurse unit director, and one associate director from the CDC were determined to be key informants via snowball sampling; they were subsequently interviewed. Interviews for other studies being conducted on behavioral changes in ICUs also informed this study. All interviews lasted from 20-60 minutes and followed IRB approved protocol. Transcripts and participant-observation-based fieldnotes were uploaded into NVivo. This qualitative data analysis program was used to link related text and find recurring themes. Using grounded theory, the hypothesis was refined. Results: Informants from the hospital system were outraged by the newspaper article, finding it inaccurate and outdated. However, they were motivated to clear their institution’s name and improve its quality of care. The CDC director who compiled the hospitals’ infection rates offered such an outcome as the purpose of the data’s publication. While beneficial in creating discourse across the hospital system, the negative press demoralized frontline staff, whose occupation within the demanding field of critical care already makes them prone to burnout. This case shows how critical it is for executives to devise and strictly follow protocols for managing adversity. Nevertheless, an institution’s goal should be to create a surveilled environment where errors, and subsequently controversial headlines, are altogether preventable. Conclusions: There is more than one advantageous way for progressive institutions to handle adversity. Institutions may ally with the press and release the news themselves, or they may use negative press to spur improvement. In the case examined, Emory chose the latter route, reaffirmed its commitment to behavioral change in medicine, and is cultivating a new social structure among providers of critical care.This work was supported from an award the James S. McDonnell Foundation (JSMF Grant No. 220020152) on Cognitive Complexity and Error in Critical Care.