By Randall N. Hyer, MD, and Vincent T. Covello, PhD Center for Risk Communication With the continuing cascade of news stories about lead in water, water professionals are in a difficult spot. “Breaking bad news” or communicating risk information to a worried audience is a challenging yet crucial task. When the chips are down and people are worried, there will be information overload with many sources screaming for attention. In this cacophony, officials must adopt special evidence-based techniques in order for the truth and helpful information to be heard. Risk and crisis communication are scientific disciplines with over 8,000 peer-reviewed publications and 2,000 books printed, along with reviews of the literature by the National Academy of Sciences and other preeminent bodies. Essentially, risk and crisis communication involve connecting with people who have an activated brain limbic system or amygdala (emotional and “fight or flight response”). This natural emotional response makes it very difficult to present detailed information in a logical fashion. Neurological studies using the latest brain imaging techniques demonstrate a clear effect of emotions on altering risk-based decision-making processes. Effective risk communication has three primary goals: to build or repair trust, to inform stakeholders about the risk, and to gain agreement (for example, agreement about what is needed). First and foremost is to build and repair trust. Never has this been more true than in the ongoing conversations about lead. Trust is the absolute currency of effective risk communication. To gain trust, one must express true empathy – “people want to know you care before they care what you know.” Studies show that listening, showing compassion, and demonstrating empathy contribute over 50% to peoples’ perception of trust. What is alarming is that this trust is assessed in as little as 9 to 30 seconds. Factors such as one’s competence and expertise contribute a mere 15-20% of perceived trust, with honesty and openness another 15-20% and all other factors filling in the remainder. When attempting to connect with people in a high concern, low-trust setting one must first and foremost demonstrate empathy and compassion before the audience will hear anything else. Decades of research on how people respond to concerning information can be organized into simple concepts or “templates”: 1. The Conviction/Compassion/Optimism template 2. The Primary/Recency template 3. The Mental Noise/Rule of 3 template 4. The Negative Dominance template 5. The Trust/Benefits/Control template 6. The Know/Don’t Know or Know/Do/Go template 7. The Anticipation/Preparation/Practice template These concepts or templates can help organize one’s thinking about how to connect with a worried and concerned audience. According to the Conviction/Compassion/Optimism template, one needs to present information that communicates conviction, compassion, and optimism to establish trust. Mayor Rudy Giuliani brilliantly performed this effect at the press conference following the attacks in New York and Washington on September 11, 2001. His remarks were brief and yet he still managed to convey a sense of conviction, compassion, and optimism through his first words: “The number of casualties is greater than we can bear ultimately.” The Primacy/Recency template covers the concept that stressed people tend to remember what they heard first and last. People tend to forget what was in the middle. When breaking bad news, it is best to present one’s main points either first or last with the least important or most complex or difficult information in the middle. Mental noise is a well-recognized phenomenon. During times of stress people’s mental capacities are typically reduced by up to 80%. Everyone has experienced mental noise. When breaking bad news one must reduce the complexity of one’s communication to the average grade level - 4 (AGL-4) level. If one assumes a general audience has a high school education, then the eighth grade level would be appropriate. Most risk communication for the general public is aimed at the 6th-8th-grade level. Mental noise also gives rise to the Rule of 3. Normally people can remember seven discrete pieces of information, such as the original seven-digit telephone numbers. During times of stress this is reduced to three, which is why emergency numbers worldwide have three digits, such as “911”. When drafting messages for one’s overarching message and detailed responses for specific questions, it is best to organize these messages or responses in terms of three key messages. In the competition for your “voice” to be heard above others, it has become even more important to speak succinctly and clearly using the Rule of 3 template. The Negative Dominance template is where during times of stress people tend to focus on the negative over any positive information. One must balance each piece of negative information with at least three positive (1N=3P). Sales professionals often claim this ratio is more like 1 in 6. In times of stress, people actively seek out multiple sources of credible information. Access to such information has been greatly facilitated by the Internet and rapid spread through social media. Helpful overarching messages include the concept of Trust/Benefit/Control. The Trust/Benefit/Control template is where the first step is to share information that can build trust (e.g., collaboration among trusted sources), the second step is to identify and demonstrate expected benefits, and the third step is to give intended audience stakeholders a sense of control (for example, by giving them something helpful to do). The Know/Don’t Know (KDK) template as well as the Know/Do/Go (KDG) template are often used to address uncertainty. KNK conveys information about what you know, what you don’t know, and what you are doing to find out. The Know/Do/Go (KDG) template conveys information about what people should know, what they can do, and where they can go for more information. These simple strategies have been demonstrated to increase people’s awareness and retention of messages regarding bad news. Finally, there is no substitute for the strategic Anticipation/Preparation/Practice template. In most settings, people’s concerns and questions can be anticipated. As a result, draft answers can be prepared in advance. Media response plans can be put together. In all cases, practice does make perfect. Mayor Giuliani, for example, has written extensively and passionately about the need for “relentless preparation” for crises. Unfortunately, preparation is often neglected until times of crises. Any and all efforts to anticipate, prepare, and practice for crises pays huge dividends. Despite the multiple challenges and hazards to individuals and organizations, breaking bad news through effective risk and crisis communication can be learned and done well. Preparation is vital. Such advance planning greatly increases the likelihood that the audience will hear the truth and that one’s effort will contribute positively to mutual interests. It is all too easy to be caught unprepared, especially for short-notice or demanding media interviews. Communicate badly and one may be perceived as incompetent, uncaring or dishonest. Communicate well and one can reach more people with a clear and credible message. One can then inform and calm a worried public, reduce misinformation, garner support, and be heard. * Author for correspondence: Dr. Hyer, Email: email@example.com , Tel: (855) 422-7474 Randall N. Hyer, MD, PhD, MPH. Principal, CrisisCommunication.net and Deputy Director, Center for Risk Communication Vincent T. Covello, PhD, MA. Principal, CrisisCommunication.net and Director, Center for Risk Communication See Part 2 of this series for more strategies on how to communicate in a crisis.