This research study has described the perception of crisis and emergency risk communication in an acute hospital in response to COVID-2019 in Singapore. Analysis of the findings revealed that most respondents reported regular updates, which is a key component in CERC (25) by the hospital were understandable, actionable, accurate, concise and timely. Updates from the hospital senior management were the preferred source of information on COVID-19 for the respondents. There was also a strong sense of trust in the credibility of the hospital among staff, and staff were clear about how to keep themselves safe in combatting COVID-19. Significant relationships however were reported between the perception of the hospital CERC, and occupation, age, work experience in the hospital, primary work location of staff, marital status, and gender. Qualitative findings revealed that the CERC cuts across hospital emergency domains, involving human resource, staff welfare, local leadership and resource reallocation. These are discussed below.
In this study, nurses, allied health professionals and administrative staff were more likely to report favourably in many areas of the hospital CERC. However, some groups, such as doctors, staff below 40 years of age, non-married, located in the outpatient setting, and with ‘5 to less than 10 years of work experience’ were less likely to report favourably in many areas of the hospital CERC. These findings suggest that there is a need to consider sociodemographic characteristics in relation to hospital CERC. Similar to planning for emergencies at national level or in cities, the presence of diverse populations in a setting or context needs to be taken into account (15). In this instance, it will be important to engage and address the different population segments within the hospital to develop stronger partnerships with them in order to promote trust and actions in response to the COVID-19 pandemic. This is pertinent because doctors, and indeed all healthcare staff, are critical members in the hospital setting and in managing a public health crisis. When audience segmentation to which communication is directed at is insufficient and content is inadequate, it could have adverse consequences on compliance with recommended behaviours in CERC (14).
Communication challenges in translating action plans on the ground level and executing logistics planning and resource reallocation was also found to be a barrier in hospital CERC. Specifically, the role of middle management or local leadership to communicate and translate hospital updates to actionable plans was found to be crucial, least they become problematic to mitigating COVID-19 pandemic because of delayed or ineffective communication. A recent WHO commissioned study highlights that local leaders play vital roles in building trust and engaging an affected population (19). Evidence also shows that providing CERC training workshops, tabletop exercises, simulations, and ensuring capacity building in this regard to enhance emergency communication response may help strengthen local leaders in their communication during public health crises (12, 26, 27). Additionally, communicating plans from scenario modelling, which provide options for action (15) may clarify for its staff the hospital’s rationale for resource reallocation. This would be relevant in the implementation of patient screening points and scheduling of roster. Articulating mid- to longer term logistical plans such as in staff reallocation issues would be important.
A lack of communication on human resource matters to address staff’s welfare issues and concerns promptly was reported to have impacted staff morale and perceived support during this crisis. For example, in this study, staff reported that the level of empathy was lower than desired and being unable to take leave to rest during the initial stage of the crisis was putting their mental health at risk. Indeed, the statement ‘SGH has been able to understand my challenges and address my concerns during this outbreak’ had the lowest endorsement rate at 79.4% from all respondents among the questions. While the hospital provides psychological, counselling, and peer support services to its staff, communicating how staff could mitigate stress and directly addressing staff’s concerns of safety and well-being still remain crucial, which could help demonstrate empathy for its people (28, 29).
Even though emails as a communication tool may be useful, respondents reported that it does not necessarily provide timely release of information, particularly in a rapidly evolving situation as COVID-19. This could affect adoption of recommended behaviours or adherence to instructions in CERC (11, 14). The use of secure text messaging applications in hospital CERC may instead provide staff with more real-time updates. After all, it is crucial to always consider the circumstances in question and the target audience in communication (30). In doing so, it would ensure an expeditious dissemination of information, and at the same time, address the needs of younger staff for more real-time updates. An anonymous feedback channel, albeit useful as proposed by some respondents, is generally not recommended as people should take ownership of their contributions, particularly in public health crises (31).
This study has demonstrated how CERC cuts across domains of hospital emergency response, such as command and control, communication, safety and security, triage, human resources, and logistics (21, 32, 33). CERC transcends all these domains at various scales, which suggests the need for coordination and collaboration in CERC (27). The interrelatedness of CERC and the domains of hospital emergency response highlight the need to consider communication at every domain of the hospital emergency response.
In essence, clear and accurate communication is necessary and indeed crucial for rapid, effective response to a critical event (33). This study has shown that while this has been achieved thus far in SGH, there remains areas in which CERC could be enhanced within the hospital setting. Hospital CERC may mirror CERC when applied to the public in many aspects in terms of enablers and barriers, but population groups, sociodemographic factors and concerns may vary. For example, this study has identified and proposed the value of addressing different population segments based on sociodemographic characteristics in the hospital. It also suggests considering CERC in the context of hospital emergency response domains. Additionally, while SGH CERC may have met the general CERC principles of be first, be right, and be credible, areas such as expressing more empathy and showing respect for its staff, and addressing different population groups within the hospital to promote action are CERC principles that still need work. The findings above have informed how CERC can be better enhanced in the hospital in the subsequent phases, particularly as the COVID-19 pandemic continues to evolve. They may also have wider relevance to hospitals and countries elsewhere, which are combatting this crisis or other public health crises.