Managing Rumors in a Heart Center

Heart Centers are high-stress environments where rumors can sprout like mushrooms and degrade team performance. How can you manage a problem that thrives in the dark, derives nourishment from misinformation, and can be extremely poisonous in your Heart Center?

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Rumors can degrade team performance. How do rumors form? And what can you do to manage them?

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Optimal performance in a Heart Center requires close collaboration between teams of caregivers working in rapidly changing high-stakes environments. When trusted information channels fail to provide us with sufficient explanation for events that we face in this stressful environment, we tend to fabricate narratives to interpret events - and this is where rumors spout and propagate.

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An Illustrative 'Heart Center Story'

The Heart Center: A large Heart Center experiences a sudden spate of poor outcomes, which, although not statistically significant, heighten stress levels among the team. A newly hired Junior Surgeon was responsible for one of the poor outcomes but has otherwise had excellent results over the past six months. Surgeon-specific data are discussed among the surgeons in quarterly meetings but are not widely shared throughout the Heart Center. At M&M conferences, discussions focus on recent individual events and surgeon-specific aggregate data is not presented.

The Junior Surgeon’s profile: The Junior Surgeon is a bit insecure in a new role and has a behavioral tendency to bristle when challenged in a public forum – leading to occasional irritation of some of the referring cardiologists. The Junior Surgeon has awareness of this tendency and typically remains silent in conferences, preferring to listen and learn. In the ICU, the Junior Surgeon is always polite but focuses on patient care to the exclusion of any social banter with the staff. In the Junior Surgeon’s first week in the Heart Center, an administrative error resulted in an incorrect cellphone number being placed on the call list. A delayed emergency response ensued, and the event was a topic of widespread informal discussions.

The Junior Surgeon is ‘in charge’: The Senior Surgeon leaves town for a one-week vacation and the new Junior Surgeon is left ‘in charge’ for the first time. A tough clinical problem arises in the afternoon, prompting a decision-making ‘Huddle’ involving several available surgeons, cardiologists, anesthetists, and intensivists. The group agrees to proceed urgently to the operating room. The Junior Surgeon calls the Senior Surgeon at his vacation home, reviews the plan, and obtains full approval to proceed - and is advised to expect postoperative myocardial dysfunction and to maintain a low threshold to utilize postop ECMO. In the operating room, the patient has difficulty weaning from bypass as expected. After discussion with the group in the OR, the team agrees that it would be prudent to utilize ECMO for postop stabilization.

Dr XXX has a perspective: Dr XXX is a very senior clinician known for fierce dedication to patients and the recent spate of poor outcomes weighs heavily. Dr XXX also has a preconceived negative impression of the Junior Surgeon based on a vague recollection of a slow response to an emergency and a few interactions where Dr XXX felt that the Junior Surgeon didn’t respond well to having errors pointed out in public. Dr XXX did not attend the decision-making Huddle or participate in the intraoperative discussion that led to institution of ECMO.

Dr XXX’s narrative: Dr XXX hears about the case while walking through the ICU and reflexively creates and articulates a narrative that aligns with Dr XXX’s preconceived notions of the Junior Surgeon. According to Dr XXX, the Junior Surgeon is a stubborn ‘loose gun’ who overstepped while the Senior Surgeon was away, resisted advice of others, and the use of ECMO should have been unnecessary.

Fallout and rumor propagation: Within the ICU, the narrative gains traction, despite many senior clinicians recognizing Dr XXX’s tendency to hyperbole. The Nurse at the Bedside, however, is impressionable and takes Dr XXX’s comments at face value and subsequently asks some colleagues about their impression of the Junior Surgeon. Until this point, the Nurse at the Bedside had a favorable impression of the Junior Surgeon as polite and dedicated to patient care. Now, however, the Nurse at the Bedside and several colleagues begin to doubt the capability of the Junior Surgeon.

When asked by the ECMO patient’s family about the Junior Surgeon and the need for ECMO, the Nurse at the Bedside is no longer sure what to say.

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What happened? A rumor sprouted as a narrative to explain events in a high-stress environment. The rumor seemed plausible, resonated emotionally with the team, and lacked contradictory evidence. Such rumors can be highly toxic in a Heart Center.

Three Requirements for Rumors to Sprout and Propagate:

1. PLAUSIBILITY: In the absence of plausibility, a rumor will not propagate. For example, a rumor that Donald Trump was an extra-terrestrial from Mars will not propagate because it is simply too far from reality. The property of plausibility, however, is malleable and a rumor’s plausibility can be enhanced if it is heard repetitively and from multiple sources. Furthermore, a rumor that resonates with our emotional state will be more likely to be perceived as TRUTH.

In the ‘Heart Center Story’ above, Dr XXX, the cardiology team, and Nurse at the Bedside were highly stressed in their worry about patient outcomes and their emotional state was congruent with the essence of the newly spouting rumor, promoting the attribute of PLAUSIBLITY.

2. EMOTIONAL IMPACT: A rumor will not propagate if it cannot elicit a strong emotional response. For example, a rumor that Donald Trump once received a parking ticket is unlikely to propagate because, within the current state of his complex legal affairs, the rumor would have no perceivable emotional impact.

Rumors come in two varieties: WISH rumors and DREAD rumors. Because caregivers in a Heart Centers are often in a state of high stress, DREAD rumors often resonate with our emotional state and are more likely to propagate.

In the ‘Heart Center Story’ above, the presence of a patient having a tough postoperative course has obvious emotional impact for the Heart Center caregivers - and the DREAD rumor resonated with the emotional state of the group.

3. DATA VACUUM: If there is contradictory evidence from a highly trusted source, a rumor will not propagate. For example, a rumor that Donald Trump was golfing in Palm Beach during his inauguration will not propagate because of the extensive media coverage demonstrated his presence at the inauguration ceremony in Washington DC.

Rumors thrive in the absence of clear, reliable information. Contradictory data from trusted sources can extinguish rumors, but such data must be accessible and credible.

In the ‘Heart Center Story’ above, the Heart Center did not have sufficient mechanisms in place to disseminate information describing how decisions were made. Dr XXX and the majority of the members of the Heart Center were not present at the decision-making Huddle or in the operating room. Furthermore, the Senior Surgeon’s input in the process was invisible to Dr XXX and other members of the Heart Center. Consequently, the DATA VACUUM created a fertile environment for sprouting and propagation of a rumor.

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Preventing rumors in your Heart Center

1. Build trust amongst team members to minimize the PLAUSIBILITY of a potential rumor. Trusted partners are less likely to be the subject of a poisonous rumor.

2. Minimize the EMOTIONAL IMPACT of potential rumors by diminishing workplace stress. Fostering a supportive environment to alleviate caregiver stress will reducing susceptibility to DREAD rumors.

3. Minimize DATA VACUUMS by using abundant, easily obtained, and trusted data to shine a light in the dark places where rumors (like mushrooms) sprout and propagate. Importantly, ensure the source of data is fully independent of Heart Center leadership, particularly if the leadership is the subject of a rumor.

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Reflective questions:

1. The Huddle process used for clinical decision-making described in the ‘Heart Center Story’ did not include a mechanism to inform the remainder of the Heart Center about the decision that was made. How does your Heart Center communicate decisions made during off-hours Huddles?

2. Trust is an important mitigator of plausibility and, therefore, rumor propagation. How did the Junior Surgeon’s personality, communication behavior, and leadership style foster potential for being the subject of negative rumors? Does your Heart Center utilize pre-emptive coaching to optimize leadership and communication skills?

3. What is your responsibility when a colleague like Dr. XXX spreads a narrative? Can you resist the temptation to participate in the propagation of DREAD rumors?

4. How did the lack of transparency in sharing surgical outcomes contribute to the propagation of the rumor? Preemptively sharing data in a transparent manner is a great way to prevent sprouting of rumors. Nevertheless, what is the right balance between real-time total transparency and taking the necessary time to aggregate data in sufficient quantity to permit statistical analysis?

5. Once a rumor is established and propagating, extinguishing a rumor can be very difficult. In fact, a recent study demonstrated that medical professionals who were given trusted contradictory data were willing to accept that a rumor was NOT TRUE, but their subsequent communications with colleagues tended to paradoxically continue to propagate the rumor. What is the best way for Heart Center leadership to extinguish toxic rumors without unintentionally reinforcing them?

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Final Thoughts

Managing rumors in high-stress environments is challenging but essential for optimal team performance. Leadership must address the root causes of rumor propagation, including trust deficits, emotional strain, and data gaps. By fostering a culture of transparency, trust, and support, Heart Centers can prevent harmful narratives from sprouting and propagating.

Thanks for reading - Be well!

#ThoughtsOnAcademicLeadership

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Some references that you may enjoy:

Chua, A., & Banerjee, S. (2018). Intentions to trust and share online health rumors: An experiment with medical professionals. Comput. Hum. Behav., 87, 1-9. https://doi.org/10.1016/j.chb.2018.05.021.

Na, K., Garrett, R., & Slater, M. (2018). Rumor Acceptance during Public Health Crises: Testing the Emotional Congruence Hypothesis.?Journal of Health Communication, 23, 791 - 799. https://doi.org/10.1080/10810730.2018.1527877.

Zhao, L., Yin, J., & Song, Y. (2016). An exploration of rumor combating behavior on social media in the context of social crises.?Comput. Hum. Behav., 58, 25-36. https://doi.org/10.1016/j.chb.2015.11.054.

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