The Impact of Public Relations on Crisis Management at Health Institutions

TABLE OF CONTENTS

ACRONYMS

LIST OF TABLES

CHAPTER ONE: BACKGROUND TO THE STUDY
1.1 Introduction
1.2 Background to the study
1.3 Problem statement
1.4 Purpose of the study
1.5 Rationale of the study
1.6 Objectives of the study
1.7 Research questions
1.8 Significance of the study

CHAPTER TWO: LITERATURE REVIEW
2.1 Introduction
2.2 Overview of Literature
2.3 Literature review underpinning study
2.4 Research variables arising from literature
2.5 Conceptual Model

CHAPTER THREE: METHODOLGY AND DESIGN
3.1 Introduction
3.2 Research Approach
3.2 Research strategy
3.4 Sampling frame, Size and Technique
3.5 Operationalization of Research Variables
3.6 Data collection techniques
3.7 Data analysis methods

CHAPTER FOUR: PRESENTATION OF FINDINGS
4.1 Introduction
4.2 Presentation of qualitative and quantitative findings

CHAPTER FIVE: DATA ANALYSIS
5.1 Introduction
5.2 Data Analysis
5.3 Answers to Research Questions
5.4 Discussion of Findings

CHAPTER SIX: CONCLUSION AND RECOMMENDATIONS
6.1 Summary
6.2 Conclusion
6.3 Recommendations

REFERENCES

APPENDICES

APPENDIX I

QUESTIONNAIRE LETTER

APPENDIX II

QUESTIONNAIRE/ INTERVIEW GUIDE

ACKNOWLEDGMENTS

I would like to thank the almighty God for giving me this opportunity and seeing me through my school programme. I could not have done it without God’s gifts of understanding, knowledge and wisdom I have been exposed to.

I want to appreciate all authors whose work are cited in order to clarify issues and contributed to the success of this research work.

I am deeply indebted to my family for the continuous encouragement and support during my research and also believing in me. Special thanks to my sister Caroline Lombe-Mangani for her advice and support and my lovely children Daniel C, Anthony Jnr K and Chisomo EJ Mulowa for their understanding especially when I could not spend so much time with them while pursuing my programme.

I owe a million thanks to my supervisor, Mr. Kabwe Teddy Kabwe for his time; exemplary supervision which was outstanding and helped me put this document together. It is under his material tutelage, guidance, supervision and tolerance; I was able to do this research work. I am grateful to you and may the Almighty God continue to bless you abundantly.

My intense thanks and gratitude go to my lecturers who have inspired me, imparted knowledge in me and whose work helped me directly to write this project work, may the Almighty God continue to bless you.

My sincere gratitude goes to my husband for moral support and taking care of the kids while I have been in school. May the Almighty God continue to bless you.

My friends, course mates who made this journey so easy for me, thank you so much. To all of you, I say, ‘I cannot thank you enough. I recognize the efforts of my friends that I cannot mention here for space constraint, but believe me your names are written in a more special place in my heart.

Sandra Lombe

DEDICATION

Dedicated to my late father Mr Christopher Musungu Lombe

May his soul rest in eternal peace

ACRONYMS

This section gives the connotation to some of the Acronyms used in this study as a requirement to complete the research, these are:

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LIST OF TABLES

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ABSTRACT

This study investigates the impact of Public Relations in crisis management at health institutions; a case study of University Teaching Hospital (UTH), in Lusaka, Zambia.

The respondents were from the PR department at UTH and also some health personnel at the institution. The study sought to respond to the following specific objectives;

- The effectiveness of the PR department at UTH
- To analyze the impact of PR in crisis management at the health institution.
- To identify key factors in the management of PR department in response to crisis management at the institution.
- To make recommendations regarding how to improve the PR and communication between the institution and its publics for improved service delivery and client satisfaction.

Literature was reviewed for information on the impact of PR on crisis management at health institutions and specific attention was given to UTH. In this study, conducted in March 2016, personal interviews, questionnaires, and direct observations were used to collect the data. Both qualitative and quantitative data analysis methods were employed.

Both quantitative and qualitative approaches were utilized and data was collected using questionnaires, interviews, observations and document review. The main findings show that the PR department does help in crisis management at the health institution and also help improve service delivery. The main conclusions are that there is need for improvements in the communication between the institution and its publics.

A quota-based convenience sampling framework was used as is common for most descriptive research methods and case studies like this one. Included in the study were as concepts of public relations, crises, crisis management, media relations, impact of PR and crisis preparedness as well as their indicators.

The research recommends that these crises should be carried out through public relations enlightenment programmes.

CHAPTER ONE BACKGROUND TO THE STUDY

1.1 Introduction

This chapter includes the following components: background of the study, problem statement, research purpose, rationale of the study, objectives of the study, research questions and the significance of the study.

Definitions

Public Relations is about reputation - the result of what you do, what you say and what others say about you. The Chartered Institute of Public Relations has defined Public Relations as “the discipline which looks after reputation, with the aim of earning understanding and support and influencing opinion and behaviour. It is the planned and sustained effort to establish and maintain goodwill and mutual understanding between an organisation and its publics”.

The need for Public Relations in organisations and institutions cannot be over emphasized. Whether internal or outsourced, PR is important as it plays a critical role in ensuring the maintenance of mutual relationships between organisations and its publics.

On the other hand, there are a lot of happenings in the world that affect the operations and reputations of all types of organizations. Acts of terrorism remains a significant threat, natural disasters seem to be growing more violent, economic uncertainty is increasing, and cyber-attacks constitute a continuing threat. These types of crises may be considered external imbalances to health institutions. There are also internal factors that put the reputation of an institution under threat. Donna R. Dinkin, M.P.H (2007), writing in her thesis, entitled Organizational Crises in Local North Carolina Public Health Agencies: A Crisis Typology and Assessment of Organizational Preparedness established a typology of organizational crises in health-related institutions as consisting 7 categories, namely: Disasters, Personnel, Quality Assurance, Legal, Public Relations, Political, and Plant/ Equipment.

By definition a crisis is “the perception of an unpredictable event that threatens important expectancies of stakeholders and can seriously impact an organization’s performance and generate negative outcomes”. Crisis management is the application of strategies designed to help an organization deal with a sudden and significant negative event. A crisis can occur as a result of an unpredictable event or as an unforeseeable consequence of some event that had been considered a potential risk. In either case, crises almost invariably require that decisions be made quickly to limit damage to the organization.

This study is focused on the application of public relations in health institutions, with specific emphasis on the University Teaching Hospital (UTH). A Health Institution is “any hospital, convalescent hospital, health maintenance organization, health clinic, nursing home, extended care facility, or other institution devoted to the care of sick, infirm, or aged person”.

1.2 Background to the study

The negative reports in the media and concerns raised by some patients, their relatives and also the general public on the reception and treatment of some patients at some health institutions can negatively change the attitudes their publics.

Some of examples reported in the media include: Where a Ndola man sued Ndola Central Hospital (NCH) and the attorney general for compensation and damages caused by the alleged negligence caused by NCH staff who swapped his baby with another after his wife gave birth in January 2010.

A mix -up of bodies at the University Teaching Hospital (UTH) which caused both mourners and hospital management accuse each other of negligence. (Mukuka, 2014). In another instance a couple sued UTH over their baby’s death alleging negligence on the part of the health personnel. Another case reported in 2014 were UTH was sued for K2 million compensation after a premature baby died due to alleged fault that developed on machines in the D-block.

There have also been cases where health personnel have been beaten and / or threatened by relatives of patients who die due to alleged negligence or delay in being attended to when they arrive at the health institutions.

The case of overcrowding in the maternity ward is yet another area of serious concern. At one point at least three expectant mothers were sharing a single mattress and even after delivery.

Reports where some babies were allegedly stolen or exchanged at birth, cases of delays in patients being seen by doctors, some even with “serious ailments” are given a month away appointment of which by that time their condition could have worsened or others could even be dead by the time their doctor appointment comes up, calls for evaluation of the impact PR plays in mitigating and addressing crises, and this may just be a tip of the iceberg.

It is because of these well-defined, elaborate concerns and reports that the impact of PR on crises management at UTH has been instituted as a case study. The present study, therefore, attempts to improve the causes of crises at UTH and improve the impact that PR has on its crises management.

1.3 Problem statement

The University Teaching Hospital

The University Teaching Hospital (UTH) is situated in Lusaka, the capital city of Zambia with a population of over two million people. UTH is the largest hospital in Zambia and serves as the main referral centre for tertiary level of care for the entire country. It is also often regarded as the best government funded hospital available in Zambia. It is also the main site for medical education and training for doctors, fellows, midwives and nurses. The entire medical campus consists of over 1,500 hospital beds with specialists available in almost every aspect of medicine. I will provide more information on the institution under Literature Review, suffice to say here that UTH has a fully functional Public Relations Department with 11 members of staff.

Naturally, Lusaka residents and those from surrounding districts have a lion’s share of access to the institution. With that indication of hospital bed space, it is clear that UTH is a massive operation of health care services.

Maureen Cho, MD (A third year Obstetrics and Gynaecology Resident at Kaiser Permanente, San Francisco while on a global health rotation in Zambia at the University Teaching Hospital), has given a bit of statistics on the Gynaecology and obstetrics unit’s operations: “On a given 24 hr. day, there are typically 50-60 vaginal deliveries, 10-15 caesarean deliveries, 3-5 exploratory laparotomies, and 15-20 manual vacuum aspirations. As for triages, about 70-80 obstetric patients and 30-40 gynaecologic patients are evaluated each day.”

This is just a simple example, but there are numerous cases seen each day throughout the hospital and incidents of unfavourable outcomes, for both patients and doctors and other staff at the institution, are generally to be expected.

1.4 Purpose of the study

The purpose of the study is to find out the impact that PR has on crisis management at UTH.

1.5 Rationale of the study

To evaluate the impact PR has on crises management at health institutions and in particular UTH. Also to assess PR departments management of crises at the health institution. Further, to establish the impact of PR in enhancing health institutions public image. This study will eliminate the gap, solve specific problems and uplift the level of professionalism in PR at UTH.

1.6 Objectives of the study

1.6.1 General objective of the study

To find out the impact that PR has on crisis management at UTH.

1.6.2 Specific objectives of the study

(i) To find out the PR departments strategic plan on mitigating crises at health institutions.
(ii) To investigate health institutions practice of Media Relations.
(iii) To find out the communication process between the PR department and its publics.
(iv) To recommend measures on how to mitigate the crises.

1.7 Research questions

The principal research question at the heart of this study asks how PR impacts on crisis management to be of benefit to a health institution. The dissertation seeks more particularly to determine whether UTH practise of PR does help to mitigate occurrence of crises and help the hospital strive towards crisis preparedness. This is in recognizing that good crisis management and PR operations can assist and support the overall institutional efficiency.

The substantive study centres on the relevant sub-fields of public relations; crisis management and preparedness as they relate to reputational capital and benefits.

However, in order to adequately answer the research question, an analysis of the literature relating to the following sub-questions is required:

1. What is the PR department’s plan on mitigating crises at health institutions?
2. How do Health Institutions practice Media Relations?
3. What is the communication process between the PR department and its publics?
4. What measures can be put in place to mitigate crises?

1.8 Significance of the study

This dissertation is important as it contributes greatly to the limited number of studies on the subject of crisis management in health institutions in Zambia. It is hoped that the study will reveal that very few comprehensive frameworks dealing with public relations exist, particularly ones that incorporate crisis management and practical to institutional levels, being UTH. This dissertation provides a greater understanding of this complex subject for practitioners of the discipline. It is the first research to be conducted into the area of crisis management and PR in the Zambian context.

This study is significant in that it will reveal data that may be useful not only to the PR practitioners but to future researchers. The significance of the study lies in that the findings will:

- help policy makers formulate policies on how to improve PR at health institutions and further improve service delivery.
- Professionally it will help the PR profession consider how PR is practiced in health institutions and help solve a lot of problems.
- Academically it will help generate interest for similar studies in future.
- Personally the study is important as it will lead to partial fulfilment of the award of a Bachelor’s Degree in Public Relations at Cavendish University Zambia.

CHAPTER TWO LITERATURE REVIEW

2.1 Introduction

The methodology adopted for this study involves a considerable amount of secondary research, utilising a broad range of literature including text books, academic journals and papers, relevant legislation, guidance documents, reports, websites, and media reportage.

This is considered important because in order to examine thoroughly the subject of public relations, it is necessary to have a comprehensive knowledge of the literature that supports its theories, processes and application as a management science.

This chapter presents a review of relevant literature to the subject under investigation in respect of definitions of concepts, overview of literature, literature underpinning study, research variables arising from literature and the conceptual model.

2.2 Overview of Literature

Definitions

2.2.1 Crises

Deon. V. Canyon and others writing in the Asia Pacific Journal of Health Management defined a crisis as ‘any event or condition that threatens the survival of the organisation’, adding that health organisations have learnt to deal with such events efficiently and humanely and their management and preparedness typically focuses on events that have been experienced rather than on a sensible range of possibilities that may include the unexpected. The effect is that health organisations may implement a suboptimal allocation of resources, leading to loss of life and a lack of public confidence in the wider healthcare system and its consequences of reduced funding, donations and other gains. It is therefore, important to constantly examine the operations of hospitals and how public relations can help mitigate negative outcomes.

In health institutions we look at PR and crisis management from a big picture and identify types of crisis as follows:

Types of Crises Experienced by Health organizations

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Source: Asia Pacific Journal of Health Management 2010

A classification of crises include immediate, immerging and sustained crisis as follows:

Immediate Crisis - that happens so suddenly and unexpectedly that there is little or no time for research and planning. For example plane crash, product tempering, fire, earthquake, terrorism, bomb scare and workplace unrest or shooting.

Emerging Crisis - this allows more time for research and planning, but may suddenly erupt after brewing for long periods. For example general employee dissatisfaction and low morale, substance abuse at work place, overcharging and poor service.

Sustained Crisis - continues for months or even years despite the best effort by management such as rumours of downsizing, retrenchments and closure of operations mergers and takes over.

2.2.2 Crisis management

Crisis management is “a set of 1 applied in handling, containment, and resolution of an emergency in planned and coordinated steps.” Practical crisis management activities include forecasting potential crises and planning how to deal with them. Crisis management often includes strong focus on public relations to recover any damage to public image and assure stakeholders that recovery is underway.

According to Jonathan Bernstein (Bernstein, 2010): Every organization is vulnerable to crises;

“If you don’t prepare, you will incur more damage.”

He says that there is need to have crisis management-related plans. While conducting a vulnerability audit (the first step in crisis preparedness) “What I often find is a failure to address the many communications issues related to crisis/disaster response. Organizational leadership does not understand that, without adequate internal and external communications:

i. operations response will break,
ii. stakeholders (internal and external will not know what is happening and quickly be confused, angry and negatively reactive
iii. the organisations will be perceived as inept, at best and criminally negligent at worst.”

However, it is commonly agreed that organisations typically employ an ad-hoc, reactive approach to crisis management rather than enabling it by making it a systematic approach to inform institutional effective and management. This is important because crises are largely due to systemic deficiencies and rarely have a single cause. A lack of adequate crisis preparedness may lead to infrastructure collapse, diminished function, and impaired outcomes for patients and lack of safety for staff and patients.

2.2.3 Crisis Preparedness

The purpose of articulating types of crises is to help come up with answers and build crisis preparedness strategies or plans; to assess the level of preparedness of hospitals so that they are able to prevent and respond to the different types of crises.

Emerging thinking in crisis management requires organizations move a step further by adopting crisis preparedness plans. This requires information on the nature of disasters that are likely to strike as well as the vulnerability of its population and infrastructure.

The emphasis is on formulation of formal strategic response plan which allows for the development of focused preparedness activities to reduce the impact of crises, and thus keep them from developing into full-scale disasters. Institutions with formal crisis response plans typically have written strategies, such as crisis plans and media relations procedures, which provide a systematic framework for responding to a variety of crisis situations.

2.2.4 Hospital

Encyclopaedia Britannica defines hospital as;

“an institution that is built, staffed, and equipped for the diagnosis of disease; for the, both medical and surgical, of the sick and the injured; and for their housing during this process. The modern hospital also often serves as a centre for investigation and for teaching”.

In this study the health institution of focus is the University Teaching Hospital (UTH).

2.2.5 The University Teaching Hospital

The University Teaching Hospital (UTH) in Lusaka is the biggest hospital in Zambia. The Vision of UTH is;

“to be the Centre of Excellency for health care in the country and the region”.

Vision and Mission Statement

The Vision of UTH is;

“to be the Centre of Excellency for health care in the country and the region by providing innovative treatment interventions through on-going research”

Mission statement

“To provide affordable quality health care, function as a referral centre, train health care providers, conduct research to find solutions to existing health problems and for the development of science”.

In conformity with its mission statement the hospital directs it efforts towards research, improving general medical services and to function as a tertiary health care institution. While recognizing that Tertiary care services are highly specialized and expensive to provide, the challenge for the institution has been to reduce the expense of treatment abroad by offering such services locally.

Over a period of time, the institution has built capacity in various areas of specialization such as Cardiology; Cardiac Surgery, ART, PMTCT, Ophthalmology, ENT, Urology, Orthopaedics and Pulmonary medicine.

UTH’s Aims and Objectives

The activities of UTH are centred on the following objectives:

- To provide general health care to all citizens of the Republic of Zambia
- To train health care personnel in medicine, nursing, physiotherapy, Radiography and other related paramedical disciplines.
- To conduct research to establish better management of commonly occurring diseases in Zambia and the Southern Africa region
- To act as a referral centre for all the country’s medical needs where such needs cannot be cared for by peripheral medical institutions.
- UTH is the principle medical training institution in the country.

2.2.6 Impact

The Online Business Dictionary defines impact as;

“measure of the tangible and intangible effects (consequences) of one thing or entity's action or influence upon another”.

Concepts and Context “Public Relations”

The related literature offers a wide range of definitions for public relations. Each definition underlines one or some of the features of public relations. In this study, public relations will be used to refer to:

… a managerial function supplying the achievement of overall organizational aims, the identification of organization mission and vision, facilitating the organizational change. Public relations department develops the connection between the external environment and the staff of the organization by bringing the expectations of community and the aims of the organization into consonance and developing positive relations.

Public Relations Function at UTH

It seems like the UTH attached significant importance to the public relations function, having as a department in the hospital. The following is what the UTH website says about PR at the hospital:

The Public Relations (PR) Department at the University Teaching Hospital (UTH) is comprised of 11 members of staff spread out across the hospital (Paediatrics, Obstetrics and Gynaecology, Casualty, Main Enquiries, Main Hospital Administration) and it functions as a link for both the internal and external public. The site states the functions of the department:

- It also facilities communication between the various media houses and it works hand in hand with them in order to create awareness about the institution.
- In addition, the team also monitors the flow of information coming from within and outside the hospital. The media are accompanied by PR staff in order to ensure that correct and accurate information is provided. PR staff ensure that informed consent is given by patients, caregivers (particularly were children are involved) and members of staff before the media can carry out its work. This is in compliance with the laws set in place by various governing bodies to protect peoples’ rights to privacy and to make informed decisions on their participation.
- Another key role of this department is to maintain a positive image and maintain good relations with people from all walks of life, which in turn creates a mutual understanding. One of the ways in which this is done is by carrying out rounds in the different areas within the hospital and getting the public’s view on the services offered.
- The department also aims to create goodwill in liaison with various co­ operating partners through public- private sector partnership.
- UTH frequently receives donations both from organizations and individuals. Activities such as these are facilitated by the PR team which is also responsible for making sure that the persons involved adhere to the standards set by management.
- Conflict resolution is one of the fundamental roles of the department. This includes complaint handling and problem solving. The PR team at UTH seeks to create harmony and a conducive environment for the public and staff.
- The department is also responsible for organizing various events and programs as well as participating in hospital activities when required.

An old PR adage says, "Let the public be damned," but our PR team believes in creating a platform for new ideas. The department will always strive to work towards the objectives, mission and the vision of the hospital within the guidelines laid down by the Ministry of Health and UTH Management.

2.2.7. PR and Crisis Management Model

Crisis Management Systems a Case Study for Aspect-Oriented Modelling Herrero and Pratt proposed a Crisis Management Model which identified three different stages of crisis management, viz:

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Fig. 1. Crisis Management Systems Feature Diagram - Part 1Gonzalez-

Diagnosis of Crisis : The first stage involves detecting the early indicators of crisis. It is for the leaders and managers to sense the warning signals of a crisis and prepare the employees to face the same with courage and determination. Superiors must review the performance of their subordinates from time to time to know what they are up to. Monitoring the performance of the employee regularly helps the managers to foresee crisis and warn the employees against the negative consequences of the same. One should not ignore the alarming signals of crisis but take necessary actions to prevent it.

Planning : Once a crisis is being detected, crisis management team must immediately jump into action. Ask the employees not to panic. Devise relevant strategies to avoid an emergency situation.

Adjusting to Changes: Employees must adjust well to new situations and changes for effective functioning of organization in near future. It is important to analyse the causes which led to a crisis at the workplace. Mistakes should not be repeated and new plans and processes must be incorporated in the system.

2.3 Literature review underpinning study

According to Coombs (2007);

“crisis managers are expected to benefit from understanding how crisis communication can be used to protect reputational assets during a crisis.”

The Situational Crisis Communication Theory (SCCT) offers a framework for understanding this dynamic. SCCT provides a mechanism for anticipating how stakeholders will react to a crisis in terms of the reputational threat posed by the crisis. Moreover, SCCT projects how people will react to the crisis response strategies used to manage the crisis. From its empirical research emerges a set of evidence-based crisis communication guidelines. SCCT is discussed and presented as the underpinning theory of this study.

The theory insists that post-crisis communication should be encouraged as it can be used to repair the reputation and prevent reputational damage. Thus, crisis management needs evidence-based crisis communication guidance.

Further, the theory emphasizes that crises can harm stakeholders physically, emotionally and financially. A wide range of stakeholders are adversely affected by a crisis including community members, employees, customers, suppliers and stockholders. Crises threaten to damage reputations because a crisis gives people reasons to think badly of the organization.

Th e theory indicates that the first priority in any crisis is to protect stakeholders from harm, not to protect the reputation. Instructing information tells stakeholders what they must do to protect themselves from the physical threat of a crisis.

Adapting information helps people to cope with the psychological threat from the crisis. A crisis creates a need for information.

2.3.1 Media Relations

As noted earlier, most stakeholders will learn about a crisis from the news media. Hence, how the news media frame (define) the crisis is an important consideration. Research from agenda setting and reputation (Carroll, 2004) suggest that;

“the stakeholders will adopt the media's frame for the crisis. A crisis manager may find it difficult to change the media's frame for the crisis and be forced to manage within that crisis frame”.

To conclude, it must be noted that ethics recommend that the physical and psychological needs of the stakeholders be the top priority in a crisis. Once stakeholder needs are addressed, crisis managers can turn their attention to other demands such as the organization's reputation.

Understanding these reactions allows the crisis manager to anticipate the level of reputational threat a crisis poses. Because reputations shape how stakeholders interact with organizations, protecting the reputation yields behavioral benefits as well. SCCT models the crisis situation and provides an evidence-based set of guidelines for using crisis response strategies that can benefit crisis managers and their organizations.

2.3.2 Models of Public Relations

Some of the key components of mitigating crises include planning and good communication. There is need for institutions to plan well in advance for crises so that it is easier to deal with them when they occur and if they do not occur that is a plus for the institution. James Grunig and Todd Hunt proposed the four models of PR in 1984. The model describes the different forms of communication between an organisation and its stakeholders. The first model is publicity or press agent, the second is public relations information model, the third asymmetric persuasion, and the last one the two way symmetrical model has become accepted as a formal definition of best practice for communication in Western markets between an organisation and its audiences. In this study, I will focus on this last model:

2.3.3 Four Models of Public Relations

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Table1: James Grunig and Todd Hunt’s Four Models of Public Relations (1984).

The organization ́s key strategic priorities are reviewed to select strategic organizational positions and goals to be communicated to internal and external publics. A key focus is therefore the organization’s strategies that have already been formulated as part of the regular cycle of strategy development or budgeting process.

From the fore going it can be said that PR as a management function is a basic need that is important to every organization. PR in this study in the independent variable and health institutions do depend on it. The performance, image and reputation of health institutions do depend on PR.

2.4 Research variables arising from literature

2.4.1 Public Relations

It can be said that Public Relations is a variable that health institutions depend on. Health institutions and UTH in particular can use Public Relations to attend to the institutions publics and also address crises.

This process is primarily composed of four steps:

(i) Research to define the problem or situation,
(ii) Developing objectives and strategies that address the situation,
(iii) Implementing the strategies, and then
(iv) Measuring the results of the public relations efforts.

PR uses the RACE paradigm: R esearch to find out the causes of crises, then takes A ction, C ommunicates and then E valuates the crises. The process always starts with research and ends with evaluation. Although it is easier to remember such acronyms, the four steps are essentially the following:

1. Use research to analyze the situation facing the organization and to accurately define the problem or opportunity in such a way that the public relations efforts can successfully address the cause of the issue and not just its symptoms.
2. Develop a strategic action plan that addresses the issue that was analyzed in the first step. This includes having an overall goal, measurable objectives, clearly identified publics, targeted strategies, and effective tactics.
3. Execute the plan with communication tools and tasks that contribute to reaching the objectives.
4. Measure whether you were successful in meeting the goals using evaluationtools.

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