Here's another one, and this is for a very different audience. This is intended to sort of highlight the annual workers' compensation due to hearing loss. And so depending on your audience, perhaps that's the more influential nugget of knowledge. And I'm delighted to see that we actually had several topics on this program talking about heat stress. And so here, now this infographic admittedly is a little bit more complicated. It's really highlighting acclimatization. But what's interesting is I think, if I remember correctly, that this infographic, I don't know if this one was tied to an MMWR or a larger publication, but sometimes we'll try to use infographics as a way to summarize a key finding from a very complicated scientific publication. And so this would be another example. So I like to sort of think about what trends seem to be impacting the risk conversation. Because as those of us that engage in risk conversations every day, sometimes it's helpful to think about whether or not there's a trend that seems to be impacting us the most. This graphic across the top sort of highlights my picks and certain trends, at least trends in my practice. There may be legal trends, and so there are certain things that arise. Since as federal government, we would be subjected to oversight, and so there's a certain amount of trends that we could expect with regard to our. This would be things like transparency and ensuring people have an opportunity to participate in how we develop our science. All those books in the middle is an old school reference to taking a whole bunch of knowledge and sort of synthesizing it into a coordinated message, right? And so the trend there, the trend there is, and so is an old school one, is this idea of systematic review, right? So gone are the days with a hand wave, you could say the literature says, you just sound like an idiot. When you say, oh, the literature, really, does the literature say that? You need to actually, if you're going to claim that a body of literature says something, you should be thinking about whether or not you've actually conducted something like a systematic review, and that's certainly a trend. And there's an expectation that when you're synthesizing knowledge, that you actually do it in a competent way. And lastly, I'm showing somebody that we might intend to risk advise, and she certainly is not waiting for you, or me, or anybody else to give her information, right? She's seeking it herself, and this is the idea of availability of information, and really self-education, and I think that there is an important trend there that we have to recognize and incorporate within our everyday practice. All right, back to basics. Risk conversation. What's risk? What is risk? When I say what is risk, what dials up into your head? And I think it depends, actually. If you're like a risk junkie, we're going to get to some of the things that I think are dialing up in your head right now. But at the very least, from this particular picture, I don't even know, I'm not even sure that risk is actually, I don't even think that the concept of risk is there, but it's actually not a picture of risk, right? That cigarette is not risk. That cigarette's hazard. That's the hazard. As a result of the hazard, what's the risk? So the risk statement would be, individuals who smoke are 10 to, what is it, 10 or 15 to 30 times more likely to develop cancer, okay? That's the risk statement. But the picture here is of hazard, and I'm not sure that people break apart hazard and risk in their head, but I would hope that in occupational safety and health, that we could do that at least. We should think about the hazard. A wet floor is the hazard, okay? It's a risk of what and to whom? Risk of falling and to whom? To the worker, okay? Risk actually is, it's a composite term. So within field, within our specialty, risk is actually attempting to communicate two pieces of information, and I'm not sure how much we understand. I think intuitively we get this, like when we have the, intuitively we get it. But I kind of feel like as professionals, we should be more, we should be better than intuition here. And so it's, and here if you look at the way NIOSH talks about this, we talk about practices in occupational risk assessment. When we discuss risk, we're talking about potential and severity. Those are your two pieces of information, right? If there's just a potential for something to happen, and if it did happen, how bad would it be? That's the severity. For folks that do actually work with our institutional review board, that particular rule thinks about probability and magnitude, but it's not uncommon for risk to travel with this idea of both potential and severity. Our sister professions, say industrial hygiene, also has risk embedded within their core competencies. And this is for you risk junkies out there, and for those of you that are not risk junkies, I encourage you to go to these resources. These things are old. These are old publications, but they still ring true today, okay? Risk assessment in the federal government, managing the process, science and judgment, and improving risk communication. This stuff is great because it helps you think about, there's risk assessment, I'm trying to assess this risk, and after you finish assessing it, then you have to try to manage it, right? And you break that apart into your head, so that when you're having a conversation with either a patient or individuals, you yourself can have the structure in your head and offer the information as it's needed within that particular context. And so I would encourage you to go back to these old, old publications and learn them. Risk assessment is things like hazard identification, okay? Then it includes things like dose response, exposure assessment, and the final risk characterization, and then risk management. A classic example of risk management would be the application, say, of the hierarchy of controls, okay? Here's the way that we're going. Now that we know about this risk, here's how I think we should control it, and there's going to be a hierarchy of controls, and embedded within this concept of hierarchy of controls is of all the choices you could make to manage risk. It seems like some choices may be better than others, right? That's the idea of a hierarchy, and that hierarchy is based on the effectiveness or the presumed effectiveness of any individual control, but, of course, you can take more than one option within the hierarchy, so you can have a whole bunch of them. All right, let's talk about the curse of knowledge, because I think this is important. The curse of knowledge is really interesting. The curse of knowledge is once you know something, you — it's hard to — like, you just can't remember or it's hard to remember what it was like not to know it. You know, once you — that's the curse. I know it now, but it's hard to remember and go back to that time when you just didn't know it, and why is that important? Because — and this image is on purpose. Because if you were the teacher in this particular photo, and I think we are trying to educate others or at least provide information to others, it's — you have to understand how somebody who doesn't know what you're about to tell them, how they might incorporate that information. That's called the curse of knowledge, and I did not just make this up. I did not — I swear to you, I did not make this up. This actually comes from — this comes from — people actually study this. This came from the — I had to, like, dip into economics, into the economics that was to find this thing. And essentially, this was — and I showed this lemons, because these guys were like — you know, they basically said people who know things think that they're good at judging because they know it, right? Because, oh, I know this, right? They think that they know how other people are going to judge the things that they already know. And so economists care about this, because — and the example they gave was lemons. And so if you're in the business of selling lemons, you probably know which lemons are better than others. And so you'll create differential pricing. These are the better lemons, and so we'll charge more money here, and these are the worst lemons, and we can charge less money here. But the point is — and you think that people are going to actually know how to differentiate the lemons, but they don't. And so you're missing — and so if they don't know how to differentiate the lemons, your presumption that people want to buy — they're going to pay more money for the more expensive ones, they're willing to buy — it all breaks down. And so the idea there is — and they showed this — that they weren't — that the profits don't necessarily accrue based on knowing more than, say, your customer. There's an educational — so there's an educational context. I try to, you know, bring it back a little bit closer to our field. And I thought this was really interesting. Again, this is just a reinforcement of curse and knowledge. But I thought what was interesting in this particular educational setting is, like, look, we're in the business of educating students. And so if that's your profession, you might get measured against how well you do educating students. And so they said, you know, well, you know, professors, when they discuss things, when they teach things, they actually often hold these heuristics in their head. You know, especially, like, in physics or some mathematical thing where they're jumping from there's this step and that step and this step and that — and they rifle through a whole bunch of steps. Now the student is faced with, like, well, I guess it must be true because that's what he just did or that's what she did. She kind of went through all the steps. I'll just — I'll just memorize it and get through this. But there's no guarantee that that student actually understands what just got taught. And they may not actually connect with the field. They may be like, oh, you know, that thing, all you do is just memorize things. It's not really a field and I'm out. You know, and so they actually looked at this and they said, oh, jeez, you know, how do we get through this? And they proposed and they said, look, if we're going to try to — so here's a little solution, right? So take notes. This is — I think actually we can — I think we can apply this and should apply this in our everyday practice. And it's this idea of making things sticky. Like making sure that it's something you can remember. So simplicity turns out to be really important. Remember I showed you all those infographics? You know, there's — we actually have something called a clear communication index at NIOSH. We worry about plain language. Simplicity turns out to be really important. Unexpectedness turns out to be important. Like open a knowledge gap. Ask a question and then try to fill it. It's a great way to bring learning into a group. Concreteness. Provide concrete examples. You know, talking about the theory, but then giving — like here's — I just told you this. Now let's do an example together. Like that concreteness I think is really helpful for learning. Credibility, of course, and that means giving others an opportunity to learn something. Emotion and of course using compelling stories. And we're going to come back to this idea of emotion and stories in just a minute. As a matter of fact, right now. So let's talk about risk perception. And you can look at this picture and ask yourself, how do you feel looking at this picture? So I'm actually from Philadelphia originally. This is terrifying to me because we really don't have volcanoes. We just — at least I didn't. Not around my high school. We didn't have a volcano. Like that makes me — like that's how I perceive this particular risk, but I can't — I can imagine that perhaps others might perceive this differently. Now this picture is intended to like create, you know, a certain emotion here because the volcano is not some nice little placid thing. But the idea is that people perceive risk. And I'm telling you this is like an oldie but a goodie. I think that this is still relevant today. This is from Covello. And this is from 1992. And it gets to this idea of how does the public perceive and evaluate risk? And so you can see the two columns. One column — I'm going to have to read a little bit of this to you. One column talks about the conditions associated with increased public concern. That's the first column. And things that make the conditions where you have decreased — like the public will decrease their concern. And then here's factors about whatever's happening. So if something has catastrophic potential, right, and that is going to increase public concern. So this is the idea of fatalities and injuries grouped in time and space. And so when you hear these fatalities and injuries and everything, you know, you're getting a lot of increased public concern as opposed to if fatalities are somehow occurring more scattered, right? So time and bunching seems to increase public concern. Familiarity and understanding — that was my point about not being very familiar with volcanoes personally. So that to me seems like it's very scary. But for others who may actually live or even work around volcanoes, perhaps they're not so scared. And they would think that you're just ridiculous. You know, that thing's been there for years and nothing's ever happened. So uncertainty, controllability, and voluntariness is really important, especially in our profession. Voluntariness turns out to be super important for workers, right? They're not making choices about what they get exposed to. Employers do. Employers maintain direction and control of the work site. And so voluntariness, I think, affects the way that individuals and others perceive risk. There are other things like media attention, trust in institutions — I'm not going to go through the whole thing. But depending on who you work for and depending on who you're advising, I think it might be helpful to have this little list in the back of your head and you can refer to it, especially if you're preparing for some sort of risk conversation. All right, let's talk about analyzing and feeling risk. Do people actually — do they analyze risk or do they feel it? Which is — you guys are smart, right? That's the false question. Of course, they do both. Yes and yes. People analyze risk and they feel it. And so here it depends. On the left-hand side is the analyzed risk, you know, your risk of getting some sort of insect bite, in particular an arachnoid. And that's your left, right? Yeah, your left. And then also your right. Here's this very scary-looking picture of a spider. So people have a tendency to both analyze and feel risk. And, in fact, this, again, this comes from — oh, gosh. I think this is the psychosocial literature in particular. And they talk about how we have experiential and analytic systems for processing risk. And so in the experiential system, it's very holistic. It seems to have affect associated with pleasure, pain-oriented, more rapid processing oriented towards immediate action. And then, of course, there's the analytical, where you have reason and logic. It's a little bit slower in processing. And people have a little bit of both, okay? And that becomes important because people will seek risk information. As a matter of fact, what happens when people seek risk information on their own? And so I invite you to think about, when you walk into the room and see a patient, and your patient presents with a particular complaint, I'm not sure how many of you ask the question, what do you think that it is? I recommend you do that. I recommend you ask patients, what do you think that it is? Because I am certain that before they've seen you, they have seen Dr. Google, Dr. whomever. They are clearly trying to figure out what they have. But here's the trick. Here's the thing. And it's like all of us. We all seem to be hardwired towards this confirmation bias, which basically means that seeking or interpreting evidence in ways that are partial to your existing beliefs, expectations, or hypothesis in hand. And the idea is, when you, you, when we, when we look for information, we kind of latch on to the things that reinforce what we're already thinking, and we kind of downplay the ones that we're like, oh, I'm not so sure. Like you kind of like discredit that stuff. And that, okay, that turned, it's good to know this, and the reason why is because it shows up in all sorts of places. It's exhibited in a variety of contexts. Sometimes it's motivated, like I deliberately want to find things because I want to prove my point, and other times it's unmotivated, like you don't really know that you're actually doing it. You should note that influenced by earlier information, pay attention to that, because I'm going to give you some ways to get around confirmation bias, but things that you encounter first kind of seem like, oh, that must be right, because that's the first thing I found. And it may actually be displaced by something called avoidance of decision errors, like the, I don't want to make the wrong decision, so I'm just going to try to, you know, get the information that I think at least it's going to help me avoid the error. Now, here's the problem with confirmation bias, as I'm talking about it lightly from an individual perspective, but let's get serious, because this actually affects us as people who practice medicine and who are in the process of trying to deliver the right diagnosis and the right treatment, this is bad. This is bad for us, and there have been studies to show that confirmation bias does affect the way that physicians will see their patients, and to the wrong, and basically to a patient's detriment. Now, I'm showing you a different context if you look in your, what is that now, your bottom right-hand corner, in legal system as well, presumption of whether or not somebody is guilty or not guilty. So confirmation bias shows up in professional settings, and I do think that we have a special duty as licensed healthcare professionals to be cognizant of it and try to compensate for it. All right. We're kind of coming to the end here, at least of my part, and big setup for you, Laura. So what do employers think about how we're doing in terms of communicating, you know? And so NIOSH, we went out, we asked employers, and they said, oh, you know, we did this, I don't know if you guys are familiar with this, the National Assessment of Occupational Safety and Health Workforce, and I kind of, I can't remember if this showed up in the previous session on, Eric, I don't remember if you guys had this in your Rise and Rise of Occupational Medicine Residencies, but this is one of the things, NIOSH went out and said, hey, to employers, you know, what do you guys think about occupational medicine physicians? Like, what stuff do they need in terms of education? And employers basically said, look, we, 38 percent of them said, we want, over the next five years, they're like, we are definitely going to be looking at folks who can communicate with workers, seem to have leadership skills, and certainly can communicate with upper management. So communication continues to be an essential trait for us as practicing physicians, people who employers look to for information, and certainly matches with one of our competencies. All right. So back again, I'm recycling, okay? So we're all recycling today. Here's your six principles for making teaching sticky, and I'm going to stop there, and I'm going to hand it over to you, Laura, and Laura has some great experience that she's going to share with you this morning, this afternoon. All right. Go ahead. All right. All right. So this is the part where you get to participate a little bit, okay? So we're going to start off with, you've heard all of the core competency background, how the government makes up all that CDC stuff that we were all using to try and save everyone during COVID, right? So now we're going to put theory and practice. So let's learn a little bit about each other. How many folks are doing, their main form of risk communication is in that doctor or provider-patient interaction? All right. How many folks are more in a chief medical officer leadership role where it's private companies with workers? Look around the room. All right. How many are in more public or government entities developing stuff for the general public or other groups? Oh, come on, raise them up high, let's see them. Okay, so there's a split here, right? No matter which group you're in, and obviously being from a railroad, my perspective right now is gonna come from a private company talking to its workers. But no matter what it is, the principles and the practices are very similar, right? The bottom line is no matter what kind of communication, no matter what group you're talking to or aiming at, the idea is to be balanced, reliable, scientific, and most of all agile, because things change on a dime, right? If we didn't learn anything during COVID, we learn that things change on a dime. So biggest lesson that you need to know, and oftentimes if you think back and you look at physicians, what happens? It's a problem with reading the room, right? So understanding your audience and who the message is going to is the biggest thing. And in order to understand that audience, you need to understand their needs, you need to understand their relationship to the incident, their issues, what are they bringing into the room? What are the questions that they want answered? What are the demographics and the culture that they are coming from? You need to be culturally competent, okay? Doesn't matter how great your message is, if it doesn't get to the people you were intending it to get to, it's irrelevant, it's meaningless, right? And you will be judged, all right? Be ready for it, it ain't pretty all the time, right? But it's not just what you bring to the table, it's not just that you're the subject matter expert and you know everything there is to know about asbestos or whatever it is, right? It's the content of that message, the credibility of the person delivering it, because once you've lost that credibility, it doesn't matter how good your message is, you're done. Right? The way you deliver it is also very important, all right? So, it's all about trust. And once you've lost that trust, doesn't matter what you do, doesn't matter how good your message is, doesn't matter how much the people in front of you need that information, they're not gonna get it. So, knowing your subject matter is the baseline, right? The assumption is you know, you are the expert on this, that's the given. Meeting the audience where they're at, making sure that you're using language that is appropriate for the room, all right? But being ready to up the technical language if somebody challenges you in that area, right? You can't dumb it down too much either. So again, it's about reading the room and knowing where you are. If there are gaps in the science, and we all just went through this, right? With COVID. If there are gaps, you acknowledge them. Don't try and fill the gap if you don't know, or if you don't have a source to back up your statement, okay? Because that's gonna go to your credibility. And you know what? We live in the gray. There aren't always black and white answers for everything. And it's okay to say that. People will respect you more if you acknowledge that. Because trust me, they're going behind you on that internet, on their phone, and they know. So don't try to hide it. Addressing what is the main concerns for the audience is another piece of this, right? You need to know what they wanna know before you walk in the room. You need to know what info they're all talking about and looking at on the internet before you walk into the room. Before you write that piece for a newsletter. Before you put the script out for a TV spot. Whatever the situation is, as much information and background that you can get, the better and more effective your messaging will be. And the other thing, and there may be some people in here that don't like this, but I like it. Occupational medicine is a team sport, right? We're part of that team. And so this is another instance when you're doing risk communication where you wanna make sure that you have involved all the stakeholders. Meaning IH, labor relations, if you have corporate communications. Whoever, whatever, whatever the subject is, make sure you've made your rounds. It makes people feel included. It makes them more likely to support whatever it is you're putting out there, okay? And it means you're less likely to have surprises because I don't know about you, but when I'm standing up there with a TV on me, you know, with a camera and a TV, the last thing I want is a surprise. And again, because of the internet, because information is so readily available everywhere, being able to provide credible sources for people to go after you're done talking and look up themselves, that are going to support what you just told them. Super important, you know, because as you know, not everything on the internet's true, right? So we wanna control the conversation and make sure that we're pointing our folks towards credible sources so that they're making educated decisions. So when you're doing communication with groups, make sure you're never losing sight of the goals, right? Information is meant to improve the audience's understanding of the situation or topic. It should be actionable. It should empower them. And ultimately, it needs to address their needs and give them enough information to act and make decisions so that they can protect themselves, their coworkers, their families, the rest of the community. Make sense? So when are there problems? As lots of times, we've all seen it. If there is a lack of resources, you don't have the ability to do certain sampling. Maybe the information is not there. There isn't enough science behind it. This is another situation where having alignment of the leadership team with whatever messaging you're putting out, if you're in a position like that, is super important. Because if you as the doc or the provider, the medical person is saying one thing and your C-suite is saying something else, you're gonna have a problem. You may not be there very long either, right? That's the other thing. The credibility of the communicator, again, is paramount. Once you've lost that credibility with your audience or they see you as not being knowledgeable, not caring, not being able to be relatable with, you're gonna lose your ability to empower people with a message. And even if you do everything right, realize that the situation that you're stepping into may have elements of hostility, disagreement. I deal with labor unions, right? So Lord knows there's a lot of white noise flying around a lot of times. That stuff, even if you do everything else right, could still impact and interfere with you being able to get a message across. You still do the right thing at the right time for the right reasons, okay? Oh, going back. This lack of interest by the audience, right? We've seen that, right? Especially with COVID. And I hate COVID. We've lost interest in COVID, right? This is an example of lack of interest. But that being said, COVID really, and that was really how John and I came up with this talk was because we were talking about all of the risk communication that we had done for the last three years surrounding COVID and what some of the pitfalls and challenges we had seen. And the interest is definitely one of it, one of the factors. Being culturally competent, meeting people where they're at, right? We've all seen that challenge with trying to get people vaccinated. A great example, right? So, we've got lots of examples of successful risk communication. There's lots of ways to do this. Always have to start with the messaging. Are you looking, is the message meant to inform people? Is it, or is it meant to influence behaviors, right? Think about it. You need to purposely and mindfully think of these things as you're developing your messaging. What kind of media are you using? Making sure you're culturally competent and we're hitting everything we need to hit. Making sure that you're acknowledging the situation that your audience is in, the place they're coming from, the concerns that they have. And then make sure at the end, there is always something to learn. No matter who you are, no matter how high on the food chain you are, there is always a lesson to be learned and there's always something that can be done better. So, make sure you go and you learn because there will be another opportunity down the road, for sure. All right. Two different types of communication. Crisis communication, when it's all gone to hell in a handbag and you're already in the midst of it, right? Versus risk communication, where something might go wrong, but it hasn't, and you just wanna educate people and be ready for it, right? So, you're not the company that sent out the product with salmonella, but you have a similar product and you're already getting the calls from concerned customers. You wanna be able to control that message, allay your customers' fears, and make sure that your product still goes out as it should. So, we're gonna talk about what I think is a good example of successful risk communication. And this has to do with how Union Pacific handles wildfires. So, on the West Coast, as many of you will know or have lived through and experienced, lots of issues with wildfires over the years on the West Coast. And being a railroad and critical infrastructure, we still have to operate when it's safe to do so. So, the question is, when you have a population in situations like this, I don't control where the fires are, the tracks are where they are, how do you empower your workforce, educate the workforce, so that they're wearing proper PPE, that they know what to look for, and that they feel comfortable and confident that the company is monitoring the situation in a way that they are, when we send you out, you are reasonably certain that it's safe to go out, okay? So, how did we do that? We did it, it was a multi-pronged approach. And a team sport, okay? It involved industrial hygiene, it involved operating, it involved labor relations, corporate communications, legal, because the lawyers are everywhere, and my occupational health nurses who are embedded in the field. So, you know, boots on the ground. So, team approach. And what we did was across the board. We did article, here you can see an article that was online that is emphasizing how everyone is aware, well, this was during COVID. So, they're wearing masks because of COVID, but that even locally, there are teams that are addressing it, right? So, you're engaging your own workforce to their peers are part of the solution, right? We made sure that leadership went out into the field, right? If my workers are gonna be out there, then your C-suite should be out there too. So, this is just a snapshot showing that the CEO was out there. You can see some of the conditions that folks were working under, replacing track that had been damaged. And then what we did was we listened to their concerns, right? Because if you're involved in any of this, you know that there are some state monitoring that goes on, looking at air quality levels, right? And most of the railroads use that as many other companies do. But we had some concerns voiced by employees that maybe that wasn't enough. And how do we know that that's applicable to me here in this yard, train yard? So, we went around, we took a look, we listened to the pulse and what people were saying. And ultimately, the company decided to invest in doing some of our own monitoring. So, back here, where is it? On the, I guess it's on your right, that's actually an air monitor that we installed. It's an example of ones that we installed around the system. So, we could do our own air monitoring. So, it validated the data we were getting from the state and we created dashboards that had real-time data that all the employees could access. So, if you were in that place, you could see. And people, and we educated them. So, they knew what the numbers meant. They knew when they should be wearing their PPE. They knew at what level we would cease operations. So, communication and education, super important. We had daily briefings. We made sure, concerted effort by supply to make sure that there were extra respirators and N95s around the system. So, I never had to take that call or hear it on the safety hotline, which we'll talk about. I didn't have a respirator, right? I don't want to hear that. There's no reason. It's all over. We do have a safety hotline used for this as well as other things. Important thing with that is to make sure that it is acted upon quickly. Timely response is super important to building the credibility and allaying people's fears. And we talked about the others. Also, I just wanted to mention that educating the employees so that they can be informed consumers of information is super important. And we did things like brochures as well because for us, we know that our particular workforce, they like to take things home. And we want them to have their family educated too, right? Because the smoke doesn't stop at work. It's when, can Johnny safely play baseball when he has asthma, right? So, we're trying to help all around with everything, family, community, and the employees. So, now we're gonna shift real quickly to a not so good risk communication scenario. And we're gonna talk a little bit about Japan's Fukushima nuclear power plant crisis. So, back in March, just quickly, back in March of 2011, huge earthquake hit Japan, 9.0 on the Richter scale, followed by a tsunami, lots of damage, structural damage to the power plant, ended up with a nuclear meltdown and radiation being released into the environment. If you're really interested, this is an interesting story if you haven't read it, I encourage you to Google it and look, there's a lot of information on the risk communication and what went wrong in Fukushima, all right? Besides the actual nuclear stuff that went wrong. This is a great case study for risk communication and learning what not to maybe do in the future, all right? The first thing that happened, so Japan has this super sophisticated computer model that can predict the spread of airborne nuclear particles, right? So, from the minute that the incident happened, this system was gathering data and making predictions of where the spread could go. The first problem and where credibility started to get lost with risk communication here was that the communication didn't happen. The government didn't let folks know about the results from this computer program and where there was potential spread. So what ended up happening, certain groups, when they evacuated, they actually evacuated from places of lower potential radiation to areas of higher potential radiation, all right? It took two weeks for the government to come out and share this data that they had with the population. And hence, they had some credibility issues. There was a lot of mistrust and anxiety that resulted as far as that goes. And apparently during that time, obviously I wasn't there, there was this push to try and reassure the population and in the push to reassure people and try and quell any sort of panic, statements of misfact may have come out or maybe not completely truthful as it turned out later. So they may have rushed to judgment by proclaiming certain foods like rice and fish were not potentially contaminated and later were found to be maybe potentially contaminated. Again, increase the public's distrust. They also had instances where they raised what was the acceptable exposure rates for children and there was no explanation. So this goes towards why you need to explain when you're changing things, right? We kind of saw that with COVID, right? Things were changing on a dime and I don't know about you, but I often found myself in the situation where I had to explain why we were changing things the way we were. So again, if you're interested, there's a lot of information out here on how things went wrong. It really created a lot of anxiety and there are some studies out there even now that are showing 10 plus years later that as a result of how that was handled, there was an increase in depression, anxiety, lifestyle changes where people were afraid to go outside that have impacted the overall health of some of these communities long-term. So very interesting. All right. So overall, the lessons we've learned. You need to be proactive. If you start to hear rumblings of something, whether it's Ebola, Zika, whatever it is, start early while you still have the energy and it's not a crisis. All right. Even when you're tired, make, you know, and we found that during COVID. Keep going back. You can't ever lose your vigilance once something starts, no matter how tired you are. Yeah. Be prepared. You are expected to be the expert. All right. So think before you say something, because you can't take it back. And the minute you say something that goes that in a moment of being tired or whatever, you're potentially risking your credibility and the trust that you've built. Make sure you have the data and options ready. Right. So depending on the situation that you're in, companies, I know mine, they're data driven. So you better have the data behind you. I better have options. Right. You and I may agree as physicians that this is the way that we go on this subject. Right. That may not fly always with the folks that we're consulting with and the people in that C-suite. So one of the lessons I've learned over the last three years is to make sure that I have at least two, hopefully three options that I can sleep with at night. And you need to know when you're going to draw that line in the sand that you're not going to walk over and be ready to take action on that, even if it means walking away. All right. Because once you've lost that credibility, even though you might think it's only for this one situation, it can follow you depending on what the situation is and who you're doing it for. All right. So be mindful. And remember that every word counts. And this one, the last thing on here, you're not always going to be comfortable with everything. Okay. But you need to be comfortable with who you are, your role in the situation, and what your goal is in the activity you're about to encounter. All right. So here's where we are down. We have ten minutes for questions and for sharing. Right. Because John and I aren't the only people in here with experience. So how about some examples or questions about situations that you all have been in that maybe were challenging or you learned something from? Thank you. Brian Davey from the World Bank. Something you didn't refer to much was putting risk in perspective and ensuring that your audience understands the way in which risk is being expressed. So two simple examples. The media perhaps overexploits a statement like group X has a 50% higher risk than group Y, which sounds frightening. But if you know that group X was 3 in 100,000 and group Y is 4.5 in 100,000, then it doesn't feel so bad. Or putting risk in perspective of familiar events that people are used to and don't worry about. So that a particular risk of a bad outcome may be the same, you know, the classical examples of dying in a traffic accident or something. I found that very helpful with the COVID side where such an unfamiliar hazard, people overreacted to the real risk, which of course was real in many places. But there was a way to make it more acceptable in terms of risks they understand. Yeah. Thank you. That's a really good point. And, you know, depending on what and I hate COVID, but we're going to use it as the example. You know, depending on where we were in that COVID pandemic, trying to address that, I mean, because if the media and everybody is saying this, you're going to hurt your credibility. And what happens if you say that something very different, right? So that goes back when I got into situations like that, where we wanted to quell the hysteria and we thought that the media was like stirring things up. How do we bring people back to being a little bit more rational and putting it into perspective? That was where I kind of had, I went to my corporate communications people and we sat down and we talked about it and we looked for examples that they felt would resonate with the population. So it's not as easy as you think it is to try and turn the ship, so to speak. If everything is saying this and we as providers know that it's not necessarily all that bad, the sky's not falling. How do I get you to where I'm at? Right? Great point. Thank you. Can I comment on that? Yeah. I'm going to make a comment on that too. Something that shows up specifically in workplace environments. And so I think your point about providing reference points for risk is important. You're trying to increase meaning. By providing a reference point, what you're trying to do is you're promoting increased meaning by the person, by the individual that's receiving this information. And in doing so you're empowering them to make choices for themselves. And so I very much appreciate that. And so we can talk, you recall I talked a little about thinking versus feeling risk. So you can have a series, you could pick your reference points. You could lead with very technical reference points depending on who this is and actually give numbers. You might give different reference points which would enable people to process that risk from a feeling perspective. But I do want to just point out one fly in the ointment. And that is that we have to be mindful that when we communicate risk that we not add our own judgment to that risk. And what I mean by that is what you consider to be a small risk may be a different smallness to someone else. And in particular for workers. And so for workers who may be asked to assume risks for the purposes of their employment, we have to be mindful that we not actually communicate risk levels that somehow take away their perception of the risk. And so I certainly am all for giving reference points. We try to do this. And by the way, this is very difficult. I find this difficult to do. We have many conversations inside NIOSH trying to think about the best way to communicate risk. I don't know how much we hit the mark all the time. But it is certainly a conversation that we would have internally. I'm sorry, I think I might have over talked to you, but go ahead. We were in the field when vaccination came out. And our team was able to achieve a 97% vaccination rate in our unit. And a lot of that went because the medical professionals and the crew took the time to explain. We used all these principles that were outlined here. But the thing that really put us over the top was the leadership of the unit, not medical people bought into it. And so when the private sees the colonel rolling up his sleeve getting poked, that goes a long way toward success of the whole mission. Because that was our mission, right? We've got to have a ready force in case we need another mission that's a little bit more critical. And we've got to have healthy people to be our primary mission as warfighters. And that was a really big success story for us because we were able to get that leadership buy-in. If we didn't get that, I don't think we would have been as successful. Thanks for sharing that. Yeah, that's a great point. Go ahead. Hello, Judy Eisenberg from NIOSH. I would really like to hear your input about message fatigue, whether it was a year into COVID and the risk and transmissions rates were so high, or things like modifiable cardiac risk factors. So how do you combat that message fatigue? People are tired of hearing the same thing over and over again, but the risk is still there. I think she was asking you. Judy can call me on the phone and ask me this question. So I kept praying for fatigue, actually, because I was getting hauled onto the UP TV, sitting next to the CEO, like once a month. And it was interfering with me being able to do other things. But unfortunately, people wanted to hear it. And they wanted to hear it for some reason from somebody like me. And so the highest participation and viewing rates were when we did COVID spots and question and answers. And I took questions freeform from the field. You could just type them in wherever you are all over the country, and we would answer them. So we started to get the fatigue once we got two and a half years in, right? Two years into it. Everybody got fatigued. I mean, how many people were in Utah last year for AOHC? Show of hands. How many people got sick afterwards? Show of hands. Yeah, right? So I mean, you know, we knew what we should have been doing. And we still, we were fatigued at that point. I think you have to change the messaging up. You have to come at it from another angle. The unexpectedness, wasn't that one of the ones? Unexpected. So changing the message up. And this is where if you have the opportunity and you're fortunate enough to have other stakeholders that work with you, like in corporate communications, figuring out how to do that. We started doing, in small areas, we would do competitions between groups, where we'd do spot checks to see who was wearing their masks correctly, right? And whoever won got like ice cream that day or whatever. So I think you combat the fatigue by changing it up, looking for new angles on the message, and a lot of prayer, probably. Yeah. Thank you. Hello. This is more of an experience, really. I love what you say about the teamwork. It works. In my experience, it works. There was an incident years ago, the place I was working, it was not in my factory, so they had to teach that event to distribution centers. Basically, it was 18 wheelers didn't follow the procedure in safety, doctors talking about safety, and the 18 wheeler crashed the foot of the work, right? So how do you communicate that? How do you try to change that mindset into the employees to start following the procedure? So we sat down and we said, hmm, what can we do? And I came up with this crazy idea. Thank God, as a team, the leadership and the safety guy were agreeing with me, and they said, okay, let's do it. What we did is we bought a couple of protective equipment, like the boots, fully new, branded from the box. We put all of the employees in front, and we did a demonstration. We also bought a piece of a cow. Yes, exactly. So we put the meat and the bone, basically, yeah, I don't know how to say it, inside the boot, and we obviously, taking all the precautions, we let the 18 wheeler drive slowly, and you could hear the crack once the wheel passed on top of the foot, even though they were wearing boots. That sound and the faces of the employees is priceless. Why? Yes, because nothing happened. It wasn't in that site, but it works. So another way of communicating things could be boots on the ground, agree with you, teamwork, but also demonstrate, be creative, be innovative, try two things different, but just an experience. That's the unexpectedness and the experiential. And experiential, too, right? Great example. Yeah, that's cool. I'll mention two examples, good news and bad news. The good news is, 1982, I was working with IBM. We were making toner cartridges for a duplicator, a printing machine, and there was a question of whether TNF, trinitrofluoranone, was a hazard or not. We had no idea. We had tens of thousands of employees who were concerned. The good news is, we invited NIOSH to come in, review the literature, and to help us design a study, a longitudinal study, and we communicated this to our employees, and they trusted us and they believed us, and so the concern went away. So that's the good news. That's a great example. The bad news, COVID. The whole country is exposed to mandates to wearing masks, but of course, there's not enough N95s, so people are told not to wear N95s, to leave those for the healthcare professionals. So there's much confusion. My friends who are certified in public health and preventive medicine are saying masks are no good whatsoever. They only monitor very small spaces. The viruses are much smaller. There's no evidence that masks do any good at all. Did we get any risk communication from the Industrial Hygiene Association, from NIOSH, or from the government about that? No. There was confusion for two years as to whether masks really were useful or not, and the most recent communications are saying they're not useful. So I think that's a lesson in humility during a time of great confusion. John can't comment. I'll comment just very briefly. I think that was a very complicated, certainly a complicated scenario, and having an understanding of what you're preventing and not preventing, I think, turns out to be important. And so I think that there was that message, and having a message sort of evolve over time, I think these are all aspects of having an appropriate risk conversation. In addition to that, there are multiple parties that you're trying to advise all at once, and so there's a difference between advising, say, a sophisticated audience versus other audiences that are very general. I'm not here to say one way or the other, defend or not defend per se, but I will say that that example that you raise, I think, is embedded with plenty of opportunity, I think, to study and really think about how to communicate risk, because I think it turns out to be really important. So thanks for raising it. And I do think that as the years go on, Kent, that they're going to dissect what happened. We're not out of it yet, so I think we need a little distance. I think we're still all a bit fatigued from it, but the autopsy's got to be done, because otherwise we'll never learn, right? So, go ahead. Thanks for the question. I just want to talk about an experience when the community, when you operate in a community within a community, and the health communication actually have effect on the other. Now, we are in a community that everything works, but we are among a community where things may not go the way people want it, and so it poses a challenge when you're trying to tell them to do the right thing. COVID will always be our reference, and when COVID came on everybody, one major thing that we battled with was the appropriate use of masks. There's nothing we did not see, number one. Then number two, they were wearing it anyhow they like. Some would put it below the chain, some on top. Anyhow, you see different things. And so when you're telling them, please be careful, this is not the right thing, they tell you something must kill somebody. So you find a friction between the ideal. Meanwhile, the community where we belong, people comply, everything works, but they go back to the community. And so when they get back to the community, you look hard among the many. So that was the challenge that we had. But the lesson there was as much as we can give the talk, communicate the health risks, and maybe help them as well. Provide the little things that they can do, but it won't go anywhere. So that's one of the challenges. Thank you. Thanks for sharing. We certainly come to the end here. I want to thank all of you for participating and sharing your examples. And hopefully you guys will continue to share your experience with us. We'll be around shortly after this if you'd like. So thank you very much.

risk communication

effective communication

audience understanding

tailored messages

credibility and trust

teamwork and collaboration

proactive risk management

message fatigue

changing messaging strategies