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In Change Management, High Stakes, Quick Think, Strategic Positioning

A Win for Patients…and Rural Providers

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Note: This piece was originally published over the weekend in our Sunday newsletter. Want content like this delivered to your inbox before it hits our blog? Subscribe here.

The Big Story: New study finds consolidation lowered mortality in rural hospitals

“Rural hospitals that merged with or were acquired into larger health systems are associated with greater reductions in mortality for conditions like heart failure, stroke and pneumonia compared to facilities that remained independent, according to a new study.

What it Means for Your Health System

(2-minute read, 13-minute podcast)

Some good news for those trying to make the case in favor of rural hospital M&A. For too long, insurance companies, policymakers and some parts of the media have been filling the “cons” column with negative consequences – real, alleged and everything in-between – of rural providers joining up with former competitors and larger systems alike. Now, this study, published in one of the reputable journals within the JAMA constellation, offers a solid datapoint for the “pro” column.

We’ve been encouraging providers pursuing partnerships to tell their story by explaining the value that partnership will create. We’ve also advocated for finding data that can undergird those arguments. And so for many reasons it was encouraging to see lives saved – mortality from heart attacks was cut nearly in half following an acquisition, mortality due to stroke decreased by about a third.

Whether your organization is looking to acquire, be acquired or simply help change the narrative around consolidation, add this study to your stack of materials. Here are some considerations as you do.

Be motivated. Nothing in the data guarantees an outcome, but rather shows what’s possible. That possibility can serve as a goal for everyone involved. “They cut mortality by half? It can be done – and let’s take it further!” It’s a way to connect back to your mission and give your people hope through the promise of making healthcare better.

Learn from the results. Use the overall data as the impetus to look at how other providers have succeeded. It’s the action to follow the motivation. That means spending time to reverse engineer the improved outcomes following an acquisition, then working to apply and explain those lessons for your specific situation. Who knows? Even hospitals who aren’t in the middle of a deal might find some valuable ideas.

Go on offense. A risk with positive data such is that it can become fetishized, something that advocates for a deal instinctively point to every time criticism comes their way. Don’t give in to the temptation. For one thing, you run the risk of muddying the waters by getting into a tit-for-tat argument. “They showed that costs went up? Well, we showed that mortality went down!” Technically accurate, maybe, but not helpful. In addition, if you use data defensively you are, by definition, reacting to the opposition. Instead, be positive and proactive by using the numbers to explain why you’re moving towards a deal and what you plan to accomplish.

Don’t expect a magic bullet. First, what does it tell us? That done well, a merger or acquisition can lead to meaningful improvements. What does it not tell us? That a partnership will lead to meaningful improvement. Be very careful to not overstate results. Getting to better outcomes will take a lot more than just partnering up and letting things run their course. It’s years of careful, mission-driven work to get the desired outcome.

Be patient. The Modern Healthcare article about the paper noted that many of the improvements “were not seen until after three to five years post-merger.” That’s a tough pill to swallow in an instant-gratification society, especially for something as acute and personal as medical care. As you proceed through a deal, it’s critical to set expectations about what is and isn’t possible, including when people can reasonably expect to see the results. But at the same time, explain to people the meaningful benchmarks along the way so they can track your progress towards the goal.

Rural hospitals are struggling and need a path forward. Recognizing those difficulties and mapping the way is the impetus for groups like Rural Healthcare Initiative. Here we have a bit of light, showing that there is a way to improve care for these communities through strong relationships. It takes time and energy to find that right partner, but here we have strong, reliable data that it can be done.

Want to learn more about the study and what it means for rural M&A? Check out the 13-minute conversation with Jarrard Inc. Partner Isaac Squyres.

This piece was originally published over the weekend in our Sunday Quick Think newsletter. Fill out the form to get that in your inbox every week.

In Change Management, High Stakes

Operations and Emotions: A Case Study from Penn Medicine’s Employee Engagement for the COVID-19 Vaccines

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When people do it right, it’s our duty to share.

The “doers,” in this case, were leaders at Penn Medicine. Their challenge was getting their workforce quickly vaccinated against COVID-19.

“Our flu vaccination each year isn’t an issue,” said PJ Brennan, MD, chief medical officer and senior vice president of the University of Pennsylvania Health System. “But for this, we had to be more persuasive. We needed an organized approach.”

In that statement, he spoke for virtually every healthcare leader across the country as they prepared for the COVID-19 vaccine rollout last fall and as studies starting last year revealed concerns about the vaccines among healthcare workers.

Penn Medicine’s approach to driving vaccine acceptance is worthy of a close look – especially for the way it connected with employees of color and groups with high levels of vaccine skepticism. And it offers lessons for other projects requiring employee buy-in that providers will always have to undertake.

How’d Penn Medicine do it? The short answer: It took a careful blend of operational nous and emotional intelligence. By May 2021, all of the health system’s employees and clinical staff had been offered the vaccine, and nearly 70 percent—more than 33,000 people—were fully vaccinated. That month, the health system was among the first, and the nation’s largest to date, to mandate COVID-19 vaccination for all its employees by Sept. 1 and for new hires effective July 1.

Taking Responsibility

Florencia Greer Polite, MD, felt the emotional weight of the pandemic from the beginning. An obstetrician, she was just settling into her role as chief of Penn Medicine’s Division of General Obstetrics and Gynecology when a close colleague got very sick from COVID-19. He was intubated for over 40 days, had a stroke and is now unable to operate on patients.

With that experience setting the tone for “the most stressful of my 20 years in medicine,” Polite considered the fall vaccine rollout. “I wasn’t sure when I was going to get the vaccine, although I knew I would eventually,” she said. “I’m not an early adopter by nature.”

But then she noted she was “a leader – and a Black leader – in this department and this institution. I considered what being at the beginning of the curve could mean for other people.” After hearing that vaccine would be arriving in mid-December, Polite ultimately leaned into her role over her natural tendency. “I said, ‘I’m getting it. I’m going to stand on the side of science and not fear.”

Not everyone in her personal circle supported her decision. Nonetheless, Polite joined a group of other Penn Medicine leaders who received the vaccine on December 16, the first day it was available.

Operating with Intention

While Polite was wrestling with her decision to get vaccinated, CMO Brennan was studying the dynamics within the Penn Medicine staff and considering the operational implications of a mass vaccination push.

What led to success was the one-two punch of an efficient operation that came to life mindful of issues of trust and emotion. So the rollout, for instance, ensured from day one that Penn Medicine staffers could see someone from their community who had opted to receive the shot.

The team recognized that no operational work could succeed without first addressing the concerns of the people involved. That concept is going to prove vital in future non-pandemic, non-crisis change management efforts. Whether getting employees vaccinated or getting them comfortable with a new strategic initiative, addressing the emotional weight of the situation must come early on. This is especially true for skeptical groups – in this case, people of color wary of vaccinations.

Here’s how it looked from Polite’s vantage point: “We’re asking you to not just trust science; we’re asking you to trust us. We did it. We’re not asking you to be blindly faithful. We’re letting you know that you can see us in action.” This idea of trust and honesty demonstrated through personal example was at the root of Polite’s ability to move the needle. She didn’t need to “convince” anyone so much as show them.

Backed by Numbers

Looking at the other side of the coin, no amount of emotional support can make up for a poorly executed plan. Weak operations can damage the most carefully cultivated trust. Feel-good stories open the door, but they don’t finish the job.

Brennan and his team turned to the numbers. They wanted to understand the nuances of vaccine acceptance across the Penn Medicine constellation with a particular eye toward job position and race. “In this context, occupation is a surrogate for zip code,” said Brennan, referencing the public health method of using residential zip code as an effective way to categorize peoples’ demographics like socioeconomic status and race/ethnicity.

“White employees had a higher vaccine acceptance rate from the get-go,” he said. Only about one in five Black employees scheduled a vaccine appointment in the first week, compared to more than half of white employees. Other groups fell somewhere in between.

Brennan and his team worked to close the gap. Polite saw her mission clearly. “I have the opportunity as the chief to make sure that we are an institution that practices what it preaches and takes care of our vulnerable neighbors in Philadelphia,” she said.

Launching the Program

Here, the emotional and operational stories of Polite and Brennan merge.

Their solution was Operation CAVEAT, a multimodal educational outreach approach about COVID-19 and the vaccine that Polite fully describes in a Los Angeles Times column she co-authored with Penn Medicine colleague Eugenia C. South, MD, MSPH.

“CAVEAT allowed us to say, ‘Here’s the organizational structure around which we can be in direct contact with the folks who need to see us,’” Polite recalled. She also connected with the CMO of the Hospital of the University of Pennsylvania (HUP) about the lower vaccine uptake in people of color.

That conversation led to an introduction to Aron Berman, who leads environmental services, food services, patient transport and materials management at HUP. “We talked very frankly about the racial dynamics of his team,” said Polite.

Berman said, “There was a very clear problem with high-stakes consequences. I was fortunate to be in a position to have this conversation” and to use his position of leadership to, “do the right thing for our Black and brown colleagues.”

Through that understanding of his team, Berman, like Polite, recognized and acknowledged that race was a significant factor in vaccine acceptance and confirmed that his team wanted to hear from Black physicians.

Matching Tactics to Needs

Having determined who employees wanted to hear from, the next step was how.

Many of the employees on the teams Berman led had limited access to Penn Medicine email. So, the system’s vaccine-related information wasn’t reaching them while false or negative information from external sources was.

The health system responded quickly with several primary tactics:

  • Individual paper “vaccine invitations” that hourly employees could take to the vaccine center and walk in – no appointment, no waiting, no worries about trying to stretch a lunch break long enough to get through the process.
  • A series of posters and one-pagers featuring Polite and other physicians with quotes about why they got vaccinated and facts from the CDC.
  • A set of vaccine-related screensavers featuring Black physicians initially located in break rooms and clock-in/out rooms but later deployed throughout the health system.
  • Inviting physicians – at least one of whom was Black – to join the daily group huddles environmental services, food services and similar teams were already having to listen and answer questions.
  • A town hall meeting, open to anyone in the University of Pennsylvania Health System, featuring a highly diverse group of speakers.

The result was a notable – though not immediate – increase in vaccine uptake among Black employees. While the 30 percent gap they initially had actually briefly widened to 40 percent as uptake among all groups grew, it then declined as the efforts among Black employees gained momentum. Moreover, it’s likely that the effort put forth by the leaders involved will have positive long-term ramifications thanks to trust gained during Operation CAVEAT and related initiatives.

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In Change Management, High Stakes

Psychology, Communications and Vaccine Hesitancy

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We fear things that can help us. Why? And, maybe more importantly, how do we overcome that fear?

A couple of weeks ago, we ran a conversation between Molly Cate, founding partner and chief innovation officer at Jarrard, Dr. Mark Wenneker, a partner at The Chartis Group and primary care internist who leads Chartis’ behavioral health practice, and Dr. Danny Mendoza, a psychiatrist with the Beth Israel Lahey Health System and an expert in behavioral health integration. In that conversation, we looked at some clinical principles healthcare leaders can apply to their teams, patients, and the public to allay fear in this bizarre pandemic world we’ve been living in.

It was all rooted in a white paper that we published along the same lines. You can find that white paper at jarrardinc.com. But as we went through that first conversation, and as things continued moving forward in the vaccine rollout, it became clear that the principles applied to vaccine hesitancy as well. There’s a whole second discussion to be had with Wenneker and Mendoza about some of the psychology behind hesitancy and how healthcare providers can sort of guide people rather than push them. This is that conversation.

In Change Management, High Stakes, Kaleidoscope

Vaccine Case Study: Understanding and Encouraging the Reluctant

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The pandemic has rocked California. And Cedars-Sinai provides care for over a million people annually across 40 locations in the incredibly diverse Los Angeles area.

Today, as vaccine distribution is underway, Cedars-Sinai is faced with a common challenge: how to encourage vaccination among Black and Latino communities.

We asked Dorian Harriston, associate director of brand strategy, to explain how Cedars-Sinai is tackling this challenge. The answer lies in the organization’s longstanding commitment to community partnerships.

photo courtesy of Cedars-Sinai

Jarrard Inc: The issue of vaccine hesitancy among the Black community is well-documented and something many providers are struggling with right now. What does it look like in Los Angeles?

Dorian Harriston: Vaccine hesitancy appears to be as prevalent here as anywhere else – especially in Black and brown communities.

From my experience, the level of education, income or job doesn’t factor into whether an individual is hesitant to get the vaccine. It’s a deeply rooted effect of historical medical mistreatment that has caused distrust. I hear the same things from family and friends as I do on social media and even colleagues in healthcare: People are afraid, and the conspiracy theories and misconstrued testimonies posted online are not helping. This is a serious issue.

How is Cedars-Sinai addressing the hesitancy?

We’ve prepared an overall strategy to strengthen our relationship with these communities. It starts by partnering with organizations that cater to the needs of Black and brown communities. We hope to be a true partner, amplifying their messages and providing support – and not just monetary support – to increase and sustain resources while conducting outreach to show commitment to our community.

What does that strategy look like in practice?

Initially, we’re doing a series of virtual talks and engaging faith, community and healthcare partners to discuss the issue in various formats. We’re enabling our clinicians and researchers to answer FAQs and attempt to ease fears by responding with facts.

We have to be honest about barriers that cause hesitancy to address them and help determine culturally relevant and satisfactory solutions. Transparency, honesty and commitment are paramount to changing longstanding thoughts and behaviors. We need to regain the Black community’s trust, and we must prepare for a long-term commitment.

Talk more about the role of your team members.

It’s essential that we take as much care internally as we do externally. We’re creating internal conversations around vaccine hesitancy and trust, taking the time to tackle this initiative collectively because it affects all aspects of the programs and services we provide as an institution. Employees must be ambassadors that carry factual and positive messages to their circles of influence. It will take a village to make headway.

How is it going?

We’re just getting started. The first step is to find out what Black and brown communities want and need. We’re doing this through our partners and stakeholders. Partnership is the key to expanding outreach and ensuring the message is reaching every audience within these communities. We need to communicate with influencers – whether that’s the internal family circle (caretakers responsible for multi-generational households, children that bring new information and technology, etc.) or external relationships (faith leaders, clinicians, community and civic leaders and friends). Organizations have provided what they believe this demographic needs for far too long without doing the research to back it up. We want to be sure we are addressing needs in a way that helps build trust and establish a consistent path to preventive care.

Healthcare is local. How do you, as a large system with a significant geographic footprint and diverse patient population, present messages that will resonate with each community while remaining consistent across the system?

The pandemic has forced our team to review our current practices for efficiency and align messages across channels. I see us working together more as a team due to COVID-19 than before the pandemic. Although we have a lot more meetings, being able to divide and conquer and form special project teams has allowed us to refine our messaging and reach a larger audience while promoting significant but often overlooked areas – in particular, research, education, and community engagement. These areas create a trifecta with clinical care vital to defining needs, breaking down barriers to vaccine acceptance, and promoting health equity. We also want to ensure that Black faculty and staff are included and visible so that these communities know there are people who look like them working on their behalf.

What advice do you have for other providers? Are there best practices that that apply across the board?

  1. It’s important to align strategy around your organization’s health equity and diversity and inclusion goals. Creating tactics is easy, but it’s essential to have a definitive strategy that speaks to who the organization is and provides a roadmap to inclusively provide for your community’s health.
  2. Ensure that your communication is honest and transparent. There’s no shame in admitting you don’t have a piece of information or don’t know something. Also, remember that one message may not be sufficient. There are varied audiences within each targeted demographic, and having a single message isn’t enough. Having multiple messages and communications vehicles could be the difference between being heard or ignored.
  3. Before beginning any outreach, know that there are no quick fixes. If your organization isn’t willing to invest budget, time and resources, don’t proceed. To battle the distrust and inequity that Black and brown communities have experienced, you must consistently engage and work to understand unique needs, health disparities and cultural norms. Have BIPOC (Black, Indigenous and people of color) on your team or as advisors to vet advertising and messaging and provide communication vehicles such as unique media outlets and preferred ways in which the target demographic seeks and digests information. One wrong message or misstep could injure an already fragile relationship with communities of color.
  4. When crafting a call to action, ensure you have the capacity and resources to engage and execute in a manner that will make it easier on your audience. Right now, individuals are afraid, anxious, angry and burned out. Anything that appears to be unclear or complicated will cause frustration, dismissal and possibly a negative perception of your organization. Ensure that your strategy allows for flexibility and resources that will help everyone within the community – even if you cannot provide those services.
In Change Management, High Stakes, Kaleidoscope

First in Line? No, Thank You

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Why Your Vaccination Communications Must Attune to Justified Reluctance of Black Populations

Nine months into the pandemic, it’s clear that Black people are suffering disproportionately from COVID-19. Now, on the verge of emergency use authorization for Pfizer’s vaccine, providers and government agencies are working urgently to determine who will receive it first. As plans are laid to prioritize and execute vaccine distribution, healthcare providers are well-served to step back and consider how they will address the reluctance of their own staff and their patients of color to get the vaccine.

Assuming Black healthcare workers and patients will want to be first in line for the vaccine is a flawed approach, according to Rick Smith, president and CEO of United Way of Ross County in Ohio, vice president of Advancement and Engagement at the Northern Pennsylvania Regional College, Warren, PA, and a seasoned communications strategist who’s served in senior roles at several prominent health systems.

Smith maintains that when it comes to being first in line for a vaccine, some African-Americans hear this: “You’re going to be the first because, once again, we want to experiment and see how it works. Once we’ve seen the results and tweaked it, then the rest of the population will get their vaccine.”

To that, their reaction is “No, thank you,” Smith said.

“That’s what society has engrained in that segment: We’re your guinea pig,” he added.

As healthcare provider organizations begin to develop their vaccination communication strategies, they need targeted and particular outreach – internally and externally – to reach and better serve Black populations who have been harmed by health researchers and providers in the past.

Jarrard Inc.’s national consumer survey revealed striking disparities in who is likely to get a COVID-19 vaccine, once available.  The results showed that 36 percent of Black respondents reported being extremely or very likely to get a vaccine compared to 57 percent of white respondents. Black respondents also reported lower levels of trust in hospitals, nurses and doctors.

Those results didn’t surprise Smith or Dr. Pam Oliver, Novant Health’s executive vice president and physician network president in Winston-Salem, N.C. and a practicing OB-GYN.

“Our African-American and Latinx communities are extremely vulnerable to disinformation campaigns because they don’t trust who we would say they should go to,” Oliver said. “They may not trust physicians. They may not even trust us, as African-American physicians, because now we’re part of ‘the system.’”

Smith said these disparities are driven by “a history of mistrust,” – alluding to decades of appalling mistreatment and atrocities the medical community has inflicted upon Black people in the U.S., particularly with experimental treatments.

Henrietta Lacks. The Tuskegee Syphilis Study. Cincinnati radiation experiments. These outrages are contemporary, modern tragedies, Smith said.

“A lot of people want to put their heads in the sand, saying that was so long ago and it doesn’t mean anything now. But these are real issues, and we’ve got to start to combat them head-on,” he said.

Further, these infamous examples don’t even account for everyday experiences Black men and women encounter within our health care system. For example, studies have demonstrated that Black women are often not listened to when reporting signs of complications and one-quarter of Black women reported disrespect and abuse from medical professionals in the hospital.

As healthcare provider organizations enjoy overwhelming trust among the public and a politicized battle over the COVID-19 vaccine looms, there’s work to do to overcome barriers to trust among minority groups. To do so, healthcare organizations should bear in mind:

Educate yourselves first to repair trust

Smith and Oliver agree that deeply educating leaders and internal teams is a crucial first step. “A public, open acknowledgement of where the opportunities are and the history is important,” Oliver said. Smith agreed: “There has to be a coming together to first be educated on the history of mistrust and abuse that one body of people have had most often at the hands of others. There is a mistrust, and here’s why.”

Communicate internally first

Doctors aren’t the only ones who interact with patients. Front desk staff, nurse aides and lab techs also need to be consistently prepared with your organization’s message on COVID-19 safety and vaccines – as they also interact with patients. To gain the trust of all patients related to vaccines, “a thought-out, thorough internal communications process needs to happen with these folks first,” Smith said. Oliver added that people should feel empowered to openly ask questions.

Don’t go it alone

While doctors do enjoy the highest level of trust among the general population (53 percent) and among the Black population (45 percent), provider organizations need to push beyond their own spokespeople – meeting people where they are through partnerships with community organizations and groups like historically black fraternities and sororities, Smith said. For instance, one of Jarrard Inc.’s large health system clients works with a network of 80 churches to reach underserved populations. People who are already trusted in the community should be visible and vocal, Smith said. As we say at our firm, “The messenger is just as important as the message.”

Start communicating early and transparently

While it’s true that no one knows when a vaccine will be safely and widely available, health systems need to start building trust and credibility on this issue now. For Oliver, that means being open and candid with internal teams about how vaccines were evaluated and identified and about any potential risks. Even if you don’t have all the answers – no one does! –transparency and openness are key. “If we wait to start communicating when we have a vaccine, it’s too late,” Smith said, adding that systems must proactively devote extra effort to reaching underrepresented communities.

Make a real commitment to meaningful action

To foster trust, Smith said, “People need to see themselves reflected in the organization.” “When African-American patients come into the room and see no one who looks like them telling them the benefits of the vaccine – there’s going to be a hesitancy,” Smith said. All organizations will benefit from a concentrated effort to diversify their workforces at all levels of the system. When it comes to regaining the trust of marginalized communities, “We can’t just tell people they should trust us because we have their best interests at heart,” Oliver said. “We have to find ways to show it.

About the national consumer survey

In partnership with Public Opinion Strategies, we conducted a national consumer online poll of 1,101 adults between July 31 through August 3. The demographics of the respondents included a representative sample of our nation in terms of gender, region, urban/suburban/rural. This was the second survey conducted in response to COVID-19 with the first occurring in April of this year. Both surveys were designed to assess the lay of the land for providers by measuring public sentiment on topics including telemedicine, federal funding, mask wearing, vaccines and provider trust.

About Kaleidoscope

At Jarrard Phillips, Cate & Hancock, we recognize the power of diversity in shaping perspective, generating awareness and leading to long-term sustainable change. This pertains to our own culture, as well as the work we do on behalf of our clients, most of whom serve diverse communities. Through Kaleidoscope, we hope to use our gifts to do good to drive toward action, broaden perspectives and be more inclusive. We acknowledge that as communicators we are better and our work is stronger when we consider all backgrounds and perspectives. We deeply value diverse viewpoints reflective of our communities and believe that only by seeking out and learning from these diverse voices are we able to perceive the world through the eyes of others. We will use our words, wisdom and resources to help our clients build a better healthcare community for the populations they serve and the teams delivering care, all while striving to eliminate racial disparities and being inclusive of all.

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In Change Management, High Stakes, Strategic Positioning

Part 2 – The New Healthcare Marketing: Precision-Based Execution

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In an earlier post, nationally recognized healthcare marketer Reed Smith teased the need for healthcare marketers to drive engagement through precise targeting. Smith is a 20-year veteran of healthcare marketing and digital innovation who serves as Jarrard Inc.’s vice president of digital strategy. We asked him to get deeper into what precision-based execution means and some specific tactics for giving it a go.

Jarrard Inc.: Explain what you mean by precision-based execution

Reed Smith: It’s about avoiding broad digital marketing campaigns. Of course, sometimes you do need to go broad with, say a general brand awareness campaign. But for the most part, when you’re thinking about service line marketing, service line growth or patient acquisition, you need to be going after very specific people. And some of the typical approaches – like running radio ads – may not make sense.

JI: Has the need for or anything about this rifle approach changed over the past few months?

RS: The last eight months have created some interesting nuances. Think about the flu shot. We’re focusing on everyone getting a flu shot going into the winter, so that’s tens, hundreds of millions of people who need it. But providers can still be very specific about the messaging they’re using. It’s not, “Hey, everyone needs to get the flu shot.” It’s differentiating between and speaking directly to moms with kids at homes or empty-nesters or teens.

All of that is going to weigh into where you get the shot, the message that you hear convincing you to get it, the medium used to deliver that message – is it a video or a photo an ad on the local public radio station?

JI: We also know the messenger is critical. How do you combine the right precision-based message with the right messenger?

RS: With digital tools, we have a true opportunity to bring that message to the right people via the right messenger in fairly straightforward ways.

People want to hear from physicians, nurses, therapists, APPs and other caregivers. Once provider organizations have identified those people, digital channels lend themselves to expertise and thought leadership. Think about all the live content we see on Instagram or Facebook or YouTube. People are already accustomed to these types of environments because they’re already doing webinars and taking to other leaders through Zoom.

JI: But are people going to see that content?

RS: Historically, we’ve seen mediocre organic performance on social channels. Healthcare marketing has had to push pay-for-performance if we wanted anyone to see our content. But a side effect of COVID-19 is that we’ve gotten a lot more traffic to our sites because people are looking for medical information they can trust, and providers have been sharing it. We’re seeing a wave of organic traffic. Now we need to leverage that opportunity.

JI: Whether a provider feels behind or keeping pace with digital, how do they grab the opportunity you just mentioned? For example, do they just start doing Facebook live or take a more measured approach?

RS: Historically I’ve been a heavy proponent of “proceed until apprehended.” But it’s important to put some nuance on that. When it comes to digital marketing there’s value in trying things out, beta testing new approaches to figure out how useful they’ll be. You mentioned Facebook live. It’s hard to understand the ins and outs and how useful it’ll be without just using it.

But ultimately, you need to think through a strategy and a plan before you get too far down the road. Healthcare marketers need to answer the question about what a new tactic means for the organization – both strategically and tactically. The other issue to keep in mind is the politics. “If I do something with one physician, does that affect another physician?” Overall, though, if you have an understand of what’s going on across the organization and have built enough credibility to get permission to test and tinker, it’s great to get into the lab and figure out what works.

JI: What else have providers learned over the past few months?

RS: What I’ve found interesting is the expectations around virtual care and other alternative delivery methods. We’ve talked a lot about telehealth and how people have experienced it and loved it. But think, too, about drive-through testing for COVID-19. That’s all in place so drive-through flu shots wouldn’t be a stretch, right? So, organizations have an opportunity because the baseline has been reset.

If you want figure out how your organization stacks up when it comes to digital maturity, check out our 28-question, 15-minute Digital Maturity Survey. You’ll get a complimentary scorecard and benchmark against industry averages.

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In Change Management, High Stakes, Strategic Positioning

The New Healthcare Marketing: Measure Twice. Improve Once.

Measuring tape displaying 7 inches on a granite countertop

We’ve long said that measurement is one of the consistent deficiencies we observe when it comes to healthcare marketing. We’re typically referring to marketing analytics – reach, engagement, reputation, etc. when we say that. But what really needs to happen is that we measure, well, everything.

Providers today must have a baseline understanding of where they are today so they can either consolidate recent gains or make adjustments based on existing deficiencies (or both). A recent McKinsey study suggests that adoption of digital tools by consumers and businesses has vaulted forward five years in just a few months. It’s happened in healthcare, largely with telehealth. But we have to go deeper. It’s not just spooling up new platforms. It’s ingraining digital thinking into the organization’s psyche, getting buy-in from leadership, making targeted investments in tools and people, and yes, measuring the crap out of everything.

It’s also about setting expectations for what digital thinking can do for healthcare providers. This is where providers are lagging. In our conversations with clients and friends from a variety of healthcare provider organizations, we’re repeatedly hearing that people simply don’t have a great understanding of what the expectations for digital are or should be.

To set those expectations, you have to be able to show what digital can do for your organization. But it’s hard to show what digital can do without having the infrastructure in place to do it.

The fix? Instead of going for the homer, swing for singles and doubles with things like:

  • Listing management
  • Scheduling tools
  • Patient portals
  • Chatbots for frequently asked questions

These are all easy to identify. Not always simple to execute, but manageable. For example, since you want people to find the right information when they search for you online, start with that foundational piece. And if you want people to schedule care at their (and your) convenience, look at online tools.

Let’s be clear: This isn’t optional anymore. Since March, the pandemic has forced providers to get those foundational pieces in place. So much care moved online during the pandemic, and we’re still waiting to see what the new equilibrium looks like. As patient expectations have shifted even more towards digital options, providers desperately need to invest in getting the basics right – even though doing so will take some work.

Aside from being the right thing for patients, it’s important for marketers to think big but act small. You need to know what marketing can do for your organization and what digital tools can do for your marketing. That’s the big thinking. But none of that can happen without the day-to-day execution. Ultimately, it’s about people. It’s too easy to get lost in some of the bigger ideas, which just leads to frustrated consumers, distracted marketing teams and dead ends for everyone. Realistically, we have to focus on connecting with narrow groups of people, driving engagement and helping them find solutions to specific needs.

That’s where precision-based execution comes in. More on that soon.

In the meantime, if you want figure out how your organization stacks up when it comes to digital maturity, check out our new 28-question, 15-minute Digital Maturity Survey. You’ll get a complimentary scorecard and benchmark against industry averages.

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In Change Management, High Stakes

You Are What You Eat!

A paper towel with measuring cups and spoons sitting on top

Four Ways to Feed the Health of Your Employees and Your Health System

I love whole foods and can eat veggies nonstop. My body returns the favor with loads of energy and the endurance I need to focus and get through the day. But like so many people, when I’m busy and overwhelmed, the first thing I neglect is my health. Whether it’s eating junk food, ignoring the treadmill, or feeding my soul useless thoughts and doubting self-talk, I begin to suffer from a lack of self-care and concern. I get sluggish. I become lazy, unproductive and feel empty and uptight.

Oh, the irony.

The same is true for the health of your health system. Regardless of today’s stressors – the immense pace of change, technology, your race to improve HCAHPS scores and reduce hospital-acquired infections – at the end of the day, healthcare is still a people business. What you feed your employees is reflected in your patient experience scores, reputation, revenue and even the state of your bricks and mortar.

These four ingredients provide the immediate nourishment your employees and organization need to stay healthy and productive:

  1. A cup of curiosity – Research shows that curiosity is vital to performance. Fostering an environment of curiosity in the workplace, while showing genuine interest in your people, is essential. As humans, we crave attention and long to know that someone cares. The simple act of asking questions to learn more about your employees meets this basic need and leads to better engagement and higher levels of productivity.

But take it one step further. Look for opportunities to create time and space for curiosity each day. A great way to begin is by asking leading questions before interjecting your ideas or the outcome. Be willing to pause, listen and acknowledge when you don’t know the answer. This vulnerability establishes trust and connection.

The bottom line: Curiosity helps us think more deeply and sensibly about decisions. It also improves collaboration, fuels innovation and creative solutions to complex challenges, while strengthening our ability to adapt to change and pressure more quickly.

  1. A tablespoon of collaboration – Employees need to have a voice; it’s critical to their health. When you create an environment that honors and supports two-way dialogue and communication, employees are happier, more collaborative and productive.

Fostering collaboration lines up closely with fostering creativity. Do a pulse check during your next meeting. Ask questions and call on people to share their thoughts and ideas. Consider calling on people by name, or saying, ‘We’ve covered our agenda, what else is on your mind?’ to draw input from those who may not have spoken. Rotate who leads your daily meetings. Ask everyone to share a win from the week. Also, from time to time provide an outlet for anonymous opinions through a dedicated phone line or online pulse poll.

The bottom line: Outlets for expression foster an environment of innovative thinking, improve teamwork and promote a healthy balance between new ideas and the tried-and-true.

  1. A dash of recognition – The majority of employees aren’t solely motivated by their paycheck. A study in Harvard Business Review revealed that 87 percent of employed Americans don’t feel they’re recognized enough, and 40 percent admit they’d work harder if they were recognized more.

Do you recognize your people? Not the “great job” recognition, but the “I see you and know who you are” recognition. Do you know their names, where they work, what they do and how they like to spend free time? I worked for a CEO who insisted on access to photos, names and job titles of everyone working in the hospital. He cared so much that he could call every person in the building by name when walking the halls. He even studied the surgical services’ roster before walking into the unit. This paid huge dividends when nurses on the unit were recognized and called on by name by the CEO.

How are you recognizing your people?  Healthcare workers were some of the most celebrated heroes in the early months of the COVID-19 pandemic. As time has passed, the fanfare has quieted, and for many, it’s now business as usual (or as much as it can be at this moment). With burnout and PTSD at all-time highs for healthcare workers and leaders, it’s more important than ever to keep recognizing your people. The best appreciation is honest and authentic. Take time to write a thank-you note and mail it to an employee’s home. Strategically place sticky notes on employee’s cars. Give public thanks in a group setting when it makes sense, or buy coffee for the nurse in line needing it to get through his shift. And don’t forget your leaders. They carry a heavy burden to ensure employees are engaged. They need to know they’re doing a great job as well. Consider delivering a meal to their home or create a leader award to recognize leaders at all levels of the organization.

The bottom line: Only one-third of U.S. workers strongly agrees they’ve received recognition for doing good work in the past week, and employees who don’t feel adequately recognized are twice as likely to say they’ll quit in the next year, according to Gallup. That’s a high price for something that doesn’t cost much.

  1. A pinch of possibility – Employee development and growth opportunities are critical to the health and viability of your health system. We know it’s less expensive to retain quality employees than to find new ones. Demonstrating there’s a future with your organization keeps employees engaged. Tuition reimbursement, leadership development training, online classes and access to webinars goes a long way in developing your team. It helps you remain competitive, reduces turnover, increases productivity and equips your people for the future.

The bottom line: There’s a correlation between engaged employees and development opportunities. A Quantum Workplace study found that 72 percent of hostile employees feel they receive too little training, compared to 43 percent of engaged employees. Competition for healthcare talent is only going to become more fierce, a pinch of possibility sweetens the pot.

It sounds so simple: “Feed your insides well and you’ll shine on the outside.” The reality is, it takes time, energy, effort and intense focus to deliver a five-star experience that will set you apart from those who are starving for great health.

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In Change Management, COVID-19, High Stakes

Hope Is Not a Strategy

A group of masked surgeons huddling and hugging in their medical uniform

While times of challenge and change are not new, none of us can confidently or reliably predict when the hurricane we’ve been living through for more than six months will end or the exact toll it will take on our personal and professional lives. Without that crystal ball, we plan as well as we can and then hope for the best.

A few years back, I had to laugh when a colleague declared that “Hope is not a strategy” after a thoughtful, proactive crisis plan we put together was killed by a “Let’s just hope, wait and see” leader.

As healthcare providers, we understand the power of hope even as we practice the science of medicine. When hope takes root, our strategies take flight as they are no longer just words on a page, but deep-seated ideas that are lived out in the minds, hearts and actions of our people and organizations. It’s that emotional connection that makes strategies and tactics effective. Facing today’s uncertainty, hope should be a catalyzing element of the strategies we create to keep people positive, resilient and moving forward together.

Consider these seven ways you may be inadvertently signaling that your organization’s strategy and future are hopeless—plus some smart countermeasures to combat the perception.

  1. You stop listening and start assuming. Your patients and employees desire for you to genuinely listen to them. Open the door to dialogue through pulse surveys, virtual town halls and focus groups. Reinvigorate your Patient and Family Advisory Council virtually and encourage managers to conduct one-on-ones with employees using a defined set of questions. Ensure the plans you’ve made align with the needs of your stakeholders.
  2. You lay aside your mission and undermine your values. While hope is necessary, it alone is not a strategy. Before announcing change, ensure your leadership team can articulate how the change will help fulfill your mission long-term. If a decision seems to conflict with your values, lean into the tension and discuss why it’s the right course. Proactively addressing tension helps people respect your reasoning and willingness to make tough decisions, even if they disagree with it.
  3. You underestimate the impact of change. This is a common mistake that can have severe consequences as people in our organizations concurrently face unprecedented (yes, I said it) challenges at home and at work. It’s more important than ever that leaders emphasize partnership over power and demonstrate they genuinely care about employee well-being. By listening, collaborating, making change more manageable and tying it to your mission, you will strengthen resilience and ensure your team has the bandwidth to make change happen. Be upfront about challenges you are facing, ask departments to come up with solutions and remain supportive by following up with a check in on how things are going.
  4. You create a steady drip of negative news. We all know the only thing worse than ripping off a bandage is removing it slowly. Organizations often get too clever in an effort to minimize negative perception and mitigate the impact of tough news. “We’ll announce layoffs next week, benefits changes in two weeks, service-line closures in October, cancellation of our expansion by Halloween…” Drip, drip, drip… Before long, employees come to believe that every communication from leadership will contain negative news. They’ll dread coming to work. When possible, consolidate tough changes into one announcement tied to a compelling strategy and vision – despite the unpleasant process. You don’t have to have all the details to do this. In fact, this type of announcement is the perfect moment to say, “We will partner with our employees, providers and leaders over the coming weeks to implement these changes in a thoughtful way.”
  5. You fuel speculation. Vague or infrequent communication leaves room for anxiety and rumor to grow. If employees or the community sense a scurry of activity among top leadership, chances are they will invent a reason that is likely worse than reality. Instead of pretending that all is well or avoiding communication, be responsibly transparent. It’s usually better to say what you do and don’t know than to let rumors and fear take over. If you can’t answer or don’t know, share what you can answer and do know, as well as what won’t change.
  6. You emphasize money and ignore the recognition gap. Money is usually not the primary reason people want to work in healthcare. The majority want to make a difference and also care for their families. Change challenges morale, so one of the best ways to protect it and foster resilience, trust and pride is by focusing on the recognition gap. Research shows that leaders believe they give recognition far more than employees perceive receiving it. Recognition has to start at the top, and it has to be a priority. Focusing on wins and encouraging those you lead won’t eliminate the sting of no bonus or annual pay raise, but it will help.
  7. You take the community’s support and trust for granted. Beyond your employees, your community is your best asset in solving challenges. And trust is the key to your relationship with the community. If you blindside people with tough news, make decisions that seem in conflict with your values or have a workforce that is actively speaking out in a negative tone, you very well may lose trust and find yourself worse off. Maintain community support by sharing regular updates, talking openly about the implications of external factors like COVID-19 and change in the industry. And, ensure your employees have the information they need to be ambassadors in the community.

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In Change Management, COVID-19, High Stakes, Strategic Positioning

Lights, Action and the Theater of Safety

The inside of an empty vintage theater

Now is not the time to be subtle.

Fear of the novel coronavirus is as intense as it was this spring. Almost 80 percent of people are afraid they or someone they love will get COVID-19, according to a national consumer survey Jarrard Inc. recently fielded in August.

To be blunt, Americans just don’t feel safe. When we asked how safe they’d feel seeking medical care, the answer was, basically, “Not very.” Whether a doctor’s office, hospital, outpatient surgery center, ER or urgent care center, people rated their feelings of safety no higher than 5.8 on a 10-point scale. (If you’re wondering, urgent care rated the lowest at a 5.0). One in four people rated their feelings of safety at a three or below in our August survey. Not good.

And not much better than the results we received in our first consumer survey back in April.

It seems we have lost some momentum.

Think about it. When providers started reopening services this summer, the entire industry was talking about what people needed to hear from provider organizations. Everyone knew about safety concerns. But what seems to have happened is that too many providers created the safety messages, checked the box, reopened their facilities and said, “We’re good to go.” And with volumes coming back, it seems like it was successful.

Digging deeper, though, that strategy doesn’t appear to have worked. Our August survey asked how long people would wait until seeking various types of medical care. Short answer: Unless they really need it, they’re probably not going to come back for around six months, maybe longer. That’s also no better than in April.

What we need, right now, is a bit of theater.

Theater, not because it’s fake. But because it’s visible, clear, obvious. And it makes you feel something. Because people want to see, hear, smell and feel what you’re doing to keep them safe. We asked people what they need to help them feel safer interacting with healthcare, outside of a major decline in COVID-19 cases or a vaccine. Their top answers were:

  • Screening everyone as they enter a medical facility.
  • Masks on everyone.
  • Enhanced cleaning procedures.
  • Isolating COVID-19 cases somewhere else.

In a vacuum, it would be easy to lean back and think it’s okay to stop your entry checkpoints. The CDC says it doesn’t make much of a difference, so why do it? Two reasons.

First, when it comes to healthcare, we know that people don’t seek out information until they need it. People aren’t thinking about the safety messages you put out two months ago. You have to keep those safety messages top of mind. You have to make sure your website and social channels still have information about what you’re doing to keep people safe.

Second, people want to see activity. They want to be a real-time witness to your extensive precautions.

The key point is that there’s a difference between actual safety and how people feel about safety.

Yes, you have to provide safety – this is theater, not a Potemkin village. That means going above and beyond, not stopping at “just enough.” Whether the CDC says temperature checks are effective or not, seeing those checks provides a feeling of safety. So does seeing environmental services wiping down public areas and front desk staff saying, “Here’s a pen that I’ve just sanitized for you.”

Now take a step back. The theater of safety should start even before someone gets to that temperature checkpoint. Providers need to be showing how they’re keeping people safe, so that they feel safer about making an appointment in the first place. That means resisting the urge to demote safety information on your website. Keep it front and center. And the same goes for social media. Proactively share safety measures when people call to schedule an appointment. Even though it’s added work for your scheduling and nursing teams, there’s a lot to be said for continuing those pre-appointment safety calls. In our observation, those brief calls have helped patients realize, “Hey, they’re thinking about me. They’re working to keep me safe.”

All of those things create the theater of safety.

It’s a little cliché in the “consumerism of healthcare” and “patient experience” worlds to point to other customer-facing industries for examples of what healthcare could/should/would be doing. But other industries are creating the theater of safety better than we are. Consider these examples:

  • Southwest Airlines is doing a fantastic job. They’ve just informed customers that they’re keeping the middle seat open through at least October 31. When you board a Southwest plane today, you can literally smell the cleanliness.
  • Savvy grocery chains like Trader Joe’s have stationed an employee at the store entrance who hands you a cart and says, “This has been sanitized for you.”
  • Even actual theaters – movie theaters – are reopening and publishing extensive plans and guidelines. So far, it looks good on paper. The proof will be when we walk in and can enjoy the full two-and-a-half hours of Chris Nolan’s latest masterpiece. (I’ll be there this weekend.)

Know that this can be done – and really must be done. In the end, it’s a great opportunity for healthcare providers to reframe their thinking and keep a good thing going. After all, the show must go on.

Review the full survey results

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