Healthcare Roundtable: Changes in protocol

From social media to reform to risk, the healthcare industry is facing a number of issues that it must address. Erica Iacono and Jaimy Lee were in Philadelphia for this Airfoil PR-sponsored roundtable.

From social media to reform to risk, the healthcare industry is facing a number of issues that it must address. Erica Iacono and Jaimy Lee were in Philadelphia for this Airfoil PR-sponsored roundtable.

Erica Iacono (PRWeek): How has the Web and social media affected your communications efforts?

Ame Wadler (MWW Group): We look at social media very much in two ways. One is: It's media and so it's a great way of getting information out. We don't distinguish social media from media. The outreach part is very consistent with our media relations approach except for one difference, which is that the feedback mechanism is rapid and such a great way of monitoring the conversation and determining what people truly care about and how much information they need. We definitely work through health chat rooms to understand what people want to hear, what they're not getting, and it gives us a rapid response mechanism to make sure that they're getting the information they need and the story right. Because it's so rapid, you can correct it pretty quickly. I think that's a value that is overlooked. We often know what they get wrong and bemoan it, but the opportunity to turn it around and get it right pretty quickly is the beauty of social media.

Lisa Davis (AstraZeneca): We've actually the changed the way we talk about it, moving from social media to digital engagement. Because the issue is [that] it's changing the way we do business and not just from a communications tool aspect. But, what you see is that different stakeholders are making decisions and they're going about doing business differently. In the pharmaceutical industry, we're actually using digital engagement to replace aspects of sales force. It's also really a way you're going to interact with people in terms of life decisions as well as information in a communications channel. It's almost broader than social media or new media. It's a way of life.

Lance Longwell (Siemens Medical Solutions USA): People that look at social media as a different animal have missed the boat entirely because the people who are the social media experts in our space are actually the same ones that are doing 50% of the job. The other 50% is NPR, the trade publications. You've almost got reporters now as their own brand with different channels coming out. The Web digital component is one, the print version is another, they're doing conferences, and it's almost a doubling or a tripling of your opportunities to place stories and influence those messages as they come across. So, we've looked at it as a tremendous opportunity to really change the kinds of stories we're placing and the game of how we're communicating.

Ian Race (Philips Healthcare): We're trying to reach a professional audience of clinicians for the most part. What blogs are they reading? What journals are they reading? What trade publications? How many of them themselves are bloggers and are those the people we want to target? Where we would have taken our messages to a traditional journalist, all of a sudden we're reaching out to a potential customer or a customer directly. It's also forced us to look at not who we're reaching but how we're communicating to them.

Eileen Sheil (Cleveland Clinic): We've identified some people in human resources who are doing recruitment through social media and that's interesting because it doesn't replace the traditional send-your-resume-in interview but it helps us become more aware of some potential people who could be a really good contribution to the organization.

Lisa Vallee-Smith (Airfoil PR): What we're seeing in working with clients across the board, not just in healthcare, is a more tactical engagement of social media and basic digital communications. The strategy behind it is an area where we have a lot of educating to do with clients. They're all fascinated by it and they talk about it a lot and there's lots of experimentation here and there. The most successful programs we do with clients, including those in healthcare, are ones that start with a message strategy and then the media follows along. With social media, you need to have a strategy behind it. You need to know why you're doing it, how you're going to leverage it. In the work that we do with hospitals, specifically, the hospitals are way behind in the use of Web sites. Digital and social media is not even on their radar. There's a huge opportunity for the provider side to really get up to speed.

Iacono (PRWeek): Eileen, do you find that to be the case?

Sheil (Cleveland Clinic): Well, the Cleveland Clinic does everything in a really big way. We're not typical of most hospitals but I agree with what you're saying about hospitals in general. We have a Facebook page. We Twitter a lot. Where we struggle is that it started out really housed in marketing. The corporate communications side, which is my area, came in and said: “Wait a minute. This is not just a marketing tool.” Now, we jointly manage it with a committee and we're very engaged. Where hospitals face challenges is that they don't want to dedicate full-time resources to that when resources are limited. Most are nonprofit. They're small. Half of the hospitals in the United States are operating in the red right now. To put resources toward something that leadership doesn't always understand is a challenge for many hospitals.

Vallee-Smith (Airfoil PR): Yet they're spending so [many] dollars to compete. There's so much money being spent on paid media to compete and yet these fundamental and social and Web media marketing strategies could be doing so much more for them. The only winner in that environment right now is the television media, which is getting this huge resurgence of traditional media buying. It's frustrating to watch spend all these resources when they could be doing basic one-to-one communication, lining up their subject matter experts, and creating that two-way dialogue with consumers who are making decisions about their healthcare in a really competitive environment.

Sheil (Cleveland Clinic): We've done more research lately, looking at why people know about the Cleveland Clinic and about 50% of the awareness of the Cleveland Clinic is based on news media coverage. That was kind of shocking to the organization because traditionally our marketing arm was a lot bigger and the focus was on advertising. But, when they looked at the raw data that really took that apart, they were surprised by what they learned. It's more so than word of mouth.

Dave Daigle (CDC): Does that include the social media or do you break that out separately?

Sheil (Cleveland Clinic): No social media. It's focused on Internet and traditional media.

Davis (AstraZeneca): Now, CDC is doing some very interesting things on the Web and with digital media. How is that working for you? Because that's a lot of investment that it looks like the CDC puts into that.

Daigle (CDC): Our social media folks have done amazing work. We do break them out from traditional media relations in a separate division. With H1N1, there was such a demand for knowledge and for information. There were audiences we were reaching that we never reached before because of the social media.

Davis (AstraZeneca): How do you measure whether it's successful for the investment?

Daigle (CDC): We know the hits and we know the views. Long term, we'll get a better idea.

Michael Fleming (GlaxoSmithKline): There is something hugely transformational right now with the way information is shared and exchanged. That is impacting a lot beyond marketing and communications efforts in our companies. One of the things you hear is that people under the age of 25 only use e-mail to communicate with their parents. It makes a point to show just how transformative technologies are with younger people. It doesn't fit neatly into any of the disciplines that our companies had organized their marketing communications efforts around. A lot of different stakeholders can bump into each other and that's doctors, that's patients, that's policymakers, and bloggers and reporters. That's challenging for big companies that have operated in a very traditional 1975 model for the last 30 years. It's also forcing us strategically to think in a more comprehensive way about how the company communicates with those external stakeholders. It can be frustrating to plan, when you're in a big Anglo-American company like an AstraZeneca or GlaxoSmithKline, and develop policies and ways of effectively getting out and dealing with this changing landscape.

Davis (AstraZeneca): Someone told me the other day that Google no longer sends out announcements in any other way than on a blog. Think about everything that they're saving, from a resource perspective, by doing that. There [are] a lot of efficiencies to be gained at a time when the economy is struggling and everyone is looking for ways to be transformative and innovative and more efficient with their resources. Digital engagement increases. More traditional forms decrease. We started out thinking about how we could control this medium in some kind of way. If the goal is to stop and set out policies and get it together before you get out there, you truly have missed the boat. We're all going to get used to [the fact] that it's a different way of living. At some point, all these extra digital departments and staffs are going to go away.

Wadler (MWW Group): In the agency setting, everybody has a digital group. The thing about our digital group that's so interesting is that they're there to be counsel to the rest of us. Having a media relations division was always kind of silly. Why would you have people who weren't ingrained in the business on a day-to-day basis talking to the media, as opposed to the people who were ingrained in the business? The same thing happened with social networking. It's as much the price of business as knowing how to write and knowing how to pick up the phone and call a reporter. It is already required that you embrace and part of how you do business.

Longwell (Siemens Medical Solutions USA): Your social media strategy has to match your business strategy. My business made the decision that we're not going to engage in Facebook. That that is not the right play for who we are as a company. Twitter is. 

Iacono (PRWeek): How has healthcare reform affected your communications strategy and the messages that you're communicating?

Michelle Davidson (Blue Cross of Northeastern Pennsylvania and AllOne): It's interesting that the Obama Administration has gone from healthcare reform to health insurance reform in the last couple months. The health insurance industry, for years, has not articulated its value very well. We have good assets and a challenged image and reputation. We're using it as an opportunity to communicate much more about who we are as a company and the role that we play in your lives. Some of the regional newspapers have heard what we have to say and we've met with them personally. They were surprised that we were advocating for coverage for everyone and [taking] the ability to exclude anyone with pre-existing conditions off the table. We are for healthcare reform. It transformed our relationship with the media. People thought it was going to be 1993 and we were just going to kill it.

Fleming (GlaxoSmithKline): As a company, we have, for many years, been trying to help people focus the healthcare policy/cost debate around what is the number-one driver of cost which is chronic disease. That has been a focus point of all of our marketing communications efforts, to help educate stakeholders about the costs and the burden of chronic disease. We've had a triple message platform, focusing on prevention; intervention, which ensures that people have access to medicines; and investing and innovation. That has been our three-pronged approach which we have tried to include in all of our external messaging. If you're in our business, people in our roles need to have increasing confidence and understanding and appreciation for the public sector, from a payer standpoint and from a standards and recommendation standpoint.

Sheil (Cleveland Clinic): We did a lot after the President visited the Cleveland Clinic to learn about our model of care. The Clinic feels strongly that the missing piece is the changing the delivery of healthcare. What really drives up healthcare costs is the burden of chronic disease, inactivity, obesity, and smoking. What we did was take the opportunity to talk not just about our model of healthcare but to talk about what really reduces healthcare costs and drives efficiencies in the healthcare system. Your businesses and ours really have a voice in helping to share healthcare reform and, again, we learned the media is the best way to do it. Our CEO has been in front of several Senate committees for his 10 minutes and there was just no follow-up after that.

Davis (AstraZeneca): I think [the pharmaceutical industry] shocked people by being supportive of healthcare reform. We need to address the uninsured for the same reason that we need to focus on prevention and wellness.

Wadler (MWW Group): We've lost the opportunity to think about healthcare in a motivational way. It's become such a business, even to the patient. As communicators, the way we talk about it has become so much about the business and so little about the opportunity to live a well, vital life.

Davidson (Blue Cross of Northeastern Pennsylvania and AllOne): We thought, as an insurer, we had an opportunity. We deal with hospitals. We deal with physicians. We deal with every part of this sector that is not working together. We had a panel discussion with a live audience. We talked about [how] this is the first step in our region to take things to the next level to keep that conversation going and start doing things that actually transform the industry.

Sheil (Cleveland Clinic): That's one of the messages that we've been trying to drive through the media is that hospitals and doctors have to be integrated.

Iacono (PRWeek): A lot of you have brought up the issue of innovation and I'm wondering how much that factors into your messaging? How important is that message of innovation and what audiences are you finding the most receptive or eager to hear it?

Race (Philips Healthcare): People have been talking a lot in this reform debate about the how high cost of healthcare is due to the high cost of technology and as more technology gets developed, costs continue to go up. When we talk about innovation, we are trying to take it away from that business level and talk about why we are doing this product developing in the first place. Certainly, there are some business opportunities there because we are selling products, but that's not the main driver of the innovation. The goal in all of our communications is to not just talk about new features or what specifications are, but to really talk about what a doctor or a nurse might experience by using something new and what that means for a patient. It might be an integration story about how different systems are coming together to talk to one another. We're focusing far more on benefit and patient benefit even though we don't communicate directly to a patient audience.

Vallee-Smith (Airfoil PR): Innovation messaging can be a double-edged sword for healthcare marketing communicators. There is a deeply entrenched and cultural fascination among consumers with technology and innovation. Healthcare marketers have done a good job of leveraging that for good. On the other hand, the innovation messaging misses the larger topic sometimes. We're almost conditioning people to make some healthcare decisions based on the newest, latest, greatest thing. The whole role of family medicine and prevention and good health is a huge missed opportunity for healthcare communications and it will ultimately working against all of us. My great hope for healthcare reform is that this will be the golden age of family medicine and that we as healthcare communicators will have so much rich information to talk about because it is so human, so personal.

Longwell (Siemens Medical Solutions USA): Patient groups absolutely understand the benefit of innovation to them because they are the folks that are still struggling with the burden of disease. They're still looking for the technology, be it imaging or pharmaceuticals, that can help them live.

Sheil (Cleveland Clinic): The patient who met with the President when he was at the Cleveland Clinic was a gentleman from Chicago. He had developed a virus that affected his heart valve and he went to every big hospital in Chicago and they told him, “We're going to have to cut you from here to here and replace your valve with a pig valve and put you on medication for the rest of your life.” He said, “I don't want to live like that.” He ended up coming to the Clinic and had robotic heart surgery. They repaired his valve and he went home in a week and a half.

Iacono (PRWeek): How important is it to get out that patient story? How many of those other stories are you telling or communicating through the media?

Sheil (Cleveland Clinic): We use patient stories about 40,000 times a year. We actually had a clinical trial and we brought in John McKenzie from ABC's "World News with Charles Gibson." We did a trial with these four patients and the story was called “Cooking Brain Tumors”. It was a deep brain tumor that was very difficult to get to. We [used a device] on the tumor and it went away. These patients, then, were cancer free. When we tell those compelling patient stories that have new technologies that are evolving or new medicines that save lives, that's a huge way to tell the story.

Iacono (PRWeek): How are you communicating risk?

Davis (AstraZeneca): It is an interesting challenge within the pharmaceutical industry that's so heavily regulated by the Food and Drug Administration (FDA) about not just what you can say, but how you say it. Everybody has picked up a magazine and seen, on one page, an ad for a medicine and then on the back, there's two-point type that comes up and down. That is required. We have been working with the FDA. The online world has changed things. You can't put fair balance on Twitter. The rules of the road are changing. The stakes are so high. If you misread something in your laundry detergent, the stakes aren't in the same place if you misread something with a medicine. We have a long history across the pharmaceutical industry and the healthcare industry of always partnering with various patient groups and community groups to work on wellness. That's how, in essence, a lot of them get their funding to do some of the groups on the ground, diabetes prevention or cancer prevention or the [American] Heart Association that gets people to walk or to run. It's good that the conversation has elevated at a level with the healthcare debate. But, it's not brand new. There's always been a need for business to contribute and help in that space. It is going to be a challenge in terms of balancing the information that people need to have about side effects in medicines, surgeries, whatever it may be. It's going to continue being a challenge as we become more innovative.

Fleming (GlaxoSmithKline): We are a very special business and we have a heightened responsibility to communicate clearly all of the information that both professional communities of physicians and patients need to make good decisions about their healthcare. We believe that we have a heightened responsibility in that area and certainly that is a priority for us as a company and as an industry. It's not even so much in the direct-to-consumer communications, but it goes beyond that to building trust with both the patients and the physicians and others, like policymakers, to give them confidence that we are doing everything with the utmost responsibility and integrity in the process that leads up to bringing a new medicine to market. That means things like being transparent about the clinical trial process. That is something where we've had a great deal of focus in terms of providing that information and trying to provide it in a way that is meaningful. A lot of it is highly technical and that is the nature of business. It's also the nature of some of the confines that we work within in terms of our marketing communications activities. We are developing and introducing more and more targeted and innovative therapies that require different types of communication. Part of [what] you're going to see is increasing engagement with third party organizations, engagement providing value in terms of disease education and awareness.

Sheil (Cleveland Clinic): We encourage our physicians and researchers to work with industry to collaborate, to develop new technologies, do clinical trials. Where we got into trouble was our lack of transparency over the years. There was a feeling from patients that: If your doctor is doing research or collaborating with industry, is he or she getting paid for that? So, are you doing this in my best interest or your back pocket's best interest? We had a huge initiative after a series of nasty, front-page Wall Street Journal stories on conflicts of interest. We posted all of doctors' relationships with industry online and how much money they make from those relationships. We also updated our conflict of interest policy. Our ability to communicate and manage that risk is really critical to the organization. Although we encourage innovation with our physicians, we also want to be transparent.

Wadler (MWW Group): When I first started in healthcare communications, companies wanted science people to work on their business. The storytelling was all very technical. It was very much about the science. [Since then], that simplification of the language has been very important because what was perceived as lack of transparency was scientific language that was not understandable by people. By simplifying language, making it more accessible, there's actually been more of an understanding of the fact that people are trying to do the right thing in sharing information and giving people information they need to make responsible choices.

Daigle (CDC): It really is a challenge, especially with a lot of our science. You're in conflict with the scientist, who views it as dumbing it down. There is that natural conflict, but it has to put in a manner that can reach the audience. Oftentimes, you have to strike a delicate balance between the scientist who is determined that this is going to be published in JAMA, but you have to try to explain that's not the purpose of a press release.

Iacono (PRWeek): For those of you in the technology space, do you require a more scientific message?

Race (Philips Healthcare): We've seen our approach change over the last couple years, too. We do sometimes have to reach a very clinical or technical audience so we try and cater specific materials for that group. But, in doing so, I think we've recognized that we've been missing out on other opportunities if we're not also going out with a clear simple and easy-to-understand [message]. We've worked really hard to play that internal tug-of-war in terms of satisfying some of the engineering or product folks, but basically explaining to them we have multiple audiences here. We may need multiple vehicles of communication to reach who we want to. In some cases, the clear, simple communication that we send out to people may just be an image.

Wadler (MWW Group): It's really important from a risk perspective, too. At the end of the day, if people don't understand what you're trying to say, there's more of an opportunity for them to get it wrong and do the wrong thing or ask the wrong questions.

Longwell (Siemens Medical Solutions USA): As more junior people, not necessarily healthcare specialists, are moving into the space and covering it on a routine basis, we have to find clearer language to communicate the risks, the benefits, as well as what does the product do, be it pharmaceutical or medical imaging. They don't need to know how to build the imaging system; they need to know how to use it and what that outcome is. We have noticed over the last few years that we're spending more time explaining that background than we ever have before.

Iacono (PRWeek): How has the shift in healthcare media affected your media relations strategy?

Sheil (Cleveland Clinic): Locally, it's more of a challenge than nationally. Our local paper has gone through substantial layoffs. The challenge I have on what we do – they're all looking for jobs. The challenge I see is that they don't have any PR experience. On the other side, medicine and science are so technical that it's sad to see fewer specialized journalists who understand it.

Longwell (Siemens Medical Solutions USA): Someone coined the term “BWARE,” bloggers with ad revenue, - no control and certainly no fact-checking - and I think we've all seen that.

Davis (AstraZeneca): There's the clarity issue, about being clear and people understanding whether it's a journalist who's been covering the beat for a long time or whether it's someone who's doing that because the story's gotten hot and they've gotten assigned. The second thing about transparency is that the expectation has changed. People want to see things now that they didn't need to see before. You've got comparative effectiveness, which is this idea of being able to show, empirically, that my X is better than your Y and to post it all. We've listened. We had some lessons to learn in the pharmaceutical industry, to be frank about it. It is interesting when you have all that information out. You have Wikipedia. You have WebMD. You've got data out there that's transparent but what does it really mean? And, what can you conclude from this? The FDA is under fire. People don't trust the FDA the way they used to. They're the agency that's been charged with making sure that all the data comes through.

Daigle (CDC): When you say the FDA is under fire, can you qualify that?

Davis (AstraZeneca): A lot of people aren't quite satisfied with what the FDA has done, in terms of being able to ensure safety across the spectrum. We happen to believe that the FDA needs to have more resources so that they can. It's a good organization. They need more resources.

Daigle (CDC): I might disagree with you, keeping in mind that your relationship with the FDA might influence what you say about them. I think they've made great progress. I think they've done some wonderful things. In some recent food-borne outbreaks, they've gotten high marks in how they've handled it.

Davis (AstraZeneca): It's not my judgment. It's not even my industry's judgment. We think they are a good organization and they could use more resources. But, they have had a rough patch.

Wadler (MWW Group): From a consumer perception, it used to be enough to say “FDA-approved” and that was the seal of approval. That's just not enough anymore.

Iacono (PRWeek): Has your approach to global communications changed?

Lance Longwell (Siemens Medical Solutions USA): For a lot of companies, there's a lot of global corporate positioning and end positioning, but the nuances of the products has still needed to be handled on a regional basis. But, in terms of corporate, that's definitely global for everybody.

Race (Philips Healthcare): One of the things that we've tried to do was to [look at] what is the information we can provide to our global network of communicators that for a top-line story is relevant for them to talk about. It still needs to be localized to be specific to whether it's product messaging or how something may have been approved or cleared by a regulatory body in that particular country. We generally view all communications as global. If we know that my colleagues in Germany are doing a story in Germany, we view it as going around the globe to ensure that if a blogger or someone picks it up in the US that, from a regulatory standpoint, we're not going to get ourselves in trouble. It has put some additional challenges, in terms of adding another layer of review, or just a watchful to what's going out there. We've been working really hard to put together a program that creates these globally appropriate messages.

Wadler (MWW Group): We have the philosophy that science happens on a global stage and healthcare happens locally. When we talk about science, it's very consistent globally. The regulatory issues are all local. The way people absorb the information is going to be culturally influenced. Communicating that consistent science across the globe is really important but understanding that how you personalize it and make it yours is going to be culturally influenced locally.

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