#FuturePRoof - why treating PR as a strategic management function is critical to the NHS

Last week I had the privilege of speaking at the NHS Confederation Communications Conference in Manchester. I showcased #FuturePRoof edition three, The NHS at 70 with lessons for the wider PR community. 

#FuturePRoof edition three is a special edition aimed at celebrating comms best practice in the NHS as it turns seventy.

I was fortunate to be invited to ConFed18 to share why communication offers the NHS its greatest lifeline as it navigates its greatest challenges and another significant period of change. 

Here's an extended version of the deck I presented which talks through key aspects of the book. 

 

Treating public relations as a strategic function is critical if practitioners are to fulfil an elevated adviser role, secure the ear and trust of management and increase investment into our services. 

Collaborating to implement one approach at scale, speaking truth to power and using frontline staff to lead debate are all key take outs from the 25 expert contributions within the book.

With thanks to conference chair Helen Reynolds (@HelReynolds) for the cartoon from the day. 

People first: What comms pros can learn from the #hellomynameis Campaign

By Chris Pointon

Communication in any setting is a vital and effective tool that is particularly important in the field of healthcare. If not done well, it can be agonising for the patient, relatives and healthcare workers.

This chapter looks at how an experience of poor communication turned into a social movement called #hellomynameis, which continues to improve communication and patient experience in healthcare and beyond.

You’ll learn:

• Why effective and timely communication really makes a difference
• How a simple introduction can improve someone’s life
• Why communication is important based on the experience of a doctor who was also a terminally ill patient


The #hellomynameis story

My wife – the late Dr Kate Granger MBE - was diagnosed in 2011 aged just 29 with a very rare and aggressive form of sarcoma that was to limit her life to only a few years. Kate passed away peacefully in 2016 on our 11th wedding anniversary in a local hospice. Over the five years of her illness she was to inspire others through many things and create a legacy that relates to communication.

During our many admissions to hospital it became obvious that not many staff members were saying a simple “hello” to Kate or I. It was disconcerting for us both and made the experience more difficult and isolating. 

Recognising ours was not a one-off experience, we decided to do something about it. Using the power of social media we started a campaign called #hellomynameis to remind healthcare workers to introduce themselves at the start of every patient conversation, helping create a more therapeutic relationship. 

At the outset of the campaign it became clear that there was very little insight and research on this topic; all we had was our experience and other anecdotal data. This strengthened our resolve and social media became a useful place to understand other people’s experiences and perspectives and to illustrate the scale of the problem. 

Our belief was that although doctors need a single-minded approach when working through a lengthy to-do list, the focus should be on providing compassionate care. Our own patient experience was improved where the communication was more personal and inclusive. 

So if a simple introduction humanised the process and took very little time, cost little or no money and improved the whole experience – why wouldn’t you do it?
 

Pushing an open door

Initial response across social media to our campaign was overwhelmingly positive and gave us the extra evidence we needed to sell the idea internally. 

Recognising the value of improving patient communication in this way, many healthcare Trusts quickly committed to implementing #hellomynameis across all levels of their organisations. 

Comms professionals helped cascade the relevant information across teams, from embedding campaign protocols to the creation of new email signatures with the #hellomynameis branding on. 

The campaign was given additional weight, gravitas and promotion through endorsements from the Prime Minister and chief executives and chief nurses, but the viral way in which it spread came down to one thing – it resonated with everyone on a very personal level. 
 

Experience helps

Through Kate’s experience as a patient and a doctor, she knew how satisfying it was to make a human connection with the patient and to hopefully make the experience less frightening and daunting for them. 

Feeling like we’d had a proper conversation with a healthcare worker made such a difference to Kate, both as a patient and also when she practiced as a doctor for the elderly.

My personal belief is that people and this applies across all walks of life, who dismiss the importance of timely and effective communication, potentially sabotage their own careers and limit their capacity for fulfilment. 

The Medical Defence Union reports that poor communication and rudeness are cited as reasons for complaints in 30% of cases. 

A great way of considering this is to really think about how you, or one of your family, members would like to be treated and treat others that way – if you do this then you shouldn’t go too far wrong.
 

Communication is key

A key part of communication is making sure that it is appropriate for the situation and will have the desired impact on the individual or group receiving it. 

As in so many situations, it is important to think before you speak and to avoid being dismissive of the person’s concerns or answers.

Across every organisation there are people who are fantastic communicators but then there are also those who need some assistance. Modelling good communication by enabling people to see it in action is critical to success. 

One of the worst situations from Kate’s time in hospital was when a junior doctor was sent in to tell Kate some bad news. The doctor didn’t look at Kate when delivering this and scurried out of the room once they had said what they wanted to say.

Communication takes many forms and is not just verbal - non-verbal signs are equally as important to think about and can be majorly significant. 

When talking about #hellomynameis, we teach people that facial expressions, eye contact, gestures and postures should not be defensive or intimidating. Little things like sitting down next to a patient so as you are at the same eye level rather than looming over them at the end of the bed makes a big difference.
 

What legacy do you want to leave?

Although the #hellomynameis campaign started in healthcare it is relevant in all parts of society. The simple act of introducing yourself creates a positive dialogue that can be built upon in terms of general engagement. 

In healthcare the patient should be at the heart of and involved in all decisions made. One size doesn’t fit all and tailoring communication to each individual is critical. This works in other sectors too.

Since its conception in 2013, the campaign has expanded and #hellomynameis now operates in over 20 countries around the world. It is heavily used across the NHS and is growing daily. This year has seen a renewed focus through the NHS’s 70th anniversary celebrations.

Patient surveys have shown improvements in patient experience since the introduction of the campaign and a significant number of Trusts now include it as part of their Trust values. I receive many messages daily from across the world highlighting its positive impact. 

Kate always wanted to make a difference to other people and with this campaign she improved communication across global healthcare and has left a very special legacy that continues to grow. I’m proud to be a part of it. 


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Chris Pointon is the co-founder of the #hellomynameis campaign, its global campaign ambassador and husband to the late Dr Kate Granger MBE.

Twitter: @pointonchris and #hellomynameis
Online: www.hellomynameis.org.uk

A creative approach to audience engagement: The story of the NHS Christmas number one

By Joe Blunden

It is not every day that someone makes a strategic decision to get the NHS to the top of the music charts, but in September 2015 it made perfect sense. At that time, staff morale was particularly low and with winter on the horizon, something had to be done.

You’ll learn:

• How it can pay to think big
• Why big does not have to be complicated
• How your contacts can become valuable team members


Never let them get you down

When it comes to public relations, there is rarely a definitively correct course of action. 

No amount of experience, education or downright brilliance can guarantee the right call every time, which means all plans and strategies are open to some degree of scrutiny. 

Is that the right approach? Will it work? What will happen if it goes wrong?

When I chose to take on Simon Cowell in the battle for Christmas number one, I faced all of those questions and more. Big and creative ideas usually are challenged most vigorously. 

This questioning can sometimes have an unfortunate bi-product. As creative as our industry can be, it can also be paralysed by fear of criticism and failure, particularly in the NHS. 

That is not without good reason of course; the NHS is the most cherished brand in the UK and anything that could undermine that should be scrutinised. 

But that does not mean we should be unambitious, tedious or lacklustre by default, especially when something transformational is required. 

In the winter of 2015, we saw the need for something big; something that could disrupt the traditional narrative and effect real change. 

Our overriding ambition was to improve the morale of staff and we aimed to do that by providing incontrovertible evidence that the public loved and appreciated them. What could be clearer proof than a Christmas number one?


Working towards clear goals

Sometimes we can be inclined to believe that big ambitions should be underpinned by complicated plans. But more often than not simplicity can be the most effective route.

Our strategy was very straightforward. Born as much out of necessity as it was design - we had no budget whatsoever and were acutely aware that we could generate relatively little impact on our own - we needed assistance to make this work. 

As a result, our plan from the beginning was simply to build relationships with as many people as possible and enable them to become part of the campaign. We knew that those who had a genuine connection to our cause would be more likely to take the step of downloading.

So, we immediately started building communities via social media; communities of people who had a reason to be grateful for the NHS. 

Unsurprisingly, we were not short of potential members and within two weeks over 100,000 people had completed our first simple call to action: join our team.

What followed over the next eight weeks was a series of equally small yet impactful requests for activity, such as ‘invite others to join’ or ‘share why you love the NHS’. With each passing request, compliance increased, as our relationship with them grew gradually stronger. 

These calls to action were complemented by a stream of supporting messages designed to increase awareness of the cause and aid acquiescence. 

Simplicity and clarity were vital to these, so we always used uncomplicated language, never shared more than two key points at once and repeated things regularly.

It was sometimes tempting to deviate from this ethos and try to communicate everything at once, or to skip straight to the ‘download now’ moment without really engaging. But I have rarely seen that approach work effectively, particularly when trying to influence thought or change behaviour. 

Instead, it was our regular, subtle stream of information and calls to action that were the key to our success. They at once provided invaluable engagement whilst perpetuating our key messages, ultimately enabling thousands of people to feel a part of something. 

This sense of belonging meant that when the request to download eventually came they were primed to take action, culminating in 150,000 downloads and £300,000 for charity.
 

Utilising our networks

Despite the simplicity of our plans, we knew it would be difficult to achieve everything we wanted to with our original team of just three. Consequently, we quickly turned to our existing networks to create a wider group with the skills required. 

We built up a selection of 40 trusted volunteers, made up of NHS staff, patients and campaigners. They all had a contribution to make, although the vast majority were obviously not trained in PR. 

I think communications professionals are often nervous about allowing untrained people to step into our world, but their ability to reach diverse audiences and provide real peer-to-peer engagement whilst offering a different perspective can be invaluable in healthcare. 

In addition, we used our connections to recruit professional support. 

There can often be a temptation, particularly in the world of NHS communications, to take on tasks ourselves wherever possible. We have all picked up an SLR camera, put together a poster using Publisher, or recorded a video on an iPhone. Of course, there is a very good reason for this; NHS communications teams have an ever-dwindling pot of resources. However, it is equally important to recognise when an expert will yield the greatest results.

That is not to say that we left most of the leg-work to others: we created much of the content ourselves, built our website using an online content management system and even designed our own branding. Yet we also recognised that in certain areas our strategy necessitated specialist input to generate credibility, maintain professionalism and ultimately get results. 

Therefore, we recruited a music PR agency to help us generate radio and TV coverage. 

This agency secured us an extended slot on the Chris Evans Breakfast Show, during which we climbed to the top of the charts. We also worked with a production company, who created a really impactful music video to compel people to download the single: it was viewed over 5 million times.

The fact that these companies kindly offered their services on a voluntary basis does not negate the fact that they would have represented outstanding value at full price. I am a firm believer that we should not be afraid to invest in marketing and communications activity if it can be clearly linked to the achievement of core goals.
 

Evaluating success

On paper our campaign was a huge success and the Christmas number one has gone down in history. 

In achieving it, we generated over 3,000 pieces of media coverage, nearly 100 million impressions on social media and lots more besides. 

We even convinced Justin Bieber, our biggest competitor, to support us.

But to judge our campaign on these elements alone would be misleading, because that was not our primary aim. Indeed, I see this approach to evaluation regularly: people judge success on the volume of coverage they receive, how many followers they have on Facebook, or any other number of irrelevant analytics, regardless of whether or not it actually led to a change in behaviour.

Ultimately, we wanted to improve the morale of staff and no number of shares or video views can prove that. Fortunately, we have received a huge amount of anecdotal evidence to suggest the campaign did have the desired impact on staff and there is not 1.6 million people who deserve it more.


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Joe Blunden is a multi-award winning communicator and marketer with over 15 years of experience across a range of industries. Currently the Deputy Director of Marketing at NHS Elect, he provides communication, marketing and branding support to over 65 NHS Trusts and clinical networks across the UK. Joe previously spent 5 years as the marketing and stakeholder engagement lead at Lewisham and Greenwich NHS Trust, working in both acute and community settings. He has a Professional Diploma in Marketing from the Chartered Institute of Marketing and a Diploma in Managing Digital Media, in addition to a degree in business.

Twitter: @NHSCommsJoe
Online: https://www.youtube.com/watch?v=T8qHXlShfUQ

Small changes big differences: A case study of a campaign that took a different approach to potential NHS cuts

By Jane Hughes

When NHS finances are squeezed, nurses feel the pain, too often being asked to do more for less. The Royal College of Nursing’s campaign helped them feel less like victims of cuts and more like active participants in the drive to help the NHS find savings.

You’ll learn:

• How face to face discussions supported by high quality and eye-catching materials can help to spread the word
• How media coverage and social media visibility on the issue of procurement has established the Royal College of Nursing as an authority on the subject
• That case studies demonstrating best practice and innovative procurement approaches are popular and worth sourcing


Small Changes, Big Difference – the problem we faced

The NHS spends billions of pounds a year on buying clinical supplies and services - essential disposable items such as gloves, syringes, incontinence pads and cannulae. 

Millions of pounds could be saved by making better decisions about what to buy, how much and when. Nurses make up 70% of the NHS workforce and are more often than not the ones using the clinical supplies. They know which products work best and where savings can be made. 

Yet too frequently, they were being left out of decisions about which products NHS organisations buy. 

With many nurses feeling powerless in the face of cuts to NHS services and an ongoing financial squeeze, the Royal College of Nursing (RCN) launched a campaign to help put the power in their hands to support their organisations to find savings. 

The Small Changes, Big Difference campaign was run in partnership with the NHS’s purchasing organisation, NHS Supply Chain and a network of nurses involved in purchasing decisions – the Clinical Procurement Specialist Network. 
 

How we did it

First, we needed to know what appetite and scope there was for change. We partnered with the leading trade magazine, Nursing Times and carried out a survey of nurses which showed that more than 80% of respondents thought they could save money if better buying decisions were made, while a quarter said they weren’t allowed to get involved and a further 28% said they didn’t have time. 

Nursing Times calculated that making better decisions could save the NHS more than £30m a year. It was clear there was the potential to put the power into the hands of nurses to help the NHS find savings without affecting clinical care. 

We needed to reach the nursing leaders with the power to change the way things were done and we needed to do that in a practical way that would help them in their day to day work. 

To do this we produced a toolkit to support Nurse Directors and other senior nurses to make the case for change in their workplace and at the Board table. It guided them though the arguments in favour of having specialist procurement nurses and the savings that could be made.

NHS Supply Chain developed a ‘traffic light’ sticker system to highlight to nursing staff which products were the most expensive, aimed at raising awareness and reduce waste. Red stickers flagged high cost items, steering nurses towards using cheaper alternatives where appropriate, or alerting them to the need to avoid waste.

We launched the campaign and materials at an event in RCN HQ attended by nearly 100 senior nurses. At the same time we had a digital launch, using our social media networks, reinforced by digital advertising to reach a wider audience. 

We produced high quality printed versions of the toolkits and other materials and distributed those through our network of regional staff. 

Every time a Regional Director had a meeting with a Director of Nursing or other senior nurse in their area, they took a printed toolkit and other materials with them and we took advantage of RCN events to share the materials more widely. The ‘traffic light’ stickers went down especially well, with their design helping to make a potentially dry subject more accessible. 

We created a Small Changes website which showcased examples of best procurement and buying practice and used social media to promote the website content. We commissioned films telling the stories of the best examples. Our films were viewed more than 13000 times, with the website visited more than 9000 times in its first year. 

We launched a social media search for more examples of best practice and were rewarded with dozens of examples from around the country. 

We generated media coverage from both Nursing Times and Nursing Standard, as well as featuring success stories in our membership magazine, RCN Bulletin, which goes to all 435,000 members. We held a fringe event for senior nurses at the Chief Nursing Officer’s Conference and we developed a presentation and booklet for RCN staff to use during meetings with senior NHS leaders. 
 

The outcome

As a result of our work, the RCN’s authority in the area of NHS procurement was reinforced and the college was invited to join a group supported by the NHS Business Services Authority, reviewing commonly used consumables in the NHS. We were also involved in a review of NHS Productivity led by Lord Carter. 

‘Small Changes’ groups have been set up in NHS Trusts around the country, supporting nurses to influence buying decisions and to share best practice. 

The campaign is ongoing, with an evaluation survey to measure improved awareness due this year. Conversations with nurses and NHS leaders, visits to our website and the number of shared success stories, all suggest raised awareness of this issue – while the Clinical Procurement Specialist Network has increased its nurse members. 

A couple of years after the launch of the campaign, the pressure on the NHS is more intense than ever. But thanks to Small Changes, Big Difference, nurses are being shown that there are ways in which they can contribute to finding financial savings, rather than simply feeling victims of cuts. And they are seeing how their involvement can also help improve patient care.


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Jane Hughes is Associate Director of Communications at the Royal College of Nursing. She’s passionate about helping improve the health and social care system, so that patients get the care they deserve. She’s spent the last 15 years in health communications – including for the mental health charity, Rethink Mental Illness and as a BBC Health Correspondent.

Twitter: @JaneHug
Online: http://www.rcn.org.uk

How social media can improve Healthcare

By Caroline Kenyon

Social media is powerful – it is instant and can spread worldwide at astonishing speed, which is why it is so effective in leadership and influencing. But in the NHS it is viewed by many as a risk rather than a resource.

You’ll learn:

• How to create a patient community that improves people’s health
• How active engagement with patient feedback improves both services and staff morale
• How a GP reduced appointments through social media


Social media. Why do it?

With around 30 million people in the UK using Facebook and 12.6 million on Twitter, these internet behemoths dwarf the reach of any media outlet. And as social media can offer information and consultation beyond a clinician’s clinic or ward, the potential for its use to improve services is huge. 

America’s top-rated healthcare provider the Mayo Clinic established its Social Media Network initially to support its own staff to use social media in their practice. It now has a worldwide membership who share learning and best practice to improve care.

Farris Timimi, Medical Director at the Mayo Clinic Social Media Network, said:

“The value of engaging in clear, open, two-way communication at every point of care has become abundantly clear. Active engagement between providers and patients, along with their caregivers, has a demonstrably profound impact on patient and provider satisfaction, patient compliance and improved clinical outcomes. Social media is helping to make much of this constructive engagement happen.”
 

Evidence that we’re not doing it

A survey by HealthChat* of 27 Trusts found that:

• Eight did not have a social media strategy and one believed implementation of a strategy was not achievable

• Ten communications teams interviewed had only a single person responsible for social media, mostly as part of a wider workload and social media was not prioritised

• Many of the Trusts did not have aims and objectives for social media

*HealthChat is a group of medical students who conducted a qualitative and literature review study into NHS Trusts’ use of social media from October 2016 to May 2017: Rosie Bhogal, Sonika Sethi, Nishma Gokani, Sharukh Zuberi, Susana Luengo, Shaneil Tanna and Jagvir Grewal, Imperial College London. Their paper will be published in late 2018.
 

Patient communities

In Greater Manchester a network of newly diagnosed renal patients was supercharged by the application of social media – with dramatic effects for some patients. 

As part of her PhD thesis, Dr Cristina Vasilica co-created with patients a website, Twitter account and Facebook group for the Greater Manchester Kidney Information Network, GMKIN. [1] 

She carried out a long term study of the impact on participants’ lives and found, in contrast to the small number of people who attended physical meetings, high levels of engagement - in particular in the closed Facebook group with 343 members. 

Participants reported real improvements in health and well-being with an increase in self-support and confidence and better self-management. 

She learned that:

1. For an intervention to work patients should be engaged. Patients engaged with GMKIN because of the information shared; it was local and they knew and trusted the staff

2. It provided information, enabling patients to recognise symptoms, understand the condition better and have hope for a brighter future

3. It triggered health improvements – an increase in self-support and confidence and better self-management

4. Social media contributed to social outcomes – people became less isolated, they cared for each other and became more interested in social activities. For example, participants indicated that they were keen to take on employment

FIGURE 1 GMKIN engagement

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Other examples of creating communities in closed Facebook groups for patients with long term conditions can be found in North Staffordshire, where Marc Schmid of Redmoor Health helped primary care staff to set up Facebook groups for 64 of the 83 GP practices to engage with patients on issues such as flu vaccines, winter pressures advice and supporting care navigation. 

Three condition-specific groups are run by clinicians at Royal Stoke Hospital covering multiple sclerosis, cardiac rehabilitation and atrial fibrillation and stroke, with membership ranging from 200 to 350.

It’s not only helping patients but also empowering staff to do more in ways they hadn’t anticipated.
 

Acting on patient feedback

At The Pennine Acute Hospitals, [2] it was the need to address low staff morale that led to the creation of a quality improvement programme in women’s and children’s services – including a new role of Patient Experience Midwife to focus on patient feedback. 

Alongside the structured quality improvement work carried out by consultants Lisa Elliott and Vanessa Blanchard, midwife Samantha Whelan became the Trust’s pioneer in using social media to engage with patients about their feedback on the Care Opinion platform. [3]

Samantha responded to patient stories in real time and where they were praising staff – which was most of the time – she shared them with the staff directly and on Twitter and Facebook. The result was that more stories were being shared and more staff became aware of patients’ good experiences and thank yous – which lifted morale. 
 

Supporting self-care and reducing demand

There are many examples of great social media messaging by comms teams to direct people away from A&E and into pharmacies or online to NHS 111. And some GPs and other clinicians are doing it for themselves. 

Dr Andy Knox in Carnforth, Lancashire, produces videos advising people how to look after themselves and tackle problems ranging from nits to back ache. 

His self-care videos on his Ash Trees Surgery website [4] and YouTube account are promoted through Twitter and Facebook and played in his waiting room. The most striking evidence of the impact of his mission to empower people to manage their minor ailments is evident in a reduction of appointments for earache; from 120 in the winter of 2015/16 to just 15 the following year - and he attributes this to his earache video.

A crusader for patient empowerment and the Director for Health and Wellbeing for North Lancashire, Andy is a strong believer in using social media and video to reach wider audiences.
 

A tweeting culture 

If we agree that social media offers a powerful engagement tool to benefit patients, then we should try to overcome the fear and doubts which stop its use by the wider health community. 

If we don’t, then we are missing a golden opportunity - and patients will create their own communities and misinformation - and #fakenews will be far riskier.

An organisation which positively encourages staff to use social media is the Welsh Ambulance Service @WelshAmbulance, where you will find a plethora of accounts on the twittersphere. 

One of these is @WelshAmbPIH run by the patient experience team to engage with the public and gather feedback to improve services. 

So how have they done it? It starts at the top, with the CEO and all the senior team using Twitter to engage with staff, partners and public. 


Sources

[1] http://gmkin.org.uk/
[2] http://www.pat.nhs.uk/
[3] https://www.careopinion.org.uk/
[4] http://www.ashtreessurgery.co.uk/self-care

Recommended resource

There’s a fabulous Social Media Toolkit for Healthcare available from Skills for Health; download it via http://www.skillsforhealth.org.uk/toolkit-download. 


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Caroline Kenyon is Director of Communications and Engagement at the Innovation Agency, the Academic Health Science Network (AHSN) for the North West Coast. She runs #EngageWell events to promote the use of social media in healthcare; find presentations on the Innovation Agency’s YouTube channel and SlideShare. 

Twitter: @carokenyon and @innovationnwc
Online: www.linkedin.com/in/caroline-kenyon-ba32555/ and www.innovationagencynwc.nhs.uk

How the North East and North Cumbria urgent and emergency care network uses integrated communications and content marketing

By Caroline Latta

This chapter is about moving away from a reliance on media relations to integrated communications on a larger geographical scale, using research and insight and strong visuals and multi-media content. It shows how the North East and North Cumbria Urgent and Emergency Care Network has helped reduce non-emergency admissions to local Emergency Departments in this way.

You’ll learn:

• How smart planning and evaluation helps secure greater investment into communications by delivering organisational objectives
• The benefits of investing in planning and insight and including multi-media content in your armoury
• Why we need to interrogate data and stop treating different audiences as one homogeneous mass

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It’s all about the planning and insight

As NHS communicators, we work with highly trained, clinical and academic colleagues, many of whom have spent years studying and carrying out clinical research and study for their professional field. 

We need to meet them on the same sound professional basis by demonstrating how data and research informs the strategies we build our campaigns upon and in turn how outputs turn into outcomes. 

In the main that means patient behaviour and ultimately the return on the investment in us as professionals and the budgets we ask for. 

This is especially important in today’s difficult financial climate, where communications and marketing budgets are seen as easy contributions to cost improvement programmes.

There has never been a better time to really demonstrate the strategic value that NHS comms can bring – and how valuable our work can be, particularly when taking pressure off Emergency Departments.
 

We need a media release to tell people to stay away from Emergency Departments?

Putting out a press release and social media messages telling people not to come to Emergency Departments of course has its place in the immediacy of the specific pressure faced by that hospital, but often the release is responding to challenges over previous days. 

What these don’t do is tackle the patient’s decision-making process to go in the first place.

All Trusts are facing exactly the same issues and inadvertently competing for the same media air space. This duplication of effort makes a good argument for working at scale across a wider geographical patch, as well as for pooling expertise and resources on a joint strategy.

To achieve population behaviour changes around the use of Emergency Departments, communicators need to persuade NHS leaders to support an at scale, insight led approach. 

We also need to stop treating all patients as one large group (at least in marketing terms) and embrace the data. Or at least embrace the people who can help us access and understand the data in order to provide a sound basis for strategy development.
 

Here’s the science bit

In the North East and North Cumbria Urgent and Emergency Care Network, we’ve achieved agreement from NHS system leaders for NHS communications leads to collaborate and use an at scale, insight-led approach to reduce high levels of non-critical Emergency Department use.

The first step was leads working with clinical data analysts to understand what information we had. 

The data told us that there were high numbers of parents with young children under five years old attending, with lots of common childhood illnesses. Often the outcome was no treatment at all but reassurance and guidance from staff.

Children account for a high proportion of attendances (2015/16) but approximately 60% of 0-4 year olds are discharged with no treatment. 

Added to this, attendances at Emergency Departments for under-fives in the North East region is 763.6 per 1,000 population, which is significantly higher than the England average of 540.5 per 1,000 population.

Using postcode data from Emergency Department attendances we were able to identify who was most over-represented and create an Experian mosaic group M (family basics) and conduct focus groups with these people.
 

The touchy feely bit

Our research showed clearly that these parents are less confident about what to do with common childhood illnesses. They also seek medical intervention earlier than previous generations, often by attending Emergency Departments and walk-in centres/urgent care centres. 

What’s more, societal changes have had an impact on parents wanting help for their child. Whereas before people would have asked parents or grandparents for help, now they frequently live apart from support networks so tend to seek medical advice. 

Emergency Departments are seen as the safe choice, with individuals being more likely to attend with a third party, particularly a child.
 

We need an app for that

It became apparent that there was significant opportunity to support this particular group of parents of young children through an educational tool, the NHS Child Health app.

If key patient groups can gain confidence and take more responsibility for their children’s health and well-being by using a self-care app, the result will be better decisions about common childhood illness and fewer inappropriate attendances at busy NHS services. 

With this in mind, an app was developed in conjunction with parents and clinical staff. As research showed that parents/carers were unsure where to go, this incorporated geo-targeting to make it easy to locate the nearest NHS service.

There were clear guidelines about tone of voice and appearance following feedback from focus groups and once developed, further focus groups were undertaken to test the app out. 

Constructive feedback was given about how the app could be improved – from needing to make the search function more obvious, to having an audio feature on the app so they could listen to the advice when taking care of their child.
 

Digital-first approach for the target group

A region-wide digitally-led marketing campaign was then developed, again using evidence from the mosaic profile. 

This was launched in partnership with a regional radio station, supported by digital advertising via Mumsnet, online newspaper sites, Google adwords and Facebook. 

Information cards were distributed to pharmacies, childrens’ centres and playgroups to encourage people to download the app.

Insertions in magazines were put into infants’ school bags and collateral supplied to all children’s-based activities in the region, such as soft play and nurseries. 

All the activity was reinforced by social media and media relations with key messages to download the app.
 

Pre-empting the surge on services

Back to the issue of media releases not being able to resolve the surge in Emergency Department attendances, some simple data analysis and tracking showed that the different days of the week and times of the year, bank holidays, major sporting events, seasons and weather influenced how busy these were. 

This led to the development of ‘surge marketing’ planning, in other words specifically timing all marketing activity for when people were in contemplation mode and thinking about going to an Emergency Department in the next few hours or day.

This is particularly important for Sunday afternoons and evenings as parents contemplating attending an Emergency Department the next day are concerned about clinical issues their child has at that point in time. This is the same on the Monday afternoon and evening of bank holidays which sees the surge switch to Tuesday mornings.

By timing the digital and radio advertising to specific times when people were thinking about whether they should attend an Emergency Department, we were able to give parents trusted information and alternative advice tailored to the concerns they had about their child’s condition via the interactive app.


The results – outputs

Between 1 October 2016 to 29 January 2018, the app had over 19,500 downloads, 51,000 sessions and 268,000 screen views, with 61% users aged under 34. 

In terms of promotion, social media had 1.3m reach, 7,600 link clicks, 53,000 video views, with digital advertising gaining 250,000 impressions, 4,600 clicks and media resulting in 21 pieces of coverage with 968,000 reach.
 

The results – outcomes

User feedback has been highly favourable. Quotes include: “A must-have app that has all the relevant information you should have on your phone.”

NHS communications leads in hospital Trusts have reported that when the app is promoted, they are seeing a reduction in attendances from under-fives.

In terms of confidence, on average the app gets 65% return visits, 10% use it every week and approximately 1 minute 35 seconds is spent on it.

For behavioural change around attendance at an Emergency Department, our comparison was for under-fives attending for minor injuries and illnesses, using data from six months pre and post.

Comparing six-month periods (October to March), on average the number of attendances of under-fives across North East has reduced from 275 to 249. The maximum number of attendances in any one month and any one area reduced from 1261 to 956.

When comparing the three-month time period (January – March), there is a further reduction from 295 to 245, with the maximum number of attendances reducing further to 796.

We are able to equate this to a saving of £12,800 to NHS within a six month period (reduction of 305 attendances at an average cost of £42 at Emergency Departments for minor illnesses) which will continue to build as continued use and promotion of the app continues.
 

Budget

The budget was £64,000 (development and testing of app - £24,000, digital advertising and printing - £40,000), funded via the North East Urgent and Emergency Care Network.

The notional cost to all NHS organisations would be calculated on a fair shares formula - 50% capita or turnover and 50% number of organisations involved in order to be fair to the size of organisations. For example – large Clinical Commissioning Group £9k contribution, small Trust £3k.
 

Making the argument for strategic value

A case study like this makes and proves the argument for how working at scale on joint issues provides the strategic value that NHS leaders are looking for from NHS communications. 

We need to be prepared to interrogate data and draw upon the full range of communications and marketing tools available, not to mention continue to make the case for investment. 

This involves writing proposals, making the pitch to leaders, using the evidence to argue why a media release will not solve the Emergency Department surge and going back with progress and proof.


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Caroline Latta is a senior NHS communicator with over 25 years’ experience. She leads a multi-disciplinary team of communicators for NHS North of England Commissioning Support. In her 16 year NHS career she has delivered several successful behavioural change communications programmes including chlamydia screening uptake, teen pregnancy reduction, bowel cancer screening uptake and increased early detections of cancer symptoms. She is currently leading service change programmes across the North East and is the region’s sustainability and transformation partnership communications lead.

Twitter: @carolinelatta
Online: http://uecnetwork.co.uk/ and http://urgentoremergency.co.uk/

Doing more with less: How NHS comms teams are responding

By Ross Wigham

When it comes to the fallacy of working life, the phrase ‘you must do more with less’ is probably up there with the very best. But now that teams across the NHS are facing up to the same financial challenges that other parts of the public sector have been struggling with since 2008, a more useful saying might be ‘less is more’.

You’ll learn:

• How to deliver value in a way that’s meaningful to your organisation
• Where to focus your efforts in a difficult financial climate
• How to think about adding real value to local NHS services


Increased demand versus a reduction in funding

Having worked in local government previously the scenario of shrinking teams and smaller budgets, coupled with rising demand and increasing expectations, is a familiar one.

The troubling challenge for communicators is around a dichotomy of fewer people and resources to do their work while coping with a huge rise in demand for NHS services at a time when patients and families have a thirst for more information than ever before.

We know that the modern media landscape is voracious and multi-faceted, requiring a range of different skills to meet the needs of a public who seek out information from a range of different channels often in real time.

Getting to grips with this demand and making sure day to day business like robust crisis communications are in place can be a daunting task. 
 

Why are we here?

It’s easy to come to a nihilistic conclusion to this sort of question (especially at a time of cuts) but before you reach for the Camus or Nietzsche, think about why your organisation needs communications and PR in the first place. Strip back everything else and take the time to ask yourself what your team can add to the overall strategic aims of the organisation.

This is the starting point for understanding how you can add value, what you should be focusing on and where you could be cutting back. It’s always better to start from the beginning and rebuild your strategy, rather than hacking away at your existing one looking for savings every year – that’s death by a thousand cuts.

Once you have this razor sharp focus on what’s important to the organisation and the senior people driving it, then you have a place to work from and a set of realistic objectives.
 

Delivering value

It’s worthwhile thinking about what we mean by value, in terms of what you can add to the organisation and also in the sense of value for money. Too often people conflate value with the cheapest possible option which is totally counter-productive. 

Your communications strategy should be able to demonstrate the value your team can add to the organisation and then look at how much that costs in terms of people and budget. The cheapest option is almost never the best one.

When you take a hard look at everything the comms team traditionally delivers try and think about what adds genuine value to the whole organisation, what is ‘nice to have’ and what gets done just because it’s always been that way.

When I first joined the NHS someone with lots of experience told me “don’t go native too soon” which for me meant thinking hard about the reasons why we do things and how much value they really add. 

One good exercise is to make a list of every single task the team does, compare it against your new objectives, then think about what you should start, stop or reduce to achieve them. In terms of value the patient should be at the absolute heart of everything, so consider why each piece of work would matter to them.


A focus on the things that matter

By focusing solely on the things that matter you can really see the benefit of ‘less is more’, although it will also mean managing expectations across the organisation. 

Identifying and publicising the key communications priorities for the year gives the space to focus properly on delivering some results and stopping the activity that isn’t essential to meeting these objectives. 

This, of course, means saying no to some people and delivering a smaller service than before which is difficult and can often feel counterintuitive to comms people who have spent years building up relationships.

This new approach needs to be signed off from the top to be successful and also needs input and approval from the key movers across the organisation so it’s accepted as a way forward. Make sure the vision is crystal clear and published in a way that’s really easy for everyone in the organisation to understand. 
 

The power of brevity

Create a ruthless focus on time management that avoids being drawn into meetings or writing lengthy strategies and reports that have no tangible value.

I’m all for flowery language and over complicated syntax and I’m not suggesting for a minute that all plans should read like a Donald Trump tweet, but there still seems to be an overriding attitude of ‘never use one word when 50 will do’. Surely the opposite should now be true with less time, fewer staff, shorter attention spans and time at an absolute premium.

Sadly, the NHS can be arch offenders at this and trying to reduce wasted time or effort is vital in becoming more efficient.

Plans should be crisp and focus on the idea of the elevator pitch with a close focus on the USP and key messaging – there’s plenty of room for background details as an appendix. That’s not to say robust planning isn’t critical (it is) but I’m reminded of another saying that goes “strategy without action is a daydream, but action without strategy is a nightmare.”
 

Deliver results

The pressure point with this approach is that once you’ve stopped some areas of work to save time and money by focusing on the key priorities then you really need to deliver on them.

This should come naturally because in theory there will be more time and space to deliver results but the key point here is to ensure everyone knows about the value that each successful project adds. Regular updates for the board, monthly monitoring reports, case studies and awards applications are all great ways of hammering this home.

Traditionally PR hasn’t been great at doing its own PR so make sure you take the time to tell your own story loudly and clearly. Don’t assume people have seen that great social media campaign or piece of broadcast coverage – make sure they get to see it and understand the value it delivers to the organisation.

It’s also important to talk the language of the boardroom and ensure your updates have the right tone and focus. 
 

The power of leadership

If you look closely at every organisation you’ve worked in, the difference between good and bad performance is so often to do with leadership. Certainly when you look across the NHS and the public sector more generally the most successful organisations are the ones which are really well led.

For me there are two key challenges for PR people: working out how to lead your own teams, but also providing strategic leadership around comms for the whole organisation.

All teams now need to be multi-skilled and it’s never been more important to know a little bit about everything. Learning and development is often one of the first things to be cut when money is short but that is a mistake. Building skills is even more important when you have fewer people but it also builds new capacity and keeps people motivated. 

Most importantly this is a change management process that will impact on people, requiring the leadership skills to navigate what is ultimately the very definition of a people business.


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Ross Wigham is Head of Communications and Marketing for Gateshead Health NHS Foundation Trust. He has previously managed communications as well as other teams at one of the country’s biggest local authorities. In 2012 he was named ‘Public sector communicator of the year’ at the UK Public Sector Communications Awards and ‘Professional communicator of the year’ at the Golden Hedgehogs. Ross is also an experienced journalist and blogger, having spent a decade in London working for top trade publications as well as producing content for firms such as Sony, HSBC and Business Link.

Twitter: @rosswigham
Online: adaywithoutoj.com

Planning and insight: winter in the NHS – using data and insight to own the narrative and change the script

By Liz Davies

One of the big challenges faced by NHS communicators continues to be persistent media narratives which focus on what is wrong with patient care, instead of the proactive work being carried out to address systemic issues.

You’ll learn:

• Why data needs to be integral to daily public relations practice
• Five lessons for changing a persistent media narrative
• How planning at scale can yield the greatest results but requires collaboration


Winter in the NHS

Winter is always a testing time for the NHS. Cold weather, seasonal bugs and an ageing population inevitably means more people get sick and more pressure on the health service. 

You’d be forgiven for thinking every year that the system is about to crumble under the strain and seriously, who could blame you? If I didn’t work in the NHS, I’d probably believe the hype and hysteria too. 

Don’t get me wrong, the pressures are very real and they are growing. What must change, however, is the relentless and perpetual cycle of negativity in the media every year when winter arrives. 

So how can we gain control of the message and change the story? As professional communicators, using data and insight from our customers and staff should be at the very core of our strategic planning to help influence such change. Here are my top five lessons for making this happen.
 

1. What do we already know?

The NHS, like many other big organisations, is data rich with an abundance of information that often goes untapped by strategic communicators. We know the peaks in demand, right down to the exact hours and days when services are at their busiest, yet we still do not use this to maximum impact. 

Did you know, for example, that hospital emergency departments see more people during summer? I suspect the answer is no.

Only by looking in detail at what our data is telling us, will we ever be able to switch from reacting to the annual media onslaught during winter, to really getting on the front foot with a compelling story - a story which connects with our audiences and influences behaviour change all year round.

As daily workflow becomes more automated, access to timely data is becoming easier, but this must become routine and entwined in our everyday business if we are to truly use data to strategically plan. 

2. Strength in numbers and system planning

A fundamental principle underpinning my practice in the NHS is to constantly think beyond my own organisation and to work with key partners to plan together. We are, after all, one NHS and what use is data and insight from one hospital or GP practice without understanding the bigger picture?

System planning at scale is absolutely critical to understand what our data is telling us and must become the norm if we are ever to truly change the narrative about winter in the NHS. Speaking with one collective voice disseminates key messages in a much more powerful way and this also means pooling budgets for maximum impact.

Of course, this comes down to strong relationships and trust, not only between professional communicators but being able to wield influence in the boardroom when it comes to resource planning and funding allocations. 

Too often in the NHS I have seen individual organisational agendas and political interferences get in the way of essentially doing what is right for patient care. Our strength in the North East has always been our ability to overcome such barriers. 

3. Own the narrative

In the NHS, we repeatedly let other people, often key national and local influencers, do the talking about us and rarely do we use our own data and insights to control the strategic narrative and engage directly with audiences. 

The politics can make this hard but, for me, the NHS still remains far too reliant on traditional media to disseminate messages and is not focussed enough on true two-way communication. An over reliance on mass media means that winter messages are focussed on what is wrong, rather than what is right.

The fact that hundreds of thousands more people are cared for every single year by our NHS is constantly overlooked. 

Over 2 million people attended emergency departments in December 2017, 3.7% more than last year. 

The numbers are staggering and there is simply no other healthcare system in the world that compares. But we must start using this data, in real-time, to focus the storytelling on the good, to motivate and inspire the amazing NHS workforce and to change the media’s fixation solely on the bad.

4. Use the service theatre

The NHS is equally guilty of failing to maximise use of its own physical environments to engage directly with captive audiences.

Walk into any John Lewis store and you will be greeted by the same corporate messaging, the same customer information and the same service experience from staff. 

The comparisons with the NHS are stark. But why? Public service is our core business so why aren’t we using our own service theatres and the people within them, in a more strategic way? 

Not only would this help us gain further insights about public behaviours during winter, but it also provides the perfect platform to playback vital pieces of information to potentially influence future decision-making. 

In South Tyneside and Sunderland hospitals last year, for example, there were over 13,000 inappropriate attendances in emergency care (over 4,500 people had a sore throat or headache). This misuse of services happens right across the NHS.

Direct face-to-face contact between patients and staff is the most powerful tool we have at our disposal and empowering our frontline teams with the information they need to educate patients on the right and wrong things to do, is arguably our best chance of changing attitudes, opinions and behaviours long-term. 

5. The job is never done

Winter in the NHS and the pressures that come with it get longer every year. The operational planning is constant. If we are honest though, how well do we do this as a collective of strategic communicators? 

There is always a sense of relief when winter is done and other competing priorities begin get a look in, but we cannot take our eyes off the ball. The data at our disposal is constantly changing and it is fundamental that we understand it and adapt our narrative accordingly. 

We must also move away from the perception that pressures on the NHS are time specific and confined to the winter months. 

They are year round and it is our role to continually engage, educate and inform our staff, stakeholders and patients alike. 

This means continually repeating consistent messages but also listening to feedback from those using our services to gain more insight into behaviours so that we can evaluate and continually refine our approach. 

Equally, if the customer experience is not living up to the message we are giving then this must be fed back to senior decision makers – this is, after all, the strategic role of PR.
 

In summary

My passion for the NHS runs deep and I have every faith that it will continue to outlive us all. It does, however, need to change and as PR professionals we should be using data and insight to influence this change. 

We’ve seen a seismic societal shift over many generations in the way people view, respect and use the NHS and indeed what they expect from it. Winter is just one example of where we could and should be using information to better educate our future generations to become good NHS citizens. 

Our collective approach to campaigning and joined-up thinking in the North East over several years to manage winter is making an impact and this comes down to strong leadership within the strategic communications function. 

The ability to influence the right decisions in the boardroom, even when that means going against the grain, is, without doubt, my biggest lesson of all.


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Liz Davies MCIPR is Head of Communications at the South Tyneside and Sunderland Healthcare Group and oversees the strategic communications function across two of the North East’s longest standing NHS Foundation Trusts. A multi-award winning PR professional and the CIPR’s Young Communicator of the Year in 2012, her previous NHS roles include Northumbria Healthcare NHS Foundation Trust and the North East Strategic Health Authority. In a previous life she began her career working in agencies in Yorkshire and Newcastle.

Twitter: @LizzlyDavies

Innovation through technology

By Alex Drinkall

Innovation is a much-used word within the NHS and as a word I associate with being aspirational I encourage its sentiment. However, as a communications professional working in the NHS it is important to remember: innovation is relative.

You’ll learn:

• A lack of access and acceptance can create barriers to technology adoption and therefore innovation
• Teams need to consider ways to address digital illiteracy for innovation through technology to succeed
• Strong internal comms is the only way to raise awareness and secure engagement where there is a call to action, particularly with a disparate and busy workforce


Equipping the workforce

Our lives are increasingly digital and we use technology every day, both personally and professionally, whether we like it or not. 

There is often the assumption that technology and innovation go hand in hand, but the opposite can in fact be true. For example, innovation can be stifled due to barriers to technology when it comes to access and acceptance. 

We see barriers to technology and digital acceptance within the NHS, which often reduces opportunities for innovation within health and social care too.

Health Education England’s (HEE) Technology Enhanced Learning (TEL) Programme has the vision that healthcare should be underpinned by education and training which is enhanced through innovation and the use of existing and emergent technologies and techniques. 

The work of the programme includes breaking down some of the barriers experienced in the NHS in terms of accessing technology. 

There is also an understanding that to embrace emerging technologies, the workforce needs to be digitally literate, so the team has been working to understand what is required to equip the workforce with the digital capabilities for living, learning, working, participating and thriving in a digital society. 

Achieving the aims of the TEL programme relies on engaging with the workforce to understand the current situation, how it could be improved and working to develop the solutions.


Health Education England’s digital capabilities

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As a communications professional working in the NHS you have to find workarounds for engaging with the disparate and busy workforce to share educational resources and gather insight to inform future work. 

The NHS employs more staff now than at any time in its history and while technology has opened up opportunities for communicating with the workforce, it is still a huge challenge.

Engagement techniques

e-Learning for Healthcare (e-LfH) is an HEE programme that works in partnership with the NHS and professional bodies to support patient care by providing e-learning to educate and train the health and social care workforce. 

HEE e-LfH is currently developing and delivering more than 100 e-learning programmes comprising over 10,000 e-learning sessions covering subjects from audiology to anaesthesia, dentistry to dermatology, safeguarding to statutory and mandatory training. 

e-LfH is well-loved and well-used by those who know about it…and this was our challenge.

In Autumn 2017 we launched a campaign to raise awareness of the e-learning programmes with the target audience being the NHS workforce, for whom the resources can be accessed for free. 

The campaign was social media-led and we directed specific professional groups (midwives, surgeons, occupational therapists, GPs, medical students etc) to e-learning programmes relevant to their roles. 

We felt the approach was quite innovative – for the NHS – as we used informal, often clichéd, puns as the narrative hooks, which were complemented with high quality images including real members of the workforce doing their job or accessing e-learning. 

We launched the campaign across Facebook and Twitter and within its first week we saw an increase in new registrations to the e-LfH Hub of 175% compared to the same week the previous year.

We followed the campaign’s launch with the development of a toolkit of assets (posters, flyers, web banners etc), which we shared with communications teams in NHS Trusts and organisations throughout the country. 

The ask was for communications colleagues to localise the materials and share the information throughout their organisation to encourage even more members of the workforce to access the free e-learning programmes.

The next phase of the e-LfH campaign is currently being planned and will be rolled out using a similar model.


Twitter chats as a data gathering exercise

One key challenge for the TEL Programme and other parts of the NHS, is getting feedback from members of the workforce on projects that are being shaped and ensuring any feedback gathered is multi-professional. 

Getting such feedback is crucial to allow the NHS workforce to increase the relevance of proposed solutions. An incredibly useful channel for us to fulfil these requirements has been Twitter and more specifically Twitter chats.

We have worked with WeCommunities to run a series of Twitter chats on subjects including: simulation, digital literacy, barriers to accessing technology, e-learning, mobile device interaction, artificial intelligence and sharing resources and innovation. 

With the help of these chats we have engaged with nurses, midwives, health visitors, AHPs, paramedics, doctors and others. 

The hour-long chats are hosted by the WeCommunities team. The TEL Programme recruits colleagues in advance to be part of the expert panel, adding context and their own experience on the subject to the discussion. 

The pre-agreed questions are asked at intervals during the 60 minutes and members of the Twitter community respond to these questions, giving their own thoughts on the discussion points and how the issues relate to their professional practice or organisation.

Not only do we gather rich insight from the workforce to inform our work during these chats, but we also connect with people who are interested in what we are doing, who often become involved in the projects long after the Twitter chat has finished. 

Building that network is so important to the future of healthcare communications and is still a key challenge – admittedly it’s easier now than it was seventy years ago when there wasn’t the technology to help.
 

Innovation is here to stay

Innovation will continue to be key to the digital transformation of the NHS and its workforce in the coming years.

How communications teams support that work is vital and is intrinsically linked to communications being seen as a strategic corporate function – but that’s another drum to bang. 

The role I have to play as a communications professional working in the NHS is to support the work happening to ensure staff have the skills they need to respond to and adopt the emerging technologies and innovations. 

However as much as digital is becoming and for some already has become, our lives – the heart of the NHS must continue to be built around compassion and care with digital and the technological advancements being part of the everyday and enhancing that care, rather than something extra.

Technology has without a doubt helped NHS communications professionals to engage more widely, but that doesn’t always mean we are using the most innovative of practices, techniques or channels. Innovation is relative. 

In an organisation that is such an institution we have to use what is available to us that is most effective in helping us to realise our aims and objectives. 

What is innovative to one communications professional may not be to another – but surely, the skill and success in our profession is understanding.


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Alex Drinkall is a freelance communications professional with over 20 years’ experience of working predominantly across the health, social care and education sectors. She has worked both inhouse and agency side for clients including Health Education England, Yorkshire Ambulance Service, Macmillan Cancer Support, Public Health England, Higher Education England and several primary care and acute hospital Trusts.

Twitter: @AlexDrinkall127 and @HEE_TEL
Online: www.hee.nhs.uk/tel

 

 

 

Selling to the NHS to enable its digital transformation

By Ben Judah

DrDoctor is a digital health company transforming the way hospitals and patients communicate, by using technology to tackle the financial strain on the NHS - one hospital at a time. We bring patient correspondence into the 21st century, to automate processes, collect outcomes, measure value and drive down costs. Our platform improves appointment scheduling, increasing clinic efficiency by reducing no-shows and filling empty slots. 

You’ll learn:

• Why the NHS doesn’t (like) change and how to achieve ‘gentle disruption’
• That even with big organisations you’re selling to a person, not a company
• Why slow and steady will always win the race


Why the NHS doesn’t (like) change

Consider Atlas – the Titan holding the world. Any slight shift in bodyweight or adjustment to the weight of the globe resting on his shoulders could result in disaster. 

The NHS is an organisation with around a quarter of a billion patient contacts per year. The risk that ‘change’ brings is colossal and because of this, the idea of ‘disruption’ is justifiably terrifying. 

It is for this reason that we at DrDoctor practice and preach an iterative approach – what we affectionately call ‘gentle disruption’ – where change is introduced in an evolutionary, patient and well-planned way.

This type of change has to come from the inside out, with the proponents of change listening to stakeholders at every level, aligning motivations and incentivising all those involved. From the patient to the admin team, doctors to senior managers, everyone must have the same goal and be pulling for the same outcome. 

The NHS is an organisation that is wary of change, but it is the opposite of an organisation against change. On every level, digital transformation is viewed as an opportunity if done right.
 

Selling to people, not companies

No company has ever bought anything. B2B versus B2C is more of a change in process than actual change in buyer. 

It would be an error of judgement to view a company, business or indeed government as the final purchaser of any product. There is always a person (or people) involved at every stage of the decision-making process. 

Different products or services are interesting to specific groups of users within the NHS and helpfully, they are signposted by job title. For example, being a technology business, we are interested at speaking primarily with CIOs or CCIOs (Chief Clinical Information Officers) within an NHS Foundation Trust. 

Unfortunately, within an organisation the size of the NHS, roles of this nature rarely share the exact objectives or responsibilities. Different Trusts and hospitals naturally have different technological needs. This means it is imperative to understand:

• Who cares about the obstacle we are trying to solve enough to deploy sizable chunks of their energy to solving it?

• Who has the decision-making power to implement it? (This is not always the same person as above)

• Who controls the budget to make this happen?

• Are there stakeholders who may raise objections?

Once we have identified these individuals, we can move forwards with the process of selling our solution. In a simple case, this can be one person, but it’s always best to be prepared for multiple stakeholders.

Selling technology in the NHS presents a unique challenge – forward thinking individuals who understand the benefits of new technology and can deliver results are often moved and can occupy a range of positions at various hospital Trusts. 

These movers and shakers may not be able to complete the project you started with them, therefore getting the buy in from those surrounding the role is crucial.
 

Slow and steady

The tortoise and the hare is a great analogy when trying to sell to the NHS – slow and steady wins the race. Designing your sales funnel to fit the style of long term relationship building is key. 

The average sales cycle from initial contact to signed contract can be around 18 months (aeons in the tech world) and where people are moving job roles at an increased rate this presents a unique challenge. 

Our cofounder Tom Whicher is an alumnus of the NHS Innovation Accelerator and has had the fortune of developing close relationships with many of the best and brightest people in the NHS. It is these relationships that make a difference. 

Regardless of a person’s position at the outset, having close ties to smart, motivated and driven people within the NHS is a great position to be in. These individuals will rise to positions of influence and will be conscious of companies who are their ‘new found friends’ following promotion.

When selling into healthcare and especially into the NHS, patience is the answer – regardless of the question – but momentum relies on nuance. It is the responsibility of the innovator to drive the project, ensuring that it doesn’t stagnate, while remaining sensitive to the buyer’s cautious outlook and need for time. 

It would be an error in judgement to assume that because your company’s product or service is being discussed internally a sale will come to fruition. Instead, the first step of the process has begun and as the innovator you must be the engine of change, swapping gears where necessary. 
 

The proof is in the pudding

Three years ago, our co-founder Tom Whicher met with Jenny Thomas, the general manager for Women’s Services at Guy’s and St. Thomas’ at a networking event, where they discussed one of Jenny’s major aims for the year - the reduction of DNA rates across her department. 

The next few months had Tom meeting with Jenny and her team, drawing up various solutions, but each struggled when it was introduced to the IT and Information Governance departments at the Trust. 

Their concern with security and ‘new way of working’ pushed them to err on the side of caution when embracing new technology, especially from a newer company. Jenny and Tom then agreed to create a Proof of Concept trial across her department, manually processing the data in a secure environment. 

The results were astounding, but rather than going straight back to the previous blockers, Tom invited around 15 other general managers from Guy’s and St. Thomas’ to a pizza and beer learning session. 

They discussed openly the concerns, data driven insights and results from the Proof of Concept trial and through constructive dialogue throughout the evening, piqued the desire of the others in the room. 

This led to a full-scale procurement process of the DrDoctor platform throughout the Trust, with a successful rollout to all outpatients’ departments beginning in April 2016. This has led to a 30% reduction in DNA rates and savings of £2.6 million within the first year of full deployment. 

The NHS has achieved an impressive amount in the last 70 years, but in relation to the illustrious history of the United Kingdom, it is still a baby - these years are formative and the need to embrace change is profound. 

There so is much to develop, learn and improve and if done correctly – pragmatically, powered by internal stakeholders and fuelled by innovators – we will surely leave a legacy for decades and even centuries to come.


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Ben Judah is the Head of Marketing and Communications at DrDoctor.

Twitter: @BenJudah and @WeAreDrDoctor
Online: https://www.linkedin.com/in/ben-judah-28916524/
www.drdoctor.co.uk

Doing digital: Evolving the public and patient interface in health through technology

By Rachel Royall

Modern medicine and healthcare relies on modern technology and communication. So in the evolving world of digital, how is the public and patient interface in healthcare changing and what are the implications for public relations practitioners for the future?

You’ll learn:

• About changing habits in how the public are seeking and accessing healthcare
• Why dedicated and professional communication is required to build public understanding and trust as the digital transformation of the NHS takes place
• How communicators have the access and the influence to champion the role of patient and public centred design and services


A digital transformation

In our everyday lives we embrace technology from shopping online and sending photos and messages to friends via various apps, to using voice recognition to tell us the weather. 

We’ve embraced and adopted technology throughout our lives with what seems like relative ease. 

Of course, we all know people who have been slower to buy the latest smartphone, or who still choose to pop into the local Sainsbury’s rather than order online, but overall technology has pervaded every aspect of our lives.

In healthcare though there is something of a dichotomy. Computers were first used in the NHS for administrative purposes in the 1960s. Since then we’ve come a long way with advancements in robotics, artificial intelligence and precision surgery. 

So why is the NHS still the biggest procurer of fax machines? Why are we still spending so much on post as opposed to embracing email for patient communication? 

On the one hand the patient interface with the NHS is nothing short of miraculous as new technologies are used to treat and cure illness and disease, transforming the dynamic between patient and care giver, yet on the other hand we are slow to adopt technology for patient communication, (apps, text, email), even though it has been widely used in other sectors for the last decade.

Digital transformation has the potential to completely change the way the public engages with healthcare. 

In the UK technology has changed the way individuals access health services. For example, the original concept of 111 was telephone advice by a remote health care professional and this is now evolving to an online channel that will enable an online consultation. People will be able to receive advice, guidance and potentially manage their journey to a GP, pharmacist or even a hospital via the internet or on a smartphone.

The patient and public interface with health professionals is becoming more informal. In some areas, people no longer have to wait for a fixed appointment to ask a doctor a question and can send a secure message via their health record to their GP, or skype our doctors so they are able to offer diagnoses or treatment via phone or computer. 

The digital revolution not only impacts on how we access services, it also impacts on how we obtain information about our health and manage our care. On Google one in five internet searches are healthcare related. 

More than 1.5 million people access NHS Choices every day to seek advice about healthcare. As patients and the public become more knowledgeable and more informed and they increase their access to digital services, it is inevitable that the ways that patients and the public access the NHS will continue to change.
 

The implications for public relations practitioners

There are challenges and opportunities for public relations practitioners in embracing the digital revolution in healthcare; digital transformation is mission critical, public trust is essential and the dynamic of power between professionals and patients is changing.

The population is growing and changing, putting additional demands on the NHS and social care. The Office of National Statistics has projected that the UK population is set to pass 70 million before the end of the next decade. 

It also highlighted the ageing nature of the UK population. In 2016 there were 1.6 million people aged 85 and over and by mid-2041 this is projected to double to 3.2 million. 

Technology can help deal with demands in healthcare, as societal change embraces the fact that many things, but not all, can be done without direct face-to-face interaction. 

Targeting the dissemination of health information to the right audiences at the right time to encourage self-care can help to reduce demand. 

Using digital technology well can free up more time for care givers to spend face-to-face with the patients who need that care. It’s all about giving people the right care, in the right way, at the right time. 

Embracing digital across the health and care sector isn’t optional, it’s business critical and the PR community is well placed to amplify this message, to encourage adoption and also to support leadership teams to understand the changing environment. 

To use the words of Robert Watcher: “The one thing that NHS cannot afford to do is to remain a largely non-digital system. It is time to get on with IT.” [1]
 

Public trust

The simple reality facing us is that without public understanding and professional engagement to build trust, we won’t deliver the potential of digital technology in healthcare. 

The NHS is one of the most trusted brands in the world with 98 percent recognition. However, the Edelman Trust Barometer shows us all that public trust in institutions is declining. Not only that but alongside immigration one of the issues that Britons are most fearful of is the pace of technological change. 

Against a constant backdrop of media crisis, the public relations profession has a key role to play in helping to build public trust in the use of digital technology for healthcare, both in terms of technology for patient care and moving information around the system and using it to improve things. 

Tactically we can help build trust by being proactive about communicating the benefits of using healthcare data for research, by encouraging the adoption of digital technology that is already in place and by explaining how we keep personal information and systems safe. We also need to be transparent when things go wrong and be open about progress and challenges. 

All of this is essential to building public trust. And whilst trust in politicians is at an all-time low, there is a huge opportunity for the NHS workforce to be advocates as trust in doctors and nurses is still high at over 90 percent. 

To truly benefit from the opportunities that digital can bring, we need the support of public relations professionals to bring doctors, nurses and all other healthcare workers with us. 

There is a piece of work here to truly engage those managing and designing healthcare systems and those delivering care, as well as to understand and respond to any concerns and to support them to see how embracing technology could transform their practice and free up more time at the patient bedside.
 

Patient power

Improved access to information and technology in healthcare shifts the dynamic of power between healthcare professionals and the patient – it increasingly puts patients in the driving seat, as they have more access to their own information. 

There is also a tension between care and technology, some systems feel clunky for nurses and doctors – they get in the way of the human relationship. The language and tone can sometimes feel inaccessible, using systems sometimes doesn’t feel human. 

Above any other profession, PRs have the access and the influence to champion the role of patient and public centred design and services, improving them for the patient and healthcare professional alike. 

PRs can help leaders listen to the public, access insight and develop technologies that meet public expectations. Also once patients understand the benefits to their care they can be a catalyst for change. 

The digital revolution in healthcare will continue apace over the next thirty years and will be unrecognisable to those of us who get to celebrate the 100th birthday of the NHS. However, it is a huge opportunity and communication is at the heart of it. 

The collision of information, technology and communications will continue to impact on the public and patient interface with the NHS. The technology in some ways is the easy bit, as the technology develops, the communications and PR profession needs to take its rightful role in the leadership of the digital agenda.

The digital transformation is not only business critical in medical innovation but also in communication innovation. 

Only through professional and ethical PR can we build public trust and only through helping our organisations listen and understand the needs of NHS staff, patients and the public will we develop services that meet their future needs. 


Sources

[1] P.6 Watcher Review: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/550866/Watcher_Review_Accessible.pdf


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Rachel Royall is an experienced Board level communications and engagement director and is currently the Director of Communication for NHS Digital, the government arms-length body responsible for implementing digital transformation across the NHS and health care in the UK. Rachel has held senior level communication roles across the public sector, including the NHS, HM Revenue and Customs, Cabinet Office and Department of Health. Graduating from Kings College London with a degree in Theology, Rachel has an MA in Public Communication, a Diploma in Strategic Communication and is a member of the Chartered Institute of Public Relations and the Institute of Internal Communications.

Twitter: @RachRoyall
Online: www.digital.nhs.uk

Achieving public health behaviour change

By Alexia Clifford

Changing people’s behaviours, especially when they are ingrained, is no easy feat. It takes audience insight, coupled with a focussed drive to raise awareness, as well as long-term engagement. Results can take years to achieve but the investment required is more than worth it in terms of health outcomes and a reduction in care costs to the state.

You’ll learn:

• How good social marketing campaigns have audience insights at their heart
• How solid measurement and evaluation enables campaigns to be more agile, responsive and therefore successful
• How personalised marketing and digital innovation can significantly help change behaviour


Change for the better

Public Health England’s (PHE) Social Marketing programmes are designed to motivate and support millions of people to make and sustain changes that will improve their health.

All of our campaigns start with insight into people’s lives. We take an audience-centred approach, which means that we work to understand how people live, how they feel about health and what it means to make good health a part of daily lives. Audience insights help inform our campaign strategies as well as the creative ideas at the centre of our campaigns.

We take evidence-based public health guidance and repurpose it. We make it user-friendly, accessible, shareable, ownable, personalised, dynamic, actionable, rewarding and, when appropriate, fun.

We use a range of behaviour change models to guide our planning, recognising that different models are suitable for different issues and audiences. For example, what may work for youth resilience may not be appropriate for healthy eating.

Rather than telling people they will feel better if they change their behaviour, we create tools that nudge people into the desired behaviour and then help them notice how much better they feel as a result.

We build on and contribute to, the evidence base for key public health challenges. Our evaluation framework allows us to pinpoint which elements of a campaign are working most effectively and what needs adjusting or improving. 

As well as looking at activity and reach across paid, earned, shared and owned channels and awareness and engagement, we look at claimed and actual behaviour change. 

Every PHE marketing evaluation follows our framework, although the combination of evaluation tools, techniques and data points varies between campaigns to reflect differences in each campaign’s objectives and structure.
 

Saving lives and money

The Act FAST campaign for stroke is one of our longest-running and best-evidenced campaigns – raising awareness of the symptoms of stroke and encouraging people to dial 999 when any of the signs are noticed. It was launched in 2009 and has been creatively refreshed several times.

Since launch and as at 2016, at least 5,365 fewer people have become disabled as a result of a stroke, giving a return on investment of £28 for every £1 spent. And in terms of behaviour change there has been a 78% increase in calls to 999 for a stroke, contributing to saving around 12.2k additional quality adjusted life years, a saving of over £410m in benefits to the state and reduction in care costs as a result for the same period.
 

An example of personalised marketing: Stoptober

Many smokers struggle to quit and need motivation and support. Now smoking rates have fallen from 20% to just over 15% of the population, smokers are also becoming harder to reach. We wanted to find the most efficient and cost effective to reach them.

We decided to use personalised marketing and the power of data to reach our audience. Personalised marketing, also called one-to-one marketing, involves using data analysis to deliver individual messages, promotions and product offerings to existing or prospective customers.

Stoptober 2016 employed a new data strategy – combining Facebook data, search and PR – which enabled hyper-targeting of smokers on social media. This involved:

• Building an Interest audience using audience behavioural data on the Facebook platform, for example users that ‘liked’ smoking related pages

• Retargeting smokers based on their engagement to previous PHE campaigns, for example those who engaged with the Stoptober Facebook video.

• Using combined survey and panel-based data to identify people who had responded as being a smoker and sending them relevant Stoptober content.

To increase engagement, we also partnered with Spotify to create a series of Stoptober playlists to reflect the various emotions that quitters experience during their 28 days - from hope, excitement and nervousness to elation. This was promoted via Facebook and through consumer PR with celebrity DJs discussing their playlists and smoking stories.

The results were impressive - we drove 16% of smokers to make a reported quit attempt and we increased the efficiency of our spend through reducing media wastage significantly (90% of social impressions were delivered directly to smokers).


An example of digital innovation: Start4Life – Breastfeeding Friend Alexa Integration

In England, almost three-quarters of women start breastfeeding when their child is born, however by weeks 6-8 this drops to 44%, making our rates among the lowest in the world. 

Online search for breastfeeding support peaks between 2am and 6am, when technology can play a complementary role to the vital support offered by healthcare professionals. We worked with midwives, health visitors and mothers to create new tools that could provide helpful advice at any time of the day or night, quickly and easily.

We developed a new ‘Breastfeeding Friend’ Facebook Messenger bot [1], an AI powered product that provides a simple interface via text-based conversations, just like interacting with a friend on Messenger. The bot is designed to provide information any time the user needs it, such as how to establish breastfeeding and check your baby is feeding well.

Over 20% of new first time mothers interacted with the Breastfeeding Friend bot during its first

month; 46% of whom signed up to receive motivational push messages, which enjoyed an exceptionally high average opening rate of 90%.

Building on this success, we partnered with Amazon to recreate this experience on the Alexa platform, moving from text-based interaction to voice interaction with Alexa. Together we built an app (or ‘skill’) for Alexa allowing mums to talk to any device running the voice assistant in order to provide help, support and advice around breastfeeding entirely through natural-voice conversation, making the experience more personal and “human”.


Sources

[1] https://www.facebook.com/Start4LifeBreastfeedingFriend/


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Alexia Clifford is Deputy Director of Marketing at Public Health England, an Executive Agency of the Department of Health. Alexia has led a number of highly successful, flagship social marketing campaigns including Change4Life, which encourages millions of families in England to ‘eat well, move more, live longer’, Stoptober, which has helped more than a million people to quit smoking and Be Clear on Cancer, which has helped to save hundreds of lives through earlier diagnosis. Alexia is a communications and marketing professional with more than 15 years’ experience across the public and private sector. She has an MSc in Mathematics from Cambridge University and an MA in Film Studies from the University of Westminster.

Twitter: @PHE_uk
Online: www.gov.uk/phe

Managing consultation and the major change process in the NHS

By Stephanie Hood

Successfully managing large-scale service change in the NHS demonstrates perfectly that excellent communications practice is no longer all about shaping perceptions but working with audiences to shape realities together.

You’ll learn:

• Major change requires capacity, capability and dedicated resource
• Co-design is the only way to develop new models of care
• Expectation management is critical to successful outcomes


Managing change means difficult decisions

Why is it we regularly see impassioned crowds outside hospitals waving placards to protect services that we know don’t always consistently meet quality standards, or which are no longer being delivered from the most appropriate place? 

Why don’t we see those same committed campaigners outside the offices of commissioners demanding better outcomes? 

Despite leaps forward in NHS transparency, people often don’t believe there is anything wrong with the status quo or believe it can all be fixed with additional funding. 

There is concern about the unknown. Judgements requiring compromise: which is more important - access and travel times, or quality and safety? People feeling ‘done to’ rather than ‘with’. Cynicism from an inability to implement change quickly and offer confidence in the new. 

Political arguments playing out which would be better targeted at politicians than NHS leaders and clinicians.

Staff who think proposals are a criticism of individual performance, rather than an acknowledgement they are delivering the best care they can despite, rather than because of, the way services are designed around them. 

Within this context, what can communications professionals do to support and help deliver major service change in the NHS?


Pre-consultation period

Negotiate and acknowledge the communications and engagement resource required as part of the programme set up. Doing it well takes capacity, capability and dedicated resource. 

The legal duty to involve and engage is at the fore and you must demonstrate evidence of this. It should be part of ongoing activity but needs focusing on the path ahead.
 

Be clear on governance

Be in key meetings, understand the politics and judgements, who is making decisions, when and how. Particularly when working across multiple organisational boundaries. Do this formally and informally. 

Remember publicly it is all ‘the NHS’; most people don’t readily distinguish between the component parts, but you need to be clear how it fits together. 

Hold the mirror up in those meetings and be the voice that promotes the patient, staff, public and stakeholder perspective. Build patient and clinical reference groups into the governance structure.
 

Create a compelling case for change – and get a mandate for it

People talk of needing to maintain public confidence in current services and a delicate balance is needed. 

But how many expectant parents knew there was only a consultant obstetrician on the labour ward for 24% of the week in one of the obstetric-led maternity units that recently needed to make changes? 

Who knows national stroke guidelines recommend units see at least 500 stroke patients/year and only one of six sites in a county-wide reorganisation currently does? 

We need to be more open about what’s working, what isn’t and what could be done better. 

Acknowledge that models from the past may have been overtaken with new evidence about what works.

A robust case for change must be evidence-based, led by and agreed by clinicians. Don’t underestimate how long this can take. 

The communicator’s role is to bring the technical document to life. Translate the complex to the simple without losing meaning, paint a clear picture of how things are and how things will be if nothing is done. Focus on what matters to people. 

Don’t stop telling the case for change story. Identify and work with stakeholders. Get a mandate for change when all agree the status quo is no longer an option. Without it people can backtrack. (‘It’s too difficult, things aren’t so bad, let’s just stick with how things are’).
 

Develop a burning ambition 

A burning ambition is arguably more powerful than a burning platform. 

Coalescing around a shared vision for the future is longer-lasting and more motivating, pulling rather than just pushing people to change. 

Engage widely and co-design with clinicians, patients and the public. Communicate the vision clearly, in a way that resonates with different audiences – what’s in it for them? 

Draw on existing insights and research, there is usually much available, you don’t need to reinvent the wheel.
 

A new model of care - the importance of clinical leadership, engagement and co-design

Getting the clinical engagement right is paramount. Clinically-led and evidence-based thinking to design new models of care takes time. 

Done best it involves many people (e.g. multi-disciplinary workshops with c100 clinicians from multiple organisations), but recognise the commitment required to do this on top of the day job – evening meetings can work best? 

Involve patients and public representatives from the start. Test the thinking then test it again with identified stakeholders. Be able to demonstrate ‘you said, we did’ feedback. 

Getting people agreed around a model is an important step forward. At this stage people can be objective - it isn’t yet focused on what services could be where. Communicate progress to wider audiences.

FIGURE 1 Overarching approach: A pre-consultation engagement process
(Timeline has many interdependencies not shown here. Example only and can take many months across each of these stages.)

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Developing (and communicating) the options – location, location, location

Engage widely in developing and agreeing the ‘evaluation criteria’ used to assess potential options and agree short-listed options for consultation. 

Agreement on the criteria and process (which should include clinician, patient, staff and public representatives) is critical when some people won’t like the outcome. 

Communicating the outputs from this stage requires detailed planning and sequenced messaging to all audiences. People will be waiting for the announcement and to understand what it could mean for them. 

Be clear these are potential options; no decisions have yet been made.
 

Assurance, check and challenge

Effective pre-consultation engagement can mean you reach a point where impatience sets in, with demands to ‘get on with it’. But a key stage includes necessary and detailed final assurance with regulators. It is ongoing, but the last stage can take some months. 

Keep communicating and planning for consultation and all that entails. There is much to do in demonstrating activity and outcomes from pre-consultation engagement, contributing to the development of the pre-consultation business case, managing multiple stakeholder relations and preparing detailed consultation plans, the consultation document and supporting collateral. 

Sign-off processes for communications material flush out previously unidentified differences of opinion and data. You must get this aligned and have a single version of the truth.
 

Consultation is not a vote

Be clear what you are consulting on and what you are seeking in response – views, feedback, support, concerns, mitigations, additional evidence, alternative solutions – but it is not a vote. 

Manage expectations. Public meetings are only one strand of your consultation activity. Targeted research (focus groups, polling, surveys); roadshows and outreach work; digital, social and traditional media; staff and stakeholder communications and engagement; correspondence; briefing; and awareness-raising, all have a role. 

Take care not to let the most vocal drown out the quieter voices – all need to be heard. 

Consultation for large-scale change is resource intensive. Don’t underestimate the communications, engagement, clinical and leadership time and resource required.

Be visibly clinically led and work as a team. You will need emotional and physical resilience, an eye for detail, responsiveness, rapid rebuttal systems to prevent misinformation from others becoming accepted truths and a determination to listen as well as to explain. 

It can be relentless. Hold on to the fact that it should lead to improved services and outcomes for patients. If not, why are we doing it?
 

FIGURE 02 Example consultation activity overview

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Activity taking place throughout consultation period

• Supporting materials, survey and information on website and signposted from partner sites

• Weekly topic-specific content shared via existing and partner channels (e.g. website, social media, bulletins / newsletters, staff briefings, etc.)

• Promotion of consultation to and in 3rd party stakeholder organisations’ communications channels

• Presentations to / attendance at key stakeholder meetings / groups

• Information displayed in provider organisations (including staff areas), GP practices, pharmacies, libraries, community centres and other public spaces

• Providing support materials for 3rd party meetings (e.g. animation, consultation documents, FAQs) and speakers where possible

• Proactive outreach to seldom heard and protected characteristic groups and targeted research programme

• Ongoing media, social media and awareness raising activity

• Regular staff and stakeholder engagement and briefings

• Targeted 1-1 stakeholder engagement to generate responses

• Correspondence, briefing and enquiries
 

Post-consultation phase

Considering the evidence and decision-making

Decision-makers must give thorough and conscientious consideration to the consultation feedback and need to look at all the evidence in the round before deciding the future shape of services. Avoid a communications and engagement void in the months after consultation before decisions are made. 

If there is legal challenge the timeline for change can be long and drawn out. Keep communicating and keep people abreast of what’s happening.
 

Implementation

Wrap the communications and engagement work into business as usual, but keep it going. 

Engage on the granular detail of implementation design, communicate early progress, address issues and manage expectations on timescales for delivery. 

Develop clear information for patients. Keep staff and stakeholder engagement at the fore. Keep messaging focused on delivering change to improve outcomes and patient care. 

If the right decisions have been made, over time those with placards might realise everyone has been pushing for a shared, broader goal around best care. 

In my view, better decisions are made when all perspectives – including dissenters and supporters - have been heard, considered and built into the final design of services. Successfully managing large-scale service change in the NHS demonstrates perfectly that excellent communications practice is no longer all about shaping perceptions. It must be about working with audiences to shape realities together. 


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Stephanie Hood has advised and supported boards, ministers, policy-makers and senior management teams in the NHS with effective and strategic engagement and communications for 25 years. Working with and across different health and local authority organisations, she has led and delivered communications and engagement and public consultations for a number of high profile NHS service change projects across the country and has developed significant experience and expertise in this area. In 2014 Steph founded Hood & Woolf, a consultancy that helps organisations have effective conversations and productive relationships with the people who matter to them and their business. Hood & Woolf are experts in communicating change, helping clients articulate a clear vision, engage with empathy and impact, tell a consistent story and get results.

Twitter: @HoodSlhood
Online: www.hoodwoolf.co.uk

Real results: The role of Communications in achieving organisational outcomes

By Kerry Barron-Beadling

Demonstrating real results from the efforts of communications has long been the holy grail of the public sector. There is plenty of data supporting clinical work such as the number of referrals, complaints letters, friends and family scores etc. But as a NHS communicator how do we demonstrate the link between our campaigns and the frontline?

You’ll learn:

• Why it’s OK that you cannot prove beyond a doubt that your work was the only factor that resulted in change – and what the one thing is you should be focusing on
• How the data you need is already out there waiting for you
• How this has already been used on two of the big issues facing the acute sector today


How can we prove what difference our actions have made as communicators?

I’ve spent over a decade in NHS communications and in my experience this has been the question that has caused the most consternation.

How do we best show the value of what we do? 

Previously the much maligned AVE was held up. At its best AVE allowed teams to produce impressive looking stats, even if they were irrelevant. Irrespective of that, AVE could not show any sort of result for internal campaigns anyway. Elsewhere good old GF was used: Gut Feel.

In a profession struggling to demonstrate its value, neither of these support our values. For too long, we have struggled because we’ve searched desperately for causation of our actions – actions that could have only related to the campaign or tactics used. 

While that may work in the private sector (where sales act as the direct result of a marketing campaign), in the public sector we don’t have definitive sales metrics to reinforce our work. 

For too long, as we couldn’t prove causation, we stuck to outputs. But there is a third way I would like to discuss: correlation.

A well planned campaign with clear objectives linked to an organisation’s strategic priorities should always be able to demonstrate a level of correlation, whether that is weak or strong.


Working on a familiar front door problem

In a previous role in an acute Trust we struggled with the usual winter pressures and would regularly get the call to put a message out on social media to ask people to use their NHS services wisely. This, it was hoped, would decrease the amount of people coming to A&E unnecessarily.

In January 2017, having seen the increased reach of video on social media sites, the communications team decided to use a video of one of our Emergency Department clinicians asking people to use services wisely, rather than a text-based message. The key messages though were the same.

The video was posed on Facebook on the Trust official page on 4 January 2017. The outputs were impressive – it became the Trust’s most popular post ever with a reach of 149k, 70.3k views, 188 reactions on the post, 1,311 shares and 84 comments on the post itself (200 on shares). 

But did it actually reduce the amount of attendances coming through the front door?

Based on Trust data, on Thursday 5 January 2017, the day after the video was posted, there was a 12.4% decrease in A&E attendances from 4 January 2017. 

As a comparator, between the first Wednesday and Thursday in January 2016 there was a 1.9% increase in attendances. This was data that was already being routinely collected at the Trust. 

Now was this down purely to the video? It’s difficult to say 100%, particularly given that other organisations were giving out similar messages at the same time. However given the size of the reach and the 14.3% difference year-on-year I believe it is possible to show a correlation between the two which demonstrates that the video message did have a short-term (24 hour) effect on reducing the number of attendances at A&E.


How do you recruit from a reducing pool?

Before I started at Sherwood Forest Hospitals, it was highlighted that the largest staff group with vacancies was Band 5 nurses – again a common issue across the acute sector.

Insight work was carried out with recent starters, recently qualified nurses and those who had worked for the Trust for less than one year. 

Staff were asked about where they saw the roles advertised, where they looked for roles, what they looked for in the roles and their perceptions of the Trust. The survey also looked at staff retention and why staff were leaving the Trust. 

With this information, a campaign was developed, which focused on Sherwood Forest Hospitals being a forward thinking, innovative Trust with a friendly and supportive environment that is easy to get to. 

The language used in both adverts and communications relating to jobs was revised using phrases from nurses in the insight results. It was also decided to use social media because the insight work showed that apart from the Trust website and NHS Jobs, social media is where most nurses look for and learn about new opportunities. 

It launched in April 2017 and within the first month, the campaign reached an online audience of 30,939. 

The first two recruitment days resulted in 29 registered nurses being recruited and more than 200 nurses (both internal and external) signing up to the Trust’s internal rota system, known as ‘bank’. The launch of the nursing recruitment campaign was also featured on ITV which reaches 5.5 million adults on a weekly basis.

In terms of outcomes, there was an increase in applications to nursing positions across the organisation, with both recruitment days seeing a 100% employment success rate. 

Overall nursing vacancies reduced from 22% in 2016 to 15.8% and in the first two months of 2017/18 nursing agency spend was £935,000 (representing a potential annual total of £5.6m and therefore a potential £2.8m saving). 

There was also a £97,000 reduction in nurse agency spend in one month from March 2017 to April 2017. We now have more substantive nurses working for us compared to 12 months ago and are one of few acute Trusts to do so. 

This is a clear correlation between this well thought out campaign, the increased substantive nurses in post and reduced spend on agency nurses. And again all the information needed to prove this was already held in the Trust.
 

It’s OK to correlate

Both these campaigns won awards. It goes to show that no campaign is ever going to be perfect or run in lab-like conditions. Proving causation is always going to be problematic, as it proves problematic for most. 

However a well-planned campaign should always be able to prove a correlation between our outputs, outcomes and then link to strategic priorities. 

If you feel unable to do this, you need to ask yourself: 1) were the objectives the right objectives? And 2) did you measure the right things? 

And 3) if you couldn’t measure the value, why did you do it?


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Kerry Barron-Beadling started her working life as a reporter on local newspapers before jumping into NHS comms more than 10 years ago. She’s always worked in the hospital sector covering small district general hospitals, big teaching acute Trusts and is currently Head of Communications at Sherwood Forest Hospitals NHS Foundation Trust, an award-winning organisation covering three sites in Nottinghamshire and a community of 400,000. She is passionate about promoting the strategic importance of communications and is one of the few Heads of Communications in the acute sector to be a member of her Trust’s executive team and Board of Directors.

Twitter: @KBeadlingBarron
Online: http://www.sfh-tr.nhs.uk/ 

Beyond communications: the added value public relations professionals offer to the NHS of the future

By Louise Thompson

Scratch the surface of any inspirational NHS leader and great communication is at the heart of their approach. 

Given this, why is the NHS still such a challenging environment for communications professionals when it comes to flourishing at board level? 

If we are to successfully position communications and engagement skills as crucial to management teams, we must look beyond our traditional portfolio remit. This is where the inherent flexibility, evolving skill set and innovative approach that we communicators possess as standard is of benefit. Proving our leadership, ethical and strategic abilities offers the opportunity to make a real difference to NHS staff and to our patients and communities.

You’ll learn:

• What ‘super powers’ communications professionals possess that make them ideally placed to offer greater strategic value within the NHS
• How those skills can help bridge the gap between the NHS and the local communities we serve, bringing the NHS values to life for local residents
• How communications professionals in the NHS can have a transformational impact on workforce and organisational development issues, such as recruitment, retention and staff wellbeing


Communications professionals can’t afford to be passengers 

I am just three years into my NHS journey and much of my prior experience has come from working with technology start-ups, where virtual reality and artificial intelligence are the norm. But although you may think the UK health service and Silicon Valley are poles apart, there are some valuable lessons I learned during my time in this sector that have shaped the strategic value I believe communications professionals can offer within the NHS.

In the start-up world, in order to sell, you have to be able to tell. Good communications and story telling are at the heart of every successful company. But these skills aren’t just limited to working with the media - they are a vital bridge to building company culture and enabling workforce engagement.

In many start-ups, the organisational structure is fairly flat and there’s no room for passengers, so every employee has to make their contribution count. This is not just in the traditional portfolio they were originally hired for, but across the board. You take on new areas of responsibility that may be a fit for you and you learn with the job. Or you don’t have a job for much longer.

We must do more of this as communications professionals in the NHS. Whilst the governance models are understandably more complex, there is still plenty of scope for us to put our hand up and take on some portfolio areas that make sense for us, given our skills and aptitude, but that are beyond what may be offered to us today. 

This is essential if we want to continue building the case for board level roles and responsibilities within communications.


Honing your communications ‘super powers’ to prepare for a broader role

What are the skills that communications professionals possess that make us fit for broader board responsibility in the future? Here are three that I think make us stand out.

• We can see around corners

Our ability to anticipate, prepare and plan means we can not only manage crises when they arrive, but we can often help prevent them altogether, proving our operational and strategic worth. This is vital when working in the fields of transformational change where every day brings another curveball and the only constant is change itself.

We can ‘speak human’

The NHS is chock-full of compassionate, caring people. But all too often that can be hidden beneath the layers of jargon we insist on adding to very simple messages. The very best communications professionals understand that simple isn’t dumbed down - it requires much more skill to deliver a message in a way that anyone can understand and then act upon. This is supremely helpful when considering adding community relations or workforce activities into your portfolio mix.

We start with ‘why’

It can sometimes be a lonely place as a senior communications professional. We are hard-wired to ask ‘why’ as the starting point for any organisational project, as we are adept at predicting the consequences if strategy or decision making isn’t robust enough. Sometimes, that can mean feeling a little out on a limb, but it is precisely this sense of constructive interrogation that enables us to build narratives that make sense for the organisation and communities we serve, even as that narrative evolves. This, more than ever, is what will be needed as the NHS navigates the transformational change required of it over the coming years.

If we are to move forward confidently, holding real strategic value within the NHS, then we must look at where and how we can best deploy our unique strengths and skills within a broader portfolio. Here are two ideas.


Connecting with your community - beyond the walls of your organisation

Community relations. Corporate social responsibility. These terms can sometimes feel a bit dry. And although laudable in terms of purpose, these activities can often wither on the vine if not placed in more innovative and forward-thinking hands.

Communications professionals are just the people to take up the mantle for community partnerships and engagement within the NHS, connecting with our strategy leads and working together to create real value ‘beyond the walls of our hospitals’ and deep within our local communities.

This is in many ways a natural extension of our engagement remit, but with service transformation and redesign so high on the NHS priorities list, there is a real opportunity now for communications professionals to grab this agenda and really make it count. We need to do this within a robust, outcomes-focused framework, linked with strategy, transformation and operational ‘grit’ that can have a tangible impact on patient outcomes and public health.

Within my local community a member of my team, alongside transformation and clinical colleagues, is working in close partnership with a local homeless charity to offer basic health checks out in the community, as well as give advice on securing GP care for those that are without a place to call home. A pilot project at the moment, there is a will to make this work at scale, which would not only start to improve population health, but could also help reduce local pressures on our busiest emergency departments. 

What started initially as community relations in the traditional sense (fundraising support offered by our hospital staff to the charity), is evolving into something deeper and more patient-centred. We started with the ‘why’ and linked this work back to core strategic objectives, then used specific skills in communications and engagement (including encouraging our transformation and clinical colleagues to come on board), as well as engagement on a very human level with the local people the charity supports.
 

Transforming the NHS outlook on workforce and workplace issues

This is a biggie. One of the most useful attributes NHS communications professionals have is our ability to grasp the bigger picture - we have to juggle it all the time when talking with the media about anything from waiting time targets to Christmas babies, to service redesign and car park woes. 

There’s generally nothing we don’t know about the inner workings of our organisation, or about how the public feels when we get it right, as well as when we get it wrong. 

This perspective is incredibly valuable when considering workplace and workforce issues and when combined with our natural inclination towards innovation, our engagement skills and our ability to ‘speak human’, we can have a real impact.

Think about the potential when there is a true partnership between Communications and Organisational Development/Workforce Transformation. Here are a few examples:

Staff health and well-being

By partnering with a fitness tracker company, my team launched a series of simple yet effective fitness challenges for staff within our organisation. These activities led to expected positive outcomes for our people (improvement in fitness levels, sleep quality etc) but also some surprising ones, such as forming new bonds at work due to the group activities and lasting behavioural changes such as parking further away from work in order to walk a bit further. It made complete sense for the communications team to develop and launch this (including liaison with the tracker company to get the partnership off the ground), as staff engagement was paramount. We needed to ensure all staff understood why we were doing this, how they could get involved and what the benefits would be. We were also able to map the results back to organisational workforce priorities such as reducing staff sickness and improving morale, which was an important part of the discussion at board level.

Recruitment and retention

These areas really benefit from deep cross-portfolio working and it’s essential that communicators get involved as a core part of the strategic offer around these issues, not just in the ‘bit at the end where we need a poster/video’. Again, our ability to start with ‘why’ and work back from there to a meaningful set of priorities and objectives, is invaluable to this essential and difficult work. Not to mention the benefits our innovative and creative approach can deliver. There is a clear opportunity for communicators to step up and lead these initiatives on a cross-portfolio basis, as critical yet supportive friends to our HR colleagues, leading to enhanced outcomes.
 

Use your super powers for good in your organisation

By at first recognising and then marshalling our specific talents, skills and super powers, we can lend real strategic oomph around the NHS Board table.

We can use our deep empathy and understanding of human behaviour to connect the corporate strategy with a narrative that speaks to people’s needs and wants, in terms they understand and can connect with.

We can peer around corners and offer advice and strategies for the plethora of transformational change projects that are now a feature of our NHS.

And we can keep starting with ‘why’, in order to make sure that our priorities are the right ones for the people and communities we serve, including our valued staff.

By looking beyond our traditional remit, we can offer so much more to the NHS as it navigates its future.


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Louise Thompson is the Director of Communications at Burton Hospitals NHS Foundation Trust. She joined the NHS in 2015 following an extensive career in the private sector, advising companies on corporate and consumer communications strategies both in the UK and internationally. Her current portfolio includes communications, stakeholder relations, staff engagement and community partnerships. 

Twitter: @MsLouiseT

Employee engagement and culture

By Alicia Custis

Firstly, culture eats strategy for breakfast. Secondly, if you are aspiring to have a uniform culture across the entire workforce, then join a cult. And thirdly, employee engagement does not equal organisational culture. 

So, let’s cover employee engagement first and the golden key. Then look at how engagement fits in with culture. And finish with the tricky, but widespread challenge of sub-cultures.

You’ll learn:

• That culture creates behavioural norms that can take a long time to shift
• About countercultures versus subcultures
• Why line managers are critical to a strong culture and should be invested in


Culture Club – part of the family, not an annual visitor

Organisations that lack a strong, energised culture may still have employees who are engaged in their work (though they’re probably unlikely to remain engaged for long). 

On the other hand, organisations with dynamic, inspiring cultures almost can’t help but have engaged employees. 

“The way things work around here” should therefore mean a place where people can participate in the decision-making process and voice their opinions, ideas, concerns, or even criticisms. 

Somewhere where employees are valued, supported and appreciated, with opportunities to be innovative and grow professionally. And of course, an open culture that embraces individuals for their diverse backgrounds. 

The list goes on, but the point is that we can’t rely on things like the annual NHS staff survey to measure achievements or shortcomings. We need pulse surveys, employee sentiment and culture assessments and real-time monitoring to rapidly assess when we’re on a high and when problems are arising. 

And we need to know what we’re measuring. That means breaking the behaviours down into activity that can be measured, with dashboards that show how behaviour and engagement alignment is tracking over time. Then using these results to focus attention and culture change efforts on problem areas.

It should be part of business, with a leadership style and communication system that reflects the corporate culture. 

We discuss our values at every opportunity in our organisation, with our value-based behaviours woven into annual appraisals and rewards for those who remember, understand and practice the principles. 

We recruit against our values, looking for attitude and fit to our corporate culture as well as ability. And, we tell inspiring stories that illustrate the mission, culture and values of our organisations. 

Culture does not make people, people make culture. It’s the people, stupid. 
 

Culture Club? What about subcultures….

Who are Mr and Mrs Average in an NHS organisation? 

Yes, we’re all firmly committed to the values of compassion and care, with a safe, high-quality health service for patients and good patient experience. But the NHS contains many powerful professional groups with associated subcultures which are often in conflict. 

These groups come together in multi-disciplinary teams, with sometimes multi-directional goals, particular attitudes and practices. We can have also other subcultures, based on geographic locations or level.

Its countercultures that are bad, not subcultures. That’s why we need to focus on creating the right environment for professional activity to thrive, within agreed standards and guidelines. Not make them feel that their way of working is undervalued or misunderstood, which could tip into counterculture territory.

We need to recognise our subcultures, consider them when planning organisational-wide initiatives, watch for signals of subculture shifts and disrupt the cynicism spiral.

Yes, that takes time and effort. But that’s the way to achieve integrity of purpose across an organisation. 


Present and engaged – why the line manager is king

It’s a feeling. Yep, employee engagement is the feelings that individuals have towards their work. It reflects how motivated and bought-in they are to the organisation and their role.

Culture manifests in deeply engrained behavioural norms that take a long time to shift, but engagement can be easily affected by temporary ‘climate’ factors, such as a bad manager, challenging project or organisational change. These factors can change from week to week, day to day and even hour to hour!

So, basically our work is never done and never ends when it comes to engagement. Plus it’s too important. 

It’s linked to staff health and well-being, patient satisfaction, effective decision making, innovation and clinical outcomes. Pretty big stuff and that’s without an era of heightened transparency, greater workforce mobility and severe skills shortages thrown in.

We recognise that effective communication from senior leaders is absolutely vital for employee engagement. But the golden key is line managers. Senior leaders need to set the tone at the top by being visible, approachable and accountable. They need to ensure there is regular and effective two-way communication with frontline staff. 

But line managers must be empowered, supported and trained to better engage their teams. They have a much more direct relationship and the evidence shows that their teams want to hear from them.

Our six-monthly communications survey with our 5000 staff consistently show that they would rather be kept informed, updated and engaged by their line manager. Those at the ‘coalface’ might not even come into contact with the intranet, newsletters and other corporate communications channels. Their manager is therefore pivotal in ensuring that information flows effectively both up and down the organisation. 

One of the peculiarities of the NHS is the fact that although only three percent of employees are officially classed as managers or senior managers, more than 30 percent of staff have responsibility for managing people. Most combine this role with clinical or other responsibilities, but wouldn’t necessarily see themselves as managers. But they have a critical role to play in engaging employees.

So, we’re putting our efforts – through management training programmes, coaching, quality materials and content and cascade and feedback systems – into them. Moving from ‘command and control’ to ‘coach and enabler.’

The line managers are encouraged to hold regular, face-to-face team briefings to feed key messages down to their staff and involve them in discussions about the priorities, challenges and potential improvement both for the team and for our organisation as a whole. 

We’re giving both support and the autonomy to deliver their messages in their way. 

Trying to ‘control’ messages means that levels of engagement get weaker and weaker the further down information is filtered. Not only do managers need to be given the trust and autonomy to shape and communicate messages in the way that they know is right for their teams, they also need input into what the messages should be. 

They will know if something is going to provoke a negative reaction and what needs to be done to reassure people. We need to empower middle managers to be able to say what, where, when and how things need to be said.

Trust is transitive. If our managers believe a message then the people who work for them are going to be more inclined to believe it.


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Alicia Custis is a multi-award winning communications specialist, with over 20 years’ experience working in PR agencies and the NHS. Alicia was asked to work at Stockport NHS Foundation Trust immediately after the saline poisoning murders at Stepping Hill Hospital in 2011, to lead on communications around the incident and develop and implement an overall communications strategy for the organisation. She was previously head of communications at The Christie Cancer Centre for 10 years.

Twitter: @AliciaCustis
Online: https://www.linkedin.com/in/alicia-custis-b162a711/

Managing internal comms within a complex web of organisations

By Kate Henry

Internal comms is often overlooked and undervalued but in a vast network of organisations like the NHS it is invaluable. Critically it helps employees buy into a shared vision and values.

You’ll learn:

• How to manage internal comms across a vast array of disparate organisations
• The type of challenges faced by internal communications practitioners
• How investment into internal comms can help an organisation of any size achieve its objectives


1.7 million staff and counting

The NHS is the UK’s largest employer, with more than 1.7 million staff across the UK. [1] It is the fifth largest employer in the world, behind the US Department of Defense (3.2m), China’s People’s Liberation Army (2.3m), Walmart (2.1m) and McDonalds (1.9m). [2]

That in itself presents a massive internal communication challenge, even before considering that the NHS is not a single entity. It is made up of hundreds of separate organisations – more than 200 of which buy health services and around 250 that provide care. That’s not including nearly 7,500 GP practices across the country. [3]

In England, these organisations are bound by the NHS Constitution, which sets out the core principles and values of the NHS. It also covers the extensive rights of staff along with a series of pledges that the NHS is committed to achieving. These pledges to staff talk about promoting an open culture, engaging staff in decisions that affect them and empowering staff to put forward ways to deliver better services.

Effective internal comms and staff engagement is crucial in healthcare; there’s overwhelming evidence which shows that engaged staff deliver better care: 

“NHS providers with high levels of staff engagement tend to have lower levels of patient mortality, make better use of resources and deliver stronger financial performance. Engaged staff are more likely to have the emotional resources to show empathy and compassion, despite the pressures they work under. So it is no surprise that Trusts with more engaged staff tend to have higher patient satisfaction, with more patients reporting that they were treated with dignity and respect.” [4]

As in any large and complex organisation, communicating effectively isn’t always a simple task; there are endless challenges to contend with. In the NHS, these include vast geographical footprints, varying cultures and sub-cultures, leadership changes, dwindling resources and service pressures impacting on people’s capacity to communicate and engage. 

There’s also the diversity and differing requirements of a large number of professional groups; the NHS has hundreds of different roles, from nurses to analysts, doctors to porters and microbiologists to librarians. 

Comms teams therefore have a significant role to play in any NHS organisation, needing to make sure that internal comms stays high on the priority list. They can make sure there’s two-way comms up and down the organisation, from ward to Board and back again. 

Equally, they’re uniquely placed to encourage and support networks and connect people across all parts of the organisation. Comms teams also have a key role to play in sharing their professional knowledge and skills, helping staff (particularly managers and team leaders) to become better communicators. 


Breaking it down - a case in point

South West Yorkshire Partnership NHS Foundation Trust provides mental and physical healthcare services in hospitals, in local communities and in people’s homes. It covers a population of 1.2 million people living across Barnsley, Wakefield, Calderdale and Kirklees, as well as providing specialist services across Yorkshire and the Humber. To do this, it employs around 4,700 staff. 

In 2015, the organisation identified a need to improve its internal communication. The comms team set about this by firstly doing a stock take and asking people what they thought. 

More than 375 staff shared their views. They were asked general questions on how they felt about internal communications and their satisfaction levels, as well as specific questions on the channels in place at the time. They were also asked about what they would like to see in the future. 

The results were enlightening, with only 57% of staff feeling that they were kept up to date with what was happening across the organisation and 45% feeling satisfied with the way the Trust communicated and engaged with them. There were lots of positive comments, as well as some really constructive feedback about areas for improvement. 

The information was used to inform a channel revamp, overhauling existing channels and introducing new ones to embed a more consistent rhythm of internal communication. These included:

• Revamping the weekly staff newsletter, The Headlines, now emailed every Monday

• Introducing staff huddles with the chief executive – informal discussions that take place for half an hour every Monday, rotating around the Trust’s key sites

• Introducing The View, a more personal, blog-style email sent every Friday from either the chief executive or member of the Board

• Giving the staff intranet a facelift and restructure, in line with a new visual identity implemented

• Introducing a new monthly team brief cascade, that provides updates on key discussions and decisions made by the Board and executive management team. The brief starts at a meeting for senior leaders and is then cascaded to all teams, ideally face to face and within two weeks

• Introducing annual staff listening events, which take place in each of the areas the organisation covers every May / June. These are led by the chief executive and help to communicate the priorities for the year ahead

• Revamping the annual staff Excellence awards to celebrate outstanding teams and individuals. 


It isn’t rocket science - it works

A year later, staff at the Trust were asked for their views again and the results showed an impressive improvement. There was a 26% increase in staff feeling up to date with what was happening across the organisation and a 21% increase in staff feeling satisfied with the way the Trust communicates and engages with them. 

External sources also confirmed improvements. The organisation’s results from the 2016 national NHS Staff Survey showed a statistically significant increase in the number of staff reporting good communication with senior managers. 

In addition, the Care Quality Commission, which re-rated the organisation from ‘Requires Improvement’ to ‘Good’ in April 2017, noted in their inspection report [5] that: 

“Staff at all levels told us how the internal communication within the Trust had improved since the last inspection”

“…increased communication had enhanced the transparent and open culture that existed across the Trust.”

“…staff articulated a change in culture across the organisation and demonstrated a clear understanding of the organisation’s vision and values and the Trust’s direction of travel.”

The work is by no means complete and the comms team continue to listen and respond to staff feedback. This is reflected by the continued improvements seen when staff were once again asked the same questions in December 2017. 

Moving forward, the team will now focus their efforts on supporting managers and leaders to communicate effectively and making better use of technology to support internal comms, such as staff apps and internal social networks.


FIGURE 1 Increase in % of staff feeling kept up to date with what is happening across the Trust

Do you feel that you are kept up to date with what is happening across the Trust?

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FIGURE 2 Increase in % of staff feeling satisfied with the way the Trust communicates and engages with them

How do you feel about the way the Trust communicates and engages with you?

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So how do NHS communicators reach 1.7 million staff and counting? By breaking it down and taking an insight-based approach to make internal comms manageable and measurable. Oh and by having fun and meeting great people along the way. 


Sources

[1] The Nuffield Trust, The NHS Workforce in Numbers, published 30 October 2017, accessed 18 January 2018
[2] Forbes, The World’s Biggest Employers, published 23 June 2015, accessed 18 January 2018
[3] NHS Confederation, NHS statistics, facts and figures, published 14 July 2017, accessed 18 January 2018
[4] The King’s Fund, Staff engagement: Six building blocks for harnessing the creativity and enthusiasm of NHS staff, published February 2015
[5] http://www.cqc.org.uk/provider/RXG


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Kate Henry is Director of Marketing, Comms and Engagement at South West Yorkshire Partnership NHS Foundation Trust. She has worked locally, regionally and nationally in a variety of NHS communications roles over the past decade. 

Twitter: @KateHnry and @allofusinmind
Online: http://www.southwestyorkshire.nhs.uk/ 

Social leadership: Cultural graffiti and sanctioned dissent

By Julian Stodd

We live in the Social Age, a time of constant change, a new ecosystem within which we must adapt and learn to thrive. The NHS is a massive structure, indeed many different interrelated structures: radically complex and creaking at the seams. But the overloaded system that we can observe, the formal system, which is owned and controlled by politicians and managers is only part of the story.

Suffusing through the whole edifice, held in a dynamic tension, is a ‘social’ system: a democratised network of local bonded-by-trust tribes, tacit wisdom, unheard stories and creative dissent. And the social structure houses many of the stories that we need to hear and holds much of the potential for the NHS to change.

You’ll learn:

• The dynamic tension that exists between ‘formal’ and ‘social’ systems and how we can use it
• The notion of social leadership and how we earn it
• The importance of storytelling and why listening may be a key skill


But first, let’s consider graffiti. Cultural graffiti.

Walk around any city and you will see graffiti: when I walk through Bristol, it’s worn as a civic badge of pride, in Singapore it’s hidden and polite and in New York, raucous and blunt. 

Graffiti is a voice that is claimed, not granted. It’s the last voice taken, when all others are silenced: fully democratised, anyone can pick up a spray can and tag their local wall. 

But graffiti is not equal: whilst it feels subversive, if you interview artists and gang members around how they ‘learn’ it and how they apply it, you will hear stories of induction, prototyping, emergent power structures, socially enforced consequence and leadership.

Graffiti is not limited to underpasses and the back door of McDonalds: there are forms of cultural graffiti within our organisations. Claimed voices, voices that may be anonymised and shared without fear of consequence, anarchic maybe, but often constructive even if rough around the edges. 

This cultural graffiti is written not in acrylic or spray, but in stories and tweets. It does not flow through formal channels but resides solely in the Social. It’s claimed and sometimes hidden, but comes with a badge of high authenticity: it’s often shared by practitioners.

The NHS has seen an emergent tribe of social media savvy cultural graffiti artists: consultants, nurses, patients, all highly connected, operating outside their ‘professional’ formal space, but nonetheless operating to comment on, or improve, the overall system.

In the Social Age, if we want to ‘fix’ the NHS, we will have to do so through the individual agency of the aggregated whole, because the challenges that the NHS faces, at 70, are not solely financial. They are challenges of interconnectivity and complexity. And they are problems that will most likely be solved from within. To solve it, we will need to involve these hidden voices. But how?
 

Social leadership

In the formal system, you are given formal authority, the type of authority that is backed by a voice saying ‘because I told you so’. Formal power is important, but not limitless. 

In the social spaces, in the spaces where the cultural graffiti is scrawled and shared, your formal power will not reach. To lead in social spaces, we need Social Leaders and I’ve spent the last few years exploring what they look like, where we find them and, perhaps most importantly, how we can become one ourselves.

If the foundation of formal leadership is hierarchy (the system by which organisations are ‘organised’), then what is the foundation of Social Leadership? 

The answer is ‘reputation’. 

Social Leadership is reputation-based authority: we earn our reputation over time, through our actions into our communities and based upon that reputation we are awarded Social Authority. So ‘formal’ leadership is authority grounded in hierarchy, but ‘social’ authority is authority granted to us by our communities. 

This type of power is contextual, consensual, awarded voluntarily, not demanded through position or rank.

Our formal leaders may carry great power but if they have not earned a reputation through their actions, with humility, into social spaces, then they may have no social authority whatsoever.

Our cultural graffiti artists, by contrast, are often practitioners acting with great authenticity and may be awarded high social authority, even though they have virtually no formal power at all.

In the context of the Social Age, all of this is significant because we have seen an overall rebalancing of power - the individual storyteller, acting with strong social authority and high authenticity, is able to hold the formal organisation to account. Social power is favoured, whilst formal power is diminished.

When the NHS started, the challenge was to create a vast formal structure, run with almost military precision.

Today, at 70, the NHS faces a new challenge: to discover, to recognise, to empower and enable its Social Leaders, because it’s these people, deeply embedded within their communities, carrying high Social Authority, who will bring the agency to deliver change. Change, without which the NHS may not last at all.


Story listening

So what is the role of formal leaders in all of this? What message should we carry forth in this age of democratised, socially moderated, amplified, authentic storytelling? How should they respond to the cultural graffiti?

They should listen.

Knowledge used to be power, but today knowledge itself has changed and power may sit not in owning it, but in creating the spaces for knowledge to grow and to be shared. 

Our formal leaders must become expert at creating and holding open spaces for collaboration. Not simple collaboration: complex collaboration. Collaboration outside any formal structure. And to do that they will need to change themselves.

Humility is the foundation of Social Leadership and our leaders need to act with it at heart. They must learn to listen to stories, not to respond, not to counter, not to own them, but to learn from them and to do so with a humility to change.

There is a specific type of story that our formal leaders must learn to engage with: stories of difference. 

It’s easy to build consensus, but that consensus usually takes place within a community of similarity. Similar roles, similar thinking. But the NHS is vast: to become interconnected, we need to build communities not simply of consensus, but of respectful difference and we need to hear the stories that will support them.

When I interview graffiti artists, they understand spaces: they know where a certain type of space exists, a special space, where graffiti is allowed. Certain shop owners, certain landlords, even certain councils, create spaces for dissent. 

In some ways, that is what our formal leaders must learn to do: to hold open spaces for people to come into, to learn to hear the stories that are shared and most importantly of all, to listen to those stories with humility and respect.

When they feel the need to respond, they simply need to offer their thanks and be grateful that the community has chosen to share its images, to paint its cultural graffiti in broad daylight, where we can all benefit from the story that it tells.


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Julian Stodd is a writer and explorer of the Social Age. His last two books have explored aspects of Social Leadership and been adopted by organisations worldwide. These organisations share a belief that the organisation of the future, the Socially Dynamic organisation, will recognise democratised storytelling, have high levels of humble Social Leadership and, more than anything, be deeply fair to all.

Twitter: @julianstodd
Online: www.julianstodd.wordpress.com
www.seasaltlearning.com

Why do we need to talk about patient data?

By Nicola Perrin

Personal data is a sensitive subject at the best of times. Confidence in its safety and security is paramount. This chapter uses care.data as a case study to show what can happen without attitudinal insight and open and ongoing two-way dialogue to change public perceptions.

You’ll learn:

• Using patient data could help save lives, but patients must have confidence that their privacy is protected
• The failure of the care.data programme demonstrates how essential it is to communicate effectively with the public and healthcare professionals
• The NHS must lead a full conversation to explain how and why data can be used for care and research and how personal information is kept safe


Learning from care.data

In January 2014, every household in England was sent a leaflet, ‘Better information means better care’. The aim was to collect patient-level data from GP practices and to link this data with information from hospitals, registries and prescribing databases in order to provide better care, inform commissioning and advance research. The leaflet set out how information would be used and the choices people had. 

Sounds good? Within a month, the care.data programme was put on hold, following a backlash in the media. It was finally abandoned two years later. 

The project failed for two main reasons: the governance processes were found to be flawed and the communication strategy was extremely poor. The opportunity to make better use of patient data to improve health, care and services across the NHS has still not been realised. 
 

Data saves lives

The NHS has a unique resource: patient records for nearly 60 million people, with information about the health of a very diverse population from cradle to grave. 

If small amounts of data from many patients are linked up and pooled, researchers and doctors can look for patterns in the data, helping them develop new ways of predicting or diagnosing illness. The information from patient records is invaluable to help develop new treatments, monitor safety, plan NHS services and evaluate policies. 

For example, researchers have been able to explore why diabetes rates vary between ethnic groups, demonstrate that bowel cancer screening is effective, check the safety of hip replacements and improve the delivery of kidney dialysis services. 

Given the huge pressures facing the NHS, making more effective use of data is crucial to provide the best patient care and to make more effective use of scarce NHS resource.
 

FIGURE 01 Using patient data to improve health and care

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But patient data is sensitive and confidential. The NHS will only be able to realise the potential if everyone has confidence that data is kept safe and secure, with access appropriately controlled. 

Currently, most people – whether the public, patients or healthcare professionals – know very little about how data is used which makes them wary.
 

Raising awareness

Public attitudes work suggests that more than two thirds of the population feel they do not know how health data is used in the NHS. 

However, the evidence also shows that the more information people have, the more comfortable they are with wider uses of data. The results are fairly consistent: people are generally supportive of the use of data for research, provided there is a clear public benefit. 

There is a caveat: giving only a small amount of information may actually raise concerns. Where people have questions over how data is used, giving too little information leaves them with unanswered questions. It is only by providing further information, about the benefits and the safeguards, that people become more reassured.

That is why it is so important that we get better at talking about patient data and why the National Data Guardian has called for a ‘fuller dialogue’ with the public. 

In response, the Understanding Patient Data [1] initiative has been set up to support better conversations about the uses of health information. Our aim is to explain how and why data can be used for care and research, what’s allowed and what’s not and how personal information is kept safe.
 

Supporting better conversations

The first priority is to talk about the ‘why’, to explain the benefits of using data. For example, the #datasaveslives campaign has been successful in highlighting the positive impacts of analysing data. 

But the failure of care.data also shows how essential it is to explain more about the safeguards and to be honest about any potential risks. There needs to be more transparency: everyone should be able to find out about how data is used, why and by who. 

The provision of clear communication material will become even more important in 2018. The new data protection legislation, which must be implemented in May, has an increasing focus on fair processing. And the introduction of a new single national opt-out, as recommended by the National Data Guardian, will only be successful if there is a robust comms strategy clearly explaining the choices that people have so they can make an informed decision.

Engagement with healthcare professionals will be crucial to help achieve this. Doctors and nurses are the gateway to the public. 

The Wellcome Monitor found that doctors, nurses and other medical practitioners emerge as the most trusted (64%) source of information about medical research, both because they are the experts and there is no reason to doubt them. [2]

Engaging the NHS workforce must be a key priority to ensure they have the resources to explain to their patients how data is used and to help implement the changes. 
 

New digital technologies

A single conversation will not be enough. As the NHS turns 70, data-driven technologies are advancing rapidly. Machine learning algorithms can already differentiate between cancerous and healthy tissue more accurately – and more quickly – than the human eye. There is significant potential for artificial intelligence to transform healthcare and to help ensure a more sustainable NHS. 

But there is also the risk of a public backlash if technology firms are seen to be processing vast quantities of data, in unexplained ways, at the expense of privacy. There must be meaningful public dialogue to help people understand the risks and benefits and to ensure that everyone can have confidence that data is being used in a responsible way. 

Unlocking patient data will help improve health and care for us all. Data really can save lives. But if we are to achieve real improvements, patients, the public and healthcare professionals must have confidence that access to patient data is appropriately managed. 

Part of demonstrating a trustworthy system is to provide clear, accessible and accurate information. We must learn from the mistakes of care.data to ensure effective communication. Together, we can champion responsible uses of patient data.


Sources

[1] https://understandingpatientdata.org.uk/
[2] Ipsos MORI (2016) Wellcome Trust Monitor, Wave 3. London: Wellcome Trust https://wellcome.ac.uk/sites/default/files/trust-in-medical-research-graphic-wellcome-apr16.pdf


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Nicola Perrin leads the Understanding Patient Data initiative, focusing on supporting better conversations about uses of health information. Previously Head of Policy at the Wellcome Trust from 2007-2016, she was responsible for leading Wellcome’s policy development and advocacy work, with a particular focus on research base funding, data sharing and innovation in the NHS. Before joining Wellcome, Nicola worked at the Nuffield Council on Bioethics and at the Science Museum. She is a Trustee of the Association of Medical Research Charities and was included in the list of 50 Movers and Shakers in BioBusiness in 2017.

Twitter: @NMRPerrin
Online: www.understandingpatientdata.org.uk

What’s next for the future of the healthcare communications profession and how do we benchmark progress?

By Daniel Reynolds

Good communication sits at the heart of how the NHS engages with its patients, local communities, staff and other key stakeholders. The leadership and expertise provided by NHS communicators has a vital role to play in improving the patient experience.

You’ll learn:

• Some of the greatest challenges facing the NHS require expert communications skills and knowledge but, despite this, the NHS communications profession is often regarded as a service-level function
• Part of the solution lies in communication leaders developing a compelling narrative on why strategic communications must be invested in as well as better measures for demonstrating impact and return on investment
• The success NHS communications leaders have in this will go a long way to helping elevate the profession to the strategic function it aspires to be


PR is a strategic management function

NHS communicators need to be involved at a strategic level if they are to play as effective a role as possible in the running of their organisations. 

However, too often communications in the NHS is not regarded as a strategic function and instead considered by many to have a second-class status compared to other board-level positions. 

A new benchmarking study published by NHS Providers provides valuable insights into the NHS communications profession and where it sits as we enter the health service’s 70th year. It offers both hope and concern for the future. 

There is much to be positive and proud of as it reveals communications professionals at their best – whether that is delivering high profile campaigns that lead to desired behaviour change, leading public engagement strategies as part of initiatives to transform the way care is delivered or providing high quality information to patients. 

Progress has been slow but there is a growing awareness among NHS leaders of the key role communications can play.
 

Getting a place at the top table

However, comments from the 130 communications leaders that were surveyed for the NHS Providers study show there is still a long way to go before the profession rightly takes its place at the NHS top table. 

Despite many communications leaders enjoying good access to their chief executive, less than half formally report into the chief executive and less than a quarter sit on the board of their organisation. This is about more than line reporting arrangements as many communications leaders report into roles beyond those in the traditional C-suite. 

More worryingly, the report paints a picture of a highly pressured and over-worked profession, with fewer staff, too many demands and not enough opportunities for professional development. 

As with other parts of the NHS, communications leaders face budget cuts as part of their contribution to efficiency savings. Many communicators fear this is eroding their ability to contribute most effectively to helping their organisation achieve its strategic objectives. 

These funding constraints and workload pressures are forcing some leaders to move towards smaller teams based on more generalist roles and fewer specialists. Again, many fear this will have negative consequences, in particular by leaving their organisations short of specialist expertise. 

These factors undoubtedly present both opportunities and challenges for NHS communications leaders. We now have a useful baseline against which we can assess future progress but there are several issues that need to be front and centre of our collective efforts to become strategic advisers and recognised as such. 
 

Investment and support in NHS communications

With the temptation to make cuts to so-called back office functions, especially when every penny not deemed to be spent directly on patient care is increasingly scrutinised, communications leaders need to develop a compelling narrative on why communications must be invested in. 

We are not spin doctors and we are not there to simply defend and manage organisational reputation, though that is of course part of the job. What NHS communicators do often has a direct result on the patient experience and, when done well, will help to improve it. 

Some of the greatest challenges facing the NHS require expert communications skills and knowledge, not least in terms of managing the engagement challenge presented by Sustainability and Transformation Partnerships (STPs) and the changes to services they will deliver. 

We must make the case for communications leaders and their teams to retain the resources they need to play a leading role in helping the NHS to respond effectively to these challenges. 
 

Demonstrating strategic value

One theory as to why communicators do not always enjoy parity with other NHS professions is that, individually and collectively, the profession may not be doing enough to demonstrate strategic value. 

There is significant variation in how much time, energy and focus communicators are putting into this, with impact assessment often sacrificed when teams are short staffed and over-worked. 

This challenge is made harder by a lack of budgets for formal impact assessment. Communications leaders, with support from the national bodies, need to make better use of formal evaluation frameworks to show their activities lead to tangible returns on investment. 


The need for more formal career pathways

Despite the number of communications staff employed by the NHS and the vital role they play, the profession lacks a clear career structure and development pathway for communicators at all levels. 

This is regarded by many communications leaders as an increasing barrier to future recruitment. 

Despite the strategic importance of what we do, there is no requirement for professional qualifications for most communications roles and staff do not need to belong to a professional body, such as the CIPR, to practice. 

If we are to be taken as seriously as we want to be, then developing more formal career pathways is an important step in the journey. 
 

Safeguarding training and development

We know that budgets for training and development for NHS communicators are being eroded. We need to find creative ways of enabling greater numbers of staff to benefit from training – whether that’s through more online learning and sharing of best practice, or more regional workshops (backed by CPD points). 

Both would enable more communicators to benefit from training and development at minimal cost to the NHS. 

In a welcome development, NHS Improvement and NHS England have renewed their focus on supporting communications development with a new programme. We need to build on this in 2018 and beyond to ensure a generation of communicators now coming through are not deprived of vital developmental opportunities. 
 

Sharing communications capacity and expertise and partnership working

More collaborative working between communicators working in Trusts and other parts of the NHS and social care presents one potential solution to the capacity gaps and deficit in specialist skills that many health organisations are experiencing. 

For example, neighbouring Trusts sharing communications capacity and expertise on a more informal basis may help to plug gaps and lead to better outcomes. 

As part of this, there is an opportunity to build better links with our counterparts in local councils as focus shifts to an increasingly placed-based approach. 

This will be important where Trusts and their local partners need to engage effectively with an often sceptical public when it comes to the major service changes that are likely to result from STPs. And it may well prompt conversations on how we ensure that we have the right communicators with the right skills working in the right places. 

The NHS communications profession has made much progress, but the success its leaders have in responding to challenges outlined above will go a long way towards elevating the profession to the strategic function it aspires to be.


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Daniel Reynolds is Director of Communications at NHS Providers, the membership body for 99% of NHS Trusts in England. He is a former director of communications at the Nuffield Trust, deputy director of communications at The King’s Fund and started his career as a journalist, including working for Sky News.

Twitter: @DanielReynolds4
Online: http://nhsproviders.org/state-of-nhs-provider-communications-201718