The rebirth of public relations
Given the issues that threaten hospitals most, the time is right
to reconsider the strategic role of public relations in our organizations

by Burl Stamp, President
Stamp & Chase, Inc.

During the past twenty years, the role of the communications professional within the hospital has changed significantly. Once focused on editing the "house organ" and nurturing select relationships with the outside world, most public relations practitioners migrated to roles in advertising and promotions during the 1990s as hospitals adapted retail and consumer goods industry marketing approaches to health care.

If a hospital manager wanted to be taken seriously in the brave new world of managed care and cut-throat competition, public relations was, seemingly, not the place to be. Most hospital public relations departments dropped "PR" from their department names and titles. Witness, as well, the evolution of the Society for Healthcare Strategy & Market Development, the professional group representing public relations within the American Hospital Association: when adding "marketing" to the original public relations society's name wasn't enough, the group merged with the planning and marketing society to form a group that would be more strategic and comprehensive in scope.

If this professional evolution were merely semantic, one might argue that angst over the loss of "public relations" is more about sentiment than substance. But in most health care organizations, the shift in orientation is more significant. With mounting challenges in managing relationships with many constitu-encies - especially employees - the need for insightful public relations expertise has never been greater. At a time when most marketing and communications departments have turned the majority of their focus to external strategies, new opportunities to influence the success and ultimately the bottom line of their organization are largely internal.

Look at the problems that keep hospital executives awake at night. For the past two years, "personnel shortages" has been one of the top two issues listed by CEOs an American College of Healthcare Executives survey (www.ache.org/pubs/research/ceoissues.cfm). Despite acknowledgement in most institutions that at least as much attention should be placed on retention as on recruitment, human resources staff, by necessity, spend time and money on the most immediate, burning problems. Thus, today's vacant position commands more attention than tomorrow's potential resignation.

But higher turnover costs are only part of the problem. More difficult to quantify are the costs of low morale and diminished productivity among employees who stay in an organization but do not reach their professional potential.

Teasing out what matters most to staff is difficult when so many factors influence morale. But looking closely at organizations that have reached a major turning point in employee satisfaction can provide helpful insights.

A union vote is arguably the most visible sign of widespread employee discontent in a hospital. Granted, the likelihood of unionization varies widely by market for reasons that are beyond hospital management's control. But regardless of the external factors, examining the dynamics inside an organization that has successfully defeated a union vote reveals the importance of communication in reconnecting with staff. One of the first important principles in these efforts is recognizing that communication is a two-way exchange where listening is at least as important as speaking.

What would happen if management cared as much about communication with staff day-to-day as they do during a union organizing campaign? If communication has the power to reverse the tide of dissatisfaction that led to authorizing a union vote in the first place, think about the impact sustained efforts could have on morale, the working environment, collegiality and organizational culture.

Rethinking the strategic role of internal communication

Who better to take a leadership role and provide sound internal counsel on strategic communication issues than skilled public rela-tions professionals. So why are leaders of marketing and communication departments so seldom called on to play this strategically important role? At least part of the blame must land at the feet of public relations professionals themselves. For many departments, the first step in changing the way PR is viewed in the organization is to change the way communication staff see themselves.

Thinking about a few key questions can help in this self-assessment:

• Do I measure my value to the organization in terms of inputs or outcomes?
  • "I write newsletters and brochures." vs. "I help the organization communicate key messages to improve employee understanding and morale."
  • "I plan promotional events." vs. "I influence employee satisfaction by finding the right venue for management to communicate with staff."
• Do I assess and understand equally where senior management and front-line staff stand on important issues, then develop communication strategies to bridge the gap?
• Do I proactively listen, especially to frontline staff perspective, as much as I reactively deliver messages?

Before considering ways to shape an expanded, more strategically important role for public relations in influencing employee morale and satisfaction, two cautions are in order.

First, perceptions do not change overnight. Depending on your department's historic role within the organization, you may be seen as treading on territory that belongs to someone else (likely human resources) or, even worse, commenting on issues that are "none of your business." Rather than trying to assert your "right" to have input on broad employee communication issues, earn your stripes and the respect of your operations colleagues over time.

Second, there is the risk that you will be labeled as naïve if you comment on complicated questions without a good understanding of the underlying operational and financial issues. Asking the right questions can be more important than stating the right opinions, even if they appear to be on target.

With these caveats in mind, consider the following suggestions to help expand public relation's role in building morale, improving retention and increasing employee satisfaction.

Listen critically, especially to front-line staff. Employee satisfaction surveys are important, but they only tell part of the story. To gain a richer understanding of where employees stand on issues and how they feel about the organization, spend time with them. In particular, get to know the opinion leaders among front-line staff who care about important issues and are willing to speak up on behalf of their colleagues. But be careful; the most vocal staff members do not always represent the views of the majority.

Spend time on the floors with nurses, in the cafeteria with staff from other departments, on the employee shuttle buses or in other places where staff congregate. Develop a sincere interest in their issues and concerns, not just a passing curiosity that could be seen as insincere or manipulative. You will soon gain a better sense of the overall mood of the organization and be able to monitor changes over time.

Develop alliances with key individuals and departments. Too often, public relations is not viewed as part of the first-string team when it comes to consideration of difficult issues. Finding allies in important places in the organization can help change this perception. For instance, fostering mutual respect and a strong working relationship with human resources staff is essential in developing communication strategies to drive retention. Also, identifying PR advocates among the core operations management group helps builds visibility and reputation for your department in the hospital. Friends in the finance department make it easier to understand the numbers side of issues. And gaining the trust and respect of physician leaders creates a higher degree of credibility for public relations in the organization overall.

Gain an understanding of the most significant operations and financial issues facing your hospital. Spending more time with colleagues in human resources, finance and operations will give you a better understanding of the difficult issues they face day-to-day. As important, your colleagues should learn as much from you as you learn from them. Providing a better understanding of the role public relations can play in announcing major decisions or dealing with difficult issues will help operations managers view your department in a new light.

Learn to advocate for employees' viewpoints in constructive, politically acceptable ways. Nothing can derail public relations' reputation in the organization as quickly as a poorly-timed, uninformed statement that appears naïve. The first step in avoiding this pitfall is, of course, making sure you appreciate the complexity and implications of key issues. But beyond this understanding, how you present opinions that are important to frontline staff is critical. Rather than making "I think that …" statements, consider "Employees believe that …" observations. Offering communication solutions to dealing with these perceptions will be most helpful to operations management.

Proactively offer assistance on communication challenges. To many finance and operations managers, nothing is quite as intimidating as a blank sheet of paper waiting for inspired words to describe a difficult decision or controversial subject. Offering to help colleagues craft critical correspondence to employees can help move the perception of PR professionals from imposed editors to sought-after communication counsel. Great writing that clearly explains issues while acknowledging implications for front-line staff makes everyone's job easier.

Assessing your internal media and messages

In addition to rethinking your role in the organization, reexamining the ways that you communicate with employees - content, media and tone - can significantly improve the chances that your messages will make a discernable difference in the hospital's success. Following are suggestions for making all communication to employees more memorable and effective.

Make it personal. Employees want to hear things from people, not from "the organization," which is one of the major draw-backs in delivering the majority of critical message through inhouse publications. One straightforward way to address this challenge is to begin including more direct quotes from your CEO and senior management in the majority of stories.

But even with personal quotes, house publications still carry an institutional tone. If something significant has happened in your hospital - positive or negative - consider a personal letter to each employee and member of the medical staff from the CEO. If you want it to deliver the greatest punch, mail it to employees' homes instead of stuffing it in pay envelopes or distributing it through departmental managers. One caveat: this approach is powerful because it is usually unexpected. Use the strategy sparingly for only the most critical messages.

Remember the messages that employees want to hear most. Regardless of the subject, there are a handful of key themes that can make any communication more powerful in the eyes of employees. Consider these messages in developing your overall communication strategy or in evaluating an individual article or memorandum:

• Why? Employees deserve to know more than just the who, what and where of an issue. Helping them to un derstand why a decision was made or an event occurred puts the issue into perspective. Often, management and public relations practitioners underestimate the ability of staff to understand the complexity of issues. But even if some employees won't comprehend every aspect of a decision, sharing the details communicates respect and your willingness to treat them as responsible partners in the hospital's success.

• Thank you. These simple words are among the most meaningful to hospital staff when they are delivered sincerely and in the appropriate circumstances. In written communication, the sentiment generally is more powerful when expressed in a quote from an individual rather than from the institution. Do the words "thank you" seem too trite, inappropriate or overused? There are many ways to express the same sentiment effectively. "We appreciate the contributions of our staff …." "I value the role employees have played in our latest success." "On behalf of the patients we serve, my gratitude goes to the ICU staff …."

• I'm sorry. Hospitals have a historic resistance to expressing regret over virtually any issue. Perhaps rooted in the flawed perception that saying "I'm sorry" means accepting complete blame, even attorneys today are acknowledging that physicians who express sincere regret to families when something goes wrong reduce their chances of being sued.

  Expressing regret or sorrow should not be confused with the need for making tough, unpopular decisions. Given the financial pressures in health care, programs sometimes must be reduced or eliminated, benefits have to be pared back and plans change. Coupled with a clear explanation of why the change was necessary, a sincere expression of regret for the way the decision affects people in the organization humanizes the message. Depending of other factors, it can also make acceptance of the news easier.

Email has made rapid communication to staff feasible. Even if all employees do not have access to their own email account, using a distribution network through front-line managers means most on-site staff members can have a paper copy of a memo within an hour of dissemination.

Finally, even with the most efficient distribution network you will not reach many employees immediately. But the fact that you made your best effort to inform staff first will build trust and confidence in management.

Think like an employee. People generally choose careers in health care for reasons that come from the heart, not from the head. Balancing facts and figures with emotional appeals is particularly effective for hospital staff. Also, tie issues back to the heart of the business - patient care - whenever possible to help employees understand the big picture underlying individual decisions.

Look beyond written communication. Because hospitals are large, diverse organizations, written documents are understandably the most efficient, predictable way to distribute information. But if in-house publications and memoranda to staff are the only ways you distribute messages, you are missing one of the most critical aspects of effective communication: feedback.

Coordinating face-to-face meetings with staff is time consuming, but the long-term payback can be substantial. Opportunities for senior management to interact with staff through open forums, house rounds or simply at lunch in the cafeteria help build morale and rapport between executives and staff.

Because of the critical role front-line managers play in day-to-day communication, the public relations department should also provide support to this important group. When controversial decisions are made in the hospital, middle managers deserve to be armed with background information, key talking points and answers to questions they are likely to hear from their staff.

Achieving Real Change

Incrementally changing the media you use and the messages you deliver to employees can make important first steps in reshaping the way public relations practitioners influence employee morale and satisfaction. But without a comprehensive roadmap that identifies significant milestone and then monitors progress against objectives, your gains will be limited.

Few communications professionals would launch a marketing campaign for a new service without a comprehensive promotional plan that includes objectives, strategies, implementation milestones and buy-in from key constituents. The same planning discipline will make reshaping employee communication more successful and sustainable.

Like the organization's external marketing plan, a strategic employee communication plan should be developed and then updated annually. In writing the plan, process will be at least as important as the final product, since one of the goals of plan development is constituent buy-in.

If one of the goals of the plan is for public relations professionals to be seen as part of the team that tackles organizational effective-ness, the strategic communication plan must be developed in cooperation with colleagues throughout the hospital. A committee of 8-10 managers from various levels within the organization should include appropriate representation from clinical operations, support services and human resources. Selecting managers who have shown the greatest interest in and insight regarding communication issues are, of course, the best prospects.

Effective facilitation is essential to achieving commitment to new approaches in internal communication. While it is tempting for the head of public relations to chair the committee, remember that it is difficult to be an impartial facilitator when you have so much at stake in the outcome. Using external counsel both for facilitation and objective assessment of current communication approaches is often beneficial, especially if the idea of a strategic internal communication plan is new to the organization.

All of the critical elements of your external marketing plan should be part of your strategic communication plan:

• Environmental/Organizational Assessment
  • Data collection and analysis
  • Market research, including focus groups with front-line staff and middle management
  • Inventory and assessment of current communication vehicles
• Strategic Vision
  • What role will internal communication play in shaping employee morale, operational effectiveness and overall organizational culture?
• Goals, Strategies & Tactics
• Resource Requirements
  • PR staff priorities
  • External agencies
  • Collateral
• Evaluation
  • Quantitative
  • Qualitative
  • Coming out of the planning process, early wins are especially important to convince skeptics and reassure ardent supporters that improved communication really can make a difference in the organization. The proverbial "low hanging fruit" will vary by organization, but obvious signals are likely to emerge from the organizational assessment work if they are not already apparent.

Like most initiatives that have a substantial, long-term impact on organization culture, changes in communication will not produce overnight miracles or make up for other management or structural flaws in the hospital. But in an era when employee commitment has never been more important to a hospital's success, management's commitment to real change in how we communicate with one another has never been more essential. No one is better suited to lead this charge than experienced, strategically-focus public relations professionals.

Burl Stamp has 20 years experience in a variety of health care and marketing management roles. Prior to launching Stamp & Chase in 2003, he was President/CEO of Phoenix Children's Hospital. His responsibilities at St. Louis Children's Hospital at Washington University Medical Center and BJC Healthcare included executive roles in strategic planning, business development, ambulatory care and marketing. His early experience includes stints in consumer packaged goods and investment banking.