Health Service Public Relations

A Guide to Good Practice

Roger Silver

• Publisher: CRC Press
• Year: 2018
• eBook ISBN: 9781315342788
• Edition: 1
• Topic: Medicine
• Subtopic: Service Industry

The first edition of this book was published at a time when the health service was less sensitive to its reputation and the effect this had on public confidence. Since then, health service reform, accountability and market forces have meant that all directors, managers, doctors and health professionals must communicate effectively, both internally and externally. This book, revised in the light of these changes, is a guide to the practical skills needed when communicating with patients, staff, the general public, opinion leaders, press, radio and television.

1

Public relations — for planned communication

Public relations is about planned and deliberate communication. In the complex and rapidly changing world of health care, any organization which fails to communicate in planned and deliberate ways may leave patients, public, staff and opinion formers confused, angry or without confidence in its work.

The first edition of this book stressed that public relations involves a determined responsibility to think, listen, inform, explain, discuss and act in the interests of the people served by an organization. It added that the responsibility becomes a duty and moral obligation in the NHS, which is paid for by the public through taxes and deals with people needing help, often when they are at their most vulnerable.

Nine years and two radical health service reorganizations later, that truth remains. But on the way something significant happened: health service reformers and managers discovered Communications. Historians of the NHS will place the discovery somewhere between the Age of Quality Assurance and the Dawn of Corporate Governance. Taking a longer view, they may record that many were so exhilarated by what they had found that they fell into a trap recognized 300 years earlier by John Locke in An essay concerning human understanding:

‘Another abuse of Language is an affected Obscurity, by applying old Words to new and unusual Significations; or introducing new and ambiguous Terms without defining either; or else putting them so together as may confound their ordinary meaning’.

The historians may go on to wonder what Locke would have made of the press statement from a hospital trust, which said:

‘We operate a Block Contract on behalf of the DHA and it is funded on the assumption that the patient case mix will not change dramatically. Unfortunately, to date, the “medical” specialty element…has, and continues to squeeze the “surgical” specialty element. In addition, we are over contract on ITU/CCU by 165 bed days’.

Or, from the minutes of a district health authority:

Provided the financial pressure upon the ECR budget is successfully resolved, through the plans in hand to defer treatments electively in certain areas, an initial year-end surplus of £70000 is currently forecast. Due to an increase over plan for level of ECR cases, activity is currently forecast to be 550 episodes higher at outturn’.

It was not only jargon that sometimes got out of hand. In the communications explosion that followed the 1990 reforms of the NHS, self-congratulatory glossy publications gushed forth on a tide of enthusiasm and optimism from nearly every corner of the newly organized service. The euphoria was eventually tempered by the realities of competition in the internal market (pace Locke), the pressure on finite resources from infinite demands for health and social care, and the challenges of handling change as revolutions in surgery and medicine began to accelerate and affect approaches to health care.

The reforms left the new NHS trusts out of the purview of the Public Bodies (Admission to Meetings) Act I960, under which statutory health bodies are legally required to conduct the business of their meetings in public. On the other hand, there have been moves towards greater openness in all government and public bodies. The NHS Executive has drafted a code of practice on openness (see Chapter 4) which was the subject of consultation as Health Service Public Relations went to press. The code, which followed the White Paper, Open Government, published in 1993, aims to make sure that people:

• are able to get information about how well the NHS is doing, the cost of services, and the standards of service they can expect
• are given an explanation about any proposed changes to services and the chance to have a say in the decisions made about those changes
• know the reasons for decisions and actions affecting their treatment.

Perhaps one of the most significant communications-related events in health care in the last decade was the freeing of GPs from the ethical constraints that had prevented them from publicizing their services. In 1990, the General Medical Council changed its rules to allow GPs to advertise their services on the grounds that ‘good communication between doctors and patients, and between one doctor and another, is fundamental to the provision of good patient care’.

These and other developments, such as the Patient’s Charter and The Health of the Nation, have caused people at every level of health care to think consciously about how they communicate with patients, communities and organizations, how they involve them, and how they forge and maintain alliances - the very essence of public relations.

Communications - Everybody’s Doing it

Every day, in countless exchanges, health care professionals and supporting staff are communicating one-to-one with patients, relatives and other users of their services. Hospital and community services, trusts, family doctor practices, primary care teams, health authorities and all the other branches of the vast health service network are communicating with each other, the general public, other agencies, key opinion formers and the news media.

Any of the following may be read, seen or heard to speak for the NHS:

• the Secretary of State
• the Ministers for Health
• the Chief Executive and colleagues on the NHS Executive
• chairmen and executive and non-executive directors of health authorities and commissions
• chairmen and executive and non-executive directors of trusts
• directors of public health
• managers of hospitals and community units
• communications and public relations managers and press officers.

At the same time, many organizations are speaking for the patient. Community health councils are ‘patients’ ‘watchdogs’; district health authorities are ‘people’s champions’. Patients are increasingly speaking up for themselves as they become actively involved in decisions about their treatment instead of just being passive recipients of it. They are also being positively encouraged to say how they would like to see services improved.

The communications dimension in health care is thus vast, complex - and largely uncoordinated. The NHS does not easily lend itself to the corporate discipline of most service organizations - the command structure of the police or military, for example, or the rigorously packaged and applied identity of multiple retail chains. The whole health care world is made up of countless millions of pieces of human interaction, in which the process of communication may be long, difficult and incomplete. Meaning and understanding are hard to achieve when messages are difficult or painful, when audiences are diverse, fragmented or worried, or when communication is by third-party media such as print and broadcasting.

There is also the inter-relationship of message, audience and media, enshrined in Marshall McLuhan’s phrase, ‘In operational and practical fact, the medium is the message’. His central thesis was that any medium of communication is an extension of humanity and necessarily determines behaviour, thinking and thus what we wish to communicate. As patients become more involved in decisions about their own treatment, so the relationship changes between patient and practitioner, and the messages by which health care is delivered also change fundamentally.

That is principally an issue for the messengers - the doctors and their professional colleagues in their confidential, one-to-one clinical relationship with the patient - and, as professionals, they are at liberty to communicate well, indifferently or badly. Except in extreme circumstances demanding intervention, the issue is outside the control of the managers. But it is not outside their influence.

The managers - from the NHS Executive to health authorities and trusts - create the conditions in which the care-givers work. Communicating effectively and constructively with them, with each other and with the public calls for conscious effort if conditions of confusion, conflict and mixed messages are to be avoided. It is especially important if there is not to be a recurrence of the kind of uncivil and well-publicized strife that has broken out from time to time between health service bodies who may have forgotten that they are part of the same national organization.

Communications cannot be left to chance. At a one-to-one level they are difficult enough. In the bustle of the NHS, they can be chaotic unless the managers are clear about with whom they should be communicating, what they should be communicating, how they should be communicating, and to what purpose.

Which is where public relations comes in.

Public Relations - What it isn’t and What it is

Public relations may be seen as a positive force or a negative force. On the negative side, it may be a term of abuse as when the journalist, Malcolm Muggeridge, seeking to reflect the public’s distaste for Anthony Eden as Prime Minister, wrote, They asked for a leader and were given a public relations officer\

It may be associated with a packaged event in which the substance of what is happening takes second place to the way it is presented.

It may be a ‘public relations disaster’ if a carefully crafted image is destroyed by the truth. Gerald Ratner’s spontaneous view that some of his products were ‘crap’, seen in light of the subsequent decline of his business fortune, is a legendary example of a public relations gaffe.

Public relations may be menacing. In a pluralistic society, the control and packaging of information may amount to no more harm than gloss and hyperbole. In a closed society it may take the form of totalitarian control of state information and misinformation.

The positive side of public relations, which is the subject of this book, has been well defined by the Institute of Public Relations:

Public relations practice is the planned and sustained effort to establish and maintain goodwill and mutual understanding between an organization and its publics.’

The Institute adds:

‘Public relations is about reputation - the result of what you do, what you say and what others say about you.
Public relations practice is the discipline which looks after reputation with the aim of earning understanding and support and influencing opinion and behaviour’.

Every health service organization, from a GP practice to the national Executive, needs to be good at this positive type of public relations, just as it needs to be good at strategic and operational planning, information and financial management, quality control, marketing and customer services. (Indeed, public relations is often a crucial component of marketing and customer services.)

Public relations contributes to the overall success or failure of the general management activity of an organization, and so ultimately to the success or failure of the organization itself. If financial management looks after the money, public relations looks after people. Public relations is about people who work for the organization and those who are connected with it as users, suppliers, regulators, competitors or pundits.

Public relations is the process by which an organization:

• establishes and maintains high-quality communications with people to fulfil its objectives or responsibilities
• analyses communication problems between organizations and audiences, and finds ways to resolve them
• devises and develops the means by which knowledge and understanding flow between organizations and the people who work in them.

Public relations recognizes the dimension and complexity of health service communications and the need for a systematic way of supporting, ordering and improving them. Through public relations, managers are given the means to consider and agree their communications priorities, and act on them.

The public relations process is primarily the responsibility of the people at the top. Sir John Harvey-Jones, management guru and former chairman of ICI, has written that a good company chairman spends his or her time on strategic planning and public relations. The same applies in the health service. Moreover, the process has to start inside the organization.

An organization is not in a position to ‘establish and maintain goodwill and mutual understanding’ externally if it lacks these qualities in relations with its own staff. Every manager has a responsibility to ensure that staff are kept fully informed about any matters which affect their working conditions, job content and prospects. This is especially important in an organization like the NHS, which is subject to ever-accelerating change.

Staff who are, or feel they are, in the dark about changes rapidly become demoralized. They will not understand change, nor co-operate in it, unless they are informed, consulted and treated in ways which demonstrate that they matter and that what they say and feel matters. Managers must take deliberate steps to ensure that staff understand clearly issues that affect th...

Table of contents

• Cover
• Title Page
• Copyright Page
• Contents
• List of contributors
• Preface
• 1 Public relations — for planned communication
• 2 Communicating with the ‘big three’ audience groups
• 3 Patients and the media
• 4 Codes of practice
• 5 Writing to be read
• 6 Products, events and programmes
• 7 Choosing the specialists
• 8 Research and evaluation
• The National Association of Health Service Public Relations Officers
• Index