Tag: culture change

Reflections of a Health Consumer Advocate on Social Marketing

By Pip Brennan, Health Consumers’ Council Executive Director

Change 2018 Conference, Griffith University

social marketing [is defined] as “the application of proven concepts and techniques drawn from the commercial sector to promote changes in diverse socially important behaviors such as drug use, smoking, sexual behavior… This marketing approach has an immense potential to affect major social problems if we can only learn how to harness its power.”

Andreasen A. Marketing social change. San Francisco, CA: Jossey-Bass, 1995.

What is social marketing? Why should we care?

The first time I heard Griffith University’s Sharyn Rundle-Thiele present on social marketing was in Perth, at Murdoch University. She was one of the guest speakers at an Australian Association of Social Marketing event presented by Perth-based social enterprise Marketing for Change. You may recall that Marketing for Change supported HCC to undertake community consultations for the Sustainable Health Review. The first thing that struck me as I waited for Sharyn’s session to begin was how different the audience was from my usual work-related presentations. There was not one WA Health Department staff member in the audience, but there were many local government agencies.

What also struck me about her presentation was not just how well-polished it was, but also how Sharyn was channeling and mobilizing among a new generation of students under her watch at Griffith a passion and capacity for co-designing social marketing messages with the very people the messages are designed to move.

The message that really landed for me in listening to Sharyn that day in Murdoch, was that the traditional preventative health leaflet will at best change behaviours for about 7% of those that read it. There was so much room for improvement, and the answer it seemed was not just better segmenting the message for those different audiences, but working with those audiences to make sure the messages land and wherever possible working beyond mere messaging to give people alternatives and not a message telling them what they ought to do.

As a consumer advocate who spends so much time trying to ensure the consumer voice is at the heart of our health service planning, this new world of public health messaging is a whole new frontier that consumer advocates needs to be aware of, and perhaps most importantly be taking a lead role in. It seems that there is a unified cry across Australia that more needs to be done in preventative health. Now it is up to consumers to ensure that preventative health is “done with” and not “done for” people.

Change 2018, Brisbane

This introduction to Social Marketing in Murdoch encouraged me to self-fund to attend a unique event at Griffith University – Change 2018. Over two days in October this year, I sat in a lecture theatre in Griffith University, a lone not for profit consumer advocacy professional in a sea of marketing professionals and consultants, academics, policy makers and government purchasers of social marketing.

I’m used to being the odd one out. I sat up the front and listened over two days, and as an outsider to the field, I took away some key insights to place social marketing squarely in the frame of a key tool to empower consumers in preventative health.

1. Social Marketing = Marketing for good

Some of the presenters were refugees from the world of commercial marketing. One noted that she threw in the towel as a marketer after she baulked at marketing alcohol to teenagers.

The reality is, we all know that marketing techniques work. What would it look like if we used these powerful tools for good?

2. Is there a problem? What actually is the problem?

The opening presentation by Professor Gerard Hastings used the story of the man whose lovely friendly Labrador dog turns up one day with the neighbour’s very dead rabbit in his mouth. This very neighbour is off on holiday and has charged the dog owner with looking after the garden, bringing in the mail etc. The very dead rabbit looks very much the worse for wear from the Labradors burying and digging up, so is washed and put back into his cage. When the neighhbour returns from holiday he is very thankful about the care and maintenance of the yard and post. He is just a bit surprised that the rabbit which had died just before they had left and had been buried in the back yard somehow magically appearing back in his cage. The point is, sometimes there is a strong belief there is a problem to be solved-but more informed research would have helped the Labrador owner to know there wasn’t a problem at all. This is one of marketing’s strengths – research that listens and learns in contrast to research asks and tells.

3. Marketing has many tools. Use them all!

Different presentations addressed the four Ps of traditional marketing (product, placement, promotion, price). A great case study was presented of a partnership project between a school and a local supermarket, which matched lessons for primary school students in diversifying the fruits and vegetables that families ate with low-priced produce which allowed the children to try different fruits and vegetables for themselves. The idea was that once the children had a chance to try the different tastes, they would continue to eat them, and meet the goal of diversifying the fresh foods that kids eat.

The point of this is – that while social marketing is most definitely not all about promotion, there are opportunities to consider how to use products, prices and placements to continue to nudge behaviours towards more positive, life-affirming ones.

Having said that, the key principle is that good social marketers work with end-users to identify the best intervention mix. Often, promotion isn’t even a part of it.

Nothing turns the curve in the regions like a community champion

The disconnect between policy makers in cities and the regional citizens they are hoping to influence can be enormous. A cane sugar farmer described how he personally had moved from a position of being vehemently opposed to any kind of change to the farming practices that had served his father and grandfather. It was the ability of the government representative to build a personal relationship, share the data about how less fertilizer and greater sugar yield would mean more profit for him, and a persistence to partner over the long haul as the successive crops proved the data right that helped create a community champion. The shift in attitude by this cane sugar farmer then caused a ripple effect that is continuing to extend across Queensland and into WA today.

Fear and statistics are popular with policy makers but don’t necessarily work…

Several presentations highlighted how government in particular are keen on social marketing campaigns which frighten people into better behaviour, and preferably include as many statistics as possible within the 3-minute advertisement. This can lead to a significant expenditure on campaigns which just don’t work.

Focus groups – are these on the nose?

Focus groups came under some criticism in terms of both their lack of diverse participants, and their tendency to ask people “what else would you like?” Being asked this open-ended question, and being in receipt of a nice morning tea and a voucher can lead people to feel they need to provide extra feedback which can dilute the social marketing message, creating a camel campaign doomed to failure.

Fundamentals of change

The closing address highlighted these key changes required to the way social marketers work:
• The focus needs to change from problem focused to solution-driven. Answers for many of the complex problems social marketers aim to tackle can be found at the community level. Sharing the problem with the general community as soon as possible will facilitate a solution focused approach
• Doing to vs doing with – the mantra “nothing about us without us” applies just as well in social marketing as it does on health consumer advocacy.
• Expert driven – to citizen led. Social marketers and other experts can never be experts in someone else’s world.
• Government driven – to on the ground/community led. No more fear-based, statistic-heavy expensive interventions!
• Solos to partnerships – thinking creatively about not for profit, government, academic and commercial partnerships can create a more effective campaign that leverages all the concepts of promotion product, preplacement and price.

Social Marketing and Preventative Health

I attended this conference because I thought there was something important on the horizon with our state’s likely increased focus on preventative health. I wanted to understand more about what social marketing could and should be for Western Australians. I left the conference more convinced than ever that this is a key tool to support creating a healthier society. As always, the key needs to be involving consumers from the beginning, and all the way through any initiative or campaign.

Patient Experience Wrap-Up Day One

On Thursday 28th and Friday 29th April the Health Consumers’ Council hosted our inaugural Patient Experience Week (PXW) with a series of events at The Boulevard Centre in Floreat. We are excited to be finalising our new HCC Podcast of those events we were able to record, and in the meantime, here are some event highlights for you from day one of PXW.

The Welcome and Introduction

Olman Walley gave a Welcome to Country on both days, providing his own unique and gracious welcome in language and with music. His didgeridoo playing was evocative and on the second day, and veered off into rap. Sense of humour that one!

Pip Brennan presented on behalf of the HCC and thanked the sponsors Illuminance and Empower ICT who provided essential support for the event. Pip then spoke about how HCC supported consumers individually through advocacy and supported health reform through consumer representative training and sector support. The importance of supporting the health sector in working with Aboriginal as well as Culturally and Linguistically Diverse communities was highlighted. Pip also referenced the December 2015 Clinical Senate Debate on the Patient Experience. She particularly highlighted the four Recommendations from that debate which were endorsed and therefore WA Health has a mandate to ensure they are implemented. The Recommendations are:

Pip Podium 4

  1. WA Health should introduce a system-wide, consistently branded ‘Patient First’ program that drives the patient experience agenda and under which all key patient experience improvement programs are measured, with results publically available.
  2. In consultation with consumer and carer peak bodies:
    •A statewide definition of a great patient experience is developed that incorporates a value-based, patient-centered approach. WA Health, as system manager, is to ensure this is adopted by the whole of Health.
    •Patient experience tools are developed or selected for use that reflect the indicators that matter to patients.
  3. The Senate recommends that a consumer is appointed as a member of State Health Executive Forum (or its equivalent post legislative amendments to create Health Service boards).
  4. The Senate recommends Chief Executive Officers visibly and actively lead consumer partnership programs and have related Key Performance Indicators (KPIs) in their performance agreement with their boards.

To see the full presentation, click here.

The Director General

The Director General of WA Health formally opened the launch and stated WA Health’s commitment to patient care, patient safety and providing the best patient experience. He highlighted that it is essential to have an organisational culture where staff feel valued and respected, and patients are treated with dignity and respect. In order to achieve that, consumers must be involved in strategic processes that guide the planning, design and evaluation of health services. He referenced the December 2015 Clinical Senate Debate on Patient Experience  and highlighted WA Health’s commitment to developing a Compassionate Care initiative. Compassionate Care is about the way in which people relate to each other. This means the way staff treat each other as well as they way they treat patients. His powerpoint can be accessed by clicking here.

DG PodiumThe Director General closed with these statements:

  • The patient journey is unique to each person. Every interaction with patients and their families impacts on their experience.
  • We must transparently measure the patient experience.
  • Lessons learnt – through both positive and negative feedback – can be used to improve health services.
  • A system-wide definition of a great patient experience should be developed.
  • Consumers must be involved in the planning, design and evaluation of health services.
  • It is essential to have an organisational culture where staff feel valued and respected, and patients are treated with dignity and respect.
  • This starts with our behaviour and our values.

Dr Karen Luxford


We were then joined on Skype by Dr Karen Luxford, Director of the NSW’s Clinical Excellence Commission. The gremlins were with us at this point, so the Skype presentation didn’t record. After Patient Experience Week was over, Karen kindly agreed to be interviewed about the Clinical Excellence Commission, their Patient Experience Week events and why the patient experience movement is important. You can listen to that audio by clicking the link below:

The final presentation of the launch was by the irrepressible Jason Wolf, CEO of The Beryl Institute. The Beryl Institute is an international community of health professionals, consumer, carer and community members dedicated to improving patient experience in health care. His presentation was highly motivating, and can be watched by clicking the arrow below. Alternatively you can view his slide presentation here.

The Actors – Two Sides to the Patient Experience

Straight after the launch, Agents Improvocateurs took to the stage to enact a patient journey scenario, inspired by stories HCC hears from consumers who seek our advocacy assistance. In the scenario, a patient had been stung by a bee near her breast and attended the Emergency Department and was then put on a children’s ward where she endured hours of hunger, (children’s portion dinners) pain (failed insertion of a cannula to administer antiobiotics, then a reaction to those antibiotics) and being ignored. She was also confused and frightened by talk of a possible mastectomy in a discussion between two health professionals in a conversation in her hearing which excluded her. The audience offered suggestions for how things could be done differently and the scenario was played through again. It also explored the situation from the provider perspective – each interaction always has at least two people and in this one we explored the fears and humiliation of the nurse who had failed to insert the cannula. Alma Digweed from Bentley Community Advisory Council agreed to join the actors on the stage and was the star of the show.

Lunchbox Session – Organisational Approaches to Patient Experience

This diverse session included a presentation from Anita Deakin and Carmel Crock, in relation to the Emergency Medicines Events Register (EMER). This interesting and innovative tool is a change management mechanism in that in encourages both clinicians and consumers to report near misses and develop a culture which supports a learning approach to near misses to support a safer patient culture. The Powerpoint presentation is available here, and you can find out more about EMER here.

Next up was James Sherriff, General Manager of St John’s Ambulance and former paramedic. James’ presentation focused on the internal change that St Johns have actively sought within the organisation to ensure front line staff always have the patient at the centre of the care. You can view his Powerpoint here.

The session closed with HCC’s Dr Martin Whitely and Murdoch researcher Dr Norman Stomski describing a key research project they have been collaborating on. HCC provides individual advocacy for mental health consumers who are voluntary. HCC sought to better understand what the advocacy intervention meant for consumers whose patient journey was far from smooth. 60 de-identified individual advocacy cases were written up for research analysis. Martin and Norman’s joint presentation can be viewed here.

Workshop Session – Partnering for Patient Experience

The day concluded with a workshop facilitated by HCC’s Steph Newell. Presenting was Professor Anne Williams on her years of research and development of Patient Experience Tools – known as PEECE and PEECH. Helen Fernando from South Australia presented on the unique and effective Messenger Model that she has developed, and  a version of the concept runs at Flinders Medical Centre. The Messenger Model involves the consumer representative providing a conduit for information about health care needs and experiences to reach front-line staff during the episode of care. The feedback about what has gone well or otherwise alerts staff to issues that may be addressed whilst the patient and family are still in the care of the health professional team so that the patient experience can be transformed. Steph Newell explained the key factors of partnership – trust and common purpose. During the workshop session, audience members were encourage to view sections of this video on patient experience and consider the scenarios within the context of the tools discussed – PEECE, PEECH and the Messenger Model.

The Theme, The Crowd

We aligned with the international theme for 2016 Patient Experience – “Connecting for Patient Experience – We are ALL the Patient Experience”