Session Overview
• Nothing is new or earth shattering
• Hopefully, you will find something of interest, a new way to look at things, or find a new opportunity to grow
• Review trends and issues
• Statistics, research and observations
• Current initiatives
• Associations, government and others
• Opportunities for the public relations professional
• Roles, strategies and tactics

Acknowledgements
• American Hospital Association
• Florida Hospital Association
• PRSA Health Academy
• State of Florida
• An extensive reading list
• Many mentors
• A great staff and wonderful clients

Background
• Primarily in Hospital public relations
• Seven years with Florida Hospital / Orlando Regional Healthcare
• Four years as a consultant
• Current clients include healthcare systems

Health Care
• It affects everyone
• It is a Right?!
• It is part of our entire lives
• It is one of the most personal experiences
• It is expensive
• It is a significant part of the economy
• It is the first or second issue on political agendas
• It is very technical and overwhelming
• It is at a crossroad of crisis…

Crisis
• The Chinese Symbol for CRISIS is comprised of two symbols:
• One for Opportunity
• One for Danger

Healthcare Statistics
• Statistics / FHA
• Health Care Expenditures-2004  
• National Health Expenditures $1.8 trillion
• Percent of Gross Domestic Product 15.5%
• Expenditures per Capita $6,167
• Florida Facts  
• Number of Hospital Employees 257,000
• Economic Impact of Hospitals*  
• Additional Jobs 102,000
• Additional Wages $2.6 billion
• Impact of Goods & Services $6.9 billion
• Federal Agencies Regulating Hospitals 26
• State Agencies Regulating Hospitals 11
• Medicaid in Florida  
• Medicaid Recipients  1.8 million
• Percent of Population 10.4
• Percent / National Rank – (2001) 3
• Uninsured in Florida - 2002 
• Total Uninsured, (non-elderly) 2.8 million
• Percent of Population w/o Health Insurance 20.6%
• Percent of Uninsured Children  8.5 Million
• Percent of Children without Health Insurance 11.6%

Trends and Issues
• Erosion of the Public Trust
• Research shows that people have become more skeptical:
• Scandals
• Pricing
• Information or the lack of
• Less personal relationship
• We can see it – Wye River Group on Healthcare
• Lack of information available – quality / price
• Interpretation of quality / pricing
• Difficult to make decisions
• Discerning best interests
• Erosion of the Public Trust
• Harvard Conference on Strategic Issues in American Health Care, 2003, Marc J. Roberts, Ph.D.
• Healthcare’s golden age…1960-1980
• The gathering storm…1980-2000
• A matured crisis…NOW
• “Trust is the universal driver of satisfaction and it’s a drier of business. It’s trust, not the euro or dollar, that’s the currency of all commerce. It’s a value proposition in which you can differentiate yourself in meaningful ways.”, David Shore, Ph.D.
• Increasing Financial Pressures
• Aging population – the “baby boomers”
• Poverty, the working poor and indigent
• Costs increase…and reimbursements decrease each year
• Managed care competition
• Continued decreases in Medicare and Medicaid funding
• State budget crises
• Social / Public Policy Impact
• Uninsured and indigent care
• KB Forbes and company
• Healthcare is driving people to the polls
• 2004 Presidential Election
• Local initiatives
• Local, state and federal activists
• Long term care
• The “sandwich generation”
• The aging population
• Concerns over conditions
• The condition of the American Family
• Trauma and Emergency care
• The top admission source for hospitals is emergency care
• In Florida, hospitals were near shutting down trauma units
• 2003 saw a failed attempt to get additional funding sources
• Legislative funding continues to drop
• Regulatory Issues
• CON 2004 changes
• How to manage community growth and increasing demand
• Regulatory assurance of compliance and community responsibility
• The cost of regulation
• Medical Malpractice
• Perhaps the most contentious issue in healthcare
• Impact on malpractice insurance
• Physician shortages and relocation
• Federal and state legislation has been attempted
• Accountability and rights…
• Workforce
• The nursing shortage
• Educational opportunities
• The Pendulum of resource availability
• Community initiatives
• Technology
• Improvements to care
• Costs associated with technology create a disparity of care
• Access to services
• Pharmaceuticals
• Costs to consumers
• Canadian vs domestic pricing
• Medicare reform
• Clinical trials
• Consumer advertising and physician relationships
• Disease and health conditions
• Cancer
• Heart disease
• Obesity
• AIDS
• Blood supply
• Current Efforts
• The Good, The Bad and…the Others
• Current Efforts
• Political and Regulatory Efforts
• Appeal to the voters’ needs
• Adapt to budget restrictions
• Ensure community safety and access
• More government involvement in finding solutions at the local, state and federal levels
• JAHCO

Current Efforts
• Business Efforts
• Cost savings and affordability
• Providing benefits or avoiding benefits
• Special interest groups and associations
• Competitive issues
• Free market challenges
• Activist and Special Interest Efforts
• A new, more aggressive and educated marketplace
• There is a special interest group for everything
• A 24/7 media cycle and the internet provide a stage for special interests
• The media has become an advocate for issues more than ever before
• Controversy sells
• Hospitals have become “Goliath”
• Healthcare Special Interests
• American Hospital Association
• Seven steps to improve the healthcare system
• Healthy Community initiatives
• Local partnerships
• American Medical Association
• Florida Hospital Association

The Public Relations Opportunity
• Communicate from an Issues Management perspective
• The physics of decisions:
• Every action we take causes a reaction in the marketplace
• Every decision has the potential for creating an issue or crisis
• Planning from an issues management perspective provides a full spectrum review of the organization’s potential challenges
• Connect all operations with internal and external communications
• Educate the leadership and create a participatory system through an Issues Summit
• Connect Community Relations, Stakeholder Relations, Media Relations, Government Relations and Crisis Communications
• Issues Management Model
• Research
• Special groups
• Earned Media
• Paid Media
• Grassroots
• Schedule
• Budget
• Work from the inside / out
• Begin with the internal audiences
• Employees are the most visible and influential voice
• Nurses continue to be the key relationship with external audiences – High Trust
• Cultural changes are important to manage change
• Creating a “learning environment”
• Loyalty
• Cost savings
• Branding and positioning – 2000 Florida Hospital
• Good decisions and bad ones – Premier Care
• Simplify the language
• Healthcare is overwhelming to the community
• We must find ways to interpret the code
• Empathetic listening and careful communications
• Create an environment that rewards the simplicity
• Find ways to better communicate quality indicators
• Be sure that communication is consistent
• Transparency is in demand
• Public Relations may not be understood internally
• The Triage brochure…
• Understand the “influencers”
• It is said that 10 percent of the population influences the remaining 90 percent…
• Build the database
• Spheres of Influence
• What is important to the key decision-makers
• Key stakeholders
• Create face-to-face communication opportunities
• The “insider” factor – ownership…
• Understand and create specific media strategies around its influence
• Share and celebrate success
• Good news never happened is it is not shared
• Find strong surrogate messengers
• Create a brand that is personal and local

Good Books
• Clients for Life
• Andrew Sobel
• What Clients Love
• Henry Beckwith
• How to Become the CEO
• Jeffrey Fox
• Good to Great
• Jim Collins
• The Tipping Point
• Malcolm Gladwell
• The Influencer