Healthcare’s Future Lies in Transformation

Dr. Ezekiel Emanuel Offers a Compelling Argument

What will the future of healthcare look like? It’s an issue that public affairs commentators and policymakers across the political spectrum continue to debate.

In 1994, the late Dr. William Kissick, a professor emeritus at Wharton and the University of Pennsylvania Schools of Medicine and Nursing, identified three competing issues that the healthcare industry has struggled to address effectively. These issues – access, quality and cost containment – what Dr. Kissick called the “Iron Triangle of Healthcare,” continue to perplex policymakers and healthcare decision-makers to this day.

Recently one of the nation’s leading healthcare policy experts, Ezekiel J. Emanuel, MD, PhD, Vice Provost for Global Initiatives and Chair of the Department of Medical Ethics and Health Policy at the University of Pennsylvania, offered some important insights into where the national healthcare system is heading, and what it might mean for the Philadelphia region. In part he rejected the conventional notion that it is possible for health care systems to only achieve two of the three parts of the Iron Triangle.  He argued all three had to be achieved together. It was all part of a symposium on “Shaping Health Care” sponsored by the Chamber of Commerce for Greater Philadelphia and The Wistar Institute.

Lowering Costs

Finding a way to provide high-value care for all Americans – namely care marked by high quality and low costs with universal coverage – is a goal shared by providers and policymakers alike. According to Dr. Emanuel, “the only way to lower healthcare costs is to change the delivery system to ensure high quality care.”

Traditionally, one of the most significant contributors to the high cost of healthcare has been the combination of providing unnecessary services and inefficiency in how necessary healthcare services are delivered.   One example is standardization of practices so everyone – from physician to nurse to medical assistant – handles the same complaint according to agreed-upon guidelines. For instance, physicians in one local oncology practice were treating mouth sores after chemotherapy in different ways.  The practice standardized to one optimal practice that everyone followed.

Another common example is the fact that some health care groups allow their physicians to control their schedules, leading to double-booking, limited hours, and an inability to work around no-shows or walk-ins.

Creating Efficiencies

Dr. Emanuel identified 12 transformational practices that he says can help physician practices and healthcare organizations improve the quality and cost of care they provide to their patients:

  1. Scheduling
  2. Registration & rooming
  3. Shared decision-making
  4. Performance measurement
  5. Standardization
  6. Chronic Care management
  7. Site of service
  8. De-institutionalization
  9. Behavioral health management
  10. Hospice
  11. Community interventions
  12. Lifestyle interventions

Many of these practices will improve  efficiencies – lowering per unit costs by finding ways to improve a healthcare process or system, or working in collaboration with partners in a way that benefits all involved parties. Others will eliminate unnecessary and undesired services – lowering total costs.

Even seemingly minor changes can show major results. For example, streamlining scheduling practices can offer several benefits: 1) It allows practices to accommodate walk-ins without long wait times instead of sending them to the more expensive emergency room; 2) it increases provider efficiency, as physicians no longer double book or adjust schedules; and 3) it decreases the amount of time wasted due to missed appointments.

Similarly, Dr. Emanuel noted that transformational organizations are providing more services, such as palliative care, in the home. This care is initiated well before a patient becomes terminally ill and is ready for hospice. This approach elicits patients’ preferences for life-sustaining treatments, such as respirators, ICU admission, or dialysis, and tries to keep them at home for the last year of life. It also makes transitioning to hospice in the last weeks of life less abrupt. All these changes lead to care that is both less costly and more in accord with patients’ wishes.

Performance Measures

The pathway for healthcare providers to truly transform also involves the use of real-time performance measures, Dr. Emanuel said. Standardizing clinical practices and treatment procedures based on measurable qualitative data is vital to reducing costs and improving outcomes.

While some physicians may insist that “their” way is the best, organizations need to convince them to adhere to guideline-driven standards. Paradoxically, one effective way to persuade doctors to adapt to standardized measures is to task them with developing the standardized practices and encourage adherence through financial incentives.

At the same time, organizations need to improve their risk adjustment skills in order to continue to improve their healthcare management practices. Risk adjustment is defined as “a statistical process that takes into account the underlying health status and health spending of the enrollees in an insurance plan when looking at their healthcare outcomes or healthcare costs.”  This ensures physicians who see sicker patients are not penalized.

The ultimate goal is to transform the U.S. healthcare structure into a truly patient-centered, efficient and cost-effective system.  Dr. Emanuel notes that the Philadelphia region is a leading example of how organizations are learning to work together to achieve those goals. He said he is confident that by 2030, the entire world will be looking at the United States to understand how healthcare transformation is accomplished.

Palliative Care Comes of Age

Once Seen as an End-of-Life Specialty, Palliative Care has Moved into the Mainstream

“It is not death that a man should fear, but he should fear never beginning to live.”

– Marcus Aurelius

For David R. Barile, MD, a geriatric medicine specialist based in Plainsboro, NJ, it was the steady calm of one of his patients – a grandmother and a woman diagnosed with a terminal illness that reinforced his vision of the promise of palliative care.

Faced with a life-threatening illness, she most likely was looking at weeks of chemo and radiation therapy that may or may not cure her. But either way, the treatments would sap her strength and make it extremely difficult to carry on with everyday activities she enjoyed.

But there was one more thing. No matter what, she did not want to do anything that would cause her to miss her grandson’s bar mitzvah. The best approach for helping her achieve her goal of living life the way she wanted? Palliatve care, which focuses on providing relief from the symptoms and stress of a serious illness.

A Question of Choice

For many doctors, the idea that a patient would choose to exert such a strong influence on her course of treatment might sound unusual. But to Dr. Barile, that kind of insight is something that has been lacking for too long.

Dr. Barile is also the founder and Chief Medical Officer for Goals of Care Coalition of New Jersey, an interdisciplinary partnership of leaders representing healthcare providers and systems, government agencies, and community organizations whose mission is to encourage patients, doctors and family members to talk about what type of care they want when facing a serious illness and to document their preferences in a care plan. Increasing awareness about benefits of palliative care is a key part of the effort. Recently, Dr. Barile discussed the topic of palliative care as a featured speaker at a Health Issues Committee Forum sponsored by the Chamber of Commerce Southern New Jersey. (Note: SPRYTE Communications’ CEO Lisa Simon is a member of the chamber’s board of directors.)

“The Coalition’s fundamental purpose is to organize medical care to help patients achieve their life goals,” explained Dr. Barile. The approach consists of four basic steps:

  • Diagnosis
  • Prognosis
  • Identifying patient goals
  • Aligning treatment to achieve those goals

Setting Goals

It sounds simple. But as Dr. Barile notes, it’s also somewhat uncommon. More common is the  approach of “diagnose then treat.” That works well in most health situations, but falls short in end-of-life care, Dr. Barile says. And for many patients it creates a very stressful and unwanted burden.

What is often lacking is patient input, he says. What are their personal goals? And what kind of treatment plan can be developed that will enable them to meet those goals?

Another advocate for increasing awareness about palliative care is Dr. Timothy Ihrig, Chief Medical Officer for Crossroads Hospice & Palliative Care (full disclosure: a SPRYTE client).

Dr. Timothy Ihrig

Dr. Ihrig is an internationally recognized expert on hospice and palliative care and a longstanding advocate for treating patients with life-limiting illnesses according to their individual priorities and life goals – incorporating full transparency and quality of life as key values in their care programs.

 

His TED Talk, “What We Can Do to Die Well,” urges doctors to focus not so heavily on clinical interventions at the expense of overlooking patients’ overall quality of life and helping them navigate serious illnesses from diagnosis to death with dignity and compassion.

According to Ihrig, at its best, palliative care is meant to be an empowering force for patients, taking into account each patient’s perception of what it means to live with a severe, chronic, potentially fatal condition and helping them live their lives with the highest quality possible.

Improving Education

Both Drs. Barile and Ihrig believe more needs to be done to incorporate end-of-life issues into medical training, so healthcare professionals can better recognize what is happening to their patients. Better training will also enable them to communicate more effectively with their patients, help them achieve informed consent in their decisions, and mutually agree on a treatment program that will meet patients’ personal goals while providing a better quality of life.

“We need to work on the language for end-of-life care,” Dr. Barile says, noting that news stories about former First Lady Barbara Bush reported that she had “stopped treatment.”

“Palliative care is a treatment. But the range of treatment options available to patients needs to be better explained,” he says.

More Cost Effective

There’s an added benefit. According to a study publishd in April by the journal JAMA Internal Medicine, patients with serious or life-threatening illnesses who have palliative care discussions with their doctors at the beginning of treatment focusing on improved quality of life, managing pain and defining goals often experience shorter hospital stays and lower costs.

The JAMA study found that overall, for patients who received palliative care, hospitals saved an average of $3,237 per patient over the course of a hospital stay compared to patients who did not. Hospitals saved an average of $4,251 per stay for cancer patients, compared to an average of $2,105 per stay for non-cancer patients.

Their conclusion: “Increasing palliative care capacity to meet national guidelines may reduce costs for hospitalized adults with serious and complex illnesses.”

Higher quality care with lower costs. Perhaps an idea worth looking into.

Philadelphia Opioid Crisis: An Approach to Save Lives

All Hands on Deck Against the Opioid Threat

One of the most serious public health issues facing us today is the opioid crisis. As the crisis has continued to grow over the course of the past decade, its impact is far-reaching in terms of financial losses as well as human costs.

As medical professionals and public policy officials strive to find answers to this continually growing problem, it is incumbent on healthcare communicators to be ready to work with their respective partners to develop strategies to reach out and bring together those impacted by this dreadful epidemic – not only abusers, but loved ones, family members, healthcare professionals, community leaders, elected officials and more.

Opioid Crisis by the Numbers

In November, a report from the Council of Economic Advisers estimated that in 2015, the economic cost of the opioid crisis was $504 billion, or 2.8% of the nation’s Gross Domestic Product that year. That number was more than six times larger than the previous estimated cost of the epidemic.

Prescription opioids are a particular problem. According to the Centers for Disease Control and Prevention (CDC), prescription opioids are a key contributor to the opioid epidemic in the United States, accounting for more than 40% of all U.S. opioid overdose deaths in 2016, with more than 46 people dying every day from overdoses involving prescription opioids. 

In Philadelphia, the impact of the opoioid epidemic has been devastating. According to the city’s Department of Health, fatal drug overdoses from 2013-2015 increased by more than 50%, from 459 deaths to 702. During 2015, Philadelphia experienced more than twice as many deaths from drug overdose than from homicide. Eighty percent (80%) of these involved opioids.

What’s to be Done?

Recently, the Healthcare Leadership Network of the Delaware Valley convened a CEO Roundtable, hosted by Cooper University Health System, on what can be done to deal with the many challenges posed by the opioid epidemic. The panel discussion sought to offer perspectives from clinical, public health, governmental policy, health system and evidence-based treatment points of view. The general consensus – there were many contributing factors to the problem and it will take a dedicated commitment of coordinated effort to bring about an effective solution.

Dr. Susan Freeman, President & CEO of Temple University’s Center for Population Health, described her organization’s approach as an “all hands on deck” effort to address many of the multi-faceted issues exacerbated by opioid abuse. Temple’s Substance Abuse Task Force Action Plan, for example, focuses on six primary areas:

  • Building trust with patients/substance abusers
  • Ceasing addiction
  • Proactively identifying patients at risk
  • Reviewing physician prescription practices
  • Education and research
  • Partnerships with entities such as the Philadelphia Department of Health and other like-minded organizations.

Focus on Families

Similarly, Douglas Tieman, president & CEO of Caron Treatment Centers, noted it’s important to remember that substance abuse is a chronic disease that doesn’t end after a 28-day rehab visit. The most effective treatments are multi-disciplinary, including medication-assisted therapy, bio-psycho-social treatment, evidence-based treatment programs such as motivational interviewing, 12-step integration, trauma and family counseling, and a continuing care plan to lessen the chances of recidivism.

Such integrated approaches can have long-term positive effects. If behavioral health, substance abuse and mental health issues are treated in time, “the costs of other health-related issues go way down as well,” he said.

Even so, getting patients and families to participate in long-term programs can be a challenge in itself.

“We live in a microwave society that wants everything immediately,” noted Alan Oberman, CEO of John Brooks Recovery Center. “Most families, unfortunately are dealing with a ‘crisis of now’ and aren’t willing to listen to discussions of long-term chronic issues.”

A Center for Healing

Adrienne Kirby, PhD and chairman and CEO of Cooper University Health Care, said her long-term goal was to create at Cooper a “center for healing” that would address many of the related factors that contribute to problems faced by substance abusers. She said Cooper has been on the front lines, working with Camden County Police, to identify and reach out to patients in need. She said intervention needs to be combined with treatment, as well as other support services, such as housing.

Another key aspect of Cooper Health’s approach is to upgrade the curriculum so that students, residents, as well as faculty, are trained to recognize and treat substance abuse patients effectively.

Information is Key

A key challenge to implementing a coordinated strategy is the sharing of information. In addition to HIPAA regulations, the infrastructure simply doesn’t exist yet to allow the exchange of bio-social information among health care entities and community-based support organizations.

“We don’t have the infrastructure for mental health that we have in physical health,” said Dr. Kirby. “The law doesn’t allow us to be there yet.”

Nevertheless, such an information-sharing capability could help ensure that substance abuse patients receive the continuing care and social support they need. For example, with patients’ permission, telemedicine apps could combine with GPS to manage patients’ long-term illnesses, monitor their activities and ensure they are complying with what is needed to maintain a healthy recovery.

Information can be even more important in terms of prevention – stopping substance abusers before they get started. Caron, for example, works with 600 grade schools and high schools to educate students about the dangers of substance abuse. According to Caron’s Tieman, if students can be persuaded to postpone their introduction to alcohol, marijuana and other substances, it can significantly delay the onset of substance abuse.

There is no panacea. The opioid epidemic has been years in the making and will no doubt take years to overcome. In the meantime, healthcare communicators who work with organizations involved in the issue need to keep abreast of news and developments so they can provide their respective audiences with timely information and advice.

 

Letter Rip: Send That Letter to the Editor

Research, Customization will Increase Your Odds of Success

The letter to the editor, alongside its big brother, the op-ed, is a tried-and-true earned media tactic. And for good reason: letters are reader-contributed, run the gamut of topics that are news-based and “evergreen,” and are generally short, which means they get read. On top of all that, newspapers publish several every day, and as a result have a solid appetite for good ones.

Frequently appearing in hyper-local markets, letters can be a significant consumer marketing tool. They are effective for a variety of reasons:

  • Educating the public (or correcting the record) about a specific health concern, issue or controversy
  • Creating/enhancing name/brand recognition within the target area
  • Establishing the client’s reputation as an authority on the specific topic or issue
  • Reinforcing the client or organization as a caring and concerned member of its local community(s)

Establish Goals, and Don’t Self-Promote

SPRYTE has had great success with well thought-out, well-researched letter to the editor campaigns on behalf of various clients, frequently publishing the same letter in a number of newspapers across the country, under different bylines, where clients have local offices or franchises, for example.

But the letter to the editor isn’t low-hanging fruit. Success hinges on several factors, not the least of which is the skill of the writer. While the urge is to get your organization’s or client’s name out prominently and positively, editors will see right through letters that are too self-promotional. Writers need to constantly ask the question, “What will the paper’s readers get out of this?” More precisely, what public good can we provide, or what useful or compelling information can we share? What important topic or viewpoint can we open readers’ eyes to?

As with just about all earned media tactics, it’s useful to lay out your goals first, then let them inform the content of your letter. If your goal is to inform readers, make sure to include facts and/or statistics. If you want to thank or bring attention to a group, highlight the problem the group or individuals have helped to solve, and what they’ve accomplished. And if your goal is to weigh in on a subject that’s being widely covered and thus gain thought-leadership credibility, be sure to base your argument on established facts and logic.

Best Practices for Your Letter to the Editor

Here are some more tips from SPRYTE’s playbook for leveraging letter to the editor campaigns:

Avoid high-traffic times of year. Saluting mothers on Mother’s Day, or veterans on Veteran’s Day or Memorial Day will put your letter into intense competition for space. Same with the winter holidays (resist that New Year’s resolutions self-help letter). Instead, if you’d like to peg your letter to a significant or recurring event, set your sights on less prominent days, such as an obscure anniversary, a lesser-known holiday, or an organization milestone that no one else can claim. In recent years, SPRYTE has jumped on Peace Officers Memorial Day, “Juneteenth,” POW-MIA Recognition Day, and National Caregivers Day, generating dozens of published letters.

Move fast. If you want to respond to a published article, or give your take on a topic in the news, waiting even a few days can make your letter to the editor stale. Monitor media coverage that’s relevant to your organization’s expertise, and get the wheels spinning for a letter the day the story runs. Submit it the next day or within 48 hours. And don’t forget to reference the specific article in your letter.

Follow the rules. Many papers have specific guidelines for letter writers, so read them and follow them. Words might be limited to 200 or even 150, so make every word count. (In general, shorter letters or more likely to be used in any case.) Some publications require you to e-mail your letter to a specific department or editor, and others have online submission forms. Submit in the prescribed format to give your letter to the editor the best chance of being used. And some papers specifically state they don’t run general “thank you” letters, or letters that don’t respond to a specific article that was published, so make note of those restrictions too.

Customize your letter. If you’ve gone to the trouble to write a letter to the editor, take the time to adapt it for every newspaper/market you’re submitting it to. Include the local office location and healthcare professional’s name, for example, rather than the CEO of the national organization. Name the city and reference the local issue if applicable. This will greatly increase the chance of your letter getting used.

Be available. Just about every paper has a letter verification process to ensure validity, and that might include a phone call or e-mail to or from the letter writer confirming contact information, city of residence and organization. Make sure the person who signs the letter to the editor is aware they might be contacted, or might proactively have to call a number to verify.

Manage expectations. Even if you get a canned e-mail that says your letter to the editor is being considered for publication, you’re only at second base. Your letter might be pushed out due to lack of space, competing, more timely topics, or a more insightful (or entertaining) letter on the same subject. Then again, if your letter is more of an evergreen, it could run days or even weeks letter when you’re not expecting it.

Letters to the editor can be a powerful tool in the healthcare communicator’s arsenal. They can build your reputation, influence public opinion, spur changes in behavior, and, as part of a bigger campaign, possibly even influence public policy. So letter rip!

 

Public Affairs and PR: Perfect Together

Government Relations and Public Relations a Team Effort

As our hometown Super Bowl Champion Philadelphia Eagles recently proved (yeah, we’re still celebrating!) to be successful, a football team needs a great offense. That means a dependable line as well as a talented backfield. And while it’s the backs that tend to get most of the glory, they can’t do it on their own.

The linemen are responsible for the nitty-gritty. They do their job in the trenches – mostly out of sight from the casual observer, blocking would-be tacklers, protecting the quarterback, opening lanes for the speedy running backs and talented receivers.

Running Backs and Linemen

A successful public affairs campaign often works much the same way. The Public Relations pros are like the running backs – running with the broader story, alerting the public to the importance of the public policy being promoted, showcasing activities and events in ways that seek to create wider public awareness and broader public support.

Their Government Relations teammates, meanwhile, do the nitty-gritty – working within the power structure, targeting the appropriate legislators, governors, staff members or other public officials to make sure the public policy initiative is moving in the right direction, fending off the opposition, opening lanes for negotiation and agreement.

When they work together in a well-coordinated team effort, magnificent things can happen.

Case in Point

As part of a recent webinar sponsored by the New England Society of Healthcare Communications (NESHCO), presenters from Care New England discussed their efforts to promote statewide legislation in Rhode Island mandating fertility preservation coverage for women undergoing cancer treatments (such as sterilizing surgery, chemotherapy or radiation) that could render them infertile.

Early on, Government Relations and Public Relations team members understood the need to work collaboratively. This was important, because, as noted, their focus can sometimes be at cross purposes.

The process began with internal meetings with clinicians, cancer specialists, lawyers, and Government Relations and Public Relations team members. The purpose: to ensure everyone on the planning team understood the issues involved so they could set a strategic direction for moving forward.

Working Inside / Outside

From there, Government Relations worked with their lobbyists and legislative staff to draft proposed legislation to provide protection to women undergoing cancer treatments. At the same time, the team worked on identifying and educating potential sponsors in both the House and Senate, and to garner support from the leadership of both chambers.

In the months ahead, the Government Relations team worked to identify and evaluate potential witnesses (doctors and patients) to appear at legislative committee hearings as well as be available for supporting media opportunities. The team also helped draft testimony and kept in close communication with legislators to alleviate any concerns that might arise as a result of the hearings and provide regular updates to key internal stakeholders.

Going Public

Meanwhile, PR worked to get the message out to the general public, in order to start building popular support for measures designed to protect the health and lives of women facing such daunting challenges. Various allies, including the American Society for Reproductive Medicine (ASRM), assisted and provided an official statement in support of the legislation that was included in a news release. That kind of support helped spread the love by encouraging others to raise their voices as well. News stories subsequently appeared in key publications including The Providence Business Journal, Providence Business News, HealthLeaders Media, US News and Beckers Hospital Review. In addition, clinicians from Women & Infants Hospital of Rhode Island provided a supporting op-ed that appeared in the New England Journal of Medicine.

Happy Ending

On July 5, 2017, Rhode Island became the first state in the nation to require insurance coverage of fertility preservation prior to radiation or chemotherapy treatment that could result in infertility.

At SPRYTE, members of our team have been involved in similar efforts over the years, including an effort in Pennsylvania to eliminate the use of certain chemicals in children’s products. The experience was very similar – working a two-pronged approach, one aimed at legislators and regulatory officials, the other focusing on building awareness in the media and among the public about the chemicals in question.

Our experience mirrored what took place in Rhode Island: working with legislative staff and sponsors, identifying and vetting expert witnesses, and updates about new scientific studies supporting the claims that children were at risk. Our story ended somewhat differently; after several legislative hearings, industry representatives agreed to stop using the chemicals in childrens’ products.

Nevertheless, the lessons remain the same. Government Relations and Public Relations professionals each bring different, but often complementary, skill sets to the table. To work together, they need to plan together, establish mutual goals, and map out a clear strategy that allows each team to do what they do best without getting in each other’s way.

From a public policy standpoint, the results can be game-changing.

Published February 20, 2018 by Spryte Communications in Uncategorized

Providers Need to Understand Patients’ Perspectives

Juneteenth – America’s Other Independence Day

Americans love their Fourth of July holiday. After all, it’s America’s birthday – the day we traditionally set aside to celebrate the signing of the Declaration of Independence and the establishment of a free nation where “all men are created equal.”

But for many, those hallowed words proved hollow. Hundreds of thousands of slaves throughout the young United States – especially in the South – would need to wait almost another century before their rights to equality were officially recognized.

Another View of History

On July 5, 1852, famed African American abolitionist Frederick Douglass, himself a former slave, delivered an impassioned speech spelling out the irony inherent in the July 4th celebration:

“This Fourth of July is yours, not mine. You may rejoice, I must mourn,” Douglass said. “What, to the American slave, is your Fourth of July? I answer: a day that reveals to him, more than all other days in the year, the gross injustice and cruelty to which he is the constant victim…”

It would take another 13 years, hundreds of thousands of lives, and a Civil War that tore apart the fabric of the American nation before four million African-American slaves would get their own taste of freedom.

Juneteenth – Freedom Reborn

On June 19, 1865, Union General Gordon Granger, military commander of the defeated Confederate state of Texas, read aloud General Order No. 3, telling the populace of Galveston that: “The people of Texas are informed that, in accordance with a proclamation of the United States, all slaves are free.”

Spontaneous celebrations among the newly freed African American population quickly erupted across the South as Juneteenth was born. African-American communities across the U.S. soon adopted Juneteenth as their own holiday, using it as an occasion for celebrating freedom with public events, picnics and church gatherings.

Lesson: Understanding Leads to Compassion

Once we understand the history of Juneteenth and how it came into being, it’s easier to appreciate why many African Americans consider Juneteenth to be a day to celebrate not only the vision of freedom President Lincoln described in his 1863 Emancipation Proclamation but also the original promise of the Declaration of Independence.

Since our childhood, we’ve been told that America is a melting pot, comprised of people from all over the world, representing a multitude of religious backgrounds, races, cultures, customs, languages and lifestyles.

Healthcare providers face the everyday challenge of understanding how these differentiating factors may affect individuals’ or families’ attitudes toward illness, pain, coping and death. It is important to appreciate why these attitudes are held, because they can significantly influence their willingness to explore various treatment options. Hospice, in particular, can be an especially touchy discussion topic.

For example, according to statistics, African-Americans comprise approximately 12% of the U.S. population, but they make up only 7.6% of hospice patients. Ironically, African-Americans have a disproportionately higher rate of cancer and heart disease, which are among the top hospice diagnoses.

Researchers point out several reasons for this incongruity. As a rule, African-American families tend to be less trustful of the American healthcare system. In addition, because medical decisions tend to be made within the family, there may be a reluctance to consult with a new, unknown healthcare professional or someone outside the home. Finally, statistically speaking, African Americans tend to be especially reluctant to cease life-prolonging procedures such as tube feeding, organ donation, and palliative care in the hospice setting – because extending life is generally seen as something to be preferred.

Honoring Differences

Healthcare communicators need to recognize that their messages may be perceived very differently by diverse audiences and adjust accordingly.

As the U.S. healthcare system continues to evolve to one that is more population health-oriented and patient-centered, there is a growing need for healthcare providers to educate patients, families and the general public about what they can do to stay healthier, as well as the nature of specific healthcare challenges and treatment options.

Understanding their emotions, how they think, and the reasons behind these different perspectives is vital to helping patients and families make treatment decisions that are most appropriate for their individual situations.

It’s not unlike coming to appreciate the Juneteenth holiday. The better we understand the history and background of our patients, the better we can understand and honor the views and emotions that influence their decisions and actions.

Opioid Crisis Requires a Community Effort

Combining Strengths to Confront a Potent Problem

One of the most prominent public affairs topics in recent months has been “The Opioid Crisis” or “The Opioid Epidemic.” Hardly a day goes by without a major news story offering up frightening new statistics about the rising number of opioid abusers, opioid-related arrests or opioid-related deaths.

Clearly, it’s a national healthcare crisis. But in Massachusetts, the problem is particularly acute. Recently, the New York Times noted that across the country, someone dies of an opioid overdose every 24 minutes, while in Massachusetts, the rate is five people a day. According to a posting on mass.gov, the official state website:

“The opioid-related death rate in Massachusetts has surpassed the national average, with an especially sharp rise in the last two years.

 “In one way or another — through deaths, nonfatal overdoses, or disruptions to jobs, marriages, families, and neighborhoods — every community in Massachusetts has been impacted by this growing crisis.”

Recently, the New England Society of Healthcare Communications (NESHCO), of which SPRYTE is a member, sponsored a webinar exploring how one community hospital was addressing the crisis. Christopher Smalley, Director of Marketing & Communications, and Sarah Cloud, LICSW, Director of Social Work, for Beth Israel Deaconess-Plymouth in Plymouth, MA, talked about how officials at their hospital worked with local government and community leaders to lead a comprehensive plan of outreach, education, intervention and treatment to address the growing epidemic.

Community Problem/Collaborative Solutions

The first step was to establish a consensus that the Opioid Crisis was more than just a drug-related problem that affected opioid abusers; it was a public health and safety issue affecting families, coworkers, students and others throughout the community. It’s a complicated public affairs/public health issue and there are no easy answers.

The catalyst was a “60 Minutes” style news video about the opioid crisis in Plymouth produced by journalism students from Plymouth North High School, which is just across the street from Beth Israel. The video showed individuals who admitted getting drugs from hospitals by stealing doctors’ notepads and forging their signatures.

The video was a wake-up call. In previous years Beth Israel had helped sponsor a community health program called “Healthy Plymouth” that focused on common concerns such as healthy eating and making healthy lifestyle choices. But opioids were a whole different ballgame. It was a problem that challenged the entire community- businesspeople, professionals and citizens of all categories.

Beth Israel led the effort by reaching out to police and community leaders. Working together, hospital and community leaders obtained a $3.7 million state grant to develop a substance abuse awareness and treatment program. Project Outreach is a collaboration of public safety agencies and healthcare providers designed to respond to the growing number of opioid overdoses by conducting follow-up visits within 12-24 hours after an overdose.

 Project Outreach

The two main aspects of the program are overdose follow-up and community outreach.

Overdose Follow-up: After an overdose occurs in a participating community the Project Outreach team comes together to decide the best course of action for the individual. If in-person follow-up is advised, a healthcare worker and police officer goes to the home of the overdose victim. The healthcare worker discusses treatment options with the individual and, if they are willing, helps get them into a treatment program.

Community Outreach: Twice a month the Project Outreach team hosts a drop-in center. At these centers, health care providers help with treatment options, provide training and distribute Narcan at no cost. (Narcan, also known as Naloxone, is often administered in emergency situations to reverse opiate overdose). The drop-in centers are open for anyone looking for information about treatment, including family members and friends. This setting provides a unique opportunity to have the undivided attention of healthcare workers who specialize in treating substance use disorders. They can also answer questions about addiction, discuss treatment options, assist on issues with paying for treatment, and help get individuals into treatment programs.

Making an Impact

During 2016, after the initiation of the program, Project Outreach recorded a total of 2,921 patients provided with behavioral health intervention in the Beth Israel Emergency Department. In addition, of 200 non-fatal overdoses in the Town of Plymouth, 91 declined services in the emergency department and received follow-up care in the community. Another 65 were located and engaged in assessment and 58 were connected to a treatment program.

During the same time, 10 drop-in centers were created within the community, each with the ability to connect patients to treatment without overdosing or having to go to the emergency department. The centers also offer Naloxone training and kits as well as referrals to support services.

A variety of awareness campaigns were also part of the prescription. Project Outreach helped provide information to the surrounding public about Naloxone, Pain Management and Wellness, as well as a MedSafe Drop Box kiosk where people can bring in personal prescriptions that are no longer needed or wanted.

Earned Media

All of this was accomplished primarily through earned media and word of mouth. The only advertising expenditure involved published rack cards to provide information about how to recognize an overdose and other healthcare issues. Stories about the program have appeared throughout the state in local and regional newspapers as well as on radio and TV.

Not only did this help minimize costs for the hospital – in the long run, it enhanced the level of community cooperation that was so important to the program’s overall success. So far, Project Outreach has expanded throughout Plymouth County to 27 towns and cities, as well as five additional hospitals. Project leaders have created a web-based database to collect real time data. They are also providing guidance to healthcare facilities and police departments around the nation as more and more localities seek answers to this virulent problem.