Creating and Promoting Effective Comparative Quality Reports For the Public

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Creating and Promoting Effective Comparative
Quality Reports For the Public

• Shoshanna Sofaer, Dr.P.H.
• School of Public Affairs
• Baruch College

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OVERVIEW

• What do we mean by effective?
• What does it take to be effective?
• Learn about your audience
• The right data
• The right data presentation
• The right information around the data
• The right dissemination and promotion

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What do we mean effective?

• Effectively communicated data is
• Actually received and looked at by the audience
• Relevant to the audience
• Trusted by the audience
• Easily understood
• Easily applied
• Appropriately used

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What do we mean effective?

• With quality data in particular, we think a
  public report is effective if it directly or
  indirectly contributes to the improvement of
  quality
• This can be achieved through different pathways
  including
• The consumer choice pathway
• The reputational pathway

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The Consumer Choice Pathway

• The logic model here is that if consumers see,
  understand and apply comparative quality data
  they will tend to choose higher quality plans and
  providers
• Yet much research indicates this doesnt happen
  too often
• Why?

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The Consumer Choice Pathway

• There are a lot of limits to the consumer choice
  pathway
• Do people have choices? Do they realize it?
• Are they actually facing a choice? Do they want
  to make a choice
• Most comparative reports do NOT take advantage of
  what we know about what works
• Other factors besides quality make a difference
  to consumers (often for good reason)

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The Consumer Choice Pathway

• What if there are actually few high quality
  options?
• What if there are some high quality options but
  they cannot or will not accept new members or
  patients?
• What about the tendency for providers to put
  pressure on consumers to make choices that dont
  fit what the data show?

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The Reputational Pathway

• People in health care organizations want to look
  good to the public and their peers
• Especially at an institutional level,
  comparatively poor performance really does make
  board members, managers and clinicians take
  action to improve quality
• Even if they dont believe they will lose market
  share in the short term

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The Reputational Pathway

• The really interesting evidence is that a
  comparative quality report that is more
  effective with consumers not only has more of a
  chance for an impact in the consumer choice
  pathway but in the reputational pathway as well
• So lets look at what it takes to be effective in
  community quality information to the consumer

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Learn about your audience

• You are NOT like the public/consumers
• The biggest mistake you can make is to assume
  that if a report would be effective for you, it
  would work with the public
• Yet the vast majority of public, comparative
  quality reports appear to be built on that
  assumption

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Learn about your audience

• Heres what you need to learn about your
  audience
• How do they define quality? What is and is not
  important to them? Do the measures you plan to
  use make sense to them? Are they important to
  them?
• Who do they think is actually responsible for
  achieving high performance on a particular
  quality measure?
• Who do they and dont they trust as a potential
  sponsor for a public report?

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Learn about your audience

• More to learn about your audience
• What terms will they understand what will fly
  right over their heads?
• How much time will they spend looking at a report
  before deciding it is, or isnt, worth their
  while?
• Think a few seconds
• If they think a report is worthwhile, how much
  time will they then spend looking at it?
• Think a few minutes

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The Right Data

• Rule One People say they want to know
  everything BUT what they really want to know is
  only what is directly relevant to their current
  situation, when it is relevant
• Content relevance is often linked to a particular
  disease or condition
• Timing has to do with that key moment when
  someone perceives both that they must make a
  decision and have the time to look at information
  relevant to that decision

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The Right Data

• Rule Two People will not value information if
  they dont understand it
• Some quality measures inherently make sense to
  consumers (e.g. many patient experience measures,
  certain safety measures)
• With other measures (e.g. process measures, other
  outcome measures, some structural measures) you
  need to help people make the link between what is
  measured and something inherently meaningful to
  them
• You need to explain the measure in plain English
  and tell them why they should care about it

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The Right Data

• Rule Three People want you to be fair
• They have strong and frequently accurate
  instincts about attribution of responsibility
• They instinctively get it that risk adjustment
  is needed, although of course they dont talk
  about it that way and dont respond well to that
  term

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The Right Presentation

• We know a lot about how to present quality data
  so it will be easily understood by the public
• Rule One Text must be short and in plain
  English (or other language) that is unlikely to
  be interpreted differently by different people
• Labels and definitions matter
• Where well-tested models exist, use them!
• Where they dont, you have to do at minimum
  expert review and ideally cognitive testing
  before you go live

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The Right Presentation

• Rule Two Make it very very easy for people to
  quickly identify high and low performers
• Certain kinds of comparison charts, using word
  icons work very well
• If you use bar graphs, put the highest performers
  at the top and the lowest performers on the
  bottom
• Yes, of course, providers are likely to resist
  this but it really makes a difference in whether
  consumers really understand the data and
  providers get to work on quality improvement

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Example of Word Icons
February 29, 2008
CVE Learning Network
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The Right Presentation

• Rule Three Dont assume people will know how to
  use the information you provide tell them
• Suggest ways they can put information together
  from different sources
• Suggest having people discuss the information
  with their providers
• Point out that they can use this information to
  help their family and friends

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The Right Information around the data

• Rule One Make it easy for people to get right
  to the data (e.g. from the first page of the
  report)
• Thats what they came for dont get in their way
• At the same time, you have to motivate them to
  look at the report by letting them know about
  quality and how it varies

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The Right Information around the data

• Rule One A You still have to use that first
  page to motivate them to use the report
• This includes clear, concise statements about
• The report sponsor and why to trust them
• Who else endorses the report
• What quality is in language normal people
  understand
• That quality varies
• That bad quality can hurt you and your family
• That the information in this report can help them
  find safe, effective health care

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The Right Information around the data

• Rules Two You can provide a lot of additional
  information after the data
• Make sure you let them know it is there
• Tabs on the top and the left side of your web
  site can work for this
• What should this include?

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The Right Information around the data

• Those pesky technical details that all the
  providers and the number crunchers thing are
  essential
• Very few people will actually read this stuff
• But it has to be there so they know you are
  willing to come clean and so your stakeholders
  feel comfortable
• However, putting all sorts of caveats directly
  around the data will only turn people off

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The Right Information around the data

• More detailed information about health care
  quality
• Specific ideas about several different ways to
  use the information in the report
• An opportunity to provide feedback on the report
• Live links to related information

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The Right Promotion Dissemination

• We have done a VERY bad job in this area
• All too often reports are never promoted and so
  very few people know they are there and check
  them out
• And we have very little solid research evidence
  of what kind of promotion actually works for
  comparative quality information

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The Right Promotion Dissemination

• However, there is knowledge about how to get
  information to people and how to get them to look
  at information
• It resides in the fields of marketing (including
  social marketing) and even advertising
• There is also specific information and tools
  about how to promote websites

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The Right Promotion Dissemination

• Some ideas
• Think about actually placing your report on
  someone elses website if lots of people in your
  audience routinely go there for trusted health
  information
• Get lots of folks to create live links to your
  report
• You will need a compelling report title and tag
  line for this purpose

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The Right Promotion Dissemination

• Take advantage of the experts on this the
  Googles and Yahoos of the world remember that
  how they make their money is buy selling
  advertising
• Consider buying ads or sponsored links
• But also make really sure that there are commonly
  used key search terms that will get people to
  your site quickly (the first page)
• This is called optimizing your site

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The Right Promotion Dissemination

• Also, really take advantage of all the
  stakeholders you work with
• Think through the extent to which each is an
  information intermediary and to whom
• Define specific strategies, collaboratively, to
  maximize your reach to your desired audience
• This process may lead you to realize that there
  are some folks missing from around your table!
• Try to borrow marketing and promotional expertise
  from them the HR people who work with you dont
  have this, but others in their company definitely
  do

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The Right Promotion Dissemination

• The trickiest issue dealing with the media
• You need them to publicize your report
• But the average journalist is trying to sell
  papers, not help you out
• They will look for the news in your report, not
  necessarily what is of benefit to the public
• You have to start early to build and maintain
  relationships with specific media folks
• And you have to frame your press releases in
  terms of what they will understand as new news

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Some Additional Resources

• Two reports authored by Shaller Associates,
  available at www.chcf.org
• Consumers in Health Care The Burden of Choice
• Consumers in health Care Creating Decision
  Support Tools that Work
• Reporting About Health Care Quality A Guide to
  the Galaxy Kanouse, Spranca and Vaiana
• Coming soon A revised and totally updated
  www.Talkingquality.gov website