1. Creating and Promoting Effective Comparative Quality Reports For the Public Shoshanna Sofaer, Dr.P.H. School of Public Affairs Baruch College

2. May 21, 2009Shoshanna Sofaer, Dr.P.H.2 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

3. May 21, 2009Shoshanna Sofaer, Dr.P.H.3 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

4. May 21, 2009Shoshanna Sofaer, Dr.P.H.4 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

5. May 21, 2009Shoshanna Sofaer, Dr.P.H.5 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 doesn’t happen too often Why?

6. May 21, 2009Shoshanna Sofaer, Dr.P.H.6 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)

7. May 21, 2009Shoshanna Sofaer, Dr.P.H.7 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 don’t fit what the data show?

8. May 21, 2009Shoshanna Sofaer, Dr.P.H.8 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 don’t believe they will “lose market share” in the short term

9. May 21, 2009Shoshanna Sofaer, Dr.P.H.9 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 let’s look at what it takes to be effective in community quality information to the consumer

10. May 21, 2009Shoshanna Sofaer, Dr.P.H.10 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

11. May 21, 2009Shoshanna Sofaer, Dr.P.H.11 Learn about your audience Here’s 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 don’t they trust as a potential sponsor for a public report?

12. May 21, 2009Shoshanna Sofaer, Dr.P.H.12 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 isn’t, 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

13. May 21, 2009Shoshanna Sofaer, Dr.P.H.13 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

14. May 21, 2009Shoshanna Sofaer, Dr.P.H.14 The Right Data Rule Two: People will not value information if they don’t 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

15. May 21, 2009Shoshanna Sofaer, Dr.P.H.15 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 don’t talk about it that way and don’t respond well to that term

16. May 21, 2009Shoshanna Sofaer, Dr.P.H.16 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 don’t, you have to do at minimum expert review and ideally cognitive testing before you go live

17. May 21, 2009Shoshanna Sofaer, Dr.P.H.17 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

18. May 21, 2009Shoshanna Sofaer, Dr.P.H.18February 29, 2008CVE Learning Network18 Example of “Word Icons”

19. May 21, 2009Shoshanna Sofaer, Dr.P.H.19 The Right Presentation Rule Three: Don’t 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

20. May 21, 2009Shoshanna Sofaer, Dr.P.H.20 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) That’s what they came for; don’t 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

21. May 21, 2009Shoshanna Sofaer, Dr.P.H.21 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

22. May 21, 2009Shoshanna Sofaer, Dr.P.H.22 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?

23. May 21, 2009Shoshanna Sofaer, Dr.P.H.23 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

24. May 21, 2009Shoshanna Sofaer, Dr.P.H.24 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

25. May 21, 2009Shoshanna Sofaer, Dr.P.H.25 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

26. May 21, 2009Shoshanna Sofaer, Dr.P.H.26 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

27. May 21, 2009Shoshanna Sofaer, Dr.P.H.27 The Right Promotion & Dissemination Some ideas: Think about actually placing your report on someone else’s 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

28. May 21, 2009Shoshanna Sofaer, Dr.P.H.28 The Right Promotion & Dissemination Take advantage of the experts on this: the Google’s and Yahoo’s 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

29. May 21, 2009Shoshanna Sofaer, Dr.P.H.29 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 don’t have this, but others in their company definitely do

30. May 21, 2009Shoshanna Sofaer, Dr.P.H.30 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”

31. May 21, 2009Shoshanna Sofaer, Dr.P.H.31 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