Some health systems may have felt like they took a sucker punch when they got a first look at their quality rating under CMS's new 5-star system earlier this year.
Few hospitals and health systems view themselves as deserving a one or two on a five-star scale, yet 24% will be publicly identified that way when the ratings are made public in mid-April. So, after getting over the initial shock, what's the best communications strategy for a response?
The temptation may be to lead with a roundhouse punch back at CMS and place the blame squarely on bad data, old data, an unfair scoring system, etc. But a better strategy may be to make love, not war – or at least make like.
Consumers want transparency about quality, and that's hard to argue with. While it's true that the data on which the stars are awarded is dated, and while it may also be true that awarding one overall quality rating to a hospital may be oversimplifying a complex reality, leading with excuses will probably lead to a public perception that you are ... making excuses.
The better strategy is to emphasize your strong embrace of quality and transparency. Cementing your reputation as a champion of those principles is far more effective in the long run – and maybe even in the short run – than gambling that explanations about methodology will be convincing.
Yet, taking the long view doesn't fully solve the short-term problems: reporters asking pesky questions about the hospital's rating; risks to staff and physician morale in the face of judgment by the federal government; disappointed board members.
There are no sure-fire solutions to these challenges that will put all doubts to rest, but there are communications approaches that can help stabilize the situation as your organization continues work to improve the rating.
Fortunately, there's still time to plan before the April release. Here are some thoughts on communicating challenging results:
Position your organization on the right side of the debate
Three words should guide you as you craft your messaging: "Keep it positive." A defensive or argumentative tone can lead your audiences to question your credibility.
Some things to consider in messaging:
• The quality/transparency movement is here to stay, as it should be. Above all else in your messaging, embrace it. What patient doesn't want to know which hospital will provide the best care and experience?
• Achieving optimal quality is a journey of improvement that you travel every day. Explain that in your messaging and commit to it.
• Explain that CMS is on a journey, too. They're working to find the best way to present quality measures to consumers. One challenge with the data, for example, is that it often reflects a reality from several years ago. This is the first time out of the box for the star system, and it too needs refinement.
We're not suggesting that the main point of your response be to blame your ratings on bad data. Too much of that sounds like excuse-making. But, there is some educating to be done that can set the initial ratings in context.
• Focus on action. No doubt your team has achievements in quality. Talk about them. Assure your audiences that you are on the case.
• Talk about other quality metrics. Does more current data reflect improvements on the metrics? If so, present that data (at a high level or with easy graphics, getting in the weeds will make most of your audiences glaze over). Do ratings issued by other organizations reflect more favorably on your quality?
Think about all of your stakeholders
Everybody has a stake in quality. Here are a few that immediately come to mind:
MEDIA
No doubt the media is an important stakeholder. Still, media exposure is likely to be a one-day event, while communication about quality should be continuous (and, in fact, is continuous via word-of-mouth and the web, whether you choose to be the source of information or not).
It's likely the reporter who calls won't be vastly knowledgeable about the various ways to measure quality, let alone the new five-star system. Clearly, this is an opportunity to educate and position your organization as a thought leader. Leverage it.
PHYSICIANS AND STAFF
Physicians, nurses and other staff members who work hard every day to deliver the best care to patients can be deflated by a disappointing star ranking. Make sure they don't learn about the rating from the evening news. Educate them about the impending announcement from CMS before it happens.
Messaging should praise their hard and good work, while also challenging them to rise to the occasion and improve outcomes. Don't get into the weeds on each area of the rankings, except perhaps with physicians, because much of that information won't be immediately relevant to day-to-day work in their areas.
Enlist department heads and front-line managers as your spokespeople to reinforce broader messages and translate them in a way that's relevant to their teams.
When you complete the short-term communication for this round of ratings, evaluate your overall program for communicating about quality. Do physicians and staff get consistent updates about what is new in your quality program?
THE BOARD
Clearly, you don't want your board to be surprised by news coverage about the ranking. Your briefing for the board should not only cover the ranking itself and plans you have for improvement, but also your short-term and long-term approach to communicating about quality.
THE PUBLIC
While media coverage is one way the public will learn about your health system's quality, there are other effective ways to tell your story.
Equip your employees and physicians with two or three clear, simple talking points they can deliver to friends and neighbors.
Monitor social media. Consider engaging with positive messages should your ranking get a lot of attention on social media.
Look for other channels. How about considering sending a letter to your community about quality at your hospital? If so, focus on the positives, don't just defend against the rating.
Focus on the bigger picture
While most of this post focuses on an immediate response, what's more important in the long run is making sure that your quality program is engrained in your culture and is always top of mind as operational decisions are made. Likewise, while your short-term communications approach is very important, the critical issue is really how you make sure you're communicating frequently – and consistently – about quality.
David Green is a vice president at Jarrard Phillips Cate & Hancock, a strategic communications and engagement firm focused solely on healthcare providers that has advised a number of health systems around the country on star ratings. Contact him at dgreen@jarrardinc.com or 615-254-0575.