Community perception: How does a hospital regain trust?

For hospitals and health systems, community perception is vital.

Hospitals are one of the essential fixtures of a town. At a community hospital, the physician or nurse treating you could be your neighbor. However, much of the sense of community at both small and large hospitals has disappeared, as many facilities have become disenfranchised with their markets.

In today's healthcare environment, hospitals and health systems must be diligent in developing and keeping a positive relationship with their community and consumers, which includes gaining their trust. Patients openly share their satisfaction and dissatisfaction with healthcare facilities, so if trust is lost, word gets out. In the consumer-driven healthcare market, dissatisfied patients may choose to get care from another provider.

But how does a hospital regain trust once it has lost it?

Losing trust

There are two types of loss of trust, according to Martie Moore, RN, former CNO of Portland, Ore.-based Providence St. Vincent Medical Center and current CNO at Medline where she provides consulting to hospitals, clinics and physician offices nationwide on nursing services and patient care.

A negative event at a hospital or health system, such as an outbreak of an infectious disease, is well broadcasted in the media and shared via social media, which creates trust issues between the healthcare organization and its community. When this happens, hospitals must be forthright, according to Ms. Moore.

"Over-communication and transparency is critical. Hospital leaders have to show that they're taking the situation seriously, are committed to the highest standard of care, and are utilizing information to improve care and facilitate assurance that it will not happen again," says Ms. Moore.

Many times, organizations will call on a clinician to communicate with the public about the negative event.

"It's very hard when you're a clinician and you're trying to do everything you can to ensure the best standard of care. There's a lot of prep work that has to occur to make sure their message is communicated effectively to the public," Ms. Moore says.

The second type of loss of trust is what Ms. Moore calls "the erosion factor." That is where the community has lost faith in their community-based hospital over time. While hospitals may have a harder time restoring trust in this situation, Ms. Moore believes it is well worth the climb.

"You want your community to feel aligned with the hospital. You want to hear people say, 'That's my hospital. That's my place,'" she says. "And again, it goes back to transparency. You have to over-communicate, and you have to share stories of the good work you're doing in order to change the community's perception. Hospitals have to know their community and be able to understand and meet their needs in order to restore the relationship."

Regaining trust: real-life examples

Ms. Moore gave the example of Texas Health Presbyterian Hospital in Dallas, which treated Thomas Eric Duncan, the first patient diagnosed with Ebola in the U.S. who died in October 2014 as a result of the virus. After treating Mr. Duncan, patient volumes and revenue dropped at the hospital. As two nurses who came into contact with Mr. Duncan later tested positive for the virus, it is likely that the unknown about Ebola caused patients to second guess visiting the hospital. Texas Health Presbyterian Hospital's daily net revenue later rebounded after the community's fear subsided.

Texas Health Presbyterian officials shared their inside story on going through the Ebola crisis and the hospital's leadership was very transparent about the mistakes that were made. In fact, the hospital ran a full-page ad in two local newspapers to apologize to the community for the mistakes that were made in handling the situation.

"And as they shared their story, the criticism being thrown at the hospital started to fade away and there was a greater understanding of what their team went through and the work they did to assure the highest level of care. Furthermore, hospital leadership strived to help other healthcare organizations learn from what they went through," says Ms. Moore.

What was not highlighted, though, was the work that was being done internally by the hospital's leadership to support their staff through what was uncharted territory for them and other hospitals across the U.S.

"Their CNO went in and cared for the Ebola patient and sought to understand what the hospital's nursing staff was facing," Ms. Moore says.

Ms. Moore also gave an example of a situation that occurred during her time at Providence St. Vincent Medical Center.

While she was CNO there, a gentleman walked into the hospital with a semi-automatic pistol and held employees hostage. While the hospital was transparent with the media during the situation, it was protective of its employees as well.

Members of the media asked to talk to staff members who were held hostage. However, Ms. Moore declined those requests, asking the media to respect their privacy and need to heal after such a traumatic event. Ms. Moore says the discussion with the media was not about what happened to these two employees, but the importance of hospitals being prepared when the unthinkable becomes reality. Hospitals have to be ready to respond to any type of scenario and leadership must be prepared to speak to those events in the moment with clarity and transparency. Communities look to those moments to reinforce their belief systems about the hospital.

"Everyone had their eyes on us. It was important for me to demonstrate that our hospital does the best job possible to protect both patients and staff members," Ms. Moore says.

The importance of community

Ms. Moore also learned a lot about the meaning of community when Providence St. Vincent Medical Center created a dance video for the Medline Pink Glove Dance Video Competition, the only breast cancer prevention campaign that unites healthcare professionals, breast cancer patients and survivors, and fellow community members – all through the joy of dancing. Since the competition's launch in 2011, more than 200,000 dancers have participated in creating videos to honor breast cancer survivors and those still fighting the disease. This year, the competition attracted 56 teams throughout the U.S. and Canada and donated more than $300,000 in support of 33 breast cancer charities.

In 2009, Providence St. Vincent became the first hospital to round up 200 dancers, primarily nurses and physicians, to participate in a choreographed video that went viral on YouTube. To date, the video has received more than 14 million views. Through the Pink Glove Dance, Ms. Moore said she learned about the importance of community.

"I never expected to receive such a positive reaction from the Portland community. People familiar with the video came to visit what they called the 'Pink Glove' hospital Stories from breast cancer patients and survivors within the community and even our own staff members started pouring in," she says. "In that moment, we were truly interconnected. The Pink Glove Dance gave us a better understanding of who our patients and employees are, which helped us form a trust with the community around us."

She also recalled hospital workers stepping onto the streets of Portland for the Starlight Parade. The parade, part of the Portland Rose Festival, draws hundreds of thousands of spectators each summer. She says she saw people cheering for them, and it truly made her understand how strong of an impact the Pink Glove Dance video had on our community.

Practical steps

In addition to participating in initiatives like Pink Glove Dance, Ms. Moore encourages hospitals to improve their community perception by forming relationships with local organizations like the chamber of commerce and hosting events such as safety fairs and walks and runs. By getting out there and simply talking with community members, hospital workers may find out what people think of the organization, which can help them think of new ways to improve perception.

"It may be hard to hear, but you've got to be willing to hear it for them to respond," Ms. Moore says. "You want to do it in a way that's not as structured as focus groups are."

Furthermore, as people heavily rely on the Internet for information, blogs are a great tool for hospital leaders to share information and interact with the public. For instance, hospitals could use nurses to give tips on child safety or geriatric care.

Hospitals must also take the time to assess their community's needs. For example, Ms. Moore says, one hospital conducted a review to understand why people were going to their emergency department after hours for dental care. Through the assessment, the hospital discovered that a particular zip code in the community had no access to dental care. As a result, the hospital's foundation funded a clinic that was staffed by volunteer dentists.

"Hospitals are kind of crazy bee hives, but if you can help your community view the hospital as a place of hope and love and care, instead of an institution and corporation, you'll start to gain that elevation of trust," Ms. Moore says. "However, you must be strategic about improving community perception. By doing so and demonstrating your determination to connect with the community, you will notice people being proactive about aligning themselves [with the] hospital."

Community perception study

Assessing the community's needs may also include doing a community perception study.

Research firm Market Strategies International recently studied community perceptions of a select group of regional hospitals in Boston, Philadelphia, Atlanta and Chicago to rank facilities on quality, care and treatment, institutional mandates, non-medical advantages, service lines and reputation. 

Jack Fyock, PhD, senior vice president of healthcare at Market Strategies International, who led the research project, says the strategic planning study was conducted last year to help hospitals in these areas understand their position in the market and what consumers think of them. The firm selected a range of hospitals that sometimes compare themselves to and included them in the study.

These hospitals were ranked based on their score on the firm's perception index, which is a summation of performance on 19 metrics, such as quality, care and treatment, institutional mandates, amenities and overall preference.

Within each city, roughly 1,800 people participated in the research. Out of those respondents, only a portion — those who know about the hospital — rate each hospital. The firm ended up with a sample of between 200 to 300 ratings of each hospital dependent on people knowing the hospital.

Dr. Fyock says while hospitals' scores on the Hospital Consumer Assessment of Healthcare Providers and Systems survey are important, those scores represent maybe 4 percent of the population that use hospitals in a given year. The community perception study is useful because it show how each hospital is viewed by the community as a whole.

"You can't manage what you don't measure, and I think many hospitals have a lot of ideas going around as to what is or isn't working with their hospital, and in order to either manage something that went wrong or manage an image, hospital leaders need to have an idea not only how they're doing but how they're doing compared to others. So this study gives them some guidance as to what that looks like and a handle on whether what they think is important is really important or not," Dr. Fyock says.


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