The choices at play when we communicate and engage

A need to better engage staff and patients was highlighted in Darzi's review, and the approach to #ChangeNHS shows how seriously the new government and 10 Year Health Plan team are taking this. Listening, hearing and acting on what's heard, alogside open, transparent communication will remain central to rebuilding trust in the coming years - and I think we under-estimate how needed that is at our peril given recent strains on the people working in and experiencing healthcare.

What do we really mean by 'communications and engagement' though? Drawing on 20 years experience in PR, communications and policy, I thought I'd share a framework that can help. In 1984 Grunig and Hunt developed four models of public relations...

Communication and engagement are two different strategies that organisations use to deliver information to their audiences.

Communication involves delivering messaging to your audiences. This can be done in two ways: through press agency / publicity or the 'public information model'.

Engagement involves building relationships with your audiences. There are again, two ways to do this: the 'two-way a-symmetrical communication model' and the 'two-way symmetrical communication model'.

In more detail...

Press agency / publicity – this is one way traffic, often termed spin and is not underpinned with research. It is often manipulative.

Public information model - also one way, and usually via press releases and other techniques to distribute info. It does not use research to guide tactics. This information transfer approach seems to be common still in the health system, at least from the centre out, typified by "information cascades".

Two-way a-symmetrical model – known as the ‘scientific persuasion’ approach, it uses research to understand audiences and tailor messages to influence and persuade them to behave in a desired way. This approach will incorporate feedback into tactics. To my mind, this underpinned a lot of the public health focused PR campaigns I was part of a decade or so ago. Examples include the (award winning!) Tin Man Campaign for NHS Blood and Transplant back in the early '10s, and the NHS Get Tested, Get Treated Hep C campaign in 2010 or so.

Two-way symmetrical model – this uses communication approaches to negotiate with audiences, seeks to resolve conflict and promote mutual benefits, understanding and respect between an organisation and audiences. It is research based and incorporates feedback into tactics - it is an ongoing process. The communications and engagement function is liaison between rather than persuader of – and all parties benefit. Both parties make use of a back-and-forth discussion with both best interests met. It is considered the most ethical model. I personally used this approach during Sign up to Safety where we took an iterative approach as our strategy overall in the national patient safety campaign. We stayed in continuous conversation with those it served, choosing to be led by them as much as possible over those who held the most power (and the purse). We looked down not up, and in effect, it required us to persuade upwards not downwards.

There were moments we failed for sure, but certain tactics helped us remain focused and sincere. One is the concept of a 'throughline'. It's the central idea of theme that connects and runs through all your activity, and what you want an audience to take away as a core message - in 15 words or less. Over five years, this evolved at Sign up to Safety, but it always allowed us to identify our USP, to focus, to push back, to identify and address drift and generally stay true to what we set out to achieve.

I could share more of our tactics if of interest (let me know in the comments below) but we could not have done this without the leadership of Suzette Woodward, a compassionate leader who acted in the service of learning more about making care safer, who listened to others expertise, inspired and lived the ideals of the campaign, and a team willing to sit with the ambiguity this approach creates.

What helped us was our solid, open, honest relationships with each other - real kindness, curiosity and humilty, not performative or nice-ness (although we are all really nice!). Our independence from the 'system' as a whole, sitting seperately to any national body, also no doubt helped. This in itself suggests more about how the current system is considered "broken" - it is not a judgement on people or effort, but on the system design and the fact it doesn't always get the results we all work so hard for, perhaps because it doesn't allow space to fully focus and be driven by both those who do the work and who experience care.

The working groups for the 10 Year Health Plan face a choice. What form of communication from here? Will it be a-symmetrical or symmetrical? I hope they choose the most ethical model, which sends a message that communication and co-design doesn't end with the creation of the plan itself. It can give us some simple rules and limited, clear shared objectives now with direction of travel, but on-going conversation will help us as we all find our way through to success.