PR training gives new life to U.S. veterans hospitals.

A new communication training program for top veterans hospital executives may help bring their PR activities out of the '50s and into the real world of today's competitive health care market.

In her book, 'Public Relations in Health Care,' Kathy Lewton describes a typical hospital public relations program that fits many U.S. veterans hospitals in the mid-1990s. The problem, however, is that her description was actually that of a typical non-veterans hospital public relations program of the 1950s. But the U.S. Department of Veterans Affairs (VA) has launched a new communication training program for top hospital executives that may help bring PR activities not just out of the 1950s but maybe even propel thinking and planning into the 21st century. They have a long way to go.

Public relations as an afterthought 

For most of its history, dating all the way back to the Bureau of Pensions in 1833, public relations in this branch of the U.S. federal government has been an afterthought -- if it was thought of at all.

There are a number of reasons for a lack of emphasis on modern public relations, including the following:

One, VA hospitals have never competed for patients and generally have limited capacity to add new patients. Patient eligibility is determined by a complex patchwork of rules and regulations, so that most kinds of public appeal would generate inquiries from people that hospitals would have to turn away.

Two, there is a strong bureaucratic attitude in the VA that "no news is good news."

Three, key audiences for the VA -- employees, veterans service organizations, medical schools and the U.S. Congress -- are reached by other means, if they are reached at all.

In short, it was easier to simply ignore public relations and dream that it was still circa 1950 when public assessments were more gentle and forgiving.

The current political pressures for a totally new national health care program -- in which the role of veterans hospitals is fuzzy at best -- have brought into sharp focus the need for more aggressive public relations. It may be years before a new U.S. national health program is completed. But one fact seems very clear: The veterans hospitals will be required to compete with all other health care providers for the opportunity to serve veterans. That's a whole new ball game for the hospitals and especially for the public affairs function.

An organizational overview

The Department's Veterans Health Administration (VHA) is an integrated health care system responsible for providing a variety of services to eligible veterans. Medical care is provided in a broad spectrum of facilities from large, complex medical centers to small primary care clinics in sparsely populated areas. The network includes 172 medical centers, 263 outpatient clinics, 35 nursing homes and 127 nursing care units. Each year, more than a million veterans are treated on an in-patient basis and 21 million as outpatients.

While overall coordination of this network rests with the VHA, headquartered in Washington, D.C., the veterans health network is highly decentralized, with heavy local autonomy. In the same way, the giant's share of the responsibility for public relations -- internal and external -- rests with hospital directors or regional public relations offices.

A sleeping giant awakens

The Clinton administration health care proposals have awakened a sleeping giant in the VA hospitals, and the need to become competitive against other health facilities is a stark reality. This also has brought about a recognition by top officials that major changes must be made, not only in the overall management of the veterans hospital system, but also in a higher level of effectiveness in its public relations activities.

This movement is being fueled by a new generation of managers who are coming into their own in the VA hospital system. They recognize that a new day is dawning in health care -- one that will involve many tough public demands, not just in quality of medical services and care, but also in the public's perceptions of how well these vital services are being provided.

Slowly -- and sometimes reluctantly -- managers in the VA hospital system are beginning to understand the necessity and value of effective public relations, both on a national level and at local facilities.

Seminar teaches executives communication skills

To take advantage of this new management awareness, the VA's Office of Academic Affairs in June 1993 conducted a week-long pilot seminar in executive communication training in cooperation with the University of South Carolina. Faculty included top communication professionals, two from the University of South Carolina. The main purpose of the seminar was to bring 24 directors of VA hospitals up to date on major PR activities and skills and how these could be used effectively in projecting a more positive public image of the resources and accomplishments of VA hospitals.

Extensive evaluation was conducted during and following this pilot session, with running changes being made to improve each day's effectiveness. The results -- from a group of hospital directors not noted for timidness in judging performance -- were outstanding. In fact, the marks were among the highest ever recorded in a VA training program on any subject.

Attenders evaluate seminars

According to the evaluations, major reasons for these high grades were quality of the instructors and the emphasis on hands-on, participatory learning based on real-life hospital problems. In addition to topical sessions, attenders were divided into small groups (no more than eight participants in each) and explored in-depth case examples of PR challenges faced by VA hospital directors. At the concluding session of the seminar, they were required to apply what they learned to come up with workable solutions to "worst case" scenarios.

More seminars planned

Building on the success of the pilot program, two similar sessions were planned for 1994. The first was held April 25-29, again at the University of South Carolina in Columbia in cooperation with the Continuing Education Department of the College of Journalism and Mass Communications. The second is scheduled for Park City, Utah, June 27-July 1 with the same faculty and curricula.

Three professors of the University of South Carolina serve as seminar faculty. Media relations is handled by Erik Collins of the College of Journalism and Mass Communications and Patricia McNeely, associate dean for continuing education and professional development. Thomas J. Madden of USC's College of Business Administration covers marketing of health care in an environment of reform.

Other seminar staff members are: Robert J. Cornet, director of communication for Towers Perrin consulting firm, speech communications; Pat Jackson, Jackson, Jackson & Wagner consultants, community relations; and Alvie Smith, communication consultant, internal communication.

More than 60 VA hospital directors are expected to participate in 1994, bringing the total number trained to about 80 out of a possible 200 eligible national and local executives. The first phase is designed primarily for hospital directors, but the training opportunity will be extended to associate directors, chiefs of staff and public relations officers.

COMMUNICATION ADVICE FOR EXECUTIVES

ERIK COLLINS University of South Carolina:

"Most senior executives treat a media encounter as something to be avoided at almost any cost or, if they are trapped into one, it is approached with loathing and genuine fear."

"With special training, however, media interviews can be turned into great opportunities for advancing their organizations' strategic goals and enhancing their own careers.

"A fundamental requirement is that executives need to know who the media are, how they operate, why they think the way they do and how to act and react during a live interviews. This is best accomplished by a discussion of fundamentals, group role playing, mock ambush interviews and simulated, in-studio television interviews. It's a very hands-on experience with all participants engaged in both problem solving and critiquing.

"A faculty team approach -- using a corporate affairs manager and a TV journalist -- adds strength and balance to the executive's experience, knowledge and confidence about how to survive tough TV interviews with a smile and maybe even a victory."

ROBERT CORNET Towers Perrin:

"In trying to improve the reputation relationships of an institution with its various publics, it helps to give a face to that institution. When you do this with an executive speaker, the publics no longer can demonize the institution or treat it as a depersonalized thing. The public relations potential of a speech depends on how well the speaker can turn the sheer fact of being present into the powerful rhetorical tool of 'presence' -- the engagement of an audience so that the speech seems like an informative dialogue.

"Most people are scared to death of making a speech. That fear can be eased with tips on how to prepare a text or outline and hands-on experience in delivering it with confidence and credibility.

"We try to instill a feeling of the power and potential an actor or actress experiences when the house lights go down and the opening applause ends. 'You own the stage, you own the platform and you want to make intimate contact with every single person, even in a room of 200 people.'"

ALVIE SMITH:

"The worst PR blunder in U.S. business during the 1980s was the failure to communicate effectively with employees on the massive changes necessary to reshape industry to compete in tougher global markets. The U.S. health care industry is faced with similar problems in the 1990s as lawmakers struggle to come up with a program to provide basic medical care to every American, a program projected to involve costs of more than U.S. $1 trillion a year, about 17 percent of the U.S. gross domestic product. To achieve maximum teamwork and support, employees in the health care industry -- public and private -- need to understand what is happening, why it is necessary, what it means to them and how they can help make the transition easier and more productive.

"The big question is whether those charged with running our health care institutions -- and their PR chiefs -- can benefit from the bitter lessons learned by American business."

"Will we communicate with and listen to our employees in building a successful team effort for making the most of the changes? Or will we be content to take whatever lumps and crumbs are left as undirected change tramples us in the dust?"

PAT JACKSON Jackson, Jackson & Wagner

"There is strong support for the idea that an effective overall public relations program for any organization starts in its own backyard -- in the community in which it operates and in which employee families live. Its behavior in the community, as demonstrated by both the institution and its individual employees, sets the true tone of what an organization stands for.

"If community relations is done right, sooner or later, grassroots success translates to national strength and influence. And in no organization is this more true than the national network of veterans hospitals and clinics located in hundreds of communities around the U.S. The sum of the parts can be much bigger than the whole.

"Community relations involves a wide variety of activities and needs to be planned on three strategic levels. One is defensive: guarding against negative acts or acts of omissions. Two is proactive, being a leader in positive acts that appeal to 'key' publics. Three is maintenance, retaining relationships with publics that are not 'key' at the moment, but still wield considerable public opinion influence and could be major publics in the future."

Alvie Smith, Birmingham, Mich., is former director of corporate communication for General Motors and is now a communication consultant. He also is author of "Innovative Employee Communications," published by Prentice Hall.

Dave West, Washington, D.C., has more than 25 years of experience in journalism and public relations and is a former executive director of the Illinois Press Association. He has been chief of communication for the Veterans Health Administration for nearly four years.