Ad Council AHRQ QuestionsCase Study

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Questions Are The AnswerAHRQ/Ad Council Case Study May 2007



Campaign Summary



Summary: ´Questions Are The Answerµ

100,000 people die each year as a result of medical error. How do you motivate peopleto get involved in their health care so that they can avoid becoming part of that statistic?

What if they don·t know much³or anything at all³about medical error or the likelihoodthat they will encounter it in their lifetime? And what if their instinctive approach to healthcare is to sit back and let the doctor figure it all out? And how do you create a sense of

urgency for people to act, without demonizing the medical community?

The ´Patient Empowermentµ campaign initiated by the Agency for Healthcare Researchand Quality (AHRQ) and sponsored by the Ad Council presented some difficult questions.Questions that required thoughtful background analysis and insight mining³andultimately a balancing act between inspiring patients to act and preserving physiciansupport of a national health care initiative.

´Questions Are The Answerµ creates a simple and upbeat dialogue that catches people·sattention. It arms patients and caregivers with a means to engage medical professionalsand enable better care. Most importantly, preliminary research suggests that thecampaign has the power to help chip away at that 100,000 figure.



Background



The 100,000 Lives Campaign

A 1999 Institute of Health report estimated that up to 98,000 people die in hospitals

each year as a result of preventable medical errors. That·s more than those caused by

feared threats such as motor-vehicle accidents, breast cancer and AIDS combined.

Who is at fault? Doctors? Nurses? Sometimes. Much more commonly, the error results

from faulty systems that lead people to make mistakes or fail to help prevent them. Like

patient records that aren·t digitized and therefore can·t be accessed by ER staff or

specialists. Or same-sized tubing in hospitals for administering oxygen and other gases.

Or prescriptions filled by separate pharmacies that cannot be cross-referenced. These

weaknesses in health care cost hundreds of lives each day.

The Institute for Healthcare Improvement (IHI), a national group of stakeholders fromgovernment agencies and the medical community, decided it was time to take on those

weaknesses. In December 2004 the Institute launched its ´100,000 Livesµ campaign

with the goal of affecting systemic change that would save 100,000 lives by July 2006.



Patient Empowerment

The Agency for Healthcare Research and Quality (AHRQ) saw another opportunity to

improve patient care. As the lead agency within US Department of Health and Human

Services with the mission of improving the quality, safety, efficiency and effectiveness of

health care for all Americans (and a member of IHI), it recognized that patients

themselves were a key line of defense.

To fortify the institutional efforts of the 100,000 Lives Campaign, AHRQ sought to help

patients by teaching them to help themselves. The agency·s research suggested that

patients who were more involved in their own care had a higher rate of positive outcomes.

AHRQ teamed up with the Ad Council. The ´Patient Empowermentµ campaign was born.

Its objective: To combat error by encouraging people to be more active and to speak up.



Insight



What We Did

To start, we wanted to get a sense of what people knew about medical error, how they

approached health care in general and what sort of language they used to talk about it all.

Our exploratory research covered a wide spectrum of health care users. Men and women.

Moms and dads. Caregivers. Low-income adults. Caucasians, African Americans and

Hispanics. Plus all of the above age 65+. Some we talked to within small focus groups.

Others we met one-on-one in their homes so that we could take a closer look into theirlives, how they organized their health care information and how they kept track of

prescriptions. Across the board, we sought to uncover how we could inspire all these

people to answer AHRQ·s call for ´patient empowerment.µ



Isn·t That My Doctor·s Responsibility?

Unfortunately, it turned out that people had little interest in participating in their own care.

Most patients preferred to be passive. Really passive. Few took notes or made lists of

questions in advance of doctor visits, and fewer still took it upon themselves to share

pertinent information with their doctors. They assumed that everything their doctor

needed to know was ´in the chart.µ And many held back on asking questions they did

have³some because they didn·t want to waste the doctor·s time, others because they

were afraid of offending him.

When it came to the subject of medical error, people were overwhelmingly uninformed,

save for three respondents who related horror stories of doctors cutting off the wrong leg

or removing the wrong paired organ. No one had any real sense of what ´medical errorµ

was, let alone that their chance of personally encountering it was roughly 25%.

Patients aren·t looking for ́ empowermentµ³or even more involvement.

They·d rather sit back and assume that ´doc knows best.µ



Just The Facts

What did seem to arouse the people·s attention were hard-hitting medical facts and

statistics. Whether they were young, old, male, female, healthy or ill, people took notice

of the 100K statistic. Additionally, the idea that doctors aren·t omniscient³and that

patients need to clue them in on their personal health developments³was compelling. So

was the scary, but often completely disregarded, notion that if you can·t read your

doctor·s handwriting on a prescription, there·s a chance your pharmacist will get it wrong.

Suddenly, we had it: All we needed to do was to scare people into putting a little more

effort into their interaction with health professionals. And we had some poignant

statistics that could carry most of the load for us. Time to write that killer brief.

Consumer research seemed to point toward a classic fear appeal: The threat is legitimate

The target is vulnerable to the threat

There·s a solution to the threat

The solution is actionable by the target



But We·re In This Together

Not so fast, said doctors. (And, truthfully, two or three of the more insightful patients.)

Physicians are part of the solution here. And playing to patient fear may demonize the

medical community.

They had a point. It·s hard to blame what is difficult to conceptualize (the medical

system); so, when patients hear ´medical error,µ they naturally think ´doctor error.µ Thephysicians, nurses and pharmacists who were working hard with the IHI on systemic

solutions to medical error deserved a more positive approach.

Besides, the most effective tactic, in the long run, would embrace collaboration. We

needed to help patients understand that their involvement in the process is not only

imperative but is welcome among medical professionals. Now we just needed a great

hook to get that idea across.



Strategy



The Target Audience

Broad target: The 25 million+ adultswho use the health care system.

Narrower target: Heavier users³because the more a person uses themedical system, the more likely (atleast in theory) that person is tobenefit from the campaign.

Core target: Mothers and adultscaring for elderly parents³because

doing for others was often moremotivating than taking better care of oneself.

Parents and

Caregivers

All Health Care

System Users

Heavier Users³

3+ Interfaces/Year

Relying on donated media, we cast a broadnet while tailoring our message towardthose we could most affect:



Starting A Dialogue

Patients & Caregivers

Want the very best health care

Want to feel informed

Want to start a dialogue

Don·t want to become experts

Don·t want to threaten or insult

The Medical Community

Want to be part of the solution

Want to be respected

Need patient information

Want more engaged patients

Don·t want to be demonized

Best Route To Engagement:

Questions

The right communications ´hookµ would create a bridge and conversation starter between

hesitant patients and information-dependent medical professionals.



Questions Are Powerful Medicine

Why questions? Exactly.

Thoughtful questions require both patients and medical professionals to ramp up their

engagement in the process, creating a win-win situation. And most of the people we

talked to had plenty of them. They just weren·t getting around to asking them.

To leverage the power of questions to help patients navigate the ´what ifsµ of medical

care (without dramatically referencing error), we crafted a hard-hitting strategic platform:

The most important question is the one you should have asked.

The creative articulation of the idea was simple and indisputably memorable: Questions

are the answer. We adopted an upbeat tone (best showcased in an over-the-toptelevision commercial) that made questions the hero in the patient-doctor relationship.

We have high hopes that the campaign will make an unquestionable difference.



Execution



´Questions Are The Answerµ Web Site

Core to the effort is AHRQ·s

patient empowerment Web site,

where patients can learn about

medical error and find out how

to improve the quality of theirhealth care. Consistent with the

advertising, questions are the

site·s main theme.

A ´Build Your Own Questions

Listµ feature helps patients and

caregivers customize a list of questions relative to their

specific health care needs.



´Questions Are The Answerµ Advertising

The creative executions³including TV,

radio, print and Web banners³

encourage people to visit the Web siteso that they can find out what ten

questions every patient should ask.

When possible, executions serve up

examples of common questions many

patients could use in their own health

care interactions.



Impact



Impact

Once completed, the campaign endured research and a rigorous approval process that

included input from AHRQ, patients and the toughest critics: Physicians, nurses, medical

assistants and pharmacists. In the end, stakeholders on all fronts of the ´questionsµ

paradigm agreed that the campaign was one that they could get behind³and one that

would inspire them to communicate better.

Campaign production wrapped in mid-March of 2007, so feedback and statistics are very

preliminary. However, by early April, the TV spot had been picked up to air in over 50

markets. And in the month of April, the special Questions Are The Answer site received

15,730 page views, with over 10% of those visitors clicking through to the ́ Build Your

Question List.µ At that rate, we·re confident that this offshoot campaign will do its part to

chip away at medical error.

Ad Council AHRQ QuestionsCase Study

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