Every communications professional knows that changing behaviour is complex. Nowhere is this more pressing than in medicine, a rapidly changing field where the behaviours and choices of healthcare professionals can lead to dramatic variance in outcomes for patients and the health service.
There are many theories that seek to model behaviour change, but when developing a medical communications plan, I think about the 'Attitudes, Skills and Knowledge' that underlie a given behaviour, and consider how these would need to change to achieve the desired outcome. Working in collaboration with the healthcare community 'ASK' analysis can help you to identify ethical, targeted communication interventions that actually make a difference to the way healthcare is delivered.
Just recently, I have started to notice another mechanism for change that would have been nearly impossible a decade ago...
The impact of digital transparency
Our online lives are transparent and visible to everyone, which makes us think carefully about how we want to showcase ourselves to the world, and how we want to be perceived. As technology embeds itself deeper into our public lives, our real world behaviour can be recorded and 'ranked' in the virtual world for all to see.
For any of you that have an online dating profile, or who buy and sell using eBay, or who use Uber to travel, or who host guests and holiday using AirBnB - you will know only too well the importance of your online reputation.
This has a profound impact on our real world behaviour.
Presumably, as our lives become increasingly digitised and transparent, this will not only effect how courteous we are to our taxi drivers, or how tidy we leave our holiday home, it will impact everything we do.
Transparency in medicine
Just this week, the Evidence Based Medicine Data Lab at Oxford University published a new tool to audit and make public information related to clinical trials that have not reported results in the time-frame required by law.
Doctors now have multiple tools that allow them to see the transparency track record of a company or treatment. These tools allow doctors to think twice about their treatment choices, especially if there are comparable treatments with full trial disclosure. This is information that can be used directly to improve patient care, immediately, and it costs nothing.
It's too early to tell how these transparency tools will change behaviour, but at the very least, one would expect the worst offenders highlighted by the tool to start prioritising trial reporting.
Audit and publish: a model for raising standards and changing behaviour in healthcare
In the age of digital transparency, the role of medical communications professionals is changing. More and more, we are bringing together health care professionals, patients, payers, policy makers and industry, to facilitate high quality dialogue and reach consensus around best practice and optimal standards of care.
Medical communication professionals that understand the role of audit and the power of transparency can offer tremendous value to a therapy area by supporting the community to implement the following steps:
1) Define standards.
Working with the full health care community to understand current unmet needs, and agree optimal current and future standards of care. This is particularly important in rare disease, where guidelines are limited and there is little consensus around what optimal care looks like in practice.
2) Audit whether the standards are being met.
Working with the community to agree clear measures of success, how to monitor them, and working with institutions to adopt and pro-actively measure those standards.
3) Identify best practice.
Working with institutions to help them share best practice with each other, and overcome any barriers to change.
Transparency in the public domain leads to accountability, which leads to behaviour change.
A clear understanding of how best practice is being achieved allows others to adopt that practice. Not every institution will tick every box, but every institution can learn from others that are already meeting the agreed standards.
Audit is a cycle of continuous improvement. This model involves continuous engagement with the full healthcare community to define optimal standards of care, refine them and repeat.
A look to the future
As medical communications professionals, we are interested in behaviour change, but we don't always do the best job of measuring impact. Audit is a powerful way to do this, and an important driver for change. In medicine, we should encourage transparency, and work hard to understand that which is important to measure and audit to improve standards of care.
FDAAA 2007 is a law that requires certain clinical trials to report results. After a long wait, it effectively comes into force from Feb 2018. The FDA are not publicly tracking compliance. So we are, here.