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Questions Are The AnswerAHRQ/Ad Council Case Study May 2007
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Campaign Summary
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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.
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Background
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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.
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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.
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Insight
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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
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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
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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
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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.
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Strategy
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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:
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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.
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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.
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Execution
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´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.
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´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.
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Impact
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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.