How internal communications saved lives.

How internal communications saved lives. The story of the West of Scotland Cancer Awareness Project Bowel Cancer Campaign 31 January 2007 Authors Lisa Cohen, Project Manager, West of Scotland Cancer Awareness Project Margaret Byrnes, Account Director, The Bridge

Contents 1 Précis 2 Executive summary 3 Introduction 4 The bottom line about bowel cancer 5 The campaign 6 Campaign results 7 The ultimate challenge 8 Our internal goals 9 How we did it 10 Internal communications structure 11 Integrated approach 12 Conclusion 2

1 Précis Who are you, and what evidence do you have to support the chances of a campaign of this nature being successful Running a campaign of this nature is ethically unacceptable. These were the internal concerns that almost stopped a life-saving health campaign before it started. This paper tells how internal communications transformed sceptics into advocates. 3

2 Executive summary This paper is a success story about a success story. It tells how the West of Scotland Cancer Awareness Project (WoSCAP) campaign on bowel cancer increased awareness of bowel cancer; increased understanding of the symptoms; changed behaviour; and saved lives. And it outlines how, had it not been for an extensive internal communication campaign, the public campaign might never have happened. Who are you, and what evidence do you have to support the chances of a campaign of this nature being successful Running a campaign of this nature is ethically unacceptable. These were typical of the concerns expressed internally when the idea of the public campaign on bowel cancer was first mooted. There were legitimate concerns about capacity and increasing demand: This campaign will swamp services with the worried well ; Services are already stretched with waiting times for patients seeking a diagnosis for bowel cancer. But a carefully constructed internal communications campaign that listened to concerns (and that acted as a catalyst to help provide solutions) overcame these worries and helped turn sceptics into enthusiastic advocates. 4

3 Introduction The story of the West of Scotland Cancer Awareness Project (WoSCAP) bowel cancer campaign is of a social marketing campaign, which could have been entered into the Cause Related Category. However, the campaign might never have been launched if the Project Team had failed to handle significant internal communication challenges effectively. WoSCAP was a partnership between the five West of Scotland NHS Boards (Ayrshire and Arran, Argyll and Clyde, Forth Valley, Greater Glasgow and Lanarkshire) and was the largest Big Lottery Funded cancer project with a grant of 1.3million over a three year period. The Project had a remit to develop, implement and evaluate two public awareness campaigns, which aimed to raise the profile of mouth and bowel cancer by encouraging the at risk population to present earlier to the NHS with signs and symptoms of either disease. This paper will describe the complex internal communications strategy that succeeded in reaching over 4500 health professionals including clinicians, GPs, pharmacists, NHS management, public health consultants and health promotion staff across the region. 4 The Bottom Line about Bowel Cancer Cancer is one of the greatest health problems facing Scotland with approximately one in three people developing some form of cancer and one in four dying from the disease. Around 3500 new cases of bowel cancer are diagnosed every year in Scotland. Today in Scotland bowel cancer is our second biggest killer. It has been clinically proven that if bowel cancer is detected early, it has an 80% chance of cure. For patients diagnosed with the disease between 1997 and 2001, five year survival rates for men were only 51.2% and 50.6% for women. This is evidence that many people were presenting late with symptoms. 5 The Campaign Research had found that, at an intellectual level, the target audience was largely supportive of early detection campaigns. However, in practice many were likely to be reluctant to come forward with suspected signs and symptoms. Given this resistance, 5

any campaign would have to offer reassurance and confidence and not evoke fear. People were also looking for reassurance that they weren t wasting the doctor s time. A TV and radio campaign was created in close consultation with clinicians, nurse specialists and other key advisors who ensured that the core messages were accurate and clear. The commercials featured an actor who portrayed a typical West of Scotland middle aged man having a conversation with himself in the mirror about his niggling worries. The radio commercial took the scenario a stage further with the man attending an appointment with his GP but still struggling to overcome his anxiety about discussing his bowel problems. The 270,000 campaign ran in two phases and was launched in a wave of publicity by the Health Minister, Andy Kerr. A series of posters and literature were developed to complement the TV and radio campaign and a photographic exhibition toured the region. 6 Campaign results Tracking was carried out by The Institute for Social Marketing. The campaign created awareness: prompted awareness of the campaign reached 71%; awareness of coverage of bowel cancer in the media increased from 39% in the baseline study to 68% in the follow up study. The campaign improved understanding of the symptoms of bowel cancer: awareness of bleeding as a symptom increased from 62% to 71% and awareness of blood in motions almost doubled from 15% to 29%. The campaign changed behaviour: A study looking at the impact of the campaign in primary care showed that there was an increase in consultations during the bowel campaign (an average of one per practice per week). An overall increase in referral rates of 10% was reported with a GP from NHS Ayrshire and Arran stating, I was impressed by the uptake of people who in the past would not have consulted. 6

The campaign saved lives. Take the results from just one of the participating hospitals: at the Hairmyres Fast Track Clinic between November 2004 and March 2005, 6 tumours, 18 polyps (pre cancerous condition), 12 cases of diverticular disease and 2 of inflammatory bowel disease were detected. All of these patients had presented as a direct result of seeing the campaign. They had therefore presented earlier than they would otherwise have done and that means a potential survival rate of 80% rather than the just over 50% that had pertained between 1997 and 2001. The campaign was admired: WoSCAP was awarded best campaign for improving health at the National Healthcare Communication Awards in 2005 But this external campaign might not have happened. And would certainly never have happened without a major co-ordinated internal communication campaign. 7 The Ultimate Challenge The rationale behind the campaign had been strong. But it was recognised that an external campaign would not work without the health professionals on board. And we had a major problem. This is what some key stakeholders had to say in the early days: This campaign will swamp services with the worried well. GP NHS Lanarkshire. Services are already stretched with waiting times for patients seeking a diagnosis for bowel cancer. Nurse specialist NHS Greater Glasgow. Running a campaign of this nature is ethically unacceptable. Bowel cancer surgeon NHS Forth Valley. Who are you, and what evidence do you have to support the chances of a campaign of this nature being successful? Public Health Consultant NHS Greater Glasgow. 7

These influential stakeholders were extremely critical of our early plans and had the power to obstruct the work going ahead. The challenge for internal communications was to change deeply entrenched attitudes and perceptions. We had to have them on board or the campaign would fail or not proceed at all. It was imperative that we started from the inside. 8 Our internal goals To overcome resistance, negative attitudes and perceptions from internal stakeholders To build positive relationships with key internal stakeholders from primary and secondary care To develop appropriate structures to communicate with over 4500 internal stakeholders To support services to cope with potential demand resulting from the campaign 9 How we did it Confidence and credibility in the campaign and Project Team would only happen if we built positive relationships with senior clinicians, GPs, NHS Managers and other key stakeholders on a regional basis. Over 4500 stakeholders represented our internal market. Success would be linked to working with people. Negotiation skills of the highest order and a persuasive, patient approach would be required. Four Pivotal areas for success 1. Setting up the right communication structures 2. Sharing common goals and agenda with professionals 3. Developing appropriate and timely methods of two way communication 4. Providing secondary care services with 100,000 to ensure services could cope with demand when the campaign was live Having the correct structures in place to reach key stakeholders was the first challenge we faced. The Cancer field is complex and there are many gatekeepers who can influence whether or not you will receive support. Our first hurdle was to get the Regional Cancer 8

Advisory Group on board. They are a network of around 60 decision-makers across the region and are a mixture of clinical and managerial specialists. They feed closely into the individual NHS Board cancer steering groups and the managed clinical network for bowel cancer. An early opportunity to present to this group proved fruitful and the Chair of the Group who is also the Chief Executive of NHS Greater Glasgow provided us with a letter of support endorsing our work. The Regional Cancer Co-ordinator, who had the ability to open doors agreed to join our steering group and succeeded in making personal introductions as required. 10 Internal Communications structure Internal Communications Structure Regional Cancer Advisory Group Steering Group NHS Cancer Steering Groups Managed Clinical Network - bowel cancer Project Team Primary Care Research and Evaluation sub group Bowel Cancer sub- group Local Implementation Teams We took the time to consult widely through senior contacts and listened carefully to their concerns. We needed to ensure they were confident in our plans they acknowledged that we were a responsible project they recognised that we wanted them to have ownership of the campaign. By presenting our proposals with conviction and enthusiasm we succeeded in attracting senior staff to sign up to become active partners e.g. bowel cancer clinicians, GP s, senior NHS Clinical Managers and nurse specialists. 9

One of the concerns expressed in the early days was whether we had the right to raise the profile of bowel cancer if services would be unable to cope with demand. Communicating with over 4500 stakeholders and keeping them informed of our plans before the campaign went live involved the development of a sophisticated communication strategy. This work was developed via the bowel cancer sub group and the Local Implementation Teams who provided us with all the contact details and between us we agreed the best methods for communication and what needed to be communicated. There also had to be a mechanism built in for people to feed back information and comments to us. Key methods used included the project website, regular newsletters, meetings, events, invitations to present at conferences and seminars, letters and emails. We informed them about all aspects of the project including campaign development, timing of each phase of media activity, launch plans, ongoing research activities, local initiatives, local service provision and our comprehensive training programmes they even led the training programmes and became vital media spokespeople for the project. 10

11 Integrated approach Integrated Approach Advertising Research Research Communication Training Service Provision Local Intiative Communication Training Service Provision Local Initiative People often associate WoSCAP with advertising but the campaign was only the tip of the iceberg and would only be truly successful if services were geared up to cope with additional demand that was likely to arise when the campaign was live. Clinicians and members of the primary care teams became active partners in the Local Implementation Teams because we had a common purpose. They appreciated the fact that they had adequate notice about the campaign and we used 100,000 of our budget to support their clinical needs. We listened and responded to concerns and compromised by cutting back on our media schedule to fund this work. The Project team facilitated the development of local policies and protocols for referral pathways within each NHS Board. Ultimately the clinicians had ownership and control of local activities and consequently went the extra mile. They ensured services could cope with demand; they led 17 training events attended by over 800 primary care staff; and they became media spokespeople when the campaign went live. Our planning with key individuals strengthened local team working and communication between primary and secondary care improved. Services were enhanced by having improved referral pathways and quicker access to clinics for patients. 11

12 Conclusion Instead of being a threat, we were ultimately seen as an ally and WoSCAP became a catalyst for change and provided opportunities to pilot new ways for services to be delivered. We achieved the win win situation we had strived for and had turned the corner with these influential gatekeepers who became vocal advocates of our work: Fortunately, the West of Scotland Cancer Awareness Project was a lot more than increasing public awareness. In preparation for the campaign, many meetings were organised to increase knowledge, awareness and readiness of clinical services in the region. As well as being educational, these meetings strengthened local team working and communication. The Project also provided financial support for local initiatives to streamline diagnostic services and reduce waiting times. This may be a lasting legacy of the campaign and I now think my initial concerns were unfounded and WoSCAP has made a positive contribution to bowel cancer services in the West of Scotland. Bob Diament lead clinician for bowel cancer services in the West of Scotland and Chair of the Managed Clinical Network. 12