Following its move to new premises, The Royal Children’s Hospital Melbourne faced negative headlines and poor staff morale – a state of affairs that threatened one of the biggest change projects in the hospital’s history. The solution lay in embedding a news culture in the hospital’s internal communications – and not to shy away from negative stories.
Image: The new building for The Royal Children’s Hospital Melbourne / Photo: RCH
Within six months of moving to an architecturally spectacular new AU$1billion building, surrounded by parkland and just minutes from the city centre, The Royal Children’s Hospital (RCH) in Melbourne was all over the news – for all the wrong the reasons.
With headlines like ‘Kids wait for surgery’, ‘Beds go to waste’ and ‘Pledge to plough more cash into struggling RCH’, the city’s daily tabloid documented a seemingly unending litany of accusations and anxieties from within the ranks of senior doctors, unnamed, at one of the world’s most influential paediatric centres.
On the face of it, the hospital had ticked the boxes of contemporary change management theory as it led its workforce of 5,000 into and through the move. Staff had been involved in workshops to design spaces and workflows in the new hospital, and then to plan for and execute the relocation, supported by volumes of information published on the intranet news portal. The ultimate key performance indicator – the on-time and safe relocation of critically ill babies and children – was readily achieved.
And yet, those headlines persisted. Declining productivity started to show up in measures of hospital performance such as average patient length of stay, and the number of patients waiting for elective surgery. By the time I joined RCH as executive director of communications, almost a year after the move, deep-seated grievance across sections of the workforce was palpable. The reputations of the hospital executive, and of the corporate communications team, were poor.
Building a news culture
What emerged, as I listened my way around the organisation, was that staff had wanted to have a particular kind of conversation about the move. They wanted to honour that dank old rabbit-warren of a building that used to be their home, where many of them had cared for sick kids for the first time, and had formed memories and bonds and identity. They wanted to talk about the aspects of change that were difficult or failing, and to voice their worries about the shiny new hospital, without being made to feel their concerns were trivial or obstructive.
By contrast, the sanctioned organisational conversation remained cheerfully transactional: what to do, when to do it, how to 5S your workspace. There was a perception that discussion of ‘real issues’ was confined to senior levels of the organisational hierarchy, behind closed doors.
In seeking to meet the communication and cultural challenges at play at the RCH, we first needed to disrupt the audience’s expectations about what sort of information would be sanctioned and shared.
We moved the most vanilla content out of key internal channels – the intranet home page news, and monthly CEO Forum – and focussed on news reportage about real issues affecting the business and the people in it. We built and tapped networks to find out what doctors, nurses and allied health professionals were talking about in private, and where possible published content that aligned with, progressed or resolved those conversations. We celebrated success as often as possible, profiling people and teams who had gone the extra mile and explaining the impact of their work on patient care, opened comment functionality on the intranet, and in 2013 launched the RCH Facebook page then other social assets.
Most importantly, we began to break our own bad news. And the people who attached their names and faces to this new approach were senior leaders, the same people who had previously been perceived as unwilling to host hard conversations. This shift was critical in capturing and converting the attention of a cynical workforce.
Over time, this approach evolved into a communications framework that I call ‘news culture’, because of its accordance with the principles of news reportage. News culture accommodates a core premise: that brands cannot dictate the conversations their audiences have, but they can earn the right to be in the conversation by consistently enabling it, endorsing its legitimac, and being a credible contributor – especially when the conversation is critical.
Early signs of success
With the transition to news culture at the RCH underway, good things began to happen. With the organisation more openly acknowledging its own faults and challenges, the negative media leaks became powerless and soon stopped. Attendances at the monthly CEO Staff Forum increased, quickly, by 400 per cent. Consumption of content on the redesigned intranet news portal grew similarly, and unsolicited, positive feedback from senior doctors and other staff was significant. Over time, as we shifted the communications focus to different operational areas to support redesign work by clinical teams, performance indicators began to return to, and then exceed, pre-move levels.
We tested the news culture framework through a number of issues and crises, and without exception found that by proactively breaking our own bad news we elicited positive audience sentiment and strong compliance with calls to action. We applied the thinking externally, and increasingly merged internal/external content delivery using key properties like Facebook to pre-emptively and directly deliver announcements and news, including negative outcomes, to an aggregated audience of interested stakeholders – staff, patient parents and families, regulators, suppliers and peers.
But the big test of news culture as a framework for change communications came in 2014, when the RCH embarked on the transition to an Electronic Medical Record, after 140 years of documenting every single element of care, on paper.
Change communications: The EMR
The project represented a $52 million investment, half of it from a state government that had a high degree of political sensitivity to big ITC projects. The software, by US firm Epic, had not previously been adapted to or used in an Australian hospital. Unlike most Epic sites globally, the RCH planned to go live across outpatients, emergency department and acute wards in a single moment – a ‘big bang’ approach. But the biggest concern was the potential for the workforce, and senior medical staff in particular, to resist the change. As noted by then-CEO Professor Christine Kilpatrick, the project was not only “transformational” in terms of patient care, but also the biggest work practice change that most doctors would experience, bigger even than the move.
The hospital’s skilful internal communications manager and I were confident that our strategy of quickly and consistently publishing the information our audience wanted to have, even when the news was not positive, would build workforce confidence in the people managing the project, and provide a big picture to help individuals tolerate personal inconvenience for the sake of a higher, shared purpose. We spent our tiny Electronic Medical Record communications budget hiring a brilliant writer with a great radar, who was embedded within the project team. She quickly developed subject matter expertise and, importantly, provided early visibility of emerging issues so that we could activate timely and productive conversations via our channels. Over a period of 18 months she wrote hundreds of eloquent ‘warts and all’ articles that were widely read and referenced.
With news culture, and its reliance on timely, relevant and credible content, providing our strategic framework, we built out the campaign with tactics and outreach including:
- Strong project branding
- 365-day go-live countdown clock on the intranet homepage
- Comprehensive project website with high-frequency publication to respond to comments, queries and frustrations
- Monthly early morning, catered Q&A forum for clinical middle managers, to create a safe space for the tabling of ‘dumb’ questions
- Monthly CEO staff forum, with an explicit ‘no question too big, too small or too difficult’ invitation
- Staff sentiment surveys
- Milestone achievement celebrations/events
- Video storytelling, including unregulated/unscripted peer-to-peer interviews
- Subscriber newsletters for (1) managers, and (2) all staff, drawing heavily on questions tabled at face-to-face forums
- Screensavers, lift screens, HD screens with artwork and taglines to drive hearts and minds engagement, and deliver instructions linked to successful milestone achievement
- WhatsApp for peer-to-peer troubleshooting at go-live
The purpose of the news culture framework is to put communications activity squarely in the realm of business impacts, so measures like reach and engagement – which capture transactions, not value creation – are of limited benefit. The communications goal was to motivate, reassure and galvanise staff to take specific actions at specific times, such as apply for project roles, attend scheduled training sessions (a challenge in any 24-hour business, with additional hurdles for older nursing staff who typically have limited computer proficiency), and know where to go for help at go-live. The key performance indicators for the Electronic Medical Record communications campaign were:
- More than half of 50 new Electronic Medical Record project team roles filled by existing RCH staff
- 80 per cent of staff competent in new system by go-live
- No negative media leaks
- Project delivered on time, on budget with no critical incidents.
The key performance indicators were achieved and exceeded: 70 per cent of the 50 roles were filled by RCH clinicians, 94 per cent of staff achieved proficiency in the system, there were no negative media leaks and the project was delivered on time, on budget and with no critical incidents. Communications support at go-live, combined with the efficacy of the dedicated peer-to-peer WhatsApp network (which saw 18,000 questions and answers about the new system exchanged in just four weeks), resulted in significantly fewer helpdesk contacts than had been experienced at other Epic Electronic Medical Record sites, or budgeted for.
The quality of the RCH Electronic Medical Record implementation surpassed the expectations of the hospital board, CEO and executive, the project director and team, even the vendor. The communications approach was widely acknowledged as a key enabler of success. In 2016, the project won the Asia-Pacific Association of Communications Directors’ Award for Internal/Change Communications.
The fine print
So, what’s the downside?
To move to a news culture, important stakeholders have to relinquish their hold on information. They have to be willing to share the news that a problem has arisen before they or their department have found a solution. Even though we know great leaders build trust and effectiveness by being vulnerable, for many managers the prospect is deeply unattractive. Cumbersome approvals processes, or a track record of not meeting publication deadlines, are symptoms that information-retention is an entrenched culture, and shifting it takes time and hard work.
News culture also demands a level of accountability that is uncomfortable for many executives and senior managers. In a news culture it is not acceptable to report, via the omniscient voice, that “a decision has been made” or that “staff are encouraged to” take a particular action; the initiative or request needs an owner who is named and quoted as part of the announcement, and accountable for delivery. Executives who are confident to back a decision in the privacy of the meeting room can feel quickly less so, when asked to put their name to it – singularly, and in full view of the workforce.
"The one thing that news culture cannot do without, however, is news writers; people skilled at finding a story in every interaction."
News culture can also raise the ire of external stakeholders – particularly regulators and political offices – who may be unaccustomed to transparent reporting of internal organisational affairs. Being well prepared with evidence about the failure of past approaches, or a detailed assessment of the likely risks of inaction, will help. These stakeholders are also likely to be persuaded, over the medium term, by the impact on external media. Once an organisation starts proactively sharing details of its failings and challenges, there is little left to be uncovered by journalists.
Against each of these examples, the sensible approach is to move forward slowly, taking care to pre-emptively identify and mitigate risks, including staying close to stakeholders whose nervousness could undermine opportunities. Start small, with a single issue or incident, and meticulously compile and share evidence of success, including that which is anecdotal, to build support. If your organisation currently inhabits a burning deck, there will be less need for caution and a compelling case to make the move: News culture is a brilliant framework for crisis response and management.
The one thing that news culture cannot do without, however, is news writers; people skilled at finding a story in every interaction, and quickly turning around strong, clear, compelling copy. By including former journalists in your communications team hires, you will develop the necessary content edge you need to start changing your organisation’s world.
Laura Richards, Manager Internal Communications & Stakeholder Engagement, The Royal Children’s Hospital
Emma Mellon, EMR Communications Adviser, The Royal Children’s Hospital
5S is the name of a workplace organization method that uses a list of five Japanese words: seiri (sort), seiton (set in order), seiso (shine), seiketsu (standardise), and shitsuke (sustain).