Let’s say that you want to turn away from all the chaos around you and focus on controlling what you can. So, maybe you devote attention to increasing vaccination rates. Say you want to have the best rates in your town or state. Or, maybe you set your goal to get your rates much higher than the national average. How do you make that happen? We put that question to a someone who’s done it.

 Dr. Todd Wolynn, a pediatrician and Executive Director of the Trusted Messenger Program, was CEO and co-founder of Kids + Pediactrics in the Pittsburgh area. We asked him to summarize the results of one of his successful vax campaigns:

“At Kids +, our data was at the top of every category. We were often told by multiple entities, including Merck, that we were the number one HPV vaccinating practice by percentage in the Commonwealth of Pennsylvania, and more than double the national average.”

How do you even begin to get to double the national average? “The ‘trick’ is, “Dr. Wolynn explained, “what we did with communication.”  He added, “Health care providers who are trusted messengers trained in best communication practices can drive quality outcomes. It could be immunizations, it could be pap smears, it could be mental health screenings. We were showing how to use communication in a powerful way to drive quality.”

As we’ll see, the key words in that statement for Dr. Wolynn are “trusted messenger.” The idea is to take advantage of the existing credibility of those in healthcare. Check these recent (12/24) Gallup data showing high marks for doctors and pharmacists, with both looking up at nurses.

So you start with a comparatively high level of trust, but that still leaves the problem of communicating while in the fog of war for attention. That problem led Dr. Wolynn to a surprising hire for his practice: at a time when Kids + had three offices and about a hundred employees, it brought on a fulltime communications person: Chad Hermann, who started as a consultant but eventually became Communications Director.

We put to Dr. Wolynn the question, Okay, so you want to improve your communication — where do you start?  “Frankly, there’s no getting around it,” he replied: “You have to be good at both in-person communication and some form of digital communication. In 2025, you must have you must have a good website one that’s intuitive and navigable and can get you the information you need, but you also need to have at least some representation on social media.”

Dr. Wolynn has plenty to say on creating a useful website and a meaningful social media presence, so much so that we’ll devote a separate article to those in our next edition. That’s where we’ll get more from Chad Hermann, who’s now the VP of Communications & Strategy for the Trusted Messenger Program. For now, let’s focus on in-person communication.

“CULTURE EATS STRATEGY FOR LUNCH”

Before hearing from Dr. Wolynn, some background on office culture by way of two quick examples of learning (or not) from customers…

When a major Las Vegas casino undertook an effort to improve customer service, it asked all the employees who interacted with customers to record what questions customers asked. The most common question? “Where’s the restroom?” That led the casino to improve signage, with a dramatic drop in that tedious question.

The head of a medical office put the equivalent of customer evaluation cards at the counter where patients checked out. When asked if reading the evaluations had led to improved performance, he admitted that no one actually read the cards; no, they only put them out because he’d been told that if someone who’d just had a bad experience was given a chance to complain right then, that person was less likely to post a bad review or file a complaint.

Those examples came to mind when Dr. Wolynn spoke of being aware of the communications culture of an office. “The biggest lesson I learned going back to get my Masters of Medical Management degree” he said, “was ‘culture eats strategy for lunch.’ Boy, is it true. Trust networks drive how people take in information and decisions they make and your title has nothing to do with it. You could be CEO of a practice, but the real communication could be with Betty who sits at the front desk and who sees everybody. If somebody says to Betty, ‘Hey, I’m here to check in. I’m going to see the doctor for my breastfeeding visit. I’m a little scared things aren’t going as good as I thought.’

“If Betty says, ‘Oh, I would never breastfeed — you can’t tell how much kids get. If you give him a bottle, you can see what’s in there and you know exactly what you’re doing.’ If Betty’s doling out that information at the front desk, you’re toast. I don’t care if you’re Dr. Spock or whoever you are, you are not Betty who knows everybody. The trust network has blown up. So you better make sure you have your entire office culture on board and frankly that’s probably a good place to start training everybody – ‘Hey guys, let me tell you in spite of hearing all this noise out there, here’s why we’re recommending immunizations for flu or COVID or measles.’ Do not assume because they work at a doctor’s office they’re already simpatico and get everything and are on board — nothing could be further from the truth.”

“GETTING ON THE SAME SIDE OF THE TABLE”

As for people administering vaccinations, Dr. Wolynn points out a common attitude when approaching a patient:  

“There are people going into an encounter thinking, ’Just let me just do volume and not quality because I don’t dare make a recommendation and find myself in an argument.’ They think that because they are untrained, so they tend to gravitate to one of two knee jerk reflexes: both wrong. If somebody is questioning in good faith the safety of a shot, untrained providers either…

One, go to fear. ‘Do you know what could happen if you don’t get this?’ Then they talk about scary things or show scary pictures.

Or, two, they go to data. ‘There was this great study that just came out of New England Journal and it had 95% confidence intervals.’ They go to data as if they’re talking to another healthcare professional.

In fact, if you were trained in good communication, you would give them your ear first. You shut up and listen.”

Dr. Wolynn then summarized a technique they teach, one that reinforces the “trusted messenger” approach. He explains:

We use active listening.  There’s a methodology called AIMS – that’s Announce, Inquire, Mirror, Secure. In a vaccination conversation with Mrs. Jones and her daughter, it might sound like this.

ANNOUNCE: “Susie needs her TDAP, her HPV and her meningitis.”  Mrs. Jones responds by saying, “You know, we’ll get that first and third one — she needs those for school. But I don’t know about that middle one.”

INQUIRE: “Mrs. Jones, can I just ask what’s your concern.” Then, step back and be quiet as she tells you that her sister-in-law posted on Facebook that it can sterilize kids.

MIRROR:  “Mrs. Jones, let me make sure I got this straight. Your sister-in-law posted on Facebook that the HPV vaccine can sterilize kids. Is that correct?” She now knows that I know what’s scaring her. Now, instead of going to fear and/or data, I can be a freaking human being and express empathy. I say, “If I thought that was true that , it would scare the hell out of me. Can I tell you why I got my kids vaccinated?”

SECURE: If she says, “You know what? OK, let’s get it today,” that’s great. But, she might say, “I just want that first and third and I’ll go home I’ll talk to my husband about that second one.” That’s when you secure the relationship by saying, “I just appreciate you taking time to tell me what’s on your mind. You know that what we do is not just vaccinations  — we took care of her pneumonia two years ago, and we stitched it her laceration five years ago. I’m always here, and we’ll always recommend evidence-based care for you. There’s nothing that I recommend for Susie that I wouldn’t do for mine.”

That secures the relationship – you’ve moved to the same side of the table — and you bring the vacinnation up at the next visit.

Would it be faster to just shrug and forget about the HPV vaccination? In the short term, yes. But Dr. Wolynn and Chad Hermann make the case that with the help of an effective website and a social media effort, there’s a strong ROI argument for taking more time, and that better communication ultimately saves time. That’s for our next issue.

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STATS OF THE MONTH

Data Constituent: Are You One?

By Bill Davenhall, Geomedicine Analyst

Nancy Potok, the former Chief Statistician of the United States, said in a recent interview that “the quality of national statistics has become a concern,” adding, “and it really reflects a lack of attention and understanding of the great public good that federal statistics are in the critical role that they play. I think a lot of people are unaware that we have 13 designated principal statistical agencies spread across government”. 

Little wonder then why there is considerable angst in the United States about the continued availability of governmental data, especially among those who have been part of the national data ecosystem. Reports of missing data are circulating, and some efforts are underway to restore or save as much of the governments historical data that is critical to ongoing evaluation of everything from business retail site location decision making to identifying various health and human service “deserts.”

The term “data constituent” needs to become important to you. If you’re a data consumer and your professional activities require data, then you are a data constituent. If your data doesn’t have a demonstrated purpose for a constituent base that can clearly identify what challenges will be like in the absence of a steady stream of high-quality, governmentally-sourced  data, your work might be in serious jeopardy.

For example, before 1970, US Census data did not make most of its data available for commercial purposes, and it was extremely hard to process the large amount of data the Bureau collected. The private sector jumped in and established a consortium to advocate for nation-wide dissemination and thus created an entire industry devoted to providing much need business development and service planning information to fuel the economy.  So, with the advocacy of the Ford Foundation’s “DUALabs” consortium, a powerful surge in strengthening the fabric of a national data ecosystem allowed innovation to flourish in both the collection, dissemination, and use of governmental data. Businesses in every industry clearly prospered having access to such affordable data.

So, what’s my point?

If your “business” depends on any governmental data that is likely to disappear, immediately begin to study ways you might replace this data using more modern digital methods. With more direct access to individuals via smartphones, new methods of recreating a more dynamic data ecosystem can evolve.

Begin to inventory what data is critical to your decision making — be it for planning, organizing, or delivering critical services. Be clear about what data is essential and what you can live without. Every piece of data typically has a known constituent, or a group of users; start to form groups that will advocate and illustrate the intrinsic value of the data you or your activity needs to carry out your work, especially information that allows you to grow your business or provide better targeted services that the public needs or demands. Below is a Data Constituent Matrix to get you thinking. Use geography as a way to think about the various types of constitutes that exist – here you can imagine all those who will struggle should the national data infostructures upon which they have built their communities and businesses alike.

The national data ecosystem is no small thing – America’s data ecosystem is one of its greatest business and human service assets – Don’t wait! – figure out what data your work “business” can’t afford to lose and make a strong case (become an advocate) for it publicly; but, also be prepared to become innovative in replacing critical data that might get “lost” or made un-available as the result of  governmental reorganization and budget cutting.

I welcome a second opinion.