December 2003 Bulletin

AAOS launches public education campaign

Academy to educate public, rally grassroots support for medical liability reform

By Carolyn Rogers

The Academy is rolling out a crucial element of its Medical Liability Reform Program — the public education campaign.

At a time when 18 U.S. states are in a severe liability crisis, the general public has remained largely ambivalent about the issue. Escalating jury awards and litigation costs have caused liability insurance premiums to skyrocket in recent years, forcing trauma centers, rural health clinics and emergency departments to close their doors. In many states, orthopaedic surgeons and other specialists are dropping the high-risk portions of their practices, retiring early, moving their practices to a neighboring state or closing up shop altogether.

Lopsided debate
Until now, however, consumers have heard primarily from one side of the debate on medical liability reform — the opposition. Media-savvy trial lawyers dominate press coverage on the issue by portraying physicians as rich, greedy and uncaring, and by emphasizing the dangers patients face at their hands. The anti-reform lobby also is adept at humanizing its message — saturating the airwaves with heart-wrenching, often indefensible ‘medical horror stories’ shared by highly sympathetic patients/victims.

With the issue already framed in such a personal way, it’s not that surprising that the rational, policy-driven, arguments offered by the pro-reform side seem to have fallen on deaf ears. However unrepresentative of reality they may be, such ‘medical nightmares’ resonate deeply with the public and often serve to overwhelm any reasoned, thoughtful debate on the crisis.
This frustrating dynamic, however, may be about to change. With a renowned team of strategic communication specialists working on its behalf, the AAOS is setting out to redefine the medical liability issue for the public, create a deeply rooted sense of urgency and generate momentum for change.

State-based campaign strategy
The sought-after shift in the political and media dynamic will stem not from retaliatory mud slinging, the Academy believes, but from thoughtful, assertive communications that tell the truth about the impact the liability crisis is having on patient access to health care.

This initiative is not intended to directly address national liability reform legislation; that task is being managed by the “Doctors for Medical Liability Reform” coalition, of which the AAOS is a leading member. Instead, this program will empower state societies, members and the patients they serve to advocate for and drive meaningful, constitutionally sustainable medical liability reform in their states.

Strategic approach
The public education campaign has two key strategies or phases. The first, referred to as “state society preparedness,” ensures that all state societies have the tools they need to engage meaningfully on this issue at the state and local levels.

The second strategy is to provide an extra level of focus and support in states where a current draft resolution is “in play,” and where a concentrated communications effort can make the difference between successful reform and continued crisis. This strategy is referred to as the “priority market outreach blitz.”


"Uncle Sam" wears a leg cast in a poster created for the AAOS Public Education Campaign on medical liability reform.

Media specialist Eileen O'Connor (in front of podium) shares post-interview comments with (from left) David Leibowitz, JD; Mike McCurry; Steven Morton, DO; and former 20/20 producer John Bilotta, during a Nov. 15, media training session.

Pennsylvania and Missouri have been identified as the crisis states that would most benefit from the extra communications blitz. Each state society will receive in-depth assistance, including a media relations program and a Web site with deeper grassroots interactivity.

AAOS advocacy “toolkit”
To facilitate grassroots advocacy on liability reform, a print and electronic advocacy toolkit has been developed for use by individual orthopaedic surgeons and AAOS state societies. The kit contains a variety of print and electronic resources designed for both patient education and mobilization and direct physician outreach to the general public, media and policymakers.

Many items contained in the toolkit can be downloaded from the campaign Web site, www.pactproject.org, when it becomes active in Jan. 2004. The acronym “PACT,” developed for use throughout the campaign, stands for “Protect Access Care and Treatment.”

Below are the advocacy tools contained in toolkit:

Campaign strategists
A team of strategic communication specialists is working with the AAOS to bring this campaign to life, and to marshal grassroots support for the effort.
This team includes: GCI Group, a New York City-based public relations firm; Grey Global Atlanta, a marketing communications firm; and Washington D.C.-based Grassroots Enterprise, Inc., a company that combines online technology and communications strategy to achieve public affairs objectives.

On Nov. 15-16, 2003, all of these key players gathered at the AAOS State Societies Strategy Meeting in Rosemont, Ill., to provide orthopaedists with an overview of the public education campaign. The most recognizable face among the eight specialists was that of Mike McCurry, former White House spokesperson under the Clinton Administration, who now serves as chairman of Grassroots Enterprise, Inc. McCurry is a senior political consultant on this project, providing expertise from a communication and legislative standpoint.

“Cool Hand Luke” problem
McCurry told the room of 100-plus state orthopaedic leaders that the lack of progress on medical liability reform “is due to the very nature of our political system.”

“I like to call it the ‘Cool Hand Luke’ problem,” he said. “You know — the old Paul Newman movie where the jailer reaches over, grabs Newman by the scruff of the neck and says, ‘What we have here is a failure to communicate.’

“The root of so much that is bedeviling our political system today is a large-scale, systematic failure to communicate,” he said.

McCurry attributes this, in part, to fallout from the technology revolution. “The Internet and other technologies have discombobulated the media,” he said.

“The traditional ways people came together to mediate conflict and discuss public issues in the public realm have been thrown aside.”

Instead, the camera is on and people “watch people bark at each other,” he said. “That formula is now applied across a broad range of issues, to the point where people no longer engage in civil discourse about issues that matter.”
Given that reality, when you take an important, complicated issue like medical liability reform and put it in front of an audience, “It very quickly turns to a default of ‘who’s got the more compelling, angry story?’” he said.

A “white hat” approach
So what can reform advocates do to get their message heard?

“We must be more compelling,” McCurry said. “We must be more personal. We must engage the patient. And ultimately, we have to use some of the very technologies that are right now discombobulating the system in order to break through it.”

The communications program that’s been designed for the Academy gives it “a 21st Century way to try to break through the clutter,” McCurry said.
Describing the AAOS initiative as a white-hat approach to the issue, McCurry said, “Our goal is to be much more innovative and creative and to try to design arguments that win. Then we want to present those arguments more effectively. We want to animate the human side of the equation by getting people to care about the issue personally in a way that they probably don’t right now.”

Core campaign messages
Getting people to care about the issue is the focus of the core campaign messages presented by Mark Marinello, GCI vice president and director of public affairs.

Every great communications campaign is built around a few core themes,” Marinello said. “It’s important to be very clear about core messages from the beginning, and to stick with them so that the campaign’s story and ‘call to action’ is always consistent and builds to drive the desired result.”
According to the communication team’s research, “patients agreed that lawsuits are affecting the health care system in a negative way,” Marinello said. However, they did not agree that caps on non-economic damages were the answer.

“This reflects the fact that patients feel more likely to be involved in a medical liability situation than in a situation without access reasonable to health care,” he explained.

Based on the team’s research, knowledge of the issue and experience with other successful health care campaigns, the following draft core campaign messages were developed:

Rationale message: Skyrocketing medical liability insurance premiums jeopardize patient access to care, and the crisis directly impacts the cost of health care for all Americans.

Solution message: Reasonable medical liability reform will stabilize this threat to the American health care system.

Call-to-Action Message: Tell your lawmakers that you support medical liability reform.

Print, radio, TV advertising
Joel Babbit, president and chief creative officer of Grey Global Atlanta, presented the ad campaign that was developed for societies to adapt for use in their own states.

The AAOS will not be able to fund the placement of ads at the national level. However, “in play” state societies are strongly urged to fund the strategic placement of paid ads as part of their communications blitz.

In line with the overall theme of the program, the ads pose the medical liability crisis not as a problem for doctors, but as an access to care problem for patients. The series includes the following print, radio, video and television ads:

Grassroots activism
Bill McIntyre, vice president for strategic communications at Grassroots Enterprise, Inc., and Arvin Rajan, president, will lead the campaign’s critical coalition building effort.

“In order to succeed in its legislative agenda, the Academy needs to expand its base of supporters well beyond its membership,” said McIntyre, who presented the online advocacy and advocate recruitment tool that will be used in the campaign.

The Academy’s online advocacy efforts will consists of three key phases:
Recruitment: In this phase, potential stakeholders beyond AAOS membership are identified, and highly targeted programs are implemented to recruit them.
Education: A campaign Web site will be developed for each state, and will serve as a destination for anyone seeking information—supporters, potential allies, reporters, legislators and their staff. It will provide supporters the opportunity to share real-life case studies/observations, and features an ‘Action Center,’ the engine for driving grassroots efforts to target legislators, the media, etc.

Mobilization: This is where Grassroots Multiplier ®, the company’s $7.5 million software platform comes into play. This technology provides an integrated platform that galvanizes stakeholders to take action, tracks their responses, and delivers real-time reports on the progress of the campaign.
“Grassroots Multiplier enables states to target segments of their activism database with the right calls to action, driving them to the campaign Web site,” McIntyre said. “There, supporters are automatically matched up to the correct targets, such as their local newspaper or legislator, and are prompted to take the appropriate action.”

Media training
Ensuring that AAOS officers are fluent with the key messages and are trained to speak to the media is the final piece of the program. Media specialist and former CNN Moscow Bureau chief Eileen O’Connor moderated the first media training session, which was conducted at the State Societies Strategy Meeting.

With cameras rolling, McCurry played the role of host in the mock “Crossfire” debates, and David Leibowitz, JD, had the thankless role of the opposing trial lawyer. O’Connor provided the post-interview analysis.
Academy members who volunteered to participate in the high-pressure debates were Alexander Blevens, MD, of Ocean Springs, Miss.; Edward L. Farrar, Jr., MD, of Wenatchee, Wash.; and Steven Morton, DO, of Osage Beach, Mo.

Media training offers orthopaedic leaders the opportunity to practice fielding the tough questions likely to come from national and local media, and helps ensure that the media pick up the best possible sound bites/quotes for their stories.

More extensive media coaching, as well as training on effective use of the advocacy toolkit, will take place at the 2004 Annual Meeting in San Francisco.

For more information on the AAOS Medical Liability Reform Public Education Campaign, contact Sandy Gordon at gordon@aaos.org.


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