The Twitter Tail Wagging the Corporate Dog

Social Media Are the Means, Not the Ends
While scanning through a long list of Twitter posts the other day, I saw a link to TechCrunch, a blog “dedicated to obsessively profiling and reviewing new Internet products and companies.” An entry by MG Siegler, “Comcast: Twitter Has Changed The Culture Of Our Company,” caught my attention.

Sure, technology can help drive cultural change. Think of the tools of war over the centuries or what the automobile has meant to society. The examples are endless. But the culture of a company?

Yes, according to Comcast CEO Brian Roberts. In response to a question about the role Twitter was playing with the cable communications giant at the Web 2.0 Summit in San Francisco, he said “It has changed the culture of our company.” He backed that up by saying that Comcast uses Twitter to scan for complaints and engage with customers.

OK, maybe Mr. Roberts got caught up in the moment. After all, he was at a social media conference. And, it’s great that Comcast is using new tools (Facebook and other networks were mentioned) to address issues around customer service. However, this does not a culture make.

Tools support the strategy (and, thus, the objective), not the other way around. The tools of war support the policies of government. The automobile supports our mobility. You get the idea. Comcast delivers communications products and services. Its culture should be wrapped up in service delivery and excellence whether Twitter exists or not.

So, if Twitter really did change the culture at Comcast – all of a sudden becoming a company focused on customers and what they want – I wouldn’t be crowing about it. I’m guessing, but what may have happened was that seeing thousands of Twitter-fueled complaints was Comcast’s wake-up call. Twitter makes it easy to sound-off – much easier than having to find a telephone number to call, listen to the prompts, press 1, listen to some more prompts, press 4, and so on. Seeing this groundswell may have acted like a cyber-mirror and forced them to look at themselves, and reflect on who their customers are and how they conduct their business.

Web 2.0 offers us wonderful tools. We’re nowhere near realizing their potential or knowing how they will evolve. What should be known (and written in stone), though, is what our companies, institutions or organizations stand for. The decision to adopt a particular technology should only be made if it helps us achieve that end.

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American Cancer Society vs. The New York Times

Feud Adds to Public Confusion Over Cancer Screening
As if there isn’t already enough conflicting information about cancer screening, a tiff between The New York Times and the American Cancer Society – two trusted sources of information – have the public scratching its collective head. It’s another example of how the current state-of-the-art in diagnostics, conflicting medical points of view, and the way in which healthcare news is communicated can cause people to either run to or away from their physician.

Veteran healthcare reporter Gina Kolata reported that the ACS “is quietly working on a message, to put on its Web site early next year, to emphasize that screening for breast and prostate cancer and certain other cancers can come with a real risk of overtreating many small cancers while missing cancers that are deadly.” Dr. Len Lichtenfeld, Deputy Chief Medical Officer of the ACS, writing in his blog, counters that it’s not true. He wrote, “The American Cancer Society is not working on any stealth project to change commentary on our website to emphasize the shortcomings and risks of screening.”

With a tone of exasperation, Dr. Lichtenfeld went on to write, “And here is another news bulletin for the press and the rest of the media: developing and accurately promoting guidelines are complex processes that don’t lend themselves to sound bite messaging.” So true. Cancer is incredibly complex and the screening tools are far from perfect. Yet, it was Dr. Lichtenfeld’s boss, Dr. Otis Brawley, who was quoted in the Times article. He said, “We don’t want people to panic, but I’m admitting that American medicine has overpromised when it comes to screening. The advantages of screening have been exaggerated.”

What’s really going on here?

1. We have a gender gap. Much of the controversy boils down to the fact that prostate screening is less effective than breast cancer screening. It’s a message not very many men want to hear.

2. Cancer diagnostics are not created equally. In addition to some screening tests having greater predictive powers than others, they do not differentiate between tumor types that may be more or less aggressive. This has a big impact on which cancers to treat or just to observe.

3. The ACS needs to harmonize its message. A third ACS executive, CEO Dr. John Seffrin, has now weighed in on this story. He said, “we have long acknowledged that cancer screening isn’t perfect. Sometimes cancers get overlooked. Sometimes cancers get misdiagnosed. Sometimes aggressive cancers can appear even after a clear screening test. It is important to acknowledge these limitations, understand them, discuss them with your doctor, and decide what is right for you.”

4. Physicians need to find the right language. The pros and cons, the risks and benefits, if and when to treat – they all must be discussed. It takes time, and it takes some skill to understand their patient and their ability to understand and deal with the facts.

5. The public needs improved health literacy. A corollary to number 4 above is that the public simply does not have a good enough grasp of the scientific concepts or the ability to assess the risks or benefits. If The New York Times and the American Cancer Society can’t agree or somehow misunderstand each other, then what hope should the average citizen have of making heads or tails of all the possible screening and treatment options?

Let’s hope we can get back on the same page and deliver timely, accurate and understandable information on what is literally life and death information.
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A Healthcare Answer For Some But Not All

The Internet Is Another Health Disparity That Must Be Addressed
If you ask your friends, relatives and colleagues if they’ve used the Internet to find healthcare information, I’d be willing to bet the answer would be yes. There’s no question that the Internet is an ever more important healthcare tool. The ability to capture and consolidate information into electronic medical records; search and share health and wellness resources, and enhance communications between professionals and patients are among the many benefits of the web. It’s OK to cheer but just not too loudly.

The problem is that our friends, relatives and colleagues aren’t everyone – not by a long shot. According to Neilsen Online, there’s a whopping 277,636,000 Internet users in the U.S. The flip side of this seemingly good news is that it leaves nearly 80 million Americans disconnected from the world wide web and, thus, unable to access important healthcare tools and information.

The web is no panacea, of course. You may have read some of my previous articles where I pointed out the problems of web-based healthcare information. Because there’s so much junk science reported and repeated in cyberspace, it can be a case of information doing more harm than good. Still, there’s a growing list of important applications that will not be available to all who could benefit from them.

Take Keas, for example, the new company that boasts Google Health and Microsoft HealthVault as partners. Keas seeks to marry personal data and health information to produce personalized health plans for individuals. Delivered right to your desktop or smart phone might be diet and exercise advice, an explanation of lab results, different treatment options or reminders to take a medication.

During the healthcare reform debates, we heard repeatedly that a key to lowering costs is to have a healthier nation and that this goal will only be possible if individuals take more responsibility for their health. While we could achieve a lot if plain old common sense was applied more often, tools like those being developed by Keas could play an important role in both learning about and managing one’s health.

If experts are telling us that things like electronic medical records, on-line health information and personalized health plans are important to healthcare reform efforts and our own personal well being then we need to be thinking about two kinds of health disparities: insurance coverage and Internet access. Creative, cost-effective ways to distribute computers and expand broadband access must take on new urgency. The benefits would be manifold.

And, access should include more than the ability to go on-line. Access is meaningless if one can’t interpret what one has found. Even for those with Internet connections, there’s an enormous deficit in health literacy that threatens the public health, such as sensationalized claims that lead people to take potentially dangerous alternative medicines or parents to refuse vaccinations for their children other than for legitimate medical reasons. If there’s any hope in increasing coverage and quality while containing (or even lowering) costs, more attention must be placed on expanding access to and understanding of healthcare information.
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Informed Dissent

H1N1 Vaccine is Here With Too Few Takers

Parents want the best for their children – happiness, success and good health. But nearly two-thirds plan on delaying or denying vaccinations against the H1N1 flu to their kids. It’s more than ironic to me, especially when so many complain about the lack of access to preventative care in this country.

Two similar polls just came out – one from the Associated Press-GfK and the other from Consumer Reports – that demonstrate that only about half of the U.S. population will be vaccinated. It’s not big news, though. This sort of result has been the unfortunate norm.

Why haven’t the numbers improved? Why are people so wary? Why are there so many who actively oppose vaccination? Is this just a case of people not being adequately informed? And, is this the government’s fault? The report published by the AP said that “The survey raises questions about government efforts to stem illnesses already spreading widely across the country.” I’m not quite sure what this statement is based on but my view is that the public-private partnership that has made millions of doses available is an impressive achievement. .

So, allow me to briefly address some of the suspicions and concerns:

Flu isn’t all that serious. Influenza and pneumonia are the eighth leading cause of death in the U.S. (over 56 thousand annually).

It may be safe but I worry about side effects. Everything we do carries a risk. One must weigh the risk of injection site swelling and pain against contracting the flu with its potentially serious sequelae.

The vaccine hasn’t been adequately tested. Again, nothing is fool-proof, nothing is risk-free. FDA’s requirements for safety and effectiveness, however, are demanding. Moreover, the methodology for manufacturing the H1N1 vaccine is no different from other flu vaccines – vaccines that have an excellent safety record.

Vaccines can cause autism and other diseases. We may never know with 100 percent certainty but every credible study and review thus far (the most recent having been conducted by the Institute of Medicine) has concluded that there is no causative link.

I don’t think I/my children will get the flu. Sure, you might get lucky but why count on this wishful thinking? It has already been reported in 37 states – a much more rapid spread than in previous years.

I don’t trust it if the government is behind it. Fine, have a healthy skepticism but please don’t take it too far. Don’t undermine your health or the health of your family by listening to the fringe opinions of people like Rush Limbaugh who recently said that “All of this is designed to get people to respond to government orders, not to do things or to do things. It is designed to expand the role and power of governments and schools, and the media, of course, just falls right in line here with amplifying the nature of the crisis.” It's too bad there's no vaccine for paranoia.

If there are such good responses to these concerns, why aren’t people listening? Why aren’t people better informed?

My sense is that people are listening. They listen to and are informed by people that make sense to them. The CDC and NIAID have been all over the news with compelling information. About half of the country will act on what they heard. The other half will not be convinced. The message from anyone employed by or connected to these sources will not be trusted.

This is a barrier that will probably take a long time to breach. The ongoing outreach and education must continue while new efforts must be established to address the reasons why health messages bounce off of so many. Politics and conspiracy theories aside, elevating the public’s health and science literacy may give everyone a common ground from which to make their healthcare choices.

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1776 Déjà Vu?

So Much Hinges On So Few

One of my children was just watching the movie version of 1776, the musical show about the events leading up to and including the signing of the Declaration of Independence. In the Broadway account, the fate of the document, the fate of the world, came down to James Wilson of Pennsylvania. Pennsylvania was, indeed, torn between reconciliation and war with England. In a last gasp appeal, John Adams spoke out. "It would be a pity for a man who has handed down hundreds of wise decisions from the bench to be remembered only for the one unwise decision he made in Congress." Wilson (who, in reality, spoke forcefully for independence) relented. He didn't want the attention or the responsibility. "Mr. Adams is correct about one thing," he said. "If I vote with you [John Dickinson], I'll be the one who prevented American independence."

Healthcare reform and the signing of the Declaration of Independence may not be in the same league of American milestones, but the parallel struck me. Of course, there have been many, many instances where critical decisions came down to one unsuspecting or unprepared (or manipulative) person. But here we are. With the so-called public option going down to defeat in the Senate Finance Committee, it is now highly unlikely that any subsequent amendments with such a provision will survive.

And what does that mean? The table is set for Senator Olympia Snowe to play James Wilson. Sixty votes will be needed for passage and it's looking more and more like achieving meaningful (though highly compromised and far from perfect) healthcare reform any time in the foreseeable future will rest with the capable centrist from Maine.

The optics aren't pretty -- the old saying about laws being like sausages comes to mind. And what got us to this point hasn't been any more attractive. The raucous Town Hall meetings over the summer -- the shouting down of elected officials and the perpetuation of false claims -- did not instill confidence in the process of creating legislation. Politicians need to pay more attention to this point. The substance is important but, when it comes to building trust and unity, the visuals and the tone mean a great deal, too.

While one voice may decide the fate of healthcare reform, it's interesting to note which voices went largely unheard. The most vocal weren't those with the most to gain -- the roughly 46 million without insurance. The squeakiest wheels were found on those who believed that reform will diminish their care or cost them more money. They had the best access to the media, the best messaging consultants. So much for Life, Liberty and the Pursuit of Happiness for the rest.

Yet, some major groups that were lined up against previous reform efforts -- most notably the pharmaceutical industry and organized medicine -- are now advertising their support. Despite the bad press over the haranguing and arguing, there has been much more engagement, much more deal making and number crunching. Making a business case, not just an emotional one, may be the winning formula this time around.

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Chill Pills All Around, Please

Outbursts and Meltdowns Punctuate the Week
Civility was in particularly short supply this past week. Representative Joe Wilson of South Carolina shattered precedent and decorum by yelling “You Lie!” at President Obama during a joint session of Congress. Tennis star Serena Williams threatened a line judge at the U.S. Open with bodily harm following a blown call. Rapper Kanye West grabbed the microphone away from Taylor Swift, trampling what was to be her acceptance speech at the Video Music Awards, to disagree loudly with the judges’ choice. Conservative “Tea Party” events protesting big government saw slogans that included "Unarmed, this time," "Impeach the Muslim Marxist" and "Obama is trying to kill my mama."

It seems that these types of breakdowns in behavior (and good sense) are becoming more strident and are occurring more often. Why?

There is often little, if any, consequence. One reason that we have so much boorish behavior and repeat offenders is that people get away with it. Most people and organizations aren’t willing to set limits. There are too few that will object when “the line” has been crossed.

You can chalk it up to emotion. We’ve heard them all this week: “I’m a very passionate person,” “It was just a spontaneous outburst,” “My emotions took over.” Sorry folks. These are tired and wholly inadequate excuses.

People can blame the “fringe.” Another convenient excuse is to say that the particular incident wasn’t sanctioned. “We can’t be held responsible for the actions of individuals” goes the refrain. Fine. But did anyone speak out? Did anyone say you’re at our event and you’re out of line?

There are some important bottom line considerations in all of this:

Behavior still counts, at least for some. Unless you want to be known as a beast, you are harming your personal brand – or the brand of your organization – by engaging in uncivilized behavior. We all know that part of successful reputation management is setting the proper tone for communication.

Examples are being set. Like it or not, these high profile offenders have fans, they have constituents. They’re role models. Without any impediments, these behaviors are bound to be emulated and propagated.

Bad behavior can incite worse. With each unchecked incident, the line separating good behavior from bad gets shifted. A new, potentially dangerous norm is set. In the most extreme case, it seems that the threshold from outburst to threat or from threat to violence is getting unsettlingly easy to breach.

Manners can trump message. At the core, though, it’s the message – the actual facts of the matter – that get lost. Are we talking about the tennis play between Williams and Clijsters? Swift’s music video? In the case of politics, we’re pulled away from an actual, healthy debate and forced to discuss the spectacle. Moreover, the public is often asked to take a side. The “if you’re not with us you’re against us” mentality still runs deep in enough of the population to threaten compromise or legitimate disagreement. This helps to crush the middle ground and polarize opinion further.

I hope the shrillness and the intolerance can be mitigated. It’s not like this is a new problem, either. It’s been discussed for millennia. Remember “Love thy neighbor as yourself” (the ethic of reciprocity)? It’s time to deliver.

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A Military Man Points the Way, Again, On Strategic Communication

An Admiral Sets a New Course
Carl von Clausewitz, the 19th century Prussian general, may not be a household name but he laid the groundwork for the way in which the modern military thinks and plans strategically. In 2001, the Boston Consulting Group condensed and rearranged his voluminous writings into a neat little book (Clausewitz on Strategy: Inspiration and Insight From a Master Strategist) that provided some important lessons for the battlefields of the business world.

Indeed, many of Clausewitz’s observations translate quite well to the issues surrounding successful communication: defining objectives, understanding the audience and their agenda, adapting to changing conditions, clear accountability and communication channels, and, ultimately, changing a behavior.

In the case of executing U.S. foreign policy, however, something has been lost. In his recent “From the Chairman” column in the Joint Force Quarterly, Admiral Mike Mullen, Chairman of the Joint Chiefs of Staff, warns that we’ve “walked away from the original intent” of strategic communication by allowing it “to become a thing instead of a process, an abstract thought instead of a way of thinking.”

Admiral Mullen reminds us of some important truisms not only for the successful execution of policy but for communicators everywhere:

Understanding. We need to start with research and data gathering. The key, of course, is turning the information into insights that will help guide the strategic initiative. What is it that our audience believes? What should be said and done to influence them? What might be our common ground?

Listening. Gaining a greater understanding of the issues and concerns, and building trusting relationships are endeavors with a component of mutuality. “Good communication runs both ways. It’s not about telling our story. We must also be good listeners.”

Relationship Building. It takes time. It’s an investment. “Our messages lack credibility because we haven’t invested enough in building trust and relationships, and we haven’t always delivered on promises.”

Trust and Credibility. The issue above speaks loudly also to follow through and perseverance. “We hurt ourselves more when our words don’t align with our actions.” And what we say and do cannot be just for show; they cannot be delivered expediently. “We’ve come to believe that messages are something we can launch downrange like a rocket, something we can fire for effect. They are not.”

Accountability and Ethics. Behavior is important. Ethics cannot be optional; they cannot be episodic. “We must be vigilant about holding ourselves accountable to higher standards of conduct and closing any gaps, real or perceived, between what we say about ourselves and what we do to back it up.”

Tone. It’s not just the substance that’s important; the way in which we communicate has a lasting impression. An unambiguous message that is encased in civility and mutual respect is the best case. “I hope we learn to be more humble...”

Admiral Mullen deserves a salute from us civilians for elevating the discussion on strategic communication, and highlighting the importance of how we go about shifting perceptions in the attempt to elicit behavior change. Now, more than ever, we should take heed of the lessons inspired by Clausewitz who, as expressed in the BCG book, offered "new ways to order thinking in disorderly times" and provided a "steadiness in charting strategy in an unstable environment."
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