As a consultant in healthcare planning and strategy, I had several standard items to discuss with clients at the start of assignments. My role in what I came to call strategic writing was to put into words the information, data, recommendations and anticipated outcomes that would achieve the client’s goals.
In other words, I was charged with finding the words to express what the client wanted to achieve. At the outset of every contract, I would advise my clients that they did not have to do any writing on their own. Their role was to talk about the issues and to provide the raw data for me to review.
Telling clients that they didn’t have to write always lessened the tension in the room. Physicians, other healthcare professionals, administrators, scientists, and government employees had enough on their own plates without my giving them homework. They had no time to write for me. My job was to write for them.
The second tension-breaker was telling my clients that they were free to comment on any aspect of the project. In other words, I encouraged them to think out of the box and to participate in subject matter that was not their traditional area of expertise. It’s amazing how technicians, for example, can contribute very positive suggestions to improve medical procedures. Similarly, physicians often recommended improvements to administrative tasks that they were not usually asked about.
I tried to assure my clients that the answers were in the room. It was my job to pull it out of the clients. I still believe this. I also assured my clients that I had a thick skin and would not take offense at any revisions they suggested to the documents I prepared on their behalf. It was their document, not mine.
Once the level of tension dissipated, and the client working committees realized that all they had to do was participate freely and then leave the writing to me, we could begin.
Three questions led off every new assignment. I began by asking who the audience for the document would be. Simple though this may sound, it was rare for the working group to agree. Was the report meant for the appropriate government body? Was it for the Board of Directors? The public? Community partners? Long discussions followed. No single document can be tailored to every reader. Until the audience was established, little could be done.
With the readership established, another discussion ensued. What was the purpose of the report? To clarify a new or changed position of the client, such as adding or deleting specific healthcare services? To obtain funding for new endeavours? To reorganize the delivery of healthcare services in a particular institution, community, region or province/territory? Again, without agreement on what was the desired outcome, the project was not clear enough to begin.
Knowing who the audience was and what was being asked of them led to the final consideration. As a strategic writer, this was perhaps the most important issue to discuss. Every project – and perhaps every piece of documentation – requires a call to action. Especially when dealing with highly technical and specific subjects, it is crucial to end with a clear “ask.”
Otherwise, the reader finishes reading and doesn’t know what is expected of them. What is an “ask”? Do you want approval from a group, government or board? Do you want a specified amount of funding for a project? Do you want the endorsement of other professions, organizations or bodies? If the document is not clear about this, it is almost certain that no action will be taken.
It is true that, if you don’t ask, you don’t get. More often than not, the readers want to help, but if they don’t know what you want, they don’t know how to assist you. Clarity is essential.
Writing about healthcare policy and strategy brings to mind several other ground rules. Demographics is high on the list of issues too often ignored. Throughout my career, I advised clients to “ignore demographics at your peril.” And of course, they did.
Now we are paying for that. As just one example, governments reduced the size of medical school and other healthcare professional training courses. (They also closed or consolidated small, local institutions. They reorganized and then reorganized the healthcare delivery system several more times.)
The rationale was usually an attempt to reduce the amount of money being spent by Ministries of Health or their equivalents. Predictions of increasing healthcare expenditures even suggested that these would take 100 per cent of provincial budgets. Cutting back on the number of healthcare professionals seemed an appropriate preventive measure.
And now, we find ourselves with shortages of medical and healthcare professionals in virtually every field.
Did it not occur to the politicians and bureaucrats that the population was not just growing but also aging? That more professionals, rather than fewer, would be needed?
We tend to see the world as it is today and assume that it will always be the same. Few people recognize that they will age, let alone that the population will change in both size and age distribution over time. Demographics would have highlighted the folly of the cut-back mentality.
The sister science of demographics is actuarial science. Used mostly to predict risk for insurance purposes, actuarial science relies on population and healthcare data to estimate life expectancy. It also predicts health span. Life span is the number of years each of us is expected to live; it varies based on the year we were born. Health span is the number of years each of us is expected to live without chronic or disabling conditions. The former is the quantity and the latter is the quality of the years.
I have written elsewhere that it is estimated that Canadians use 80 per cent of their healthcare services in the last 20 per cent of their lives. This illustrates the difference between life span and health span. Whether each of us wants to live as long as possible, or as long as we are healthy, is a column for another time.
My call to action is to have readers recognize the importance of demographics and actuarial science as key elements in any discussion of healthcare planning or strategy. And to recognize that “solutions” which seem to solve today’s problems will likely not solve them in the long run.
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