Social Marketing. Health and Social Care: Ignore this Tool at your Peril!

One way of health promotion is to develop a campaign that seeks to address the population as a whole or total. Change for Life would fit under this generalist approach.

Another effective approach or option is social marketing which is a more sensitive and accurate methodology that uses the latest thinking in marketing segmentation for targeted health engagement.

 

BlueGirls

An example might be helpful. Jedele & Ismail (2010) report the following social marketing campaign evaluation. They were interested in two things:-

  1. Raising awareness of and
  2. Screening for oral cancer.

And given this was a social marketing campaign in specific segments of the total population, namely African-Americans in this case as this segmentation were a high-risk group in the Detroit/Wayne County Michigan area.

The programme benefits were:-

  • Citizen engagement at this segment level
  • Reduce the death rate
  • Improved detection rate earlier in the pathway
  • Increased screening rates at years 1, 2 and then 3.

The social marketing campaign costs were calculated per individual. What is important to understand is that the ways by which the campaign was designed, developed and implemented was participatory. Stated simply they spoke for themselves.

During the campaign:-

  • 1,327 radio spots were aired
  • 42 billboards displayed
  • 2 excellent Newspaper adverts were placed in papers read by that segmentation
  • 242 educational sessions were completed
  • The hotline (manned by African-Americans) received a stunning 1,783 calls
  • Interestingly 67% of the hotline callers stated that their call was prompted by the radio advertisement

Outcomes

The clinic screened 1020 adults with a total cost of $ 795, 898 which is some $ 783 per patient (directly screened) as there would be wider systemic benefits for raising awareness too. The outcomes were reported as:

  • 3 cancers detected (early stage detection)
  • 2 pre-cancers
  • 12 tumours detected

This is one example of an effective social marketing campaign. There are others from a community-based stroke preparedness intervention (see Boden-Albala et al., 2014).

And, in terms of emergency care flows a neat study from McGuigan & Watson (2010) looked at the beliefs, concerns and factors influencing patients decisions to attend their local emergency department (ED). They unpacked all the segmentation data and rightly concluded that:

A targeted social marketing campaign is needed to address the misconceptions of people who present at EDs” (p. 34).

This latter inquiry reminds me of a campaign at Barnsley that a colleague completed. This insight data-driven inquiry looked at attendance rates spikes and trends at the local ED. She led a team that developed an innovative campaign that addressed specifically young girls aged between 16-24 and then, very specifically, ‘binge-drinking on a Friday night’. The insights from the intelligence led to a successful campaign for this particular segment or group and thus reduced both attendance as well as admission rates for this group.

To meet rising demands and associated costs on health and social care I’d suggest social marketing is an essential tool.

References

Boden-Albala et al (2014). Methodology for a Community-Based Stroke Preparedness Intervention. Stroke.

Jedele & Ismail (2010). Evaluation of a multifaceted social marketing campaign to increase awareness of and screening for oral cancer in African-Americans. Community Dental Oral Epidemiology, 38: 371-382

McGuigan & Watson (2010). Non-urgent Attendance at Emergency Departments. Emergency Nurse, Vol 18 (6), 34-38.

‘Lessons to be Learned’ is this anything more than a rhetorical device?

network
You might recognise the picture above as a human neural network. This is the miraculous or amazing ways by which the human brain disseminates information that we all use to make sense of our external (environmental) and internal (psychological) worlds. I believe that this is a useful metaphor for learning at a number of levels, including individually, team and organisationally.

This blog is all about learning. But the motive behind writing it is all about relieving pain, upset, misunderstanding and disappointment. Consider the following scenario:

A loved one is treated poorly by a provider of care/ treatment. This results in serious harm or death. Given the seriousness of the error an external review is completed taking several months. Consequently a comprehensive 157 page report is produced. The same day this becomes available a press statement including the phrase that we all recognise instantly: “The organisation accepts the reviews findings and acknowledges that lessons must be learned” is given to the national, regional and local media.

Even though several months have passed for you the associated emotions remain raw or visceral and there is this sense of an injustice. You are energised to do three things. Firstly, you read carefully all similar reviews of the same type of error over the last 10-years. Secondly, you ask the organisation to demonstrate the ways by which they have implemented the ‘lessons learned’ from these previous reviews that you have found. Lastly, you informally ask friends that work in that organisation in what ways the ‘lessons learned’ from these reviews has shaped their professional practice over the last decade.

It is an obvious point but worth exploring none-the-less, what difference will it make to you if you discover that very little genuine learning has taken place? And, of course, if you discover that learning from previous reviews has indeed re-shaped professional practice and informed the ethical culture of the organisation what difference would this make to your sense of justice/injustice?

Around 7-years ago I was asked to review (yes me too!) and then design and implement a learning architecture that would address the points that I have outlined above. This is roughly what we co-created.

As a matter of interest this was within healthcare, but as I said before I believe the design features, or principles, could be applied in most organisational contexts such as banking/finance, IT, social services, foster care, schools/education, and the military, and the voluntary sectors such as charities and churches.

We mapped the following key learning building blocks:-

  • Insights from International, National Reviews
  • Learning from other external Reviews
  • Learning from Organisational ‘near miss’ events (logged)
  • Insights from Programme and Project ‘Lessons Learnt’ reviews/ evaluations
  • Learning from Conferences and other CPD events
  • Team Based Learning
  • Individual Learning (PDR)
  • Communities of Practice (Professional)

With bi-directional information and learning ‘flows’ we anticipate the following direct outcomes and wider systemic benefits.

Outcomes:

  1. The rate, or pace, of learning across the network ‘nodes’ should increase over time- given that we have specifically “designed-in” the learning connectedness
  2. There should be some correspondance of learning from each ‘output’ to the relevant learning ‘input’. In this way, we can see that any relevant learning from say a specific project review/evaluation should expected to be found, in say, the ‘community of practice’ for programme/project managers
  3. The same of course, could be said for any professional such as nursing, teachers, investment bankers and so forth
  4. Consequently, the knowledge management skill par excellence- is extracting the right degree of learning granularity from each knowledge input to each learning output

Benefits 

  • Having professional ‘communities of practice’ connected to learning knowledge management will enable skills and knowledge transfer in the most effective ways
  • The added-value from international/national reviews has genuine legitimacy to individual learning- with explicitly mapped transfer points or nodes across the network
  • The learning network is a key enabler for cultural and team climate improvements to this end
  • Individual learning evidently ‘scales-up’ to organisational learning. For example, an individual attending a CPD event would share a brief of that learning that is disseminated to each and every node

whatisbp
 Jason is a Business Psychologist.

 

 

Organisational Transformation: New Talent Might Be Essential!

transformational

One of the most accepted leadership paradigms is that of the transformational leader. Work/Occupational Psychologists have been promoting this model for those organisations that have transformational programmes or strategies to implement. Thus, Work Psychologists have been helping such organisational to identify, recruit, and further develop the right individuals that fit this model and the strategic need. To be fair to the leadership field this is a plethora of robust empirical evidence supporting this model.

 

Over the last 35-years I have worked in the private, public and not-for-profit sectors. Over the last 15-years I have also been a Coach to Senior Directors/Leaders within those sectors too. Over this time I have questioned whether it is better to bring-in new top talent or external strategic Consultants to develop the existing leadership team (or more likely a ‘blend’ of all three approaches). I have often wondered when a top team is struggling to make proper in-roads whether Senior Directors can become too familiar with their organisations. Can you get over familiar with the culture and does this prevent the necessary challenge and energy to implement change?

 

I guess stated simply my question can be framed as: Can over-familiarity prevent the next stage of the transformational journey?

 

With these questions in mind I was delighted to come across a neat research paper developed by Russell Guay (2013). It is entitled “The relationship between leader fit and transformational leadership” and you can locate it in the Journal of Managerial Psychology. Vol.28(1), 2013, pp. 55-73.

 

Guay (2013) draws on the transformational literature and develops a model that explores 3 types of fit between the leader and the organisation:

 

  1. Person-Organisational fit: the extent to which their own values fit with those of the employing or host organisation
  2. Needs-Supplied fit: the extent to which the job meets the leaders own need
  3. Demand-Abilities fit: the extent to which the leader has the knowledge, skills and experience to meet the demands of the job at hand

 

For those of you with a research bent- he uses structural equation modelling to statistically demonstrate the best fit of the data-set/ results. Now in my view…here’s comes the fun part! The insights and application!

 

 

Guay (2013) reports a negative relationship (-0.17) between 1 and the outcome measure of transformational leadership. He also reports that as he hypothesized there was a positive relationship between 2 & 3 (0.14 & 0.24 respectively). Lastly, he also reports a negative relationship between tenure in the organisation and transformational leadership behaviours.

 

So what might this mean in practice?

 

Evidently, we are ‘bang on the money’ when it comes to our well established transformational leadership model. When any job supplies our personal needs for development, challenge and growth (2), and we have the pre-requisite skills, knowledge and experience then we can empirically anticipate, in all good faith, the organisational transformation.

 

Then, here comes the caveat. Or at least, here comes my interpretative caveat…over familiarity with the organisation may well prevent the leader from implementing the transformational necessary. So it seems there is an ‘upper limit’ for some Director posts (and one could sensibly argue any post associated with the transformational programme or strategy) to stay in the same organisation. This also helps explain the negative relationship between tenure and a lack of transformational outcomes/behaviours too.

 

Of course, as with all empirical inquiry there is the classic ‘more research is needed’ and this holds true here too. Just how long is the question and, of course, if we take any existing ‘top team’ can we inject some new transformational energy/blood by changing one or two of the Directorship posts and, by so doing, refresh the energy, the focus, and the necessary challenge.

 

These insights also help to explain why external ‘Change Consultants’ earn their buck… because if you want to keep a fairly stable, senior team (for identified stability or even organisational political purposes), then having a ‘fresh but critical’ pair of eyes can have the same effect. However, this latter tactic would seem to hold true… just as long as you employ some ‘fresh transformational blood’ further down the organisational hierarchy to get into implementing the identified transformational programme.

 

 

Yes Minister! Survival Skills for Public Sector Leaders?

Yes Minister

 

 

“Yes Minister” is a totally hilarious sitcom (full of wit and loaded with satire) and in my view one of the best of very British TV programmes. It was written by Antony Jay and Jonathan Lynn. According to Wikipedia it was first transmitted by the BBC between 1980 and 1984 and was split over three, 7-episode series. It had a huge critical and popular success. The series also received a number of awards; including several BAFTAs and in 2004 was voted sixth in the Best Sitcom poll. Quite a success story!

It was so popular that the BBC very wisely produced a sequel entitled “Yes, Prime Minister”, and this ran between 1986 to 1988. In total there were 38 episodes which is a significant achievement by today’s standards. What I have also learned is that several of the very best episodes were then adapted for BBC Radio, and later a stage play was produced in 2010.

So what is it all about? Before I describe it can I just say that one of the main reasons I find it so fascinating and entertaining is that I have family, friends and old school chums that are currently civil servants and they all testify that the key themes and ideas resonate with rich authenticity.

As you might have guessed Yes Minister is set principally in the private office of a British Cabinet minister in the (fictional) ‘Department of Administrative Affairs’ in Whitehall, London. So the programmes substance or dynamic interplay, is the ways by which the British civil service ‘comes-up against’ Ministerial politics, policies and tactics. Stated simply, Ministers want to get things done quickly whereas the culture of the civil service is risk averse and cautious. Therein sets the tension!

With the scene set it..the series follows the hilarious ministerial career of The Rt Hon Jim Hacker MP, who is superbly played by Paul Eddington. You cannot but ‘howl’ as his various struggles to formulate and enact legislation or even effect quite simple departmental changes are frustrated, or subtly opposed, by the British Civil Service, and in particular his Permanent Secretary Sir Appleby (who is skillfully played by Nigel Hawthorne).

Jim Hacker’s Secretary is a chap called Bernard Woolley who is played by Derek Fowlds. What is equally amusing is the ways by which he is constantly caught between a ‘rock and a hard place’ of the dynamics between his commitment to his Minister, Jim Hacker, and then his loyalty to the Civil Service. The pressure from the latter embodied and enacted all too skilfully by the commanding presence from Sir Humphrey. As the Psychologist, Jung, once remarked the most emotive and memorable human albeit psychological drama’s can be traced to a ‘triangular dynamic of relationships’.

So what can we learn as we apply this to us and leadership development and even leadership career longevity?

What strikes me is that in this series the civil service acts as an effective ‘buffer’ between key public sector and business leaders and the Minister. This acts as a form of relational protection and, of course, ‘saves face’ when disagreements might arise. What do I mean by this? Well, putting this bluntly what any public sector leader does not want is any Minister having to put things very directly to them ‘mano a mano’ in any form. This is process failure!

This latter ‘end point’ reminds me of the proverbial ‘kiss of death’. Consequently, a wise, mature and ‘grounded’ public service leader would be actively looking for and rightly understanding any Ministerial ‘clues, hints and points’ from which to ‘get under the message’ so as to prevent the process failure noted above from actually occurring. And, in this same way, an effective and bright civil servant would also be looking to make active facilitation to this same end.

So, my advice is.. when the Minister speaks- pay full attention and when he provides ‘hints and tips’…pay even more attention. #survivalskills

 

“Let’s kick their ass and get the Hell out of here”

Custer

 

Within a short 60-minutes some 226 US soldiers has been massacred by the Indians. The latter had over 1,500 warriors and had more reliable and effective Winchester rifles. Ambrose (1996) rightly notes that the ‘Battle of Little Bighorn’ is arguably the most written about military event in American history which is quite something!

From my very own experience, it is fair to say that I have met three leaders that remind me of General Custer over the last 16- years of working as a Work/Business Psychologist. Recently, I have been reflecting on what leadership insights we might gain from re-examining General Custer from a Work Psychology perspective. By way of methodology I have adopted the type of discourse analysis as advocated by Parker & Pavon-Cuellar (2014). In this way I have completed a short intensive research review and consequently completed an analysis of the key themes. Lastly, I mapped these across to psychological evidence-base.

Up front and central I’d like to argue or construct a view of Custer as embodying the psychological ‘dark triad’. This is a ‘diabolical trinity’ of three key personality constructs, namely:-

  1. Narcissism which can be witnessed by pride, egotism, a lack of empathy and grandiosity.
  2. Machiavellianism which is characterised by the exploitation and manipulation of others for one’s own ends and a strong motivation and focus on one’s own self-interest. This also includes tactics such as deception, lying and lack of moral values
  3. Psychopathology which can be witnessed by anti-social behaviour, impulsivity, callousness and a lack of remorse.

You will notice that although these three components are conceptually ‘teased apart’ in practice they overlap. I have noticed in at least two clients that these components seem to ‘spark off’ one another. Lastly, each component has a statistical normal distribution. That is to say, a less ‘acute’ type can be found in non-clinical settings such as the workplace. This resonates with Lowen (1985) in his first-class and very accessible book on Narcissism has found a similar pattern.

  1. Narrcissim

“In years long numbered with the past, when I was merging upon manhood, my every thought was ambitious- not to be wealthy, not to be learned, but to be great. I desired to link my name with acts and men in such a manner as to be a mark of honor, not only to the present, but also to future generations.

“The largest Indian camp on the North American continent is ahead and I am going to attack it”

Both quotations from George Armstrong Custer, 1867.

 

OK let’s take a look at Custer’s narcissism. Firstly, we have the display component. For example during battle he would ride on a white horse; whereas his troopers would be on black horses as a key differential in terms of the positional display of power, authority, as well as the visual impact signifying difference and the element of deferral. Perhaps a modern equivalent would be a very expressive ‘executive’ car. Andrist (2001) states that he was “greedy for fame” and many commentators (e.g. Kershaw, 2005) have noted how he enjoyed making public speeches- primarily about himself and his successful campaigns to date (see Macnab, 2003).

It is also fascinating to note that Custer frequently invited correspondents to accompany him on his campaigns to report on his military skills and prowess. It is also sad to note that two of them lost their lives at his ‘Last Stand’.

Ambrose (1996) noted that within the U.S. Army Custer was described as being a vain, self-seeking and glory-wanting individual. Andrist (2001) believes that Custer was photographed more than any other Civil War officer; which from a narcissist frame of reference literally speaks volumes!

Custer also loved dressing very flamboyantly. He often wore or ‘sported’ a uniform that included shiny boots, tight olive trousers, a tight hussar jacket of black velveteen with silver on the sleeves, a sailor shirt with silver stars on his collar, and a red cravat. To ‘top it off’ he was had a wide brimmed slouch hat, and styled his hair in ringlets with cinnamon scented hair oil. Quite the image!

  1. Machiavellianism

“Hurrah boys, we’ve got them! We’ll finish them up and then go home to our station.”

Next, let’s briefly explore some of the ways by which Custer was a Machiavellian Connell (1997) reports that many of his peer-group saw Custer as someone that “really wanted to be seen as important but not caring how he got there.”

Connell (1997) reports how during the course of his military career Custer was prone to disobey orders, as well as openly criticize those senior to him in the military hierarchy. For example, he charged the Secretary of War of ‘hypocrisy’ saying that they were signing treaties with the Indians with one hand and them killing them with the other.

Custer also had the classic Machiavellian tendency ‘show-off’ to those in positions of authority/power when it was the right time to do so when seeking his own shameless self-promotion and vain ambitions. One of the most telling examples is when on May 24, 1862 General Barnard and his senior staff were assessing a potential crossing point on the Chickahominy River. Custer was waiting for his ‘moment’ so when General Bardnard said to his team “I wish I knew how deep it was”…with that Custer gently wiped his horse and rode- out to the middle of the river and shouted victoriously “That’s how deep it is, Mr General”.

What unfolds next is very important for our interpretive purposes as Custer was consequently given permission to lead a successful attack across the River and this resulted in the capture of over 50 Confederates. Following this successful campaign, he is also then personally congratulated for his gallantry by the General.

These details are psychologically relevant as this set-up the ‘reward’ frame of reference for the type of ‘heroics’ that Custer was in far too desperate need for. Of course, this deep-seated need for achievement and recognition was a classic ‘double-edged sword’ and would lead to his demise along with his brothers Thomas Custer and Boston Custer who died with him along with his brother-in-law, James Calhoun, and nephew, Henry Armstrong Reed.

  1. Psychopathology

“They tell me I murdered Custer. It is a lie. He was a fool and rode to his death” (Chief Sitting Bull).

 

For me the most telling psychopathological moment is back in 1866. By way of context the western frontier was conflict ridden. Unaccustomed to the tactics of the Cheyenne and Arapaho, Custer spent months fruitlessly chasing after elusive bands of warriors. At one point, he became so frustrated that he abandoned his command and dashed 150 miles in 55 hours just to spend one day with his wife.

 

For this insubordination and deserting his post the records state that he was court-marital and consequently suspended from the Army for a year. However, General Philip Sheridan came to his rescue and recalled him to lead a winter campaign against the Cheyenne. In a bloody dawn attack along the Washita River in 1868, Custer and his men killed 103 Indians. The records demonstrate that very few were in actual fact were warriors. Tellingly the majority were women, young children and old men. Custer demonstrated neither mercy, nor compassion nor any element of empathy. This was a massacre!

 

As time progressed Custer noted that the military culture turned a blind eye to some of his more brutal methods of ‘leadership’. As with all mavericks this was mainly because he ‘delivered results’. Unfortunately, given his personality problems Custer became extremely ruthless. For example, it is reported that on at least three occasions when he was challenged by subordinates he did not hesitate to kill them for ‘insubordination’. There was no room for any ‘critical friends’ in his psychological space.

I would argue that Custer’s lack of empathy was one of the factors which meant that he rejected help from new technologies and instead relied too heavily on his own military skills and methods. He outright rejected the Gatling gun. Next his forced his men to use single-shot Springfields, whilst the Indians used much more reliable and effected Winchester rifles.

On the day of the battle, Custer divided his 600-man command in the face of vastly superior numbers into three battalions. Thus, the refusal of an extra battalion reduced the size of his force by at least a sixth, and then rejecting the firepower offered by the Gatling guns played into the events of June 25 to the disadvantage of his regiment.

To be fair, prior to the ‘Battle of Little Bighorn’ Custer had experienced some measure of campaign success. But he ascribed this more to his own method of the ‘Custer chase’ which relied heaving on three factors:

  • having first-class reconnaissance intelligence,
  • the element of genuine surprise, and lastly,
  • Outnumbering the enemy.

Most historians note failure on all three tactical components with his fateful and infamous ‘Final Stand’.

Conclusion

Like Achilles, it seems that Custer achieved in death, the lasting fame that eluded him in life. For many years, the public saw him as a ‘tragic military hero’ and ‘a gentleman’ who ‘sacrificed his life for his country’. To this end, Custer’s wife, Elizabeth helped construct this narrative with the publication of several books including: Boots and Saddles, Life with General Custer in Dakota (1885), Tenting on the Plains (1887).

My own analysis is that General Custer was a psychologically flawed individual and that this can account for:

  • his exponential rise through the ranks with little/limited actual military experience
  • his very brutal treatment of the ‘enemy’ more especially the vulnerable (e.g. unarmed women, children and the elderly)
  • his reliance upon his own skills and rejection of help or new technologies
  • ultimately- his key military failure

 

 

Interested in Further reading?

 

I enjoyed reading Stephen E. Ambrose (1996): ‘Crazy Horse and Custer: the parallel lives of two American warriors’: New York: Anchor Books.

References

Ambrose, S.E. (1996). Crazy Horse and Custer: New York: Anchor Books.

Andrist,R K (2001). The Long Death: The Last Days of the Plains Indian, Editorial Galaxia.

Connell, E. (1997). Son of the Morning Star. Farrar, Straus and Giroux.

Custer, George Armstrong (1874) My Life on the Plains. New York: Sheldon and Company.

Kershaw, R. (2005). Red Sabbath: The Battle of Little Bighorn. Ian Allan Publishing.

Lowen, A. (1985). Narcissism: Denial of the True Self. Touchstone Books, New York.

Macnab, D B (2003). A Day to Remember: Introducing the Drama, Irony, and Controversies of the Battle of the Little Bighorn, iUniverse.

Parker, I. & Pavon-Cuellar (2014). Lacan, Discourse, Event: New Psychoanalytic Approaches to Textual Indeterminacy. Routledge. London

Perrett, B. (1993). Last Stand: Famous Battles Against the Odds. London: Arms & Armour.