Chief communications directors could assume the status of other top policymakers in large health systems, given the increasingly political climate of the industry. But so far, it's only happened to a small extent.
That's one area explored in a benchmarking study of communications departments in nine health systems. The study, believed to be the first of its kind, was recently released by Sutter Health of Sacramento, Calif., an integrated healthcare organization with hospitals, medical foundations and managed-care components.
Steve Heath, Sutter Health's vice president of communications, conducted the survey of 1993 data to find out how his department ranked.
Basis to judge.The 160-page report gives health systems a basis to judge their communications departments, which can include marketing as well as public relations. It covers department staff size and composition, the director's span of control, department services, use of outside vendors, salary expenses, direct expenses, hourly costs for free-lance work, publications staff output, and advertising budgets.
Exact comparisons are difficult because communications departments vary in terms of structure, functions and budgeting. However, sharing data could help them become more efficient.
"I think we're going to become more open with each other," said Bill Colwell, vice president of public relations and marketing services at EHS Health Care in Oak Brook, Ill. "To do that you had to have a start, and I think this was an excellent start."
Mr. Heath contacted 11 medium-to-large, not-for-profit healthcare systems in politically active areas with aggressive media-circumstances similar to his. Nine systems including Sutter Health returned a 60-question, 300-item survey. One respondent, UniHealth America in Burbank, Calif., didn't provide financial data. Some information from another respondent, HealthSpan Health Systems in Minneapolis, was excluded because of a recent merger.
Benchmarking-determining how to structure, staff and run services for the best results-isn't new in the clinical arena. And with capitation increasing and local employers demanding lower premiums, Mr. Heath reasoned it was only a matter of time before his own department's resources would be scrutinized.
"In my view it would be naive to think that if the operating departments were being subjected to this type of study, that the staff departments would not be," he said.
No typical model.The survey shows there's no typical model for communications departments. Staffing, budgets, core services, structures and reporting relationships varied widely.
For instance, the percentage of a system's expenses devoted to communications ranged from 0.12% at Sutter Health to 0.77% at EHS (See chart, p. 90). EHS' Mr. Colwell said some systems underreported spending because they don't have a unified communications budget.
Structural differences also hinder comparisons. Baylor Health Care System in Dallas is reported as having the most layers-three-between its communications department head and its chief executive officer. Baylor's public relations staff operates under two human resources managers, but the system has two related posts-marketing and government relations/communications-that report directly to the CEO.
"Baylor's always been very proactive in that regard," said Marti Quisling, Baylor's vice president of marketing.
According to the report, only one of the nine systems, Group Health Cooperative in Seattle, placed the communications department head in a direct reporting relationship to the CEO, and that was done in 1992. Six of the nine had one management layer between the department head and the CEO, and one had two layers, the report says.
Three department heads reported being members of some of their system's policymaking and strategic-decisionmaking bodies.
Sensitive industry.The more politically sensitive the industry, the more likely communications directors will serve on policymaking groups and sit at the same management table as senior officers for operations, finance, human resources, legal and strategic planning, says the report, which was written by Mr. Heath and Jim Caster, communications manager at Sutter Health. Mr. Heath is a former director of corporate communications for Pacific Bell.
In the late 1970s and early 1980s, prior to and during the breakup of AT&T, phone companies had communications officers reporting directly to CEOs and participating in policymaking, the report says.
Similarly, "healthcare certainly can be defined as a politically sensitive industry, and all of the systems involved in this study say they operate in very sensitive public-policy environments," the report says.
In terms of department structure, Mr. Heath likes EHS, which is centralized in that one department produces all formal communications materials, yet staff are located at regional facilities. The managers of those facilities assist with staff evaluations. "It allows the organization to speak with one voice, puts personnel closer to their customers so they can be more responsive, and prevents the system from becoming overly bureaucratic," Mr. Heath said.
Mr. Heath conducted the survey on his own time. He plans to do follow-ups by polling more systems and using a computer spreadsheet program to collect and analyze data. "This is something that's going to benefit all of us," he said.
The report was discussed publicly for the first time last month at the American Hospital Association's Society for Healthcare Marketing and Public Relations conference in Orlando, Fla. It's available by contacting Sutter Health at 2800 L St., Sacramento, Calif., 95816; 916-733-3823.