Robert Fromberg
Editor-in-Chief, HFMA
“They realized the need for a story, complete with enemies and villains.” Bob Woodward, The Agenda.
In 1992, the Clinton administration struggled to communicate its complex first budget plan to a wary Congress and public. Hillary Clinton, according to Bob Woodward, proposed a time-tested approach from the communications professionals’ playbook: tell “a simple story, with characters, with an objective, with a beginning, middle, and end.” According to Woodward, the Clintons believed that story also needed villains.
Another storyteller who uses the heroes-and-villains approach for complex issues is Michael Moore. As I write this column, Moore’s latest movie, SiCKO, has not been released; however, based on the trailer and advance accounts, the hero may not be clear, but the villain is: insurance companies. And no one will be surprised if hospitals are cast in a supporting-villain role for anything and everything from long emergency-room waits to illogical pricing.
From Superman to Star Wars, the heroes-and-villains formulation is successful at rallying an audience. That’s great in a comic book, an adventure novel, or a blockbuster movie. And in an unfortunate way, it works well in politics, simplifying complex issues and motivating voters to support certain candidates and initiatives and defeat others. The unfortunate parts are the oversimplification and emphasis on the negative.
Healthcare executives need to tell complex stories. They need consumers to understand hospital pricing and quality, and to take advantage of community benefits designed to improve health. They need to renegotiate contracts with managed care organizations. They need government to understand the effect of the payment system and to improve that system.
However, the heroes-and-villains approach is terrible for these stories. It may be efficient to demonize managed care organizations or pharmaceutical companies or the federal government. But that ultimately gets us only to a stalemate. There is no point in defeating these groups when the only positive change will come from involving them in solutions.
There is, however, a compelling story line that is suitable for health care. (No, not the fall of the tragic hero.) I once attended a talk by Martha Nelson , the editor of People magazine. She said the issues of People that sell the best have on their covers “ordinary” people who had done extraordinary things.
I call this a purpose-and-passion story. A purpose-and-passion story could highlight people who have overcome obesity or alcoholism, practitioners who identified a mysterious condition, staff who found ways to help people with financial challenges to fund their health care. A purpose-and-passion story even could be told about your hospital’s efforts to create a rational pricing system.
A good purpose-and-passion story doesn’t need a villain. There is a beginning, middle, and end. There is rising action. There is an inspiring conclusion. And the motivating force is all directed toward accomplishing something worthwhile. Now that’s a story line for health care.
