Questions Are The Answer

AHRQ/Ad Council Case Study  May 2007

Campaign Summary
 Summary: “Questions Are The Answer”
100,000 people die each year as a result of medical error. How do you motivate people to get
involved in their health care so that they can avoid becoming part of that statistic?

What if they don’t know much—or anything at all—about medical error or the likelihood that
they will encounter it in their lifetime? And what if their instinctive approach to health care is
to sit back and let the doctor figure it all out? And how do you create a sense of urgency for
people to act, without demonizing the medical community?

The “Patient Empowerment” campaign initiated by the Agency for Healthcare Research and
Quality (AHRQ) and sponsored by the Ad Council presented some difficult questions.
Questions that required thoughtful background analysis and insight mining—and ultimately a
balancing act between inspiring patients to act and preserving physician support of a national
health care initiative.

“Questions Are The Answer” creates a simple and upbeat dialogue that catches people’s
attention. It arms patients and caregivers with a means to engage medical professionals and
enable better care. Most importantly, preliminary research suggests that the campaign has the
power to help chip away at that 100,000 figure.
Background
 The 100,000 Lives Campaign

A 1999 Institute of Health report estimated that up to 98,000 people die in hospitals each year
as a result of preventable medical errors. That’s more than those caused by feared threats such
as motor-vehicle accidents, breast cancer and AIDS combined.

Who is at fault? Doctors? Nurses? Sometimes. Much more commonly, the error results
from faulty systems that lead people to make mistakes or fail to help prevent them. Like
patient records that aren’t digitized and therefore can’t be accessed by ER staff or specialists.
Or same-sized tubing in hospitals for administering oxygen and other gases. Or prescriptions
filled by separate pharmacies that cannot be cross-referenced. These weaknesses in health
care cost hundreds of lives each day.

The Institute for Healthcare Improvement (IHI), a national group of stakeholders from
government agencies and the medical community, decided it was time to take on those
weaknesses. In December 2004 the Institute launched its “100,000 Lives” campaign with the
goal of affecting systemic change that would save 100,000 lives by July 2006.
 Patient Empowerment

The Agency for Healthcare Research and Quality (AHRQ) saw another opportunity to
improve patient care. As the lead agency within US Department of Health and Human
Services with the mission of improving the quality, safety, efficiency and effectiveness of
health care for all Americans (and a member of IHI), it recognized that patients themselves
were a key line of defense.

To fortify the institutional efforts of the 100,000 Lives Campaign, AHRQ sought to help
patients by teaching them to help themselves. The agency’s research suggested that patients
who were more involved in their own care had a higher rate of positive outcomes. AHRQ
teamed up with the Ad Council. The “Patient Empowerment” campaign was born. Its
objective: To combat error by encouraging people to be more active and to speak up.
Insight
 What We Did

To start, we wanted to get a sense of what people knew about medical error, how they
approached health care in general and what sort of language they used to talk about it all. Our
exploratory research covered a wide spectrum of health care users. Men and women. Moms
and dads. Caregivers. Low-income adults. Caucasians, African Americans and Hispanics.
Plus all of the above age 65+. Some we talked to within small focus groups. Others we met
one-on-one in their homes so that we could take a closer look into their lives, how they
organized their health care information and how they kept track of prescriptions. Across the
board, we sought to uncover how we could inspire all these people to answer AHRQ’s call for
“patient empowerment.”
 Isn’t That My Doctor’s Responsibility?

Unfortunately, it turned out that people had little interest in participating in their own care.
Most patients preferred to be passive. Really passive. Few took notes or made lists of
questions in advance of doctor visits, and fewer still took it upon themselves to share pertinent
information with their doctors. They assumed that everything their doctor needed to know
was “in the chart.” And many held back on asking questions they did have—some because
they didn’t want to waste the doctor’s time, others because they were afraid of offending him.

When it came to the subject of medical error, people were overwhelmingly uninformed, save
for three respondents who related horror stories of doctors cutting off the wrong leg or
removing the wrong paired organ. No one had any real sense of what “medical error” was, let
alone that their chance of personally encountering it was roughly 25%.

Patients aren’t looking for “empowerment”—or even more involvement.

They’d rather sit back and assume that “doc knows best.”
 Just The Facts

What did seem to arouse the people’s attention were hard-hitting medical facts and statistics.
Whether they were young, old, male, female, healthy or ill, people took notice of the 100K
statistic. Additionally, the idea that doctors aren’t omniscient—and that patients need to clue
them in on their personal health developments—was compelling. So was the scary, but often
completely disregarded, notion that if you can’t read your doctor’s handwriting on a
prescription, there’s a chance your pharmacist will get it wrong.

Suddenly, we had it: All we needed to do was to scare people into putting a little more effort
into their interaction with health professionals. And we had some poignant statistics that
could carry most of the load for us. Time to write that killer brief.

Consumer research seemed to point toward a classic fear appeal:

 The threat is legitimate
 The target is vulnerable to the threat
 There’s a solution to the threat
 The solution is actionable by the target
 But We’re In This Together

Not so fast, said doctors. (And, truthfully, two or three of the more insightful patients.)
Physicians are part of the solution here. And playing to patient fear may demonize the
medical community.

They had a point. It’s hard to blame what is difficult to conceptualize (the medical system);
so, when patients hear “medical error,” they naturally think “doctor error.” The physicians,
nurses and pharmacists who were working hard with the IHI on systemic solutions to medical
error deserved a more positive approach.

Besides, the most effective tactic, in the long run, would embrace collaboration. We needed to
help patients understand that their involvement in the process is not only imperative but is
welcome among medical professionals. Now we just needed a great hook to get that idea
across.
Strategy
 The Target Audience
Relying on donated media, we cast a broad
All Health Care net while tailoring our message toward those
System Users we could most affect:

 Broad target: The 25 million+ adults

Heavier Users— who use the health care system.
3+ Interfaces/Year
 Narrower target: Heavier users—
because the more a person uses the
medical system, the more likely (at least
in theory) that person is to benefit from
the campaign.
Parents and
 Core target: Mothers and adults caring
Caregivers for elderly parents—because doing for
others was often more motivating than
taking better care of oneself.
 Starting A Dialogue

The right communications “hook” would create a bridge and conversation starter between hesitant
patients and information-dependent medical professionals.

Patients & Caregivers The Medical Community

 Want the very best health care
 Want to feel informed
 Want to start a dialogue
 Don’t want to become experts
 Don’t want to threaten or insult
 Want to be part of the solution
 Want to be respected
 Need patient information
 Want more engaged patients
 Don’t want to be demonized

Best Route To Engagement:

Questions
 Questions Are Powerful Medicine

Why questions? Exactly.

Thoughtful questions require both patients and medical professionals to ramp up their
engagement in the process, creating a win-win situation. And most of the people we talked to
had plenty of them. They just weren’t getting around to asking them.

To leverage the power of questions to help patients navigate the “what ifs” of medical care
(without dramatically referencing error), we crafted a hard-hitting strategic platform: The
most important question is the one you should have asked.

The creative articulation of the idea was simple and indisputably memorable: Questions are
the answer. We adopted an upbeat tone (best showcased in an over-the-top television
commercial) that made questions the hero in the patient-doctor relationship.

We have high hopes that the campaign will make an unquestionable difference.
Execution
 “Questions Are The Answer” Web Site

Core to the effort is AHRQ’s

patient empowerment Web site,
where patients can learn about
medical error and find out how to
improve the quality of their health
care. Consistent with the
advertising, questions are the
site’s main theme.

A “Build Your Own Questions

List” feature helps patients and
caregivers customize a list of
questions relative to their specific
health care needs.
“Questions Are The Answer” Advertising

The creative executions—including TV,

radio, print and Web banners—
encourage people to visit the Web site so
that they can find out what ten questions
every patient should ask.

When possible, executions serve up

examples of common questions many
patients could use in their own health
care interactions.
Impact
 Impact

Once completed, the campaign endured research and a rigorous approval process that included
input from AHRQ, patients and the toughest critics: Physicians, nurses, medical assistants and
pharmacists. In the end, stakeholders on all fronts of the “questions” paradigm agreed that the
campaign was one that they could get behind—and one that would inspire them to
communicate better.

Campaign production wrapped in mid-March of 2007, so feedback and statistics are very
preliminary. However, by early April, the TV spot had been picked up to air in over 50
markets. And in the month of April, the special Questions Are The Answer site received
15,730 page views, with over 10% of those visitors clicking through to the “Build Your
Question List.” At that rate, we’re confident that this offshoot campaign will do its part to
chip away at medical error.