Hive Health

Why is an enormous pencil case resting on my stack of clinicals? Got a few pitches on. Here is how I work in times like these:

1. Learn about the disease area. That means patients. I read blogs, make notes, and try to speak to as many actual patients as possible. The point is to imagine the smallest change this product can bring to their lives.
2. Pull up a recycling bin. I think in words, not pictures, but I eschew the laptop in favour of big pens and lots of paper. There’s a widely held belief that no idea should be thrown away in initial stages, no matter how “bad”. I can’t work that way. If it makes me cringe, it will never be right.
3. Keep books around. Dip in frequently to find words that spark the imagination.
4. Leave. I enjoy having people around me when I’m thinking hard. But I do so love the chocolate mousse cake at Mamas and Papas. It’s surprisingly calm and quiet in their top floor café. You can sit and write for some time. Display a buggy catalogue or similar to avoid suspicion.
5. Collaborate. This is really obvious. I like to work alone first, then share ideas with everyone else.
6. Nourish.  I am into Cadbury’s Fingers right now. Suck for a slow release of energy into the mucosa of mouth and tongue. Place a few within reach and use with care – I almost ate a pen lid today.
7. Go to bed. To get new business, you must produce really good work while managing the usual workflow. I need my brain to razor through daily tasks while it’s unconsciously creating. Getting loads of sleep keeps my cognition snappy. And proper sleep is the best substrate for those little ideas.

 

Sitting down this week with a group of nurses led me to give some thought to the types of work they do and the role they have.

Nurses have long been considered the ‘touchy feely ones’, with GPs dealing with the pragmatics of  prescription and referral. As the UK system evolves it increasingly requires a different, more-doctor-like-nurse, with changes in responsibility, remit and patient influence. Resulting in less time to do what is often considered a foundation of nursing – care. Alongside this evolution, sits a fundamental patient requirement to still have ‘caring’ held high. I believe we still need to place value on someone who is willing to sit and explain what we have missed, didn’t understand or are just worried about. It strikes me that these two requirements can be often at odds.

Our role as communications guys needs to evolve to help bridge this divide between the demands of the structure and that of the patient. In the old days it was enough to target this group as an advertising audience, whereby we would fight for share of voice in the b2b journals. We spent time defining key messages, and shouting them, thinly veiled ad ideas, carrying key messages, kept front of mind, alongside a hope that they would somehow be spewed up during the all important consultation.

In this new world, we need to leap forward and try to understand them not as consumers of journals, and message parrots, but as partners and conduits to driving a better patient experience. This requires a very different approach, and a need to evolve from top down parasitic paternalism to sharing values of partnership, respect, and mutual understanding. I think we  need to ask ourselves - how might our brands catalyse their talent? Rather than how best might we use them to our advantage.

Antiretroviral therapy (ART) can extend the lifespan of people living with HIV. Highly active versions of ART medications have even been shown to prevent progression to AIDS. However, these medications are only effective if they are taken as prescribed. Unfortunately, adherence to prescribed ART regimens is poor. The consequences of these poor adherence rates are significant – patients with HIV who have been non-adherent are more likely to progress to AIDS, even if adherence subsequently improves.

Non-adherence is complex and multi-determinant, and is frequently intentional amongst patients with HIV. Barriers to compliance that are consistently reported by patients include: “don’t understand treatment and/or suspicious of medication”. This suggests that a communication-based intervention designed to demystify HAART medications, i.e. to improve patients understanding of their medication and of the consequences of non-adherence, might improve adherence. Indeed, this has been shown to be the case. I believe any successful intervention will involve a significant component of peer-to-peer communication, as opposed to being reliant solely on doctor-disseminated materials. Communications technology is advancing at an unprecedented rate (see our twitter account), and the scope for peer-to-peer communications is massive.

Patient choice is a hot topic in healthcare, so it was interesting to review the latest clinical guideline from NICE: Medicines Adherence and Patient Choice 

Hive’s focus is patient-centric communication, but we don’t claim to have all the answers on the perplexity of patient choice. It’s a tough one for NICE too, who admit that there are gaps in evidence-based learnings. I picked up on a more basic disconnect – NICE’s policy is one of optimal Adherence, but it is Choice that underpins any behaviour. So, more patient choice infers that adherence is optional rather than optimal.

Patient choice embraces much more than adherence. How the two fit together might go like this: more honesty and understanding between doctors and patients leads to shared decisions about treatment. This increased choice translates into a prescription that is handed over with the mutual assurance that every item will be taken as prescribed. Less wasted medicines and consultation time, arguably better health outcomes for individuals.  

Can this happen when medicine and humans are an unpredictable mix? Not only do people respond differently to treatments, but our choices change from moment to moment. We try things, get a result, forget what it was that gave us that result, and start from the beginning. We’ve only our own bodies to give us feedback, and sometimes that feedback isn’t clear enough to justify repeated behaviour.  

Still, people like the sound of choice, at least in theory, and NICE outlines the many ways that doctors can improve at delivering that right. The guidelines are a step in the right direction, albeit a giant leap from current practice. Eyes will be rolling in surgeries at the thought of fitting more whys and hows into a standard consultation.

Of course, the real mental shift lies not with providers but with users. NICE has not yet issued patient guidelines on choice, and whether or not they do, every patient must find out for themselves what choice really means and how to play it out. I often politely accept a prescription knowing I’ll never fill it. I think I would be braver in talking to the doctor about this if I had proof that there is value in doing so.

 We need a bit of genius to get this right. Let’s teach kids about choice: how to visualise the results of actions, verbalise the decision and analyse the outcome. What else – any ideas?