Talking risk: how to communicate health outcomes to non-health economists

You’ve scrutinized the data, crunched the numbers and arrived at a solid risk assessment. But how do you communicate that information so that great-aunt Betty can decide whether to take your drug for her heart condition?

While other health economists understand you when you talk about the probabilities, costs and benefits of a particular outcome, it’s a different picture when it comes to a math-phobic general public.

So how do you get your message across to someone who may struggle to calculate the price of that shirt on sale for 30 per cent off? Keep the following tips in mind:

1. Express risks in absolute terms rather than relative ones. If patients are told a particular drug doubles their probability of developing liver cancer, for example, many will decide the potential risks outweigh the benefits. But phrase it in absolute terms –2 people in 10,000 who take the drug will develop liver cancer, compared to 1 in 10,000 who don’t take it – and their decision might well change.
2. When it comes to probabilities, frequencies are easier to grasp than percentages, so say “6 in 1,000 people will experience this side effect,” rather than “you have a 0.6% risk.” If you mention several different frequencies, keep the denominator consistent to avoid confusion.
3. Include comparisons to other treatments and to no treatments to help patients make a well-informed decision. If taking a particular birth control pill carries a risk of dying from a blood clot, for example, compare that to the risk of side effects from other birth control measures or the risk of dying during childbirth.
4. Different people absorb information more easily in different ways, so include diagrams to reach visual learners. A pictorial representation of the number of people affected – a Paling Palette© highlighting three human figures out of a thousand, for example – is an excellent way to convey percentages, while line graphs quickly convey trends and bar graphs make comparisons easier. (See issues 11, 12 and 13 of Heath Outcomes Communicator for tips on making the best use of graphics.)
5. Avoid vague language that even other health economists or doctors will have trouble interpreting. How frequently does a “rare” side effect occur? How probable is a “moderate” probability?
6. Similarly, avoid economic language that can convey a very different meaning to Joe Public. To you, “a significant risk” may mean a statistically significant risk, but a non-economist will interpret it to be a highly probable outcome or a risk that carries grave consequences. Similarly, a layperson might believe a “conservative estimate” actually underestimates the likelihood of a particular outcome, while a “positive trend” brings exclusively good news.

Ultimately, patients will evaluate risks and make health decisions based on a number of factors, including many that aren’t rational. That’s not going to change. But by presenting your information as clearly as possible, you can make sure they make a truly informed decision, not one based on misunderstanding or confusion.

How to improve staff morale

Sustaining staff morale is about much more than delivering a wage slip at the end of the month. If the past few years of restructurings, closures, and layoffs in the pharma industry have taken a toll on the office mood, perhaps it’s time for a little shot in the arm.

The following nine-point guide can help you boost workplace satisfaction – and reap the rewards of a more motivated workforce, lower staff turnover, and a positive environment

Know your staff
Some employees are driven by results, others by process; some focus on the big picture, while others love details; some are introverts, and others wilt without lots of interaction. By taking the time to understand what makes each person tick, you can keep them motivated and create the conditions to help them thrive.

Communicate
Closed doors breed rumours and fear, so make a point of keeping everyone in the loop about corporate decisions and impending issues. Make sure your employees know how their work is having an impact. Finally, remember that communication is a two-way street. Ask for input, and take it seriously.

Offer support
When you provide training and mentoring, you’re sending employees the message that they’re worth investing in – and giving them the tools to succeed. Programmes can be formal or informal, in-house or external, just so long as they fit the specific needs and interests of your staff.

Give and get feedback
Employees shouldn’t have to wait for their annual review to find out how they’re doing. Give feedback regularly: praise an accomplishment or nip a problem in the bud before it becomes a big issue. At the same time, ask questions. Are they happy? Is there anything you could do to help them work more effectively?

Recognise good work
Who doesn’t like to be acknowledged for a job well done? Whether it’s an accolade at the weekly departmental meeting, a simple thank you in the hallway, or a formal corporate award, recognition lets people know that their efforts are appreciated.

Crank up the challenge
Boredom creates a breeding ground for discontent, so give your employees work they can sink their teeth into: a new project, for example, or the autonomy to make more decisions.

Tame the bureaucracy
It’s the bane of big organisations and the number one frustration for the people who work in them. You’re guaranteed to make your employees happier by minimising red tape and running interference as much as possible.

Foster camaraderie
Promoting better staff relationships doesn’t have to be touchy-feely or involve clinging to a rope 30 feet above the ground. Rather, it simply needs to get employees interacting in new ways. The better everyone understands one other, the more effectively you can all work together.

Add a spoonful of sugar
Small perks can sweeten the workday. An indoor putting green or corporate concierge may not be in your budget, but perhaps a departmental cappuccino maker is. Or consider no-cost approaches like offering flex time, dress-down Fridays, or an iPod-friendly work policy.

How to participate in or lead a panel discussion

As health economics plays a more prominent role in medical research and public policy, participation in panel discussions – either in front of a live audience or behind closed doors – is becoming part of the job description.

Done well, panel discussions can provide important insights into a topic and can allow the audience to interact with experts with whom they might not otherwise have the opportunity to meet. Done poorly, panel discussions can either devolve into chaotic ponderings or become yet another exercise in didactic drudgery. Here are a few tips on how panel discussions should be held.

If you are a member of a panel:

• Determine the purpose of the panel. Is the purpose to make experts available to audience members (so questions should come primarily from the audience)? To stimulate discussion with provocative ideas? To serve as a point-counterpoint discussion? To arrive at a consensus on a topic?
• Know what is expected of you. Too often, panellists arrive with a full slide set, ready to give their standard presentation. Will you be expected to show slides? If so, how many? Are you expected to make opening remarks?
• Know your fellow panel members. Find out who else will be on the panel, and what expertise they bring, to avoid any surprises.

If you are leading a panel:

• Choose panel members who can effectively think and speak off the cuff. Even though it is not a formal format, good presentation skills are still necessary.
• Prepare your team. Ensure every panellist understands the format – the number of slides to bring (if any), questions they might need to prepare, key discussion points to cover.
• Prepare yourself. Bring your own questions, in case the audience is reticent.
• Guide the audience. Introduce each panellist (more on introductions below) and describe the discussion format. Repeat each audience question and call upon a specific panel member to answer it.
• Stay on message. If taking questions from the audience, discern between appropriate and inappropriate/unrelated questions.

A good panel discussion depends as much if not more on the panel leader than the panel members. The key is to find a panel leader who is willing and able to exert control.

Finally, public speaking is not only about you as a presenter. If you are asked to introduce a speaker:

• Do your homework. Try to obtain from the speaker directly what he or she would like to have said about them. Not all of the information on a person’s CV is relevant.
• Personalise it. Chances are you’ve been asked to introduce the speaker for a specific reason. Try to share with the audience your relationship to the speaker, perhaps sharing a personal story.
• Stay at the podium. Too often we see the host desert the podium before the speaker arrives. It is your responsibility to greet the speaker at the podium, especially as the speaker is there at your invitation. Once the speaker arrives at the podium, shake the speaker’s hand and then step away.

Dealing with the media – confidently

The media can be a powerful vehicle for raising your profile, getting your message out and gaining credibility, but not everyone feels comfortable confronting a reporter’s microphone. If the mere thought makes your palms sweat, take heart. The following tips will help you stay calm and in control during your next interview.

Buy yourself time

When a journalist calls, never feel pressured to answer questions on the spot. Find out what publication or program the piece is for, who the audience is, and what the angle will be. Then schedule the interview for a few hours or days later. Even 15 minutes will give you a chance to collect your thoughts.

Focus on key messages: Take that time to decide what key points you want to communicate. Make them clear and snappy and bring them to life with a few telling examples or statistics. Then rehearse everything out loud until it rolls off your tongue smoothly. Practice does make perfect!

During the interview, don’t be afraid to take the initiative

If the reporter’s question isn’t giving you the opening you want, respond briefly and then segue to one of your messages by adding “I think a crucial point to remember is…” or “the real key to this issue is….”

Relax!

A few deep breaths before you begin will reduce muscle tension.

Worried you’ll forget an important fact?

For a print or a radio interview, keep a cheat sheet handy. And if you don’t know the answer to a particular question, just say so. Similarly, if an answer doesn’t come out perfectly, there’s no need to panic. Unless you’re doing live TV or radio, it’s fine to say: “I did a poor job of explaining that. Let’s try it one more time.” If you are live, a good trick is to say “in other words …” and then rephrase your response.

Duck the difficult questions

When a contentious question comes up, avoid it with a smooth segue. Briefly explain why you’re not prepared to respond:

• “That’s outside my area of expertise”

• “I don’t feel comfortable speculating on that”

• “I can’t comment on that because of confidentiality issues”.

Then follow up immediately with a phrase such as “but what I can tell you is…” or “but the point to stress is…” and return to one of your key messages. Voilà – you’re back in control!

How to be a more effective public speaker

A frequently overlooked professional skill – especially among scientists – is public speaking, yet the inability to effectively communicate your work can place significant roadblocks in your career.

Here are some ways to remove those blocks:

1. Be prepared. It is your responsibility as a speaker to ensure that all of the equipment works (ie, laptop, laser pointer, lights, PowerPoint program and any animations or video clips within the presentation). You should also view the room layout before your presentation, including walking around the room to ensure all attendees will be able to see and hear you.
2. Practice. One of the most egregious errors public speakers make is going over the time limit. Practice your presentation and be sure it can be done within the allotted time, allowing for questions when appropriate.
3. Introduce yourself. An effective way to gain control of your presentation is to write your own introduction. Supply the person introducing you with the information you wish to be said about you.
4. Record yourself. Most of us don’t realise our speaking idiosyncrasies – the unconscious ums, ahs, and okays, and other nervous ticks or “space fillers” we use. Record yourself giving a presentation to hear which one(s) you use. Only when you recognise them can you begin to eliminate them. Videorecording can show you the physical tics.
5. Watch others. Make notes when you watch other presenters – even news reporters on television – about your likes and dislikes of their presentation skills.
6. Take a public speaking course. There are numerous public speaking courses available. One of the most well known is Toastmasters International, which uses a step-by-step programme to help the speaker address such skills as use of visual aids, vocal variety, and organising a presentation. Each speaker is given constructive criticism in a supportive environment. Toastmasters is available in 90 countries.

* Mary Gabb is a past President of her local Toastmaster’s club. Toastmasters is a nonprofit organisation.

The power of emotional intelligence

When the Harvard Business Review published an article on emotional intelligence several years ago, it attracted a higher percentage of readers than any other article published in that periodical in the last 40 years – and the pace of growth continues. This year The First International Congress on Emotional Intelligence will be held in Spain [19–21 September] and the Sixth World Summit will be held in South Africa [10–12 September].

The increasing recognition of the power of emotional intelligence is global and illustrates its importance in business, where it’s said to help communication, self-direction, problem-solving, learning, creativity, and decision-making.

Emotional intelligence is the ability to identify, understand and appropriately use feelings. The term encompasses:

• Self-awareness – knowing your emotions, recognising feelings as they occur, and discriminating among them
• Mood management – handling feelings so that they’re relevant to your current situation and you react appropriately
• Self-motivation – “gathering up” your feelings and directing yourself towards a goal, despite self-doubt, inertia, or impulsiveness
• Empathy – recognising feelings in others and tuning in to their verbal and nonverbal cues
• Managing relationships – handling interpersonal interaction, conflict resolution, and negotiations

Emotional Intelligence has proven a better predictor of future success than traditional methods like the GPA, IQ, and standardised test scores. There now is a considerable body of research suggesting that an individual’s ability to perceive, identify, and manage emotion provides the basis for the kinds of social and emotional competencies that are important for success in almost any job.

Furthermore, as the pace of change increases and work makes ever greater demands on our cognitive, emotional, and physical resources, this particular set of abilities could become increasingly important. Hence the great interest in emotional Intelligence on the part of corporations, universities, and schools which has inspired research and curriculum development throughout these facilities.

Building one’s own emotional intelligence can have a lifelong impact. In corporations, including emotional intelligence in training programs has helped employees cooperate better and become more motivated, thereby increasing productivity and profits.

Big Brother may be reading your emails

Billions of emails are sent each day round the world. What most people don’t realise, however, is that email is like a postcard; it can be read by anyone who knows how to access email as it travels from computer to computer across the internet, until it reaches its destination. Thus, the sender must assume that his or her emails are being read by others, just like a postcard.

If you need to send sensitive information, such as a social security number (in the USA, or its equivalent in other countries), sensitive company information, or patient records, you should not include it in the body of the email or as an attachment. There are several alternative solutions:

• Encryption. It is relatively safe to send a password-protected, encrypted file via email. However, the filename should not give any information about the contents (eg, Clinical_Trial_Results.doc). If the file is intercepted, the thief most likely would not be able to unpack it without the password, provided the password is strong (more about that below), but you have just informed or confirmed for the thief that the information of interest is right there in his hands, which would make him work all the harder to crack the password. Emails themselves can also be encrypted.
• FTP (File Transfer Protocol) sites. In general, one cannot assume that an FTP site is secure. Even if the FTP site is secure, transfer to the site may not be; an unencrypted transfer can be intercepted. However, most FTP programs allow the user to perform encrypted transfer. Also, even if the FTP site is insecure, one can still transfer a password-protected, encrypted file.
• Protect your liability. You most likely will have seen language in some emails, along the lines of, ‘This email is intended only for the individual to whom it is addressed. It may contain privileged and confidential information…’, asking readers to disregard the message if they are not the intended recipients, and that the sender is not responsible for any damage caused by sending the email. Check with your institution’s legal department on appropriate language for your emails, which may vary by department.

Use a strong password
Passwords are increasingly susceptible to cracking, but if carefully crafted, they can make it much harder to decode. Microsoft recommends using a password that has eight letters minimum (preferably 14), mixing upper and lower case letters, including at least one number and also, preferably, a symbol. People often use variations on their own name, a pet’s name, or their children’s name(s). However, the password should not contain a word that can be found in the dictionary. Examples of weak and strong passwords are:

• Weak passwords: Fluffy, MyName
• Strong passwords: FluFfy!115, Hamp1on#723

Passwords are most often stolen through ‘phishing’ (ie, an email containing links to fake websites that appear to be legitimate websites, for the purposes of harvesting passwords) and ‘social engineering’ (a collection of techniques used to manipulate people into performing actions or divulging confidential information). In fact, a password is more likely to be phished than cracked.

Patient confidentiality
It’s important to maintain confidentiality of patient records, even if those records are pseudonymised or anonymised for health economics research. Both the American Medical Association and the UK General Medical Council have stated that patient records transmitted electronically fall under the ‘doctor-patient confidentiality’ agreement, and so need to be protected.

If all else fails, remember to close/lock your computer screen when you leave your office!

Giving and taking feedback

Somewhere inside all of us is the desire to be ‘good’ and to be liked. And, as a result, we may find we shy away from taking criticism (either positive or negative) and likewise get nervous about how to give criticism. Some of this nervousness is undoubtedly due to the very word ‘criticism’; it conjures up feelings of blame and failure. If the word ‘feedback’ is substituted for criticism, the whole thing almost immediately feels better and less confrontational.

Learning to both take and give feedback is an essential part of any job; these tips will help you examine both parts of the exchange and make the process less daunting and more effective.

Giving negative feedback

• Always try to resolve any issues face to face, in a quiet and private space – preferably in the space/office of the person whose work needs improvement – as this will make them feel more at ease and less threatened.
• Be calm and controlled; never let anger enter into this exchange.
• Give a clear message of exactly what is not working and what can be done to improve it. Be specific about the change or result you want and involve the person in thinking through solutions.
• Never criticise the person, only the work or the behaviour; and empathise as much as possible.

Positive feedback

• Giving positive feedback is as important as giving negative feedback and needs to be done in much the same way; don’t let emotion enter into the discussion and be clear about what was done well and why.
• Don’t give too many compliments too often otherwise their value will be diluted and the act may become suspect.

Taking negative feedback

• Try to focus on the issue and not the person or behaviour of the person who is giving the feedback.
• Make sure you understand exactly what is being said and take a moment to analyse it in your own mind.
• Don’t argue with the criticism and collect your feelings after the meeting. If you feel that you have been unfairly criticised then re-schedule a follow-up meeting to resolve this.

Accepting compliments

• Accepting a compliment means working out what the compliment is and demonstrating that you have understood and received the message.
• Don’t be coy and respond with a flippant statement which will only de-value and possibly offend the person giving you the compliment.

Candid feedback helps growth; if we are off track a little, or an employee of ours is, then the right kind of feedback can quickly re-route things. The more your career advances, the more your job should involve helping others to develop; knowing how to do it well increases the likelihood that it will be acted on and that you will be liked.

Bridging cultural gaps

There is an increasing need for all of us to develop strategies for dealing with different cultures as business becomes more international and cross communication among different disciplines increases.

Liaising with colleagues from different cultures and backgrounds can become a large part of many jobs and is often a demanding task – working inside multi-cultural teams needs skill and sensitivity. Very likely there are simple language barriers, different communication styles and contrasting etiquettes. For example, in many Eastern cultures it’s polite to copy executives in on all emails, while in the US this might be viewed as irritating because it creates clutter.

The first step in bridging cultural gaps is to understand ourselves; none of us are neutral observers, we all have ingrained prejudices and preconceptions of our own. This is part of the influence of our own culture. We should try to identify and be aware of what constitutes ‘normal’ behaviour; what are our values? How do we see the world? What kind of behaviours and preconceptions in social and business settings do we regard as the norm?

Next, we need to attempt to understand the factors that have determined what our counterparts in different countries regard as the norm, from factual to attitudinal to behavioural (for example, certain particular economic factors will influence attitudes and this will shape the behaviour of the culture). This demands careful analysis – it can help to think about the attitudes which you and others are likely to have to factors such as:

• time (e.g. how important is punctuality and sticking to deadlines?);
• truth/openness (e.g. what are the cultural attitudes towards honesty, right and wrong?);
• relationships (e.g. how are other people regarded, such as those who are older or senior, younger or junior etc?);
• communication (e.g. are there particular etiquettes, does the culture demand frankness or the converse?)

Whilst all of us will see these factors in different ways to some extent, people from the same cultural backgrounds generally exhibit similarities in their cultural assumptions and attitudes.

The third step is to know how we are seen by others and the last is to learn to adapt, whilst remaining true to our own values.
It really does help if we make a conscious, non-patronising effort to alter our communication styles if we are to work effectively with people from other cultures. Since English is now the international language, thinking about how we can adapt our native tongue to help non-English speaking colleagues can be a great way to start.

In praise of eloquence

Calliope (one of the nine daughters of Zeus and Mnemosyne) – the Muse of epic poetry and eloquence

By David Woods (dwoods@rxcomms.com)

When the body of Shakespeare’s Julius Caesar is brought before the Romans, does the bard have them say “Whodunnit?” No, he has Mark Antony deliver the eloquent “Friends, Romans, Countrymen” speech. And the Roman poet Horace showed his lyrical skill with: “Pick today’s fruits, not relying on the future in the slightest.” Carpe diem. He did not, you will note, say “Have a nice day.”

Not only has eloquence departed, but so it seems has simple direct speech. And is it any wonder when many university students can’t construct a coherent sentence, and ‘remedial English’ is a regular part of the college curriculum?

Allan Bloom, author of “The Closing of the American Mind,” thinks this is because students have lost the practice of reading; they want to be thought “authentic” by having few cultural pretensions and by refusing to make what they see as “hypocritical ritual bows to high culture.”

This, in turn, says Bloom, is because schools have failed to persuade students to read – let alone to like it. And this leads not only to loss of precision and colour in language, but also to a defensive posture that language doesn’t matter.

Thus, when I’m urged to observe the No Smoking sign or, worse still, to adhere to it… it sinks in that imprecise language occurs when people don’t think first about exactly what it is they want to say. Either that, or it’s a lack of vocabulary that can be papered over by such excrescences as the prevalent and ubiquitous “like,” as in “I’m not – like – into reading.”

Language is the most expressive and subtle instrument of communication that exists. Scientists, however, often sprinkle their language with jargon in trying to show that they’re doing something important. And politicians – who, heaven knows, should be masters of oratory – contribute to the decline of eloquence.

George Orwell, whose prose was eloquently clear and direct, believed that the great enemy of clear language is insincerity. He suggested that political language consists largely of euphemism, question begging and cloudiness.

He gives a wonderful example of the decline of eloquence, starting by quoting the well-known verse from Ecclesiastes: “I returned and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all.”

He translates this into modern English, as follows: “Objective consideration of contemporary phenomena compels the conclusion that success or failure in competitive activities exhibits no tendency to be commensurate with innate capacity, but that a considerable element of the unpredictable must invariably be taken into account.”

Why this decline in eloquence? In part it’s the failure of schools to teach reading and language skills; it’s also the lowest common denominator language of television and, increasingly, of newspapers. I fear that it may also have to do with notions of egalitarianism: that to speak with clarity and verve is somehow elitist or effete.

Part of the solution might be a renewed respect for graceful speech and writing. This will be attained by proper and early teaching, wide and eclectic reading; and perhaps, in the interim, by ridiculing or satirising the sloppy language that is the product of sloppy thinking and that makes for mighty dull listening.

“Talking and eloquence are not the same,” said Ben Jonson. “To speak, and to speak well, are two things.”

nce, starting by quoting the well-known verse from Ecclesiastes: “I returned and saw under the sun, that the race is not to the swift, nor the battle to the strong, neither yet bread to the wise, nor yet riches to men of understanding, nor yet favour to men of skill; but time and chance happeneth to them all.”

He translates this into modern English, as follows: “Objective consideration of contemporary phenomena compels the conclusion that success or failure in competitive activities exhibits no tendency to be commensurate with innate capacity, but that a considerable element of the unpredictable must invariably be taken into account.”

Why this decline in eloquence? In part it’s the failure of schools to teach reading and language skills; it’s also the lowest common denominator language of television and, increasingly, of newspapers. I fear that it may also have to do with notions of egalitarianism: that to speak with clarity and verve is somehow elitist or effete.

Part of the solution might be a renewed respect for graceful speech and writing. This will be attained by proper and early teaching, wide and eclectic reading; and perhaps, in the interim, by ridiculing or satirising the sloppy language that is the product of sloppy thinking and that makes for mighty dull listening.

“Talking and eloquence are not the same,” said Ben Jonson. “To speak, and to speak well, are two things.”