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Apr 1999

PR is good for your health

Tim Burns, Test Research, outlines how PR made a difference for the National Health Service

Tim Burns

Editorial coverage in the media can benefit your brand, or it can harm your brand, but it cannot be ignored. Indeed, for many organisations, it can be the only medium available to promote their messages.

One of the most successful practitioners of the art of media 'spin' is the Virgin Group. Virgin has gained, and occasionally suffered, from the publicity flair of its founder. We first measured the power of the Virgin publicity machine back in 1996, when we looked at publicity surrounding the announcement of Richard Branson's first (of many) plans to circumnavigate the globe in a hot air balloon.

Over three days in June 1996, the media coverage he obtained amounted to around 57 GRPs-worth of free publicity in the national press and, within a week, a quarter of the population was aware of his proposed trip. Furthermore, we found an astonishingly high correlation between levels of exposure to media coverage of the trip and awareness of his plans.

There can, however, be a downside to such media attention and for Virgin it came later, in fact at the time of the 1998 Labour Party conference. After a few Labour MPs were delayed on their train journey to Blackpool, the media were full of criticism of Virgin Rail. This was noticed by 53% of adults – with 5% even claiming to have heard Branson swearing in an interview on TV.

The effect of PR on the NHS

Frank Dobson may not be in the same league as Richard Branson when it comes to media spin, but the brand he is responsible for, the National Health Service, does have a substantial media profile. Not only is the NHS the largest organisation in Europe, but it is one of the best known and best regarded in Britain. It is one brand that can truly claim to provide a service from cradle to grave.

In recent years, however, financial pressures and seemingly endless reorganisation have had a debilitating effect on what might be termed NHS brand values. With a proliferation of independently managed hospital trusts, GP fund holders and health authorities, the perception of the NHS as a uniform national 'brand' has taken something of a battering.

The management of the NHS (the NHS Executive) was anxious to revitalise the NHS 'brand' and to position the NHS, not as a relic from the past, but as a modern organisation, central to the lives of people in Britain, and ready to meet the challenges of the next millennium. 1998, the 50th anniversary of the founding of the Health Service, provided a good opportunity for the promotion of these attributes.

Financial and PR considerations meant that an advertising-led programme was a non-starter (envisage the headline: 'Nurses pay for Saatchi ad campaign'). By contrast, the stature of the NHS and media interest in its activities made a PR-led programme particularly feasible.

Although one objective of the anniversary programme was to involve NHS organisations and staff at the local level, much of the impact of the campaign came from coverage in the media. To evaluate the success of its campaign and to provide guidance on how to improve future communications activities, the NHS Executive commissioned Test Research to undertake an integrated communications assessment.

Traditionally, PR has been assessed by media evaluation, which has tended to concentrate on output measures such as the slant and content of media coverage achieved. However, in its evaluation for the NHS, Test Research used its media evaluation system to link output measures to outcome measures – in other words, to see how exposure to differing mixes of media coverage affected audience reaction.

We did this by linking media content analysis to industry audience data (NRS, BARB and RAJAR) to determine variations in exposure to different messages and message slant by audience groups. These output measures were then linked to our PRTrack tracking research to measure take-out, shifts in public attitudes and the link between these and message exposure.

A popular subject

Media coverage of the Health Service is considerable. Between January 1998 and the end of August we estimate there were over 53,000 articles in national and local newspapers covering the NHS. Using its media evaluation system Test Research read and analysed a sample of over 15,000 of these articles and a further 571 broadcast news items. The print coverage alone gave the average adult 185 opportunities to read something about the NHS during this eight-month period.

In the early months of the year, little coverage was directly related to the anniversary or indeed to the underlying themes of modernisation and value that the NHS wished to promote. Rather, the media were following their own agenda, and coverage was generally critical, concentrating on negative stories of waiting lists, inadequate funding and low pay. Bad news sells and if you think agency creatives can be a little prickly, spare a thought for the press officer trying to cajole a cynical journalist into taking a more positive stance on bed shortages in a children's ward.

As the 50th anniversary approached, public exposure to media coverage of the NHS increased in response to the campaign – with exposure peaking in the weeks surrounding the actual anniversary date (5 July). The slant of media coverage also improved markedly as the anniversary date approached (see Exhibit 1). More detailed analyses of the content of such coverage showed how the subject matter also shifted as the anniversary approached. The media began concentrating less on weaknesses in the organisation and performance of the NHS and more on its historical contribution and its plans for the future. Public exposure to media articles extolling the capability of the NHS and its central role in national life grew substantially.

Not only was the public exposed to more (and more positive) coverage, but people were also conscious of this change in the media's stance. The proportion of the public who could recall reading something about the NHS in the press rose from 29% in January to 50% in August. At the same time, they seemed to notice the more positive vibes coming from the media (Exhibit 1).

Our analyses also showed that top-of-mind awareness of the anniversary grew in direct proportion to the public's exposure to media reporting of the anniversary. Until late June neither the media nor the public were paying much attention to the anniversary, but at the end of that month media coverage increased sharply, boosting public awareness (see Exhibit 2).

When we looked at the peak period of media coverage (late June), we found a close correlation between levels of exposure to media coverage and recall of that coverage, by both gender and class. Men and upmarket groups were more likely both to have been exposed to coverage and to recall having seen it. They were also more likely to be aware that 1998 was the 50th anniversary of the NHS (by July, 76% were aware of this when prompted).

However, the same pattern did not hold by age (see Exhibit 3). Younger people were exposed to similar levels of coverage as their elders, but had much lower recall of such media reports and much lower awareness of the fact that 1998 was the anniversary year. The results seemed to confirm other findings highlighting low levels of interest among the young in the Health Service and the need for the NHS to adopt a more proactive approach to such groups (particularly given its current recruitment needs).

Such variations in 'take-out' by age are consistent with other findings that demonstrate the extent to which individuals are selective in what they pick up from the media. As one might expect, consumers are more likely to notice and recall issues that are of interest and relevance to them. Certain subjects – nurses' pay, waiting lists and increased funding – were consequently more likely to be recalled than other subjects such as the re-organisation of the Health Service, despite the latter generating greater coverage and exposure.

With these 'popular' subjects, however, there did seem to be some correlation between the date of media coverage and the date of public recall (see Exhibit 4). However, the correlation was not with the absolute level of exposure, but with each topic's share of exposure. In other words, if the topic (say, waiting lists) was one of a limited number of health issues being covered at one time, then people would be more inclined to recall seeing it. If, however, the media were full of health stories then there seemed to be a lower correlation between exposure and recall.

EXHIBIT 4: PUBLIC RECALL OF NHS COVERAGE vs EXPOSURE

At the bottom line, the campaign did have an effect. Not only did the slant and pattern of media coverage improve (even waiting lists were getting positive coverage by August) but public attitudes shifted, and in line with the improved media coverage. At the end of the anniversary campaign, more people were inclined to see the NHS as running the Health Service effectively, and there were big improvements in public perceptions of the attempts being made to reduce waiting lists.

Perhaps most startling, however, was the considerable improvement in overall brand image. One would normally expect a broad measure such as overall satisfaction with an established brand to be relatively stable in the short term. However, satisfaction with the NHS shot up in late June (the period of peak coverage) and, although it declined subsequently, satisfaction levels appeared to have stabilised at noticeably higher levels than they had reached previously (see Exhibit 5). And all without a single penny being spent on advertising.

EXHIBIT 5: OVERALL SATISFACTION WITH NHS

Obviously the NHS is an exceptional case. Few organisations would have the limitations on advertising faced by the NHS, its media profile, or the opportunity to capitalise on such a significant anniversary. Marketing for most organisations comprises a mix of above-the-line and below-the-line communications, but in the past marketing communication has been dominated by advertising.

Where marketing has led, research has followed, and the bulk of research spend and innovation has been devoted to the measurement of advertising effectiveness – and particularly to the measurement of TV advertising. Advertisers have been inclined to assume that any shift in brand imagery or brand disposition must be an advertising effect. PR and other communications have tended to be seen as peripheral activities, undertaken merely to support the advertising campaign. Even the PR industry has adopted advertising value equivalents as a core measure of PR effectiveness. Could one envisage an advertising agency measuring its success in terms of editorial value equivalents?

But time moves on. With the growth of niche marketing and fragmentation in the media, advertising will be forced to yield a greater proportion of the marketing budget to other forms of communication. The research industry is beginning to adjust to this shift in emphasis but tracking research remains unhealthily fixated with the 30-second commercial. The weakening of advertising dominance can already been seen, even in sectors that spend significantly on TV and other forms of advertising.

This shift was demonstrated in a small study of retail communications undertaken by Test Research in the run-up to Christmas last year. In this study we used our new integrated communications tracker, Through-the-Line, to evaluate the effectiveness of the communications activities of three major grocery chains – Asda, Sainsbury and Tesco. Our study was undertaken in an area of southern England in which Sainsbury and Tesco had the dominant share of the grocery market. Asda was, however, a significant advertiser.

We found that advertising for all three retailers was fairly prominent, although unprompted recognition of Asda's contribution was significantly lower than that for Tesco (the Baby Jesus ad).

As one might expect, given relative market shares, Asda's share of 'word-of-mouth' communication was on the low side. When it came to PR recall, however, Asda had a noticeably larger share than the competition (see Exhibit 6). And who was it that people felt they were hearing more about recently? Not only was Asda the store people were conscious of hearing more about, but on our disposition scale it was the store people would most like to try.

A small-scale study and by no means a completely conclusive result, but an indication that we all need to think more about the relative effectiveness of the different communications we use – and about our ability to measure these effects.

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