Helen Osborne: Welcome to Health Literacy Out Loud. I’m Helen Osborne, president of Health Literacy Consulting, founder of Health Literacy month and host of this podcast series Health Literacy Out Loud. In these podcasts, you get to listen in on my conversations with some pretty amazing people — hearing what health literacy is, why it matters, and ways we all can help improve health understanding.

Today, I’m talking with David Walsh who is a principal in the consulting firm, SmartLaunch, which is based in Havertown, Pennsylvania. With expertise in strategic and business planning, marketing, and financial management, David helps both for-profit and not-for-profit businesses manage change, maximize opportunities, and launch new ventures.

David recently helped develop a business case for Health Literacy Missouri and launched them as a new, independent, non-profit business entity. David has a lot of experience working with groups. He tells me he is number eight in a family of twelve children. He sure knows how to stand out from a crowd and get heard. Welcome David. 

David Walsh: Thanks Helen, happy to talk with you today. 

Helen Osborne: When I got started in health literacy about 15 years ago, there wasn’t a crowd at all. But now more and more groups and organizations are coming in and getting active in health literacy. Why do we need to consider business principles as we go forth in this work? 

David Walsh: Healthcare is a very big business — a multi-billion dollar operation. Hospitals, healthcare companies, insurance companies and doctors are now thinking much more in terms of the business and the financial side. 

Helen Osborne: So, we need to be thinking like businesses. It is not just enough to know about health literacy and care about it to our core. We have to talk the language of other people making financial decisions. Is that right? 

David Walsh: Yes, I think you need to really talk that language because that’s how they’re thinking. I always like to say you should put yourself in your partner’s shoes and think of how they’re looking at their operation. A lot of these discussions come down to the financial side — it’s really the money that allows hospitals and healthcare organizations to provide the highest level of care, to have the funds to do cutting-edge research, and have the resources to be their best. 

I always like to look at things in these financial terms because that’s how organizations view their business. If you can talk this language and understand their perspectives, you will have a leg up on many other people in the community.

Helen Osborne: Listening to you, I sense an association to what we’re asking of patients and families. We’re asking them to learn the language of healthcare, patho-physiology, treatment, and screening. Are you asking us to understand and work with the terms and language of business? 

David Walsh: Exactly. 

Helen Osborne: Okay, so we have to do something that’s really hard. Can you start us down that path. What are some beginning words and terms we need to know to be a participant in this conversation? 

David Walsh: Some of the words that come up are “return on investment” — what kind of financial benefit or mission benefit these organizations have for making an investment in health literacy. They’re going to have to put dollars out there. But what are they going to see in return? “Return on investment” is something that you’ll hear in any sort of financial discussion. 

Helen Osborne: Does that have an acronym? 

David Walsh: It has, ROI.

Helen Osborne: So we have to not only learn the terms but also those nasty little acronyms. 

David Walsh: You have to learn the acronyms and things like “P&L,” which is “profit and loss.” And profit is not a bad thing. In any business, be it for-profit or non-profit, profit allows organizations to fulfill their mission. It allows them to do what they set out to do. In the case of healthcare companies, it’s to provide higher levels and better levels of care for their patients. So profit is not a bad thing. It’s not a dirty word. 

Helen Osborne: So you already introduced a few different terms. We have return on investments, ROI, profit and loss, or P&L. And you’re saying profit is an okay thing, in fact you need it. And you’re also talking about mission– why people are doing this work. Is that the underlying concept? 

David Walsh: Yes, I think that’s what is so important in the work that non-profit organizations do. It’s really about the mission, whether it be making healthcare more understandable as many health literacy organizations do. Or it’s providing patient care and cutting-edge research. It’s all about the mission – the dollars allow you to fulfill that mission.  

Helen Osborne: You also talked about some structures.  When I introduced you, I talked about for-profit and not-for-profit, also called as non-profit. Can you distinguish between those types of businesses, please? 

David Walsh: For-profit and non-profit — it’s really a distinction about tax regulation. A for-profit operation is set up to benefit the shareholders. A shareholder could be a single person or a large group of people, as is the case of many large corporations. In a non-profit, the excess revenue does not go back to any shareholders but gets invested back into the organization. That is the main difference between the two. Profit in a for-profit goes back to shareholders. In a non-profit institution, it gets invested back in the mission of the organization. 

Helen Osborne: Probably the vast majority of our podcast listeners are working at not-for-profit organizations. But no matter what our business structure, we all need to be mindful of that bottom line — return on investment. 

David Walsh: Yes if you can understand the language of business then you’ll be able to help move your organization forward in a much better way. 

Helen Osborne: You just talked about moving forward. What does that mean — to be moving forward? 

David Walsh: Moving forward is about advancing the mission, making progress, and having greater impact with the various audiences that you want to interact with. It is getting your message out there in a much larger way — reaching a larger number of people that are hearing your message. In the case of health literacy, it’s making healthcare more understandable.

Helen Osborne: Is it ongoing? Will this sustain us if we’re moving forward? 

David Walsh: Yes, I think it will sustain you. I don’t know if you ever get to a specific end point because I think you always want to continue pushing yourself to do better, do more. There are always going to be additional opportunities, additional people to talk to, and additional stories to tell. You are constantly keeping things going. Sustainability is another one of those words that people should understand. Sustainability can mean a lot of different things. In different industries, people are talking about sustainability from an environmental standpoint. But from a business standpoint, sustainability means that the organization will be able to continue because it has the resources. That is, it can pay people to be involved with the organization, pay for marketing, and pay for programs and services. 

Helen Osborne: We in health literacy need to think about this. A lot of people who contact me are excited about health literacy. Maybe they just heard about it, believe in it very strongly, have done something towards it and feel it’s very important. I know there is a gap from that first passion into making a long-term difference. What advice do you have for people as they move forward?

David Walsh: My advice is to create a plan focused around the business side. Say what it is that you’re going to do. Decide what product, service, or program you want to get out there. Decide who is going to get that service. Now you have a program and audience. Then look at how you are going to deliver that service. What do you need to do? What kind of people? What kind of technology? What kind of support do you need to do that? 

And then you need to find ways to fund those resources — coming up with the dollars, revenue to support it. You can find revenue in a lot of different ways. One is through “contributed support” which is private donations, foundations, or research grants.  Or maybe it’s “fee for service” when people pay for your knowledge, expertise, or training programs.   

You want to create a plan that shows you have enough resources to adequately carry out and provide that service, and that it’s sustainable. It’s like your monthly budget at home. If you have more money going out than coming in, over the long term you’re not going to be sustainable. The same principles apply to your health literacy passion. No matter whether you set it up as a separate business or a separate organization, you still need a plan to say what you’re going to do and how you’re going to do it. Maybe it’s to work within an existing organization and provide a plan to your “higher ups” – such as a department within a larger hospital. They want to see a plan as to why health literacy makes sense for them.

Helen Osborne: I really appreciate that. I remember from my hospital days when I first heard about health literacy, I knew that the people I needed to convince were the chief financial officer and the hospital president. Clinicians “got it” right away why health literacy mattered. It would have really helped a lot at the time if I knew these business components. Is having these principles in place sufficient to move forward? 

David Walsh: The other piece that I think you need to move forward is a strong champion — someone you can go to who is really going to help and give an added voice to your cause. You might look for this champion or advocate within some other part of your company or organization, or even outside. But I think it’s important to have someone else voicing support of the program. I think that’s critical. The other part of a good plan is the people — that’s where this champion comes in. 

Helen Osborne: So, it’s not just the “worker bees” but also outside voices giving credibility? 

David Walsh: Yes.

Helen Osborne: Who are the other people that should be involved?

David Walsh: Looking at a typical organization, you need to get people from your marketing department involved because additional exposure is always good. I think having someone from the legal side is important because lawyers can always throw up some roadblocks to any good idea or good program. Get them involved early in the process. And you want to have some finance people helping with numbers. These are some of the key players who need to be involved within any type of organization. 

Helen Osborne: That helps us get started. Now, let’s move this forward. After a program or business entity has the people and plan in place, then what? How do you kind of keep on track as you go ahead? 

David Walsh: You need to look at the key drivers of the marketplace. 

Helen Osborne: That’s another new term. What do you mean by “drivers”?

David Walsh: Drivers are the things that are really important to your audience. One good driver is patient satisfaction. Health literacy can help improve patient satisfaction. From a hospital’s standpoint, one of their goals or drivers (another way to look at a driver is as a goal) is to attain a very high level of patient satisfaction. But if you have patients walking into your hospital who can’t figure out where to go and t get lost or confused, some may walk right out of the door or not get to appointments on time or miss appointments.

If you can create way-finding programs or signage that allows these patients to better navigate the hospital, then their levels of satisfaction will go up. They’ll be happier and might go back to the hospital over and over again. It’s just like in any regular business  that wants to see happy customers. A hospital wants to see happy patients. I think health literacy can help them get there by giving clear communication, better communication, easier to understand communication — so patients feel confident and pleased with their overall experience. And so the driver in this case is patient satisfaction. If your organization can talk that language and say this is how we help improve patient satisfaction, it goes a long away. 

Helen Osborne: I can think of so many different drivers or goals we could have. We can have patient satisfaction, we can have reducing medical errors, we can have reducing dollars or decreasing returned or unplanned visits. I could think of so many different ways that we can have those goals. It almost feels overwhelming. 

What I’ve also learned from watching you work with Health Literacy Missouri is a concept of, I forget the exact word, a kind of shedding of goals. 

David Walsh: That’s right. The terminology I used was “goal sacrifice.” 

Helen Osborne: Goal sacrifice.

David Walsh: It means prioritizing your goals and saying which ones are the most important. Then which ones can you sacrifice at this point given what you want to do? As the outsider coming to help move Health Literacy Missouri forward, there are so many opportunities. That’s what I’ve seen in my work over the last several months with Health Literacy Missouri — opportunities are so vast that you have to really pick and choose which areas, goals to go after. 

One of the other important things in any business is focus. You need to have that focus. Tying back into how to keep things moving forward — you need to have a discussion with hospitals, healthcare companies, insurance companies to see what their top goals and priorities are. A lot of times they’ll have a public strategic plan or annual report that clearly identifies their goals. If you can tie into goals that are most important for these companies and organizations, you’re going to get a lot more attention from their senior people. And that, in turn, allows you better access and potentially better funding and resources.

Helen Osborne: Once we have the plan and goals, how do you know if you are on track and accomplishing the goals? 

David Walsh: That goes back to having a plan. You want to make sure that you have some measurable goals so you can go back and check how you’re doing. Any good plan has milestones and timelines associated with it — what you want to do, by when. So you can go back and say — we said we were going to talk to this many people by this time of year. You should be able to say, “Okay, we achieved that goal.” And if you haven’t, that’s your opportunity to re-look at your plan. 

In the planning work that I do, I always like to see on an annual basis that you go back and revisit your plan. Whether or not you feel you’re doing great or doing bad, no matter what, you should always go back and say, “Okay, here’s what we said we’re going to do a year ago. Now lets see how we did up against those goals.” There is a phrase from the business world, “If you don’t measure it, you can’t manage it.”  All your goals should be measurable.

Helen Osborne: I actually do that for my own business. Even though it’s a small business, I do have measurable goals. I also put myself on a routine. December is the time I look at the year past and plan for the year ahead. Is that a common cycle? 

David Walsh: Yes, it is. Year end is when a lot of companies do their annual planning. I think the important part is getting into a routine, doing that on regular cycle. As long as you are doing it regularly, you’ll be okay.

Helen Osborne: Lets fast forward a year from now. Wearing your business hat, where would you like to see health literacy programs go?

David Walsh: What I would like to see is higher visibility of health literacy. I’m hearing a lot of talk about it at the state level, at various state coalitions. But I think there is an opportunity to get it out on a much broader scale, into more mass media outlets so that people are talking about health literacy.

I compare it to some of the discussions that have gone on over the last year about financial literacy. In this economy, people have said it’s really important to have good financial literacy — to understand mortgage or credit card documents. I think that should be the same for health literacy because of all the healthcare contracts and insurance contracts we sign –we need to understand what we’re doing. 

And I think this year with healthcare reform, however it turns out – there will be a lot more responsibility put on the consumer. If we start to understand that language a lot better, we’ll be in a much better place. I think there is real opportunity to get it talked about on a much broader scale than is happening right now. 

Helen Osborne: Thank you. You’ve put together the drivers, goals, time, vision and mission. I thank you very much for sharing these business principles with us. With health literacy, we cannot just say “I’m just doing a good job, this is important to me, this is important to my patients.” We also have to frame this in a sustainable way which means learning the language of business and using its principles. I thank you so very, very much David.

David Walsh: Thank you, Helen. I really enjoyed this.

Helen Osborne: I learned a lot from talking with David Walsh and hope you did too. But health literacy isn’t always easy. For help communicating your health message, please visit my Health Literacy Consulting website at www.healthliteracy.com. And while you are there, feel free to signup for the free e-newsletter, “What’s New at Health Literacy Consulting.” New Health Literacy Out Loud podcasts come out every few weeks. Subscribe for free to hear them all. You can find more information about each episode along with important links at the Health Literacy Out Loud website, www.healthliteracyoutloud.com.

Did you like this podcast? Did you learn something new? If so, tell your colleagues, tell your friends. Together lets let the whole world know why health literacy matters. Until next time, I’m Helen Osborne.