Community Relations and Communication Review

Document Sample
Community Relations and Communication Review Powered By Docstoc
					    Community Relations
Communication Review

Report to Governance and Human Resources Committee

Board of Directors

Vancouver Island Health Authority


January 26 2009
2 | P a g e  
Table of contents

Section 1. Introduction ..................................................................................................................4
   Background ...............................................................................................................................4
   A word on the terminology.........................................................................................................5
   Overview: A challenge that is more than communication..........................................................6
Section 2. Findings: communication unit ......................................................................................8
   Communication activities and the B.C. health care sector ........................................................8
   Communication planning.........................................................................................................10
   Comparison of communication units .......................................................................................11
   News media (print) coverage of health authorities ..................................................................14
   Comments on the communication unit ....................................................................................15
   The role and influence of the communication unit...................................................................17
Section 3. Findings: stakeholder & community relations ............................................................18
   A northern success story.........................................................................................................19
   Building credibility with community allies.................................................................................20
   Comments, and the link to reputation......................................................................................21
Section 4. Conclusions ...............................................................................................................22
   Summary of analysis ...............................................................................................................24
Section 5. Recommendations .....................................................................................................25
   Recommendations: board of directors ....................................................................................26
   Recommendations: executive .................................................................................................27
   Recommendations: communication unit .................................................................................28
Appendix A: List of interviews and meetings ..............................................................................30
Appendix B: Interview questions.................................................................................................32
Appendix C: Best practices rating system ..................................................................................34
Appendix D: Organization charts ................................................................................................35

3 | P a g e  
Section 1. Introduction

                In a sector like health care, which is characterized by finite resources, critical
                outcomes, substantive regulation and strong emotions, communication plays an
                integral role in fostering awareness, understanding, community support and public

                For this to happen effectively, words (communication) must align with deeds
                (actions) – and those deeds must consistently reflect corporate behaviours and
                policy not only in tune with the organization’s stated values and mission, but
                community expectations.

                 It is here, at the crucible of words and deeds, that strategic communication
                functions work best to build organizational credibility and public trust.

                Irvine-Workman was retained by the Vancouver Island Health Authority (VIHA) to
                provide advice and recommendations regarding improvements to the authority’s
                communication activities, and in particular, increased effectiveness in community
                and stakeholder relations.

                Requested deliverables included:
                  A situational review of the communications function, resources and
                  organizational structure within VIHA, and the existing deployment and use of
                  these resources, including a comparative analysis with the communications
                  functions within other B.C. health regions.

                   A review of the effectiveness of VIHA’s external relations activities and
                   recommendations as to how this function could be improved and strengthened,
                   with reference to industry and sector best practice methods and processes, and
                   including a statement of expected outcomes.

                   A comprehensive report describing the findings and conclusions arising from the
                   reviews conducted in the first two points. The report would include a detailed and
                   fully costed work plan together with a realistic timetable for implementation by

                VIHA requested that the review focus on the corporate communication and
                stakeholder relations activity of the authority rather than on service delivery or
                interpersonal contact between health care provider and client.

4 | P a g e  
                A word on the terminology
                Throughout the review, interview participants used a variety of terms, many inter-
                changeable, to describe expectations for and responsibilities of the communication
                unit. These included public affairs, external relations, community relations,
                community engagement, branding, marketing, stakeholder management, etc.

                For the purpose of this report, we have focused on the role communication units
                play in supporting community relations – meaning ongoing relationship building and
                dialogue on common interests, rather than formal project consultation and
                community planning processes.

                VIHA requested a draft report within a very tight timeline of approximately four
                weeks from the start of the project. Research was conducted through:
                   Interviews and/or group meetings

                   Reviews of critical incidents to clarify the focus of communication activities (a
                   means of confirming the information discussed in the previous two points) and,
                   as part of this review, identify any barriers (such as timing, involvement in
                   planning and decision making, financial resources, or staff training or availability)
                   to effective communication and community relations

                   Analysis of media coverage of VIHA and three other health authorities

                   Tracking of planning processes and decision making

                   Review of budgets, organizational structure, job descriptions and related

                   Review of communication planning and tracking materials

                   Review of a report on the communication unit prepared in 2003;
                   recommendations from this report were acted on by the authority

                   Review of the VIHA strategic plan and documentation regarding the role of the
                   board and senior management

                   Gathering comparative information from communication units in the Vancouver
                   Coastal, Fraser and Interior Health Authorities.

                A list of interviews and questions are appended to this report. Due to the tight
                timelines for this project, interviews focused on the VIHA board and senior
                management, communication staff within VIHA and other health authorities,
                representatives of regional health districts, and key partners (foundations and the
                ministry of health).

5 | P a g e  
                Because of municipal elections across the province and other conflicts, some
                elected officials at the local and provincial levels were not available for interviews.

                Interviews were not held with other individuals or community groups because the
                schedule did not provide enough time to arrange meetings with a sufficient number
                that would be representative of all regions in the VIHA catchment area. Securing
                additional input from these individuals or groups is addressed in the report’s

                In total, 43 people participated in the interviews.

                The information gathered in these steps was then analyzed and compared to best
                practices in communication and stakeholder management. Reference was made to
                professional standards (Canadian Public Relations Society and International
                Association of Business Communicators), the consultants’ many years of
                experience in stakeholder relations, and the approaches taught in graduate schools
                of communication, conflict management and business administration.

                Overview: A challenge that is more than communication
                VIHA’s challenge with communication – and by extent, its perceived reputation and
                community relations – cannot be examined in isolation of the context in which it
                operates. Health care regularly ranks with Canadians as one of the top public policy
                issues, along with the environment and the economy. Spending on health care is, by
                far, the largest area of provincial expenditure. And, with a rapidly aging population –
                the plus-85 group is the fastest growing segment of the B.C. population – that
                requires more frequent and more expensive treatment, the pressures on health care
                delivery are probably greater than on any other public service. Specific to VIHA, all
                those interviewed agreed the health care sector is defined by passionate views,
                frequently polarized positions, difficult choices and a highly politicized environment.

                In this climate of heightened public interest and scrutiny, “negative” news can create
                more interest, noise and visibility than positive stories. The distinction between the
                community’s right to be informed versus its ability to provide input or share in
                decision making can easily become confused by both organization and public, and
                subsequently challenged.

                To state the obvious, VIHA operates in an environment marked by conflicting
                opinions, beliefs and values inherent in health care debate. And by its very nature,
                conflict is interactive, interdependent, and never under one person’s (or
                organization’s) sole control.

                Furthermore, VIHA’s world may be characterized by more conflict than most.
                Interview participants easily recited myriad examples illustrating the complexity of
                funding limitations, government authority, expansive geographic reach, diverse

6 | P a g e  
                stakeholder expectations, and competing community interests. All these can work
                against a collaborative environment.

                In this sense, VIHA has less a problem of “ineffective communication” per se, than a
                reality of differing expectations that need to be managed and mitigated through
                responsive communication strategies and insightful decision-making.

                Historically, this has not always occurred. The organization often finds itself caught
                in a repeated and escalating cycle of attempts to contain issues. Not only is this
                exhausting internal capacity, it is dulling belief in and appreciation of public relation
                risks, demoralizing staff, and reinforcing a negative image at odds with much of the
                excellent work and standards undertaken by VIHA.

                A change is required and highly desired both by VIHA and the communities it
                serves. This was underlined again and again by interview participants, and
                demonstrates an organizational and community will for improved relationships.
                There is a general realization that while the community dialogue on health care will
                always involve issues of contention, the common goal of healthy communities
                demands an ability to communicate and understand each other’s point of view in a
                way that leads to increased consensus on actions.

                We contend that the means for doing so involves more than a necessary
                restructuring of the communication function to expand strategic focus, skills and
                capacity. Equally, it involves VIHA’s leadership team. It is imperative that the
                communication unit has a greater strategic role and voice in risk management and
                decision making. This input should be based on strengthened processes to analyze
                and discuss issues, set priorities, analyze risks, and decide on the most appropriate
                responses to various situations. Ideally there should be involvement from, as
                appropriate, the relevant program staff, members of the executive, and the board of

                Change also involves greater outreach on the part of the senior management team,
                supported by the communication unit, in building relationships with communities.

                This report comes to these conclusions by analyzing the approaches of other
                communication units, the fall-out from recent communication incidents, and the
                perception of current activities focused on community relations.

7 | P a g e  
Section 2. Findings: communication unit

                In terms of best practices, communication units have several functions in an
                    At a strategic or executive level

                       Develop and manage the implementation of a strategy aligned to overall
                       organizational goals and values that promote favourable relations between
                       the organization and its key stakeholders

                       Provide an “outside-in” perspective to the board and senior management on
                       how the organization is being perceived by its stakeholders and identify
                       potential opportunities or threats in terms of community relations

                       Using the intelligence mentioned in the previous point, offer counsel to senior
                       management on the reaction of the community to potential actions by the
                       organization; this counsel may argue for changes or cancellation of plans if
                       actions are inconsistent with organizational values, as well as strategies to
                       build community support and acceptance for decisions that are being

                   At a management or tactical level

                       Implement the corporate communication strategy through communication
                       and community relation activities

                       Manage the communication activities related to the potential actions
                       discussed above on both a pro-active and reactive basis

                       Deliver various communication services required by the organization, such
                       as web site management, news scanning, event planning, or internal

                An analysis of the ability of the unit to deliver these services is provided in this
                section, where the focus is on structural, staffing, and resource factors, and in the
                next section, where the focus is on the relationship of the unit to VIHA’s senior
                management and the role of the unit in executive decision making.

                Communication activities and the B.C. health care sector
                Comparing the communication unit to the best practices listed above requires an
                understanding of the unit’s relationship with the ministry of health and any
                constraints placed on it in terms of expectations, policies or resources.

8 | P a g e  
                In British Columbia, all communication units of health authorities operate according
                to a protocol developed with the provincial government. This protocol clarifies the
                roles of the ministry and authorities in explaining provincial health policy and
                coordinates the delivery of health care-related information to the general public. It
                provides for a close working relationship, with the authorities keeping the ministry
                updated on all communication-related activities, and the ministry providing guidance
                and approvals on communication activities.

                Also influencing unit activities is the very complex health care environment with
                active public interest groups, high levels of media interest, and differing points of
                view regionally. These factors reinforce the tendency towards a short-term, issues-
                focused unit.

                Reflecting these realities, communication units focus on public affairs (media
                relations, issues management and government relations) and communication
                services (web, visual identity guidelines, writing and design, event planning, etc.).
                Other communication activities, such as community engagement, internal
                communication or promotion of specific programs fall outside the ministry’s protocol.
                Given this, it is unrealistic to expect a change in the protocol’s emphasis on public
                affairs and issues management.

                An important question to ask, however, is if a communication unit can provide both
                public affairs and community relations at the same time. The short answer is yes,
                with appropriate leadership and sufficient resources. The longer answer is still yes,
                but with the qualifications outlined below.

                Health authorities are very lean in management resources and budgets, with the
                bias always being to focus spending and staff time on delivering front-line health
                care services. Public attitudes towards health care spending reflect this point of view
                and are very critical of any spending on “overhead” in lieu of service delivery.

                This was reflected in many comments made during interviews that were critical of
                VIHA for “wasting a million dollars on communication” – and point toward a potential
                danger of employing marketing campaigns to burnish image. Any incremental
                spending on community relations must be seen by the public as an appropriate use
                of taxpayers’ dollars, or resources must be shifted within the unit between public
                affairs and community relations.

                Would a shift to more community relations undermine the public affairs capacity of
                the unit? Not necessarily.

                As shown in the following analysis (see “Comparison of communication units”) other
                authorities have placed more of their communication staff in regional and/or
                community relations roles. This has allowed them to pre-empt many issues and, as
                a result, reduce the amount of staff time devoted to public affairs.

9 | P a g e  
             For example, at the Interior Health Authority (IHA), which is a comparable size to
             VIHA, staff time on issue management has reduced since more emphasis was
             placed on community relations and active communication strategies.

             On paper, the VIHA communication unit has several staff tasked with community
             relations or other pro-active communication programs (both external and internal). In
             reality, much of their time is spent on managing issues. Rebalancing these
             workloads is achievable, as shown by the results in other authorities. It is also
             necessary if VIHA wishes to implement a comprehensive and effective community
             relations strategy.

             Communication planning
             The VIHA communication unit produces a communication strategy each year
             designed to set goals and direct activities.

             In terms of best practices, a communication strategy is a tool to achieve specified
             goals efficiently (for the minimal investment of time, staff, and resources). It should
             set out the general themes and goals for the year and identify the specific programs
             to achieve these ends. Communication plans are then developed for each program
             and provide a hands-on level of detail – measureable goals, clearly identified target
             publics, clearly specified channels of communication, timelines, budgets, resources,
             and evaluation – to guide implementation.

             The 2008 strategy developed by the unit combines elements of communication
             strategies and plans. As a result, it is confusing as a document meant to guide the
             unit throughout the year.

             For example, the strategy sets outs very broad goals, but also lists expected
             outcomes. The two lists are not in complete alignment. Neither includes measurable
             (quantifiable) results and the focus of the evaluation is more on outputs (web site
             visits, participation rates) than outcomes (such as changing perceptions or building
             support). Five key publics are listed, but rather than a strategy/plan targeted to each
             public, the document lists four strategies. Each strategy is a list of action items, or
             tactics, rather than a discussion of how the strategy links back to the overall goals, is
             targeted to a key public, and sets out the general direction/means of achieving the

             In conclusion, the strategy needs restructuring and added content to provide a clear
             direction for the unit.

             The unit does not produce a separate community relations strategy. There is
             reference to “strengthen relationships with communities, stakeholders and
             government bodies” in the communication strategy, with specific plans targeting
             external stakeholders and government partners. Each of these plans is a list of
             bullets (see the previous comments regarding the limitations of this approach).

10 | P a g e  
             Furthermore, the plan for external stakeholders relies on one-way communication
             rather than dialogue or community outreach. The plan for government partners
             notes the importance of face-to-face meetings but, like the plan for external
             stakeholders, offers only a cursory level of detail.

             As a follow-up to the communication strategy, an update was prepared in May 2008
             outlining a list of actions to shift from a reactive approach to communication to a pro-
             active stance. The note included tactics targeting both internal (staff and physicians)
             and external (government, media, general public) publics. As with the strategy, the
             note focused more on specific actions rather than outlining a comprehensive plan.
             A number of these tactics are being used, but given the feedback of stakeholders,
             the effectiveness of these activities is questionable. In the absence of an integrated
             approach to community relations, the whole is less than the sum of its parts.

             Several communication plans and briefing notes were reviewed. In general, these
             documents follow government standards. As with the strategy, the plans do not
             typically set quantifiable goals and the means of evaluation are often missing or
             based on outputs. The level of detail provided in plans and notes is very extensive
             (given the workload on the unit, it is impressive that the plans provide this level of

             Issues response and media relations are strengths of the communication unit and
             this was evident in the analysis and recommendations outlined in the briefing notes.
             Communication planning, on a project or tactical level, appears comparable to that
             found in the provincial government or other large public sector agencies. Strategic
             communication planning, in contrast, is not as comprehensive as tactical
             communication planning. In addition, community relations planning tends to focus
             on one-off activities and is not coordinated through a comprehensive strategy.

             Comparison of communication units
             To determine if the VIHA communication unit is appropriately structured, staffed and
             resourced to achieve “best practices”, it was compared to the communication units
             at the Vancouver Coastal (VCHA), Fraser (FHA) and Interior Health (IHA)
             Authorities. Results are summarized in the table on the next page.

11 | P a g e  
                         VCHA                      FHA                        IHA                       VIHA

Head             VP, Communications        VP, Communications Chief                             Chief
                 and Public Affairs        and Public Affairs Communications                    Communications
                                                              Officer (CCO)                     Officer

Structure        Corporate                 Public affairs (media,   Officers in each of         Communication
                 communications            government and           four regions                leads or advisors
                 services (web,            community relations)     (reflecting                 that are organized by
                 special projects and      and corporate            organizational              specific functions
                 regional                  communications           structure with              and tasks; two
                 communication) and        (program support,        regional chief              advisors based in
                 public affairs (media     professional             operating officers)         Nanaimo (with
                 and external              services, web, etc.);    and a corporate unit        central and north
                 relations); 3 directors   2 directors report to    providing                   island
                 report to VP; staff       VP; staff are spread     communication               responsibilities); staff
                 are split between         between major            services (web,              are mainly based in
                 regions and               health care centers      internal, program           Victoria
                 corporate                 and the corporate        support) and
                                           office                   corporate public
                                                                    affairs; all staff report
                                                                    to CCO; staff are
                                                                    decentralized with
                                                                    most working in the

Staff            VP and director           VP and director          Flat structure does         Strategic-level
                 levels provide            levels provide           not offer strategic-        advice provided by
                 strategic-level           strategic-level          level expertise other       CCO and
                 expertise; staff skill    expertise; staff skill   than through CCO,           communication
                 sets focused on           sets focused on          however regional            leads; staff
                 functional expertise      functional expertise     staffing is designed        background includes
                 (media relations,         (media relations,        to provide both             public affairs (issues
                 web, etc.)                web, etc.); deliberate   public affairs (media       management, media
                                           effort made to           relations) and              relations), planning
                                           strengthen               community                   and professional
                                           stakeholder relations    engagement                  services; community
                                           function by hiring       (planning) skill sets       engagement
                                           staff with experience                                (strategic level)
                                           in community                                         expertise is limited

Resources             $2.6 million              $2.2 million             $1.5 million                $1.1 million
                      budget                    budget                   budget                      budget and
                      22 FTEs                   17 FTEs                  9.3 FTEs                    9.6 FTEs
                      VCHA budget is            FHA budget is            IHA budget is               VIHA budget is
                      $2.8 billion;             $2.2 billion;            $1.5 billion;               $1.6 billion;
                      communication             communication            communication               communication
                      budget is .09%            budget is .1% of         budget is .1% of            budget is .069%
                      of total                  total spending           total spending              of total
                      spending                                                                       spending

12 | P a g e  
             Community engagement and stakeholder relations:
               VCHA: Community engagement (largely a planning function) is under VP,
               Strategic Initiatives, but used to be under Communications and Public Affairs.
               Community engagement team oversees the Community Health Advisory
               Committee, which is a consumer-driven, volunteer group. In contrast,
               Communications and Public Affairs initiated Local Governance Liaison
               Committees, involving regional forums of external stakeholders including elected
               officials, with follow up actions coordinated by regional chief operating officers.

                     o Comments: Regionally located communication staff have an informal
                       “dotted line” relationship with site management, although accountability
                       lies with the corporate function

                 FHA: 3 FTEs for community and government relations unit plus media relations
                 unit (both regional services located at corporate office); in process of developing
                 a community relations strategy and measurements

                     o Comments: Moved three years ago from regional to central model (like
                       VIHA); communication is set up to meet corporate and community needs
                       with a 50:50 split of staff between local and corporate; has most MLAs
                       and municipalities in the Lower Mainland; have staffed up community and
                       public affairs capacity to strengthen contact with municipalities and other

                 IHA: Regional structure of unit is designed to improve community relations;
                  authority is now working on a community engagement strategy (required in
                  stakeholder’s letter of expectations) led by planning unit with input from
                  communication director

                     o Comments: Authority weathered a severe crisis a few years ago that
                       threatened to undermine public support (the situation involving the Albo
                       family when an elderly patient was transferred away from a facility in Trail
                       where she was residing with her husband to a facility in Grand Forks,
                       where she died two days later); a review concluded there was “a culture
                       of bad decisions and poor communication”; subsequently IHA has put
                       greater emphasis on community relations and involving the
                       communication director in decision making

                 VIHA: Community relations is built into job descriptions of staff but workload
                 tends to focus on issues management (reactive) rather than pro-active
                 communication activities; the community relations function does not have a clear
                 lead manager or strategy; unit structure is not designed to put as much
                 emphasis on community relations as in other authorities. Community
                 engagement on project-specific planning lies with the planning unit; outreach
                 and consultation activities are also practiced by the chief medical health officer.

13 | P a g e  
                    o Comments: Moved to centralized delivery model and left two
                      communication positions in regions (central and northern island
                      responsibilities); heavy workload on media relations has reduced
                      community relations-related activities; staff tasked with program-related
                      communication (potential community engagement focus) tend to be
                      advisor-level not leader-level

             News media (print) coverage of health authorities
             News coverage is a reasonable indicator of the workload of a communication unit.
             Coverage for VCHA, FHA, IHA and VIHA was tracked for the past 12 months using
             the FPinfomart database (newspaper coverage across British Columbia). Results
             are summarized in the accompanying table.

                                VHCA             FHA               IHA                VIHA

   Number of stories      543              715               750              1,797

   Potential readership   49.8 million     39.3 million      18 million       44.5 million

   Estimated ad value     $2.115 million   $1.143 million    $609,000         $874,000

             Regional factors influence the number and impact of individual articles. For
             example, news outlets in urban areas have larger circulations, and therefore greater
             reach and advertising value (as is seen above with the results from FHA and

             In terms of the favorability of coverage, results are summarized below. Note that
             major outlets tend to focus on major news stories – often controversial – which can
             skew the overall favorability rating towards the negative.

14 | P a g e  
                                       News Coverage Comparison



                  30                                                             Neutral
                  20                                                             Negative


                          VIHA         FHA           IHA        VCHA

             A starting point for improving an organization’s reputation is to generate more
             positive than negative news coverage. VIHA’s +/- rating is -6%, but moves to 0%
             when the stories about Cowichan Lodge are excluded from the analysis. IHA has
             the best rating at +15%, while FHA scores +2% and VCHA is -10%.

             Comments on the communication unit
             An analysis of the VIHA communication unit shows that:
                The structure, skills set, staffing level and budget of the unit are appropriate for a
                unit focused on meeting the public affairs and related communication service
                requirements of VIHA and the ministry, but there is limited capacity to support
                community relations

                 The VIHA unit is comparable in staff levels to other communication units

                 VIHA spends less on communications, in terms of share of revenue, than all
                 other authorities, creating an opportunity to add resources and staff to the unit to
                 enhance community relations while keeping the budget, in share of total
                 spending, comparable to other health authorities

                 The VIHA unit has less capacity to offer strategic-level advice than other
                 communication units

                 Planning needs to be improved at the strategic level, but is comparable to other
                 agencies at the project or program level (however, there is a weakness in the
                 lack of measureable outcomes)

                 VIHA communication staff are the most highly centralized of all authorities

                 VIHA operates under greater media scrutiny than other authorities due to a
                 unique mix of being in the provincial capital and the added news scrutiny by
                 major media that this places on the public sector, as well as serving a large and

15 | P a g e  
                 diverse region; as a result, VIHA necessarily devotes a greater proportion of staff
                 time to issues management than other communication units

                 Excluding the Cowichan Lodge issue, VIHA’s news coverage is balanced - the
                 authority is relatively successful at generating positive news coverage

                 Despite the focus and workload demanded by the ministry, other units have
                 developed effective community relations programs

                 There is a trend in other authorities towards developing more comprehensive
                 community relations programs, including organization-wide community relations
                 strategies, added staffing, and greater public consultation; VIHA is lagging
                 behind other authorities in regards to community relations activities and

16 | P a g e  
The role and influence of the communication unit
The structural review provided in the previous section discussed the capacity of the
communication unit to perform its duties. However, to be effective, the unit must also have
better influence at and access to the executive and board of directors at more appropriate
points in the decision making process.
Equally, there must be an executive mindset that is receptive to an “outside-in” point of view
and willingness to factor in community impact and stakeholder relations into decision making,
along with prominent “bottom line” elements such as fiscal constraints and competing demands
on funding. Furthermore, as with all executive dynamics, there must be a culture of trust,
openness and encouragement for discussing alternative views and options to ensure that
consensus and solidarity is built for hard choices.
The role of communication management in VIHA decision making was analyzed by reviewing
two recent incidents: the proposal to close Cowichan Lodge in the summer of 2008 and the
cancellation of cancer surgeries in Campbell River in late October 2008. In both cases the
activities and decisions involving the communication unit were tracked and analyzed.
The two issues reviewed illustrate the impact that a communication point-of-view can have on
organizational decision making, risk management and community relations.
In summary, our review of the Cowichan Lodge issue concluded that there was a gap in the
decision making process regarding the involvement of the communication unit in decisions
related to the proposal. Specifically, the process did not involve the unit early enough for
communication personnel to offer advice on the community relations impact of the decisions
being considered. This undermined VIHA’s ability to communicate effectively on the decision.
In contrast, the Campbell River situation shows that a controversial decision can be managed
relatively effectively with communication involvement at the early stages and throughout the
timeline of the issue. Given the controversy surrounding the situation, the communication advice
was appropriate.
One flaw in this process was that the information provided to the communication staff contained
an error regarding the staff responsible for the decision leading to comments as to who was at
Assigning fault is typically not a recommended option for several reasons, including that the
available information in the early stages of an issue may be incomplete, that discussing fault
shifts the public focus away from the corrective and responsive actions being taken by the
organization, and that the leadership the public looks for on an issue is undermined when an
organization is not accountable for actions by its employees.
This error extended news coverage beyond the normal news cycle for this type of story.
However, VIHA reacted quickly and effectively when the error was identified with appropriate
internal and external communication responses.
The contrast between the two situations shows the importance and benefit of early and
meaningful involvement by communication personnel in analyzing and responding to issues

17 | P a g e  
Section 3. Findings: stakeholder & community

             The previous discussion on comparative communication unit structures and critical
             incident analysis underlines a key finding: VIHA lacks an integrated and
             comprehensive community relations program.

             This is not to suggest that community relations activities are completely absent.
             Many managers interact with stakeholders on a regular basis. The VIHA board has
             initiated stakeholder receptions, Q&A formats, and public open houses tied to its
             general meetings, which are held in communities around the Island. And the
             planning unit follows a Public Participation Framework when engaging with the
             community on specific projects, such as consultation related to the expansion of
             Royal Jubilee Hospital.

             Yet VIHA has not executed a strategy to build an extensive and informal network of
             partners or allies at the local level. This means that VIHA frequently lacks the local
             stakeholders needed to champion controversial decisions or at least acknowledge
             their inherent complexity. It also means that since these community leaders are not
             aligned with VIHA – or perceive VIHA as understanding local needs – they can
             easily distance themselves or become vocal opponents of VHIA decisions, as
             happened with municipal officials in Cowichan.

             This situation is further exacerbated by several factors. The first is a tendency for
             regional government leaders to compete among themselves or across regions for
             community-specific health resources, particularly if funding is constrained. Any
             incentive for regional collaboration is muted when decisions become polarized by
             communities as win-lose situations, such as the proposed amalgamation of
             Campbell River and Comox hospitals into a regional hospital for Comox-Strathcona.

             Furthermore, the volume and geographic expanse of VIHA stakeholders, coupled
             with the limits of senior leadership capacity, mean that even the choice of whom
             VIHA engages with has a tendency to be politicized. This sets up a potential “all or
             nothing” dynamic for stakeholder relations. Another factor involves a lack of clarity in
             roles and responsibilities. For example, some interviewees suggested that the
             mandate of the regional hospital districts is unclear or misunderstood by local

             Others cited a failure – by VIHA and the public – to clearly distinguish between
             dialogue that gathers input to shape VIHA decisions and that which is deliberately
             done for shared community decision making. Yet another point of view charged that
             VIHA – in order to mitigate conflict – may passively allow municipal officials to

18 | P a g e  
             believe they have more influence on decisions than is the actual case, thereby
             subsequently escalating or prolonging opposition.

             A northern success story
             An exception to this situation is within the Mount Waddington region. There, the
             creation of the Mount Waddington Health Network – a grassroots group largely
             initiated by the community, for the community – plays an important role in enabling
             dialogue and understanding with VIHA, as members advocate for regional health
             care issues.

             The elements of the network’s evolving success are instructive:
               A clear mandate and purpose that links the delivery of health care services to
                local economic and social development needs

                 An openness that represents diverse demographics and includes participation
                 from rural communities across the region, their elected officials, and health and
                 non-health care professionals

                 A volunteer steering committee, co-chaired by an aboriginal and non-aboriginal,
                 which is recognized by VIHA, the regional hospital district, and the communities
                 themselves as a voice for the region’s constituency

                 A good working relationship with VIHA’s planning team, visibility with the VIHA
                 board, and regular meetings that tackle topics of local concern and rotate among
                 different communities across the region.

             Having noted these elements, the political climate of the region may be unique,
             given that it is fostered by geographic fact. Rural and remote, the communities that
             make up Mount Waddington recognized from the start that the power of their
             advocacy came from collaboration, not competition. Collaboration not only allows
             the network to establish a common purpose, it provides a single identifiable source
             for VIHA and the regional hospital district to engage with, thereby creating an
             accessible channel for two-way dialogue and community-based strategies.

             Location and politics aside, however, there are other attributes that demonstrate
             potential for replicating the community relations success of the Mount Waddington
             model. These hold promise for mitigating the broader challenges of municipal
             support, competition and need for clarity, as outlined earlier.

             One is the role that open and transparent information plays in ensuring informed
             dialogue and building trust. The Mount Waddington interviewees could not
             emphasize enough that the network’s desire to seek and VIHA’s willingness to
             provide data at the local level was critical – not only to their ability to understand and
             craft community-based solutions, but to VIHA’s image and capacity to demonstrate
             that it cared about local issues.

19 | P a g e  
             Such information, shared with network partners, underpins the collaborative
             approach and collective value to their constituency that the network provides.
             Equally so, it increases the value of member feedback, through informed and
             reflective discussion, to the hospital district and VIHA.

             Information also provides an additional benefit. The network’s ability to access local
             health care data and understand its relevance creates a responsibility for getting the
             facts right, errors corrected, and rumours squelched within its communities – even if
             there is disagreement with VIHA on context and direction. Network interviewees
             stressed that they took this responsibility seriously. Furthermore, by being
             accountable for factual communications, this strengthens the clarity of the network’s
             mandate and its relationship with VIHA.

             The importance shared information plays in community relations strategies is further
             addressed in the recommendations.

             Building credibility with community allies
             Returning to VIHA’s need to establish community allies, the issue of the Campbell
             River Hospital was also illustrative; in this case, for the extent and tone of reaction to
             the incident earlier described.

             Deferrals of surgeries are a relatively common occurrence in the health care system.
             As such, a deferral should not be news. However, deferring a cancer surgery, due to
             the “hot button” nature of cancer treatment, does increase newsworthiness. And,
             when the release of this information comes from a credible source like a doctor, the
             interest of the news media is all but assured.

             A doctor going public with a concern rather than working through internal complaint
             systems does not – on its own – prove that relationships or communication with the
             medical community are in need of repair. However, when combined with the extent
             of media coverage, and the tone of editorials and letters to the editor, this incident
             shows that broader community relations in the Campbell River area are strained.
             VIHA is not being given the benefit of the doubt by its stakeholders or the public.

             The incident also points out the risks associated with a health care system operating
             at or in excess of its capacity. All systems have limits, and when the margin of error
             within a system is reduced, the risk of an unintended failure or accident increases.

             Similarly, highly complex organizations will malfunction from time to time. Issues
             management is a tool to respond to these malfunctions, but it is not a tool for
             managing ongoing relations with stakeholders. Therefore, while the communication
             response appears to have been effective at responding to the situation at hand, the
             lack of a broader community relations strategy weakened the overall response.

20 | P a g e  
             Comments, and the link to reputation
             Overall, it is challenging to analyze the reputation of VIHA. While improvements
             were suggested by some interviewees in terms of developing branding or marketing
             campaigns, the authority’s image is very complex. As noted earlier, there is also
             risk that such activities – if accompanied by high profile marketing tactics – would be
             seen as a squandering of public dollars.

             More relevant is the need to ensure that VIHA’s actions and communications are
             aligned to organizational values and public expectations. In this way, VIHA’s “brand
             identity” would be consistently reflected in words and deeds that build trust and
             credibility. This is not to suggest a gap in current behaviour – only an uncertainty
             among interviewees, including board members, as to whether the required
             alignment is adequately demonstrated and visible.

             Currently, VIHA’s reputation can be defined in several ways, such as the reputation
             of front-line service providers and their clients, or by community, or by stakeholder
             group. Yet, as an overall entity, VIHA’s reputation appears weak. Many comments
             from those interviewed for this project, both internal and external, use descriptors
             like “bureaucratic”, “removed”, “aloof” or “Victoria-centric”.

             Many external stakeholders saw VIHA as more of an opponent than partner in
             delivering better health care, even though the same individuals considered their
             local health care providers to be top notch. Others noted a positive relationship with
             VIHA senior management, while acknowledging that the wider community’s
             perception of VIHA – the corporate entity – was negative and damaging.

              The decoupling of front line services from the corporate entity means that VIHA can
             be positioned as the problem in improving health care, as compared to the service
             providers, who are the solution. This positioning sets up an “organizational
             scapegoat” dynamic. It makes it very difficult for VIHA to strengthen its reputation
             across Vancouver Island and build up reputation or brand “equity”.

             This equity, in effect the benefit of the doubt, is particularly useful in times of crisis,
             such as with Cowichan Lodge or the cancellation of surgeries. A poor reputation
             also makes it more difficult to develop partnerships and local champions.

             Without a pro-active community relations program, VIHA’s ability to turn this
             situation around is severely constrained. In essence, VIHA needs to break free of
             the negative and escalating cycle of reactive issue containment, while still
             maintaining its capability in issue management.

             To do so, It needs to add comprehensive community relations strategies to its
             toolbox of project-specific community engagement, government liaison and media

21 | P a g e  
Section 4. Conclusions

             The functions typically carried out by a communication unit are summarized in the
             following graphic. It shows that a best practices unit uses communication in pursuit
             of organizational objectives, and that the unit has the capacity to both plan and
             deliver these programs.

                                         Aligned to achieve                  Community relations
                                        organizational goals
                                                                                   Analysis and options from 
                                           Issue resolution                        organizational perspective

                                       Com planning                                     Technology and web

                                Budget controls                 Managerial                 Issues management

                                       Writing                                                  Meeting facilitation
                         Media relations                        Professional                        Production

                          Materials                                                                    Staging 
                       distribution                                                                    events

             From our observations, the VIHA communication unit has a high level of
             competency in administrative and professional categories. The unit is also
             competent at the managerial level, particularly in issues management. Services at
             the strategic level do not encompass all best practices, particularly in the lack of a
             comprehensive community relations program. The emphasis on issues
             management, as discussed earlier, biases actions towards the short term rather
             than towards a longer term focus on building relationships and resolving issues.
             However, this comment applies as much to the VHIA leadership as it does to the
             communication unit and it must be considered within the constraints of a one-year
             funding cycle.

                                                                   Active programs to engage with community, 
                                                                   including consultation, collaboration and 
                                                                   empowerment (shared decision making),  such as 
                                                                   town hall meetings

                                                                                Targeted programs to build 
                                                                                awareness and understanding with 
                                                 Outreach                       specific groups, such as 

                                                                                            Responsive programs that release 
                                             Information                                    information but rely on groups and 
                                                                                            individuals to find and understand this 
                                                                                            information, such as news releases

22 | P a g e  
             We also reviewed the type of communication activities carried out corporately to
             assess if these activities aligned with our observations regarding strategic
             communications and community relations.

             We observed that most activities fall into the categories of either information or
             outreach. Day-to-day activities by the communication unit tend to be informational
             (media relations) due to the heavy workload in issues management. Most
             communication planning includes outreach activities, but the ability to deliver these
             programs is constrained by budget and time pressures (staff time tends to be
             devoted to issues management). Other outreach activities include on-going contact
             by the executive with stakeholders, the CEO newsletter and the receptions and
             open meetings held by the board of directors.

             The planning unit engages in dialogue-based communication for the various projects
             under its control. Stakeholders noted this and gave credit to the unit for providing
             opportunities for collaboration and input to the decision making process. In
             comparison, stakeholders felt there was little other dialogue occurring with VIHA.

             To build credibility with stakeholders, VIHA must be seen as accessible, receptive
             and responsive (in terms of appropriate actions) to community concerns, as
             opposed to indifferent, reactive, and defensive, which all undermine credibility. Most
             stakeholders described VIHA in the latter rather than the former terms, reflecting the
             earlier comments about the weak corporate image of the authority. VIHA requires a
             shift in communication activities to place greater emphasis on dialogue-outreach in
             order to rebuild its credibility with the community.

             To more closely analyze the current state of communication and community
             relations management, the key issues that we identified in our review were analyzed
             using a five-point scale representing best practices in communication management.
             See Appendix C: Best practices rating system for an explanation of the rating

23 | P a g e  
                                       Summary of analysis

        Activity            Rating                Current state                     Comments
Community relations         1 to 2     Activities lack coordination and a   Requires VIHA-wide
                                       strategy                             strategy and integration with
                                                                            public participation activities

Strategic communication     2          Process occurs regularly but is      Requires more detailed and
planning                               incomplete                           comprehensive planning

Tactical communication      2.5 to 3   Approaches “best practices”, but     Requires modest
planning                               requires more work in evaluation     refinements (greater
                                       and measurement                      emphasis on measurement
                                                                            and evaluation)

Issues management           3          At a “best practices” level          No changes required

Communication role in       3          As a member of the executive, the    No structural change
executive                              role is institutionalized            required, but function should
                                                                            have a more strategic role

Communication role in       1 to 2     Despite membership on executive,     Lack of early communication
executive decision                     in many instances the                input undermines and
making                                 communication function is not        weakens decision making;
                                       involved at the early stages of      function must demonstrate
                                       operational issues and decisions,    value that goes beyond
                                       and as a result, cannot offer        issues management
                                       strategic advice

Public participation (via   4 to 4.5   Strong methodologies that rate       Best practices are restricted
planning process)                      above “best practices”               to planning unit; opportunity
                                                                            to extend to other areas of

We believe that the immediate goal should be to move all elements of communication and
community relations to at least a 3 rating, with a longer term goal of achieving a rating of 4 or

24 | P a g e  
Section 5. Recommendations

             We recommend strengthening the ability of the communication unit to provide more
             strategic-level leadership on communication issues, and to shift VIHA corporate
             communication activities towards more dialogue-driven practices. Both of these
             goals can be achieved by expanding the role of the unit to include community
             relations under the leadership of a new chief of communication and community
             relations. We believe these changes are realistic and achievable before the end of
             the current fiscal year.

             In terms of a community relations strategy, VIHA only has to look back three years
             to find a good model for an organizational approach to community relations – its
             consultation process on the five-year strategic plan featuring the active participation
             of the board of directors, the CEO and the senior management team. As one
             participant from that process said, “recommend real, timely and more frequent,
             community consultation.”

             Repeating this process, and extending the principles of community engagement
             beyond the planning function, would resolve many of the issues identified in this

             What is the “ideal state” for community relations? It is not to involve individual
             stakeholder groups or the community at large in every decision made at VIHA.
             Rather, it is to build community support for the delivery of health services on
             Vancouver Island through greater understanding and awareness of VIHA activities
             at both organization and local levels, by explaining major decisions, and, when
             appropriate, involving local and stakeholder groups in setting priorities through
             consultation and other public participation processes.

             This ideal state does not mean that conflict or disagreement will disappear. Different
             points of view create competing priorities. However, inclusivity tends to generate

             Any gains realized through these actions will only be maintained through board and
             executive leadership, greater involvement of the communication unit in strategic
             decision making, and an on-going commitment to building community relationship
             and participation in the health care system. All of these activities must be based on
             the communication principles of transparency, timeliness, openness, and complete

             In support of this approach, we propose the following recommendations. We have
             attempted to make these as neutral as possible in terms of added time requirements
             on management, or cash costs on the authority.

25 | P a g e  
Recommendations: board of directors
    1. Update VIHA’s strategic priorities to include a specific reference and accountability to
       community relations. This should build on the mission statement reference to “involving”
       local residents and the value of “partnership and collaboration” and ensure organizational
       values are consistent with policy decisions and actions.

Work plan and timeline:                               Resource and budget:
   Discuss at next board meeting with update             Requires executive discussion led by CEO;
   completed by start date of new CCER (see              may require research into priorities of other
   below)                                                authorities (for example, IHA)
   Task CEO to bring forward recommendations             No budgeted expenditure required, but would
                                                         involve several day’s worth of staff time

    2. Review the board’s community relations activities to further increase contact with key
       stakeholders and improve access for the general public

Work plan and timeline:                               Resource and budget:
   Review structure, timing, format and location of      Requires research into practices at other
   public board meetings in order to provide more        authorities and/or any governance issues
   opportunities for community engagement                regarding changing the structure or format of
   Incorporate into creation of corporate                public board meetings
   community relations strategy                          No budgeted expenditure required, but would
   Task CEO, the new CCER and board liaison to           involve several day’s worth of staff time
   develop options and present to board

    3. Revise board briefing note format to include an explicit section documenting community
       relations impact and proposed response to this impact

Work plan and timeline:                               Resource and budget:
   Introduce at next board meeting                       Requires new briefing note format plus memo
   Task board liaison to update and CEO to lead          to executive/senior management explaining the
   discussion with executive committee on any            policy change, expectations and any changes
   changes required in the production of briefing        in processes
   notes and related materials                               No additional expenditure required
        Executive discussion should include the
        role of the communication unit in
        conducting and/or reviewing the community
        relations impact

26 | P a g e  
Recommendations: executive
    4. Review format and frequency of executive meetings to provide more opportunity for open
       and comprehensive discussions on all issues, including those involving controversial or
       challenging decisions

Work plan and timeline:                                  Resource and budget:
   Complete review and implement changes this               An outside facilitator may be useful in leading
   fiscal year; review should ensure that                   an executive discussion on this topic
   communication input is provided on all major             Cost of facilitator estimated at less than $3000
   decisions or issues                                      Would involve staff time
   Task CEO to take a lead in ensuring that new
   processes are implemented to allow
   comprehensive discussion by all members of
   the executive
   Outcomes should be linked to the new board
   briefing note format

    5. Continue and expand the CEO and executive team’s meetings and speaking opportunities
       with stakeholders

Work plan and timeline:                                  Resource and budget:
   Use recent municipal elections (changes in               During this interim period the CEO and senior
   local elected officials) as opportunity to meet          leadership team should commit at least one
   with all regional hospital districts before the end      day a week (20% of their time) to community
   of the calendar year                                     relations
   Task led by CEO                                          Travel costs

    6. Update executive management committee protocols to ensure that major decision
       documents used by the executive are reviewed in advance by the new CCER of external
       relations or chief communication officer and that briefing notes include a section offering
       analysis regarding the community relations and communication impact of the decision
       (similar to board briefing notes)

Work plan and timeline:                                  Resource and budget:
   Introduce immediately                                    No budgeted expenditure required, but would
   Task CEO’s office to complete, with                      involve several day’s worth of staff time
   communication unit input                                 Linked to review of executive-level discussions
                                                            and decision making

27 | P a g e  
Recommendations: communication unit
    7. Restructure communication unit by expanding portfolio under a chief, communication and
       external relations (CCER), who is a member of the VIHA executive and replaces the
       position of chief communication officer, to include community relations*

Work plan and timeline:                                Resource and budget:
   Hire CCER before end of fiscal year                    Restructuring is a significant activity that will
   Report to board and executive and introduce            require input from executive, unit staff and
   new structure before end of fiscal year                support from HR; in total, several weeks of
   Task CEO (with appropriate staff support) with         staff time is required
   hiring CCER                                            To ensure review is completed on time, CCER
   Task CCER with reorganizing communication              may require outside consulting assistance; cost
   unit                                                   estimated at less than $7000
        Planning unit should be involved in the           Any incremental cost of CCER salary is built
        changes to ensure maximum overlap and             into current communication budget
        integration with public participation

    * New individual should update structure and consider decentralizing unit with more staff placed
    outside Victoria; various realignments should be reviewed, such as following the Fraser or Interior
    models and placing staff at the major facilities (hospitals)
    As part of developing the corporate community relations strategy, review the staffing level and budget
    of the unit to determine if it has adequate resources to support a community relations function

    8. Develop a corporate community relations strategy including KPI(s) and publish an annual
       report or update on community relations**

Work plan and timeline:                                Resource and budget:
   For roll-out by the start of 2009-2010 fiscal          Developing the strategy is a significant
   year; tied to the restructuring of the                 undertaking that, like the restructuring of the
   communication unit                                     unit, will require input from the executive,
   Tasked to CCER                                         managers and the planning unit; work on the
       Work on the strategy can start immediately         strategy overlaps with the restructuring
       by developing an inventory of all current          In total, several weeks of staff time is required
       community relations activities at VIHA,            (when the community consultation is factored
       listing stakeholder groups and points of           into the time requirements)
       contact, and using this information to             Community relations will require additional
       conduct a gap analysis                             expenditures and possibly staff dedicated to
        Analyze the benefits of existing community        the function
       relations activities, such as the CEO              Over time, an effective community relations
       newsletter, within the framework of the            program can reduce issues management work
       strategy (this requires assessing all current      (as is the case with the Interior Health
       activities and determining if they should          Authority) and allow staff time in the
       continue or note); work on this assessment         communication unit to shift to community
       can begin immediately                              relations works, however in the first full year of
   Update the external stakeholders baseline              the strategy it should be expected that staff
   survey (2006) and use it as the basis for              time on issues management will not be

28 | P a g e  
    ongoing tracking of community relations; use          significantly reduced
    the questions in the survey as the basis for          Therefore VIHA may need to increase
    developing KPIs                                       communication and community relations
    In the new year (after the CCER position is           expenditures in the short term; a goal of
    filled), conduct a community consultation             keeping total expenditures to less than 0.1% of
    process to seek input on the strategy, including      revenues would keep the unit budget in line
    the role of community leaders, frequency of           with other authorities and allow for the
    meetings, reporting vehicles, etc.                    appropriate investments in new communication
                                                          activities, training, restructuring, and related

    ** The creation of the strategy should include a review of successful public participation activities,
    including the creation of the Mt. Waddington Health Network and the Jubilee Tower to assess if the
    community relations processes can be repeated in other areas of the region; tactics should respond
    to the community need for local information
    The large number of stakeholder groups in the authority’s catchment area means that for a strategy to
    be efficient and effective some means must be developed to make the best use of board and
    executive time in terms of community relations; with this in mind, the strategy should review
    structures at the regional or local level to streamline contact (the Mt. Waddington approach may be
    useful in this regards)

    9. Conduct a performance-to-plan review of the current communication strategy and revise
       the strategy for 2009-10 to fill any gaps identified in the review and incorporate clearly
       stated and measurable outcomes (see comments on page 8) as well as measurable KPIs
       for the unit and the means for tracking these results

Work plan and timeline:                                Resource and budget:
   Task to acting CCO and new CCER                        May require consulting assistance to upgrade
   Complete performance-to-pan review by end of           format for plan and/or research and develop
   January for use in 2009-10 planning                    KPIs; cost estimated at less than $5000
   Incorporate new KPIs into 2009-2010 strategy           Depending on use of consultant, may require
                                                          several days of staff time

    10. Develop a risk assessment tool for use by community relations and communication staff
        when assessing the impact of a situation; the tool should quantify and rank community
        relations and communication impact and list categories of response matched to the
        rankings (this tool would be incorporated into the issues management system and
        reporting to the executive on the impact of major decisions, as noted above)

Work plan and timeline:                                Resource and budget:
   Task to acting CCO or new CCER for                     May require consulting assistance; cost
   completion this fiscal year                            estimated at less than $3000 for development
                                                          and training of staff
                                                          Depending on use of consultant, may require
                                                          several days of staff time

29 | P a g e  
Appendix A: List of interviews and meetings
VIHA and related agencies
    Chair, board of directors

    Board of directors (available members)

    Board liaison

    President and CEO

    Executive VP and COO

    Executive VP and CMO

    VP Planning and Director Planning and Community Engagement, VIHA

    VP People, Organizational Development, Practice and Chief Nurse Executive, VIHA

    Chief Medical Health Officer

    Director, CEO Office

    Acting CCO

    Personnel in the communications unit, corporate and strategic services

    Executive director, Victoria Hospitals Foundation

    CEO, Nanaimo and District Hospital Foundation

    CRD HDB: Esquimalt mayor

    CVRD RHD: board chair, CVRD CAO, and councillor from North Cowichan

    Comox-Strathcona RHD: board chair

    Chair and member of Mt. Waddington Community Health Network

    MLA, Esquimalt-Metchosin

    VP Communications and Public Affairs, Vancouver Coastal Health Authority

    Acting VP, Communications and Public Affairs, Fraser Health Authority

    Director of Communications and Health Promotions, Interior Health Authority

    Director, Health Services Communications Office (Ministry of Health Services/Public Affairs

30 | P a g e  
    Director, Community Development Communications Office (Ministry of Community
    Development/Public Affairs Bureau), formerly Director of Communications and Health
    Promotions, Interior Health Authority

31 | P a g e  
Appendix B: Interview questions

    What do you believe the current reputation of VIHA is within the communities it serves?

    What key factors contribute to or influence this perception?

    What are the expectations on the part of Opposition in terms of VIHA’s community outreach
    and stakeholder relations? How would you characterize the current relationship with VIHA?

    In reflecting on what makes for effective community engagement, what ideally would be the
    role of VIHA’s executive or senior management team? How would you see this integrating
    with the operational role of VIHA’s communications unit?

    How could VIHA better serve your needs or that of your colleagues in terms of
    communications and community relations?

Regional hospital districts
    What do you believe the current reputation of VIHA is within your community/region?

    What are your expectations for this project with regard to strengthening VIHA’s reputation
    and community outreach/stakeholder relations?

    How would you describe your relationship with VIHA?

    What is the role of the VIHA board, executive and senior management in community
    relations? What is the role of the communication unit?

    What should VIHA’s priorities be over the next 18 months to achieve more effective
    community relations?

    What role could you/your board play in strengthening VIHA’s community relations locally?

VIHA board of directors
    What do you believe the current reputation of VIHA is within the communities it serves?

    What are your expectations for this project with regard to strengthening VIHA’s reputation
    and community outreach?

    As a board chair/member, what do you believe is the role of the executive and senior
    management in community engagement? What do you believe is the role of the
    communications unit?

32 | P a g e  
    In defining and/or clarifying these roles, is there also a greater role that the Board,
    collectively or individually, should or could play in community engagement? If so, what
    would be required to make this happen?

    In terms of governance, does the Board receive sufficient information and intelligence on
    community relations and stakeholder issues? Of the information currently received, what is
    most helpful? What could be enhanced?

    Is there sufficient alignment with the provincial government in terms of information flow,
    decision-making, and autonomy to enable VIHA to meet Ministry expectations for effective
    community relations?

    What are the Board’s key priorities over the next 18 months in terms of more effective
    community relations?

    What do you believe the current reputation of VIHA is within the communities it serves?

    What are your expectations for this project with regard to strengthening VIHA’s reputation
    and community outreach?

    What is the role of the executive and senior management in community engagement? What
    is the role of the communication unit? Is there sufficient capacity, time and resources to fulfill
    these roles?

    How does this align with the provincial government’s expectations and authority?

    What are your key priorities over the next 18 months in terms of more effective community
    relations? What could your unit/you contribute to achieving these priorities?

33 | P a g e  
Appendix C: Best practices rating system

The “best practices” rating is based on a five-point scale where larger values in the scale
represent higher levels of organizational commitment to, integration of, and performance on the
practice. Each practice may be classified as: 1) ad hoc, 2) planned, 3) institutionalized, 4)
evaluated, and 5) optimized.

Ad hoc: Communication is unorganized with minimal resourcing or budgets. Success is based
on the competence and efforts of one or two “heroic” individuals. Despite this chaotic
environment, communications practice may be implemented successfully. But because it is
uncoordinated, efforts are often inefficient and go over budget and schedule. Quality is variable
because different people perform the practice over time.

Planned: The practice is planned and deliberate as opposed to being performed on a reactive
or “as needed” basis. Resources are allocated to the practice, responsibilities are assigned,
and the process is managed. The practice does not occur regularly and may still be performed
by one or two individuals.

Institutionalized: The practice is routine and part of the organization’s “fabric.” The
organization has qualitatively determined the “best” way to approach the practice and has
institutionalized it. Practices are known and coordinated within and outside the organization.

Evaluated: The practice is evaluated and analyzed. Measures of performance and progress
are collected and analyzed. Often a quantitative understanding of success is known and
tracked, and the organization has a better ability to predict or estimate performance.

Optimized: Because of its recognized importance to the organization, the practice is
continuously reflected on and improvements incorporated.

A shift from the left to the right of the scale implies a movement from communication that is
reactive and disorganized to pro-active and purposeful.

34 | P a g e  
Appendix D: Organization charts


          Vancouver Coastal Health
        Communications & Public Affairs
               October 2008

                                                                                                             Dir ector In fo Acc ess
                           Execu tive Assistant        Vice Pr esid ent, Co mmunic atio ns
                                                                                                                      (F OI)
                             Kaye McMahon                       & Public Affair s
                                                                                                                  Traci d ePape
                                (Acting)                          Clay Adams

                             Regional Image
                                Arch ivist
                               An drea Lam

                              Reg Direc tor
                               Corp orate                                                                                Ac ting Reg Direc tor
                            Commun ication s                                                                                 Pu blic Affairs
                            Warren Bickford                                                                                  Gavin Wilson

                                                                                              Communic atio ns
                                                                                              Tho mas Przywara
                            Spec ial Projects                                                                                                 Sen ior Med ia
                                                                  Regio nal                                                                 Relations Officer
                            Alyssa Polin sky                  Commun ications                                                             Ann a Marie D'Angelo
                                                             Maureen Malanchu k

                              Electr onic                          Regional
           Regional        Commun ications                     Commun ications                                                               Extern al Relation s
                               Spec ialist                           Leader                                                                       Advisor
      Commu nic ation s
       Leader (VCHRI)        Den ise Leech                       Tiffany Akins                                                                     Vacant
         L isa Carver
                           Commun ications                          Reg ional
                          Sp ecialist - Gr aph ics              Communication s
                              & Production                            Leader                                                                  Public Relations
                           Paul Romanowski                        Clive Camm                                                                       Offic er
        Data Steward
                                                                                                                                                Tru di Beu tel
         Arth ur Yee

                             Spec ial Pro jects                     Regional
                                 Officer                         Commu nication s
                              James Nesbitt                          Leader                                                                 Ch inese Media an d
                                                                   Chris Freek                                                                  Co mmunity
                                                                                                                                            Relatio ns Specialist
                                                                                                                                                  Celia Lam

                            Commun ications
                               Officer (EE)
                              Co nnie Wilks

                                                                                                                                             F inan ced by
                                                                                                                                       other d ept./org anizatio n
                                                     Re gional Communica tion s Leaders ho ld VCH-wide
                                                       portfolios in HSDA s as well as the en tire h ealth                             Term Position
                                                                           authority .
                                                                                                                                        Co nsu ltant

35 | P a g e  

36 | P a g e