1. Dilemmas and dynamics of media management An explorative study on media strategies of health care inspectorates in Europe Prof. Mark van Twist Presentation at 20 th EPSO Conference Helsinki, Finland (September 30 th 2015)

2. EPSO conference in Utrecht (2012)

3. Starting point: a personal puzzle Dutch Health Care Inspectorate closes down intensive care units in hospitals, to end life threatening situations. (Former) Inspector General is asked to come and explain this action on national television in the Netherlands. Expecting applause for showing decisiveness, instead he is criticised severely: unexpected shift in ‘blame game’

4. Paradoxes of media management 1 st paradox: The essence of inspection is making sure everything is allright - by exposing what is wrong. 2 nd paradox: Inspectorates are invisible in the media if nothing is wrong - and (so) their work is successful. 3 rd paradox: Inspectorates become visible when things are wrong; then easily framed as ‘failing’ in ‘blame game’. 4 th paradox: not only critical reports make Inspectorates vulnerable, supportive reports do so even more.

5. Mediatization perspective Preliminary research on perceptions of media influence by EPSO members, first presented in 2012 in Utrecht… Informational biases in the media (Bennett, 2009): – Dramatization – Personalization – Authority disorder bias – Fragmentation Media logic ‘invading’ and ‘colonizing’ other domains?

12. Perceptions of media-attention by EPSO-members (2012 EPSO conference in Utrecht) – Increasing media attention for supervisory work – Can be productive but also counterproductive for the work of the health care inspectorates – Media coverage and frames can be influenced by the health care inspectorates – Inspectorates should reflect on how they develop effective media strategies Conclusions of preliminary research

13. EPSO conference in Brussels (2013)

14. Mediatization perspective Agenda setting perspective Public relations perspective FocusContextIssuesManagement Focal pointDevelopments in the media landscape Agenda setting and impact of the media Selling messages and using the media Research questions How is news created and to what extent is media logic taking over other domains? What factors influence the issues on political and administrative agendas? How are messages communicated effectively through media to an audience? Interesting phenomena to look at Signs of adaptation of political-administrative life to media logic. Reporting in media on governance processes Dynamics of agenda setting, windows of opportunity in the media to put issues on relevant agendas. Ways to communicate ideas, closeness of journalists with politicians and how journalists are 'used'. Theoretical perspectives on influence of media

15. View of mediaView of governancePolicy prescription Media- tization perspective: bending with the media: Media as independent negative force, highly biased, that should make more room for balanced news Media disturb governance and supervision, make things complex, are a disturbing, often annoying factor for inspectorates Not much can be done. Very difficult to cope with media logic, limited influence on media Agenda setting perspective: undergoing the media: Media as 'natural phenomenon‘, that definitely show signs of 'media logic' but can be influenced Media are an inherent element of governance and should be taken as it comes and managed as good as possible You cannot really influence media. Be pragmatic and think about what you want to communicate Public Relations perspective: Using the media Media are just as dependent on the dynamics of the governance process as they can help shape it. In highly complex and dynamic governance processes the media can be an instrument in the hands of inspectorates Create strong images and communicate them, go along with complex decision- making process.

16. Distinction between strategies for: – Impact enhancement: attracting positive publicity on the organization. For instance by publishing information, press conferences, pre-arranged interviews. – Damage control: protecting the organization against negative publicity. For instance by the spinning of potentially damaging stories or the suppressing of potentially damaging information. Framework for research on media management

17. Study on relation between EPSO-members and media (2013 EPSO conference in Brussels), first results: – Ambivalent relationship between media and health care inspectorates. – Both serve as ‘watchdogs’ in the public domain, but they do not so in a concerted effort. – The media can create windows of opportunity and provide a platform for sending messages to public. – But the media can also interfere with inspectorates efforts e.g. by holding them accountable for incidents Research on media management

18. EPSO conference in Porto (2014)

19. Research approach Step 1: Discussing experiences with the media Step 2: Collecting cases Step 3: Performing a vignette study (questionnaire) Step 4: Discussing and interpreting results

20. Country Belgium Denmark Estonia France Netherlands Northern Ireland Norway Republic of Ireland Portugal Sweden United Kingdom 21 Respondents from 11 countries

21. 16 vignettes tested by EPSO contacts: most of them relevant in different national contexts

22. Vignette: example Your supervisory organization is conducting its regular periodic review of all major hospitals. There are no specific complaints or negative sources of information. You receive a request from a television broadcaster wanting to make a program about the work of your inspectors. – Strategic option: Do you collaborate with the makers of the television program, who will show the work of the inspectors inside the hospitals?

23. EPSO conference in Helsinki (2015)

24. Media management: dilemmas (1) An Inspectorate should always actively inform the public on incidents through the news media even when this greatly damages the trust in the health care sector. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

25. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Negative news: passive communication or active informing? You want to inform the public about problems, but prevent media- attention to be disproportionally damaging to the health care sector Snowball effect: enlargement and hyping of negative messages Negative news is often amplified and hyped, which can cause extra damage to the reputation of the sector Consider the longer- term dynamics of negative news Example: - Some issues can be solved ‘behind the scenes’ - Meet frequently with journalists to accomplish more- informed publications

26. Media management: dilemmas (2) An Inspectorate should always actively inform the public on incidents through the news media, even if there is the risk of ‘backfiring’ in the blame game. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

27. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Negative news: better to emphasize or downplay the role of the inspectorate? You want transparency and need publicity to exercise influence on the sector, but negative news is often interpreted as ‘failing supervision,’ which diminishes the image and effectiveness of the supervisory organization Unintended consequences: backfiring efforts to send critical messages Supervision in media reports is often ‘failing supervision’ Consider the frames and the weaknesses for the image of the supervisory organization Example: - Discuss talking points before the broadcast

28. Media management: dilemmas (3) An Inspectorate should always publish reassuring news about health care organizations, even when it makes the public sceptical about the inspectorates independence. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

29. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Reassuring news: better to send reassuring messages, or no? You want to publish reassuring news, but the more positive the news, the more sceptical it could be received Media can reframe a message from a different perspective: ‘hitting the target, missing the point’ Reassuring messages from supervision are suspicious Consider the broader context and history in which the message will be interpreted Example: Link news to other positive events from the past to show a positive pattern

30. Media management: dilemmas (4) An Inspectorate should always publish reassuring (good) news about health care organizations, even if this makes the sector & Inspectorate vulnerable in a later stage. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

31. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Positive news; remain on the background or publicly celebrate successes? You want your positive message to make the proper impact, but media attention is always contested by other issues Variability of media attention: media attention depends on the density of issues Good supervision is usually invisible; the amount of media- attention is dependent on other issues on the agenda Consider attractiveness and timing of the message Examples: - Generate media attention: create event with famous guests? - Prevent media attention: reschedule press conference to coincide with other media event?

32. Media management: dilemmas (5) An Inspectorate should collaborate with television broadcasters if they propose to make a ‘real life’ program on the work of inspectors. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

33. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Permit journalists close proximity to the inspectorate’s work, or keep them at a distance? You want to moderate which (sensitive or personal) information becomes public, but also show journalists a real impression of the work Quickness of story building Media construe their storylines and only use small bits and pieces of the information from the supervisory organization Consider involving journalists in real-time aspects of inspectorate work Examples: - Let journalists tag along with an inspector for a day - Give selected journalists a scoop before the event, so they include it in their coverage

34. Media management: dilemmas (6) An Inspectorate should inform the media on findings in their reports even before the work is complete, to help create the ‘right’ story lines. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

35. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Discuss early findings with the media, or share conclusions after work is complete? You don’t want to prematurely share information, but also can’t afford to be overtaken by events Self-reinforcing storylines Once a storyline is established, it is self-reinforcing and the option to send another message decreases substantially Consider the timing of public messages during the start of story- building Examples: - Be proactive in creating storylines - Publish parts of research before media coverage - Add to a story-line, instead of contradicting

36. Media management: dilemmas (7) If the Inspectorate is being criticized in the media it is best to wait for attention to ebb, not to start defending the Inspectorate by bringing out new information. – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

37. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Counter media hype by waiting for attention to ebb, or persist at the media’s tempo? You want to defend yourself when there is criticism, but don’t want to strengthen the negative cycle by firing up the debate Vicious cycles Defensive messages often elicit negative responses, but staying silent can reinforce that as well Consider the depth and length of criticism and the reaction on a defensive tone

38. Media management: dilemmas (8) An Inspectorate should stick to the facts and never engage in ‘framing contests’ or make use of biases in the media logic (e.g. dramatization, personalization). – Yes or no? Why? – What are opportunities and threats of each option? – What conditions would you set to either yes or no? – Who should be involved in discussing, deciding and reflecting on this particular media strategy?

39. Dilemmas and dynamics of media management DilemmaDynamicParadox / effectsIntervention options Adjust public statements to accommodate dominant media logics and biases, or emphasize organizational and professional logic? You want to stick to the facts and your role, but also cover the proper frame in order to get the message across Parallel stories, conflicting logics Formal, legal statements speak to the facts, while moral statements speak to the emotions Consider the personal side of communication - Express sympathy or other emotional involvement - Use facts besides emotions, but not to contradict them

40. Study on dilemmas and dynamics of media management (2015 EPSO conference in Helsinki): – Important role for the inspectorate leadership – A well-functioning organization – Connecting media strategies with other actors – Connecting internal and external media strategies – Attention to facts and framing – Establishing continuity during crisis – Prevent disasters after the disaster – Structural media management: toggling time horizons Research on media management: conclusions

41. EPSO conference in …. (2016)

42. Social Media & Inspectorate 2.0? Inspection 1.0 Inspection 2.0 Social Media Strategic challenge for health care inspectorates: to identify a)the tension between organizational capacities and the need to adapt to the nature of open and/or citizen generated data and social media b)the potential of big, open and/or citizen generated data and social media to create public value through inspection

43. Innovations in health care inspection? Looking for innovative media management practices deemed relevant, appropriate and useful in the context of being ‘watchdog in the public domain’: – More interactive: e.g. Wheredoesmymoneygo.org, Zorgkaart.nl – More citizend initiated: e.g. Mypolice.org, Patientslikeme.com – More dynamic: e.g. Twitter day, Recovery.gov

44. – User generated content on quality of health care – Patient centered – Personal experience – Soft information – Rating of doctors – Number of likes… – Comparing providers – Potential harm – New challenges: selection bias & social desirability bias – ‘Crowd validation’ & important source for Inspectorate? Interactive Accountability

45. Citizen Initiated Accountability – Online – Local knowledge – Crowdsourcing – Interactive – Using open data – Prosumers – Wiki wisdom – GIS & Mash ups – Self organization

46. – Information on quality of public service organizations – Problem spotting – Detect fraud/waste – Visualization – Predictive value – Engage citizens – Coproduction – Opportunities to participate – Upload/download information – Developing new and innovative strategic options Dynamic Accountability

47. Sender: message Reciever: effect Process model of communication in traditional media: Network model of communication in social media:

48. Mass mediaSocial media Characteristic Relevance for Inspection (1.0) Characteristic Relevance for Inspection (2.0) Model Process model Only enable one-way communication Network model Enable many-directional communications System Analog/ printed High risk of information manipulation Digital Near real time data sharing and transportation Direction Vertical /top-down (In)formal account giving to superiors Horizontal Directly (in)formal account giving to citizens and social movements InteractionOne-way Accountability institution interrogates the actor Many-to- many-ways Users can interrogate by engaging in peer-to-peer interactions Information Medium created content Actor provide data and institution question their adequacy User generated content Information is created, recreated and monitored in a peer-to-peer setting AudiencePassive consumers No citizen participation / few are consuming Active consumers Prosuming / Consumers, co- creators & co-producers AccessLimited by gatekeepers Pre-selected tailor made information Mostly unlimited Organizing their own institutions and information channels

49. Optimistic view: user generated state, cocreation – Open innovation (Chesbrough, 2003) – Wisdom crowds (Surowiecki, 2004) – Wikinomics (Tapscott, 2006) – Crowdsourcing (Howe 2008) Critical view: big brother, soft sister – Cyberocracy (Ronfieldt, 1992) – Monitory democracy (Kean, 2009) – Armchair auditors (OPI, 2013) Inspectorates & Social media strategies: disruptive innovation?

50. Contact Netherlands School of Public Administration J. (Jorren) Scherpenisse Msc Lange Voorthout 17 2514 EB The Hague Telephone: +31 70 30 24 933 e-mail: scherpenisse@nsob.nlscherpenisse@nsob.nl www.nsob.nl/en Erasmus University Rotterdam Departement of Public Administration Prof. Dr. M. (Mark) van Twist Postbus 1738 3000 DR Rotterdam Telephone: +31 70 30 24 932 e-mail: m.vantwist@fsw.eur.nlm.vantwist@fsw.eur.nl or twist@nsob.nltwist@nsob.nl