This paper comparatively examines the Public Relation (PR) practices in public & private hospitals of Peshawar to investigate the practices followed by the Public Relation Officers (PROs) and the barriers they face in order to develop cordial ties between the internal and external public of health department for effective health care delivery. The Public Relation Departments (PRDs) are struggling to build strong bonds between the patients, accompaniers and health institutions. This research aims to examine the difference between PR practices of Peshawar’s public and private hospitals by employing the Grunig and Hunts Four Models as a theoretical framework. The respondents were selected for the research via the purposive sampling technique. A semi-structured interview protocol was developed for this purpose. The study shows that the PROs in these hospitals follow none of the four models. It is recommended that hospitals should hire PR professionals, arrange health communication literacy seminars and conduct research for confidence building between the internal and external public of the health department.
Public Information Officers (PIOs), Citizen’s Trust, Gruni and Hunt’s Four Models of PR, Public, Private Hospitals & Public Relations.
Research in health communication has witnessed considerable growth in the field of communication in the last two decades (Abroms & Maibach, 2008). The phenomenon has yet not been stopped and continues to witness further improvement. However, there is still an ardent need to set up efforts for the improvement of health communication for the benefits of clients and customers of health institutions (Enemyeona, 2014) .In fact, this is most needed in developing countries like Pakistan and especially the terror-torn province Khyber Pakhtunkhwa (KP).
In KP health communication, literacy seminars and implementation of research seem to blur and unadoptable. In the present scenario, health communication research and its adoption in the province is a must for the development of fruitful and healthy relations between the internal and external public of health institutions.
Expertise in the field of health communication is a sine-qua-non in the overall achievement of health care delivery goals and objectives. Central to the actualization of these goals and objectives are the hospital Public relation Departments (PRDs) (Enemyeona, 2014). Given that PRDs in hospitals and health professionals play crucial roles in disseminating health messages to customers and clients, it becomes pertinent that the researcher's audit hospital PRDs in Peshawar to ascertain their role. Therefore, this paper intends to find out whether or not the Public Relation practices in hospitals meet the international standards and practices; if not, then why, and suggest ways of empowering PRDs to improve health communication in their respective hospitals.
The study aims to identify a different set of PR strategies used by PROs to bridge public and health institutions in Peshawar. Moreover, the study plans to examine the difference between PR strategies and practices at public and private hospitals. Also, the study intends to investigate the hurdles in the dissemination of health communication at public and private hospitals in Peshawar.
For this purpose, four research questions were formulated. 1. What are the PR strategies orchestrated by public relation departments in the hospitals of Peshawar? 2. What are the barriers that affect or tend to hinder the public relation officers from achieving their objectives? 3. What are the main differences between PR practices in public and private hospitals of Peshawar?
As to the scope of the study, there is a huge gap in research on the PR strategies and practices in KP. Therefore, the endeavor to conduct research in a particular area and context is new. It gets significance because the study adds a formidable body of knowledge in the area, educates practitioners about the public relation practices and health communications in hospitals, suggests solutions to the problems in dissemination of health information, informs the concerned authorities in hospitals and especially in the Ministry of Health on the reasons why health communication packages are the sole responsibility of hospital PRDs and explore the difference in PR practices at private and government hospitals.
The incumbent government of Pakistan Tehreek-e-Insaf in KP has come with a slogan of health, education and good governance. In order to provide health facilities to the public and develop healthy relations between government health institutions, and they are targeted public, the government has promulgated Medical Teaching Institutions (MTI) Act 2015. According to MTI, PROs would be appointed in all the medical teaching institutions of the province to develop cordial and strong relations between health institutions and its public.
However, despite the passage of three years of the promulgation of the MTI and promised provision of free health facilities, those people who can afford charges in private hospitals still prefer to visit private hospitals in Peshawar. It seems that an atmosphere of mistrust between public health institutions and its public still prevails. In such situations, community members question the work, ethics and behavior of public relation officers (PROs)/ media managers, which create an atmosphere of mistrust among the health institutions, and they are targeted public. In this situation, the role of the PROs in public and private medical teaching institutions of Peshawar becomes critical. It is important to understand public relation strategies and practices in public and private medical teaching institutions of Peshawar.
Public relation practitioners play a key role in developing and maintaining an organization’s performance. As Gilstrap &Berner (2017) study argues that PROs are responsible for producing relevant and strategic communication which can improve their services, enhances their credibility, strengthens their relationship with the internal and external public; strengthens employee’s morals; extracts positive feedback by educating the public about their brands and services (Gilstrap & Bernier, 2017). Similarly, Gordan & Vamstad also showcase PROs role as that PROs are the bridge between the public and policymakers. They informed the public as well as policy makers about the problems and suggested solutions. Therefore, it is imperative for public relation practitioners to provide credible and authentic information to the public and policymakers (Gordan & Vamstad, 2018).
Orchestrating a clear-cut and well defined public relation strategy is the first and foremost step in developing any public relation campaign. As Krishna, Connaughton, & Library, in the fresh study, conclude that to achieve successful communication, it is pertinent to firstly appoint related professional then provide training (Krishna, Connaughton, & Linabary, 2020). The study further suggests that PRDs should define the target communication channels, techniques of communication and should also establish approaches and models of communication (Krishna, Connaughton, & Linabary, 2020).
The world in which we are living is faced with tremendous change. The social, cultural, economic and technological changes have shaped various institutions. However, for institutions, this change has become more complicated. As, (Geçikli, 2014) study reveals that public relation institutions may reorganize their structure in order to keep up with the developments, if necessary. Then, remodelling becomes a necessity for health institutions as it is for the other public service corporations (Geçikli, 2014). Therefore, to keep pace with the fast-changing worldview, it is necessary to review our public relation practices within the scope of health communication to get a more recent and functional pattern of public relation.
Unfortunately, in developing countries, the PRDs are way behind the standard as Enemyeona’s (2014)study finds that the nascent practice of public relation has yet not touched the desired international standards in Oman. The PRDs are not fully professionally staffed, equipped and financed to work as full-fledged units in hospitals. Besides, they do not involve in media relations, webcasts/pods, and health campaigns to keep face with the rapid technological development around the globe (Enemyeona, 2014). Moreover, media organizations also lack professional staff on health communication. The reporters are covering irresponsibly without knowing the sensitivities of health communication. Jawaid & Jawaid’s research reveal that Media houses do not employ professionals with some core knowledge on health-related issues that they cover (Jawaid & Jawaid, 2018).
Guidrya et alstudy add that social media and mobile technologies are playing an ever-increasing role in the dissemination of information to and from these organizations, leading many public relation practitioners to view these platforms as both an effective and essential avenue for strategic health communications (Guidrya, Jin, Messner, & Meganck, 2017).
Shah, Khan, & Jan’s (2017)study reveals that PIOs follow the Press Agent model of PR while pursuing their jobs in the police department of KP, which does not satisfy the real practice of public relation. Their study recommends the recruitment of well-qualified professionals for the rendering of standard PR services in the police department (Shah, Khan, & Jan, 2017).
PR activities are crucial for the achievement of any institution’s goals. As, Henslowe study (2003) states that some organizations value and practice public relation while others usually misinterpret PR with propaganda (Henslowe, 2003)
Covington (2019)study explains the importance of public relation activities, arguing that 80% of the issues management facing has propositions. Good services coupled with sound working practices and fair treatment of employees and medical staff is not enough unless a sound program of public relation is developed and practice (Covington, 2019) d. With sound PRDs the hospitals get a good name and help the early recovery of patients as well. She further points out that jagged conducts of minor class employees; negligence in patients’ care, undue delay in care of patients, poor information and guidance systems are the common complaints of the public which PRDs needs to address.
For enhanced results of this study, in-depth interviews had been conducted with PROs working in private and public hospitals in Peshawar to examine the PR strategies and practices that the PROs follow while performing their respected duties. Therefore, the data was collected from the PROs of private and public hospitals of Peshawar and analyzed respectively using the thematic analysis technique.
A sample of six PROs working at different public and private hospitals were selected- Three from private and three from public hospitals. The private hospitals include North West General Hospital and Research Center (NWGH), Shaukat Khanum Memorial Cancer Hospital and Research Centre(SKMCH&RC), and Rehman Medical Institute (RMC). While the public hospitals include Lady Reading Hospital (LRH), Khyber Teaching Hospital (KTH), and Hayatabad Medical Complex (HMC).
A systematic process was followed to approach the selected PROs. Initially, the researchers’ compiled a list of PROs then randomly contacted each. The purpose of the study was explained to them, and their verbal consent was sought. The researcher then set up a time at the respondents’ convenience for the interview. Each interview lasted for 30 to 45 minutes.
To conduct an organized interview, the researchers developed a semi-structured interview protocol. Face to face interviews was conducted in a language of convenience from the respondents. The interviews were documented and analyzed as conducted. The interview process was stopped at the saturation level.
For data analysis, the thematic analysis technique has been adopted. Nowell, Norris, White, & Moulesargue that thematic Analysis can be used to make sense of seemingly unrelated materials. It can be used to analyze qualitative information by identifying, analyzing, and interpreting patterned meanings or themes (Nowell, Norris, White, & Moules, 2017). Themes were identified by the explicit meaning of the data. After the identification of themes, the data was analyzed and interpreted under a particular theme with reference to research questions. The transcription of the interviews was transferred to the qualitative analysis software NVIVO (developed by QSR International). This study followed six steps. These steps include: (1) reading the transcript several times and taking initial notes; (2) coding exciting parts of the data systematically; (3) combining the codes generated in the second step into themes; (4) rechecking all the themes and creating a map of themes; (5) clearly defining the themes, and refining the themes in comparison to the overall story the data says; (6) analyzing the themes and relating back the themes to the study‘s research questions and the theoretical framework or literature review.
Kaplan argues that a theory is a way of making sense of a disturbing situation (Kaplan, 1964). The theoretical framework gives direction and provides the backdrop to research against which the standard and quality of current practices of public relation will be gauged. Out of many communication theories and models, (Grunig & Hunt, 1984)Models of Public relation have been selected for the research analysis.
Grunig and Hunt presented four models of public relation in 1984. Sledzik confirms that Grunig and Hunt’s four models have revolutionized PR discipline (Sledzik, 2008) These models have attempted to capture the different methods and techniques of public relation to sustaining and poster healthy relations between an organization and its targeted public. Sledzik believes that the four models-The Press Agent Model, Public Information Model, Two-way Asymmetric Model and Two-way Symmetric Model- are likely to encompass a considerable number of public relation practices and techniques (Sledzik, 2008).
“Four Models of PR” by Michael Shiflet and Jasmine Roberts
Results and Discussion
The following themes emerged from the analyses of the interviews with Public Relation Officers (PROs) of the selected hospitals. This study defines a PRO as someone who performed public relation activities for the selected hospitals irrespective of what was the job title of that person. Therefore, the respondents selected for this study had different titles such as PRO, media coordinator and focal persons. However, they were performing the same job, i.e. managing public relation of the respective hospitals. Moreover, the names of all the interviewed PROs are undisclosed because they insisted not to disclose their identities for certain reasons.
Research Q1: What are the PR strategies orchestrated by public relation departments in hospitals of Peshawar?
The study findings show that the PROs of both the private and public hospitals lack essential PR strategies and literacy on Health Communication.
Lack of Public Relations Strategy
The first major theme that evolved was the lack of a public relation strategy. All the respondents contended that they did not have an organized public relation strategy, nor they had a well-documented communication plan. Both the private and public health institutions lacked proper communication strategy. All the PROs opined that their sole responsibility was to build a positive image of their organization. However, no strategy-document existed to define goals and objectives, tools of communication and channels of communication to develop cordial relations between health institutions and its public.
“We have no predefined communication strategy. The notion of building a positive image of our organization is generally well known and understood by top management and PR professionals. We also have an idea about our targeted population. However, in the documentary form, a proper communication plan did not exist, which will serve as a roadmap for conducting PR activities,” one media coordinator of a public hospital said.
As there is no PR strategy, PR practices have become individualistic and dependent on the perceptions and assumption of the PROs. Different PROs sees their jobs differently, dependent upon their study, experience and relations with the public. As the other media coordinator of the private hospital summed up his role in the following Words
“We have no PR strategy or communication plan to develop a positive image of our organization. In fact, the PR practice is mostly individualistic. The PR practise is dependent upon the practitioner’s personality, educational and cultural background. It is as wide and varied as human nature itself”.
The same theme resonated throughout each interview process. However, most of the practices were the same in various hospitals. However, the concepts, understanding and address of PR activities were different and unique to the persons sitting on the PR chair. Their experiences, education and mentalities were guiding them in their professional life.
Lack of Health Communication Literacy
Health communication training and seminars are not efficient to develop professionalism. The respondent noted that health awareness campaigns, walks and days for awareness about the diseases, like TB Day, HIV Day etc, have been observed by all the hospitals, which are mistakenly considered as health communication awareness training. But they are health awareness campaigns, not health communication awareness packages and seminars, which will resultantly develop health communication literacy. When asked by a public hospital media coordinator about the health communication seminars, he described the days, walks and seminars to create awareness about various diseases. However, when the researchers explained the difference between health communications literacy seminars and health awareness seminars, he said:
“We are arranging health awareness seminars, celebrating TB, Diabetes day etc. We also have to conduct walks to create awareness about various health-related issues like pollution and drug addiction. However, as for as the health communication literacy campaigns are concerned, we have not witnessed anything like that yet”.
Another Media Coordinator of a private hospital disclosed that seminars for developing health communication literacy are nowhere in the whole province. Once, they have put a proposal of arranging a health communication seminar/cricket tournament to the media organizations of the Peshawar. However, the media persons opted for a cricket tournament. He shared these views in the following Words
“Health communication literacy seminars are a must for all the public relation officers and reporters working on health beats. They need to know about the terminologies, sensitivities and ethics of health reporting. However, these kinds of activities have yet not been conducted in KP. Once, I put a proposal for conducting a health communication literacy seminar/cricket tournament before the health reporters. They opted for a cricket tournament”.
All the PROs unanimously admitted that health communication literacy programs had not been introduced in the whole province, which would be really fruitful for public relation practitioner and media professionals. Some of the PROs considered health awareness programs and health communication literacy programs the same. However, when explained, they admitted that there is no such program in the whole province.
Research Q2: What are the barriers that affect or tend to hinder the public relation officers from achieving their objectives?
The study findings show that the PROs are unable to perform their duties with competence as most of them are not qualified PROs; as mentioned above, they lack basis Public Relations strategies. And then there is One Way Communication, because of which the flow of information remains from top to bottom. Lastly, apart from financial hurdles, all of them confirmed a lack of awareness to be the foremost hurdle in their job.
One Way Communication
The flow of communication is one way in most hospitals. Out of five PROs, only two were able to bounce back the decisions against PR ethics. One-sided flow means that the communication is from top to bottom, that is, from the top management to the public relation officers and then to the public. Mostly, the fountainhead of communication is the owner or CEO in private hospitals while, in public hospitals, it is the health ministry, and their dictations are followed by the MS of the hospital and then the PROs etc. One of the public hospital focal persons said:
“Any program related to health awareness is first decided by our top management. They send us a letter to give proper coverage of the event in the media. Then we send press releases and invitations to print and electronic media for giving proper coverage to the event. And the event gets due coverage in the media”.
In some hospitals, PROs are dealing with issues related to patients. PRO of a private hospital said that his job is not to deal with media and doctors. He is just to guide patients to various wards. Issues related to media are dealt with by MS of the hospital.
“I am a public relation officer. My job is to deal with patients, their complaints. I have to give them proper guidelines regarding wards and related doctors. While the issues related to doctors and media are dealt with by MS of our hospital”.
During the whole interviews process, it was a common theme that, in the public hospital, the flow of information is mostly from the MS office (which is directed from the health ministry), and in a private hospital, it is from the CEO office. However, a meager amount of the dictates are bounced backed, or in some cases, reluctantly accepted.
Hurdles in PR Practices
Apart from financial hurdles, most of the hurdles described by PR practitioners can be put under the umbrella of ‘lack of awareness. The entire PROs unanimously complained of lack of education and awareness in the internal and external public. They said that journalists should be professionally trained in health communications. Doctors and top management should also understand the pressure on PR professionals as media need news, while the top management does not want to give negative information to the media. Besides, patients should also know their rights and responsibilities. In this regard, a media manager said that;
“Our target population lack awareness. Our patients do not know their rights and duties. Our doctors should also deal with the patients politely. The media persons are always in a hurry to break the news first; they did not authenticate the news. Besides, the top management always tries to hide negative news from the media. All the stakeholders should cooperate with us and properly understand the pressures on media professionals”.
Another PRO expressed the same theme in the following words;
“I, as public relation officers, face hurdles in different dimensions; our public, especially patients, are mostly illiterate. They do not know their duties and rights. Besides, non-professionalism, doctors’ ignorance, and poor coordination between media and top management on news coverage are the most common barrier in making a positive image of our organization”.
The above theme resonated in all the interviews. All of them lamented the lack of professionalism in media and doctors’ community, while ignorance of the public and poor coordination of media and top management always creates hurdles in strengthening the relations between health institutions and their targeted audience.
Research Q3: What are the main differences between PR practices in public and private hospitals of Peshawar?
The study findings reveal that there were no sharp differences between public relation practices in public and private health institutions. As the regional, cultural and religious backgrounds were the same for both the variables. Most of the themes that emerged from the study were common in both the public and private sector; however, during the interviews, when asked from the PROs, the following differences surfaced;
Public Hospitals are Overburdened
It was a common stance of the PROs in public hospitals that their hospitals are overburdened. They are visited by thousands of patients and accompaniers daily. It is very difficult for them to deal public properly. As the public hospitals are providing services free of cost, they are visited by a huge number of patients. While private hospitals are comparatively visited by a skimpy number of patients. Apublic hospital PRO said:
“Our hospitals are overburdened with patients. The XYZ in Peshawar is visited by 5,000 patients and 3,000 emergencies daily. Besides, there are media persons and internal employees. So, dealing with such vast public is not an easy job”.
While the same feeling was expressed by another public hospital PRO in the following Words
“We are faced by a huge influx of patients. In fact, we are here in capital of the province, so the serious patients all over the 26 districts of Khyber Pakhtunkhwa are being referred to Peshawar by the concerned district headquarters hospitals. Besides, patients from newly merged tribal districts and Afghanistan are also visiting our hospital. So, it becomes very difficult for a single public relation officer to deal with so many patients”.
Overloading is really another common theme in a public hospital. It makes the public relation practice in public hospitals different and difficult from that of private hospitals. The issue of overburdening is directly proportional to the poverty and geographical situation of Peshawar city, as it is bordering tribal districts (former FATA) and Afghanistan.
The difference between Earning and Spending
The private sector hospitals are earning money whereas giving quality healthcare to the public. Because of commercial goals, they want to get more and more money by catering to more and more patients. And for this purpose, they will adopt easy and attractive policies. While, the public hospitals are spending money; they are overburdened and the doctors are relieving patients as soon as possible so that new comers may be accommodated. A media manger of private hospitals shared his views as:
“We are introducing new health care policies to provide quality services to our clients. As the lifeblood of our organization is the fees extracted from the patients; so we are prone to attract more and more patients. And for this purpose; we have to provide the best services to our patients and their accompaniers”.
While another private hospital PRO said;
“Besides serving people, our services do have commercial ends. The public hospitals are budgeted by the government and health ministry. However, in private hospitals, an employer has to earn for himself and his employees. And the only source of our income is money generated from services provided to patients. So our mission is to provide quality services in order to attract more and more patients”.
The theme of difference of spending and earning was evident in the entire interviews. It makes the Public relation practice in public and private hospital sharply different from each other. As the public hospital is spending money on patients and the private hospitals are earning money from patients while providing services to the patients.
The public relations practices in health institutions of Peshawar are passing from the age of transition. Findings of the study revealed that the PR practices are progressing from the Public Information Model to the Two-way Asymmetric Model. In fact, the public relations practices in hospitals of Peshawar are having dominant traits of Public Information Model i.e. dominance of sender over the receiver, one sided flow of communication and lack of research. Moreover, no health communication literacy seminars and packages are organized by the Hospitals’ PRDs, while PRDs lack professionalism.
Despite much of the similarities, the some differences were found between the PR practices of public and private hospitals of Peshawar. The public hospitals were over burdened due to heavy influx of patients from Tribal districts, KP and Afghanistan. Moreover, the public hospitals were mostly visited by uneducated-poor-people who are hard to handle; the chain of hierarchy is long while decision making and its implementations are difficult in public hospitals. In contrast, as a profit organization, the private hospitals want to attract more customers, they are not overburdened. Furthermore, they are visited by rich, educated people andthus are easy to handle for PROs. Also, they pay more for health services with expectation for special treatment.
The findings of the study suggest that media and PRDs should develop organized PR strategies to develop cordial relations of confidence between masses and health institutions. They should also establish full-fledged public relations departments with media monitoring and research cells, while health institution must put it mandatory to hire PR professionals. The PRDs should also conduct health communication literacy seminars to develop professionalism. Besides, proper coordination, balance and parallel flow of communication are needed among the PROs, top management, media persons, patients and other employees.
Lastly, this study suggests that more research on the topic is needed as there is a huge research gap to fill. Also, it is qualitative research and rare because this will be the first research conducted on the PR practices and strategies in Peshawar hospitals. Moreover, this study is focused on only six hospitals in Peshawar. Other researchers are encouraged to conduct research on the PRDs of various health institutions- on district-level hospitals. Additionally, they can interview media persons, hospital employees and patients to understand or examine the effectiveness of PR techniques.