There has been considerable discussion in recent times about ‘local’ versus ‘global’ engagement strategy, or whether there is some kind of mystical balance of the two. Earlier this year Creation Healthcare was pleased to facilitate seminars in New York and London with leading global pharmaceutical and healthcare companies, during which the constraints and opportunities of global healthcare engagement strategy were discussed.

Creation Healthcare are long-time proponents of setting aside time to define an overarching global strategy; we are therefore sometimes asked by new clients, “Do you really think we should have a global engagement strategy?”

This is a great question, to which we (almost) always answer “Yes”.

Some may say, “What about the local nuances?”; “What about the language challenges?”; “What about the regulatory variations?”; “What about the different technology constraints in each region?”; and so on.

We certainly do understand these issues. With 30 consultants all over the world Creation Healthcare is well aware of the challenges facing each territory, and we are constantly increasing our local in-country knowledge in order to make the best recommendations for our global clients. As much as we often encourage global strategy, we also know that it is absolutely necessary to have a local, tailored strategy to suit each individual territory or brand.

It is also true that at a global and companywide level, there are inevitably some common guiding principles that can bring continuity and consistency to the way an organization communicates, presents the brand personality, and ultimately engages with people – even on an international scale.

Incidentally, if you are skimming this article to find the quick-fix, ‘give-me-the-ten-tips’ commandments, you may wish to pull out now.

The reason for the title of this article is that it describes an approach, rather than a one-size-fits-all solution.

Let me explain using a ubiquitous metaphor. Most people in the world – regardless of their own personal religious belief, country of origin, or language – have heard of the so-called “10 commandments”. Indeed, quite a few people could list at least some of them from memory.

Interestingly, orthodox followers of the ‘Torah’ (as these books of laws are known) usually insist that there are actually 613 commandments all told, and that the 10 commandments are more of a ‘table of contents’ – a sort of cheat sheet for remembering the detailed laws and regulations.

Elsewhere, there is even a further distillation in to just two guiding principles. It is fair to say that in religious circles the 10 commandments have certainly permeated the human race over the past several thousand years, across millions of people in many languages and cultures.

We’ve found that this same concept also works for guiding an organization in healthcare engagement. Creation Healthcare maintains that it is possible to create ‘10 commandments’ which can be implemented globally, to bring new levels of (consistent, on brand) engagement.

Of course there really isn’t a single set of ‘10 commandments of healthcare engagement’ that would apply equally well to every company or organization, hence you will find no simple list here as a ‘take-away’.

Rather, each organization is uniquely different in its own right, with particular heritage, traditions, idiosyncrasies and ‘personality’. Therefore it makes perfect sense that each company should really develop their own global engagement strategy (and resulting 10 commandments).

Creation Healthcare can deliver a customized process to help you formulate your own global strategy 10 commandments; all you have to do is give us a call now.

Earlier this year I wrote about how language barriers are creating a new digital health divide and I suggested that the single biggest barrier to successfully connecting patients online internationally is language. On the one hand, the Internet has broken down many boundaries and has changed the geography of healthcare, uniting patients and healthcare stakeholders all over the world so that people are not constrained by information available in their own country alone. Yet on the other hand, language has become an even greater barrier as it separates people into groups – the advantaged or the disadvantaged – based on the information they can access.

I concluded that innovation is required, and offered some ideas about how to tackle language barriers in healthcare engagement. Now, in this report, I explore some of the innovative solutions being developed that are transforming healthcare engagement, improving access to healthcare, and literally saving lives by breaking down language barriers.

Solving patient-clinician language barriers

In the United States, over 34 million people speak Spanish as their primary language at home. When it comes to providing effective and reliable healthcare to this Spanish-speaking population, it is in the face to face encounter between physician and patient that any language barrier becomes critical.

I spoke with Dr Martha Bernadett, Executive Vice President at Molina Healthcare, a leading national healthcare provider in the United States, about the challenges of ensuring effective healthcare communication amongst non-English speaking communities in the US.

“It’s in the patient-clinician face-to-face encounter that patients gain the most important information and have the most important interaction,” says Dr Bernadett. “All other non-face-to-face interactions are trusted in a secondary manner, compared with the face to face encounter with a nurse or physician. After that is any written communication that the patient might take home, that they use to convey to family members what happened at that encounter. Those are the two critical elements in healthcare delivery where you don’t have as much margin for error.”

Molina Healthcare focuses on enhancing the relationship between patients and physicians, enabling them to communicate effectively with each other. Dr Bernadett told me that matching physician and patient language is an important aspect of the work they do. Where language matches or bilingual healthcare professionals are not available, interpreters are used for face-to-face encounters. Pre-translated documents also play an important role in efficient and accurate cross-language interactions.

Automating patient-physician interaction

Meanwhile, new technologies for automating translation are emerging and have been used successfully in healthcare. Staff at Bayshore Community Hospital in Holmdal, NJ, communicate with Spanish-speaking patients using an automated spoken translation tool that listens to a sentence in English, translates it to Spanish and speaks the Spanish sentence to the patient.

I spoke to Dr Mark Seligman, President and Founder of Spoken Translation whose product, Converser for Healthcare, is the innovative tool used by the hospital to engage patients in their own language and I asked him what makes the product reliable enough for use in a medical environment.

One of the keys to the product’s effectiveness, as Dr Seligman demonstrated to me, is ‘back-translation’ which confirms to the original speaker in text, what the translated text looks like when translated back into its original language. Through this innovation, it is easy to identify whether the context of an English word with multiple possible meanings has been correctly understood. If not, the correct meaning or inference can be specified by the user before the correct translation is spoken by the tool.

In the example below, the ambiguous meaning of the word ‘right’ in “Your right knee is broken” is clarified by selecting the correct meaning:

This is certainly an effective tool for reliable, context-sensitive translation that is making a real difference to areas including patient safety and compliance. The tool includes pre-translated compliance tools such as an informed consent form.

“Consent becomes a stronger thing when you can know and prove what you have said in a foreign language”, says Dr Seligman. The tool retains a transcript of conversations so it is possible to review exactly what was said. This opens another possibility for the future – the integration of transcripts with electronic medical records. Dr Seligman hopes this will be achieved next year.

“The challenge [of integrating with electronic medical records] is organisational rather than technological”, says Dr Seligman.

If this is starting to sound a little too much like a move towards fully-automated medical interactions, Dr Seligman is quick to reassure that Converser is not trying to replace human interpreters.

“Human minds, human hearts, human cultural understanding is irreplaceable.” says Seligman. “We’re not trying to replace humans. Converser will always work along with human interpreters.”

Emerging applications for automated translation

I asked Dr Seligman about the potential application of Spoken Translation’s technology into digital engagement channels such as social media. He explained that this is where he started out in the mid-1990’s, working on automating chat translations and it is certainly something that he hopes Spoken Translation will return to in the future. The company has a vision for applying their technology of today to live, verifiable, chat translation:

Spoken Translation’s vision of the future: live, verified chat translation

Other innovation in the pipeline includes server-based technology that would allow Converser to be used from portable and mobile devices. Dr Seligman hopes this will be available for iPhone and Blackberry during 2011.

Purpose built automated healthcare translation

During my research for this article, I was pleased to learn from TAUS, a think tank on translation strategies, about customized machine translation systems (aka automated translation) which are designed for use in specific sectors. This is in contrast to Google translate which can be unreliable for specialist areas such as healthcare. These customized engines are trained using database of previous translations from a specific industry and include features to ensure consistent use of terminology. The result is better quality, more accurate translations.

Just such a sector specific solution is used by the Pan American Health Organization (PAHO). Their system was originally developed in the 1970s, and today covers all combinations of English/Spanish and Portuguese and is being used daily for 90% of all PAHO’s translation needs, as well as by 75 clients. Another example is a Danish customized machine translation provider, Languagelens, whose purpose built solutions are used during clinical trials by pharmaceutical companies. Whilst human translators are needed to ensure that the final text is up to the high quality needed, the use of such customized automated engines drives down the cost of translation, increasing the amount of translation that can be done, and speeds up time to market.

TAUS also told me that it is possible to create automated engines rapidly when needed – within three weeks of the recent crisis in Haiti both Google and Microsoft added Haitian to the list of languages supported by their automated engines.

Real-time translation crowdsourcing

As automated translation technologies are deployed into healthcare environments, other innovative approaches to solving the automation challenge are emerging. New York, US based SpeakLike has developed a process that is enabling social media engagement to take place across 37 languages. Sanford Cohen, SpeakLike’s CEO told me that they were looking for a solution to enable real-time chat amongst people speaking different languages.

“We explored machine translation and found it was not good enough for our needs,” explains Cohen. “So we thought, ‘if machine translation were perfect, it would be integrated into everything we use – it would be in our email systems, in our chat systems, and in our content  management systems; but it’s not. But why can’t we have something that can be integrated into everything we use, with good quality translation?’ That’s when we started looking at crowdsourcing.” Cohen says this idea was how SpeakLike started:

“We got a large number of translators on our system, and users could send in a request when they needed it, 24/7, and then whatever translators were available or logged in first would provide the translation.”

The first application of the process was live chat, and in a 2008 beta SpeakLike demonstrated live, real-time chat between three users speaking English, Spanish and Chinese. This technology was implemented by PETLinQ, a provider of radiology imaging software management tools, to enable their user base of 71,000 doctors to collaborate in their own language.

After experimenting with the physician-patient interaction, where a dental reconstructive surgery in New York could support its worldwide patients pre- and post-surgery via international chat, SpeakLike started to develop other applications of the process. The translation platform was expanded to integrate with email, website content, and social media applications.

Today, a Twitter connector automates the translation of tweets, enabling either a single, multilingual Twitter feed or separate feeds for each language. Meanwhile, for bloggers using WordPress, a plugin automatically posts translated content into languages selected by a content author.

SpeakLike’s system is designed to manage the end to end process, automatically notifying translators, managing translated content, and publishing based on user options.

Cohen told me of a customer who was previously waiting typically for two weeks to have website updates translated into nine languages, but their content was out of date within four days. By integrating SpeakLike into their content management system, they were able to publish translations within less than 24 hours.

Responding to international health crises

The potential for transformation that can be achieved when people from different countries collaborate to solve healthcare challenges is exemplified in the work of international aid organisations such as Médecins Sans Frontières, where healthcare specialists from around the world work together in response to a crisis. But when the international team leaves an area of need, local physicians are often left without access to the international knowledge pool that exists during an aid mission.

Murdo Bijl, Founder and Executive Director of Health Connections International, saw this situation first hand when working with Médecins Sans Frontières in the former Soviet Union. The experience inspired him to set up an organisation focused on facilitating and promoting communication between professionals through multi-lingual exchanges of information. Health Connections International operates on a non-profit basis and focuses on improving responses to the HIV, tuberculosis and drug use epidemics in developing countries and resource-poor environments.

The organisation’s online knowledge and information sharing platform has been designed to allow healthcare professionals across the globe to share their experiences and exchange information, quickly and easily across multiple languages.

Healthcare professionals register as members of My Health Connections and can ask medical questions in their own language. Most questions are then manually translated and labelled by subject area (such as HIV/AIDS, treatment, medication) before being routed to an appropriate expert to be answered. Once answered, the response is translated back into the language in which the question was originally asked. It’s a laborious process but the result is a rich and growing knowledge base accessible in multiple languages.

MyHCI includes a growing, multilingual expert medical information knowledge base

I spoke with Murdo Bijl about his vision. He told me that in the proof of concept that has been running since April this year, 600 unique questions and answers have been posted. He said that as the number of questions and answers continues to grow, the knowledge base will be able to provide the answers to most commonly asked questions:

“There will be a moment when the knowledge base will have enough information for people to find the answers to their questions. Then all the questions will be translated into Russian, Spanish, Arabic and Chinese. Right now we have 500 Q&As online, translated into Russian.”

Supporting hard-to-reach healthcare professionals

In Kyrgyzstan and Tajikistan, local ‘focal points’ have been set up to bring Health Connections International’s service as close as possible to those healthcare professionals who may not have access to the Internet. As Bijl told me:

“We work with the medical academies and the ministry of health in the countries where we operate. They create their own knowledge centre in the capital city, with small focal points throughout the country which are equipped and manned by local physicians.

“In Kyrgyzstan and Tajikistan, we have twenty four ‘focal points’ on the premises of the ministry of health’s facilities, such as an AIDS centre or tuberculosis clinic, where local doctors who may not have access to the Internet can take their questions.”

Bijl says that the online model has allowed Health Connections International to continue to support medical professionals when other more traditional methods and have been unable to:

“What we’ve seen in Kyrgyzstan is that when many organisations had to halt their programmes because of political unrest and violence, we had an increase in user traffic. So even in political unrest, the work goes on.”

But Bijl is not content to stop at the existing online solution. He is already exploring new channels to increase the reach into low-income countries using mobile technologies.

“The next step for us will be to use mobile technology. 3G is virtually everywhere now in the low-income countries where we operate.”

Global collaboration

Amidst these examples of innovation in translation, TAUS supports the translation industry and aims to help the world communicate better through better translation, actively encouraging collaboration, sharing of knowledge amongst stakeholders and open innovation.

I spoke with Rahzeb Choudhury, TAUS’ Operations Director, about their vision for collaboration between translation organisations. He told me about the TAUS Data Association, a collaboration platform for sharing translation data, where Molina Healthcare is one of 40 founding members. This non-profit organisation provides an open platform for sharing translated texts into a single shared database which is a key enabler for experimentation and innovation, providing open access to language resources to help train better customized automated language solutions such as those used by PAHO and Languagelens.

The resulting repository of translations currently contains 2.6 billion words in 315 languages, including a giant corpus from the European Medicines Agency. The benefit of such a platform for healthcare (or any industry) can be seen by searching for a medical term in the free language search engine.

A glimpse of what is possible

From face to face physician-patient interaction in the United States to crisis response in the former Soviet Union, it is encouraging to see innovators establishing approaches and technologies that are breaking down barriers and achieving successful multi-language healthcare engagement. There is much still to be achieved, yet the examples here provide a hopeful glimpse of what is possible.

I am grateful to TAUS for their support in researching this report. My thanks are also due to the following:

Health Connections International
Molina Healthcare]
SpeakLike
Spoken Translation

Pfizer’s Get Real, Get a Prescription campaign won four Communiqué Awards at last week’s Award ceremony in London, including the prestigious Campaign of the Year Award.

The Annual Communiqué Awards have been running since 1998 and recognise the best of healthcare communications.

With Digital Engagement Strategy provided by Creation Interactive, Pfizer’s campaign was launched in direct response to research highlighting that more than 330,000 men purchase prescription-only medicines from unregulated sources, such as Internet sites, every year in the UK.

‘Get Real, Get a Prescription’ included a hard-hitting advertising campaign, with digital components including a website supported by engagement through social media, YouTube, online PR, natural search optimisation, and search advertising. Creation Interactive’s management of the digital components and ongoing monitoring of all digital channels allowed Pfizer to respond in real time to Internet user activity.

Daniel Ghinn, Creation Interactive’s Director of Digital Engagement, Healthcare, said that the awards recognise the campaign’s results in influencing user behaviour.

“Ultimately, the real result of any campaign must be measured by its outcomes. The effectiveness of Pfizer’s campaign was measured and proven in terms of real user behaviour results. Pfizer winning these Communiqué awards is a reassuring sign from pharmaceutical industry colleagues that a successful campaign is indeed one with successful outcomes”, said Daniel.

Find out how Creation Interactive’s Digital Engagement Strategy helped create this successful campaign for Pfizer in our ‘Get Real, Get a Prescription’ Case Study.

Engaging the online community can be difficult amidst sensitive regulatory issues faced by pharmaceutical companies.  So when Pfizer wanted to educate Internet users about the dangers of buying prescription medicines from unregulated sources such as illicit websites, they asked seasoned healthcare industry experts Creation Interactive to research Internet user behaviour.

Creation Interactive’s independent expertise helped define a digital strategy that integrated social media, natural and paid search, video, and content syndication with an offline media and PR campaign.

Download the case study and discover how:

• Insights into Internet user behaviour informed discussions with medical, legal and regulatory stakeholders to shape the digital engagement strategy;
• An extensive multi-agency campaign was implemented successfully in a tight timeframe;
• Analysis of online campaign activity helped to refine strategy execution in real time and improve results.

Some years ago the importance of website accessibility came to the forefront when the Target corporation of the United States of America was sued by the US National Federation for the Blind (NFB). The issue was not that the website failed accessible standards, but that no significant progress towards accessibility had been made on the website’s accessible features following complaints raised twelve months earlier.

Accessibility is not just about anti-discrimination law

Whilst maintaining a compliant site means avoiding unnecessary litigation, there are so many other advantages for keeping up with the latest standards of accessibility. The “Guide to good practice in commissioning accessible websites” (British Standards Institute 2006, ISBN 0 580 46567 5) raised a few interesting commercial points about the need for accessibility in the United Kingdom:

• The Family Resources Survey [2] found that there are almost 10 million disabled people in the UK with a combined spending power in the region of 80 billion pounds per annum. Furthermore there are millions of other individuals that are affected by sensory, physical and/or cognitive impairments, including those resulting from the ageing process.

• Research undertaken by the DRC “The Web: Access and inclusion for disabled people” [3] has confirmed that people without disabilities are also able to use websites that are optimised for accessibility more effectively and more successfully.

• Content developed upholding World Wide Web Consortium (W3C) guidelines and specifications can be more easily transferred to other media, such as interactive TV, mobile phones and handheld computers.

• Accessible content, for example where a text equivalent is provided for graphical elements, is highly visible to search engines, often leading to higher rankings.

New standards are on the way

As technologies and techniques change, so does hardware and software. Naturally the standards that made a website accessible several years ago will be showing their inadequacies as vendors try to deliver solutions that take users of the Internet into the future.

It is for this very reason that the Website Content Accessibility Group is recommending a new set of standards to build on the existing framework. Web Content Accessibility Guidelines 2.0 (WCAG 2.0) have been in development for some time, and will inevitably become a standard in the near future.

The same questions that were asked by marketing departments and executives are likely to surface again: “Do we have to do it, and how much will it cost?”. Not that executives or marketers are in any way discriminating, but that it can seem like a forced expense that may be unbudgeted.

A new opportunity for a new generation

Rather than perceiving changing accessibility standards as a threat or weakness to the business, they actually present an opportunity to develop a new strength in the marketplace. Companies should enthusiastically embrace the opportunity to develop a fresh new site, build in some new and much needed functionality, and to capitalise on some of the trends in online social networking. All made possible by a change in accessibility standards.

Never forgetting those that actually use the site

An unfortunate aspect of some standards development processes is that although with best intentions, the standards do not always reflect the very real people that are using the Internet every day, despite needing various enabling technologies.

Real world accessibility is quite different to the tables that are spat out from automated accessibility validators. Interestingly many users simply ignore any part of the site that refers to ‘how to user this site’, or ‘Accessibility help’. Like any person browsing the Internet, they are not thinking about ‘how’ to use it, and especially not how they ‘should’ use a particular site: they simply get on and use it.

So in thinking about making a website accessible as new standards come into play, don’t simply accept the website designer or developer’s certificate’s of validity, rather make sure that some real world accessibility and usability workshops are held.

Creation Interactive has helped organisations such as the Royal London Society for the Blind to implement a website which the real world blind and visually impaired students enjoy its content every day.

Download an article about developing
or updating an accessible website
(PDF 80 Kb)

If you would like to ensure your website is accessible in a meaningful way, or would like to organise a usability workshop, please contact our team on 0207 812 6474.

Education providers have a diverse range of stakeholders to communicate with. The Royal London Society for the Blind, one of the UK’s leading providers of specialist education for the visually impaired, has a wider audience than most.

Three separate special education establishments from nursery to adult education, as well as employment services, a radio station and corporate hospitality venue keep the charity’s marketing and communications team on their toes.

Understanding user activity

One of the challenges for education providers online is ensuring that all stakeholders can easily find information relevant to them, whilst gaining an on-brand expeirence of the college or establishment. Having planned an information architecture that will achieve this, it is essential not only to measure how a website is being used but to understand what is being measured. This was a problem that Creation Interactive solved for the RLSB with a workshop tailored to their website and its structure.

As Emma Vidler, RLSB’s Marketing Executive explains:

“My colleague and I recently attended a Web Analytics Workshop as we were finding it difficult to interpret the huge amount of information the website monitoring software gave us. As and had worked closely with us throughout the design process they understood our site objectives and produced a tailored workshop. This has proved invaluable and we are now able to interpret the results and make recommendations that will improve the effectiveness of our website and achieve our objectives.”

Turning website analytics into business insights is an essential skill for web marketers. If you would like to know how we could train your online marketing team, .

The term ‘social network’ often brings to mind the big names in social media such as MySpace, FaceBook, or Bebo. But some big brands are building their own social network websites where they can carefully control the brand experience, providing premium content restricted from public access.

These kinds of social networks are not intended to appeal to a mass consumer market. In fact the opposite is true: they are intended to provide members with a sense of exclusivity. The result can be significant brand loyalty amongst members, if the network is well targeted.

Building brand loyalty

This was the approach taken by L’Oréal Professionnel when they wanted to build brand loyalty amongst graduates of its colour specialist course, believing they will be the industry’s next major salon owners. We helped them to create a website for graduates, and used targeted email marketing to communicate the exclusive privileges of being a member of the Colour Specialist website.

Allegra Ziletti, new media manager at L’Oréal Professional Products Division, describes how the website builds on graduates’ experience of the L’Oréal Academy:

“The site was created by demand from graduates who were hungry for a constant flow of information, which they could add to their learning. It gives them a real opportunity to share and tap into their peers’ expertise while seeing what’s going on behind the scenes.”

Online support

The website acts as an online support service, providing industry news and a forum for hair professionals to develop their talents. Only authorised users can access the information, which includes previews of new products and collections. The site also includes career development tools, with information on training and technical resources available for downloading.

You can read about how other brands are using social networks in . Or contact us if you would like to find out how Creation Interactive could help you to make the most out of new social trends on the Internet.

A global brand owner and one of the world’s largest businesses asked us to help them improve their online support for school science education in the United Kingdom. After carrying out a market research activity and reporting on the competitive landscape online, we suggested running a workshop with three primary target groups – teachers, students, and parents – to explore their approach to learning science on the Internet.

Listening to real users

Having established relationships with participating schools, we planned and facilitated an interactive workshop. By observing real users and listening to their frank and honest comments, we were able to discover new insights about how each of the target groups use the web to support science education.

Informed recommendations shape website design

We documented and interpreted the workshop’s findings, and produced a set of informed recommendations about the immediate and longer term web strategy. This provided an advantage to our client in a competitive market and helped to shape the design of a new website. Our strategic input did not end there – we continued to engage with real target users during the new website design, allowing design decisions to be made based on ongoing feedback from the target groups.

Putting strategy before design

This kind of approach ensures far greater return on investment in a web design project. The alternative approach would be simply briefing a design agency to create a new site based on uninformed design preferences. Experience shows that failure to consider strategic insights prior to the graphic design stage, the satisfaction of releasing a new website can rapidly turn to disappointment.

Read more about putting strategy before design in Benjamin Dwyer’s article.