According to an exclusive poll, the college may have transformed a largely hostile membership into a supportive one.
There was a lot of conjecture in the office (some of us still come in) this week over my proposed First Draft topic.
Itâs derived from a series of what I think are statistically valid surveys (responses over three surveys average over 650) done by Healthed over four years, and which indicate a significant shift in the attitude of the members of the RACGP towards their college.
The Net Promoter Score (NPS) of the college has in the period of four years gone from a âdisastrous, no matter how you look at itâ -50 (just before the late Dr Harry Nespolon got elected in 2018) to âa still pretty bad but vastly improvedâ score of -17 just over two years ago (a few months before the election which Dr Karen Price won), to a âvast improvement and possibly even respectableâ +35 just over a week ago.
NPS is a globally recognised and universally used, standardised methodology for benchmarking and trend analysing customer and employee engagement with a brand or organisation.
Before the election of Dr Nespolon as college president in September 2018, Healthed surveyed college members with an NPS question and the score came out as -50.
If that sounds bad (itâs really bad) you can actually do worse. I used to work for Reed Elsevier once and our global division of that group â business publishing â managed a -60 one year (we were being sold off to private equity and the troops werenât entirely happy about it).
The quick version of how it works: you ask someone how likely it is they would recommend a brand or an organisation to a peer (which is advocacy) and you score that question 1-10. You then take everyone who is a 9-10 (advocates) and subtract everyone who is a 1-6 (detractors) and the difference is your NPS.
NPS is huge globally so there is a lot of data on a lot of different organisations and brands, meaning you can often benchmark your score against the averages for similar organisations or brands in similar markets. Some markets, like banking and airlines, do much worse on average than other markets, like healthcare provision, so you might have an awful score compared to health service provider but be the best in your category of airlines.
When we first started reporting the collegeâs NPS back in September 2018, we couldnât find any seriously equivalent organisational benchmarks, but it didnât really matter. -50 is simply a terrible score. Itâs pretty much what you might get today if you did an NPS on Qantas.
Most members hated the college, its uppity and unapproachable management and board, and felt trapped by its fees, CPD monopoly and membership requirements. There was plenty of anecdotal evidence to support the result.
Last weekâs result and the striking underlying trend raised some eyebrows in the office. Questions arose about sample sizes and whether Healthedâs sample was representative of RACGP members in general.
You can see why the journos might be skeptical (good journos have to be).
Given how hard it actually is to change peopleâs thinking and attitude towards established brand attributes (and the RACGP had some pretty deeply ingrained attributes a few years ago), if you believe these results, they tell you just how well college leadership has done in these years.
It hasnât been easy trashing the Qantas brand, as an example. It was a rockstar consumer brand a few years back. It took a lot of hard work and incompetence on the part of management to bring it down so quickly so far.
Anecdotally, all the journos in the office reckoned that the college was still on the nose with plenty of members. But then, the members theyâre mostly talking to arenât representative either.
Itâs not A-grade research by a research company, that is for sure. But the sample numbers are good, ranging from 450 to over 900 college members, and theyâre made up of Healthed clients, all AHPRA verified, well distributed and identifying as college members.
Healthed, if youâre wondering, is the largest GP educator in the country by quite a margin. It has provided its service in a very consistent and particular way over nearly 15 years as far as brand is concerned: inexpensive, efficient (one-day face-to-face sessions in capital cities, or fortnightly webinars), well researched topics, easy to attend, good KOLs, and while pharma supported, only KOLs can present (disclosure: Healthed is a 10% shareholder of The Medical Republic but it has no sway over what we do or say).
This profile might I guess somehow select for a certain kind of RACGP member who might end up answering in a different way to another population of members who donât do CPD or education this way.
But it really doesnât matter because one of the key uses of NPS is âtrend analysisâ.
Whether Healthed represents a weird bunch of RACGP members or not (i.e. a skewed sample), this bunch of possible skewees went from largely hating the college to largely thinking itâs OK, within four years.
When you take the result and try to work out what happened, there are quite a few moments that may have changed minds. Here are a few things I can think of, off the top of my head:
- Dr Nespolon was a straight shooter who cut through to members quickly, especially when he promised to ditch PLAN, and he did it early in his tenure. He didnât get on very well with the board, but you suspect his preparedness to ask hard questions publicly contributed to his popularity and that could have helped membersâ attitudes to the college over time. There was a feeling someone was genuinely going into battle on their behalf for the first time in quite a while.
- Late in Dr Nespolonâs term, a long-term CEO that a lot of members were increasingly unhappy about, and who reigned over an era of board and management empire-building without a lot of meaningful member engagement, left the organisation. This possibly earned some more brownie points from some members.
- The CPD monopoly which the college held for so many years, which had more or less forced members to stay long past their training and registration days, was at least in part broken by the Department of Health in a new CPD regime. The options were introduced for members to not be members and still do CPD, albeit, they didnât end up very practical options. Although the college worried incessantly that this might break them money wise, it didnât, and by accepting their members should have easier options to leave if they wished, it quite possibly improved the relationship between members and their college.
- Adjunct Professor Karen Price, who followed Dr Nespolon, did a few things that created some continuity in Dr Nespolonâs drive for better engagement with members. The most important (which will surely be remembered in her legacy) is her breaking ranks on Canberra and very publicly declaring that members needed to abandon universal bulk billing because the government looked like it was never going to catch up remuneration via the MBS.
- Covid:
- GPs were besieged and the college did a lot practically to support them where it could.
- The public persona of the president became a lot more public as a result of covid and perhaps GPs started feeling better represented as a result.
- Partly as a result of that raised public profile GPs started getting paid attention to a lot more in the media.
- The new CEO, though relatively quiet, appears to be a lot more in sync with the membership, possibly via the board and president, and has pushed strongly a lot of new listening and engagement initiatives.
- For the first time in a long time, most of the major media started reporting about the serious issues facing general practice, particularly in rural and remote areas, and what that might actually mean for the future.
Of course, we have no data on whether any of these events caused such changes in the NPS score. We are speculating.
For a podcast interview we did with the outgoing president Professor Price this week, to be published next week, we outlined the latest NPS results we have for the college and asked her to comment on them. She said:
âI think there’s been a better dialogue, and certainly in my two years I’ve been unrelenting in forcing the college in its entirety to think about its mission statement, which is to enable the members to deliver high-quality health care. I’ve hopefully role-modelled a vision of professionalism that we need. You never know how it appears, but I hope it’s been apparent.
âI think thereâs also the use of social media, the GPs Down Under group and all the other groups â there’s lots of other groups â where many senior people who’ve been involved in the college and understand the relationship with government, which is always challenging.
âPeople are saying, âwell, actually, this is legislation, that’s not the college; the college is a large advisory body, nobody else does legislation except the governmentâ.
âUnderstanding the governance of the country or the governance of medical politics has really helped people understand the importance of having a strong organisation like the colleges, like the RACGP, in the room fighting for them â and not even using the word âfightingâ, I think that’s sometimes an unfortunate word â but having dialogue with the government in an evidence-based way to really influence and inform.â
Hmmm ⌠I liked my reasons better.
One thing for almost certain is there are going to still be quite a few members out there who, like some of the journos I talked to, donât entirely buy this result in terms of overall performance of the college in terms of member engagement.
And in this respect the doubters could still be right.
The most important thing this NPS result is telling us is the trend, not the overall position of all members towards the college.
By that I mean memberâs attitudes to the college are certainly changing for the better in a major way.
But do a significant proportion of members now support the college in what it does and how it does it?
You canât actually make that conclusion, even from this last vastly improved result.
Thatâs a different question to NPS.
We are going to ask Healthed to ask it in the near future.
How good is the college, then, compared to other member organisations at least?
We would need a reasonable benchmark against which to measure the +35 result, which we donât have because the RACGP as a member organisation is actually pretty unusual in its characteristics.
At the most general level the experts say anything above 0 is good because your responders are more loyal than not. Bain and Co, who started NPS, say anything above 20 is favourable, above 50 is excellent and above 80 world class.
In that respect the college has a little way to go yet perhaps and the next president will need to keep hard at what Dr Nespolon and Professor Price appear to have started.
âAnd the winner is ⌠â
No drum roll, itâs going to be Dr Charlotte Hespe by a good margin, according to a poll conducted by Healthed at the same time it did the NPS earlier this week.
She also wins the office poll of journosâ predictions, if that helps anyone betting on the result (although if anyone does lose money, we arenât paying them back).
Just one problem to the above. Unlike the NPS numbers, the sample size wasnât very good (323) and of the that sample the majority of responders said they were undecided so the numbers on voting intention were way too small to be valid probably.
Of those who did say they intended to vote, those who declared their intention to vote Hespe far outnumbered those who plumped for the next two most popular candidates, Dr Nicole Higgins and Dr Chris Irwin, and the other contenders were a long way off being competitive.
But itâs a bit of a dodgy poll.
Still, the same poll, at a similar time prior to the result announcement, predicted the winner last time.
Whoever does win is going to need to take heed of the two predecessors, both of whom turned out to be rebels to varying degrees in Canberra, and to some extent in the college board room.
Thereâs a lot that still needs changing.
