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Health care trustees should know all about communication, because it is critical in both clinical quality and performance improvement. Still, in the area of advocacy, which also is a form of communication, most of us trustees do not deserve a good grade.

In Arizona, the budget crisis has forced substantial Medicaid funding cuts over the last two years. Our method of using a professional lobbyist, state association and hospital senior staff, and a few of the largest systems' public affairs departments was not able to stop those cuts. This has resulted in a 100 percent increase in uncompensated care at my system, Maricopa Integrated Health System in Phoenix, as well as other hospitals throughout the state. This is devastating our balance sheets and, if unchecked, will kill thousands of private sector jobs in the area. Why were we so ineffective at such a critical time?

Before getting involved in health care, I was active in my local school district. This included attending many parent-teacher association, budget task force and textbook selection meetings as well as renovating a playground, picking up items for the booster club rummage sales and attempting to chaperone kids who were twice as smart as I. Many of us then became hard-core supporters whenever the district needed voter approval in an election. We found ourselves erecting "Vote yes on the bond" signs and passing out fliers at polling places. Most of those issues were approved by voters, even in difficult economies. Schools clearly have learned how to get adults involved.

It is time for health care trustees to help our institutions garner similar broad support and political power. The American Hospital Association has effective campaigns, including the new "We Care, We Vote" initiative. Unfortunately, trustees lack the tens of thousands of "soldiers" to carry these messages forward.

My experience as a trustee has taught me that in health care we have two ways to tackle difficult problems: hire a consultant or form a committee. I have asked the Arizona Hospital and Healthcare Association to do the latter to help hospitals mobilize their communities. In my proposal for a state trustee and volunteer advocacy group, I included the following ideas for such a group and for individual hospitals.

1. Build committed, diverse membership. Ideally led by a trustee, the volunteer advocacy committee members must care deeply for their hospital and be committed to communicating its interests to elected officials. It should have a diverse membership, including auxiliary members/volunteers and foundation board members. Clergy, hospital employee family members, vendors and others who are invested in the hospital's future should be considered as local campaigns are designed.

2. Raise trustees' standing. Hospitals should build the prestige of their trustees in the community. All trustees should have business cards to encourage contact from community members. In some cases, hospitals should consider paying dues to service clubs, chambers of commerce, toastmasters or other civic organizations to enable trustees to serve as representatives of one of the largest economic engines in the area.

3. Use multiple communication channels. Trustees should use their communication skills by making presentations at local service clubs, political party meetings, churches, newspapers, PTAs, chambers of commerce or any other organization that will hear us out. Many should be sending letters to the editor or submitting "my turn" columns to local newspapers and appearing on local television or radio public affairs programs.

We should not whine about funding but rather showcase the wonderful care our hospitals provide, the work we are doing to become more efficient and our progress in improving quality outcomes. We can explain our business model, mention how many jobs depend on the organization, and point out the funding cuts and regulations that challenge our sustainability. Residents should know that there is no guarantee that a hospital will be around in the future. For this grass-roots strategy, the committee might train hospital staff to build the presentations and help trustees improve their public speaking skills.

4. Look for political savvy. Hospitals could begin considering political connections as they choose their board members. I'm not suggesting we go back to honorary boards and selecting individuals based on their fundraising ability, but I do believe boards need members who are politically savvy and who count powerful public leaders among their friends.

5. Educate legislators. Hospitals should be formalizing campaigns to educate their legislators. A local legislator who receives 100 requests for face-to-face visits with constituents and 250 phone calls, letters and email messages from supporters of a local hospital may realize that he or she needs to support this critical community asset rather than following an unfavorable party platform.

6. Collect the data. We should create a registry of all legislators in the state and track visits, calls and other contacts from hospital advocates. When the AzHHA or AHA sends its public policy folks to call upon an elected representative, they should be armed with all that contact data.

"White coat tours" or coffee klatches for candidates are other ways to spread a hospital's message. Trustees could use this volunteer advocacy group to learn about these and other strategies to reach local lawmakers.

If our state leaders reject federal Medicaid expansion funds or other solutions for long-term sustainability, the future of our system will be bleak. We must use every available resource to ensure that our lawmakers know the political and community consequences of failing to address this financial dilemma. More than 100,000 patients and 3,800 employees will and should hold my board responsible for failure. I'm not going down without a fight.

Residents should know that there is no guarantee that a hospital will be around in the future.

Bil Bruno (Bil.Bruno@mihs.org) is a member of the board of directors of Maricopa Integrated Health System, Phoenix, and the AHA's Committee on Governance.