Autopsy of a Content Strategy

The Medical Content Examiner’s Report

***

Ladies, Gentlemen, Non-Binaries,

Perhaps a proper report shouldn’t start in epistolary format, but I feel that my presentation at the 2021 Healthcare Internet Conference was really a love letter to my work over the last couple years. Mind you that work is not over, but still it’s been and continues to be a labor of love.

So what better tribute than to present on all my favorite things? We did indeed, me and my audience, become medical content examiners, for an hour or so.

Please enjoy this summary of the highlights, and, as always,

Cheers,

J

***

The Body—of Content

Timeline: August 2021

Data collection period: FYs 20 & 21, Jul 2019–Jun 2021

When I started planning this presentation, it wasn’t so much from the perspective of a problem to be solved, as a case study of an experience from the bottom up. Nine+ years ago, when I started this job at University of Utah Health, I had no idea where it would take me. Right now, it’s into the realms of content strategy. 

Before presenting, I always present/workshop my ideas for an audience. I find I can get very stuck inside my own perspective, and the feedback I get from my own reviewers is invaluable. For this presentation the feedback was: What are you making an argument in favor for? What problem are you really trying to solve?

I was intent on talking about the problem that I did solve: How to find organization and meaning in the content I worked on and propel it forward. Feedback from the team identified for me the question and the problem that we did solve: Documentation in service of content strategy.^

I covered the three following learning objectives in my presentation.

1. Documentation in Content Strategy

There are many pros and cons for documentation. Agile project management processes were formed on the mass retirement of much of documentation, but I think most content strategists could find value in documenting their content strategy. 

In a poll I was able to conduct at HCIC21 (thanks to the conference’s use of the app Whova, which made the experience a pleasure), I found that 70% of my poll respondees did not have a documented content strategy.

Image 1: Poll results from question: Do You Have a Documented Content Strategy? Btws, a shout out to those who do have documented strategies. I should have asked you to self-identify so we could share techniques!

The Content Marketing Institute notes that compiling a documented content strategy makes you feel more successful because you more easily demonstrate your success and feel more effective.

Image 2: Screenshot from Content Marketing Institute’s research summary on the pros of documenting your content strategy.

Boy howdy do I feel that way! The efficacy and control I feel over our work—not to mention contribution—was and remains significantly heightened by our use of a documented content strategy.

2. The Bone Structure—Content Modeling

For some reason, content modeling always felt somewhat of an enigma to me. I think that the more you dive into your content—and in this case document it—the clearer it becomes. Now I need to figure out a better way to communicate that model as my current model is a wee bit involved.

Image 3: Content model mockup; color coding shows the different purposes of the content.

I also expanded this model out to our entire ecosystem. I plan on using this model to communicate the expanse of our content types and perhaps argue in favor of a more coordinated approach. There is no doubt that we collaborate, but I know we can do so better and more clearly in a way that impacts our users.

Figure 4: Content model including content by many other entities: public affairs, publishing, strategic, physician referral teams, and others. All content in yellow circle references the content managed by my team.

3. The Analysis—A Reporting Process

Analysis is ongoing, as we all know. Whether it’s in pdf, dashboard, or other interactive format, the visualization of a body of work is most gratifying. It also can lead to a supremely successful feedback loop with particular clients. Here’s one example for you, the one I referenced in my presentation but didn’t include in the slides.

Skull Base Surgery Program

Clients: Neurosurgery & Otolaryngology Services

First off, I have to applaud these services for their collaboration. Collaboration between services in a health system can sometimes be very challenging. (Does the financial reimbursement model have something to do with that?) Whatever the cause, it takes forward-thinking specialists who can give patients an easier entry to get high quality care. And putting the patient first is the difference between a fair experience and an excellent one.

When we started work on the website for this program, our subject matter experts were very insistent on two things:

  1. We needed a program webpage.
  2. We needed webpages specific to anterior and lateral skull-base surgery.

Of course, I never say no to our stakeholders (in that direction lies madness…). I do, however say “and…”. In this case, I said, “and” to these pieces:

  1. What Are Skull Base Tumors
  2. Acoustic Neuroma: What to Expect at Surgery

These were experiments, of course. As you can see from the below screenshot, thanks to the experiments, the site traffic increased exponentially.

Image 5: Screenshot of Skull Base Tumors website report slide showing the exponential increase since publication in January 2020.

Users want to know what they will experience, where, and how.

In the report back to the client, there may have been some shocked faces. Then there was increased belief in our credibility. Now there is serious excitement for all of us. We are ALL collaborators. 

I look forward to what we are compiling now to increase our positive patient experiences.

Feeling like a mad data scientist certainly increases my feelings of efficacy and satisfaction. There is nothing more satisfying than establishing a successful and collaborative team that cares about the end goal: empowering patients to find good, quality healthcare.

The Writeup

Then, in the presentation, I shared our content strategy template, which you can find here. It contains all the elements you would expect.

Image 6: U of U Health content strategy template. Developed after research online and with information from marketing plans.

As we continue to work on this year after year, we gather more information and build a greater understanding of our audiences. Will this someday lead to personalization and greater refinement for the sake of our users? I sure hope so!!

So there you have it! The autopsy, or at least the summary report. Let me know if you are using a documented content strategy and if it works for you. I’d love to hear your experiences.

*Werking it is a form of the verb “work” but in drag queen speak. If you want to meet the forerunners of pop culture, do a little research into drag queens. If not, just sit back. You’ll soon see many of their -isms of every kind in mainstream pop culture.

^Immense thanks to my support team—Ashley, Nisjet, Sophie, Spencer B., and Mike H.—your absolute domination of all the things that needed to be done while I was gone made me feel so grateful. You are beyond competent—you slay.

The Value Proposition & Cats

Outcome vs. Output, Quality vs. Quantity, Hybrid vs. Central

I was recently reading an article in Wired magazine that postulated time traveling (not surprising) and used it to put forth a commentary on our contemporary society (not surprising). They posit that a social scientist plucked from the eons of time is brought forward to 2019. Would said personage be “as astounded by our world as we like to think?”* The article author thinks not. And why not?

“Anyone familiar with the ancient Egyptian fixation on felines (cat statues, cat pictographs) and the mid-century American obsession with TV would at least have some pretext to accept that one of the largest conglomerates on the planet is the owner of a massive video site with millions of cat clips.”

— Zeynep Tufekci*
Cats laughing emoji

Now that was surprising! I could hardly contain myself!!! It’s totally true!! Our lives (or those of my friends and I) revolve around the feeding, cleaning-up-after, and placating of cats. That aside, humanity, if I can be so bold as to comment collectively, really hasn’t changed—despite the evolution of our tool set.

We remain as selfishly stupid and as supremely susceptible to the seven sins as at any time in history before. So where, I must ask, is the value proposition in that? And are ALL those cat clips really necessary?

Which leads me to the next rail car on my thought train: Outcome vs. output and how it contributes to value.

Outcome vs. Output

As has been documented many times over, we are a world obsessed with output. And our clients demand it. What they don’t tend to think about in marketing and content strategy is that to be truly successfully, content output must be matched up to a content strategy and an outcome. Otherwise, where is the value add?

To be truly successfully, content output must be matched up to a content strategy and an outcome. Otherwise, where is the value add?

Confession: A highpoint in my life is viewing a stymied subject matter expert, generally an MD in my industry, as I debate with them pros and cons of content output vs. content outcome. Does the content truly help us meet our goals? I’m sure my glee is palpable…

For example, here is some of our top performing content of all time: interviews with subject matter experts published with transcripts to our website.

A list of our top performing site assets (specifically interviews with subject matter experts)
Fig 1. Our top performing interview transcripts of all time on healthcare.utah.edu/the-scope; these 20 assets (out of 15,000) drive 20 percent of all our website traffic.

Out of all our content, approximately 30 assets (.002%) our of 15,000 drive almost a quarter of all our web traffic. (See Fig 1. Note that I added 10 of our top performing blogs to 20 of our interviews for the 30 assets, which I didn’t show in the figure—sneaky. Sorry about that. They do exist!!)

To me, this sparks multiple suppositions:

  • We should be actively promoting that content as part of our ongoing strategy.
  • This content clearly resonates with an audience and resonating with your audience is important.
  • We need to create more MORE!

In slowing down to consider more fully however, are these really should-do’s or are they rather could-do’s? Where is this traffic going after it arrives? And what outcome are we looking for? The further research I conduct into this question, the more I question our content machine.

Don’t get me wrong, I believe you must have that eternal balancing of the scales. A conglomeration of high performing cat clips was not established without much experimentation and mass quantities of cats. But I do believe we must create with an eye towards quality.

Don’t fret overly much about keeping the content scales balanced with both quantity and quality. A conglomeration of high performing cat clips was not established without much experimentation—and mass quantities of cats.

And I’m grateful to note that in my organization we are also becoming obsessed with outcome and quality of outcome.

Quality vs. Quantity

I find that sometimes our higher quality content is not necessarily our highest performing nor are we producing it in high quantities. Here I must pause and identify a value add for our organization.

For my team, we have determined that measurable outcomes consist of, essentially, lead generation. How many clicks on the “Schedule an appointment” button can we track? How many taps on the scheduling phone number? Can we get all this data lumped together onto a dashboard that reflects in a quantifiable number the difference our team is making?**

Alas, there are major gaps in our data collection. We cannot track if an appointment was actually requested once a lead has called the phone number. Nor can we track if a request form submission has led to an appointment scheduled. We also cannot connect whether a particular lead driven by video or written content has resulted in a higher value patient for the organization (namely resulting in a surgery—something our specialists find extreme value in—and not only for the revenue).

And for other teams creating content in our organization, quantification and value remains somewhat mystical. What is the value of that high performing content that drives so many site visits? Since it was technically created in the name of brand recognition, how can it hurt us to have such massively successful content?^

One also can’t negate the benefit of this content for our internal stakeholders. Is some volume necessary to keep the peace even if the long-term value is negligible? (Btws, I’d say yes. If you have to create something for a stakeholder to give them a twinge of joy or that, hopefully, leads to data collection on why it’s not a value add—BY ALL MEANS VINDICATE YOURSELF. And if you fail, it was in the spirit of experimentation. We must keep our sense of humor about us.)

But still I do pause to wonder, could quantity hurt us? When does quantity negate a value add? (More on that in an upcoming post as I have been watching some experimentation in our content ecosystem.)

When does quantity negate quality and therefore its value proposition?

Sidenote in the name of quantity: #DYK that the monuments of ancient Egyptian culture morphed from pyramids of massive size to smaller hidden tombs to temples that remain UNESCO heritage sites to this day? We all have heard of the Egyptian obsession with a life after death, but did you also know that they massively stockpiled provisions and small representations of servants (ushabtis) and the like to aid them in their next-life journeys?

Sometimes I can’t help but think that the ushabtis and cats mummified for this cause, while probably high in quantity and supportive of Egypt’s economy, probably did not return the value expected by their purchasers…

Enough already now though of the musings and questions and assumptions. Let them have solutions! Let us unsheathe the teeth and claws. Which of these propositions leads in a bid for value?

Hybrid vs. Centralized

I dare you to identify frameworks in your life that are hybrid partners vs. centralized in nature. A few come quickly to mind:

  • Pointillism: The foray of Georges Seraut into complete paintings made of dots that unify to create figures and forms (the forerunners of pixels).
  • The EU: A union of countries vs. Great Britain standing independent. #Brexit
  • Fashion: Mixed prints over matchy-matchy, both of which schools of thought vie for dominance.
  • The US of A: An experiment in democracy that resulted in independent states in tenuous balance with a unified (supposedly) federal government.
  • Google: Which business model focuses on global dominance but also opens numerous projects and businesses in the name of innovation and experimentation.
  • Alpha cat (me) vs. baby cats in my household.

Notice that in all of these situations, there are a variety of models, from rebel (Seraut’s points) to central (Google) to hybrid (the US of A). There is no clearly dominating model that seems to work better than any other.***

Dennis Shiao, for Content Marketing Institute writes that companies, much like those parallel examples above, organize around content in three different models (as illustrated in Fig 2):

  1. Rebel
  2. Hybrid
  3. Central

And here I make my stand and offer my solution for the pursuit of value: With the caveat of leadership influence, I make a bid for the hybrid model.

Fig 2. Visualizations of content organization models: 1) Rebel (or as I like to say—singular sensation), 2) Hybrid, and 3) Central (around our mummified cat of course)
Fig 2. Visualizations of content organization models: 1) Rebel (or as I like to say—singular sensation), 2) Hybrid, and 3) Central (around our mummified cat of course)

I proffer the proposition that true value lies in a balance between the content created by rebels and the overlord conjointly, for these reasons:

  • Agents of chaos can sometimes make amazing content.
  • Without centralized and singular guidance, mavericks can lack backing to move a project forward and harness the quality of their content for the most value.
  • Too strongly centralized methodology can establish a series of hoops so discouraging that it precludes any creativity or timeliness.
  • Conflict between methodologies can lead to sparks of genius that would otherwise never achieve combustion.

And therefore, my value proposition: Don’t dismay if you have content creators who aren’t following all the best practices or centralized standards. Some of the stuff they create is amazing and resonates with an audience.

Do strive to represent a unified brand and style guide to represent consistency and quality in your work. Do work towards data collection and quantification of output in the hopes of demonstrating good practices.

Hybridize and experiment.

My value proposition: Work towards a hybrid content model where you empower individuals but maintain a strong centralized brand and structure around desired content outcomes.

While I like to think that I am the alpha (and can site evidence towards this theory), I must acknowledge that I often bow to the vagaries of my felines. Without their hidden depths and uncanny ability to surprise me, however, I would not be such a delightfully centered eccentric.

We are, of course, each a singular sensation.

Sketch of mummified cats from the British Museum: A Guide to the Third and Fourth Egyptian Rooms, Natural History Museum, London
Sketch of mummified cats from the British Museum: A Guide to the Third and Fourth Egyptian Rooms, Natural History Museum, London (altered)

*”Free Riders” by Zeynep Tufekci. Wired Magazine Sep 2019

**Let me refer you here to an amazing podcast from Brain Traffic with Kristina Halverson and some content data analysts at Harvard who have been able to create such a magnificent dashboard. I am simultaneously immensely envious that they have an actual data scientist and extremely chuffed that my department is also dabbling in this. Democratizing Data at Harvard

^I want to assure you that I have plans around establishing and assigning a measurable value to this. If only I could find the time for the analysis!!

***I’m ignoring the fact here that Google basically owns all of us.


The Art of the Content Audit

Originally published on Pulse, University of Utah Health’s intranet, June 12, 2017, this is a case study about a content audit for the Women’s Health Services website at University of Utah Health.

Content, if you haven’t noticed, is a complex beast. For example, we spend a lot of time focusing on good content, what it is, where we get it from, and how we deploy it. But we spend less time than we ought on considering the outcome we want from the content we curate and post.

A content audit is a tool that allows us to review the content we have and take its pulse. It’s a great benchmarking tool with which to craft and test which content pieces are performing the best and where there might be gaps in the content. If there is important content missing that would benefit our users, a content audit is likely to reveal this.

Goals​

For our content audits [at University of Utah Health], we have identified these specific goals:

  • Reduce number of website pages with thin or low-performing content
  • Combine pages with thin content OR flesh these pages out, depending on website goals
  • Archive pages that are out of date, no longer applicable, or very low performing
  • Identify areas where we might want to add content

Where to Start

An audit can be as in depth or concise as the site necessitates. You can also tailor the information you collect in the audit to fit your overall site goals. The typical content audit might include these items:

  • Analytics
    • Page views
    • Time on page
    • Bounce Rate
  • SEO factors
    • Meta title & length
    • Meta description & length
    • H1 heading
    • H2 heading
    • Subtitles: additional use?
    • Word count
  • Content type (video, form, text, etc.)
  • Contact information
  • Images
    • Type of image
    • Image alt text
  • Affiliated documents
  • Duplicate content
  • Last modified

We determined to add in these additional audit points as particularly applicable to our patient-facing sites:

  • Call to action
  • Referring physician link included?
  • Specialist list included?
  • Related MBM specialty?
  • Affiliated service line
  • Affiliated marketing campaign
  • Affiliated research or other programs
  • Any additional content
    • Patient experience story included?
    • Health Feed/Scope inclusion? [U of U Health blog and podcast respectively]
    • Related tags to Health Feed/Scope
    • Clinical trials inclusion?
    • Patient education?
    • Vendor library content included?

Once you have outlined what you would like to inventory, you can begin to collect the data.* Take a look at the content inventory for our women’s health services website:

Redacted content audit women's health
What the full content audit looks like for women’s health services; please forgive the omission of analytics data!

Now that we’ve inventoried the content (rather exhaustively), we can examine how each piece is performing and make some assumptions as to whether the page should be kept, revised, or removed.

Example: Content About Midwives

Previously, we had two website pages about midwives on our women’s health services site.​ The page /what-is-a-certified-nurse-midwife.php receives far fewer page views than the /midwives.php page. However, this is not necessarily a bad thing, particularly as the time on page is over 1 minute. That’s a lot of time in our virtual ‘verse. So the content is important to those who are looking at it, even though the page doesn’t receive a lot of traffic.

In this case rather than get rid of the content, we are going to optimize it by moving it onto a page with more visibility, in this case /midwives.php. This should increase the main midwife page’s value while indicating to Google that we have both updated our site and checked our content for accuracy. (When search engines crawl websites they look for a number of factors that might tell the importance of the webpage. One of these factors is the date the page was last modified.)​

Webpage featuring content about midwifery (or midwives) on University of Utah Health’s women’s services website

The sticky navigation (a navigation bar stays with you as you scroll down the page) allows readers to access all the content about midwives and our services without leaving this page for another. Thus we’ve consolidated a low-performing, but important, page into the content with which it fits, letting the search engine know that we’ve updated the content by modifying the page, while keeping content that is clearly valuable for our readers.

End Objective: Increase Quality of Page Visits

This is just one page treatment out of many options that we might use when it comes to structuring content. All of the content audit goals lead to the most important objective of our content strategy: increase not just traffic to the website, but the quality of the traffic; namely, we want this content to show up for the right people at the right time in the right place.

Where Do We Go Next?

What happens after an audit? We look at the recommendations we’ve made after reviewing each page and determine who is responsible for whatever action needs to be taken. We also track the progress of the content updates.​

Ideally, we apply this process to all our websites on a regular basis, ensuring that our content remains up to date and within best practices.

And that, my friends, is the short of it (the long is all wrapped up in all that data and detail gathering). In the next few months, we’ll keep checking in on this content to see how the website data analytics change (usually we must allow about six months to get a relatively accurate picture of how the content is performing—performance has leveled out by then after the significant changes have been made to the site by then).

*I’m afraid I’ve had to redact the data here; I’m sure you understand!.

5 Reasons Writing for Web Is Different Than Writing for Print

Cover of Writing for the Web Guide
Cover of Writing for the Web Guide

Originally published Sept 19, 2014, on Pulse, University of Utah Health Care’s intranet. Used with permission.

Every medium requires slight adjustments in writing style, tone, punctuation, formatting, and the like. The web is no different. While the current goal of web content specialists is to create content that is device (or it could be said medium) agnostic, the overall style and tone of web writing is far more personable and relaxed than has been the case for print writing. Here are five reasons why web writing is different from writing for print:

1. It’s interactive.

When we visit any page on the web, we do so with the expectation that we can leave the page at any time via hyperlinks or search if we don’t find what we’re looking for. And there, in a nutshell, is the web: we are usually searching for something. While this can be the case with printed material, the web culture demands faster results—pretty much right now.

2. Readers scan paragraphs rather than reading them.

Most readers are either searching for specific content or browsing. As such they tend to scan paragraphs for the information that most appeals to them. Usability tests have overwhelmingly confirmed that this is how we read the web.* If that’s the case, we need to alter our writing techniques to match. We need to include subtitles, catchy first lines, and highlighted areas of importance via techniques like bold text, anchor text for a hyperlink (though this will take your reader away from your page), or bulleted lists.

3. Tone and style are more informal.

There are tons of different articles and pages, even books, on the web, but the writing tone and style that overwhelmingly define it are more informal. This is in part due to how we read articles, but it’s also a product of the intimacy of the web. Web pages have varying levels of credibility due to the democracy of the web: anyone can post almost anything, and many, many pages are personal sites and posts by individuals, which are not vetted through editors or any other sort of accrediting body. This naturally leads to a lighter, more informal style.

4. TL; DR: Shorter is sweeter (most of the time).

Too long; didn’t read. Literally. Readers are turned off by articles that take way too much time to describe something that could be done in a condensed manner. For example that last sentence could have been: “Readers are turned off by articles that aren’t succinct,” or “Readers like short articles.” The general rule of thumb is to cover the subject adequately, but not over the top. Some writing styles lend themselves to the verbose, but know your audience. As a general rule, shorter is sweeter.

5. It’s never finished!

People who spend vast amounts of time on the web innately understand this. News that is updated in real time is valued more for its timeliness than for its definitive nature. This doesn’t mean that content of a more evergreen nature (or always valuable) isn’t an essential part of any site, but rather that updates, corrections, or changes are just as important to the written piece because of the way we use the web.

* http://www.nngroup.com/articles/how-users-read-on-the-web/ Yes, this article is older, but it’s that evergreen sort of content, and from a highly, highly reputable source.