Fledgling is thrilled to have provided early funding for the Escape Fire campaign and to have supported, with our funding partners, some of their targeted screenings. We congratulate the team on additional support from the Robert Wood Johnson Foundation that has allowed them to continue to reach and engage key stakeholders in transforming our healthcare system.
Even as they continue their work, we can share some key lessons from their campaign. Namely, the importance of using each screening opportunity to advance the campaign’s core goals and the power of strategic partnerships to help reach and engage professionals working within a system that needs to change.
WHAT’S THE STORY?
Escape Fire presents a comprehensive look at the broken U.S. healthcare system. It focuses not only on the problems and perverse incentives of our current system but highlights solutions and those who are working for change as well as poignant stories of patients working toward health. In the film, we see physicians taking a different approach, corporate leaders experimenting with new programs that focus on prevention, and the U.S. military testing pain management strategies to reduce reliance on pharmaceuticals. By focusing on these change agents, viewers see that we all have a role to play in changing our healthcare system.
WHAT WERE THE GOALS?
The vision for the film and audience engagement campaign is to transform healthcare and change how the public views health and healing. With this in mind, they laid out three goals:
1. Raise awareness: Give a straightforward understanding of the underlying causes of the American healthcare crisis
2. Mobilize viewers: Grow the movement to transform healthcare with partner organizations
3. Affect change: Inspire Americans to participate in this transformation on a personal and community level
The Escape Fire campaign was designed to extend and grow the dialogue across multiple platforms and move the audience from passive moviegoers to active reformers.
WHAT WAS DONE?
Escape Fire premiered at the 2012 Sundance Film Festival, where it was nominated for the Grand Jury Prize and won the Candescent Award given to one outstanding socially conscious documentary. It went on to play at numerous film festivals, earning multiple awards, and premiered in theaters in October 2012 – reaching 18 markets nationwide. The film had a national primetime broadcast on CNN in March 2013, screening several times over the course of a two-week period along with a 30-minute panel discussion led by CNN’s Dr. Sanjay Gupta about themes in the film. The team used all of these opportunities to drive discussion and engagement both online and offline.
The Escape Fire website and social media campaign is robust and action-oriented, providing opportunities for visitors to engage with the film and issues. Visitors to the site have the opportunity to create their own “First Aid Kits,” which ask them to share how they would change different aspects of their own healthcare experiences. They also have the opportunity to share their own solutions, or “escape fires,” for dealing with the healthcare crisis. As of October 2013, close to 3000 people have submitted their personal “escape fires”.
“We wanted the website to be a place where visitors could learn more about the issues but also offer their own solutions and begin to think about what they can do as individuals to change the system.” – Matthew Heineman, Director
Importantly, the campaign also focused on offline engagement – organizing hundreds of community screenings. At this point, they have done over 750 non-theatrical community screenings. They provided support to screening organizers to help them create post-screening panel discussions and encourage issue-centered engagement. For example, like the online engagement, event attendees were asked to create “First Aid Kits” or describe their own “escape fire”, providing anyone who watched the film with an opportunity for action that required them to think about and develop possible solutions. These were then shared more broadly using social media.
The campaign also leveraged their national broadcast, working with groups that could help them reach and engage their key stakeholders groups. For example, the campaign partnered with the National Student Nurses Alliance, the National League of Nurses, the American Association of Colleges of Nursing, Nurses Organization of Veteran’s Affairs, and the Visiting Nursing Services of New York to spread the word about the broadcast to the nursing community. These partners helped promote the event to their membership, co-wrote a nursing-focused insert for the screening discussion guide and aided in developing a national call-to-action. Using these specially designed tool kits and discussion prompts, nurses came together in small groups to facilitate conversations after the film and shared thoughts with others in their community and across the country.
The campaign also targeted policy makers, military leaders and current and future healthcare providers. To reach healthcare students and future providers, the team facilitated two national screening events. In advance of the film’s theatrical release, Escape Fire organized a Fall 2012 “kick-off tour” that included simultaneous screenings at 60 medical schools for approximately 5,600 students, faculty, and community members around the country. In Spring 2013, the campaign partnered with the American Public Health Association and screened the film at 46 locations to roughly 2,500 students and professionals during National Public Health Week.
To reach military providers, the Escape Fire campaign worked with the Veterans Health Administration Office of Patient Centered Care and Cultural Transformation to create a 30-minute version of the film that was live-streamed simultaneously for nearly 1,000 leaders at all 152 VA medical centers. Additionally, the film screened at the Pentagon for top military leaders, hosted by the U.S. Army Surgeon General. The campaign also worked to reach policy makers, encouraging members of Congress to see the film. In some cases, they sent copies to key members.
Perhaps most intriguing, the campaign came up with a terrific way to reach and engage practicing physicians and nurses in the U.S. These groups are critical to creating change, but can be difficult to reach. In an unprecedented professional education opportunity, through a partnership with the American Academy of Family Physicians (AAFP), watching Escape Fire qualifies for continuing medical education (CME) credits. The AAFP is one of the largest national medical organizations, representing 110,600 family physicians, family medicine residents, and medical students nationwide. And, CME credits from the AAFP can translate via reciprocity into American Medical Association (AMA) Category 1 credits. By accrediting the film through AAFP, the campaign is able to offer CME credits to the largest possible number of physicians. To receive credit, physicians and other healthcare practitioners watch the film and then fill out a short survey hosted on the Escape Fire website.
Building on this model, the campaign also partnered with Nurse.com to make Continuing Nursing Education (CNE) credits available to over 8 million nurses in the U.S. as well as continuing education credits for other groups such as dietitians, occupational therapists and health educators. In the first two weeks, more than 1,000 nurses participated in this opportunity – and the number continues to grow.
WHAT WAS ACHIEVED?
Even before its scheduled Capitol Hill screening, Escape Fire had an impact on national policy. After seeing the film, Senator Richard Blumenthal (D-CT) was inspired to introduce an amendment to the 2012 National Defense Authorization Act, authorizing the Department of Veterans Affairs to intervene to prevent over-medication and suicide stemming from soldiers’ access to prescription drugs. Senator Blumenthal also contacted the VA’s Office of Patient Centered Care and Cultural Transformation and asked what Congress could do to help them. He also co-hosted with Senator John McCain (R-AZ) a Capital Hill Screening of Escape Fire to engage more leaders in the conversation.
The VA also sees Escape Fire as valuable to their efforts to improve care. They have stated that moving in a new direction will require a culture change and that this process will ultimately take years – but they see Escape Fire as a tool that can help push this transformation forward immediately.
“Our partners have actively shaped our work throughout this campaign, and we’ve depended on them to give Escape Fire the largest possible impact each step of the way.” – Rebecca Stern, Outreach Coordinator
The film has successfully reached and engaged practicing and future physicians and other health professionals who are critical players in changing our healthcare system. The Fall 2012 Kick Off Tour reached thousands of medical students, and the second tour reached even more medical schools with over 90 screenings nationwide in September 2013. Several viewers indicated that they will use the film in their ongoing course work. As one educator stated: “This movie has become part of my curriculum and I would recommend this documentary to everyone. It is a MUST SEE.” Others focused on how it inspired medical students. As the organizer at Florida International School of Medicine shared, “Many found that [Escape Fire] reminded them why they want to go into the medical profession and also that there is hope for the future with individuals of the mindset of those in the film.”
In addition, hundreds of practicing physicians have claimed CME credit made available through AAFP. As of September 20th, 2013 650 physicians had claimed CME credits, and 97% of those stated that this activity supported improvement in healthcare.
The film reached a broad audience through its release in theaters and national broadcasts on CNN. An estimated 2 million people tuned in for the primetime broadcasts alone. Importantly, almost 120,000 people have engaged with the Escape Fire website and 10,000 took action via the First Aid Kit. This activity produced a huge impact online – Escape Fire’s twitter hashtag, #rescuehealthcare, trended in the U.S. During the week of the CNN broadcast, they had roughly 75 million impressions of #rescuehealthcare and “@escapefire” on Facebook and Twitter.
What is impressive about what they have achieved to date is their ability to reach and engage key stakeholder groups. As we all know, the healthcare system is complex and the change process can be long and difficult to measure. We know this process will require involvement from individuals and community groups in the general public, but also policy makers and healthcare providers, particularly doctors and nurses. The Escape Fire campaign has successfully reached all of these groups and has provided opportunities for thoughtful action and engagement. “Our partners have actively shaped our work throughout this campaign, and we’ve depended on them to give Escape Fire the largest possible impact each step of the way.” – Rebecca Stern
WHAT CAN WE LEARN?
The Escape Fire project offers several key lessons. It underscores how understanding your target audiences can help prioritize campaign activities. It also shows the importance of leveraging each distribution opportunity for action, and perhaps most importantly it demonstrates the power of mutually beneficial partnerships.
The Escape Fire team remained focused on their goals and developed key partnerships to help them reach and engage critical stakeholder groups. They relied on these partnerships – with the military, with medical schools, and with provider organizations – to help them organize targeted community screening campaigns and provided guidance and support so that these screenings were maximized and the audience members engaged in thoughtful discussions. Likewise, they recognized the terrific opportunity that a national CNN broadcast presented and worked with nursing organizations to develop materials that were targeted and relevant to nurses. And it was through a partnership with the American Public Health Association that they were able to reach the public health community.
The Escape Fire team also recognized that busy physicians and other clinical providers were critical, but difficult, to reach. The accreditation of the film for CME was an innovative way to reach this audience. They provided an incentive for physicians, nurses and others to watch the film and engage with the issues. This is an interesting model that other campaigns that seek to reach busy professionals should explore.
Frances H. Cornelius, PhD, MSN, RN-BC, CNE, is a clinical professor and department chair for advanced role master of science in nursing and complementary and integrative health programs at Drexel University in Philadelphia. She is a board-certified nurse educator and has taught at the college and university level since 1990. She has an extensive clinical background in medical–surgical, psychiatric, oncology, and community health nursing. In addition, Dr. Cornelius has substantial experience in the design, development, and delivery of online, hybrid, and traditional course content as well as the integration of learning technologies into the classroom. Her area of research involves student learning, development of clinical decision-making skills, and clinical competency using handheld mobile devices.
In 2010, Dr. Cornelius was the recipient of the Outstanding Educator in Online Learning Award from Drexel University Online. She is currently a master reviewer for Quality MattersTM, a faculty-centered peer-review process that is designed to certify the quality of online and blended courses. She is a National League for Nursing (NLN) Certified Nurse Informaticist and a National Library of Medicine Medical Informatics fellow. Dr. Cornelius is the coeditor of PDA Connections: Mobile Technology for Health Care Professionals (2007), an innovative textbook designed to teach health care professionals how to use mobile devices for "point-of-care" access of information. She is the coeditor and author of Ethical Health Informatics: Challenges and Opportunities (2016). She is also a coauthor of an innovative series of six National Council Licensure Examination (NCLEX) review books, published by Springer Publishing Company, designed to support development of critical thinking among nursing students using unfolding case studies infused with mobile decision support resources to replicate realistic clinical experiences.