Playing the long game

A white light box is on a yellow background. The words on it say 'One step at a time'.

Playing the long game

A white light box is on a yellow background. The words on it say 'One step at a time'.

I recently found myself engaged in a spirited debate with some of our engaged members about what makes for successful advocacy. It took place on social media, which wouldn’t be anyone’s first choice of platform for nuanced, constructive debate but alas, there it played out.

It is partially because of the incompleteness of that conversation that I am using this forum to provide a more rounded analysis.

Members were commenting on the APA’s 10-year Future of Physiotherapy plan and our pitch to government to establish an Australian trial of the funded first contact physiotherapy model. 

Both are substantial pieces of work, articulating a vision and a pragmatic approach to making better use of physiotherapy in our beleaguered health system.

These advocacy pieces attracted criticism from a group of members for representing, and I paraphrase here, an approach that is too safe and too easy to ignore to prompt change. 

The group was in favour of using more aggressive tactics to get our message across, involving media and short, memorable slogans. 

It got me thinking about the building blocks of successful advocacy in health.

Firstly, context is everything. 

It is important to understand what environment we’re working in, who our stakeholders are and what we’re asking for. 

Health reform is almost always a slow burn, a steady sequence of decisions and changes, the cumulative effect of which can loosely be called reform. 

Reform in a single leap does not happen often—the last time it did was in 1984, with the introduction of Medicare.

Our most important and influential stakeholder in advocacy is the government. 

We have had two-term governments for over 70 years. 

Most prefer to leave reform items to their second term, once their feet are truly under the desk and they have a good understanding of the reforms that are likely to get them re-elected. 

At that point, they have less than four years to make substantial changes in their chosen areas.

That means we have to do the grunt work. 

Whatever we are asking for has to be founded on solid logic—an action plan in a compelling package. 

It’s an approach that is less flashy than a memorable three-word slogan, but it’s a necessity for system change.

Why not both? Proposals of substance and catchy three-word slogans? 

The answer is that there is indeed room for both (as the group of engaged members rightly pointed out), but not one without the other. 

Slogans without substance are the advocacy equivalent of fast fashion—forgotten next season.
As to what approach works best, there is no one-size-fits- all. 

Aggression in advocacy can work and when it does, its success is very visible. 

We all remember campaigns that tapped into a certain Zeitgeist and created change. 

It typically works for hot, emotive issues that play on our visceral fears or desires. 

Aggressive advocacy is risky business. 

The choice to engage decision-makers with aggression has to be made with a cool head, having taken into account the costs and benefits on the table.

I am a proponent of a full advocacy arsenal, with a wide suite of options at our disposal. 

Our advocacy is built on rock- solid proposals—evidence-based, logic-backed solutions to the problems that plague us. 

Sometimes it will require quiet back-door influence and relationship building over the long term. 

At other times, an assertive approach, assisted by pithy, memorable slogans, will be our go-to. 

A sophisticated advocate knows what to use when.

It is incredibly easy to get frustrated about advocacy setbacks or the slow pace of change. 

But it’s important to take a helicopter view and assess all that has been achieved over the course of a decade. 

We have had many wins along the way and our influence among stakeholders grows stronger every year. 

There is no disputing our position as an essential pillar of the health system. 

It’s a position we will advance and protect with all our advocacy might.


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