World Federation of Chiropractic Identity Consultation: Report and Recommendations

1. World Federation of ChiropracticIdentity Consultation:Report and Recommendations WFC Assembly Sydney, Australia June 15, 2005

2. Agenda • The Challenge • The Process • Today’s Purpose • Strategic Overview • Where Are We? • Where Do We Want To Be? • The Way Forward

3. The Challenge To determine an international identity for the chiropractic profession that is appropriate, accepted and relevant to the public.

4. The Process • Orientation • Research • Global Chiropractic Review • Global Identity Survey with the Profession • Taskforce meeting and consensus • Positioning Strategy • Recommendations

5. Today’s Purpose Present an overview of research and Task Force findings and provide recommendations for the global identity of chiropractic moving forward

6. Where are we? • Lacking a clear and unifying idea about chiropractic • Focused on debating our identity amongst ourselves • Thought of and utilized by the public as primarily back pain experts • Aspiring to be valued as overall contributors to quality of life through chiropractic health care • Despite high levels of patient satisfaction, often seen as lacking integrity Strategic Overview

7. Where do we want to be? • Improved Profile • Chiropractors valued as ethical, highly educated and highly skilled healthcare providers • Enhanced image • Chiropractic seen as an effective mainstream source of focused scope, primary health care. • Increased impact • Chiropractic services well, widely and regularly utilized Strategic Overview

8. How do we get there? • Stake the right claim • By developing a health service brand platform for chiropractic. One that is supported by consumer-relevant brand attributes. • Market the idea • Take the brand platform to the profession and get all on board. This identity must be theirs. • Foster alignment • Encourage support of the brand idea globally Strategic Overview

9. Where are we today?

10. Where are we? • There is both a need and a desire for a clear global identity for chiropractic • Many jurisdictions are developing their own • In today’s wired world successful brand ideas are by necessity global in nature • The profession believes a clear public identity is important • 90% of WFC survey respondents strongly agreed that “It is important for a profession to have a clear public identity” • Most chiropractors believe the profession does not have a clear public identity • Only 4% of survey respondents strongly agreed that “the chiropractic profession has a clear public identity” WFC online survey of chiropractors Oct. 11 to Oct. 24 2004 3,689 completed surveys

11. Where are we? • The public identity of chiropractic is not only an on-going source of debate for the profession, it is also a distraction • Too much time is spent debating each other on the issue internally • The professions’ effort should be focused on promoting an idea to the public

12. Where are we? • While the public is the ultimate audience for a global identity, the immediate need is to create an idea for the profession to rally around • The public identity issue has historically lacked leadership • The profession has moved in many different directions • There are many camps promoting different identities and ideas for the profession • Countries • Associations • Chiropractic Colleges • Individuals • The WFC has now been charged to act.

13. Where are we? Public opinion data was only available for Canada CCA Environics survey was a phone survey of 2001 adult Canadians from Feb. 8 to Feb 20 2005 The margin of error is plus/ minus 2.2 percentage points, 19 times out of 20 • To the extent there is a public identity for chiropractic, it is back - and back pain - focused • Chiropractors perception of the public view: • 81% of respondents said the public currently views chiropractic as management of back & neck pain • 60% said the public views chiropractic as management of spinal problems • What the public says: • A 2005 Canadian public opinion survey found that top-of-mind public awareness was most often associated with back pain, bone cracking, and back adjustments • Six in ten Canadians see chiropractors as health care professionals who treat back pain • Many surveys in Australasia, Europe, North America, agree

14. Where are we? • Back pain is why most people go to the chiropractor • New Zealand: 66% of chiropractic users went for back pain • Denmark: Lower back pain was the reason half of new patients sought chiropractic care • Sweden: Two out of three new patients sought chiropractic treatment for low back problems • Europe: A 1993 European survey of 244 chiropractic patients in 14 counties found that 51% of new patients had back related health complaints • United States: Back pain relief is the reason why at least 68% of patients visited chiropractors • Canada: Six in ten users went for back pain and one in 10 for spinal problems See www.wfc.org under Identity Consultation, Research, for details

15. Where are we? • The public identity for chiropractic must resonate with both the public and the profession because: • 54% of respondents said the public view of the profession and chiropractors’ view were both equally important when communicating with the public to promote the use of chiropractic services • 25% said the general public’s view should receive more emphasis • 21% responded that chiropractics’ view of the profession should receive greater emphasis WFC survey of the profession, October, 2004. See www.wfc.org for detailed survey results.

16. Where are we? • There are major gaps between how the profession would like to be perceived and how the public currently sees it • Most chiropractors (91%) believe they should be perceived as offering primary care, either with a focused (55%) or a broad scope (36%) • However, only 44% believe this is how the profession is currently perceived • Only 3% said the profession is seen as primary care: broad scope • 88% believes the profession should be seen by the public as mainstream, while only 12 % say it should be seen as complementary and alternative • Yet only 11% of chiropractors think that the public currently perceives the profession as mainstream and 89% think the public currently perceives the profession as complementary and alternative WFC survey of the profession, October, 2004. See www.wfc.org for detailed survey results.

17. Where are we? • The profession wants to be viewed in a broader, more coherent health context • 83% of chiropractors said chiropractic should be perceived as wellness care • 75% said management of spinal problems & their impact on general health • 72% said management of neuromusculoskeletal conditions and their impact on general health • 65% said vertebral subluxation and its impact on general health WFC survey of the profession, October, 2004. See www.wfc.org for detailed survey results.

18. Where are we? • Chiropractors do not feel that the public sees the bigger health improvement picture • Only 6% of DCs surveyed said the public currently perceives chiropractic as wellness care • 17% said the public views chiropractic as management of spinal problems and their impact on general health • 13% said the public views chiropractic as management of neuromusculoskeletal conditions and their impact on general health • 5% said the profession is viewed as vertebral subluxation and its impact on general health WFC survey of the profession, October, 2004. See www.wfc.org for detailed survey results.

19. Where are we? • Currently there is limited public support for the idea that chiropractic care improves overall health • In a 2004 US survey, only 24% of Americans would consider going to the chiropractor to improve their overall health • In a 1990 West Australian survey, 72% of the public agreed that chiropractic was important in the health care system, but only 4% would visit a chiropractor “to maintain good health” • A 2005 Canadian public opinion survey found that 65% of Canadians agreed that regular chiropractic care can improve overall health, but only 24% agreed strongly See www.wfc.org under Identity Consultation, Research, for details

20. Where are we? • And there is little existing research or scientific evidence to support chiropractic’s role in overall health improvement • Yet there is a great deal of research on the costs (physical, societal, and economic) of back pain and disability • Strong research support for chiropractic’s ability to treat the causes of back pain

21. Where are we? • Universally, chiropractic has high levels of patient satisfaction • 1997 survey by Consumer magazine in New Zealand found chiropractic had the highest level of user satisfaction of all non-conventional health therapies • Numerous American studies have found that 90% or more of chiropractic patients are satisfied with their care, which is higher than satisfaction with MDs • A 2003 Canadian survey found that among back pain suffers, chiropractic had the highest level of treatment satisfaction with 69% very satisfied and 23% somewhat satisfied

22. Where are we? • Efficacy of care, specialized knowledge, patient-centered approach, pain relief and chiropractic’s ability to help patients return to function are its most valued attributes • Chiropractic’s ability to get patients back to work/daily activities and their patient-centered approach were seen by chiropractors as the most important factors in shaping the public’s perception • Spinal care expertise and chiropractics’ pain management and ability to help patients recover from pain were also highly rated by DCs • Various consumer studies suggest these are the advantages consumers associate with chiropractic WFC survey of the profession, October, 2004. See www.wfc.org for detailed survey results.

23. Where are we? • Non-drug/non-surgical health care is a key brand attribute • The profession supports it • The majority of the profession (79%) support the WFC’s policy statement opposing the use of prescription drugs • Chiropractic practice delivers it • Some public recognition of it • Very timely in today’s health care environment But it is not the whole picture

24. Where are we? • The spine is key to the profession’s public identity • 85% of DCs surveyed said the nervous system is of central importance to the practice of chiropractic, while 72% said the spine was of central importance • Yet 66% said the spine was of central importance to the public identity of chiropractic and only 60% said the nervous system was

25. Where are we? • Complementary/alternative vs. mainstream is less and less the issue • Complementary and alternative healthcare are entering the mainstream, with chiropractic leading the way • More and more people are going to chiropractors, massage therapists, acupuncturists, homeopaths and naturopaths, etc.- surveys in many countries. • Greater public and private medical insurance coverage for some services • 43% of Americans in one HMO survey on alternative care said they viewed chiropractic as mainstream – not alternative

26. Where are we? • Medical doctors are important but they are a secondary target in the public identity initiative • Physicians’ power of influence with the public remains strong, but is declining • 2005 CCA survey found that 82% of Canadians agreed that the health care system relies too much on medical doctors and does not use all health care professionals effectively • 60% of Canadians agreed that they would only visit a health professional on the advice of their family doctor, but only 34% agreed strongly • 84% of Canadians agreed they were interested in alternatives to health care provided by medical doctors • In the WFC survey, of 17 factors, DCs considered attitudes of other health care professionals the least important in shaping the public’s perception

27. Where are we? • Lack of public awareness of chiropractic qualifications may not be as important as DCs think it is • Only 20% of chiropractors believe the public is aware of the level of education of chiropractors • While public awareness of the level ofchiropractic education should be improved, it is not all that bad • Canadian 2005 survey found that 56% of Canadians said it was true that DCs required 4 years of intensive full-time education following 3 years of university

28. Where are we? • But ethics and the professional conduct of some members of the profession are areas that need to be addressed • 86% of WFC survey respondents said concerns around ethics and professional conduct have a significant impact on public confidence • 2003 Gallup poll: Americans see chiropractors as the least honest and least ethical health professionals • Only 31% of Americans considered chiropractors ethical and honest • Compared with 83% for nurses, 68% for MDs, 67% for pharmacists, 61% for dentists and 38% for psychiatrists • Chiropractors fall below bankers (35%) and just above State senators (26%) • 2005 Canadian survey found that 82% of Canadians agreed that chiropractors are ethical and honest, but of those 45% agreed somewhat and only 37% strongly

29. Where are we? • Global chiropracticrepresentatives determined that while very saleable, back pain is not the appropriate identity focus for the profession • WFC Identity Consultation Task Force • 40 representatives from around the world • Academic, research, association, vendor and patient representation • 2nd Task Force meeting in Hayward California, January 2005 agreed: It is too limiting and too divisive to build the profession’s identity around back pain going forward See www.wfc.org under Identity Consultation, Research, for details

30. Where are we? Task Force consensus statements – January 2005 The Ground: The foundation on which chiropractic stands • A focus on neuromusculoskeletal disorders and their effect on general health and quality of life (wellness), with emphasis on the relationship between the spine and the nervous system. • A specialized approach to examination and diagnosis. • Patients managed principally by spinal adjustment, other manual treatments, exercise and patient education.  Without the use of drugs and surgery, enabling patients to avoid these wherever possible.  Collaborating with other members of the health care team.

31. Where are we? Task Force consensus statements The Ground continued: • A patient-centered and biopsychosocial approach.  An emphasis on personal responsibility for health, self-care, and the self-healing powers of the individual.  A goal of encouraging patient independence. • High educational standards, evidence-based practice, commitment to research. The Pole: What chiropractic stands out as: (Conservative) spine care expert and specialist

32. Summary Implications • The profession needs a clear global identity for the public and for itself • The identity for chiropractic must resonate with both the public and the profession • There is a huge gap between where the profession is in the public’s mind – the fixers of back pain and where it wants to be – quality of life through expert spinal care and its impact on general health • Chiropractics’ spinal care expertise and effectiveness in treating back problems are core strengths • Non-drug, non-surgery is a brand advantage Where are we?

33. Where do we want to be?

34. Identity Goal Create oneclear global identity for chiropractic that leads to greater public understanding, acceptance and utilization of chiropractic servicesand therefore a greater futurerole for chiropractic with the public and within national health care systems

35. Strategic Imperatives • Positioning • Create an idea for chiropractic in the public mind that can bridge the gap between where we are (the fixers of back pain) and where we want to be (improved health and quality of life through chiropractic care) • Method • Adopt a clear focused idea (the Pole) supported by chiropractic’s market-relevant brand attributes (the Ground) and the personal characteristics of chiropractors (Personality/tone) • Leadership • Ensure that the profession supports and advances the chosen identity Where do we want to be?

36. Vision and Mission Vision: • A world where people understand that chiropractic answers their need for the most expert and conservative spinal care and the impact of this on general health because of the relationship between the spine and the nervous system WFC’s Mission: • To lead and communicate the chosen identity for chiropractic around the world Mission of Member Associations: • To lead and implement the chosen identity in theircountries, creating brand and strategy Where do we want to be?

37. How do we get there?

38. Chiropractic Brand Platform Proposed “Pole”( brand platform): The experts in spinal health care within the health care system How do we get there?

39. Supporting “Ground” (brand pillars): -Ability to improve function in the neuromusculoskeletal system, and overall health, well-being and quality of life -Specialized approach to examination, diagnosis and treatment, based on best available research and clinical evidence, and with particular emphasis on the relationship between the spine and the nervous system -Tradition of effectiveness and patient satisfaction. -Without use of drugs and surgery, enabling patients to avoid these where possible -Expertly qualified providers of spinal adjustment, manipulation and other manual treatments, exercise instruction and patient education -Collaboration with other health professionals -A patient-centered and biopsychosocial approach, emphasizing the mind/body relationship in health, the self-healing powers of the individual, and individual responsibility for health and encouraging patient independence.

40. Tone/Personality What are we like? Expert, professional, ethical knowledgeable and Accessible, caring, human, positive How do we get there?

41. The Way Forward What the profession should do: • Every jurisdiction should embrace the new positioning and bring it to life locally • Share the brand idea and get buy-in from the profession • Redo local communications to reflect the new brand idea • Build the case locally • Generate local support, research studies, papers, experts • Get it out there – publicize it

42. The Way Forward • What WFC should do • Be a broker or clearinghouse for the new identity • With National Associations • With Colleges • With key individuals • Promoteresearch to support the new identity • Build credibility for the idea • Facilitate interaction • Define further activities such as partnerships with WHO, making identity the subject of the next WFC/ACC Conference

43. Proposed “Pole”( brand platform): The experts in spinal health care within the health care system

44. The Ground: Brand Pillars -Ability to improve function in the neuromusculoskeletal system, and overall health, well-being and quality of life -Specialized approach to examination, diagnosis and treatment, based on best available research and clinical evidence, and with particular emphasis on the relationship between the spine and the nervous system -Tradition of effectiveness and patient satisfaction -Without use of drugs and surgery, enabling patients to avoid these where possible -Expertly qualified providers of spinal adjustment, manipulation and other manual treatments, exercise instruction and patient education -Collaboration with other health professionals -A patient-centered and biopsychosocial approach, emphasizing the mind/body relationship in health, the self-healing powers of the individual, and individual responsibility for health and encouraging patient independence.

45. Tone/Personality What are we like? Expert, professional, ethical, knowledgeable and Accessible, caring, human, positive