Questions I Get About the Standards and Practices for Organizations in an Era of Misinformation and Declining Trust
In the early nineties, when I first formulated the plans for what is now KFF, the idea was to establish an organization that would be an independent, trusted source of information in a health system increasingly dominated by well-funded health care interests and by partisan politics. What I didn’t anticipate early on is how much more important trust and credibility would come to be in our current era of misinformation and declining confidence in data, evidence and experts. That’s probably why I have been asked much more often recently about how we operate at KFF and what steps we take to maintain credibility in the face of misinformation and declining trust.
For one thing, we will soon roll out a new program designed specifically to help counter misinformation in health and rebuild trust, complementing our longstanding role as a go-to source of information ourselves.
From the start, our independence has been vital to our role. There has always been a little confusion about whether we have a connection to Kaiser Permanente (we do not), or are a foundation (also no, we are an endowed non-profit, technically a public charity). Those are among the reasons we changed our name to “KFF.” The rebranding helps us dispel confusion. A larger task is to more clearly articulate what we are—a unique, 3 in 1 organization—with no reservations about breaking down some traditional barriers or being somewhat different.
Beginning decades ago, we set out to combine policy research, polling, and news in a single organization with a common mission—to fill the need for nonpartisan information on national health issues. The idea was that the three kinds of information together would give us the power and reach to play a role on the national health care scene as at least a modest counterweight to the money and politics dominating health policy. We wanted our data and stories to amplify the voices of people who are underserved in our health system and could be better served by health policy.
Ours is a vision of a different kind of information organization: Not a policy research or a polling shop, and not a news organization, but a combination of all three. One consequence of that: News organizations who regularly cite us sometimes don’t know what to call us. Mostly they shorthand us as a “health policy research organization,” one third of what we are, a policy research, polling, and news organization. Of course, we understand that’s a mouthful and we continue to consider the one or two words that would more succinctly and accurately capture KFF other than the somewhat bland but accurate, “health policy information organization.”
Our multiple and different streams of information help us reach the wide range of audiences we want to reach. The policy analysis and polling primarily reach policymakers and media, while our national news service reaches the general public across the country, with our accountability journalism and investigations engaging policy audiences as well.
There is much more to say about KFF information strategies, but one thing is central: We combined the different kinds of information for a reason. The policy analysis provides the hard data about the policy ideas and programs that policymakers need to evaluate proposed legislation and provide oversight, and news organizations need to cover it. The polling amplifies the voices of people with data. In our polling we emphasize people’s experiences in the health system, not just opinion, and we use rigorous sampling methods we have developed to reach groups that are often missed by others. Our people-focused journalism adds in-depth coverage of how policies and the health system are affecting the American people and communities, augmented by investigations that look deeply at systems and policy failures. Together, the data, voices, and storytelling give us a more comprehensive armamentarium of information on the issues we work on.
It’s not simple to knit together different professions and cultures in a common mission at KFF. What counts as “evidence” for researchers is not the same as for journalists. Pollsters have to be concerned about public perception not only about what is true, because as we see every day, perception can drive opinion and politics. Our journalists have editorial independence over individual story ideas and content because that’s what real journalism warrants, but not mission or strategic directions for the news operation or spending or hiring, because they are part of a single organization with an integrated mission and priorities and established standards, just as their counterparts in policy analysis and polling are. You can read more about it here.
To maintain credibility and trust we have adopted several standards and practices over many years that are our “rules of the road.” These are some of the more important ones, which others may find applicable today, especially given declining levels of trust and misinformation.
- The organization and its work should always operate independently of political or commercial interests. KFF has established policies requiring that. We have board-adopted guidelines requiring that we maintain independent control of all of our work, including from funders. (KFF is 70% supported by our endowment and 30% by outside funders who enable us to undertake big projects we could not otherwise handle with our regular operating budget.)
- Our work should be as objective as humanely possible and acknowledge countervailing evidence or facts where they exist. Health policy is, after all, mostly about tradeoffs, so almost everything has pros and cons even if the weight of an analysis, a poll, or story may point in one direction. (We recognize that objective is not neutral in the combat zone of heath policy, but facts are essential to informed debate and policymaking.)
- Tone and respect for all sides and points of view matters to us. No snark, including on social media. It’s not only about comportment—snark and gotcha turns the public off and reduces trust. We don’t focus on individuals; we are not in the bad doctor, hospital, or government official business. We focus on policy and systems issues.
- We make everything public. Methodology. All findings and data. That way others can see how we reached the conclusions we did and differ with them if they choose to (occasionally they do).
- If there is an outside funder for work, the sponsor should always be disclosed, and all sponsors/funders are disclosed on our website.
- We may be unique in this respect: We don’t accept outside remuneration ever for anything—boards, speeches, publications, teaching, even the most prestigious awards. We don’t believe in having any financial ties with anyone involved in the areas we study, poll about, or report on. Nor do we invest directly in health companies.
- We state conclusions based on evidence as clearly and strongly as we can, but we don’t ever take a position on policy issues. That’s to avoid becoming just one more combatant in the health care wars; we have plenty of those in health policy. (KFF has never taken a position on anything, and there will never be a KFF policy recommendation or health reform proposal.) We studiously avoid words like “should” or “must.”
Then there are three broader considerations:
- Topic selection can convey bias every bit as much as study or poll or story execution can. If you do 50 studies of expanding insurance coverage and one on the impact of health spending on state or federal budgets, or 50 stories on the problems with the for-profit health system and one on innovations that improve outcomes or lower costs, you probably have a bias. We have not always handled this perfectly at KFF, but we work on it. Individual studies, polls or stories may have a focus or draw a particular conclusion, but balance across the totality of what we do as an organization is important to our honest broker role.
- Much of the work we do is critical in one way or the other of the failures of the existing system. Holding the health system and government accountable for its shortcomings is a fundamental obligation we have as policy researchers, pollsters, and journalists. But in this era when misinformation and eroding trust are an existential threat to information, organizations, experts, and democracy, we should at least ask ourselves before undertaking a project whether the benefit from it is worth the further erosion of trust that may come from it. Usually it will be, but accountability isn’t our only goal and these days it’s worth asking the question and again, maintaining balance.
- We keep people centered in the work as much as possible. So much of the information enterprise in health today is oriented to determining what shiny new object will take off (think AI), change the world (again), and make money, or what the impact of a policy proposal is on the federal budget, or whether a small change in payment will produce somewhat greater value for the dollar. Meanwhile, average people can’t get an appointment with a doctor or find their way through the health insurance maze, or worse, pay their medical bills. Many remain chronically underserved or mistreated in our health system and struggle to afford care. That’s why we center people in our work at KFF. It’s a choice we have made reflecting our values.
Each of our core health policy program areas—policy research, polling, and journalism—have additional practices they need to observe to meet the standards of their professions but overall, this list summarizes the overarching standards we follow at KFF, which apply to the whole organization.
Our organization may be sui generis, but it behooves all of us to think through the standards and practices and communications strategies that will earn trust. The current environment makes it much tougher for the facts to be heard and believed, but if we are to have any shot at informed debate and reasoned policy, we have to try harder and smarter to get the facts out there.