Listen First!

Lessons for Communicators from a Street Doctor

Cover detail from Stories from the Shadows, Dr. Jim O’Connell’s memoir.

Dr. Jim O’Connell is one cool dude.

He’s a professor at Harvard Med and Mass General, president of the Boston Health Care for the Homeless Program (BHCHP), and he’s spent more than three decades treating homeless patients.

But the most impressive thing about Jim isn’t his resume; it’s that he’s so dang likable! He radiates humility, a surprising quality in such an accomplished guy.

I met Jim in New Orleans, where he was a speaker at Burness’ 30th anniversary retreat. At Burness, we use strategic communication to make people act. That means while Jim is on the streets of Boston literally saving lives, we’re behind our computers writing op-eds and tweets, creating videos and pitching reporters with research that, we hope, might trickle down to help someone save lives.

So our fields are slightly different. But we share a common goal: to make people’s lives better and to help create a more just world.

During Jim’s talk, he imparted some wisdom that applies not just to his work as a doctor but to mine as a strategic communicator.

Here are a few lessons I learned from Jim:

1. Listen first.

“We’ve been doing this work for 15 years without a doctor, thank you very much.”

Fresh out of his residency in the ICU at Mass General, Jim headed to work at Pine Street Inn, a homeless shelter in Boston. Jim had excelled in medical school and figured the nurses at Pine Street would be thrilled to have him — the first-ever doctor on staff. But on his first day, they said, “We’ve been doing this work for 15 years without a doctor, thank you very much,” took away his stethoscope (literally) and told him to spend his first two months on the job just listening. He credits much of his success to those months. Listening to the nurses and patients taught him how to build trust, suspend judgment and practice humility — all critical skills for serving patients who are homeless.

Listening first is important in strategic communication, too. As consultants, when we begin a project, we’re tempted to lead with ideas, to state our opinions with authority from the get-go. But we’re much more effective when we start by listening to the people our work is aiming to help or influence. Whether that means doing a learning tour with foundation program officers or hanging out with Indigenous Peoples in their forest homes in Latin America, getting firsthand information from experts of all types helps us figure out the right framing and tactics that will move people to act.

2. Be careful of the money frame.

“We don’t get people housing because it’s economically valuable; we do it because it’s the right thing to do.”

Jim noted that several organizations working to house homeless people have adopted the “it saves money” narrative. There’s nothing wrong with highlighting research that shows your work makes financial sense, but he cautioned against using that as your only frame. Why? Because if research comes out that shows your approach actually does not save money, you’re out of luck from a communication perspective — but you will still want to do the work! In Jim’s words, “We don’t get people housing because it’s economically valuable; we do it because it’s the right thing to do.”

As communicators working for social change, we search for the angle that will resonate most with the audience we want to influence. Often, it’s money. But when we use that as the only narrative, or even as the most important narrative, we risk diluting the real reason we do this work: to help create a more just and sustainable world.

To use Jim’s frame, we don’t fight for oral health care for rural kids, stand up for indigenous land rights, or work to reduce childhood obesity because it saves money; we do it because it’s the right thing to do.

3. Involve the people you want to reach in decisions.

At BHCHP, where Jim is president, several homeless people are members of the decision-making board. This means two things: BHCHP is held accountable to high-quality work, and the rest of the board and staff get invaluable insight into what services actually will work for the homeless population. That level of understanding could not possibly come from a board made up of people who have never been homeless, no matter how diverse their backgrounds.

The same concept works in strategic communication. Do you want to reach teachers with a new study on how kindergartners learn empathy? Put a teacher on your project team. Do you want to get teenagers to stop smoking? Form an advisory board of teens to vet your ideas. If you have limited resources, find friends or relatives who belong to your target audience, and get input from them. At the very least, hold focus groups and do informal message testing.

Some of the best communication strategists are the people you’re aiming to reach. It takes time to find them and get their feedback, but it will make your project so much better.


Jim is a professor of medicine, but in New Orleans, he was also a professor of communication strategy.

There are plenty more nuggets of wisdom from Jim: Don’t judge. Photos matter. Stories can change people’s minds. Find those and more in his interview on NPR’s Fresh Air and in his new memoir.