Public Relations Review, 17(3):257-278 Copyright 0 1991 by JAI Press Inc.

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Conceptual Differences
in Public Relations
and Marketing: The
James E. Gmnig Case of Health-Care
and
Larissa A. Gmnz> Organizations
ABSTRACT: Competitive pressures have caused many health-
care organizations to subsume public relations programs within
marketing units. The result is more one-way and less two-way
communication with publics leading the authors to conclude
communication programs based on marketing theory will not
achieve the same results as those grounded in public relations
theory.
Findings from several studies of health-care organizations are
reviewed in relation to the authors’ normative theory of public
relations.
Dr. James E. Grunig and Dr. Larissa A. Grunig are faculty
members in the College of Journalism at the University of Mary-
land. Many of the concepts described here develop from their
recent service as principal investigators on a five-year IABC-
funded national assessment entitled “Excellence in Public Rela-
tions and Communication Management.”

Ideally, organizations should practice public relations

strategically. That is, they should identify the publics that are most likely to
constrain or enhance the ability of the organization to achieve its mission and
then develop programs to communicate with those publics (L. Grunig, J. Grunig

Fall 1991 257

 Public Relations Review

& Ehling, in press; J. Grunig & White, in press). Dozier and L. Grunig (in press)
have argued that at some point in their history, most organizations develop their
public relations programs strategically-that is, the presence of a strategic public
provides the motivation for initiating public relations programs. As time passes,
however, organizations forget the initial reason for the program and continue
communication programs for publics that no longer are strategic. Broom (1986)
has called this the historicist approach to public relations. When public relations
is practiced as it historically has been practiced, communication programs become
routine and ineffective because they do little to help organizations adapt to dynamic
environments.
Most organizations continue the historicist approach to public relations until
they confront a crisis. A nmmative-prescriptive-theory of public relations would
specify that organizations should plan public relations strategically, especially when
they face a turbulent environment. Our descriptive research, however, shows that
organizations often do not practice public relations as our normative theory says
that they should (J. Grunig, 1976; Schneider [aka L. Grunig], 1985a, 1985b; J.
Grunig & L. Grunig, 1989).
Most health care organizations now face a turbulent environment-because of
increased competition, the high cost of new technology, new diseases such as
AIDS, and the intervention of activist groups and government (see, e.g., Spicer,
1988). Few of these organizations seem to have adopted a strategic approach to
public relations, however (Fabiszak, 1985). Rather, they have moved to marketing
to confront the problem, which historically has been practiced more strategically
than has public relations. Unfortunately, when organizations approach public
relations from a marketing perspective, they lose the ability to deal with crucial
public relations problems (Ehling & White, in press).
In this article, we will present a theory of the relationship between excellence
in public relations and organizational effectiveness. We base this theory on the
results of a lo-year program of research on the public relations behavior of
organizations (J. Grunig & L. Grunig, 1989) and on a comprehensive literature
review that four colleagues and we have conducted to build a theory of the nature
of and relationship between excellence in public relations and organizational effec-
tiveness (J. Grunig, in press a) .l That literature review is the first step in a six-year
project funded by the Research Foundation of the International Association of
Business Communicators.
We have constructed two types of theories from this research: a normative
theory of how excellent public relations should be practiced and a positive theory
of why some organizations practice it in that way and others do not. When applied
to health-care organizations, especially, a critical component of both of these
theories is the distinction between public relations and marketing-because our
theory of excellence maintains that marketing and public relations should be
separate functions. Thus, we will present an overview of the theory first. Then,
we will discuss the implications of that theory for distinguishing between public
relations and marketing. After explaining those implications, we will present the
results of two studies relating these theoretical concepts to health-care organiza-

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 Conceptual D@ences in Public Relutims and Marketing

tions that we have advised at the University of Maryland (Fabiszak, 1985; Buf-
fington, 1988).

EFFECTIVENESS AND EXCELLENCE

The concepts of effectiveness and excellence provide the

key building blocks of our theory of public relations. A theory of organizational
effectiveness tells us how public relations contributes to the success of an organi-
zation. A theory of excellence tells us what attributes a public relations program
should have to be able to make such a contribution. At this point, the theory is
normative because it specifies how public relations departments should be struc-
tured and managed to be able to contribute to organizational effectiveness. Massie
and Weitz (1977) have pointed out, however, that the best normative theory is
one that has been shown to work in the real world-that is, it also is a good
positive theory. Thus, in this article and in our research, we present evidence that
the normative theory we have constructed works in the real world as well as
evidence of the conditions necessary for it to work.
Our theory of how public relations contributes to organizational effectiveness is
based on three key concepts: autonomy, interdependence, and relationships. The
first theories of organizational effectiveness defined effectiveness as the extent to
which organizations were able to meet their goals (see, e.g., Price, 1968; Robbins,
1990). Those theories assumed, however, that organizations were closed systems-
that they could fulfill their missions without support or interference from their
environments. In other words, the closed-system perspective assumed that organi-
zations had autonomy from their environments and that internal management struc-
tures would determine the difference between effectiveness and ineffectiveness.
Theorists such as Katz and Kahn (1978) soon turned to an open-system perspec-
tive. That perspective recognized that organizations are interdependent with other
organizations and groups in their environment. It also recognized that these other
systems influence both what goals organizations choose and the extent to which
they can meet those goals. Pfeffer and Salancik (1978), for example, defined
success in meeting internal goals as “efficiency.” They defined “effectiveness” as
“an extemzal standard of how well an organization is meeting the demands of
various groups and organizations that are concerned with its activities” (p. 11).
Public relations has a role in making organizations effective because it f-its into
what organizational sociologists call a boundary spanning role-it helps the or-
ganization to manage its relationship with groups in the environment. Organiza-
tions struggle constantly to achieve their mission-the goals selected by internal
decision makers-in the face of constraints imposed by outside groups or interests.
In the words of Pfeffer and Salancik (1978), “Organizations comply with the
demands of others, or they act to manage the dependencies that create constraints
on organizational actions” (p. 257).
If they had a choice, most senior managers would prefer their organizations to
remain autonomous from their environment (see, e.g., Mintzberg, 1983, pp.

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 PtLblicRelations Review

631-663; Hage, 1980). Autonomy allows organizations to pursue their goals

with the least interference from outside. Organizations do not want to be regulated
by government or pressured by activist groups. Loss of autonomy costs money-to
comply with regulations or to make changes to accommodate pressure groups.
Having willing consumers and employees also increases an organization’s au-
tonomy, because fewer changes in behavior are necessary to sell them a product
or to get them to work productively.
Most organizations find autonomy to be an impossible goal, however, because
they must confront the reality of interdependence with other organizations and
groups. According to Pfeffer and Salancik (1978), “interdependence exists
whenever one actor does not entirely control all the conditions necessary for the
achievement of an action or for obtaining the outcome desired from the action”
(p. 40). Gray (1985, 1989) defined interdependence in terms of multiple stake-
holders in an organization. Gollner (1983, 1984), then, defined public relations
and public affairs as the management of interdependence.
The reality of interdependence means that organizations have relationships
with outside stakeholders-with publics and other organizations-whether they
want such relationships or not. Relationships limit autonomy, but good relation-
ships limit it less than bad relationships. Building relationships-managing
interdependence-is the substance of public relations. Good relationships, in turn,
make organizations more effective because they allow organizations more freedom
-more autonomy-to achieve their missions than they would with bad relation-
ships. When they give up autonomy by building relationships, ironically, organi-
zations maximize that autonomy.
Communication plays a crucial role in building and maintaining relationships.
Therefore, it follows logically that public relations-managed communication-
makes organizations more effective by building relationships with publics that
can constrain or enhance the mission of the organization. It also follows logically,
however, that public relations departments must have certain attributes to be able
to contribute to organizational effectiveness. Thus, the second part of our theory
deals with excellence-concepts that describe how public relations should be
organized to be able to make the organization more effective.
Like Peters and Waterman (1982) and many other writers on excellence in
management (see J. Grunig, in press 6), we have searched for the attributes of
excellent public relations. Peters and Waterman (1982) searched for attributes of
excellent management empirically, by looking at the attributes that organizations
with strong financial performance had in common. In contrast, we have searched
the theoretical literature for concepts that defme what public relations should be
like, logically, to build relationships with key publics.
One of those key attributes is that public relations should be a separate function
from marketing. Our major purpose in this article is to show why public relations
should be a separate function. Thus, we turn first to a conceptualization of the
two functions, giving special attention to these functions in health-care organiza-
tions. Then, we introduce the remaining attributes of excellence in public relations

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 Conceptual
D@wues in PublicRelationsandMarketing

and show their connection with the conceptual difference between public relations
and marketing.

PUBLIC RELATIONS AND MARKETING

In recent years, much has been written about-a blurring of

the distinction between public relations and marketing. For example, the director
of Hill & Knowlton’s marketing communication division argued in PR Week that
the cost of television advertising and the clutter of messages in that medium made
public relations an important component of the marketing mix (Phillips, 1988) :

Hill & Knowlton recently polled marketing executives at 20 of the top 50

advertisers. Without exception, the men and women interviewed said they
were using public relations more than they did five years ago. One said his
company now assigned public relations specialists to every marketing group.
Another predicted that in five years PR will be the most important component
of the marketing mix. (p. 6)

Phillips added that instead of reporting to vice presidents of public relations,

public relations specialists more often deal with vice presidents of marketing,
forcing them “to learn the language of marketing and (to) use sophisticated
marketing techniques” (p. 6).
As competition increased in the health-care industry, hospitals and other health
organizations moved from informal public relations activities to organized public
relations and marketing programs (Fabiszak, 1985, p. 116). In 1972, only about
30 percent of hospitals had organized public relations programs. Of 244 hospitals
who returned questionnaires in Fabiszak’s national sample, only 54 had no public
relations department. About 68 percent of the hospitals responding conducted
marketing activities-two-thirds from a public relations department and a third
from a separate marketing department.
According to Kotler and Andreasen (1987, pp. 34-35), hospitals became in-
trigued with the “new idea of marketing” because of growing competition and
declining numbers of patients. ‘(unfortunately,” they explained, “too many
thought of it in terms of image building and promotion.” Similarly, Novelli,
president of the Porter/Novelli public relations and social marketing firm, said
that the trend toward marketing in health care has had limited effect because of
“lack of training in marketing and little or no evaluation of the programs’ return
on investment” (PRSA iVewsZe.tter,June 1988).
Kotler and Andreasen (1987) added, however, that in the mid- 1980s hospitals
began “to understand what marketing was all about”:

Then, rather than trying to convince these target audience members that the
hospital already was giving them what they wanted, they began to change
their present offerings and develop new offerings to meet what their target
audiences wanted. (pp. 34-35)

Fall 1991 261

 When health-care organizations began to use marketing, however, the distinc-
tion between public relations and marketing often became blurred and in some
cases resulted in a turf war between the two functions. After a Public Relations
Colloquium held at San Diego State University to discuss the relationship between
marketing and public relations, a press release (San Diego State University, Jan.
25, 1989) quoted Kotler on the “war:”

“The relationship between marketing and public relations in hospitals has in

some instances turned into an all-out turf war,” said Philip Kotler, one of the
leading marketing scholars and a professor at Northwestern University. “And
when this happens the organization suffers,” he said.

‘There’s a genuine need to develop a new paradigm under which these two
subcultures can function effectively in the best interest of the organization and
the publics it serves,” he said.

Novelli (PEG4 NewsZetter, June 1988) pointed out that administrators of health-
care organizations are trying to make marketing more effective but that they also
have reexamined the purpose of public relations-“specifically, to build long-term
relationships with patients and other audiences.” In another newsletter (p’ reporter,
April 25, 1988), Novelli added that public relations does not belong under
marketing:

It is a management function in its own right that should have direct access to
the top and be involved in every department. PR pros are the ones who can
help hospitals through tough times, by maintaining good relationships with
health consumers and medical staffs.

In the same issue of pr reporter (April 25, 1988), Mike Killian, the director of
marketing and public affairs at the William Beaumont Hospital in Royal Oak,
MI, also described the importance of public relations in building relationships.
Marketing is a line function, he said, “with emphasis on product management
and sales, and public relations is a staff function, playing a critical role in long-term
relationships with the community, medical staff, government, etc.” The Public
Relations Symposium at San Diego State (Jan. 25, 1989) concluded that both
marketing and public relations build relationships but that public relations has
more of them with which to deal:

Public relations deals with a whole host of relationships, based on mutual

accord and positive behaviors between an organization and its environment.
Marketing is charged with attracting and satisfying long-term customers or
clients to achieve an organization’s economic objectives.
Building and maintaining relationships between an organization and the people
upon whom the organization depends is a common responsibility. Marketing
concentrates on customers while public relations manages other relationships
which affect the way an organization operates: employees, shareholders, public
officials, neighbors and consumer groups.

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 ConceptualDifferencesin Public Relatkms and Marketing

A Theoretical Distinction
The growing sophistication of both public relations and
marketing in health organizations requires a conceptualization of the two functions
if we are to understand fully the role of public relations for those organizations
and to avoid its sublimation into the marketing function. The distinctions between
public relations and marketing as well as the overlap of the two functions can be
seen most clearly by examining the roles of public relations practitioners (Broom
& Smith, 1979; Broom & Dozier, 1986; Dozier, in press).
This research shows that public relations practitioners fill two major roles,
communication technician and communication manager. Communication techni-
cians are the writers, editors, and publication designers. Communication managers
are the planners and evaluators of public relations programs. Communication
technicians apply technical skills to execute programs developed by communication
managers. Communication managers apply theories of communication and man-
agement to the resolution of public relations problems.
Although we are not aware of similar research on marketing roles, it seems
clear that the manager and technician roles also occur in marketing. When the
manager and technician roles in public relations and marketing are compared, the
distinction between the two fields seems clear.
At the theoretical/managerial level, the marketing function is concerned with
products, services, and customer markets. Public relations, in contrast, is concerned
with all relevant publics of the organization. The major purpose of marketing is
to make money for an organization by increasing the slope of the demand curve
(Ehling & White, in press). The major purpose of public relations is to save
money for the organization by managing threats to its mission or mobilizing
support for it. At the technical level, public relations uses journalistic techniques,
strives for free space in the media, produces publications, and uses interpersonal
means of communication. Marketing relies on advertising and other paid methods
of controlled communication.
Confusion between marketing and public relations occurs because the
techniques of public relations often are used in support of marketing theory and
the techniques of marketing often are used in support of public relations theory.
In the past, marketing theory has been more advanced than public relations theory.
Organizations that wanted to manage public relations strategically, therefore,
turned to marketing managers because strategic management has been part of
marketing theory for some time. When marketing practitioners manage public
relations, however, public relations usually is reduced to technique rather than
strategy (Kotler & Andreasen, 1987, p. 577). Public relations practitioners become
mere technicians working in support of marketing-rather than public relations-
objectives.
Most normative theories of marketing specify that marketing should be managed
strategically. We argue similarly that public relations should be managed strategi-
cally if it is to be effective. When an organization manages one of these functions
strategically but reduces the other to a technical support function, it loses a valuable

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 Public RelatiumReview

organizational function. In health-care organizations, the public relations function

often has been lost or distorted when marketing moved in. In the next section
of this article, then, we describe a strategic theory of public relations that our
IABC research team has concluded is a characteristic of excellent public relations
departments. We continue by comparing and contrasting that strategic theory of
public relations with strategic theories of marketing.

STRATEGIC MANAGEMENT OF
PUBLIC RELATIONS

The IABC research team (J. Grunig, Ed., in press) began

its work by setting forth a normative theory that prescribes how to do public
relations in an ideal situation. The team argued that excellent public relations
departments will practice public relations in a way that is similar to the normative
model, in contrast to the way that public relations is practiced in the typical, less
excellent, department.
The first attribute of excellence in our normative theory specifies that public
relations should be practiced strategically. An organization that practices public
relations strategically develops programs to communicate with the publics, both
external and internal, that provide the greatest constraints to and opportunities
for the organization. These strategic publics also can be called “stakeholders.”
Strategic management is an attribute of excellence that can be derived logically
from our theory of how public relations makes organizations more effective. As
we stated above, public relations helps organizations manage theirinterdependence
with publics that interact with the organization as it pursues its goals. Organiza-
tions plan public relations programs strategically, therefore, when they identify
the publics that are most likely to limit or enhance their mission and design
communication programs that help the organization manage its interdependence
with these strategic publics.
Without publics, there would be no need for public relations programs. Publics
arise from situations in which organizations have consequences on people who
were not involved in making the decisions that led to the consequences-people
such as employees, members of a community or environmentalists. Publics develop
around these consequences and “make an issue of the situation” (Vibbert, 1988)-
they communicate with others who are affected by the problem, organize into
activist groups, and take the issue to the media. Issues occur, therefore, when the
interdependence between the organization and its internal or external publics is
not well managed and conflict results.
Strategic public relations begins when communication practitioners identify
organizational behaviors that have consequences for people inside or outside the
organization who did not make the decision-behaviors that are likely to produce
publics who, in turn, create issues. Strategic management of public relations, then,
follows these steps, which are helpful in comparing the strategic management of

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 Conceptuul D@maces in Public Relations and Marketing

public relations with the strategic management of marketing (J. Grunig & Repper,
in press):

1. In carrying out their missions, organizations have consequences

on people who do not make the decisions. Public relations should
identify these consequences.

2. Publics arise around a consequence and threaten the mission of

the organization. Public relations should segment and identify the
publics.

3. If the organization does not modify the behavior that caused the
consequences, publics “make an issue” of the consequences.

4. Public relations should develop objectives for communicating with

potential and actual publics and plan programs to achieve the
objectives. Public relations programs are most effective if they are
begun after stages 1 or 2 rather than stage 3.

5. Communication programs are implemented.

6. Effects of the communication programs are evaluated.

The strategic process for planning marketing programs is similar. The following
list, for example, contains the most important components of the process as
described by Kotler and Andreasen (1987, pp. 160-167) and Cravens and Lamb
(1983, pp. 5-20):

1. Define corporate (organizational) mission in light of environmental

conditions.

2. Define and assess markets that further corporate mission.

3. Set marketing objectives and strategy.

4. Develop an organizational structure for implementing marketing

programs.

5. Execute marketing programs.

6. Evaluate marketing performance.

The major differences in these two lists are in the first two steps. Both processes
begin with the mission of the organization. The role of public relations, however,
is to identify the consequences of the mission on people outside the decision struc-
ture. Marketing also begins with the mission of the organization, but marketing
selects the segment of the environment that will make it possible to implement its
mission. Public relations, in contrast, tries to change the mission to avoid confron-
tations with publics that make implementation of the mission costly or impossible.

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Without public relations, organizations will be divertedfiom their missions. With-

out marketing, they would miss an essential mechanism for implementin. their
missions. Both functions are essential to an organization. When one function is
sublimated to the other, it follows, we believe, the organization will not be likely
to practice the sublimated function as completely as the dominant function.
One could argue that this explanation of the first difference in the strategic
process between public relations and marketing makes public relations reactive
and marketing proactive. Clearly, however, public relations does not have to wait
for publics to threaten the organization before it reacts. It should anticipate when
the decisions of the organization will have consequences on publics and take steps
to influence the decisions to minimize these consequences or to involve publics
in the decision process. Buchholz (1982, p. 464), for example, called this kind
of organizational behavior interactive rather than reactive. Thus, marketing can
be said to be proactive when it creates a market while public relations is interactive
when it identifies consequences on publics and brings the perspective of publics
into the decision-making process.
The second difference between public relations and marketing occurs at the
second step of the strategic process, where there is a difference between the
concepts ofpublic and market. Marketing theorists most often refer to segments
of the population as markets whereas public relations theorists call them publics.
A “market” is a segment chosen by an organization to help meet its mission.
Bonoma and Shapiro (1983, p. 2) stated, for example:

If segmentation is done well, marketers can make intelligent choices about the
fit between their company and products and the needs of each segment. Those
segments that fit the company’s capabilities are chosen for penetration. Those
segments that do not suit the company’s capabilities are left for others to serve.

Levitt (1986, p. 5) put it even more simply: ‘The purpose of a business is to

create and keep a customer.” Organizations, in other words, create and seek out
markets. Health-care organizations, for example, must attract patients and get
doctors to use their services to accomplish their missions.
Publics, in contrast, organize around problems and seek out organizations that
create those problems for them-for information or help, for redress of grievances,
to pressure the organizations, or to request that the government regulate them.
For health-care organizations, these publics might be regulatory commissions,
governments, unions, professional associations, dissatisfied former patients, or
community groups. As publics move from being latent to active, organizations
have little choice other than to communicate with them (Grunig & Hunt, 1984,
pp. 143-147); or g anizations can choose to ignore markets if they wish.
Consumers provide an example of the difference between publics and markets.
They constitute a market segment for marketing communicators, but they become
a public of concern to public relations practitioners when a faulty product creates
a problem that turns a market into a public. For example, users or potential users
of IUDs were a market until the product had serious consequences on health.

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 Conceptual Differences in Public Relutiuns and Market&J

Then, many of the users organized into a public that brought litigation and sought
government regulation.
J. Grunig (1989a) reviewed theories and techniques that have been used by
public relations and marketing practitioners to segment publics and markets. These
techniques include demographics, psychographics, values and lifestyles, cultural
analysis, geodemographics, and situational issues. He maintained that public rela-
tions practitioners should use concepts that will segment active and passive publics.
Active publics define what issues are important for organizations and threaten
their mission. Passive publics may take in information randomly from the media
or other sources, but this passive communication seldom has cognitive effects and
even less often has attitudinal or behavioral effects.
Dewey (1927) recognized the crucial role that active publics play in American
democracy: After recognizing that problems affect them, publics organize into
issue groups to pressure organizations that cause problems or that are supposed
to help resolve problems. Active publics, therefore, begin as disconnected systems
of individuals experiencing common problems; but they can evolve into organized
and powerful activist groups engaging in collective behavior (J. Grunig, 1989b).
J. Grunig has developed a situational theory that classifies publics by how they
respond to specific situations or problems (see, e.g., J. Grunig, 1983; J. Grunig
& Hunt, 1984, Ch. 8). Nuclear power, energy shortages, pollution, marketing
of infant formula, and AIDS are such problems. In particular, the theory explains
when publics will be active and when they will be passive. Three independent
variables in the situational theory distinguish active from passive publics: problem
recognition, level of involvement, and constraint recognition. Active publics rec-
ognize an issue as a problem, believe it involves them personally, and believe they
are unconstrained enough to do something about it.
Marketing theorists, in contrast, can rely on concepts that segment markets
rather than publics-concepts such as psychographics, values and lifestyles,
geodemographics, or demographics. These concepts identify, for example, poten-
tial users of health services better than they identify people who are likely to
organize into publics that are concerned about poor service to the community.
The public relations practitioners who do segment their audiences, however,
more often use market segmentation concepts than public segmentation concepts.
That use of marketing techniques in public relations, therefore, is in our view
one of the adverse effects that the sublimation of public relations into marketing
in the health-care industry and elsewhere has had on public relations.
Strategic management of public relations, in summary, is one of the crucial
elements of an excellent public relations program that has been identified by our
IABC research team. At the same time, strategic management also seems to be
an important component of excellent marketing programs. The two strategic
processes differ enough, however, that a public relations program organized
strategically by marketing theory could not achieve the same effect as a program
organized by public relations theory.
We turn next to a second characteristic of excellent public relations programs,

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 Public Relations ReGw

the use of a symmetrical model of public relations. Here, too, we have found that
marketing theory leads to a model that is not so effective for public relations as
it is for marketing.

MODELS OF PUBLIC RELATIONS

“Models of public relations” is a term we have used to

define and classify four approaches to public relations. The four models evolved
from three studies we conducted to classify public relations behaviors and explain
their occurrence (J. Grunig, 1976; J. Grunig, 1984; Schneider [aka L. Gnu-rig],
1985a). J. Gnu-rig and Hunt (1984) also described the historical development of
the four models in their public relations textbook. The models relate to excellence
in public relations because they define the type of communication programs (step
4 of strategic management) that allow organizations to form trusting and mutually
acceptable relationships with strategic publics.

Presuppositions

The broadest distinction among these models of public

relations comes at the level of presuppositions. Philosophers of science have iden-
tified two levels of theories-levels that apply to the scientific theories of research-
ers as well as to the pragmatic theories of practitioners. These levels are those of
pzsugpositions and those of laws m pr~ositions, (J. Grunig, 1989~).
The second level of theory, the laws or propositions, are familiar to most
researchers and practitioners. Most can be presented as if-then statements, such as:

If a public perceives an involvement with the consequences of what an organi-

zation does, then it will communicate actively with the organization.

The first level, that of presuppositions, is less familiar to practitioners and

scholars. Presuppositions define the world view of scholars and practitioners.
They are a priori assumptions about the nature of truth, of society, of right or
wrong, or simply of how things work in the world. The presuppositions that
make up the world view of scholars or practitioners cannot be measured or tested
directly. Still, they are extremely powerful. Presuppositions determine the priority
that people give to problems they choose to study or solve. Presuppositions also
affect the theories that people choose to solve these problems. Neither practitioners
nor scholars generally study problems or use theories that do not fit within the
boundaries of their world view.
We believe that much of the practice of public relations has been built on a set
of presuppositions that has made it less effective than it could be, has led to
unrealistic expectations about the effects of public relations, and has limited its
value to the organization it serves. The predominant world view of public relations
is based on asymmetrical presuppositions. This world view assumes that organiza-
tions and opposing groups use communication to persuade or manipulate publics,

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governments, or other organizations for the benefit of the organization sponsoring

the communication program and not for the benefit of the other group or of
both. In the language of game theory, public relations based on asymmetrical
presuppositions is a zero-sum game: One organization, group, or public gains
and the other loses.
An alternative to this world view is based on a set ofsymmetrical presuppositions.
A symmetrical world view sees public relations as a nonzero sum game in which
competing organizations or groups both can gain if they play the game right.
Public relations is a tool by which organizations and competing groups in a
pluralistic system interact to manage conflict for the benefit of all.
One of the most important consequences of sublimating public relations to
marketing is that marketing typically takes an asymmetrical view of relationships.
Sublimation forces that world view on public relations. For example, in a story
about the Public Relations Symposium held at San Diego State University, the
San Diego BusinessJournal (Wells, May 15, 1989, p. 17) quoted Thomas Wilson
of the Wilson & Frank Associates firm in San Diego as saying, “Marketing and
public relations are generic terms that mean communications. They both are used
to get people to do what you want them to do.” Mike Killian of the William
Beaumont Hospital in Royal Oak, MI, however, saw the difference when he said
(PR Repmter, April 25, 1988), “In marketing, I have a competitive instinct and
look at the market in terms of what it will buy. I can’t think this way and at the
same time think about coalition building and public accommodation.”
Marketing probably takes an asymmetrical approach because asymmetrical pre-
suppositions work better there than in public relations, even though marketing
theorists often use such symmetrical concepts as “bilateral exchange” or a “customer
orientation.” Customers usually do not have to buy the products of a given
organization. Publics, in contrast, usually cannot avoid the consequences of an
organization’s behavior-consequences such as pollution, discrimination, chemi-
cal waste, or poor health care. Because publics are more involved with an organi-
zation, persuasive communication seldom will work well enough to keep them
from being a threat to an organization’s mission.
Although the advent of marketing in health organizations may have benefitted
public relations by introducing strategic planning to that function, marketing also
has been detrimental to public relations because it seems to have led public relations
away from the two-way symmetrical model that our research suggests will be
most effective. This, we believe, is further evidence to support the need to separate
marketing and public relations in health organizations.
J. Grunig (1989~) tried to make the case for symmetrical public relations prag-
matically as well as philosophically. The literature review by the IABC team
suggests that external communication programs and internal communication sys-
tems based on symmetrical presuppositions characterize excellent public relations
or communication departments. Philosophically, we believe that symmetrical
public relations is more ethical and socially responsible than asymmetrical public
relations because it manages conflict rather than wages war. But, pragmatically,
our literature review shows that symmetrical communication programs also are

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 Public Rehtiom Review

successful more often than asymmetrical ones and contribute more to organiza-
tional effectiveness.
Within this broad distinction between asymmetrical and symmetrical public
relations, J. Grunig (1989~) identified four models of public relations-the press
agentry, public information, two-way asymmetrical, and two-way symmetrical
models. The first three are asymmetrical; the fourth is symmetrical.
The press aJentry model applies when a public relations program strives for
favorable publicity, especially in the mass media. A program based on the public
infoomzationmodel uses “journalists in residence” to disseminate relatively objective
information through the mass media and controlled media such as newsletters,
brochures, and direct mail. Both press agentry and public information are one-way
models of public relations; they describe communication programs that are not
based on research and strategic planning. Press agentry and public information
also are asymmetrical models: They try to make the organization look good either
through propaganda (press agentry) or by disseminating only favorable informa-
tion (public information) (J. Grunig, 1989~).
Public relations departments that take a strategic approach base their communi-
cation programs on more sophisticated and effective models than these two. The
third model, the two-way asymmetical model, is a more sophisticated approach in
that it uses research to develop messages that are likely to persuade strategic
publics to behave as the organization wants. Our research suggests, however, that
two-way asymmetrical public relations-like press agentry and public information
-is less effective than two-way symmetrical public relations.
Two-way symmetrical describes a model of public relations that is based on
research and that uses communication to manage conflict and improve understand-
ing with strategic publics. Our IABC literature review suggests that excellent
public relations departments model more of their communication programs on
the two-way symmetrical than on the other three models.

Research on the Models in Health-Care Organizations

Two studies have measured the extent to which health-care

organizations practice these four models of public relations: Fabiszak’s (1985)
survey of 244 hospitals and Bufhngton’s (1988) case studies of 10 state Blue
Cross and Blue Shield health plans. Table 1 shows the mean scores for each of
the models for the two kinds of health organizations. The means were calculated
from responses to four items for each scale. Respondents choose a score from 1
to 5 to indicate the extent to which they agreed that each item described the way
their organization practiced public relations. The means in Table 1 show the
average score on the four items for each scale.
These studies both show the press agentry model to be most common in health
organizations. The public information model was least characteristic of public
relations in the Blue Cross-Blue Shield organizations but equal with the two-way
asymmetrical and symmetrical models in the hospitals. In both kinds of organiza-
tions, the two-way asymmetrical and symmetrical models had means at or above

270 VoL 17, No. 3

 Conceptual Difirences in Public Relations and MarketinN

TABLE 1

Mean Scores on Four Models of Public Relations

for Two Kinds of Health Orzanizations

Press Public Two- Way Tivo- Way

Agenbry Information Asymmetrical Symmetrical
Scale = l-5

244 Hospitals 3.30 3.05 3.04 3.06

(Fabiszak, 1985)
10 Blue Cross, Blue Shield
Health Plans 3.39 2.88 3.23 3.21
(BuJ%gton, 1988)

the midpoint of the scale (3.00), showing the growing sophistication of public
relations in these organizations.
Fabiszak’s (1985) results show that use of the two-way models may be a function
of the marketing activities in health organizations. She found negative correlations
between the frequency of marketing activities iu the hospitals she studied and the
press agentry model ( - .09, n.s.) and the public information model ( - . l&p< .Ol).
In contrast, marketing activities correlated .29 (pc.01) with the two-way asym-
metrical model and .22 (p<.Ol) with the two-way symmetrical mode1.2 The
stronger correlation of marketing with the two-way asymmetrical model supports
our theoretical contention that marketing imposes an asymmetrical world view
on public relations activities. However. the moderate correlation with the svm-
met&al model shows that marketing, too, can be practiced symmetrically. ’

ADDITIONAL CHARACTERISTICS OF
EXCELLENT PUBLIC RELATIONS
DEPARTMENTS

The theory and research reviewed thus far in this paper

have shown, in summary, that the most effective public relations programs are
those that are based on strategic management and the two-way symmetrical model
of public relations. The IABC research team went further, however, and identified
what research and theory suggest are other characteristics of programs that have
the greatest potential for practicing strategic, two-way symmetrical public rela-
tions. These characteristics provide additional normative guidance for health or-
ganizations planning public relations programs. These characteristics are:

Public Relations Roles

Public relations departments have greater potential to practice strategic manage-

ment and to use a two-way model of public relations if they include communication

Fall 1991 271

 Public Relations Review

managers who conceptualize and direct public relations programs as well as com-
munication technicians who provide technical services such as writing, editing,
photography, media contacts, or production of publications.

Equal Treatment of Women and Men

The feminization that is occurring in the public relations profession and particu-
larly in public relations education will limit the potential of a public relations
department if the organization discriminates against women and keeps them out
of the management role. More women than men are being educated in the type
of public relations described by our theory of excellence. Thus, excellent public
relations departments have women in management roles and have mechanisms
to help women gain the power they need to advance from the technician to the
management role.

Academic Preparation and Experience

Excellent public relations departments have practitioners who have learned the
theoretical body of knowledge that is developing in public relations-knowledge
that they need to practice the other characteristics of excellent public relations.
Some practitioners have gained this knowledge from experience, self study, or
professional development courses. More and more practitioners are getting this
knowledge from a university program in public relations, however, and most will
get it that way in the future.

Organization of the Public Relations Function

Many organizations splinter the public relations function into a supporting tool
for other departments such as marketing, finance, or personnel. In addition, many
single public relations departments have developed historically rather than strategi-
cally, reflecting the preferences of top managers with the most power when the
public relations function first developed. In contrast, our literature review showed
that public relations cannot be practiced strategically unless the departments:

Locate the public relations department in the organizational structure so that

the department has ready access to senior managers.
Integrate all public relations functions into a single department rather than
subordinate them under other departments. Only in an integrated department
is it possible for public relations to be managed strategically.
Develop dynamic horizontal structures within the public relations department,
making it possible to reassign people and resources to new programs as new
strategic publics arise and others pass.
Excellent public relations departments do not occur by accident, nor can they
be found very often. At one stage in our research, we believed that an organization’s
environment would predict how public relations would be practiced: Organiza-
tions could adjust to dynamic, complex environments only by practicing strategic,

272 Vol. 17. No. 3

 Conceptual D@rences in Public Relutions and Marketing

symmetrical public relations. More than a dozen studies, however, failed to support
this environmental imperative (J. Grunig & L. Grunig, 1989). We believed, in
essence, that the normative theories we have presented thus far in this paper
would also serve as positive explanations of why organizations practiced public
relations as they do.

TABLE 2

Correlations of Four Models of Public Relations

with Seven Characteristicsof an Organization’s Environment

Press Two- Way Two- Way

49-Y Infimnation Asymmem*d Symmetrical

Complexity of Knowledge -.15* -.12* .04 .Ol

Complexity (Number - .08 .Ol .12* - .04
of Occupations)
Complexity - .07 - .16* .09 .13*
(Level of Education)
Size -.15* - .09 .Ol .05
Scale (Repetitiveness .07 .12 - .21* .09
of Demand)
Constraints - .03 - .02 - .04 .08
Uncertainty .ll” .Ol .13* .ll”
*p<.o5
**p-c.01
Source: Fabiszak (1985)

Table 2 shows correlations that Fabiszak (1985) computed between seven

environmental variables, which Hage and Hull (1981), Hage (1980), and J.
Grunig (1984) isolated from the literature on the environments of organizations,
and the four models of public relations. The table shows a slight tendency for
the two-way asymmetrical and two-way symmetrical models to be practiced in
complex, large-scale, and uncertain environments and the press agentry and public
information models to be practiced in less complex, small-scale, and stable environ-
ments. Nevertheless, the results are weak and mixed.
In place of this environmental explanation of why organizations practice public
relations as they do, we have adopted a power-control perspective as a positive
theory of how public relations departments and programs come about: Organiza-
tions choose the programs they do because the people with power in the organi-
zation choose them. Table 3, for example, shows that when administrators of
hospitals are rated as valuing and understanding the public relations function, the
hospital is more likely to practice the two-way asymmetrical and two-way sym-
metrical models and less likely to practice the press agentry and public information
models. The strongest correlations are with the two-way symmetrical model.

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 Public Relations Rev&

TABLE 3
Correlations of Four Models of Public Relations
with Support and Understanding of Public Relations by Top Management

Press Public Two- Way Two- Way

&entry hfhua tion Asymmetrical SylllXnetll’Cal
Values Public Relations -.18X” - .36** .19** .31**
UnderstandsPublic - .17* - .42** .14* .24**
Relations
*p-c.05
**p<.o1
Source: Fabiszak(1985)

We and the others on the IABC research team have identified two concepts that
seem to affect who comes to power and ultimately how public relations will be prac-
ticed: organizational culture and the potential of the public relations department.
Organizations with participative cultures are more likely to have a set of organi-
zational presuppositions that favor symmetrical public relations. They also are
more likely to appreciate the value of a public relations program with the potential
to practice that excellent public relations (as described by the characteristics re-
viewed above). If the public relations department has the potential for excellence,
the head of that department also is more likely to be included in the dominant
coalition where he or she can influence how public relations is practiced. When
the department has little potential, public relations programs are chosen by domi-
nant coalitions with little understanding of modern, sophisticated public relations.
Buffington’s (1988) study of 10 Blue Cross-Blue Shield organizations showed
the effect of organizational culture and potential of the public relation department
on the choice of a model of public relations. Buffington defined organizational
culture according to Ernest’s (1985) typology of four cultures. Ernest’s four cul-
tures are defined by the interaction of two dimensions: authoritarian vs. democratic
and reactive vs. proactive. “Systematized” cultures are authoritarian and reactive.
“Entrepreneurial” cultures are authoritarian and proactive. “Interactive” cultures
are democratic and reactive. “Integrated” cultures are democratic and proactive.
Nine of the 10 Blue Cross-Blue Shield organizations studied either had in-
tegrated or entrepreneurial cultures. Six had entrepreneurial (authoritarian/
proactive) cultures; five of these six organizations had their highest scores on the
press agentry model of public relations. In the three organizations with integrated
cultures (democratic/proactive), the two-way symmetrical model was used in com-
bination with the two-way asymmetrical and press agentry models. Professionalism
in the public relations department, as defined by the number of people with
education in public relations and membership in professional associations, was
higher in two of the three organizations than in the third. In those two cases,
two-way symmetrical public relations was the predominant model. In one of the
organizations with an entrepreneurial culture, a high level of professionalism

274 Vol. 17, No. 3

 Conceptual D$%enus in Public Relations and Marketing

allowed the public relations department to practice the two-way symmetrical

model in spite of the negative influence of the culture.
These results, then, support the hypothesis of our IABC research team that
excellent public relations programs will be found most often in organizations with
participative, democratic cultures and in which professionalism increases the po-
tential of the public relations department. Buffmgton (1988) also pointed out,
however, that most of these Blue Cross-Blue Shield plans emphasized marketing
in their public relations efforts, an emphasis that probably resulted from the
predominant authoritarian cultures in these organizations and that seems to have
produced predominantly asymmetrical public relations programs.

CONCLUSIONS

We have developed a normative theory of public relations

that stipulates that excellent public relations programs practice public relations
StrategicaJJy and use a two-way symmetrical model of public relations when they
do so. We also have identified four other characteristics of excellent public relations
programs that are logically related to strategic management and the two-way
symmetrical model.
At the same time, we have shown that competitive pressures have caused many
health-care organizations to sublimate public relations to the marketing function.
Sublimation of the public relations function, however, results in a more asymmetri-
cal approach to public relations, even though public relations may be practiced
according to a strategic model of marketing. As a result, organizations lose the
valuable function that public relations provides-of managing interdependence
with publics that constrain the autonomy of organizations to pursue and meet
their goals.
Finally, we have presented a positive theory to explain why some organizations
practice public relations in the excellent and effective way described by our norma-
tive theory and other organizations do not. We have shown that health-care
organizations do not practice public relations strategically and symmetrically unless
they are led by a dominant coalition of managers who value and understand public
relations as a management role and as having a symmetrical purpose. The organi-
zations, in turn, have participative rather than authoritarian cultures and have a
high level of professionalism in their public relations departments that raises the
potential of those departments.

NOTES

1. These colleagues include David Dozier of San Diego State University, William Ehling
of Syracuse University, Jon White of the Cranfield School of Management in the
United Kingdom, and Fred Repper, retired vice president of public relations for
Gulf States Utilities of Beaumont, Texas.

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 Public Relatims Review

2. Although three of these four correlations are small, the correlation between marketing
activities and the two-way asymmetrical model is at a level that Cohen (1977, pp.
79-80) would call moderate for the social and behavioral sciences. He reported that
a correlation of .lO is small, .30 is moderate, and .50 is large in these sciences. Thus,
the correlation of marketing activities with the public information and two-way
symmetrical models is a small one.

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