What Boards Really Mean When They Demand ‘Awareness’

Terri Clevenger

Every CEO knows the moment. The board meeting has gone smoothly, but then a director leans forward and makes a pointed observation: “We need more awareness.”

The instinctive response is to call the communications team and order more press releases, a push for media coverage or perhaps a glossy feature in a paid-for outlet. In other words, “awareness” gets reduced to public relations.

But when your board is demanding awareness, they rarely mean public relations alone. They’re talking about something far more strategic, far more consequential—and something far harder to measure with simple metrics. True awareness isn’t just about headlines. It’s about reputation.

Reputation is the sum of perceptions held by stakeholders. It answers the questions: “Can we trust you?” “Do you deliver on your promises?” “Are you who you say you are? Should we invest or partner with you?”

Reputation can’t exist in a vacuum. Before stakeholders can evaluate you, they must first be aware of you. Awareness isn’t reputation itself, but it’s the critical precondition: Without awareness, there’s no perception to manage, no trust to build, no credibility to lose.

This is why boards press leaders on awareness. They understand that in the life sciences industry, reputation is often a company’s most valuable asset, shaping valuations, partnerships, trial enrollment and adoption. Awareness is the gateway to reputation: the entry point through which stakeholders form judgments that determine your future.

The misconception: awareness ≠ PR

It’s easy to see how this misunderstanding arises. Historically, public relations has been the domain of “awareness campaigns.” Count the clips, measure the impressions, tally the share of voice and awareness is achieved.

But most boards don’t think in terms of column inches. Their responsibility is to safeguard the long-term trajectory of the organization. That requires something deeper than media buzz.

Plenty of biopharma companies, for instance, have enjoyed a splash of headlines when raising a funding round or announcing early trial data, only to see reputational cracks widen soon after. A favorable article might spark a moment of recognition, but without credibility across stakeholders, awareness fades and reputation stalls. PR is often noise; awareness is signal.

The four elements of awareness

To understand what boards are really asking for, leaders must reframe awareness as a multi-dimensional foundation of reputation. Through our work with healthcare brands, we’ve identified four areas of awareness that every company must manage:

1. Market awareness:

• Investors, analysts and competitors must recognize your company’s positioning and potential.
• Market awareness shapes financial reputation, influencing valuation and resilience in turbulent markets.

2. Clinical/scientific awareness:

• Physicians, researchers and key opinion leaders must understand your science and the rigor of your data.
• This awareness builds scientific reputation, without which breakthroughs remain unrecognized or distrusted.

3. Patient/community awareness:

• Patients and advocacy groups need to perceive your brand as trustworthy, relevant and aligned with their needs.
• Here, awareness nurtures social reputation, the credibility that earns patient loyalty and advocacy partnerships.

4. Internal awareness:

• Employees must be aligned with the mission and able to articulate the story.

Internal awareness reinforces cultural reputation, proving that values are lived, not just claimed.

• Seen together, these elements make it clear: awareness is the framework on which reputation is built. Without broad, consistent visibility across stakeholders, reputation is fragile, hollow or fragmented.

Why boards care

Boards are stewards of value. They know that reputation is one of the few intangible assets that can decisively protect or destroy enterprise value. According to Echo Research’s 2024 report on Reputation Value, corporate reputations across the S&P 500 make up 28 percent of market cap, with healthcare among the top three industries benefiting from a strong reputation.

But reputation begins with awareness. If investors, scientists, patients and employees are not aware of you—or are aware only through a narrow or distorted lens—your reputation cannot mature. That’s why boards demand it. Awareness isn’t the goal; it’s the raw material from which reputation is shaped.

This shift reframes awareness not as outputs (coverage, mentions, impressions) but as outcomes (confidence, trust, adoption, alignment).

• Market outcomes reflect reputation in analyst reports and valuation.
• Scientific outcomes reflect reputation in citations and KOL endorsements.
• Patient outcomes reflect reputation in advocacy partnerships and trust indices.
• Internal outcomes reflect reputation in retention and cultural strength.

Building true awareness

So, how should leaders respond when their board demands awareness? By treating it as a strategic reputation-building exercise, not a communications campaign.

Start with the narrative. A clear corporate story is the DNA of both awareness and reputation. This narrative must be compelling, universal and timeless, thereby resonating with Wall Street, scientists, patients and employees alike.

Integrate across channels. Awareness must be consistent. Reputation fractures when investors hear one story, patients hear another and employees live a third. Every channel, from IR decks to patient portals, must reinforce the same values and vision.

Measure what matters. Move beyond media metrics to reputation indicators:

• Investor perception surveys.
• Analyst commentary.
• KOL influence mapping.
• Patient trust surveys.
• Employee advocacy scores.

Awareness as survival. In healthcare, awareness and reputation are inseparable. One without the other is dangerous. Awareness without reputation is a fleeting buzz. Reputation without awareness is invisible potential. Together, they are the lifeblood of growth and resilience.

Consider two companies in the same therapeutic space. One has cultivated multi-lens awareness: investors respect its vision, physicians trust its science, patients value its authenticity and employees live its culture. Its reputation is strong because awareness is broad and consistent. The other has a flurry of headlines but little else. Which survives setbacks and earns trust over the long haul?

Boards know the answer. That’s why they demand awareness, not as a vanity metric, but as the foundation of reputation.

So, when your board says, “We need more awareness,” listen for the deeper message. They’re asking whether your company is visible and credible to the stakeholders who matter most. They’re asking whether your reputation can grow, sustain and protect enterprise value.

Because in the end, awareness isn’t PR—it’s reputation in the making.

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Terri Clevenger is Head of Integrated Communications at Waterhouse.