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“The concept of creating an online community based on wellness is a natural extension of Inova Health System’s branding promise,” says Chris Boyer, Senior Manager of Digital Communications for Inova Health System. “The FitFor50 site also integrates a number of social media platforms, including blogs, Facebook, Twitter and YouTube. We’ve made an effort to ensure users of the site can interact with the content in ways they are most comfortable.”

As of September 21, the FitFor50 website had more than 26,000 unique visitors, and more than 6,000 people had registered for the Wellness Playbook.

“This is a terrific example of a health system using health and wellness to engage consumers and build its brand,” said Interval president Chris Bevolo. “Rather than the typical approach of touting specialties or technologies that many consumers don’t need or can’t relate to, wellness is actually relevant to most people, and Inova has done an amazing job of leveraging wellness to connect with those in its market.”

“Why should we invest in XYZ? We don’t get paid for that.”

This often comes from a CEO or CFO of a hospital, and what they mean is that whatever it is your asking them to invest in, the organization doesn’t get reimbursed for it. For example, we’ve heard this used in regards to investing in a better patient experience. One CFO we know said the following during planning for a major expansion:

“Why do we need to spend so much on patient rooms? We could just stick them in the hall and we’d get paid the same.”

Recently, this gauntlet has been laid down in front of marketers seeking to spend marketing dollars to promote health and wellness messaging from their organization. Why spend money there, the argument goes, when the hospital doesn’t get reimbursed for helping people stay healthy?

There are some exceptions – helping diabetics meet certain benchmarks, for example, can be tied to better reimbursement from payers. But from a short-term perspective, that’s mostly accurate – hospitals and physicians don’t get paid for keeping people healthy (though federal reform could eventually change that equation).

Here’s the disconnect: you will get paid from promoting health and wellness, just not today. Investing in health/wellness messaging, or a better patient experience, are examples of investments in building stronger brands, with the goal of increasing loyalty, word of mouth, and yes, over time, revenue.

So here’s the tip: next time this comes up, use our old branding friend Starbucks to make your point. Imagine the CEO of Starbucks had once said: “why should we invest in hiring friendlier baristas, or buying more comfortable furniture? We don’t get paid for that, we get paid when people buy our coffee.”

Seems kind of silly, right? People buy more coffee because of the investment in the Starbucks experience, and more people will engage your organization more times when you invest in the patient experience, or help them stay healthier with services, communications, education and more geared toward wellness. (Remember, the beauty of promoting health and wellness is that it’s relevant to your audience, making them more likely to notice, listen, and engage when they need you.) It’s not about getting paid today, it’s about getting paid tomorrow.

The entire visit took an hour from start to finish, almost all of it waiting. “How could a dermatology practice afford such poor service?” I thought, especially given the multitude of options available to us in our area and the commodity level of care we needed.

Much of the revenue generated by dermatology groups is from elective cosmetic services – botox, microdermabrasions, etc. – and dermatology could be considered one of the surest forms of retail offerings in healthcare. Meaning price, convenience, service and experience all (should) play a significant role in customer choice.

Alas, despite the fact we were 10 minutes early, we waited in the reception area 25 minutes past our scheduled appointment, and after we were called back, waited another 20 minutes in the exam room. At that point, I told my daughter to put her shoes and socks back on, and we proceeded to leave. Coming out of the room we walked smack into the doctor coming in, who apologized for the delay, and we went back into the exam room for the 10 minute visit.

This whole experience amazed me given the elective nature of the dermatology business, and what I would assume is an understanding that serving customers right would be a key to success. But the kicker was the sign posted on the waiting room wall: “If you have been waiting 30 minutes past your appointment time please inform the receptionist.”

Nearly every doctor’s office, lab and waiting room has a sign similar to this, and typically they provide timeframes of 15 or 20 minutes. These signs are meant to acknowledge and allow for the variability inherent in many care encounters. Sometimes physicians or other caregivers need more time, and a delay can’t be helped. Depending on the situation, twenty minutes is either no big deal (the ED) or fairly annoying (scheduled lab visit). But I’d never seen one allowing for 30 minutes in a clinic setting like this. What this sign conveyed to me was that the clinic has accepted the fact that they can’t see patients on time, and they wanted patients to accept that fact as well.

The sign reminded me of one of my favorite business books, “The Feiner Points of Leadership,” by Michael Feiner. The author, a professor at the Columbia University Graduate School of Business, talks about management strategies using real-life stories from his own executive career at Pepsi, and his style is as down-to-earth and cuttingly honest as I’ve read anywhere. In his book, the first “law of leadership” is called the Law of Expectations, where he states:

“People live up to their perception of our expectations of their performance. More simply, people respond to the level of confidence you show in them.”

Now consider that sign again, and the impact it’s having on this dermatology group’s brand. From a brand experience perspective, it’s literally giving staff and physicians a pass on improving service and efficiency, solidifying as policy the idea that a 30-minute wait is not only acceptable, it’s likely the norm. Now consider it from a brand perception angle: How do I feel as a customer of this practice, knowing that I’m pretty much guaranteed to wait, possibly 30 minutes (or more) past my appointment time? Annoyed, angry, irritated, and itching to tell others — feelings the practice will have to work hard to help me forget if it wants me to recommend it to anyone else.

In this case, the brand perception became the brand reality, and when it came time to schedule the next appointment, I walked straight out of the office.

When it comes to your brand messaging, what expectations are you setting? It’s one thing to ensure your brand promise and values are grounded in reality – puffery and exaggeration have their own dangers. But it’s quite another to set brand experience expectations so low that they allow for an unacceptable reality. Doing so will not only assure a poor experience, it will assure your customers will seek a more respectful and satisfying alternative.

A few years back, we worked with a large dental practice that wanted to stand out in the market. In the initial meeting, we discovered management believed their best bet was to promote the expertise of their dentists, a decision based primarily on the results of an annual survey that showed respondents ranked “skill of my dentist” number one from a list of values they thought important when choosing dental care.

Think about that for a minute. Now imagine you’re buying a car, and someone asks you to rate the following values based on which are most important to your purchasing decision:

1. style
2. gas mileage
3. reliability
4. engine size
5. that it won’t catch fire when driving in temperatures above 75 degrees

Given that list, which answer do you think would come out on top? Wouldn’t you select “e,” because after all, do the others really matter if your car threatens to spontaneously combust when driving in warmer climes?

Yet that same logic applies to the survey question on how customers choose a dentist. We don’t know anyone (normal) that thinks, “You know, I like it when my gums bleed, or my dentist wields a drill like a jackhammer.” So we think it’s pretty safe to say “skill of a dentist” is a given when looking for dental care. But that doesn’t mean a dental practice should base its market differentiation on that value. Imagine a car company centering its marketing on the tagline: “The Wren – the car that doesn’t catch fire, even in the summer.”

How Customers Think

On one level, this story illustrates a bad survey technique, but more to the point, it supports our contention that when it comes to healthcare marketing, organizations need to stop asking their customers what they think.

To many of you, this will sound sacrilegious. Experts implore: “Listen to your customer, the customer is always right, be customer-driven.” But listening to consumers and asking consumers what they think can deliver two very different insights. Turns out it’s how you listen that matters. The key is to not listen to what consumers say, because research shows what consumers say and what they do has little or no correlation.

Perhaps one of the best resources on this topic is “How Customers Think: Essential Insights into the Mind of the Market,” by Harvard Business School professor Gerald Zaltman. Zaltman uses research to show that 90% of what influences a consumer’s decisions and preferences lies in the unconscious mind. Because surveys and focus groups only tap the conscious mind, accurate insights into the true preferences of consumers are missed. In fact, consumers are not aware of the hundreds or thousands of factors that influence their decisions and preferences, so simply asking for that information will result in predictable answers (i.e., “I value the skill of my dentist”), but not necessarily the answers that reflect future, or even past, behavior. (Zaltman proposed a deeper “metaphor-based” interview approach to tap into that unconscious thinking.)

In essence, consumers don’t really understand why they make most decisions, so asking this question can be fruitless, or worse, misleading. Other books that support the contention that companies gain little from asking customers how they think or act include:

Buyology – Martin Lindstrom
Selling the Invisible – Harry Beckwith
Predictably Irrational – Dan Ariely

The same ol’ same ol’

Yet despite the evidence that asking consumers what they think or want is misguided, hospitals and health systems still do it, and they do it a lot. They ask what consumers think of their advertising, which heart center they would prefer, and how many beds a new hospital should have. And they use the answers to guide their marketing strategies.

Why does this still occur? For some, it’s an opportunity to show they “listen” to their community. (Surveys and focus groups can actually serve this purpose, but just not in gaining a better understanding of what works in the market). The lack of popular alternatives is another reason – “How else will we know?” (more on that later). But the two most popular reasons are a), because that’s what they’ve always done, and b) “CYA.” Many executives feel that if surveys or focus groups aren’t conducted, the sole responsibility for a marketing program’s failure will assuredly be laid at their feet.

Redefining how to “listen”

So how does an organization truly gain understanding of its customers, what they like or how they act? Again, you can listen to your customers, as long as you listen to their behavior, not their words. (One exception is the metaphor-based interview technique outlined by Zaltman). Some examples of how to gauge behavior include:

Observe
The practice of ethnography – the social science of observing people in their natural environments – is a powerful tool used by leading organizations like Proctor & Gamble to understand how consumers actually behave in given situations. Observations often provide far more insight into potential problems and possible opportunities than traditional research can.

Prototype
Whenever possible, create a prototype and let your customers actually test the experience, instead of simply asking them how they would respond to it. This could be done with a prototype patient room in a new facility, or a new web-based tool. Combined with observation, you’ll learn a lot about how customers might actually respond to your offering in the real world.

Test and Adjust
For some marketing activities – advertising or PR, for example – it’s nearly impossible to gauge how people will react from what they tell you. They don’t even know how advertising impacts them, so how can they help? Whenever possible, test marketing efforts to see how responses vary. Use different creative approaches in different, separated markets to see if one or more drives different behavior, such as attendance at a joint-pain seminar. Or, how changing the hours in a clinic might vary utilization in one community when compared with other office hours in a similar community.

All of the above techniques can work in certain circumstances, but the silver bullet of absolute certainty about what works and what doesn’t with your marketing efforts is elusive and may never be found. There are interesting explorations into the consumer mind using fMRI technology (see previous blog post), but even those just answer what a consumer may be thinking, not the more important question of why. In the end, you need to trust yourself, your team and your partners — those who have dedicated their careers to understanding marketing and consumer behavior — to provide the best guesses when the unknown prevails.

After all, some of this is straight common sense. Running a consumer survey that asks “which is more valuable when choosing your care, your doctor’s recommendation or a hospital’s advertising?” will provide results that should surprise – or enlighten – no one.

The Truths We Hold Self-Evident

As immutable as the laws that rule nature (the sky is blue, the earth is round), are a set of guiding principles we at Interval refer to as the “Truths We Hold Self-Evident.” These “truths” influence pretty much everything we do. Our thinking. Our approaches to marketing and client challenges. Our recommendations for and execution of marketing strategies and tactics for our clients. This belief system springs directly from our experience marketing and branding hospital and healthcare systems exclusively over the past six years. We accept and believe these truths passionately, as do our clients. But every once in a while we encounter those that, for whatever reason, do not. Some are marketers stuck in the traditional approaches of the past. Others, skeptics looking for proof. Throughout the year, we are presenting a series of articles articulating these Truths, their implications, and why we consider them self-evident. That said, there is plenty of room for debate and controversy. Consider this a standing invitation to join what we hope is a lively and illuminating conversation. At the very least, theses articles will clarify our biases while helping you better understand the issues and broaden your perspective on them.

Kudos to the NP! She clearly gets it, and is being proactive in including price considerations as part of her consultation. I’ve had physicians mention price before, for sure, but usually as an afterthought, or after prompting (see my guest blog post on the HealthLeaders Media site vis-a-vis pricing and a stubborn wart). This was my first encounter (outside of MinuteClinic) where pricing was a natural part of the experience.

After a lunch of potato sandwiches and SweeTarts (just kidding), I had an appointment with a nutritionist, and I had been told previously it might not be covered by insurance. At the registration desk, the woman reminded me again of this, and asked that I sign a form stating I knew this was possible. Of course, this is as much a CYA policy as it is savvy patient communications, but what I was struck by was they had included the cost of the session on the form ($260 – yikes). Even better, the woman made a point of showing me the price and saying, in a respectful tone, “Just so you’re sure, here’s what the price would be.” Now, while standing in line in the waiting room, it would be hard for many to say, “Holy crap, are you kidding? Count me out.”. But nonetheless, she was making extra sure I had all the relevant information, even if it might cause me to reconsider or cancel. And that is what I call transparency in action.

For me, these were new experiences, and given my frequent encounters with the healthcare system, I found them enlightening given current market trends. What other examples do you have that seem to point to changes in how hospitals and health systems are dealing with price transparency? Do you find these examples encouraging, as I did, or do you feel they’re signs of trends moving in the wrong direction? And, does anyone know of a nutritionist who offers volume discounts?

So there are two blog posts in one here:

First, this is an interesting tactic by the paper. For a long time, this was a typical maneuver by magazines – keeping stories from current print issues off their web sites for a period of time. But recently, I’ve noticed that’s gone away. Typically, if I see a piece in a printed magazine I want to reference, I can usually find it on the web site right away. And of course, there are some media outlets that charge for online content, such as the Wall Street Journal. I don’t want to get too in-depth on the pros and cons of this strategy by the Star Tribune, mainly because I want to spend more time on the story itself. From my perspective (someone who still receives the print version of the newspaper because I love reading an actual print copy of something while sipping my coffee, and who looks at the arrival of my magazines in the mail as a little Christmas present each week), I say, “bravo!” I’m now getting access to content that those not paying for the paper typically get for free. My guess, though, is that there will be a mini-backlash from those who use the web primarily for content gathering. In most circumstances, restricting something that was previously free is not received well.

Anyhoo, on to the second part of the post – the actual topic of the story. Once again, reporter Chen May Yee is ahead of the curve in reporting the changing dynamics of the healthcare industry. The story details the varying efforts of hospitals and health systems in the Twin Cities to mitigate the rising flood of bad patient debt by trying to help patients understand their costs before they are incurred. These efforts can include upfront informational calls, suggestions of partial upfront payments, and offers of financing or payment plans. The data is staggering. According to the story, patients generated more than $600 million in unpaid bills at Minnesota hospitals last year, up from $150 million the year before.

Even more astounding, to me, were some of the reactions captured in the story. A woman who was planning a C-section delivery of her baby at a local hospital had received a call from the hospital explaining the costs and suggesting an early start to the payments. The patient’s initial reaction?

“In this the state of economy we’re in – that they’ll shake you down even before you have your baby?”

Shake you down. Wow – our society obviously has a long way to go if we’re hoping people will start understanding the cost side of their healthcare decisions. Apparently, having a baby is supposed to be free? (Later, it’s noted that the woman is an attorney at a large law firm – holy irony, batman). Then later, Steve Parente, a health finance professor at the Carlson School at the University of Minnesota, is quoted as saying, regarding the idea of offering financing:

“Hospitals should not be doing this stuff. It’s not in their core business.”

Not in their core business? They’re not making shoes or selling condo plots here. If collecting payment for services rendered is not core – to any business – I don’t know what is. From my perspective, any hospital not trying to get out ahead of patient payment issues is making a huge mistake. Certainly, creating a revenue stream from customer financing is one thing (see Target Corporation and the struggles they’re having with their once-profitable credit card business). But trying to help your customers figure out how to pay for your services is quite another.

His quote is another example showing that while healthcare is changing dramatically in this country, many of us are not prepared for those changes. We often rap our own clientele – hospital and health system leadership – for not moving fast enough to understand and take action on these changes. Obviously, they aren’t the only ones struggling to understand the changes.

It makes sense. The more paranoid and cautious we are about our jobs and the security of them, the more we might question leaving for any type of appointment. This might be especially true if it’s a preventative health visit, like a twice – yearly dentist appointment. Depending on the profession, some people struggle with it anyways – economic times or not – because they don’t want to dip out of work and notice being missed. Now more than ever though, people weigh the pros and cons of this, and know they can always reschedule when the time’s better, and get to it when they can. But this also begs the question – when is a better time? If this is a common response heard by healthcare professionals, it’s time to start catering. More than ever, it shows how patients could really benefit from things like extended or later evening hours, or weekend hours, to help accommodate.

Ultimately, it seems, people are going to sacrifice being healthy for face time at work. Once we bounce back from this, they’ll be back in the dentist chair at 10AM on Tuesday’s, but until then, and even after – it’s always good to give them options.

I have a condition that requires a three-hour IV infusion every couple of months. I’ve been having the treatment at the same hospital in the Twin Cities for four years, and probably have numerous stories – good and bad – I could tell. Overall, I’ve been very pleased with the care I’ve received at this system, and feel somewhat loyal to the people who care for me. Nevertheless, this week I received my treatment at the hospital’s brand new, multi-million dollar facility, which just recently opened. The center is gorgeous, with numerous amenities, private rooms, flat screen TVs – a wonderful environment. What struck me was that from the moment I arrived, the staff I encountered seemed to talk only of the negatives. They were still working out the kinks, the TV’s were the wrong kind, the private rooms led patients to bemoan the loss of community, there were no clocks in the rooms, nurses couldn’t interact with each other as easily now, volunteers were complaining about the additional space they had to cover, and on and on. Some of this was conveyed to me directly, but most of the comments were made between staff members in my presence, mostly right in my room. To be sure, one of the nurses pointed out some of the features such as the heated chairs and the wireless Internet access. Another showed how the view would soon include a wilderness area and walking bridge. But these positive comments were far outnumbered and definitely overshadowed in my mind by the negative.

The experience reminded me of how hard it is to change mindsets and attitudes, or to demonstrate the power of an off-hand comment. Of course, staff should never bitch in front of patients, yet it happens all the time. But I kept wondering: why, with this obviously first-class facility, would the staff focus so much on the negative? One thought: is this Midwestern modesty? Could the folks who work here be embarrassed by their “riches,” and use the cutting commentary as a way to ensure the proper perspective? Was it what one of my MBA instructors called the Monkey Tree Theory of Management in action? (This says that if an organization was a tree full of monkeys, the leaders at the top would look down at employees and see a bunch of monkeys, and the employees on the bottom would look up at leadership and see a bunch of monkey’s asses.) Was it staff conveying the popular “they don’t get it” mantra about administration, even with a beautiful new facility? Our director of design, Adam Meyer, postulates that hospital staff are so used to being around patients that they forget the impact they can have with what they’re saying. So they talk to each other about the bad computer system two feet from my chair because to them, I’m just part of the room, another patient in a long line of patients. Or perhaps it’s their way of connecting with patients, developing a kind of “us vs. them” bond, or trying to relate on a more down-to-earth, “real” level.

Here’s the deal – the people who cared for me that day were good people, caring people, and, no doubt, great at what they do. One of the nurses conducted one of the best IV installs I’ve ever had (not only no pain, I didn’t feel a thing!) Let me tell you, I’d trade a no-pain IV for negative commentary any day of the week. So on one hand, I hesitate to criticize any of them – they have a difficult job, there’s no doubt.

On the other hand, I tell this story to demonstrate that no matter what the reason behind it, comments like I heard do have an impact on my experience. I can only guess as to why they let these negative comments slip, and I certainly don’t have the answer on how to change that behavior. All I know was that, either inadvertently or intentionally, the negativity took the luster off a beautiful new facility. And that seems like a shame.

Now, a story in the February 16 issue of BusinessWeek seems to validate this belief. Titled “Nurse, More Caviar” (always good to exaggerate to make a point), the story discusses research by two RAND economists, who in a study of more than 8,700 Medicare pneumonia patients, seemed to have correlated hospital popularity in this group with a high “amenities” score from the patients themselves, which outranked high quality (as measured by mortality rate). Says the article:

“A high amenities score, they found, predicted keen demand much more than a low pneumonia mortality rate did.”

In other words, patients were more likely to select a hospital based on its amenities than on the level of its clinical quality. The economists give a couple of reasons for this outcome, including the scarcity of quality medical information available to patients, making it harder for them to judge based on this criteria, and that many patients most likely associate the higher quality facilities themselves (as reflected in the enhanced experience) with higher clinical quality. As we’ve discussed before, we’d also advocate that many people don’t know how to compare clinical quality data even when they have it. In fact, the problem these days is less a scarcity of quality data, and more an overflow of it – how does a patient know which resource of data to trust? On the other hand, we all have experience evaluating personal service, the taste of food or the quality of the in-room flat-screen television.

The article goes on to conclude that as hospitals fight to market themselves, they may abandon “attracting the best doctor,” and instead focus on “giving them (the patients) wireless Internet.” While the experience distinguishes brands in most industries, you still always need to have a great product (in this case, a great clinical product). And as always, it can be dangerous to read too much into a correlative study, which only shows how two variables move in concert, not necessarily that one variable (great amenities) causes another (higher patient demand) to move.

But hey – these are RAND economists, in a BusinessWeek article, with a study involving more than 8,700 patients. We’ll take that kind of validation any day!

According to the study, when people were selecting new primary care physicians, 50% relied on word-of-mouth recommendations from friends and relatives, while 38% also used physician recommendations and 35% health plan information (40% of respondents to the survey used more than one source of information when choosing). Moreover, most consumers relied exclusively on physician referrals when it came to choosing specialists and facilities for medical procedures.

These findings jibe with the traditional views on patient decision-making, supported by research from folks like Press Ganey over the years. Word-of-mouth has always been at the top as far as patient information sources, with physician guidance right behind. Does this mean the impact of consumer-driven healthcare, and the related drive to inform patients through third-party resources, has been overblown? Well, not necessarily. Certainly, changing patient behavior, thought patterns and research methods won’t happen over night. And word-of-mouth and physician referral will most likely always be among the top resources for patients. But the study itself needs to be reviewed in the proper context. Despite the December 2008 release date, the survey itself was conducted between April 2007 and January 2008, 12-18 months ago. A lot has changed since then. More people are in consumer-driven plans with high deductibles and copays, meaning more people will be “shopping” for care. More resources – including HCAHPS and Consumer Reports – have joined the fray, providing more prominent resources for consumers. Perhaps most notably, the economy has gone in the tank, which inevitably is forcing those with more financial skin in the healthcare game to be more prudent with their dollars. That, in turn, will likely lead to more price shopping, and less trust of a physician’s recommendation (“Do I really need that MRI? How much does it cost? Maybe I should shop around.”)

Our guess? While the traditional influences on consumer healthcare decisions will still hold sway in 2009, other forms of influence, from employer-sponsored guidance to third-party web sites, will continue to grow in strength.

A situation I experienced — albeit not healthcare related — recently left me thinking about this.

(Imagine flashback sound effects)

The other night my wife asked me to look at something in the basement bathroom. Upon entering the bathroom I was greeted by gurgling coming from the shower floor, as water and sediment were rising from the drain. I know very little about the intricacies of home plumbing, so after plunging it a few times I called a plumbing service. Not wanting to cash in my 401k to cover the emergency fees that evening, I opted to schedule a visit the next day.

The next day rolls around and the plumber shows up. At this point, the water has slowly drained out of the shower. He runs the sink and flushes the toilet. Sure enough water starts backing up through the shower drain. Rather than “snake” the line his recommendation is to have a different company come out and do camera work — run a cable camera down the drain to scope out any possible issues. “I guess that makes sense,” I think to myself. He then says, “We have a great relationship with another company that does this kind of work. Running a camera will cost about as much as snaking the line.” He added, “I could snake it now, but if the problem is a broken pipe or tree root then it’s not going to make a difference.”

He calls the other company and sets up a time for them to come out. I shell out fifty bucks for him showing up, and he’s out the door.

Day two rolls around and I get a call from the second company. They ask, “So, what exactly did Bob (not his real name) tell you yesterday?” I give them a recap of what’s gone on so far. They say, “Well, we can’t do camera work until we’ve snaked the line to make sure it’s clear. I’ve got someone on their way to your home now to assess the situation.”

At this point numerous expletives are swirling in my head. I don’t want to be rude, so I thank the woman on the phone and wait for the next dude to arrive. He does. I give him a recap of the situation and he immediately lays into the other company. “I don’t know why they would have told you that… we can’t do camera work until the line has been cleared… I keep having to fix these guys’ mistakes… customers are ticked because they aren’t fixing their issues… I’m sorry you’re having to deal with this… ” He blasted them pretty hard — which was interesting since the first plumber thought he had a great relationship with the second group. Then he proceeded to clear out the clogged line quickly and easily.

As the customer, I appreciated the honesty of the second plumber. And being that he came in and fixed the problem with ease and confidence, I put a lot of stock into his words. I paid the first guy to simply stare at the drain. Who do you think I’ll be calling when I need service in the future?

Word of mouth is the most powerful and effective form of marketing. When your partners have nice things to say about you, those words have a huge impact — much more than when those same words come from someone within your organization (AKA: tooting your own horn). But when your partners have bad things to say about you, it’s even more detrimental than bad mouthing from competitors.

Don’t just assume that your partners are saying nice things about you. If the crappy situation (pun intended) I just experienced tells you anything, it’s that you need to know for certain what your partners are saying.

On a side note, the CEO of HealthShoppr, Vijay Goel, M.D., has what looks like a great blog, Consumer-focused Health Care. Check it out…