“Our organization’s mission states ‘We lead our community to better health and well-being at every stage of life,’ and this campaign is a powerful reflection of that,” said Suzy Turpel, director of marketing at Allegiance Health. “Interval was instrumental in helping bring this campaign to life in a compelling and effective way.”

The campaign was originally developed by Interval as a brand building campaign for Allegiance Health itself, but realizing the synergy with the goals of the HIO (founded by Allegiance Health in 2000 to improve the health status of the community) and its plans for a community-wide wellness program, the campaign was launched under the HIO brand.

“Here’s another great example of a healthcare organization leveraging health and wellness content to build bridges to its community,” said Interval president Chris Bevolo. “We continue to passionately encourage other organizations to pursue campaigns such as Step by Step, or the FitFor50 campaign from Inova Health System.” (For more on wellness marketing, see Chris’ recent blog post, “Mayo Clinic goes big on wellness.”)

There’s the frustrating: The “new front”? Hospitals have been jockeying to position themselves for about two decades now. It seems that whenever a mainstream media source “discovers” hospital marketing, then it must be a new phenomenon. It’s not. (Listen to our podcast on the NPR story a few weeks back on hospital marketing, as the moderator nearly gasps “hospitals compete?!?”).

There’s the obvious: live-tweeting and increased social media use by hospitals have been around for a couple of years now. “Emotional print campaigns” and “reputation ads” focusing on awards and rankings have been around for a lot longer. Which means these strategies can’t possibly stem from healthcare reform. And do we really think that the millions of new people who come onto the insurance doles will have the freedom to travel the country to choose care and still stay “in-network?” (Actually this raises a lot of interesting questions about whether there will be “networks” anymore, or what the true financial opportunity for domestic medical tourism is, but I’m on a roll here.)

There’s the hairpullers: Ned Russell, managing director of Saatchi & Saatchi Wellness states: “They (medical centers) need to attract talent and get funding. How do they do that? By increasing their patient base. How do they lure patients? (wait for it) Their advertising. Doesn’t seem to matter these days how far away a patient is.” Shocking that an ad agency exec would tout advertising to build brand and increase volumes. The Russell quote is immediately followed by this: “Indeed, 25% of the patients at the Mayo Clinic in Rochester, Minn., come from 500 miles away or more.” I believe it’s pretty well established that the Mayo Clinic has attracted patients from around the country and the world for decades, and over that time THEY NEVER ADVERTISED. (I suppose I don’t need to repeat that great hospital brands are built by delivering great care and experiences, right? Right?)

And there’s the hilarious: this gem from Mike Guarini, president of Ryan TrueHealth: “I say ‘refreshing soda,’ you think Coca-Cola…I say ‘cancer treatment,’ you think Sloan-Kettering.” There are oh so many ways to go with this one. Suffice it to say I believe in branding, I believe in positioning, I believe in advertising, but healthcare is not a soft drink (or, see “Joe Public Doesn’t Care About Your Hospital.”)

OK, so I’m sure this all sounds catty. There is some good stuff in here. Ed Bennett once again provides some level-headed perspective about social media for hospitals: “I tell hospitals ‘Don’t get into social media because you think you’re going to get more patients. Do it because you’re helping be responsible to people reaching out looking for answers.”

Overall though, this piece will not help hospital marketers who struggle everyday with a lack of internal sophistication when it comes to their trade. I fear this will serve as fodder for chief surgeons, service line directors and other executives, who will point to a leading marketing and advertising pub and say, “See? We’re XYZ Medical Center, and WE need to advertise more to build a national reputation and compete with Mayo Clinic and Johns Hopkins.” Guess that’s good for ad agencies, and for the one or two dozen leading providers that might actually have a shot at a national reputation. But not good for the 97% of the other organizations who struggle enough with building brands and increasing volumes in their own markets.

Thus end’th the rant. What do you think? I’m I being too critical here? What did you think of the article?

“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.

According to an article in the Burlington Free Press on Monday, Vermont state representative Steve Maier is proposing legislation to ban hospitals from spending money on advertising or marketing in the state. Here’s a quote from the article:

“It’s not producing health care,” Maier said of the money spent on advertising (quote from a previous online version of the article).

Given the focus on healthcare costs at a national level, it’s not surprising a politician has latched onto the relatively easy mark of hospital advertising. (It is surprising that it took this long). Let’s put aside the argument surrounding advertising that supports public health issues such as obesity, smoking or wellness for a moment. There are at least three reasons I can think of why such a proposal doesn’t make sense.

First, a hospital’s marketing expense is a tiny fraction of its overall expense. To be generous, let’s say it’s 1% of revenues, including all marketing salaries, external expenses, media, etc. Obviously it’s higher in some places and lower in others, but the point is that eliminating this expense won’t do much of anything to impact the cost of healthcare in the U.S. Of course, this is politics, so the actual impact of something is pretty much beside the point.

Second, there are serious free-speech issues involved, and it’s very rare for the courts to allow a restriction on an industry’s ability to communicate or promote itself. This will likely be the reason legislation of this nature won’t go anywhere, and if it does, why it won’t survive.

The third reason, and the one that is perhaps the most frustrating, is that hospitals and health systems in the U.S. – whether they’re for-profit or non-profit – must compete for patients to succeed. That’s the way the market is set up, and unless we went to a single-payor Canadian-style system, that’s the way it will likely stay. And with that type of market, organizations must be allowed to do whatever it takes to attract the customers (patients) they need to succeed. Many in the public would find this nonsensical or outrageous – “why do hospitals need to spend money to attract patients?” And politicians can prey on the public’s misunderstanding of the business of healthcare to drum up support for this type of legislation. But those who want hospitals banned from advertising their services miss the point that these are businesses that compete in an open market, and that’s a good thing.

If you believe in capitalism, you believe that competition drives innovation, efficiency, service and more. Competition should make healthcare better, not worse, though not everyone agrees with that. But the point is a bit moot – as long as we have the “system” we have of providing care, where providers must compete to find and keep patients, they should be allowed to use the tools other businesses use to pursue the same goals, and that includes marketing and advertising.

What do you think? Is this just an obvious/defensive position coming from a healthcare marketing firm? Will this legislation or others like it take hold? If they did, what would they mean for hospitals and all of us marketers?

To give this a little context, the SVP had focused most of her efforts on business development, and specifically, on acquiring physician practices and building physician referral channels. So the comment was really about comparing the value of marketing to that of business development when it comes to business growth. In addition, it’s assumed that “marketing” was meant to equate “consumer marketing.”

Not surprisingly, we take a tad bit of exception to classifying an entire discipline as stupid. But for starters, let’s acknowledge the reality: when it comes to affecting immediate and substantial business growth, typically nothing can be as effective as acquiring physician practices, specialty practices, or merging hospitals and health systems. The surest way to increase market share or dramatically increase volumes is to lock-in independent referral sources, or acquire competitive businesses. In essence, organizations are “buying” new patients, and mergers and acquisitions are a time-tested way in any industry to grow business. In healthcare, one sign that hospitals and health systems recognize this power can be seen in the growing cache of business development titles. Often, what used to be senior marketing titles now include ‘business development,’ and business development is typically seen as a higher-level discipline than marketing throughout the industry.

Does that mean spending time, energy and money on marketing your hospital is, in fact, stupid? Er, not exactly. Let’s start with the well documented fact that the majority of mergers and acquisitions in business fail. For example, a BusinessWeek article titled “When CEO’s Go Courting, Watch Out,” cites research showing that 60-70% of deals fail, stating:

“Mergers tend to destroy value, not create it.”

One of the primary reasons for this is that trying to mush two corporate entities into one is not easy, and if not handled well, costs increase, efficiency drops, service and quality suffer, and customers flock to competitors. The same can of course happen in healthcare, so simply buying patients by acquiring a physician practice doesn’t guarantee a hospital will keep those patients. Systems become ineffective, doctors aren’t happy, negativity abounds, patients flee. Marketing communications, of course, can play a huge role in communicating the benefits of a merger, and can help specifically target patients with important information and service recovery efforts. Acquisitions reflect a hospital’s desire to obtain patients, but they don’t necessarily reflect what patients themselves want. Without effective marketing communications, it would be very difficult to maximize the impact of a key acquisition or merger.

Second, consumer marketing should help create demand, regardless of what acquisitions are made. Strategies such as driving orthopedic surgeries through joint pain classes, or offering heart disease screening to build downstream cardiac business, are all driven by consumer marketing. There is no doubt that much of a hospital’s business is referral driven, but sophisticated organizations don’t stop there, realizing there are many opportunities to drive patients in through marketing directly to consumers.

Which brings us to the third point – business development and marketing shouldn’t be an either/or proposition. Unless your plan is to acquire all the providers in your market (or you live in Canada), there will always be competition for healthcare services. And whenever there is choice in a market, you will need to fight for your customers using marketing and brand building strategies. Compared to the big growth spike that comes from a large merger or acquisition, ongoing consumer marketing may seem like a long, slow slog. But it will pay dividends when done well. In the end, if both you and your competitors are pursuing strategic business development, but only one of you is also investing in marketing, who do you think will come out ahead?

What do you think? Is marketing a hospital a waste of time? Do you hear statements like this from senior leadership? How do you respond?

As we’ve stated many times over the past year in our blog posts, podcasts, and paper, we feel passionately that marketers should strive to measure the success of their efforts whenever possible. Measurement allows you to demonstrate marketing’s value to leadership, and, more importantly, to better understand what works and what doesn’t. That kind of measurement discipline can help marketers answer that dreaded question by allowing them to pull from past experiences and demonstrate that yes, this can work, and this is how it has in the past.

Except in one case: when the idea is brand new and hasn’t been done before, either by you and your organization, or, even worse, by anybody else. Of course, launching a new idea before anyone else can lead to great success (iPod, TiVo, Starbuck’s “third place” experience, etc.) But in a conservative culture, the lack of a proven track record is often what kills an innovative idea. An article in this week’s BusinessWeek titled “Innovation’s Accidental Enemies” does a great job of reminding us why the lack of a proven track record should be considered an opportunity, not a deficit.

It starts with a story of a bank CEO presented with a new approach to finding and landing high-end customers. The CEO asks “Have any other big banks done this?” and the consultant answers, excitedly, “No, you’ll be the first!” Of course, that leads the CEO to kill the idea on the spot. (insert rimshot here) The authors then go on to provide a different type of thinking that can help organizations keep an open mind to opportunity called abductive thinking. Instead of using inductive or deductive thinking – both of which rely on existing information to make conclusions – abductive thinking is the “logic of what could be.” Quoting the authors of the article:

“Asking what could be true – and jumping into the unknown – is critical to innovation.”

So as you work on your marketing plan for 2010, have you left room for innovative ideas? Are you considering trying something that you’ve never tried before, or better yet, what no one has ever tried before? Learning how to use abductive reasoning might help you respond to the inevitable challenge of “prove it.”

In general, this seems like a pretty fair assessment, though certainly expertise concerning social media varies greatly, falling along a scale from “luddite” to “multiple social media efforts led and measured.” And there are many odd twists to the question of expertise as well. For example, there are a class of folks who seem to believe that simply by using social media, they then have the the proper credentials to drive organizational strategy, or sell consulting services in this area. And while it would seem impossible for someone to lead a social media effort without actually using the tools themselves, being a user does not equate to strategic or even tactical expertise. Just because I watch a lot of TV doesn’t make me a great television producer or screenwriter, yes?

The latest issue of BusinessWeek has a great article on the growing backlash against social media consultants and “experts.” The title – “Beware social media snake oil” – pretty much speaks for itself. Perhaps the best insight comes from James Cooper, who serves as digital creative director at Saatchi & Saatchi, a global ad agency. Cooper states that anyone who unequivocally claims that using social media will work is either “lying or deranged.” His point is that the medium is still too young to guarantee results, and he likens the innovative nature of social media to that of venture capital, where 1 out of 10 bets might pay off, while the others fail completely. He also worries about how results are measured:

“If something’s got 20 million hits on YouTube, that’s a good thing. But what if half the comments are negative? I don’t think anyone’s got a long-term case study yet.”

Social media offers potential opportunities to hospitals and other providers in the areas of brand building, customer service, marketing, public/community relations and more. But the jury is still out on whether in the end all of the hoopla and effort will pay off in material ways from a long-term perspective.

Of course, that’s no reason to drop or minimize social media as a marketing/communications tool. It just means healthcare marketers need to go into the effort with eyes wide open. Social media should still be considered an innovative strategy, and with innovation goes the understanding that failure is sometimes an accepted part of the game.

Have you been pitched by a “social media expert”? How do you determine someone’s credentials with such a new medium? Are you OK with “failing” in order to learn what works and what doesn’t?

So after my planned presentation, we dove in. As you can imagine, many of the topics we’re all familiar with raised their ugly heads: convincing leadership to use social media, dealing with negative blog comments or tweets, how to reach your own physicians with your message, etc. But the one that came up most of all was dealing with those leaders – both physician and administrative – who make poor marketing decisions based on ego-driven needs. “Clinic X is running ads about this, so should we” or “We need to promote the fact that I’m board certified (and the ad needs to include my face, because EVERYONE knows me)” or “We’re going to promote this new award and spend hundreds of thousands of dollars to do it (despite the fact everyone else is promoting some other award, and most consumers don’t care).” (For more on this phenomenon, check out this past post, “Healthcare marketing’s secret (and unfortunate) raison d’être.“)

One attendee offered a suggestion that made me think of a strategy we’ve advocated before for helping to deal with the ego-driven marketing request. She mentioned that when a doctor was crying for an ad to promote an accolade, she worked with him to create a small print ad, letting him contribute ideas, copy changes and approvals along the way. The ad was small, so the expense was low. But she said the result was the physician was happy, and she was able to limit the time/money/energy suck a larger effort would have entailed.

This fits with a strategy we’ve tossed around before, that of opening a second front in your marketing war. The main battle line in that war is all you do to drive significant business success, build brand, increase volumes, create patient loyalty and more. But often, the ego-driven marketing request runs counter to these goals. Some marketers try to fight the good fight, and with some patience, the right leadership and the right approach, you can overcome ego-driven marketing requests most of the time. But in many cases, you can only say no so many times before you’re marginalized or run out on a rail. So while we still advocate fighting the good fight, consider opening up a second front, where you pull away as few of the supplies, ammo and soldiers as possible from the main front to placate the ego-driven marketing requests. By placating these requests, but minimizing their impact, you may still be able to fight that main battle effectively.

In some ways, this sounds underhanded, or like your playing a game with your leadership. In a perfect world, you wouldn’t have to – they would trust your marketing expertise and you could drive marketing strategy the right way. But it’s not a perfect world, and your choices are often to give in, or fight until they grow frustrated with you and find someone else who will give in. Instead, while you fight the good fight, and try to educate leaders about the right way to market, consider opening that second front.

What do you think? Too political or unethical? Ineffective? Or are you already working two fronts?

According to the article, market research firm Verilogue recorded 12,500 patient-physician conversations in 2008, and in only 23 instances did they find a patient making a specific request for a drug by name. That’s a .0018% success rate for those of you counting. What makes this study legit is that rather than asking consumers how the ads impacted them (and as we’ve discussed before, it’s hard to trust those answers), they used ethnography to study the actual behavior of consumers. Undoubtedly even more troubling for pharmaceutical marketers, the research showed that when drugs were mentioned specifically by name, it was often to inquire about those nasty side effects. For example, popular sleep aid Ambien (one of my favs!), was “often remembered for side effects like hallucinations, sleep eating and other problems.” Not surprising, given how much time/print-space must be given in drug ads to outline all possible side effects (nothing better than hearing about a new drug for helping to cure stomach discomfort that has a potential side effect of causing stomach aches). Perhaps the negative impressions generated by the side-effect content helps explain how Ambien sales declined 37% last year, despite a $151 million in direct-to-consumer advertising.

Putting aside the fact that selling drugs is a completely different business than selling hospital services, what can hospital marketers learn from this?

For one, it gives more ammo to the philosophy that the impact of “old” marketing, or “above the line” marketing (defined as paid mass media advertising) is waning (see great discussion on that topic from last week on our blog). Perhaps more importantly, it goes to show that marketing healthcare products and services is rarely as simple or direct as promoting other products where consumers can react immediately to a message. (Though it would be fair to say there are likely other studies showing how these drug ad strategies are having an impact, or at least did).

But maybe the best lesson is that this study reinforces one of our favorite mantras: just because other organizations are pursuing a marketing strategy doesn’t make it right for you, or, for that matter, doesn’t mean it’s effective at all. As we’ve stated before, healthcare providers are notorious for driving marketing strategies based on what they see others in their market doing, whether it’s featuring a physician on a billboard or running a print ad touting the latest award. But if much of what is being done in hospital marketing is based on outdated philosophies or ineffective strategies (which, in our humble opinion, much of hospital marketing is), then the last thing you’d want to do is copy what the other guy is doing. With this study showing the ineffectiveness of direct-to-consumer pharma ads, healthcare marketers have one more piece of evidence backing that contention.

Here’s how it works: at most fast food joints, the left side of the menu typically lists the value meals, be it the Supra Burger Special or the Chicken Hero Hefty Pak. The right side of the menu is usually filled with individual items, drinks, desserts and other miscellanea. How does this relate to healthcare marketing, you ask? All too often, healthcare marketers are ordering off the right side of the menu. That is, they’re focused on individual tactics, such as creating a new brochure or making a television buy, in complete isolation from other tactics, or worse, without the structure of a plan to guide their thinking. This usually happens because someone somewhere in the organization has made a request – “we need a brochure to build awareness of our clinic” or “can we run an ad to promote our new surgeon?” Other times, healthcare marketers are tempted by isolated opportunities: a special radio buy price, free production for a cable TV spot, or a discount on 2-color printing at their favorite print shop (ok, that example is about 12 years old – does that still happen?)

Why is this bad? Well, everyone knows that the best value lies on the left side of the menu, where the burger, fries and cola are not only cheaper when bought together as a meal, but also often come in a better package. In healthcare marketing, the left side of the menu represents integrated solutions. What is more effective, a quarter page newspaper ad promoting your new primary care physician, or a newspaper ad combined with a lunch-and-learn at the library, supported by a special web presence, a blog post, and a concentrated social media push?

The next time you’re faced with a request or an “opportunity” for a one-off marketing tactic that isn’t supported by a broader plan, think twice. For the best value (read: results), ordering off the left side of the healthcare marketing menu is the way to go. Then the only choice you’ll face is whether or not to super size it.

(Editor’s note: OK, so this might be considered really lame marketing terminology. But we couldn’t resist. And who knows, maybe in three years, we’ll be reading on Wikipedia how “Left side of the menu” marketing got its origins.)

In the book, Christensen states that there is a pattern in any industry in which the transformation of the body of knowledge about that industry progresses from an art to a science. At the same time, he states:


“Made possible by advances in technology and science, the migration of problem solving from a small group of experts to a larger population of less-expensive providers who simply have to follow the rules is a widespread foundational phenomenon that underlies the transformation of industries ranging from animation to architecture to aviation; and from telecommunications to taxes.”

He goes on to use this framework to show how the diagnosis and treatment of medical conditions lies on an axis starting with intuitive medicine, where conditions “can be diagnosed only by their symptoms and only treated with therapies whose efficacy is uncertain. By its very nature, intuitive medicine depends heavily upon the skill and judgment of capable but costly physicians.” The next stage he calls empirical medicine, where “pattern recognition” has emerged and correlations between actions and outcomes are consistent enough that results can be predicted with a good probability. Finally are those conditions that fall under precision medicine, which can be “precisely diagnosed, whose causes are understood, and which consequently can be treated with rules-based therapies that are predictably effective.” At this end, conditions which used to require teams of specialists and a hospital environment to diagnose and treat – such as strep throat – can now be handled much faster, much cheaper, and by those with much less training than a medical doctor.

Whew – OK, now apply that idea to healthcare marketing, and I’ll bet you’ll see where I’m going with this. On the one hand, the marketing strategies and tactics most hospital marketers employ fall squarely in the intuitive realm. That means they require the experience and judgement of experts to understand and employ (at a high cost to boot), there is no “cookbook” for success (as Christensen puts it), and outcomes are by no means guaranteed, or even sometimes easily measured. Think brand building, awareness advertising campaigns, social media, or public relations. There are some strategies that might fall in the empirical realm, such as using joint pain seminars to drive orthopedic business. After a few runs, an organization will have a good idea that:

A (holding a joint pain seminar at the library) + B (using a surgeon to speak) + C (using a personalized letter from CRM as invitation) etc. should = D (100 attendees) and E (20 consults) and F (5 joint replacement surgeries).

On the other hand, you can see why this reality meets resistance from others within the healthcare organization, namely administrators, physicians, service line leaders, etc. They would like marketing efforts to fall into the empirical realm, i.e.: “can’t you guarantee that by doing A + B + C in this plan and spending $200,000, we’ll see a $500,000 increase in contribution margin in six months?” It’s never fun to have to answer “no, we can’t guarantee that,” but perhaps understanding this framework as Christensen outlines it, and using it to help set expectations and explain the state of the marketing industry will help break down barriers. At the same time, marketers as a group should be fighting like mad to move the discipline away from intuitive and into the worlds of empirical and precision whenever possible. For future discussion:

• which strategies and tactics in healthcare marketing are intuitive, which are empirical, and are any precision?
• will some marketing strategies (corporate identity development, brand building, etc.) ever reach a scientific level of precision?
• how and why other industries (such as wireless or airlines) have more examples empirical and precision-level strategies when it comes to the science of marketing.

Finally, I believe all of this, but it also can sound like a cop-out. It it? What do you think?