Healthcare By The Slice

I owe credit to my friend Jeff Thul (a keen observer, that Jeff) for noticing something interesting on the top of a bowl of Starbucks oatmeal. There a little message informs customers that their order will taste best if they wait three minutes to eat it.

So this means–Jeff’s astute observation not mine–Starbucks is selling an admittedly imperfect product, and they are admitting it is imperfect, but by doing so they are elevating customer satisfaction. Starbucks knows speed is more important to their customers than perfect taste. so they deliver where customer expectations are most acute, and apologize for their lack of perfection in other areas.

That’s really smart marketing. And there are applications to health care to be mined.

A consumer of health care has many expectations. They enter a hospital or physicians office with a complex backstory of needs, fears, biases, misunderstandings, conflicting advice and past encounters. Let’s admit it to ourselves–most health consumers are primed for a less than perfect experience. In truth, a high percentage of the time, we can’t deliver perfection, even if we want to.

So what do we do? Let’s make sure we can and do deliver in the areas that are most immediately important to the consumer.

What are those most important things? It is incumbent on each health care marketer to discover that for his or her own consumers and services, but the findings might look something like this:

• For urgent care, speed
• For primary care, comfort
• For specialty care, coordination
• For life-and-death specialties like oncology, personal advocacy
• For surgery, organization
• For hospice, compassion

There are lots of examples of consumer services that were originally complex, but became simple.  For example, buying a computer, launching a website, making a will, finding the best rate on a hotel–there are simple alternatives for all these things.

Accessing health care remains a fairly complex process, with appointments, referrals, EOBs, deductibles and copays.  And there is still no easy way to comparison shop doctors, hospitals and outpatient services.

But that will change.  The key question for health care marketers is will you drive, ride or follow the change?

When it comes to adding up their marketing assets, hospitals and health systems put a lot of emphasis on dollars, facilities, doctors, networks, technology, data systems and such.  That’s appropriate.  These things are important.

Two critical attributes that most health care marketers overlook, however, are speed and coordination.  The reasons many marketers can’t count speed and coordination among their assets are that they are characteristically slow to make decisions and then clumsy in their implementation.

Whether it’s moving into a new market, responding to a competitive challenge, acquiring a technology, promoting a doctor, implementing patient care processes, evaluating data or crafting a plan, the health system that can act quickly and decisively, and then implement its decision across multiple operating entities has a powerful advantage.

I submit speed and coordination are two major reasons for-profit health systems have flourished at the expense of public, not-for-profit health systems.  The for-profit guys know how to act fast and make their decisions stick.

Speed and coordination win championships, gold medals and market share.

A friend of mine just had the misfortune of chest pains on the Friday before Christmas.  He went to an emergency department, where a physician admitted him.  He spent Saturday and Sunday lying in bed waiting for a one-hour test on Monday.  Ultimately an arteriogram revealed no blockage, no heart attack, no problem . . . except for a huge hospital bill.

I could truly relate to my friend’s experience.

A few years ago I ate a $10,000 burrito.  Actually the burrito was $10, but the Sunday morning trip to the emergency department it led to ended up costing $10,000, half of it out of my pocket, almost all of it unnecessary.  After the triage nurse gave me an antacid, I felt fine.  Blood work showed no elevated enzymes.  I wanted to go home and said so.

But the emergency room doctor, seeking to minimize his liability, essentially scared my wife into insisting on my admission.  He told her there was a good chance that if I went home I could be back at the ER in a few hours dead.  He said the safe thing to do was to admit me and let a cardiologist run some tests on Monday.

This particular hospital was known for its cardiac program.  It has a much-promoted heart-attack rule-out protocol that sounds good in the marketing pitch, but in reality does not work.  It offers all the cardiac bells and whistles, but not on Sunday.

Hospitals and health systems are always looking for meaningful ways to position themselves against competitors.  Here’s a winner–be the hospital that is truly a 24/7 hospital.  What you do Monday through Friday, do it on Saturday and Sunday.  Do it efficiently and effectively.  Save your customers money.  Provide unique value.

Airlines perform full service on weekends and holidays.  Police do it.  Firemen do it.  Utilities do it.  Emergency crews do it.  Even restaurants and shopping malls do it.  Why not hospitals?

Some people view new medical technology as they might a mime on the street. The response is something like, “That’s interesting . . . but I hope I never see it again.”

After all, you have to get sick before a medical machine, drug or technique really becomes meaningful. If I’m in pain, then I want to know all about your digital whiz-o-matic. But if I’m feeling immortal, and no one close to me is sick either, then your new machine is probably irrelevant.

In the wider world, consumers adopt technology in predictable patterns. There are the early adopters–the geek types who keep up with the latest of everything. These are the people who camp out at the Apple store, and then go to their basements and disassemble their new i-stuff so they can blog about it. The rest of us are followers, embracing the technology as we perceive a need or desire to have it.

Hospitals tend to ignore this established pattern of consumer behavior. They advertise their new technologies as if everybody wants them, when really no one does. No one stands in line to get it first. Technology is scary. And a lot of health care advertising centered on technology looks scary.

But there are exceptions.

When The Johnson Group creative team first watched video of CyberKnife in action, they were reminded of the animated lamp at the beginning of Pixar films. Even though the name—CyberKnife—seemed intimidating, the technology itself was life-like, graceful, even personable.

CyberKnife is the first robotic radiosurgery device for cancer treatment. Rather than moving in an arc like a linear accelerator (now there’s an intimidating machine!), CyberKnife moves like a robot on an automotive assembly line. It targets tumors precisely and kills cancer cells quickly without pain.

There is a video on YouTube that shows a CyberKnife dancing. It inspired us to showcase the technology, not as simply the topic of our advertising, but as the star.

CyberKnife, like all new technologies, should be marketed to the early adopters first. In the case of cancer treatment technologies, the early adopters are physicians.

Yet even healthy consumers relate to this ad. It’s not scary. It is friendly. It seeks to establish a connection with the consumer that informs without frightening.

By the way, the marketing staff at Erlanger Health System held a contest to let employees submit names for their new CyberKnife. The winning name? Hope.

She’s a star.

I love to watch Troy Palamalu, the whirling dervish of a strong safety for the Pittsburgh Steelers.  Wherever the ball goes, Palamalu seems to be there—stuffing a runner, picking off a pass, scooping up a loose ball.

During the recent Super Bowl loss to the Green Bay Packers, however, Palamalu seemed remarkable by his absence.  The offensive scheme of the Packers greatly neutralized the Steelers’ defensive star.

I’m a football fan, but far from an analyst.  Yet it seemed clear to me the Packers won the big game because they did the basic things—blocking, tackling, holding on to the ball, knowing where the playmakers were—better than Pittsburgh did.  The spectacular did not win the spectacle.  Fundamentals were more important.

What does this have to do with healthcare marketing?  A lot.

Health systems and hospitals put a lot of energy into spectacle.  Big ads, big events, big news.  Yet it is the little things, the basics of human interaction and personal relationships, that ultimately drive a health system to a winning position in the marketplace.

There is a hospital I know well that is on the verge of bankruptcy because, over the span of a decade, it lost virtually all its primary care and specialty physician support.  Economics and competition played a big role in shifting physician loyalties, but at the heart of it all were weak relationships.

In the words of one physician who moved out of the declining hospital’s office building, “They made promises they did not keep.  They acted like didn’t care.”

By “they,” this doctor meant the leadership of the hospital.  It wasn’t a failing practice that prompted the doctor to leave, it was a failed relationship with the hospital CEO and his marketing team.

I used to work with a large orthopedic group that built a marvelous new office building in the shadow of a hospital.  It was a fortuitous move for the hospital, which was third largest in the market and desperate for growth in orthopedics.

Yet despite all proximity and convenience factors, the doctors in that group gradually shifted 100% of their surgery to a competitive hospital about a mile away.  Why?  According to the surgeons it was poor relationships with the first hospital’s leadership.  “We didn’t feel like we could trust them,” said one doctor about the rift.

Relationship basics are usually less dramatic than broken promises and trust.  Just failing to communicate, failing to notice, failing to remain open and receptive to ideas—these fundamentals can send even a championship healthcare team into a tailspin.

And for a team trying to find its form, fundamentals are even more critical.

About two months ago I heard about a new medical group that had formed from several independent practices.  I used to work with some of these doctors, so I was a interested in their new venture.  I decided to drop into their new office to say hello and look around.  I had heard through the grapevine patient volume was behind early projections.

The office made a positive early impression.  Good location.  Logo etched in the double glass doors.  Nice furniture.   But my impressions turned sour pretty quickly.

I stood at the reception desk for—I timed it—over four minutes.  During that time the main receptionist talked on the phone and never acknowledged me.  Another front office worker shuffled files on a counter less than five feet away and never acknowledged me.  A management type, complete with blue business suit, walked to the counter and never acknowledged me.

I walked around the reception area, nodded to the two patients waiting who were looking as neglected as me, and then walked out.  I could have been a new patient. I could have been anyone.  They will never know.

That group is putting a lot of money into advertising these days, which is a good thing.  Yet no amount of advertising will ever be more important than the basics of a competent, friendly staff member making a good first impression.

I’ve been traveling a lot lately, which means I’ve had ample opportunity to see a lot of billboards.  Let me say the view is bad, in more ways than one.

On a recent trip into downtown Atlanta on I-75, for example, I tried to read what must have been 100 billboards over a 10-mile stretch.  I emphasize “tried” because with only one exception, they were unreadable or unmemorable under the conditions of the day.

These 90 and 9 bad billboards could not be read for the following reasons:

• Messages were too long to be read at 70 miles an hour
• Type was too small to be seen from road level
• Imagery was too bland, busy or boring to attract attention
• Color combinations lacked contrast and reversed type was illegible
• Logos or names were too small to even identify the sponsor
• The message was too vague or unfocused to be remembered

I drove this same stretch twice within a few hours and tried deliberately to remember some of the boards, messages and sponsors, but found later I could not remember any, save one.

The board that got it right was for Ted’s Montana Grill.  The name was large and set within the outline of a huge buffalo.  The message?  “Great Steaks.”  That’s it—two words, plus the name.

Interesting that the guy who made his millions in the outdoor ad biz before he launched the 24-hour news revolution still knows how outdoor works.

Health care providers are particularly misguided about outdoor advertising.  Healthcare is a complex business, and many health care providers find it impossible to resist producing complex messages, even within the limits of a billboard.

I recall a billboard from my home area that showed a picture or a linear accelerator, with a doctor in the foreground, with a team of nurses.  The message was some long statement about quality cancer care.  The doctor’s name was on the board, along with the name of a hospital, and the name and address of the cancer center.  The board was perched about 70 feet above a busy interstate for a year, at a rate of several thou a month.

While I can’t sign an affidavit about the effectiveness of that billboard, I can tell you that at the end of the year the board came down, the physician left town and the cancer center changed hands.  The only party to make anything off that advertisement was the outdoor advertising company.

I think many times—and physicians are particularly guilty here—healthcare entities choose billboards because they have limited budgets.  They believe it is all they can afford.  Because they see the board as their only hope, they load it up with too much information.  The result is that their limited money is mostly wasted.

Physicians are used to giving orders and having everyone follow them.  I’ve worked with a number of physicians on marketing ventures over the years, and they sometimes bristle at the notion that someone knows more about a topic than they do.  If they insist on putting two pictures and a paragraph on a billboard, they can probably pressure an ad company into accommodating them.

Sometimes you spot an example that is so egregious you just have to pull over and take a picture.  The advertiser here may be a great doctor with a product or service that will change the world, but it’s not getting through on this board.

Healthcare is a complex and expensive business.  What a shame to waste so much effort and money on bad billboards.

Want to produce better billboards?  Keep them simple, short, bold and memorable.   If you can’t limit your message to 5 or 6 words, or communicate your message in less than 5 seconds, get some expert advice or rethink your plans.

Also shown is a billboard design I would place in the good category.  It features a short, readable message and bold colors.  It uses a well-known symbol to connect the message to the sponsor, as well as the sponsor’s name simplified to a single word.  The message can be absorbed and understood by most drivers, even if they only have time to see the one, central word–OUTCOMES.

The primary difference between bad billboards and good ones is sacrifice.  Those able to pare down the message to the purely essential will be the most successful.

Even if 50 is the new 40, it still marks the decade of life when things start to fall apart.  I am well into my 50’s and am blessed with good health, but all around me I see friends dealing with serious stuff.

Big decisions must be made about cancer treatments, arthritis, early dementia, heart disease and Parkinson’s.  These are heavy health burdens that don’t include the sagging eyelids, basal cell skin growths, near-sightedness, hormone replacements, elevated cholesterol and love handles that are less worrisome, but still important to those contemplating the scalpel and a $5,000 deductible.

It is interesting the degree to which these big decisions are influenced by really small ones made when my friends were in their 20’s.  Back then they needed a flu shot, a physical or a prescription for birth control.  So they asked a friend, or ran their fingers through a phone book and picked a doctor.

For many, there is an excellent chance the doctor chosen years ago for something minor continues to influence the biggest decisions of their lives.  What specialist do I choose?  What hospital?  Should I have that procedure now, or wait?  Should I take this expensive medication . . . for the rest of my life?

All around I see health systems spending millions to make sure patients have the best possible experience when they walk through the sliding doors.  And that is certainly important.

Few health systems, however, put equal emphasis on the small transactions that introduce a new patient to the health system and, for many, establish a pattern of consumer behavior that will influence the organization for generations.

What happens at the primary care office, in the emergency department, at the urgent care center, in the waiting room, at scheduling, when the copayment is collected, when the follow-up is scheduled, when the test result is reported (or not)—all these little experiences determine if a new patient will ever hang around long enough to become an old one.

The primary influencers over these interactions are often hourly employees, overworked office managers and salaried physicians who don’t own the practice, and who care more about making the kid’s soccer game than talking to patients.

Great health systems are built on the compound interest of millions of little consumer decisions.  Great health care marketers never forget this truth.

On the web recently I came across a presentation by Allison Hunt, a marketing executive from Toronto.  She gave a remarkable presentation while on crutches, explaining she was recovering from hip replacement, courtesy of Canada’s national health service.

Let me set up the story by saying that Allison Hunt seems a youthful and successful person, near the height of her professional potential.  But she was in pain from a diseased hip, and she had already endured many months of pain waiting for an appointment with a surgeon.

At her exam the surgeon gave her a good, bad news scenario.  He would schedule her surgery right away, but the first available slot was 18 months away.

While leaving with the disappointing news, Hunt noticed a sign in the hospital’s gift shop asking for volunteers.  She signed up for a half-day a week, hoping through proximity to somehow move her name up the waiting list.  To speed the story up . . . she was successful.  She networked her way to the OR table.

Hunt joked her actions were un-Canadian.  They were also very un-American.  Can you imagine any American reacting calmly to an 18-month wait for anything?  Can you imagine an American volunteering as a way to care, even free care.  I think most Americans would call a lawyer.

As Americans contemplate reform of our health system, it is prudent to think about how American consumers will respond.  For the last 40 years we’ve been a “health industry.”  We churn it out–mass producing access to every type of service.  Our customers generate “demand.”  Even those who depend on public health, have an expectation of service that can be measured in hours and days, not months.

It’s hard to argue that the world needs another blog, but I am wading into the crowded pool.  My intent is to provide useful, practical and (on good days) stimulating information for those who care about health care marketing can use to perform at a higher level.

And to minimize boredom on the bad days, my pledge is always to wrap it up in 399 words or less.

I would not commit to this column if I did not think I had something to say.  I’ve been involved in marketing and promoting health care services since the Nixon administration and, for better or worse, I’m still at it.  I’ve seen the good, bad and the silly.  I’ve made mistakes and learned from them.  I’ve got, as old guys like to say, experience.

But I’m not yet old and neither are my ideas.  Thankfully, people still value what I say enough to pay me for my time.  In this blog, however, I plan to give away as much as I can in little fruitful slices.

One of the symptoms of a lot of years on a job is that one develops philosophies.  When it comes to marketing health services, I’ve developed some guiding beliefs I think serve the industry well:

• The patient—the consumer—is the ultimate point of it all.  Forget the patient and you are lost.
• Health care is big, confusing, scary and frustrating.  Our job is to make it feel small, understandable, comforting and simple.
• For most of what we sell, consumers have to be sick to buy it.  No one is more vulnerable than a sick patient.  We have the power to abuse them, but not the right.
• If we are going to spend precious health care resources on advertising and promotion, we had better say something meaningful.

So my blog will cover the relationships between health care providers and patients, the systemic challenges that confront health care marketers in the quest to do the right thing well, and our efforts—good and bad—to advertise, promote, communicate, educate, sell and generate return on investment.

That’s the plan.  Click on my RSS feed for new installments.  Write me if you want to debate or discuss.  If anything I write strikes you as helpful, I would love to know.