Healthcare By The Slice

It’s the first week of school in my part of the world, and this morning I passed a school with a sign in front reading, “Welcome Back Faculty, Staff and Students.”  The order of the greeting made me wonder which group is really most important at that school.

Without the students, would there be any faculty and staff to welcome at all?

Hospitals and healthcare marketers have a hard time figuring out who is first in their roster of customers.  Is it doctors?  Insurers?  Business?  The board?  Those in the C-suite?  Media?  Major donors?

Patients–the reason the hospital exists–can often slide to the last in line.  The brochures and ads claim otherwise, but more vocal constituencies get the most attention, at least some of the time.

The best healthcare patient research is to be a patient oneself, which I was recently.  While overall I was pleased with my care and outcomes, it was striking how little things influence perceptions of provider performance.

Here is an example of what I mean.  After arrival at the emergency department, a nurse handed me a cup and asked for a urine sample.  I stepped into a restroom and did my duty, but the nurse never came back to do hers.  That cup remained on my side table until I was discharged home, which was over 4 hours.

Hmmm!  Was that sample important?  If so, why didn’t they test it?  If not, why did they ask for it?

Here is another example.  After arriving in an outpatient testing area, I was instructed to remove all my clothes and put on a hospital gown.  My changing area was a converted hospital room.  Nowhere in that room could I find a hook, hanger any method of hanging my clothes.

Hmmm!  Do these people ever use their own facilities?  Do they ever look at what they expect from a patient point of view?

Moments after waking from an outpatient procedure, a recovery room nurse whispered in my ear, “I understand you are a healthcare consultant.  If you know of anyone looking for an LPN let me know.”

Hmmm!  Is this place having management issues?  Is the staff rebelling?  Are people that desperate to get out?

Quality in healthcare is measured best by outcomes.  Measures of patient satisfaction are ultimately based on dozens of little things that build or diminish patient confidence.

Some efforts to advertise the benefits of the daVinci surgical robot have been hilarious.

I recall one hospital that used a picture of a surgeon with robotic arms.  The ad made the doctor look like a villain from a Spiderman movie.  Going for the other extreme, another hospital used a picture of a toy robot, intended to somehow represent the $1 million surgical tool.

To be fair, the daVinci is a very difficult piece of technology to image and message.  Visually it has all the charm of a deer tick.  When it is in use the surgeon sits with his face and hands hidden, showing only his backside.

It’s also difficult to write ad copy about because there have been a number of critical stories in media, telling a skeptical public that the daVinci is a big, expensive toy that provides no real medical benefits.  In fact, in the wrong hands, it might even be harmful.

If you have the technology and also surgeons with the right skills, how do you tell a credible story?

Too many creative challenges start and end with Google.  A marketing director or a copywriter wants to create an ad on the new whiz-bang technology, so they search some websites, read the manufacturer’s FDA-approved hyperbole, and conceive some ideas.  That works sometimes, but not every time.

Creating great health care advertising means getting out of the office, talking to clinical people, watching them work, talking to patients, observing the real impact.

A few months ago The Johnson Group took on the daVinci challenge.  As part of our research for a new television campaign, we went into surgery, maipulated the daVinci’s robotic arms ourselves, and talked to surgeons.

Trying to explain what the robot could do, one of the surgeons showed a picture of a small origami swan folded using the daVinci.  The swan was perfectly folded and smaller than a penny.

“Can you do that?”  someone from our team asked.

The answer from the surgeon was yes, and a creative solution to the daVinci problem was conceived.

The final commercial, titled “The Right Hands,” won a bunch of awards.  More important, it registered with consumers.  The practice of the surgeon featured in the ad swelled with new patients.

To view the commercial, click here: The Right Hands

Inspiration comes from a lot of sources.  Sometimes it sparks to life out of seeming nothingness.  Most often, however, inspiration comes not through the Corpus Callosum of brain, but through eyes, ears and wandering feet willing to get out and explore.

Want to be more creative?  Read less and observe more.

Is advertising a new idea?  Is it some radical new concept that must be tested to be trusted?

Invariably it is companies that can least afford to waste marketing resources that will spend money on one-off advertising experiments.  There is no strategic intent beyond throwing some generic message out there to see if anyone (a spouse, a neighbor, a friend) notices it.

Only those marketers who don’t know what to do will do anything at all and call it marketing.  Better to invest in a good strategy than in an ad.

When people gather there are always predictable dynamics.  In the group there will be at least one leader, and perhaps two who will fight for the alpha position. There will be one or two who are timid, who sit on the perimeter and seldom speak. The rest will be in the middle, waiting for something to happen, or waiting to go home, whichever comes first.

The middle group is the majority. If they find an accommodating circle to talk to or hang with, then they are comfortable and the conversation is good. If they find an alpha leader who entertains, engages or attracts, then they are comfortable with that, too.

If they encounter opposition, tension, or the risk of embarrassment, then those in the group grow uncomfortable and they withdraw, speak tentatively and wait for the spirit of accommodation and comfort to reappear.

This is the reason focus groups are a poor substitute for making decisions.  Focus groups are good for providing insight into people’s experiences, and the way they think and prioritize, but these are insights that merely inform a decision.  The group cannot provide the decision itself.

Too many times marketers observe a focus group and latch onto the opinions of the majority as the conclusive take-away. They think an particular idea, ad concept or offer must be the best option because most in the focus group said they liked it best. Too often however, the majority option is not the best, it is the safest. Group-think coalesces around the ideas that make the group feel most comfortable.

In the end the best marketing decisions are informed by research, but they are made from the gut.   The most successful marketers never allow research, qualitative or quantitative, to make decisions for them.

Research told the legendary Steve Jobs “Apple” was a lousy name for a computer company.  That about sums it up.

The newspaper of record–The New York Times–reported Monday that hospital spending on advertising is up over 20% for the first six months of 2011.  And who says there’s no good news?

Let’s put the story in perspective.

The report says spending was $717 million for the first half of the year.  If you double that to estimate an annual figure, then total hospital spending on advertising would be $1.43 billion for all of 2011.

In 2010 total expenditures in the nation’s hospitals was approximately $800 billion, which means spending on advertising by hospitals approximates .0018 of revenues (using last year’s revenue projection).

I wonder how many other consumer-oriented industries spend only 18 cents for every hundred dollars of revenue on their advertising and marketing?

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.

The recent announcement from Apple that The Beatles catalog is now available on iTunes was remarkable in a way that had nothing to do with music.

I was amazed by the image of the boys Apple posted to its home page, and featured in its store windows.  The photo of John, Paul, George and Ringo, the survivors now old enough to sing “When I Was 64,” reflects extraordinary freshness and a contemporary cool.  It is hard to think of many other 40-year-old images that remain as appealing, as cutting edge as this one of The Beatles.

It got me thinking about images that stand the test of time, that people notice and connect with anew, even though they are old.

The Statue of Liberty is such an image.  A perfectly balanced mix of masculine muscle and feminine resolve, we all respond to Lady Liberty, whether we see her in New York Harbor, on a stamp or in a lousy Ghostbusters sequel.

To cite a marketing example, Cinderella’s castle, the central symbol of the Disney empire, is another time-tested image that makes the cut.  It calls to every generation.  Whether you love Donald Duck or Hannah Montana, that castle pulls at you with promises of magic and sweet memories.

Not every icon and symbol stands up to passing generations and changing tastes, at least not without refurbishment.  The Golden Arches, the AT&T globe and the Apple apple have longevity, but they have been updated and rehabbed to remain relevant.

The Beatle photo on the Apple site prompted me to think about whether there are any images or symbols in health care that stand-up despite the passage of time and without an overhaul.

The ubiquitous cross does not qualify, because it is generic and must be embellished to represent a hospital or health system.  The nurse in white?  Long gone.  The stethoscope?  That’s a prop rather than a symbol.

There might be only one viable candidate.  We seasoned people remember Marcus Welby, MD, a sappy 70’s era television drama about a trusted, selfless doctor who always did the right thing for the right reasons.  The show is a relic, but check out the picture of star Robert Young, dressed in scrubs, mask pulled below the chin.  The image quality could be better and this pose is a little sappy, but the picture, or something very close to it, would look at home in a lot of contemporary healthcare websites or ads.

What in the health care world speaks to us from generation to generation?  The confident, wise, experienced doctor.  He or she is the iconic image that represents quality, trust and the hope of a better outcome.

We would be justified in labeling the heroic doctor in scrubs a cliché, but it is not a tired cliché.  Young or old, we all want a Welby to hold our hand.