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.

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?

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.

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?

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.

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.

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.

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.

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.

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.