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The Marketing Whisperer

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Milwaukee Not All A Twitter Over Hospitals' Use Of Social Media
(See original post in HealthLeaders Media)

Within the last month, two Milwaukee health systems described surgical procedures on Twitter, the micro-blogging site. In mid-April, Aurora Health Care twittered a knee surgery. Two weeks later, not to be out-tweeted, ProHealth Care went live online with a surgical operation of a local resident, Paul, who shared his experience with prostate cancer on YouTube, Twitter, and Facebook.

Following these events, The Business Journal of Milwaukee conducted an online poll of its readers. The question: “Should hospitals use Twitter or other social media during operations?“

Overall, 69% of respondents said hospitals should not use social media to broadcast operations, while 18% were in favor and 13% were undecided. A sampling of reader comments published in the journal:

• They should be focusing on the patient who’s ‘under the knife.’ Distractions can cause problems. No one wants to hear ‘oops’ during surgery.”
• “The health care system should be focusing on a patient’s health and safety, and not other distractions.”
• “This is taking social media way too far. There are some things I don’t want to read about.”
• “Focus on the business, not the hype.”
• “Why criticize the health care systems providing this information? No one is forcing anyone to review the information they are providing.”

There was one (almost) positive comment: “Why criticize the healthcare systems’ providing this information? No one is forcing anyone to review the information.”

It should be pointed out that the poll was probably not scientific and that the paper asked the question without explaining that the surgeons who were working on the patient did not stop to post on Twitter. The patient who shared his prostate surgery on YouTube said in a written statement that he did it to educate other men about the disease. Furthermore, a hospital spokesman said that the hospital did not have any editorial say over what the patient posted from diagnosis through surgery.

But Milwaukee may represent a microcosm of the larger healthcare problems besetting the nation as a whole. The business community here feels it is paying way too much for employee healthcare.

Is the Brew City overly conservative in its view of hospitals using social media? Would the respondents in the Business Journal have been more accepting if the hospitals had twittered about something other than surgery? Would explaining how the twittering was done have made a difference in the results?

Regardless, the perception among these readers in this particular poll was decidedly negative. It would be interesting to hear if the reaction is the same in other markets. Could there be a Twitter backlash building?

Beyond ROI:  New Measures For Marketing Success

Hospital marketers take heed: measuring ROI (return on investment) for your efforts is on trial. While the marketing discipline in hospitals has matured from PR shop and brochures to strategically-driven business development, hospital marketers generally rely on traditional measures of marketing success, measures that over time are falling short in proving marketing’s value in many organizations. A recent survey by HealthLeaders Media revealed that only 8% of hospital CEOs rate their marketing programs as very strong, and that nearly 60% of CEOs hold a neutral or negative view of their organization’s marketing efforts. This, despite serious efforts on the part of hospital marketers to quantitatively demonstrate the value of their efforts. Why are marketers finding themselves subject to such a crisis of confidence? Is it because senior administration is overly pre-occupied with traditional ROI on marketing investments? Or is it because we, as marketers, have failed to effectively shape our leadership’s thinking as to what the reliable measures of success should be?

As professionals who are continually bridging the internal and external communities to create valued services, we know that today’s healthcare delivery is more art than science. Today’s best practice is tomorrow’s runner up. Benchmarking is clearly the right thing to do, but it can institutionalize current ways of doing things and stifle new or alternative approaches to measuring marketing’s value. You’ve probably heard the famous quote by Wayne Gretzky, the former hockey star. When asked to explain his successful career, Gretzky is reported to have said that, rather than skate to where the puck is, he skated to where he figured the puck was going to be. For hospital marketers, this means anticipating the next market move. Marketing is a team effort, not a department’s responsibility. The traditional measures of marketing success—increased market share, increased hospital occupancy, improved customer satisfaction—must be transformed into great outcomes, unparalleled patient safety, improvements in the community’s overall health status, and innovative approaches to customer service. Otherwise, it’s just numbers on a scorecard.

Hospital marketers can strengthen the perceptions of their value to their employers by doing more to tie the results of traditional ROI measurement to improvements in the health status of the community and to innovations in service and product delivery. Specifically, marketers would do well to:

• Re-define their role as the chief business coach. Educate your leadership on the differences between the marketing department and MARKETING.
• Start associating all of your activities with outcomes that go beyond short-term “bods in beds” thinking. Show how what you do leads to new investments in clinical tehnology, enhancements in the community’s health status, innovation in products and services, and to recruitment of the highest level performers.
• Forget comparing yourself to industry norms. All that matters is your impact on your customers and your community.
• Bolster your budget for physician relationship management. If your budget is limited, sacrifice some advertising dollars and non-strategic sponsorships and put that money into building physician loyalty.

 

Can Failure Really Be Your Friend? There’s an outdoor billboard near General Mitchell International Airport (Milwaukee’s major airport) with a picture of Abraham Lincoln. The caption reads: “Failed. Failed. Failed. And Then…….”. Underneath this phrase appears one word: “Persistence.” This billboard, produced by the Foundation For A Better Life, has appeared in cities and states around the country as part of a series of uplifting, inspirational themes. Because I was curious to learn more behind the campaign, I went to the Foundation’s web page: www.forbetterlife.org.There I saw a series of billboards featuring a variety of famous and not so famous individuals who represented values such as Albert Einstein (confidence), Shaquille Oneal (perseverance) Winston Churchill (commitment), and Christopher Reeves (strength). All of these people faced incredible odds in their quests to succeed in their chosen fields: Einstein was a poor student who failed math; Shaquile Oneal earned his college diploma in the off-seasons when he wasn’t playing basketball; Churchill was considered a poor communicator early in his life; Reeves was thought to be just a Hollywood lightweight by many of his peers, until he showed a level of courage that many people with his tragic condition wouldn’t find in themselves. In today's email, I found more on failure that further supports last week's blog on why so many people are reluctant to take any chances in life. A message from Marketing Profs entitled: "Make Failure Your Friend". The message cites a quote from Marketing Safari by Hjortur Smarason: "Mistakes are a necessary part of learning, development and innovation..... "There's a lot you don't understand until you try it on yourself. And if you let the fear of failure stop you from trying something new, you'll face nothing but stagnation." "One mistake doesn't mean that the next attempt is more likely to fail," says Smarason. "Actually, it should be the contrary. It should be more likely to succeed as that person hopefully learned something from the mistakes." To be sure, risks must be calculated and carefully vetted. But one must keep in mind that nothing worthwhile on the face of the earth came about because of a reluctance to take on risk. So get out there and swing for the fences--unless you never want to cross home plate.    (Courtesy of National Geographic) The Law Of The (Work) Jungle                Thousands of miles from here,deep in the heart of the Serengetti National Park in northeastern Tanzania,the wildebeest run as a pack to make it harder for the attacking hyenas to pull any one of them down. The luckier of the herd are in the middle-- the best place to be for survival, whereas the ones on the outer flanks are the most vulnerable to being caught and eaten by their savage predators. They live a fast life, these flankers. They know that one slip and they’re a goner. Yet they also know that a hyena can only catch one wildebeest at a time, so the odds are good that they won’t be the one that fattens a hyena’s belly. Eventually, some of the middlers will find themselves out on the flanks. Those that have grown soft and slow from too much time in the middle will suffer the consequences of not having kept themselves in shape. Thinking about the wildebeest (I watch a lot of Animal Planet)  got me musing about how many of us get up every day and go to work to survive rather than to thrive. Indeed, how many of our workplaces today encourage people to push themselves, to take on challenges that could result in great success? People are reluctant to try something new for fear that, if not successful, they will lose stature in the organization and be held personally accountable for failing . Thus, individual initiative is subordinated to “groupthink”, and innovative ideas are stifled.  True, there are those companies where employees are rewarded for looking for ways to improve customer service, productivity, and sales. But even in these environments, employees still perceive that it is safer to “stay in the middle”. In an era of global competition, it seems we are becoming a nation of middlers when we so desperately need more flankers. With that thought, The Whisperer urges you to always stay nimble and creative in your thinking. It’s good hyena insurance. My Head Hurts, Herr Doktor  This week a Belgian company, InBev, purchased Annheuser Busch for $52 million. Hearing about this got me to thinking: why couldn’t a European country, particularly one that has had a long history of managing health care for its citizens, run our health care system? Why not totally outsource our third party quasi- government/private health care-financed miasma to a country like Germany, which has been in the social security business since Otto von Bismarck designed the first modern public welfare system in the mid 1800’s? Before you conclude that I have had one too many Bud (er, excuse me, InBev) lites, consider that many of the western European countries, including Germany, France, and Spain, have high-speed intra- and inter-country rail service. Europeans drive more gas-efficient automobiles and get their health care taken care of in technologically up-to-date and clean facilities.While still small in number, more and more Americans are traveling for medical care to western (and eastern) Europe, as well as to Thailand and India, because out of pocket costs are lower, even including the travel portion. And it’s a well-established fact that western countries with standards of living similar to ours have better morbidity and mortality statistics than our own in many of the leading health care indicators. According to the travel web site www.justlanded.com: “The German health care system has the reputation of being one of the best in the world. There is an extensive network of hospitals and doctors covering even the remotest areas of Germany. Waiting lists for treatments are rare. Medical facilities are equipped with the latest technology and the statutory health insurance scheme provides nearly full cover for most medical treatments and medicines. Almost everybody in Germany has access to this system, irrespective of income or social status.” This by no means is to say that Germany and countries like it have solved the problem of financing health care. In fact, according to justlanded.com, Germany’s medical costs are among the most expensive in the world. The difference is that more of the dollars spent on health care go toward the provision of care as opposed to paying for the bloated overhead and administrative costs associated with our crazy-quilt third party payment “system”. Oktoberfest is just around the corner, so hoist one high, all you consumers of 16% of the U.S. Gross Domestic Product. This one’s for you! No Doctor, It's My Left Leg When was the last time you checked your medical records for accuracy? Have you ever checked them at all? The whisperer thinks it’s incredible that, with all the money being spent on converting to electronic medical records, innumerable mistakes are still being made that go uncorrected. In computer technology parlance, this is known as “GIGO” (garbage in, garbage out); i.e. if faulty information is entered, then the output of that information will be faulty as well. For example, I have found things in my medical records that have said that I am currently married (I have been divorced for over ten years), that I am five years older than I actually am, and that I am allergic to cats and dogs (I am not). Granted, these are not life and death mistakes, and it’s not as if these mistakes would likely lead to an inappropriate treatment or, worse, an adverse clinical event. Nevertheless, they should not be there. Why not make it a required part of the history-taking process that patients review the information that is recorded in their charts before it gets memorialized in an electronic file that will likely never be corrected? The federal government requires that the three credit bureaus make available a free credit report at least once a year so that consumers can check to see if erroneous information is in their credit files. Why not do the same with our medical records? Many patients have no idea as to what is written in their charts and would be horrified to read the misinformation that exists in their charts. Some of the blame belongs with patients, who should be more vigilant with their providers. But a lot of the blame belongs with providers for not taking the time to assure that they have accurately heard and recorded what their patients have told them.  What Makes A Great Group Practice? In his 2001 book, Good To Great, author Jim Collins talked about research he and his associates had conducted on why some companies thrived during economic downturns and others in the same field floundered. Although the companies that Collins and his team studied didn’t include medical group practices, there are a number of principles that are relevant to physicians trying to run a successful business. So what makes a group practice great? In many cases, marketing makes the difference between a mediocre group practice and an exceptional one. CEOs will tell you that the “moments of truth” for a business occur in daily operations. All the publicity, promotion, and advertising in the world won’t matter one bit if the word on the street is that it is difficult to make an appointment or get in to see your physician. Those who would separate marketing from operations fail to see that the two are integrally wound together. Timely appointment-setting, friendly reception, respect for the patient’s opinion, and protecting patients’ rights are all things that happen through customer interaction—which is operations and marketing. In a recent focus group I arranged and witnessed, the facilitator asked participants what they felt truly equated to a great experience when seeing a physician. “I was concerned that there may have been wrong information in my medical record and asked if I could review it,” one participant said. “Not only did they let me review it, but they apologized after I pointed out mistakes in the record and promised to correct them. They also asked that I double-check with them later to make sure the corrections were made.” Another participant boasted that the nurse arranged for a pick up when she wasn’t able to drive. Others lauded simple things like being able to make appointments online or in the evening and being informed of the doctor’s progress every ten minutes when waiting for an appointment. These are the things that Jim Collins would say are the mark of a great, not just a good, medical group practice. They are the result of truly listening to the patient, putting the customer (patient) first, and doing something as opposed to just talking about it. At first, employees and their managers are worried that implementing patient-driven enhancements will take too much time and cost too much. However, practices that operate with a focus on the patient have actually seen employee morale improve while costs have not skyrocketed. In fact, in some cases, they have gone down because of spin-off efficiencies as a result of process improvements. A number of progressive medical groups have learned the secret to building and sustaining patient volume. They have integrated market research into their efforts to improve operations, and they have fine-tuned their operations to incorporate marketing concepts. But even the best-run practices struggle with the on-going throughput/efficiency vs. customer satisfaction challenge. There is an opportunity cost to an unused MRI machine or an empty exam room. Machines and buildings have sunk costs that must be covered by paying customers. To the degree that a practice can accommodate throughput without sacrificing clinical quality, it will achieve coverage of the fixed and variable costs that exist with all operations. But will it achieve customer satisfaction? A recent study that was reported in the Denver Business Journal suggests that efforts at increasing efficiency can be compatible with customer service. The article claims that overbooking patients (similar to how airlines overbook flights) may be better for large practices where there can be a significant number of patient no-shows. Which leads one to ask: Wouldn’t it make sense to find out why there are so many no-shows and devise a strategy that would cut down on them? This is where market research and strategy can be instrumental in not only improving operational efficiency but in increasing patient loyalty and satisfaction. Together, operations and marketing help bring in patients and keep them coming back to a physician’s practice (if medically necessary). There are many factors involved in attaining patient loyalty, including competent clinical management of chronic disease from specialists and pharmacologic management of cholesterol levels and blood pressure by primary care physicians. However, what makes a patient refer other potential patients to the practice (the “multiplier effect” of marketing), is primarily the skills and understanding of the physician in meeting the patient’s specific health care needs. And what makes you’re a great group practice is making your interaction with patients more than just a “get ‘em in, get ‘em out” experience. Customer Service Expectations Are Universal Last week I received an email from someone named “Pablo”. No last name, just Pablo. At first I figured it was spam and moved it to my junk mail folder. But something told me I should open the message, so I did. Turns out Pablo is the director of marketing at the Hospital of the University of Navarra, Spain. He had bought a copy of my book—The Complete Guide To Hospital Marketing—via the internet, and wanted to tell me how grateful he was to have read it. He also said it was comforting to see that hospital marketing is taken seriously here in the U.S. Folks, I’m not making this up! Here are Pablo’s own words (there are a few grammatical and language roughspots, but the meaning comes through loud and clear): “Sincerely, the best thing of the book is the approach of the hospital marketing. In Spain…people who work in hospital in marketing matters are not respected. For you, hospital marketing is really a branch of marketing, and you speak about with authority, so, it’s very good to read people who think that marketing in the hospital is not for the crazy people, but for the people who understand the hospital context and who know the importance of hospital role in the society.” Pablo goes on to write: “In Spain, the hospital marketing is technology, technology and technology. We have forgotten the role of human experiences, the essence of healthcare brands.” The funny thing about this email from a hospital marketer in Spain is that it could have been written by someone right here in the good old U S of A. Unfortunately, many of our hospitals focus their marketing on technology just as Pablo says his hospital does. About six years ago I made a trip to Germany, a few months after the horror of 911. While there, I visited the University of Heidelberg and its teaching hospital. I was impressed that they had technology even more advanced than that in some of our university hospitals. But more impressive was the friendliness I detected in the staff, the cleanliness in the halls, the ease I had in communicating with the physicians and nurses. Somehow it's comforting to know that hospital marketers across the world are concerned that "we have forgotten the role of human experiences." Wouldn’t it be great if there were international standards for customer service in health care? Multi-Tasking And Rising Attention Deficits:  Just Coincidence? It’s in practically every job description: “Fast-paced environment; must be able to multi-task”. Employers once prized those employees who could put their entire attention to a task to be sure it was done right. Now, if you can’t prepare your powerpoint presentation while you carry out an important phone conversation , eat your yogurt lunch, and respond to the latest email from your boss, you may be headed for the glue factory. Whatever happened to focusing on the task at hand, and to doing a thorough job? Is speed that much more important than accuracy? Is it really more productive to do so many things at once? Has efficiency trumped effectiveness? Ever since the early 20th-century time and motion studies of Frederick Taylor, workplaces have looked for ways to get employees to do more in an eight hour day (now a ten to twelve-hour day/night). Typing 75 words a minute was better than 60. Speeding up the testing of more water heater cylinders on the production line, even though the error rate for detecting defects increased, was valued in that industry. The multi-tasking craze has taken the “doing more is better” thinking to the point where it even is affecting the quality of information we receive in our electoral process. Politicians are forced to sound-bite their way onto CNN, MSNBC, and Fox News. Does our collective intelligence as an electorate increase proportionally with the more talking heads we listen to? I would love to see a research study to determine if there is a correlation between poorer decision-making and multi-tasking. And I would love to hear what you all think on this subject. Oops—gotta go, my cell phone is ringing, my cordless is ringing, I'm balancing a salad on my lap, and I’m trying to follow the stock market gadget on my desktop as I type this.........