Marketing Those Who Came Back

Step into a hospital anywhere in the western world and you are in all likelihood to run into an Indian doctor sooner than later. The medical education system in India churns out doctors in large numbers and many of them choose to go abroad for advanced training and skills enhancement. Many of these settle down in the new country, which is more than happy to welcome highly educated and skilled doctors to its shores. It works well for the doctors too, they learn new things, train in some of the finest institutions in the world and than are able to make a decent living in their adopted country.

This is the way it was till recently.

Now with India making rapid strides in healthcare and even attracting patients from across the globe, many of these doctors are choosing to return to India. They are able to find employment in the new high tech hospitals, which have sprung up in the last 8-10 years. The reasons for this are not far to seek. Indian hospitals can now easily be compared with any that they might have worked in earlier, in the west, the standard of care is often superior, the financial rewards far better than what they were a few years ago, and life in upmarket urban India quite comfortable. Moreover, India is home for many with responsibilities for aging parents. Some are also not comfortable with their children growing up seeped in the ubiquitous and consumerist western culture.

All this is great, except for the fact that some find going in India quite tough. The hospitals that employ the returning prodigals, soon realise that these doctors will take time to settle down and find their feet in the changed Indian environment. Having been away for years they do not have a bank of patients, who can start patronising the hospital. Often their salaries are more than those hired from other Indian hospitals and with no patient base to speak off, these doctors are immediately under pressure to justify their high salaries. They usually need urgent Marketing support.  

Marketing these doctors wouldn't be too difficult. However, marketers like me realise to our dismay that many are just not willing to make the effort, which is required to establish their credentials back home. Many believe that their foreign accents and fancy certificates will suffice to get them patients. Unfortunately, this never works.

Their are really no short cuts to building a practice. It requires painstaking engagement with the local doctors, establishing a rapport with the local communities around the hospital and delivering great experiences to patients who come in. Dr. Paramvir Singh a gastroenterologist, who returned from the US to join Artemis Health Institute in Gurgaon is a case in point. He decided early on that he will have to work closely with the marketing team and pestered each and every member of the team to take him out for meetings with local doctors, deliver talks in corporates and interact with the local community leaders. Dr. Singh also ensured that he called those referring patients to him, discussed the  case and politely thanked the doctor for his support. He also became friends with all the marketing executives, who found him very accessible and ready to go out with them on short notice. All this worked like a charm. Dr. Singh is today, about a year in pratcice in Gurgaon a very busy gastroenterologist indeed.

Sadly, many of those who returned find it hard to cope with the grind. Many carried a lot of baggage from the US, had an attitude which borders on arrogance and found it difficult to connect with the local doctors. Many confessed of not being comfortable interacting with some of these doctors, they questioned their practices and were just not able to treat them with respect. Not surprisingly the local doctors too turned up their noses at these 'upstarts'. The hospital sales team just couldn't make any headway.

Some of those who came back, found going out with the hospital sales team a chore well beneath their dignity, the heat and the grime of India beyond the air conditioned surroundings of the hospitals too much to bear. Others found it difficult to work long hours, 7 days a week, (which is the lot of most doctors in India) and cope with the relentless pressure of generating patients for the hospital.

No wonder many of them are contemplating returning back, others are holding on grimly, hoping with the passing of time patients will surly come. They may or may not, the struggle for these doctors is not ending anytime soon.

Pic courtesy www.flickr.com/yodababy79

Obesity is fast becoming a global epidemic. While so far the disease has largely been limited to the developed world, it is now rapidly spreading its wings to countries like India, where increasing affluence and prosperity is driving huge lifestyle changes.

Obesity is a disease of the affluent. The link is easy to establish. The intake far exceeds the requirement. In Indians, latest research also indicates the presence of a gene, which converts excess food into fats and deposits it in the abdomen. Thus the normal paunchy Indian, (I dare say pretty much like me!) can blame his genes as well as his lifestyle for his ample girth.

Obesity has been recognised as the underlying cause of many a disease including diabetes, coronary heart disease, joint and spine related problems, and liver diseases. The fight against obesity is now becoming a huge challenge and is a great opportunity for healthcare services marketers.

Here is what they can do to win this battle.  

Design a Great Product

Obesity must be treated like a disease. A great obesity management program should include a scientifically designed and customised exercise regimen, specially tailored diet programs, counselling and of course for the morbidly obese the choice of various surgical options. These should include a minimally invasive bariatric surgeon and a cosmetic surgeon working together to offer a comprehensive surgical package.

The Obesity Program should be marketed as a package. Quite often hospitals make the mistake of focusing too much on the surgical treatment and ignore non surgical options. This is a mistake because consumers tend to look upon this with suspicion. Afterall, if the choice is between surgery and exercise and dieting, most people will choose the latter with alacrity.

The marketing of an obesity program should involve engagement with customers through a well defined marketing program.  The communication mix should include multimedia advertising including print, radio, cinemas, and outdoors advertising. It should also include a generous dose of below the line communications.

1. A Testimonial Campaign

It is a great way to advertise an Obesity Management Program. I know it is cliched and done to death by a large number of Obesity Clinics. However, I believe it always works. There is nothing like an obese person's picture before and after joining the program to convey the benefits of the program. The trick here is to use this in a 360 degrees campaign. Use the same message in the newspapers, lifestyle magazines, bill boards, radio, TV and even in the below the line communication.

2. Public Forum

 Organising a public lecture on Obesity and its management helps connect with the right audience. At Artemis Health Institute, Gurgaon we organised many such lectures on varied topics and the response was always great. Moreover, we mostly had people in the audience, who either themselves were suffering with the disease or were caregivers to someone suffering from it. These were always interactive sessions with a team of doctors, physios and even patients with successful outcomes interacting with the audience.

3.Go to School

Childhood obesity is rampant and believe me there is nothing that worries a parent more. With all pervasive McDonalds, Domino's, Pizza Huts around the corner, and the shrinking spaces outdoors, the young are succumbing to obesity like never before. Schools, would be happy to provide an opportunity to the hospital to interact with children through lectures, talks and direct invitation to parents to help their kids stay healthy.

4.Engage Where you Can

An engagement activity with the obese at the nearby jogger's park might be a good idea. Similarly one can engage with them outside a popular food joint, a mall or a theatre. A message delivered on a table mat in a restaurant or a small film in a cinema theatre, while presumably munching a bag of buttered popcorns can work.

5.Educate Educate and Educate

Most people suffering from severe/morbid obesity are quite unaware of the surgical options available. Dr. Deep Goel, who Heads the Minimally Invasive and Bariatric Surgery program at Artemis Health Institute says ' Surgery is a viable option for the morbidly obese. In the hands of an experienced surgeon it is quite safe, is done laparoscopically and the patient needs to stay in the hospital for just 3 days'. A hospital will do well to develop literature about the surgical options available, the benefits and the associated risks. Put this up on the website of the hospital, use it as a handout to patients coming as outpatients, send them as emailers to patients with BMI index in excess of 35.

6.Stay the Course

From a hospital marketer's perspective the trick is staying the course. Looking for quick gains from the program is foolhardy. In my experience it should take at least a year before the program starts showing tangible results. The good news is that it is a self sustaining program once a critical mass of patients is achieved. Word of mouth starts spreading fast and patients follow patients.

Pic courtesy www. flickr.com/Henry Scow

The Dentist,Reader's Digest and Colgate

The current issue of Reader's Digest in India has a impressive looking (and if I may also add forbidding) dentist on its cover and a lead story about how a trip to a dentist can help predict all manner of disease. It is as if the dentist holds the key to deciphering all the medical problems that I may encounter in my life hereafter.

The story makes for strange reading.

Is this a surprise that a regular visit to a dentist may help detect oral cancers. I would be surprised if my dentist in today's day and age ignored suspect looking patches in my mouth, which may later turnout to be cancerous.   

The other point that this story makes is that untreated oral infections can have serious and sometimes fatal consequences. But wouldn't you think that this may be true of any infection. An untreated infection in the foot may also fester, the infection may spread, may become gangrenous, may require serious surgery and at times may lead to septicaemia and death. What is so special about an untreated oral infection?

Unbelievably the story makes the incredible claim that the dentists during the course of routine dental examinations can spot signs of Diabetes, Heart Disease, as well as rare skin and auto immune diseases. I would love to meet a dentist who can do this. Those I have worked with for many years have no such claims to fame.

And here comes the real gem' But the good news is that with good old regular brushing and flossing you may prevent all that. And by seeing your dentist often you can nip most problems in the bud'. For all of you who might be wondering what is so great about it, you are advised to look at the opposite page. The bright and the familiar red of a Colgate ad can hardly be missed. The ad headline reads 'Are your clean teeth hiding signs of decay? For a Free Dental Check-Up in your neighbourhood sms...' You get the picture now, right.

The story continues in right earnest about terrible afflictions of the gum, which can cause all manner of illnesses and of course the ad down below says 'For a truly healthy mouth you need protection from as many as 12 teeth and gum problems' Need I say more.

It is sad to see a venerable magazine like Readers Digest in such dire straits. I have been a reader and collector of Reader's Digest, since when I was hardly 10 years old. The most charitable explanation that I can think of for all this is that these must be desperate times for them. After all selling ones soul is never easy.

And as far as Colgate is concerned, I can only say that they have a very bright brand manager, who thinks all of us consumers are incapable of putting two and two together and see through what this is really all about.

Pic courtesy www.flickr.com/cjanebuy

Lessons in Healthcare Marketing Communications

Building healthcare brands is an arduous task. 

It takes enormous effort to get it all right. The mix of customer experiences at various hospital touchpoints, the look and the feel of the hospital, the people and of course the communication. No one goes to a hospital willingly or to enjoy a few days of well deserved rest. Neither is it a place, which attracts willing repeat customers. Customers in a hospital are necessarily driven by a misfortune, which involves something as precious as their or a loved ones health. A hospital visit is also usually fraught with risk. Fear and anxiety generally accompany a customer to the hospital.

Building brands by delivering great experiences to customers who are in this frame of mind is tough. Communicating with customers to influence their choice of a hospital in dire and difficult circumstances is often akin to walking a tight rope. The message runs the risk of being perceived as either too commercial (this hospital seems to be hoping that I fall sick and land at its doorsteps), too glib (it trivialise something as serious as my health and well being) or just too smart or plain dumb.

Here are some lessons that I learnt, while handling communications for large hospitals.  

The Customer is Not a Moron

Healthcare Marketers tend to assume that the customer knows nothing. They believe that healthcare and medicine are way too esoteric and difficult for a non medico to comprehend. We often forget that this is not about a tumour or a disease, it is all about a human being, an individual who is sick. There is no one who knows his problems better than the individual suffering from the illness and he is quite capable of making intelligent choices that he believes the are best for him. As healthcare marketers, we must respect this.

Talking Down to the Customer Never Helps

Many a times I have come across communication, which is downright patronising. It talks down to the customer rather than engage with him in any meaningful dialogue. I believe a good piece of marketing communication must appeal to a customer at a sublime level, it should make a subtle point rather than being in your face and loud. And yes one can be subtle and yet appealing.

Too much is always too little

In a hospital, virtually everybody and their uncles are expert marketers. A cardiac services ad will require inputs from cardiologists, cardiac surgeons, hospital leadership team, medical superintendent, the COO, the CEO and pretty much everybody else who works in the hospital. And all of them will want the ad to include something or the other, which in their opinion is important about the hospital and must be communicated. The brand team will be buried under an avalanche of opinions, which must be included in the ad. Leaving any of that will typically upset one or the other doctors, leading to an ugly situation. In all this the customer will generally come last. 

It Must always be about the Customer

It unfortunately very rarely is. The communication is more often than not about the hospital, the doctors, the equipments, the technology, the systems,... The breast clinic is not about the breast surgeon or the mammography machine, it must be about early detection and comprehensive care. Everything else including the doctors are just means to that end.

In India, healthcare marketing communications is in its infancy. I am sure as we see more corporate hospitals and greater marketing talent moving into healthcare, the transition from the hospital being the center piece to the customer becoming the focus of communication will commence.

The sooner the better for all.

Pic courtesy www.flickr.com

Should their be Money Back Guarantees in Healthcare?

I know I run the risk of being shot by friends and colleagues for even suggesting something like a ‘moneyback guarantee’ in medicine. I am aware of all the usual arguments about why it cannot be done and why my understanding of issues in medicine is so limited.  Let me begin by capturing some of these arguements.

Medicine is a profession, which involves huge risks. Our understanding of how the body works and heals is limited. All the advances in medicine that we have witnessed in the past decades, while incredible do not still allow us to say with certainty that what works for John will also work for Joe assuming they have similar problems and are being treated by the same doctor. Each individual is different, and he responds to medicine in a different way. Moreover, medicine is an inexact science, the outcomes are dependent on too many factors beyond the control of the doctor and that it is next to impossible to predict a successful outcome. 

I agree with all this, except the fact that outcomes cannot be predicted with any degree of success. They can be. Cardiac Surgeons blithely talk about a success rate of more than 98%  for something as delicate as bypass surgery and surgeries involving the prostate, gall bladder and hernias have a close to 100% success rate. I also know of Orthopaedic and Spine Surgeons, who pride themselves in success rates of over 98%. These are facts that can easily be ascertained and documented.

If we know that the mortality or complications rate for a particular surgery in a particular hospital is in excess of say 98% than I see no reason why a moneyback guarantee can not be issued. The hospital stands to loose the fee earned in just 2% of the cases averaged out over a period of let us say a year. Financially this makes complete sense.

Surgeons and clinicians regularly communicate these risk factors to individual patients. My mother needed a bypass surgery last year. The surgeon we went to had a more than 98% success rate with this kind of surgery and he told us so. That really helped my mother, who was extremely worried about being under the knife. Now why can’t this be communicated to a wider audience and also put some money where one’s mouth is?

Let us also consider what the promise of a moneyback guarantee tells me - the customer. First and foremost it establishes the point that the hospital has complete faith in the abilities of its surgeons and doctors, it is willing to wager its money on a successful outcome. The moneyback guarantee also tells a patient that the hospital is absolutely confident of its systems and processes, nursing care and infection control protocols. Above all it makes the point that the hospital is willing partner in sharing my risk at least to a certain extent.

Imagine, what a powerful tool a promise like this can be in the hands of skilled marketers. The promise smacks of supreme confidence and provides a powerful reassurance to patients. It makes the hospital standout from everyone else as unique. It inspires trust amongst customers. It sounds honest and makes the hospital look like a partner in the process of care for the patients.

I do believe that the time for limited money back guarantees in healthcare has arrived. All it requires is a bit of courage from a surgeon and a hospital to stand up and go for it.  

 

The image is courtesy www.flickr.com

Should Doctors Advertise?

Advertising has traditionally been a strict no no amongst the medical fraternity. It has always been considered infra-dig. A doctor's face peering down from a bill board or staring you in the face from the pages of your favourite magazine does make one feel a little uncomfortable. We have all been brought up to look on the medical profession as something noble and with a strong orientation towards service to humanity.

However in today's times I am not sure this argument really holds. If a doctor chooses to advertise his skills and does it honestly without taking recourse to exaggeration and hyperbole, is there anything really wrong with it? If a doctor has unique skills and training, which helps him get better results, than isn't advertising these, allow consumers of healthcare make better informed choices? Why do we have to look upon this particular doctor as 'too commercial'?  

It is also believed that doctors who spend a lot of money on advertising will eventually recover these from hapless patients. There is no evidence of this and to believe that just because a doctor chooses to build his practice by advertising, he will also resort to unethical practices (to make money to pay for the advertising) is wrong. If a doctor is keen on cutting corners to make a fast buck, he will do so anyhow.

I  do believe that it is important for doctors to connect with consumers. They must inform the society they serve about their skills, training and experience. Advertising can be a strong and powerful tool to do this.

The big question really here is what kind of advertising should doctors undertake to attract more patients. I believe the ads should be honest and truthful. They should not make promises, which are misleading and difficult to believe. The advertising should largely stick to facts. It may be wrong to say that 'I am the best/most skilled cardiac surgeon in town'. However, the same point can be made by stating that 'I have done 10000 cardiac surgeries in the past 10 years with a success rate of 99%'. Consumers are not morons, they will get the message.

A separate regulatory body might be required to ensure that doctor's advertising is fair and makes truthful and verifiable claims. This can be an independent body created by medical community with representatives from the world of advertising, media and aware members of the society. The society can develop a 'code of ethical communication' for all doctors to follow, while advertising their services. The media can stipulate that they will accept ads only if cleared by this body.

I do hold that the time has come when doctors were allowed to advertise their services. Not only will this help doctors attract more patients, it will also help consumers choose their doctors better. 

The pics are from www.flickr.com

Outreach Programs - Lessons for Healthcare Marketers

Outreach Programs are essential weapons in the armoury of a healthcare marketer. The programs are widely used for creating awareness about the hospital's services amongst people, who live in communities away from the hospital. Quite often these programs also serve as screening services for more serious disorders and the hospital naturally hopes to attract some of the patients requiring higher end diagnostics and treatment to its doors.

Very often the communities served by the outreach programs are either rural or semiurban, where the availability of good quality, modern healthcare is very limited. These communities too hugely benefit from these outreach programs as they get access to good quality healthcare services.    

Inspite of a win win situation both for the hospitals as well as the far flung communities served by a hospital's outreach program there are not too many real success stories of outreach programs. Good intentions rarely translate into effective and successful programs.

Artemis Health Institute (AHI) based in Gurgaon in the National Capital Region of Delhi last year instituted an outreach program which involved the cardiology teams. The program comprised of weekly outpatient clinics by cardiologists at Sohna, Rewari and Bhiwadi, semi urban communities all located with in a radius of 50 kms from the hospital. The three locations were carefully chosen as they are well connected to the hospital (the driving time less than 90 mins)  and there are no qualified local cardiologists. The population of the towns is about half a million each.

The program has been running for more than a year now with less than satisfactory results. Everybody agrees that the opportunity is huge. Yet there is really very little to show for it on the ground.

The lessons learnt are simple yet profound.

A community outreach program can be a success only if the doctors involved un the program are completely committed to it. At Artemis it was always a challenge to get the doctors to go. The doctors felt that going out in the 'field' and seeing patients at an outreach clinic, (which would typically run from a local ill equipped but popular hospital) was beneath their dignity. Some believed that it just served no purpose as patients seen at these clinics were too poor to go to private and expensive hospitals like AHI. 

Some would complaint that there is no point in traveling so far unless there are enough patients. This was like the proverbial chicken and egg. Patients will come if the doctors show up regularly and on time. A no show also destroyed the relationship with the local hospital as their credibility suffers as well. At Artemis we never could convince our senior doctors that this was worth their time and effort.

An outreach program must be an integral part of the Marketing Program of the Hospital and the hospital must spend the money needed to popularise the program. At Artemis the clinic was advertised with the help of local ads, handbills and banners. However, there were always severe budegtary constraints. The money was never enough.

Consistency of the program is essential. It is imperative that as far as possible the outreach clinic be run by a single physician. This enables the local population to forge a relationship with the doctor, whom he knows he can meet every week. At Artemis this was rare. Though the clinics were assigned to a senior physician, he seldom went. Sending someone else usually a junior greenhorn served no purpose. The patients could see through his inexperience.

Time is essential for the success of the program. It is quite unfair to expect that the program will deliver a large number of patients in a hurry.  A level of trust must develop between the doctor and the local folks, before patients turn up at the door of the hospital. In my estimation a minimum of 6 months of regular effort is a must. At Artemis we were always in a rush.

The Local partner is important. The local partner must be selected with care. His expectations from the program should be ascertained and a fit between the hospital and the local partner should be evaluated. The local partner wants an association with a bigger tertiary care hospital as it adds to its own prestige, At the same time he hates being pushed around by the big hospital. At Artemis we tried hard to get the fit right. I would like to believe we succeeded more often than we failed.

I also know of far more successful programs initiated by the doctors themselves usually in communities where they have their own roots. Dr. Anil Bhan a cardiac surgeon ran a successful program in Srinagar, Kashmir for many years. That however must be the subject of another post.

The image is from www.flickr.com

The author was till recently the Head of Sales and Marketing at Artemis Health Institute, Gurgaon