The Healthcare Marketer’s Life

Yesterday evening while I was returning from work a friend called. He has recently taken over as the Head of Marketing Communications at an upcoming hospital. I had met him a few weeks ago to congratulate him on his new assignment and he seemed quite kicked about his new role. He had grand plans of changing the way the hospital communicated with its patients and other stakeholders, he wanted to run customer facing programs, drive relationships with patients through effective engagement and deliver uniformly great experiences to those who touched the hospital.

Yesterday over the phone Ajay felt he had made a big mistake by joining the hospital. I was quite flummoxed by this turn-around. Further inquiries revealed a familiar story. The hospital has a brand new CEO, someone who has worked for many years in hospital operations but have no knowledge or appreciation of communication. However, like most folks he too believes that marketing communications is hardly something to be left to experts. In fact the CEO believes that he knows exactly how a piece of advertising or a brochure should look like. Download the text from the web, adapt it by rewriting some of it, slap a few images downloaded from the net and include the mandatory images of some if the hospital doctors, run it past a few senior hospital bigwigs and, voila the ad or the brochure is ready. As far as hospital signage are concerned, the CEO feels that they really are meant to provide legible directions to the patients and fussing over them, their aesthetics and design is a gross waste of time, energy and money. Well I might be exaggerating a little here but this is really the long and short of what Ajay felt his CEO was doing and no wonder he had started feeling frustrated in the set up.

Marketing folks in hospitals always grapple with the problem of every one who is anyone coming up and advising them on how to create a piece of communication. Some doctors love to see their pictures in the ads and some other feel great if gory images of them operating heroically could be included in the communication. The CEO’s love to mutilate the advertising copy, insist on correcting perfectly well written text, increasing or decreasing the font and of course having the logo bigger, bolder and always 2mm to the right! Many a times the marketing communication executive has to sweat many hours trying to accommodate the conflicting wishes of the CEO, the star surgeon and his favourite flunky. All in a day’s work for the intrepid marketing guy, who can be forgiven for wondering if he is the only one who knows nothing about marketing communications.

Those who have worked in hospitals long enough know how to maintain a fine balance. They will wait till the last-minute, before asking a doctor to go through the text and approve the ad, they will sneak it past a doctor who they know is not too interested in the brochure’s finer details, they will get the mailer made and when a livid doctor would approach them on their failure to show it to him, they will deftly show an e-mail sent a few days ago knowing fully well that the doctor rarely checked the mail. Tricks of the trade, which one learns on the job.

Well, while all this may sound hilarious, the fact is that a hospital marketer’s life is not easy. If the hospital is doing well, his budgets are the first to be cut (why do we need to spend money on advertising, we have hardly a bed to spare!) and God forbid, if the hospital is not doing too well, the marketer knows that the hospital can hardly spare cash to blow its own trumpet. The doctors and particularly who head various departments are always after his life to see their ads in the newspapers, whether the marketer has the budget for such advertising is of course none of their concern. The CEO is always looking to pinch a few more pennies from a meager budget and he insists on stretching the money to impossible levels.

Such is than the life of a healthcare marketer.

Usually, in all this the silver lining is a boss, who understands the inner dynamics of the hospital, who knows how to work with medical folks without unnecessary confrontations, who lets the marketing guy go about his job without much hindrance and steps in to resolve conflict as it arises. He is the one who understands the aspirations of a good marketer as well as the concerns of the medical folks in the hospital and strives to achieve a balance.

At the end of the day, and in like most other things in life, a fine balance is the key.

The Silly Question of RoI in Healthcare Marketing

The other day I was with Dr. Jadhav who heads the Marketing function at the well known Narayan Hrudayalaya in Bangalore. Dr. Jadhav was keen to use radio for his hospital’s communication needs and I was hoping to persuade him to advertise with Fever 104, the radio station owned by The Hindustan Times, my current employers. Narayan Hrudayalaya, which is a well-known cardiac hospital thanks to the famous Dr. Devi Shetty and his pioneering initiatives, has recently started a Cancer Centre as well as a Multi Speciality hospital and wanted to promote these. The aim of the communication was to tell the citizens of Bangalore about these services available at Narayan Hrudayalaya and to drive ‘footfalls’.

While I discussed the plans with Dr. Jadhav, I could not help but notice his concern about the RoI on his marketing spends. Dr. Jadhav was very clear that if he spent Rs. 100, he needed 3 times the sum in revenue, which could be directly attributed to this activity. I could easily relate to this because this is exactly the kind of expectations the management teams had of me, when I headed the Marketing function at Max Healthcare and Artemis Health Institute.

I wish calculating RoI on healthcare spends was this easy. While there are many websites, which help one calculate RoI on marketing spends using complex formulae and spreadsheets involving the lifetime value of a customer, the cost of capital and what have you, I believe quite often the best way forward is a subjective gut feel and patience.

Measuring the success of a healthcare marketing campaign by merely counting the number of queries/walk ins generated in the hospital OPD is a great folly. The hospital business is unlike any other business and one must remember that exciting marketing communication alone will not lead to people walking in to check out the services of the hospital. This can happen for a new restaurant or a movie theatre, but for someone to visit a hospital he must have a pressing need.

Tactical communication involving discounts, freebies and the like should be handled with care. I am not sure I would prefer to go to hospital for cardiac surgery because there is a discount being offered on the surgery, or I would like to go under the knife at a particular time just because the hospital is offering a deal. Come to think of it, I would be downright suspicious of the hospital if it tries to hustle me into a medical procedure by making a commercial offer.

Marketing spends in a hospital must be looked upon as an investment in the hospital brand and the values it stands for. The customers should be informed about the services of the hospital, the experience and training of its doctors, the robustness of its systems and processes and above all the promise of the experience the hospital hopes to deliver to its customers. It can highlight its ease of access, competitive pricing vis-a-vis other hospitals and superior services. The hospital must showcase medical excellence, send out stories of success against great odds and constantly remind its customers what it truly stands for. It needs to communicate all or some of these over time before it should even attempt to measure the RoI.

A hospital’s brand equity is built over many years and much as hospital marketers would like to hurry this up, there are just no shortcuts. A hospital must set aside a small sum of money (7% of sales in the first years tapering to 2-3% in later years) year on year to spend on connecting with its patients and the local communities it hopes to serve. It should diligently spend this money informing, educating and reinforcing its brand values.

A few years later, the hospital will find itself buzzing with patients and no one would really be interested in the RoI on marketing spends.

Marketing With In

Here is an interesting exercise that I recommend hospital marketers to try out with their colleagues in the hospital. Select a group of 30 individuals working in the hospital, preferably those who handle customers. Include in the group a few medical folks, doctors, nurses, front office executives, billing executives, F&B personnel and a few guys from housekeeping. Ask them simple questions on what the hospital brand means to them.

You would be surprised with the variety of answers you are likely to get.

All marketers try and look for a unique customer proposition for their hospitals, one which they believe the hospital delivers to its customers. The proposition is carefully selected after many a long ‘brain storming’ sessions involving the hospital’s leadership team, the branding and communications experts from advertising agencies pitching for the lucrative account. After these hectic sessions what often emerges is a positioning statement, which is than condensed into the hospital baseline, which is than incorporated in the logo of the hospital. It is in essence the consumer promise, which than is communicated to the external world in right earnest. However, what they fail to do is communicate this promise with the same vigour and zeal with customer facing employees, who are actually tasked with delivering this promise.

Let me take examples from two hospitals, where I used to work.

Artemis Health Institute in Gurgaon says that it is all about the ‘art of healthcare’. Max Healthcare similarly professes to be ‘caring for you …for life’. Artemis believes that its services are differentiated from other hospitals because it focuses on the softer side of medicine. The arguement is that the best infrastructure and world class medical faculty is a given, and easy to replicate. What really distinguishes this hospital from others is not what it delivers but how it delivers. Similarly Max Healthcare is all about superlative care, what the hospital calls ‘patient centric care’. It prides itself in delivering great patient care at all customer touchpoints and at every patient interaction.

Now these are indeed lofty goals. I would even go ahead and aver that when these hospitals were being conceived and set up, the founding teams did believe in these ideals. The hospital communication program was designed to put across these differentiations and a fair amount of energy and effort was expanded in developing communication, which helped establish the hospital’s core values. However, and here is the nub of the matter, these hospitals just did not do enough to communicate these values to their own folks down the line who were actually supposed to deliver these sterling objectives.

In the initial days of commencing operations the hospitals did make an effort to train people in handling and treating patients as customers. However, the initial enthusiasm waned soon enough, competition poached many a well trained individuals and somewhere in the hurly burly of running large hospitals the idealism of the past gave way to an all pervading cynicism. Training individuals in the ideals and core beliefs of the hospital became a chore and the trainers too lost their passion.Thus the marketing promise, the all important differentiator remains only in the minds of resolute brand managers who faithfully continue to reproduce these lines with the hospital logos and the colours.

Unfortunately, this is true of most hospitals I know. A brand promise must be delivered unerringly and all the time. For, which hospitals must spend time and serious effort in keeping the promise alive amongst those who are supposed to deliver it a million times everyday.

Pic courtesy www.flickr.com

Driving OPD's

Outpatient Department or the OPD is critical in the marketing of a hospital. It is the OPD, which drives the admissions in the hospital and the diagnostics including the pathology and imaging. It keeps the doctors busy and the hospital buzzing. The success of various Marketing activities is usually measured by the number of incremental patients who walk through the hospital doors during the promotion.

Here are some ideas on driving the OPD volumes.

Marketing Promotions

I know, many people believe that for a hospital to be involved in Marketing promotions is a strict no no. Offers like free consults and 30% off on all diagnostics somehow seems too much like a 'Sale' at the neighbourhood supermarket. However, the truth is that promotions work. Many people like to avail of the promotional offers, walk into the hospital to see a doctor for a long ignored niggling problem and many like to avail themselves of a discount on a CT or MR. The trick here is not to overdo it and to ensure that the communication is not overtly commercial or over the top. I would reckon 4 big promotions a year, (one a quarter) would be fine.  

Neighbourhood Engagement

A hospital wanting to have a buzzing OPD, must try and engage with those living in the neighbourhood. A busy OPD usually means that the hospital enjoys the patronage of its neighbours in a big way. Thus weekend neighbourhood health camps,  regular clinics in the societies around the hospital and fam visits to the hospital by local opinion leaders goes a long way in establishing a good connect between the hospital and the local communities. Neighbourhood relationship programs offering benefits to local residents and the senior citizens always works.

Connecting with the Doctors

It is imperative that the doctors doing the OPD's connect with the local populace. Artemis Hospital started doing a monthly lecture involving its senior doctors. Every month on a Sunday morning the hospital would invite residents to listen to its expert doctors talk about Heart Disease, Arthritis, Back Pain and even more serious issues like dealing with Cancer. The program worked well with the auditorium filling up and people have a wonderful time interacting with the experts. They got to know and interact with the doctors outside their OPD chambers and it worked wonders in establishing relationships. 

Local Advertising

Local advertising helps the hospital brand remain top of the mind. Advertisements talking about the hospital's philosophy and commitment, its super specialities, its highly evolved expertise in certain areas and the emergency services help demystify the hospital and keep it fresh in the consumer's mind.

Specialised OPD Clinics

With in the OPD there is always the opportunity of establishing super specialised clinics involving several consultants and services and offering these as a bundled convenient offer. Thus a diabetes clinic would involve a diabetologist,  an ophthalmologist, a podiatrist, a dietician and even a psychologist. They can come together to offer a package, which would involve round the year care through active follow ups and regular testing. 

These are just a bunch of thoughts and I am afraid nothing very revolutionary. However, I have seen in my experience that very often hospitals fail to do these 'small' things consistently well. The programs are initiated and then abandoned, management attention gets diverted to more flamboyant projects and these 'day to day' programs are given short shrift. I believe that OPD's can only be built gradually, one step a time and constant engagement through well thought out programs and communication goes a long way in establishing the trust, which drives the OPD.

Hospital Marketing to those Next Doors

Marketing a hospital to those in the neighbourhood is often looked upon as the 'low hanging fruit' by many a marketer. The thinking goes something like this. 'We have just started a great hospital and those in the neighbourhood cannot help but notice the swanky chrome and glass exteriors and the blazing signages on the top of the 10 floor edifice. We have world beating technology and some of the most competent and respected doctors joining us. We are streets ahead of all those who have been in this neighbourhood for years and we really do not consider them as competition. All those who have been living in this community will now flock to us.'

Honestly, this is a recipe for disaster, yet so many of us marketers are so blinded by our spanking new hospital that we do not see anything beyond it.

Members of the local community are not going to queue outside a hospital just because it has opened its doors in their community. They have existing relationships, habits and healthcare consumption patterns that they have been comfortable with for years. A new hospital needs to make a serious effort to engage with them and persuade them to give the new hospital a try.
Some of the things that I have learnt, while being involved in the launch of 5 hospitals in the last few years in and around Delhi involve strategies for creating awareness, engagement and a uniquely differentiated experience to those in the neighbourhood.

Local communities will start taking an interest in the hospital if the hospital takes the initiative to engage with them. At the Artemis Health Institute in Gurgaon we started a program, which involved conducting a healthcamp in the condominiums in the neighbourhood of the hospital. The camps were held with clockwork regularity for more than a year. In the initial stages I would often go myself and hang out with the residents, while they met the doctors and underwent basic tests. I and other members of my sales team would talk about the hospital's facilities, services and the like without making it apparent that we were actually delivering a sales pitch. I would also meet the office bearers of the the local condo associations and discuss over a cup of tea as to how the hospital can be a part of the life of the local community. Since most of them were elderly folks who would need healthcare, this was generally a topic of great and often personal interest.

We soon hit upon an idea that in communities where the numbers of the elderly were large, we may set up small clinics with in the community. The clinic was run from a small room provided by the community and we would send a doctor for a few hours per day. The community also allowed us to advertise the clinic, which created greater awareness about the clinic and by association of the hospital. Soon we started getting referrals from these clinics and the emergency calls too increased. Buoyed by the success of the experiment we set up a few more clinics and with in a year we were getting calls from various communities asking us to open these clinics in their communities. The good word spread quickly.

At Artemis we also started awareness programs called 'Public Forums', which were lectures delivered by our doctors. We would advertise the lecture let us say on 'back ache' through print ads in local newspaper supplements and handbills. We would hold the lectures on Sunday mornings in the hospital auditorium and would typically have over 200 people from local communities attend. The sessions will include a lecture followed by a lively question and answer session with the experts and end with a light lunch. We discovered that many people would stay back to consult with the doctors. We believed that an aware customer will find it easy to choose us for his surgical needs. The success of Public Forums branded 'Let's Talk' were an example of how the Medical teams in the hospital worked with the sales and marketing teams to engage with the local residents.

Soon we also introduced an interactive website, uploaded the content of these lectures for people to download and also allowed them the freedom to write to the doctors, create their own pages and share relevant content with each other. The effort was to create a community of people, who suffered from a particular condition and to allow them to interact with each other as well as with the hospital.

While at Max Healthcare, we initiated a branded Neighbourhood Program for the adjacent South Delhi localities, which offered special benefits to folks living around the medical centre. The benefits included discounts on the hospital's regular charges, priority services and a dedicated family physcian to take care of day to day needs of the residents. The local residents were required to enrol for the program and were issued nicely designed cards, which served to identify them at the hospital counters.

To remain top of the mind and ensure good relations with the local communities we supported by advertising in the local resident directories, sponsoring local events and signing up advertising space with in the communities.

The engagement with the local communities is an investment that a hospital should not think twice about. It brings returns much faster than big ticket advertising and fancy launch parties. It also costs a lot less.

All it takes is dogged persistance, patience and a bit of luck.

The images are sourced from www.flickr.com

The Marketing of a Doctor

Do doctors need Marketing ?

I have worked for more than 8 years in healthcare services Marketing and am yet to meet a doctor who says that he does not need Marketing support. The funny thing is that all of them believe that the Marketing team always does more for the next guy and all of them collectively believe that the Marketing team does very little work in the hospital!

Dr. Bharat Inder Singh a well known family physician in South Delhi and former colleague at Max Healthcare, once told me that the only marketing he knows is putting a board outside his clinic and start treating patients well. Things have moved on since. Things really have moved on since.

I have learnt that while the hospital needs to quickly establish itself as a centre of excellence, the individual doctors are the most important element in the Marketing of a hospital. In the early phase of a hospital it is mostly the doctors who will draw new patients largely from the pool of patients they have treated earlier. While this may last as a steady stream for a few months, this stream of patients will never be adequate to sustain a new hospital. Thus doctors need to get involved in the Marketing of themselves. The Marketing team's task is to create opportunities of engagement of these doctors with potential patients, referring doctors and increasingly HR managers in large corporates. In this post I will examine the role of the doctors and the medical teams in connecting with the referring physicians.

The success of this effort is largely based on how well this collaboration between a doctor and the Marketing team works.

A doctor, who has joined a new hospital needs to understand that it will take some time for the patients to start trickling in. I have known many a doctor who are extremely chary of going in the 'field' with the sales team. This is somehow considered to be infra-dig. They would much rather be in the hospital and wait for the patients to materialise. Some would rely on expensive advertising rather than 'soiling their hands' with the sales folks, asking for patient referrals.

Rarely has this approach succeeded in generating patient traffic.

Most successful doctors know that their is no shortcut to success. Customers today have choices and those who go out to engage with customers, the local populace and the referring doctors stand a much greater chance of building a thriving practice. They also know one simple truth...there is no shame in asking people to visit them if they need help or taking out a prominent local doctor for dinner to get to know him better and build a relationship, which will culminate in patient referrals.

Continuing Medcal Education (CME) programs generally a euphemism for an evening do, involving local physicians (or those of a particular speciality) are common. These provide a platform for a set of doctors usually from a hospital to engage with local outside doctors. In my experience these are necessary in the initial phases to introduce a set of hospital doctors to referring doctors. It is rare that on these occasions a relationship can be forged, which will culminate in patients for the hospital. The next stage of engagement is generally with a smaller group of doctors (10-12) over cocktails and dinner. Finally the sales team will get the hospital doctors to meet referring physicians one on one. It is of utmost importance that a relationship is established between the doctors themselves. Patient referrals follow automatically.

Once patient referrals start, the hospital doctors must keep the referring doctor in the loop. A thank you letter, a phone call informing of the patient's progress can go a long way in cementing the budding relationship. The sales team's role here is to ensure that nothing slips between the cracks and they usually facilitate the communication between the hospital doctors and the referring physicians.

Medical conferences, paper presentations, academic newsletters also help in establishing the hospital doctor's credibility. It is important that the referring doctors be fully aware of the capabilities of the doctors they are refrring their patients to. The conferences also serve as a networking platform for all the doctors.

While all these help get patients for the first time, a doctor will start referring patients on a continuous basis only once he develops confidence in the doctor he is referring patients to. This can only happen when the medical outcomes are good, the patient has a great experience in the hospital and the communication channels between the referring and the referred doctors are working well. I have known of a hospital, where an orthopaedic surgeon and a laparoscopic GI surgeon will happily get patients from the referring doctors, while the cardiologists and the cardiac surgeons will endlessly struggle. The reasons for this were not far to seek. The medical outcomes in cardiology and cardiac surgery were not as good as those in other areas, the doctors hardly ever communicated and the reasons for poor outcomes were always swept under the carpet. I am afraid the situation in this hospital is unlikely to improve unless the core problem is acknowledged and fixed.

At the end of the day the sales team is just as good as the weakest link in the medical delivery team.

The Role of Referral Fee in Healthcare Marketing

Referral Fee has always been one of the most controversial issue in the Marketing of Healthcare Services in India.
Large tertiary care hospitals derive much of their revenue from patients who are admitted in the hospital. The revenue comes from the room rent (that the hospital charges from the patients), the surgical fee, the anaesthetist’s fee, the Operating room charges, the investigations that the patients need during their stay in the hospital and the medicines and other sundry consumables that are used by the patients.
Patients who need admission rarely walk into the hospital requesting admission. They generally come through the Emergency Room (the ER) or are referred by their family physicians or other specialists who practice outside the hospital. Many a times patients are also referred by smaller secondary care hospitals or nursing homes.
Quite often the large tertiary care hospitals find themselves wooing these individual family physicians, specialists and smaller nursing homes. The wooing may take the form of a well defined relationship program, which may entail engaging the referring doctors by offering them ‘visiting rights’, free passes for CME’s (Continuing Medical Education Programs), junkets abroad mostly in the guise of International Conferences, subscription to prestigious medical journals (usually quite expensive) and lavish dinners and entertainment.
More often than not the hospitals today offer a cash payout to these doctors usually a percentage of the bill the referred patient runs up in the hospital. This payout is called the ‘referral fee’.
The referral fee is looked down upon by most hospitals. In my conversation with senior doctors and sundry hospital CEO’s I have always noticed the sneering tone in which the ‘other’ hospitals are always derided for its questionable practices. It is always like ‘everyone does it except us’. I have had the occasion to sit in meetings after meetings (usually of start up hospitals) where hospital policy is enunciated in high falutin language and the referral fee is trashed as an ‘unethical practice’, which our hospital will never resort to. Usually 6 months or less into operations the reality of referral fee raises its head and suddenly it becomes alright to pay, mostly because the other hospital across the city does it all the time.
The CEO who had almost sacked the Sales Head for suggesting Referral Fee as an option for driving sales is discreetly instructed to figur out a way to offer the fee to referring doctors. Issues regarding keeping a track of ‘referred patients’ and their bills , the network of doctors to be paid off and the exact mechanism of the payoff are discussed and finalised. The money begins to flow. All this is of course very hush hush and in public the stance always is that we have nothing to do with such reprehensible practices.
The question that really begs an answer is whether this practice is really as obnoxious as it is made out to be?
Let us examine this issue from the customer’s perspective. I as a customer would trust my family doctor to refer me to a hospital, which he thinks will provide me the best care. To send me to any other place for commercial or any other reason is clearly wrong. By doing so my family physician breaches my trust.
However, will I still object if my doctor refers me to a hospital, which he genuinely feels is the best for me and also gets paid for it? I would probably be not bothered about this kind of financial arrangement between my family physcian and the hospital.
Now if the hospital was to offer me a discount, which is equivalent to the doctor’s commission, will I still not object. Will I be okay if the hospital was to inflate its pricing by 10%, which is supposed to be paid to my doctor. The answer would be a most emphatic NO. Why should I end up paying a heftier hospital bill just because my family doctor sent me to the right hospital?
How can one be sure that a Family Physician will not end up sending a patient to a hospital, which pays him the most? It is mostly upto his conscience. The referral fee will be an inducement for at least some doctors to refer patients to a hospital, which may really not be best for him. This unfortunately my friends in the world of medicine vehemently deny. Unfortunately as long as the perinicious system of referral fee remains there is no way of ensuring that a patient will not deliberately be referred to a hospital, which may not be the best for him.
Thus I believe that the Referral Fee should not have any place in the practice of medicine. Hospitals succumbing to this practice because of pressure for early profits from their stakeholders must stand firm.The healthcare industry needs to self regulate. Maybe the government should set up a regulatory body with real powers to check and discourage these practices.
As far as patients are concerned they must encourage their family physicians to offer them choices, check out the referred doctor’s credentials and the infrastructure available at the referred hospital. Blind trust in the matter of ones health can turn out to be quite perilous.