The Search for Strategy:
Lessons from the Front Lines
Kathleen L. Lewton, MHA, Fellow PRSA
Steven V. Seekins, MPA, Fellow PRSA
Lewton,Seekins&Trester
AAMC Group on Institutional Advancement
March 27, 2009
Today, it seems it’s all about
TACTICS
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Blogs
Podcasts
Social media
DTC ads
PR
SOCIAL Media
Websites
“Webinars
Buzz marketing
And social media
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Brochures
Celeb spokespersons
Special events
Social Media
Billboards
Mobile vans
Refrigerator magnets!
SOCIAL MEDIA
SOCIAL MEDIA
SOCIAL MEDIA . . . . .
But as Sun Tzu wisely said:
“Tactics without strategy is
the noise before defeat.”
Of course he also said:
“Strategy without tactics is the
slowest route to victory”
But without a chicken, there will never be any eggs.
We aren’t anti-tactic.
We’re just pro-strategy,
as the foundation for successful tactical execution.
So today, in this room . . . .
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There will be no talk of Twitter
There will be no focus on Facebook
Or My Space (or YOUR space)
Or any other tactics du jour
• “Blogs are SO yesterday”
• “Facebook – all the old people are on it”
• And Twitter . . . . . . . .
These are serious times
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And getting grimmer
We selected this topic long before October
2008 . . . .
But now, with the economy in tatters, it’s
even less sensible to talk of tweeting
The pundits say healthcare is recessionproof . . . . . not what we’re hearing from
CEOs and CMOs and CPROs
Our E-inboxes read like this:
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“Navigant just told the CEO I have 50%
more staff than I need – HELP –
benchmarks, quick!”
“I can hit my budget cut targets if I just
dump our advertising in Q 3 and 4 . . . . but
then what do I do next year?”
“I know I can’t say I won’t make cuts – or
can’t – but I have no idea what I should
keep, or if there are better ways to do what
we’re doing.”
“WHICH staff are essential?”
And from an AMC CEO:

“No one on my team of institutional
advancement people can seem to figure out
a strategic game plan to help us hunker
down and survive – they’re all arguing about
which area is more important, and why they
need more budget. When can you get
here?”
The news is bleak and
AMCs are particularly hard hit
Everything that impacts a “regular” hospital,
plus:
 State budget cuts
 Research dollars drying up
 Disproportionate share of charity care
 High expectations
 Demanding faculty
 Government policy oversight
And so, the CEOs turn to:
Marketing – more patients, more volume
with better payer mix
 Development – more donors, bigger
contributions, and QUICK!
 PR – no crises, better coverage, higher
rankings
 Alumni – make ‘em happy so they give
more money . . . . . .
And could you all do this with fewer resources,
please??

And right now, unfortunately, our
reputations are at an all-time low
How much do you trust businesses and
organizations in this sector to do what is
right?
2008
2009
Healthcare
58%
42%
Pharma
52%
42%

Informed U.S. residents, Edelman Trust Barometer study
The good news??
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We’re rated higher than banks and
automakers
But BELOW retail, technology and
consumer product manufacturers
And for first time ever, we’re on same level
with pharma industry
Other findings: Few information
sources are seen as credible
Analysts
Biz mags
Friends/peers &
Company employees
Media stories
Free Internet portals
Corporate sources
Other blogs
Social media
Ads
47%
44%
40%
36%
27%
19-26%
16%
15%
13%
And yet the hunt is still on . . .
For that magic bullet
 Q: How many conferences, webinars,
seminars and teleconferences are there on
Social Media? (A:4,258)
 The hype seems to overtake reality
 Witness the “Obama won via the Internet”
myth
Obama team,
2 hours post-Grant Park:

“It was our grassroots strategy that made
the difference”
• Note: Strategy
• Note: Traditional grassroots
• Note: Internet was a tactic they used as part of
the core strategy
• BUT there’s something in the DNA of marketing
and related disciplines that seems to make us
focus on what’s new, what’s hot – because who
wants to do the old basics?
Reality: In a time of chaos,
sustainable strategies are essential
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So let’s begin at the beginning . . . .and
ground our discussion in a core reality
Patients are at the center of our enterprise
Without them:
•
•
•
•
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No revenues
No clinical trials
No education
No us
And yet there’s more misinformation about
the patient audience than nearly subject in
healthcare
How do people think we
attract patients?
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Marketing
Advertising
Ratings and rankings
Gorgeous facilities
Glitzier websites
Direct mail
What else?
The reality:
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Where do you go for information &
recommendations on what hospital to
use when you need a procedure?
My doctor
Another doctor
Friends/family
Health plan
Internet
Media
74%
15%
10%
7%
2.5%
2%
Ctr. for Health System Change - 9,400 households
The reality:
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Where do you go for information &
recommendations on selecting a specialist?
My PCP
Friends/family
Another doctor
Health plan
Internet
Media
69%
20%
18%
10.5%
6.8%
 4%
AND:
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Where do you go for information &
recommendations on selecting a primary
care doctor?
Friends/family
50%
Another doctor,
health professional
38%
Health plan
35%
Internet
10.8%
Media
 7%
AND . . . .
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While it varies by market, generally 80-90%
of consumers say they already have a PCP
So do the math:
• Specialists and PCPs drive hospital choice,
Internet/media, etc., are barely considered
• PCPs drive specialist choice
• And of those approx. 15% of consumers are
looking for a doctor, fewer than 10% use Internet
or media sources for information or guidance
The implications for strategy?
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Physician recruitment, retention, relations
and referrals are critical
Word of mouth – from friends and family – is
also important, which means that . . . .
Patient satisfaction is essential, to drive
word of mouth and impact physicians
The implications for strategy:

And reputation management matters –
because affects all of the preceding, plus:
• Employee recruitment, retention, performance
and morale
• Ditto physicians, faculty
• Drives donations, grants, alumni support
• Attracts partnerships and alliances
• Supports or undercuts promotional efforts to
build market share (Good service/bad hospital
vs halo)
• Plays a role in decisions by managed care
companies, foundations and more . . . . .
LS&T’s recommendations for
Sustainable Strategies
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Build the foundation: a strong and
enduring institutional reputation that can
withstand crises and support other all
advancement functions
Focus on superlative performance of our
core work: care and caring for patients
Create a highly satisfied and motivated
workforce
Build powerful relationships with those who
bring the patients, do the teaching and
conduct the research
Strategy 1: Reputation Matters
Reputation is real – and has impact

Today we’re going to look at:
• How reputations are built, nurtured and
managed
• Why it needs to be an INTEGRATED process
• How a strong reputation helps an organization
survive a crisis
First, a sampler of crises past and present. . .
Mt. Sinai New York 2002
“On top of the fiscal mess came the death of a man
who had donated part of his liver in January 2002 .
. . . .a state investigation found “woefully
inadequate care . . . . Violations in 80 of 195
complaints patients had brought . . . . .The sum
of it all has been a crisis of spirit.”
“Today, most worrisome are the occupancy numbers.”
New York Times
Tenet 2003
“Amid widespread media coverage, Tenet said
patient volume had declined 20 to 30%
since the start of the investigation.”
Modern Healthcare
Duke 2003
“A Death at Duke
“In the future, we can expect more publicity after
major errors in medical care, especially when
communication breaks down and trust is lost.”
New England Journal of Medicine 3/20/03
“Ms Santillan’s plight also tarnished to some degree
the reputation of one of the nation’s most renowned
hospitals.”
NY Times 2/22/03
And in just past six months . . .
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$13.5 awarded in hospital death; Jury faults
doctors at Dana-Farber (Boston Globe)
• “Dana-Farber did not issue an apology”
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Immigrants Facing Deportation by U.S.
Hospitals (New York Times)
• “Sister Margaret McBride, vice president for mission
services at St. Joseph’s in Phoenix, which is part of
Catholic Healthcare West, said families were rarely happy
about the hospital’s decision to repatriate their relatives.
But, she added, “We don’t require consent from the
family.”
And . . . . . .
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Top Psychiatrist Didn’t Report Drug Makers’ Pay
(New York Times)
• “Repeatedly assured by Dr. Nemeroff that he
had not exceeded the limit, Emory did nothing.”
And (truly) that just skims the surface
Reputation matters
“If you lose money for the firm, I will be very
understanding. If you lose reputation for
the firm, I will be ruthless.”
Warren Buffett
to Salomon Brothers employees
Warren Buffet
To Salomon Brothers employees
Reputation can be managed
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Every organization HAS a reputation, even
if no one knows what it is or tries to manage
it
Reputations can be created and nurtured,
repaired and restored, managed and
monitored
And reputations can be damaged by poorly
managed crises
The Reputation Equation
Reputation = Perception
Perception = Reality + Awareness
Reality = E2
Personal Experience +
Trusted Endorsements
In healthcare, E2 rules
because reality reigns
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Promotion aside, the truth is that reality (as
interpreted by personal experience and
trusted sources) dictates patients’ choice in
healthcare
Promotion can build awareness and amplify
the reputation, but it can’t override nor
create reality
The HCO reputation
management track record: C
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And AMCs have often done even worse
HCOs have the prerequisites for positive reputation
given their lifesaving work and AMCs have even
more assets including high profile brand names
• Always assumed favorable reputations as a “given”
• Many did not actively work to sustain reputation based on
performance
• Many focused more on promotion

HCOs prone to crises
• And many high profile crises have been handled badly at
AMCs
Flash forward to 2009:
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All health care, all the time – and clearly
Obama intends to keep it front & center
Every sector is seen as a villain or potential
villain (MDs, Rx, HMOs and yes, HCOs)
• And we all provide enough fodder to make the
concerns realistic
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The transition from white hat to black hat
continues (nurses are tarnish exempt)
And the public doesn’t know who or what to
trust
This is significant because
without trust . . .
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The bond that is essential for human service
organizations broken
The impact can be massive
•
•
•
•
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From clinical outcomes
To philanthropic support
To over and re-regulation
To patients not trusting caregivers
So the time for reputation management is
now!
A good reputation
is like money in the bank
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A solid reality-based reputation means the
AMC has full account in the goodwill bank
So when crises occur, as they will and do,
the AMC’s reputation destroyed
• But if the goodwill bank is empty, damage can
be lethal

Managing the crisis effectively will keep that
reputation and the bank account intact
• Alternatively, if the crisis is not managed
effectively, even a big bank account can be
overdrawn
Building Reputation:
The Basics
1. An integrated process
2. The ARM Approach:
Audience identification
Audience research
Message development
3. Effective crisis management
The AMC reputation in a complex universe
Donors, grantors
Prospective
employees,
faculty
Influencers
Employees
Patients
Residents,
students
Families/
Visitors
Reputation
Government Referring MDs,
Faculty
Alumni
health pro’s
Volunteers
Community
Media
Reputation Basic # 1:
An Integrated Process
Reputation Basic #1–
An integrated process
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Managing reputation requires an integrated
approach involving multiple functions:
•
•
•
•
•
•
•
PR
Marketing
Alumni
Development
Employee relations
Physician relations
And . . . . .
An integrated reputation plan
 fighting for CONTROL
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It does require a collaborative, inclusive
team approach
• Get the right people at the table – someone has
to make the first move
• Focus on institutional goals
• Build consensus on on master audience list
• Use research data to:
–
–
–
–
Identify current communications channels
Identify appropriate messages
Shape strategies and tactics
And settle disputes
Above all else, set clear,
measurable objectives

If we are clear on the desired outcome, we
can figure out the key audiences and how to
move them to action
• SO, why do we need this ad/brochure/campaign?
–
–
–
–
–
Increase “awareness” – why? To what end?
Increase volume of procedures
Increase inquiries as first step to an appointment
Change perceptions of poor quality
Increase donations, employment applications, physician
referrals, etc.
Once we know the objective . .
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We can create a plan with an outcome that
can be tracked, monitored and measured
And measurement is critical
• Not everything can be measured precisely, but
most things can be counted
–
–
–
–
Calls, inquiries
Appointments  admissions  revenues
Changes in awareness, perceptions
Donations
The KEY question:
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What do we want this
audience/individual to DO?
From there, we can develop:
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Core messages and messages tailored by
audience
Clearly identified tactics, many that will
reach multiple audiences
• Edelman study found that 60% say they need to
hear messages at least 3-5 times, from multiple
sources, for credibility (10% say 6 times or
more)
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Implementation responsibilities based on
expertise, experience and interest
Then execute
(the plan, not each other)
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Goal is to ensure no audience is overlooked
or ignored
And that there’s no duplication of effort
Build in monitoring and benchmarking
Keep the team together to track, make midcourse corrections, evaluate, revise plan
Reputation Basic # 2:
The Good Old-Fashioned
A.R.M. Approach
Reputation Basic #2:
The ARM Approach
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ARM = Audience, Research, Message
Works for all audiences, and for:
•
•
•
•
Reputation management
Donor communications
Alumni relations
Marketing, and more
ARM: Audiences:
Who ARE those guys?
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Before we can decide which audiences matter the
MOST when it comes to building, enhancing a
reputation, we first need the complete list
HCOs have a tendency to overlook some key
audiences (or not even realize they exist)
Those audiences that are on the radar screen are
often viewed too broadly, as large, homogenous
groups (“physicians”), when in reality they are
comprised of many subsegments
Start with:

Employees
• Current, retirees, past,
families

Physicians
• Faculty, voluntary
attendings, referrers,
potential referrers

Patients
• Current, former, families

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Governance
Payors
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Medical students,
residents, fellows
Med school alums
Donors, grantors
Non-MD referral
sources
Media
Community
• Civic, business leaders;
neighbors,
organizations
And don’t forget:
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Volunteers
Vendors
UNIVERSITY
• Faculty, staff,
students/families, alumni

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PETA et al
KOLs nationally
Associations

“Consumers”
• Many may be part of
another audience already
and thus are getting your
messages
• Important to consider
differences between
segments (age, ethnicity,
income/ education,
diagnosis, attitudes,
healthstyles, gender) and
when/how to segment
even further (not all
“women” share same
concerns, issues, needs)
While all audiences matter . . . .

Some are either lethal weapons or can be your
advanced life support when it comes to reputation,
especially in crises, because they speak from
personal experience
•
•
•
•
•
•
•
•
Employees
Patients
Physicians
Employees
Patients
Employees
Physicians
Employees . . . . . .
Three key audience questions:
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The marketing questions:
• Q 1: Who makes the final decision?
• Q 2: Who impacts the decision?

The reputation question:
• Q 3: How will other audiences react?
Q1:
Who makes the final decision?
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
The myth of the “empowered consumer”
Empowered? Yes, . . . and no
• Some are, many are not
• Even web searchers download the articles and
take them to “my doctor”
• Only 31% of heavy users (over 65) go online
• Hospital choice -- “where my doctor goes”
• Sophistication overrated -- witness the demise of
whole-body scan centers
Consumer role varies widely
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Decision maker – sometimes, when there
are no constraints
Active participant – the self-confident
Influencer – asks question, expresses self
Order taker – many still are, limited by:
• My doctor only prescribes, my doctor only
practices at . . . .
• My insurer only covers, my insurer only pays full
price for . . . .
In general:

The more sophisticated the decision, the
less confidence the consumer has
• Choosing an ortho surgeon vs. demanding a
specific brand of hip implant

It’s important to know what factors impact
YOUR consumer audience
• CEOs/administrators/marketers tend to
overestimate consumer “empowerment”
• Doctors tend to underestimate it
• To know for sure is to ask, via research
Q2: Who influences decision?

Potential patients are influenced by the
doctor, of course
• But also the office nurse, the PT, other HCPs
• The insurer, both directly and indirectly
• Advocacy groups (depending on Dx), clergy,
other trusted sources
• Still overlooked too often: FRIENDS & FAMILY
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Donors influenced by peers, reputation
Doctors influenced by patients, KOLs
Slogging through the audience
ID process can be a struggle


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Too often service line managers and
product marketers want to default to
consumer promotion
Identifying who really makes and impacts
decision can be like peeling an onion -takes a while and can be painful
BUT focusing on the wrong audience -- or
ignoring a key participant -- can lead to “less
than success”
Q3:
How will other audiences react?
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Never forget that any marketing or
organizational decision is observed by “nontargets”
Messages are overheard and can be
misunderstood unless the impact on these
audiences is considered
The patient who is a donor, the doctor who’s
the parent of a potential student . . . .
Above all else, key audiences
must not only know you . . . . .
But also must love you (or at least like or
respect you)
 That means building relationships
 And that process begins with understanding
the audience
 And that means research
ARM: Research helps us
discover:



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Who are our stakeholders (audiences) –
what are they like?
What do they know and feel about us now?
What do we need to tell them to build
awareness, credibility, support (message)?
How do we reach and motivate them
(strategies and tactics)
Audience research is the core
of reputation management

You can’t start creating messages without
knowing what stakeholders
•
•
•
•
•
•
Know
Believe
Feel
Want/ don’t want
Need
Value
Research has special role
in HCO and AMC setting . . . . .



Because the decision-makers are data
driven (H1)
Because it provides a benchmark against
which to measure
Because it provides a road map for each
stakeholder group
• What messages work, don’t work
Research shapes strategy,
provides essential insights

The 3 A’s of research: Don’t Assume, don’t
Adapt – ASK
• “Oh we KNOW how they feel”
• “They did this in Birmingham”
• “It worked for Coke”

Research not only provides insight into
target audience, but also creates
benchmark against which to measure
The methodology mix:

Consumer research -- the more qualitative,
the better
• Surveys -- hard #s, but no context, nuance
• Focus groups and personal interviews allow you
to probe, ask why and what if

What you want to know:
•
•
•
•
What they know and how they know it
How they receive and process information
What they care about, worry about
Who & what impacts healthcare decisions
The methodology mix:

Physician research -- hard to come by, but
invaluable
• Key questions: how do you get info (channels),
who do you trust, what do you believe
• Check the “surroundsound” effect -- who also
plays a role in MD decisions
• Personal interviews help avoid the “mob effect”
in MD focus groups
The ideal methodology mix:
• Focus groups and personal interviews
↓
INSIGHTS
• Surveys (phone, online, intercept)
↓
DATA
• Focus groups and personal interview
↓
CLARITY
And the core research program
should also include:
Employee attitude/opinion studies
 Ditto for physicians/faculty
 Routine consumer awareness/preference
benchmarks as well as major studies
 Referring physician/provider surveys
 Community/opinion leader perception audits
 Multi-faceted patient satisfaction program
And all of this data helps us develop
MESSAGES!!!

ARM: Oh, yeah, the MESSAGE
(we’ll get to that after we decide on ads vs. Twitter vs.
stadium signage)
The reason many communications
campaigns fail is simply because the
message doesn’t work, for one of four
basic reasons:
•
•
•
•
They don’t understand it (Comprehension)
They don’t believe it (Credibility)
They don’t care about it (Relevance)
It doesn’t touch their emotions (Resonance)
C2, R2
Comprehension –
do they get it?

HCOs are huge abusers of jargon
• Acronyms, science terms, insider info (Magnet)


And we pile on the FACTS, FACTS, FACTS
And we often rely on print channels when
the “average” consumer audience includes:
•
•
•
•
Illiterates
Semi-literate
Anti-literate
Poor vision, hearing
Credibility –
do they believe it?




Overpromising, directly or indirectly
Overendorsing
Overqualifying
Overhyping things that have no inherent
credibility to the average consumer
• Ratings, rankings
• Awards
• Credentials that are unintelligble to the
consumer (FANA, FACHE, CRRRRRRT, etc.)
Relevance –
does it matter to THEM?

Do they care about:
• Service or product or procedure they figure
they’ll never ever need or use
• Who manufacturers anesthesia equipment
• Lots of high tech terms
• Hospital that’s two hours away
• We, us, our . . . . . . . all about YOUR assets
rather than their real-life needs and how they will
benefit
Resonance –
does it touch their feelings?

For a message to move audience to action,
it has to touch heads and hearts
• Real people with real stories
• Showing rather than telling
• Don’t be afraid of what we think of as the same
old types of words and visual images IF they
resonate with your audience
Only one way to ensure
messages will work

Test, test, test
• In your market(s)
• With your target audienceS
• With a talented moderator/interviewer who can
play word games

And remember, when asked what’s
important in terms of corporate reputation,
91% of Edelman respondents said
“companies that can be trusted
communicate frequently and honestly”
Reputation Basic # 3:
Effective Crisis Management
CPR =
Advanced media relations

It’s not “if” a crisis happens – it’s when and
how soon and how BAD is it
• Medical errors are inevitable
• Patients/families now understand why and how
to take their stories public
• AMCs still seem to be caught off guard, to
respond with arrogance and reinforce preexisting negative stereotypes
And CPR is needed because:

It’s life or death
• Media coverage is instant
• Web coverage is instant-er

The outcomes are critical
• Litigation
• Damage to reputation
• Loss of confidence among patients, physicians
and EMPLOYEES
• Loss of productivity
• Undercut all your marketing efforts
When the crisis comes,
it is a CRISIS

Crisis PR may be only 2% of a PR job, but it
can often be make or break
• Reputation can be irrevocably damaged – not by
the medical or institutional mistake, but by how
the institution reacts and responds
• The public WILL forgive mistakes – but NOT
dishonest, disingenousness, arrogance
Some make CPR sound simple

But it’s not
• No cookie cutter approach that works in every
case
• A plan is only a piece of paper without
institutional buy-in and people with experience
and judgment to execute
• Situations can be anticipated, but real life can be
different
• It‘s about people – unpredictable people – and in
health care, it’s about life/death
It begins with a mindset





Strategic communications process in place
Full buy-in of senior management
CPRO part of senior management team
Detailed operational plan
Pre-existing conditions: strong credibility
and good relationships with media
And also requires:


Effective internal and stakeholder
communications channels already in place
and fully road tested
Spokespersons already trained and tested
• One MUST be an MD, ideally not the CEO

And a full account in the goodwill bank
What organizations want from
PR: The 4 C’s
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In a Crisis, CEOs want Calm Counsel from
their in-house team and consultants
• Our collective wisdom abased on accumulated
experience
• Our third party objective viewpoint –
unemotional, providing clear guidance based on
expertise
• Arms, legs and warp speed communications
counsel and tactics that can turn things around
What’s needed
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A team that will help management
• Moderate their emotional responses, so anger,
fear or bitterness don’t drive decisions
• Face facts with straight talk, even if it’s not what
senior management wants to hear
• Keep all the balls in the air – remember the
things they may forget
• Put out the fire AND keep the plane in the air
and headed to its destination
And there are two responses to
managing crisis comms:
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Utopia: there’s a plan, and the crisis fits
the plan
Reality: the crisis is a unique little firestorm
.....
BUT the institution is prepared with all the
tools in place AND has rehearsed via
scenario drills
The Basics:
Anticipate and Rehearse
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Issues anticipation
• The predictable and generic
• The “that could be US” opportunities
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Routinely (at least quarterly) put the team
through a crisis drill with a scenario “torn
from the headlines”
Scenario drills deliver
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“Working” these issues provides ideal time
to:
• Kill the “no comment” mentality
• Try out spokespersons and decision-makers –
role play
• Confront the “WE DON’T MAKE MISTAKES
LIKE THAT” mentality
• Thrash things out with legal in advance
CPR: The crisis is NOW
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When the crisis happens, the first pulse to
take is your own
Bring in outside counsel
• Internal staff simply cannot be objective and
immune to emotion
• Outside counsel can confront CEO, MDs, angry
Board chairman, et al
CPR: The crisis is NOW
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The message must:
• Focus on the harmed party – NOT “we”
• Be utterly candid – “I don’t know that now” is OK,
no comment is not
• Begin with statement of compassion
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Know how to apologize or at least express
regret
• Accept blame if an error has been made
– Assume there WILL be a lawsuit someday
– Worry about court of public opinion NOW
CPR: The crisis is NOW
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Get to your internal audiences BEFORE
they see the coverage and stay in touch
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Employees
Board, governance
Physicians
KEY community opinion leaders
Patients, past patients
Stay below radar – e/vmail, CEO phone
calls, employee meetings – but assume
everything will go public
USE your website!!!!
CPR: The crisis is NOW
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Monitor media coverage – correct rumors or
misinformation
Monitor public opinion, formally and
informally
Know when to go back to “normal” mode
Make sure management is still flying the
plane!
It’s now a brand new world
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The medical error issue will not go away,
even without cases like Jessica
“Inappropriate” deaths are inevitable and
unavoidable, as are all kinds of other errors
Media smell blood in the water
HCOs that are deficient in good patient
relationship skills increase the likelihood of
family going public
Strategy 2:
Superlative performance of our core work
Our core work:
Patient care and caring
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Reputation is built on reality (remember the
equation)
And reality means how we perform, how we do our
work, how we take care of and build relationships
with our core stakeholders, beginning with patient
care
• Promotion is an important part of burnishing reputation
because it builds awareness – but the foundation is
performance
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So marketing/PR must be integrally involved in
organizational performance, not just relegated to
promotion or communications
Patient satisfaction
(still a work in progress according to HCAPS)
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Patients are “expert endorsers,” and their opinions
are based on their experiences
Thus, their satisfaction is essential in terms of
shaping reputation and driving word-of-mouth
endorsements
Management of function requires group effort
• PR/marketing should support/staff the function to ensure
that data is translated into action
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Requires coordination with all operating units –
rarely does a problem have a single owner
Patient satisfaction is a
mission, not a program
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A question of culture – starts with the “quest
for excellence”
Quality care and optimal outcomes require
satisfying patients.
• There are strong correlations between patient
satisfaction and clinical performance, and patient
satisfaction and outcomes
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Red flag:
In Health Leaders survey, CEOs ranked
customer satisfaction as 10th out of 14 top
priorities – but marketers rated it as #1
function gaining importance
The marketing/public relations
role begins at the top
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Marketing/PR officer often needs to help make the
case for culture change
First, the CEO; then tackle the rest of the gang:
• Bring data
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Ongoing phone surveys (core benchmarking tactic)
Quick response feedback system
Focus groups
Expectation/gap analysis
Print survey, primarily for good will
• Bring strategy, models and tools
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If you have a crisis, leverage it
If you don’t have a crisis
• Lead by inspiration
• Model the competition
The marketing/public relations
role also includes:
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Culture management
Keep the platform burning
Provide measurement tools
• Manage the survey
• Shoppers
• Other feedback mechanisms (Web, callbacks)
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Spread the message
• Successes AND failures/challenges
• Metrics outcomes and benchmarks
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Keep it on top management’s agenda
Make it stick - even though you’re
big, complex & decentralized
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Clear vision, definitions and standards
New processes to support new cultures
• HR policies and practices critical
• Reliable tracking systems
• Accountability mechanisms
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Disciplined, methodical rollout plan with
standardized communications
Benchmark against AMC peers AND your own
market competition
The Ritz-Carlton Formula
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Make management visible
Imprint the standards
Lineups: everyday, everyone (more on that)
Put employee satisfaction first
Strategy 3:
Create a motivated workforce
#2 Create a highly satisfied and
motivated workforce
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A core sustainable strategy because:
• Employee behavior drives QUALITY, patient
satisfaction, market share (and cost
containment, etc.)
• Employees can support or undercut all
messages to other stakeholders
• RED FLAG:
• CEOs rated this #14 out of 14 top priorities for
next three years, marketers rated it 7 out of 10
– Too important to be left to HR or medical education
– Marketing, PR, alumni relations experts need to be
involved in a collaborative effort
Workforce communications
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Requires multiple channels
• Education/literacy variations
• Employee preferences
• Repetition important
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Face to face with supervisor remains #1
preferred channel
• Publications, e-mail, videos, etc., can be used to
reinforce, explain details
The Huddle: A breakthrough
communications tool
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Systematic process for assuring
group discussions every day
Case in point: Oakwood Healthcare,
Detroit MI
The VanRinsven
formula for victory
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Hire right
Do “onboarding” by top leadership in person
Create “emotional engagement”
Show employees AND physicians that an
environment of engagement is in THEIR
best interest
Strategy 4:
Build powerful MD relationships
Physicians matter in many ways
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REMEMBER THE STUDY: They DELIVER
the patients
Physician opinion vital in maintaining
reputation
AMCs often take a pieces/parts approach to
MD relationships: very fragmented in terms
of responsibility for managing
• Many people can be involved, but someone has
to own responsibility for the process
Physician relationships
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Must be based on MDs #1 concern:
RESPECT
Must be driven from the top down
Walking the talk is critical
Most MDs, when asked carefully, will admit
don’t want ultimate, total control – but they
absolutely DO want input, to be listened to
Physician communications 10.0
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Brutally brief
Actionable
RELEVANT
In the format THEY choose
• Maybe combination of email, blast FAX and yes, even
snail mail
• We NEED them to get the info
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Peer to peer is critical for credibility
And they still want the respect of face to face time
with admins
And the old standby – repetition – is absolutely
critical with this audience
Two special challenges:
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Referring physician relationships:
• Referring physician study rated AMC X as best
in specific specialty
• Yet #4 of 5 in terms of “where I refer my
patients.” WHY? Poor treatment of referrers.
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Alumni support (or lack of)
• Those residents . . . are transformed into the
doctors who rate and rank
• Most want to be proud of their alma mater – so
keep them informed, give them fodder to brag
about
When you put it all together:
Start with a powerful, positive reputation =
core of institutional advancement
+ Motivated workforce that delivers quality and
efficiency and patient care/caring
+ Engaged physicians who deliver patients
and clinical quality =
Satisfied patients who deliver positive word-ofmouth endorsements that enhance AMC’s
powerful, positive reputation . . . . .
Stay in touch
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We welcome phone or email questions and
dialogue
Klewton@LSTLLC.com 917 734 5376
Sseekins@LSTLLC.com 818 378 6664
Extra Credit:
Community relations still matters
Well executed CR efforts can truly
differentiate the AMC from competitor
and/OR help repair a reputation
Out there in the community, are:
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Our patients and potential patients
Our employees and their families
Our physicians and donors
All the people who can say yea or nay about us
CR is an area long ignored by most HCOs and a lot
of AMCs because it seems “old-fashioned”
• It isn’t Twitter but it is critically important in times of
shrinking resources
• When we go to the legislature for support, we want our
community behind us
It’s back to our roots
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“Hospitals exist with the tacit permission of
the communities they serve”
And the only force that ever stopped the
WalMart juggernaut was organized
community opposition
So it’s time for total immersion in the
community, building trust by being there,
being credible and demonstrating caring
Back to the very basics
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Relationships put a face on the organization, we
personalize it
• It’s harder to dislike organizations where you know the
people
• And in crises, people who know you tend to believe you
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CR should be seen as a primary PR function – NOT
as an add on to someone else’s job
Not budget intensive when compared to other
functions, but it does take staffing
• Takes commitment from senior management – personal
time commitment
CR 101 begins with the basics
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Advisory Boards are foundational strategy
• IF you use them effectively
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Have a role and goal
Cast a broad net
Create a solid structure
Listen – and then respond
Make them “insiders”
Use them as loyal advocates
And the old stand-bys
still work!
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The All NEW Speakers Bureau
• Give it a jazzy name, a logo, a brochure, a
champion and you’ve got SB for a new decade
• AMCs have what consumers want: nice smart
people who know a lot about health care and
community organizations podium, audiences
– Seek out platforms that match marketing strategy
– Prep and train speakers, send out with our core
messages
– Evaluate and monitor
– Seize the day – breaking news
And the old stand-bys
still work!
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Bring ‘em in – AMCs fascinate the public
And there are other ways to get the
consumers into you facility
Offer free meeting space – and tack on a
mini-tour to one of your hot service lines
For target audiences, supplement the (well
trained and monitored) tour guide with a
physician in a hot specialty
Outsiders IN:
The Influentials Program
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Invite the right people -- create a powerful
database
• Yes, the usual suspects (mayor, council, C of C,
biz CEOs) BUT go further
• Look at ALL segments of your community
(education, arts, social services, labor unions,
minority groups, etc.) and do the research to find
the leaders
• Who are people who can influence several
hundred other people?
– Clergy, activists, Junior League president, etc.
Insider influencers
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Treat influentials like the special people they are:
private, first-class dinner hosted by CEO, chairman
of the Board
Exciting presentation by compelling physician on a
hot or timely topic
After the party’s over . . . . . the work has just begun
• Frequent personal updates from CEO (letters, one-onones, etc.)
• “Insider” status – they hear the news FIRST
• Find ways to involve them based on their needs
• Mini-internships or “go alongs” can be very effective
Insiders Out:
The Ambassadors Program
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Community liaisons can be the best
communications channel ever!
• Takes time and careful management, but pays
huge dividends
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The true value of this program becomes
evident when you have a crisis and need to
get truth to the community
OR when you have an issue and need to
build grassroots support
Outside ambassadors
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Find the people in your AMC who know the
people out in the community
• Begin with audit of who’s involved in what – and
don’t just ask management
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Invite participation, outline role clearly,
provide incentives
• Most important incentive is feeling of
“contribution”
• “Ambassador” title and a plaque also help!
Outside ambassadors
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Liaisons’ primary role: LISTEN
• Early warning system for emerging issues or
anti-AMC sentiment
• Need easy mechanism for getting info and
feedback to PR
• Personalized facet of environmental scanning, to
add real life reality to the data
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When needed, liaisons can also deliver
messages – but must be done without
compromising their status in the group
Inside and Outside:
Partnerships
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Sponsorships -- $$ in return for a logo (one
among many) on a 5K Walk T-shirt
• ROI negligible
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Partnerships – long-term side-by-side
commitment that builds trust and
relationships
• You’re OUT THERE, being visible and credible
• Your people work side by side with other
community leaders
• The ultimate win/win
The Partnership Paradigm:
It takes hard work
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“Mission” goes real-time
Begin with the community’s need (not the
AMC’s agenda)
You may need to lead the community needs
assessment (which is a great position)
ID problems which can be solved at local
level
Focus on healthy communities
Partnership principles
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Pick the problems that you are most suited
to address
• The AMC can provide brains, or brawn or bucks
– or all three
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Find one or more appropriate partners
(generally local, but other sources can
support with funding – i.e., RX companies)
• Media outlets can be great partners – just be
equitable
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Manage the partnership like a business –
measurable objectives, biz plan, monitoring
and evaluation
And make sure the Board is
involved, too
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Board members are from and of the
community – built-in credibility
• Board CR Committee should take the lead
– Opinion leader visits, briefing lunches/breakfasts
• All Board members should have briefing cards
and info updated regularly
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And finally – don’t neglect health
education/prevention programs
• Whether inside out, or outside in, they impact
reputation and market share