Can University of Illinois Hospital Save Its Brand?

A decision by hospital leaders to participate in an advertising effort with an equipment vendor was intended to promote institutional expertise with robotic surgery. Instead it sparked an outcry among critics.

Despite the countless blog posts, tweets, and articles published about the University of Illinois Hospital & Health Sciences System's da Vinci advertisement controversy, I'm still left with one resounding question: How did so many high-ranking officials think featuring several physicians and staff in a medical device company-financed ad was a good idea?

To briefly recap, a full-page ad promoting da Vinci robotic surgery, and featuring a dozen U of I physicians and staff in white lab coats, ran in the January 19 issue of the New York Times Magazine. The hospital was not compensated by Intuitive, the medical device company that makes the da Vinci technology, for its staff members appearing in the ad, although several of its doctors had done consulting work for the company in the past. In fact, one surgeon received about $16,000 in the most recent one-year reporting period, the Chicago Tribune reported.

The hospital's decision to participate in the ad was intended to promote institutional expertise with robotic surgery. Instead it sparked an outcry among critics, none louder than former Beth Israel Deaconess Medical Center CEO Paul Levy, who called the hospital's ethics into question in a series of blistering blog posts.

Perhaps Enrico Benedetti, head of U of I's surgery department, said it best while debating the pros and cons of the ad in an email, obtained by the Tribune under the Freedom of Information Act: "On one side it would be a lot of free publicity for our program, on the other side we could be criticized to be included in an industry generated campaign."

And therein lies the rub—a hospital can promote its expertise with a specific medical device in a number of ways, so long as it is the hospital that pays for the ad.

"It is not unusual for health systems and medical centers to promote their use of a specific advanced technology, such as the 64-Slice CT for coronary angiography, Gamma Knife for applying image guided radiation to brain tumors, or the da Vinci Robot for minimally invasive robotic surgery. The ads typically promote the benefits of these newer technologies," Dan Dunlop, CEO of Jennings, a North Carolina-based healthcare marketing agency told me. I exchanged emails with Dunlop this week. "However," he wrote, "they don't cross the line of actually endorsing the product. They are typically presented as one treatment option that the institution has in its arsenal."

But by appearing to endorse the product, the U of I's sullied its ethical standing in public's perception.

"Ads where physicians appear to be endorsing commercial products may then call into question the motives of the physician when making a specific recommendation for treatment," Dunlop says. "In this case, is the physician recommending the Da Vinci because of a relationship with Intuitive or because it is the best course of treatment? Is the physician being compensated by Da Vinci for the endorsement? It is a slippery slope."

And though the fine print states that the hospital and its staff were not compensated for appearing in the advertisement, the fact that even one of the physicians had a previous financial relationship with Intuitive is enough to give the general public cause for concern.

So where does U of I, or any organization facing ethical criticism, go from here? Well, that depends on the strength of its brand foundation. An esteemed organization like the U of I "has a great deal of equity and trust built up with its brand constituents," Dunlop says.

"My belief is that this won't seriously erode that trust. This was an example of extremely bad judgment by a small group of physicians who have an existing relationship with the vendor they promoted," he says. "Without a doubt, the university will work swiftly to more clearly define the ways in which it handles relationships with commercial entities, to avoid any perception of undue influence upon its medical decision-making."

To their credit, U of I and Intuitive have since pulled the ads, and the university says it's running a thorough investigation to determine why so many senior leaders made a decision that was out of step with the organization's code of conduct.

"As a large and complex organization that adheres to high standards, the U of I is compelled to tell its public this fact: the University is run by fallible human beings," University spokesman Thomas Hardy acknowledged in a statement. "It is operated by people trying their best. We regret when those efforts fall short."

What I'll be looking to see, if the report's findings are made public, is if the university and hospital put a process in place to make sure marketing decisions like this don't slip through the ethical cracks again. And if they do, that's something every hospital and health system should take note of.

"In a large health system, mistakes are going to happen. On occasion, physicians are going to act independently in a manner that could negatively impact the image of the organization," Dunlop says. "The health system or university has to communicate clearly—and frequently—with its physicians and vendors that any communication of an endorsement, implied or otherwise, is a breach of university policy."

Unfortunately, in this case Benedetti and the rest of the hospital's decision makers found out the hard way that "free publicity" often comes at a high cost.