I spent time earlier this week reading some of the 2008 Top Leadership Teams entries for community and midsized hospitals. It's always nice to learn about organizations that are getting it right--overcoming obstacles, improving their finances and clinical outcomes, boosting patient and employee satisfaction. Yet as I reviewed the entries, I was reminded that the biggest hurdle for many community hospitals is simply getting started.
Many of these hospitals faced obvious problems. Some were drowning in red ink, some had lousy employee satisfaction, some were losing patients to other hospitals, and some were dealing with all of the above. Other hospitals faced less pronounced challenges. How do you maintain quality and employee and patient satisfaction while relocating to a new facility? How do you improve documentation systems and improve employee satisfaction? While the starting points for these hospitals varied, the end goal was the same: How could they transform themselves from being just a good hospital into a truly exceptional healthcare facility?
For many of these facilities, getting staff members and trustees engaged in the improvement effort was the first obstacle to overcome. Some employees may already believe their organization is great--even if there is no measurable data to support that claim--and the notion that their hospital doesn't already provide the best care may be news to many community hospital trustees. Senior leaders need to eradicate the mindset of, "We don't have a problem with that." From what I have heard, the best way to do this is through open communication, transparency, and measuring data. How do you know what needs fixing if you don't track and measure staff engagement and quality?
Hospitals need to engage every employee from the chief executive officer down to housekeeping staff, says Steven J. Simonin, CEO of Wright Medical Center, which won the HealthLeaders Top Leadership Teams award for the small hospital category in 2007. "It is all about accountability, communication, and dealing with your low performers," he says.
Other hospitals must overcome the thinking that their facility is handicapped by limited staff, money, or volume, and therefore can't achieve greatness. When it comes to quality, for example, many small facilities lack the IT to adequately measure and report their quality. Most don't have a dedicated quality department either, so the responsibility often falls to nurses and physicians, further removing them from direct patient care. Limited volumes and smaller sample sizes mean statistical reliability can come into question. But experts agree that having a different set of quality metrics is not the answer. Small hospitals need to be held to the same standards as larger facilities. They may even have some advantages over larger systems; their small size often enables them to implement changes quickly that can improve quality, experts say.
I spoke with Mike Youso, president of Fairview Northland Medical Center, after his 40-staffed-bed hospital won the Premier Award for Quality in heart failure and acute myocardial infarction in 2007 for the second year running. His advice for small community hospitals? Set the expectation and have no exceptions. "We had to finally decide that we were going to stop moaning about the criteria and just get it done."
Carrie Vaughan is editor of HealthLeaders Media Community and Rural Hospital Weekly. She can be reached at cvaughan@healthleadersmedia.com.
In their quest to motivate chronic disease members to make healthier choices, managed care companies have added new programs and positions.
Who knew that a staple of the healthcare system might have been the answer all along?
Community pharmacists can help improve outcomes for the chronically ill, while assisting employers contain healthcare costs, and relieving physicians stretched for time. At least that's what two recent studies on diabetic patients are reporting.
Pharmacists have been taking on greater responsibilities as of late, most visibly through the Medicare Modernization Act, which offers a larger role for pharmacists through medication therapy management (MTM) services. MTM utilizes pharmacists, many of whom are certified diabetes educators, to advise patients about medication use and lifestyle issues, such as diet and exercise.
Most often thought of as the person who fills our prescriptions, reminds us of side effects, and answers our questions about cold and flu medicines, community pharmacists are an untapped resource.
The Diabetes Ten City Challenge (DTCC), which combines community pharmacist coaches with value-based insurance design (VBID), is the latest to show how pharmacists can play an additional role. Built on the successes of the Asheville Project, a pharmacist-driven diabetes program implemented in the city of Asheville, NC, the DTCC was created to test a self-management/pharmacist coaching model in multiple locations. The employer-based diabetes self-management program, run by the American Pharmacists Association (APhA) Foundation, is in 10 locations with 29 self-insured employers.
An interim report released in the March/April issue of Journal of the American Pharmacists Association reported that the DTCC decreased patient blood pressure, and A1c and cholesterol levels, improved care measures, and helped create patient self-management goals after one year.
Another recent study by the University of Oklahoma Health Sciences Center's College of Pharmacy in Oklahoma City released the findings from a nine-month study Evaluation of a Community-Based Diabetes Management Program among HMO Enrollees, which reported pharmacists helped improve patient A1c levels and move the majority of the intervention group to within the A1c level goal after only nine months. Support for pharmacists playing greater roles is backed by pharmacist advocacy groups, and managed care organizations are intrigued. Gordon Norman, MD, MBA, chair-elect of DMAA: The Care Continuum Alliance, a disease and health management organization, recently told me he thinks pharmacists and pharmacy techs could be valuable members of a health team.
A pharmacist could meet patients between physician appointments, test patients for A1c and cholesterol levels, coach patients on health issues, and create clinical, fitness, and nutritional goals. After the visits, the pharmacists could update the patients' physicians. All of this kept patients in the DTCC focused on improving their health.
There is still the question as to how to reimburse pharmacists who are performing these MTM services. Pharmacist coaches' work can mean improved outcomes and lower healthcare costs so it only makes sense to create a reimbursement structure. In the DTCC, the self-insured employers reimbursed pharmacists for patient visits depending on the fee schedules negotiated by the local pharmacy network, which self-insured employers and managed care companies would need to mirror if they expect pharmacists to take part in MTM programs.
Pharmacists are showing they can be valuable pieces in the care team. Do managed care companies make them part of the healthcare solution or do we miss out on adding a potentially valuable member to the care team?
Kathy Divis, president of Greystone.Net, an Internet consulting firm based in Atlanta, talks about how hospitals can use different new media methods to reach out to medical staff and referring physicians and talks about the latest online trends that hospitals are using to engage all physicians.
Corliss Hill, national director of UnitedHealthcare's Generations of Wellness program, which offers services designed to meet the needs of black-owned businesses and the African-American community at large, talks about how the program was recently endorsed by the National Black Chamber of Commerce and how health plans can create programs that effectively engage the black community.
The University Of Kansas Hospital, located in Kansas City, has been a regional academic medical center since 1906. Having a long standing history within a competitive marketplace, the hospital decided to launch an "uncommon" branding campaign featuring a timeline of its successes.
"We're in an area were a lot of local hospital are very interested in the opportunity of branding themselves as an academic hospital," says Julie Amor Director of Marketing for The University Of Kansas Hospital. "We've been an academic hospital for more than a hundred years. This campaign was created to be educational and as a way to differentiate ourselves within the market." The campaign, which uses print, billboards, TV, and radio, maintains a strong focus on the brand and the history of the brand while pushing campaign messages of "uncommon care" and the choice for academic medical care over any other.
This push can be seen particularly well in the TV spots which showcase the hospital's long line of historic accomplishments. The spots, which feature The University Of Kansas Hospital's long time spokesperson, actor Tom Skerritt (who starred in such films as Steel Magnolias and A River Runs Through It, among others), use an unusual, panning, two-dimensional film style. Each spot opens with Skerritt introducing the viewer to The University Of Kansas Hospital's history. Skerrit takes the viewer along a timeline of accomplishments paired with unique two-dimensional imagery that is displayed before a three-dimensional background. "That technique was helpful," says Amor. "Covering 100 years of history in 30 seconds is a challenge, and it allowed us to do so in an interesting way."
"Overall this is a branding campaign with the intention of educating people on academic medicine," says Amor. "I think one of our billboards sums up the campaign best. It says, 'Before it was called academic medicine, we practiced it.'"
For more information on the campaign, go to The University Of Kansas Hospital's Website, www.kumed.com.
Kandace McLaughlin is an editor with HealthLeaders magazine. Send her Campaign Spotlight ideas at kmclaughlin@healthleadersmedia.com If you are a marketer submitting a campaign on behalf of your facility or client, please ensure you have permission before doing so.
The first pass at your hospital or health system budget is complete; once again the numbers don't balance. You've asked your team for transformational new ideas and they have none. Programs have been cut and costs trimmed year after year with little sustainable effect.
Service line strategies, physician integration efforts, and millions of dollars in capital investments have failed to produce market-changing increases in volume. At best, your organization has kept pace. What you need is significant and sustained top-line revenue growth. But how can you achieve it?
One solution is to restructure the hospital "front end" around customer segments and organize teams to manage product development and marketing strategies to grow volume within each group--a "market segmentation" strategy. This is a very different approach than the standard "service line" strategy. Many hospitals today are structured around specialists, organs, and diseases, befitting a physician and specialty-centric perspective on the task of making sick people well. The problem with that approach, when translated into marketing and sales, is that customers have multiple organs and complex conditions that require matrixed rather than sequential management--something a narrow service line is ill-suited to sell or serve.
Simply put, the structure of most hospitals may make sense for back-end clinical organization, but as a front-end interface it is not aligned with the purchasing patterns of the market or structured for sales.
Organizing Around Services Consider the relatively healthy 62-year-old woman with a family history of heart disease, slightly elevated blood sugars, a cranky left knee, and mild incontinence which, as of yet, hasn't stopped her from taking a daily 30-minute walk to keep her heart healthy and Type II diabetes at bay.
She's a target for the hospital's cardiac service line. And diabetes service line. And the orthopedic and gynecological service lines. All four service lines are marketing to her. Each is staffed to meet her needs. One might actually win her business. But there are clear limitations to this approach:
Marketing effectiveness is diffused. To win her business in each line and meet the full range of her needs, the hospital must make the pitch and the sale four times--a confusing and expensive proposition.
Advertising that is cast to sell the specialty or organ-specific service may not resonate with the drivers of her purchasing decision.
It is difficult to position a brand and differentiate a product relative to the competition because the hospital must position four products--cardiac, diabetes, orthopedics, and gynecology--against different competitors, again creating a confusing mix of messages and no clear driver on sales.
Perhaps most critically, none of the four service lines are configured to understand or serve the totality of her needs or their changing dimensions. One customer becomes four different profiles in the marketing mix.
Organizing around services has gone through several incarnations over the years, often producing the same limited results. It has proven difficult to generate and sustain market traction when the basis of differentiation is the organization of clinical service inputs (which is usually the same or very similar at every hospital) rather than an understanding of the needs of clusters of customer in the market and a differentiated approach to serving them.
Organizing Around Customers A different theory, and one that is being adopted effectively in other industries, is to organize around prioritized customer segments that the enterprise wants to serve. The essence of this approach is to:
Organize around groupings of customers with common attributes (demographics, values, behaviors, etc.) who can be marketed to with services that meet the unique needs of each segment and are linked to the drivers of their preference and purchasing decisions.
Vest responsibility for product development, marketing, and sales with teams organized (and incented) specifically to understand and serve those segments.
Reconsider the approach to our 62-year-old woman. Your hospital's market research has identified active older women managing complex medical needs as an opportunistic market target. You develop a marketing strategy around women who are active and pro-active in managing the common ailments of aging (heart, diabetes, gynecological concerns, and musculoskeletal conditions). A team is charged with understanding the needs and the purchasing preferences for this profile. It develops specific services and channels to serve this segment. The team manages the brand within the segment.
The marketing approach may be top-down, slicing the population into clearly defined segments--in this case post-menopausal women. Or, it may be a bottom-up approach that builds on the profile of individual consumers and creates clusters of similar customers in the market (active older women managing multiple disease risk factors, etc.). This approach enables a form of mass customization, which can be effective in healthcare markets that are at both growing broader and narrower:
Broader in the sense that consumers are building more inclusive definitions of "health" and "services."
More narrow in that genetic advances, technology, and pharmaceutical design are creating personalized medicine that can enable "niches of one."
Evolutionary approach = revolutionary outcome Suggesting that clinical service lines be replaced by a customer segmentation strategy is a radical notion. Yet evidence from other industries suggests that re-organizing around customer segments can be an effective approach to growing top-line revenue. The middling experience of many health systems with their service lines suggests that a new strategy may be warranted.
George Day, professor of marketing, co-director of the Mack Center for Technological Innovation, and director of the emerging technologies management research program at the Wharton School of the University of Pennsylvania has documented some of the success that enterprises have had with re-organization around customer segments. He cites IBM, Capital One, and Fidelity Investments as organizations that have successfully achieved sustained success by re-organizing around customer groups.
In his May 2006 study of 347 medium- to large-sized firms, published in Knowledge@Wharton, Day detailed evidence that reorganizing into customer-focused front-end teams delivered improvements on many fronts, including:
Greater accountability for customer relationships.
Improved information sharing on customers.
Enhanced ability to respond quickly to changing customer needs.
Overall, a greater degree of consumer-friendly services.
Day cautions that re-organizing around customer groups is not a strategy without risk. Hospitals must understand that this is a truly transformational approach that will impact (and have its success shaped by) the organization's culture and operational capacity. However, Day also demonstrates that the evidence points to clear competitive advantages for hospitals and health systems that successfully implement this strategy.
"This design flourishes when customers want solutions that are customized to their individualized needs and delivered through a single customer contact point," says Day. Both are clear trends in healthcare markets that are being rapidly reshaped by consumerism and growing out-of-pocket healthcare expenditures. Customers are searching for greater customization in their care, which technology and scientific advances are making possible. Health systems and hospitals alike have invested millions in building primary care networks, call-centers and other vehicles to serve as a primary access point for consumers. The strategy seems to fit well with the trends reshaping the healthcare industry.
Day reported mixed results in terms of improved financial performance, largely because the time-frame required for implementation can be long, requiring sustained focus on changing customer preferences and potentially high short-term costs associated with the reconfiguration of the enterprise. One offset to these higher short-term costs is current investments in electronic medical records. Day's study suggests there is a strong need for internal information management tools to link the customer-segment teams, noting that the cost of building cross-system platforms is a barrier to realizing a quick return on the strategy. Many hospitals and health systems already have those cross-system information management platforms in place.
Implementing a "Segment-Line" Strategy So what would your hospital look like if it re-organized its service lines into customer segment-lines? And what impact would that re-organization have on volume and top-line revenue? For an answer I go back to the core benefits that Day documented:
Greater accountability for customer relationships.
Improved information sharing on customers.
Enhanced ability to respond quickly to changing customer needs.
Overall, a greater degree of consumer-friendly services.
Each is a critical factor in efforts to generate more referrals through existing referral relationships, more primary referral relationships into your hospital, and more business directly from consumers. These are core characteristics of successful organizations that hospitals have struggled to develop with current strategies.
Perhaps it's time to re-think your model of organization. It's a core question that leading hospitals and health systems may need to explore to deliver better clinical, customer and financial results in the years ahead.
Michael Eaton is vice president of The Strategy Group in Norfolk, VA. He is a consultant, speaker, and author. He can be reached at eaton@thestrategygroup.com .
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Under new rules unveiled by the Department of Health, UK hospitals will be allowed to use direct marketing and press and radio advertising to compete for patients' business. The code of practice also allows private companies to sponsor hospital wards and NHS services. The rules coincide with the introduction of a new system which lets patients choose any hospital in England for non-emergency surgery.
Consumers today know how to leverage their power, and they trust their instincts, explore options, see through the hype and run from canned marketing, according to this blog posting from BrandVenture. Recent statistics show 76% of consumers follow their own internal instincts versus listening to the experts--up from 63% in 2002.
Lee Memorial Health System, a system in Southwest Florida, received high marks on the federal government's newly released patient satisfaction survey. The new data doesn't offer a complete picture of Lee Memorial's system, however. Southwest Florida Regional Medical Center and Gulf Coast Hospital are not included because of gaps in the survey process, and Lee Memorial Hospital and HealthPark Medical Center are looked at as one entity because of the way they are licensed.
Patients treated at Kaiser Permanente hospitals in Southern California were less satisfied than many of those at other hospitals in the region and across the country, according to the findings of the patient satisfaction survey overseen by the U.S. Centers for Medicare and Medicaid Services. None of the 10 Kaiser hospitals in Southern California exceeded the regional average when patients were asked if they would "definitely recommend" the hospital.
