adapting mainstream marketing techniques for difficult to recruit providers

1. Adapting Mainstream Marketing Techniques for Difficult to Recruit Providers Letty Cherry Kreger, MHA VaxTrack Immunization Registry Riverside County Department of Public Health Riverside, CA

2. (Introduce self) Today I will be sharing the background of why we implemented the �Seven Steps� technique and why we use sales techniques in our marketing. Then I will discuss the Seven Steps to success and share some real life applications and results before we conclude.(Introduce self) Today I will be sharing the background of why we implemented the �Seven Steps� technique and why we use sales techniques in our marketing. Then I will discuss the Seven Steps to success and share some real life applications and results before we conclude.

3. Background Riverside County stats 4th largest county in CA >7200 square miles IIS currently pediatric, becoming life-span in 2009 Riverside County Providers 1086 providers identified 487 providers enrolled 435 are either new or in active recruitment There are currently more than 1000 eligible providers in our provider management database � this includes public and private providers who immunize children and adolescents, birth hospitals, schools, day care, foster care, WIC, etc. Almost 40% are enrolled, and another third are new or in active recruitment. 25% of total providers are PMDs (273) - incorporating basic sales & marketing techniques (for overcoming objections, for using the features and benefits of the registry to focus on the needs of the office) has helped VT staff enroll 61.5% of the PMDs Of the remaining PMDs that are not enrolled, 63% state they are �not interested� (74/117)There are currently more than 1000 eligible providers in our provider management database � this includes public and private providers who immunize children and adolescents, birth hospitals, schools, day care, foster care, WIC, etc. Almost 40% are enrolled, and another third are new or in active recruitment. 25% of total providers are PMDs (273) - incorporating basic sales & marketing techniques (for overcoming objections, for using the features and benefits of the registry to focus on the needs of the office) has helped VT staff enroll 61.5% of the PMDs Of the remaining PMDs that are not enrolled, 63% state they are �not interested� (74/117)

4. Background - continued 188 private medical doctors (PMDs) enrolled (>60% of eligible PMDs) Recruitment activities incorporate basic sales and marketing techniques �Selling� a product / service Overcoming objections, assuming the sale, WIIFM + features & benefits Basic sales techniques haven�t worked for all providers. Of non-enrolled PMDs, 63% are �Not Interested.� There are currently more than 1000 eligible providers in our provider management database � this includes public and private providers who immunize children and adolescents, birth hospitals, schools, day care, foster care, WIC, etc. Almost 40% are enrolled, and another third are new or in active recruitment. 25% of total providers are PMDs (273) - incorporating basic sales & marketing techniques (for overcoming objections, for using the features and benefits of the registry to focus on the needs of the office) has helped VT staff enroll 61.5% of the PMDs Of the remaining PMDs that are not enrolled, 63% state they are �not interested� (74/117)There are currently more than 1000 eligible providers in our provider management database � this includes public and private providers who immunize children and adolescents, birth hospitals, schools, day care, foster care, WIC, etc. Almost 40% are enrolled, and another third are new or in active recruitment. 25% of total providers are PMDs (273) - incorporating basic sales & marketing techniques (for overcoming objections, for using the features and benefits of the registry to focus on the needs of the office) has helped VT staff enroll 61.5% of the PMDs Of the remaining PMDs that are not enrolled, 63% state they are �not interested� (74/117)

5. Background - continued Question: How many of the NO�s are not from key decision-makers but from �the gatekeepers�? Staff members who don�t want another task Office Managers who are short-staffed Decided to adapt another marketing technique (Seven Step Approach) Of the provider offices that have told us they are not interested; is the doctor/director/owner really not interested or is it just the gatekeeper that is not interested. Gatekeepers probably view registry as just another thing that will be added to their already full plate and decide that they will just say that the provider is not interested. With this in mind, we decided to employ another sales technique that would hopefully yield a positive response from the gatekeeper/office staff. The Seven Step approach was adapted from a technique that is used by people in the direct sales, insurance and home based business � those using this technique had on average a 33% success rate � 1 yes for every 3 asks.Of the provider offices that have told us they are not interested; is the doctor/director/owner really not interested or is it just the gatekeeper that is not interested. Gatekeepers probably view registry as just another thing that will be added to their already full plate and decide that they will just say that the provider is not interested. With this in mind, we decided to employ another sales technique that would hopefully yield a positive response from the gatekeeper/office staff. The Seven Step approach was adapted from a technique that is used by people in the direct sales, insurance and home based business � those using this technique had on average a 33% success rate � 1 yes for every 3 asks.

6. What is theSeven Step Approach? It is a series of 7 steps designed to help achieve a sales/marketing goal. The first three steps set the tone by getting a �YES� response before you state the purpose of your call. When followed, it helps increase your success rate by incorporating other basic sales techniques Overcoming objections Asking for the appointment Using scripts to enhance success

7. Why use the Seven Step Approach? Office staff have decided to say NO before they know the facts The Seven Step Approach creates an environment where our message can be heard by: Seeking �yes� responses from the start Industry* success rate = 1 yes / 3 �asks� You may be asking why use a sales technique to tackle this barrier, why not? After all we are selling a product/service People are preprogrammed to say NO - When you are confronted with a sales call, isn�t that your first instinct? It is part of human nature to say no without having the information needed to make a decision. (Because we are busy, we don�t want to be bothered, etc) Therefore, sales techniques � such as overcoming objections, focusing on the features and benefits + the WIIFM to meet THEIR needs - can create an environment where you can share the facts needed to make an informed decision. You may be asking why use a sales technique to tackle this barrier, why not? After all we are selling a product/service People are preprogrammed to say NO - When you are confronted with a sales call, isn�t that your first instinct? It is part of human nature to say no without having the information needed to make a decision. (Because we are busy, we don�t want to be bothered, etc) Therefore, sales techniques � such as overcoming objections, focusing on the features and benefits + the WIIFM to meet THEIR needs - can create an environment where you can share the facts needed to make an informed decision.

8. The Fundamentals of the Seven Steps Approach Follow the steps in order Use the words provided Give the person time to respond Tone and delivery is important Smiles are heard In order for the 7 Step approach to work, there are certain fundamental rules that must be followed: Always follow the steps in order Unless otherwise stated, use the exact words provided (you will be able to customize them a bit based on your situation) When indicated, make sure to allow time for the person to respond before proceeding - don�t be so nervous that you rush ahead. This is a technique that is primarily used when calling providers by phone � therefore, tone & delivery are important � smiles are heard Scripts will help, especially as you are learning the techniques. But you need to practice the scripts to make them your own. When the words are your own, you will sound more confident and less hesitant (uh, umm)In order for the 7 Step approach to work, there are certain fundamental rules that must be followed: Always follow the steps in order Unless otherwise stated, use the exact words provided (you will be able to customize them a bit based on your situation) When indicated, make sure to allow time for the person to respond before proceeding - don�t be so nervous that you rush ahead. This is a technique that is primarily used when calling providers by phone � therefore, tone & delivery are important � smiles are heard Scripts will help, especially as you are learning the techniques. But you need to practice the scripts to make them your own. When the words are your own, you will sound more confident and less hesitant (uh, umm)

9. The Seven Step ApproachOverview Step 1 � Begin the Call Step 2 � Disarm Your Contact Step 3 � Get Permission to Talk Step 4 � Reason for the Call Step 5 � The Objection Step 6 � Positioning Question Step 7 � The Close

10. Step 1 � Begin the Call Expectation: Get a simple response from your contact (Hi, Hello, Yes, Who?) Say: �Hello Suzi, this is Letty Cherry Kreger calling.� Wait for a response before continuing to next step Wait to identify yourself further. In this step, you want to get a simple response from your contact. If someone else answers and asks what the call is regarding, just say �I need to speak with ____.� Remember you are not identifying who you are with at this point.In this step, you want to get a simple response from your contact. If someone else answers and asks what the call is regarding, just say �I need to speak with ____.� Remember you are not identifying who you are with at this point.

11. Step 2 � Disarm Your Contact Expectation: Get a YES response from your contact Say: Begin your sentence with either If you recall� I understand� Pause long enough to get the response. Decide in advance what statement would work best for your call. Because people are programmed to say no, you want to �Disarm� them by getting them to say yes. You should have a list of statements that you can choose from that will work for your situation. Know what you are going to say before you say it! You need to pause long enough for the person to respond with the �yes�Because people are programmed to say no, you want to �Disarm� them by getting them to say yes. You should have a list of statements that you can choose from that will work for your situation. Know what you are going to say before you say it! You need to pause long enough for the person to respond with the �yes�

12. Step 2 � Disarm(continued) I understand that you are the office manager for Dr. Smith. If you recall, I spoke to you last year about whether your office had internet access. (Demonstrate this by saying what the expected response would be)(Demonstrate this by saying what the expected response would be)

13. Step 3 � Get Permission to Talk Expectation: You must have permission to talk before the call continues to Step 4 Sales techniques doesn�t mean �sales type� Say: �Is this a convenient time for you to talk?� or �Do you have a moment to talk?� Yes response � go to step 4 �It depends� � more information needed. Go to step 4, but you may have to stop Now you need to get permission to talk further. Do this by simply asking: �Is this a convenient time for you to talk?� or �Do you have a moment to talk?� You will get one of three responses: (1) yes � proceed to step 4, (2) It depends � they usually need more information - go to step 4, By getting permission to talk, you are getting them to say YES again Now you need to get permission to talk further. Do this by simply asking: �Is this a convenient time for you to talk?� or �Do you have a moment to talk?� You will get one of three responses: (1) yes � proceed to step 4, (2) It depends � they usually need more information - go to step 4, By getting permission to talk, you are getting them to say YES again

14. Step 3 � Get Permission to Talk (continued) �No� response � find out a good time to call back, but maintain control of the conversation �Would an hour from now (tomorrow morning, next Tuesday, etc.) be a better time?� When you call back, you must repeat the first 3 steps: �Hi Suzi, this is Letty Cherry Kreger calling. (Pause) If you recall, you thought that this afternoon would be a better time to talk. Do you have a moment to talk now?� (3) no � find out a good time to call back, but maintain control of the conversation by suggesting a time to return the call. DO NOT Leave it up to the provider to call you back; chances are they won�t When you call back, you will be repeating steps 1-3.(3) no � find out a good time to call back, but maintain control of the conversation by suggesting a time to return the call. DO NOT Leave it up to the provider to call you back; chances are they won�t When you call back, you will be repeating steps 1-3.

15. Step 4 � The Reason for the Call At this point explain who you are and the purpose of the call Say: Use words like hoping, need, visit, wondering, trying. Expectation: You will either make an appointment or get an objection. Ask for the appointment! During this step you want to state where you are calling from & the purpose of your call You will either meet your objective or get an objection. Be personable and caring (seeking a controlled, predictable responses) Be personable and caring � you are seeking controlled, predictable responses You need to ask for what you want During this step you want to state where you are calling from & the purpose of your call You will either meet your objective or get an objection. Be personable and caring (seeking a controlled, predictable responses) Be personable and caring � you are seeking controlled, predictable responses You need to ask for what you want

16. Step 4 � The Reason (continued) �I am calling from the VaxTrack Immunization Registry, and I have been trying to follow-up with pediatric offices who are not yet enrolled in VaxTrack. I was hoping to spend about 15 or 20 minutes showing you the software and discussing how it would benefit your office. Would a morning appointment or an afternoon appointment be better for you?� The controlled, predictable response in this example is that they will schedule an appointment either in the morning or afternoon. Did you notice that I gave them the entire reason, then ASSUMED that they were going to make an appointment by asking whether they wanted a morning or an afternoon appointment. By providing two choices, most will pick one� you can continue to use two choices to narrow it down. (morning or afternoon, early in the week or late in the week, Monday or Tuesday)The controlled, predictable response in this example is that they will schedule an appointment either in the morning or afternoon. Did you notice that I gave them the entire reason, then ASSUMED that they were going to make an appointment by asking whether they wanted a morning or an afternoon appointment. By providing two choices, most will pick one� you can continue to use two choices to narrow it down. (morning or afternoon, early in the week or late in the week, Monday or Tuesday)

17. Note! Seeking �Yes� responses in the beginning makes the contact more receptive Give two choices for the appointment (early in the week or late in the week, Monday or Thursday, morning or afternoon, etc.). People tend to select one. If you make the appointment at this point, you have achieved success in 4 steps! Each Yes you get makes the individual less likely to say no when asking for an appointment (although it still can happen) Giving two choices is another sales technique. If you give people two choices they will usually choose one. So far, this is as far as we have had to go!Each Yes you get makes the individual less likely to say no when asking for an appointment (although it still can happen) Giving two choices is another sales technique. If you give people two choices they will usually choose one. So far, this is as far as we have had to go!

18. Step 5 � Expect an Objection People are programmed to say NO, so expect an objection Expectation: Continue the conversation in favorable terms in spite of the objection. Say: Use �OK� or �I understand� �OK, before I go, may I ask you one quick question?� �I understand. Before I go, may I ask you one quick question?� When you get an objection, you want to continue the conversation on favorable terms, by saying: �Ok, before I go, may I ask one quick question?� or �I understand. Before I go, may I ask you one quick question?� When you get an objection, you want to continue the conversation on favorable terms, by saying: �Ok, before I go, may I ask one quick question?� or �I understand. Before I go, may I ask you one quick question?�

19. Step 5 � Expect an Objection (continued) Pause long enough for the contact to respond. Expect to hear YES, OK, or SURE If the contact says no, end the call by thanking the person for his/her time. When you say �Ok� or �I understand,� you are agreeing with the person. This type of response increases your chances of getting permission to ask another question, which allows the conversation to continue on favorable terms However, if the person says no, the call ends. When you say �Ok� or �I understand,� you are agreeing with the person. This type of response increases your chances of getting permission to ask another question, which allows the conversation to continue on favorable terms However, if the person says no, the call ends.

20. Step 6 � Positioning Question Expectation: Ask questions that reveals a potential need or motivation. The question must be open-ended Again, pause long enough for the person to respond LISTEN to identify their need This step is critical. You know you have a good product/service to offer, and you just need to make the other person sees that too. Therefore, you need to look for a potential need or motivation that you can meet. Have a prepared list of open-ended questions Listen carefully, because you need to repeat back that information in the next step!This step is critical. You know you have a good product/service to offer, and you just need to make the other person sees that too. Therefore, you need to look for a potential need or motivation that you can meet. Have a prepared list of open-ended questions Listen carefully, because you need to repeat back that information in the next step!

21. Step 6 � Positioning Question(continued) Say: �If you could improve anything about your ____, what would it be?� �If you could change one thing about your ____, what would it be?� Example: If you could improve one thing about your vaccine inventory management, what would it be? If you could improve one thing about your vaccine inventory management, what would it be? If you could change one things about the immunization services you provide for your patients, what would it be? If you could change one thing about how you notify parents that their children need immunizations, what would it be? These are just two possibilities � be creative, but use these wordsIf you could improve one thing about your vaccine inventory management, what would it be? If you could change one things about the immunization services you provide for your patients, what would it be? If you could change one thing about how you notify parents that their children need immunizations, what would it be? These are just two possibilities � be creative, but use these words

22. Step 7 � The Close Expectation: Ask for the appointment again by restating your reason for calling and repeating their identified need. Say: Use �especially� in your response. Also use words like hoping, need, visit, wondering, trying. Ask for the appointment If you get another objection, thank the person for his/her time and end the call. Again, you want to ask for the appointment In order for this step to be effective, you must REPEAT the IDENTIFIED NEED. The word �Especially� must be used in the response� it has been shown to make a difference in responses givenAgain, you want to ask for the appointment In order for this step to be effective, you must REPEAT the IDENTIFIED NEED. The word �Especially� must be used in the response� it has been shown to make a difference in responses given

23. Step 7 � The Close(continued) Example: �This is one of the reasons I was especially hoping to visit with you, so I could share how similar offices found that they were able to become more efficient after they joined the registry, even though they did not increase the size of their staff. Again, I would only need about 15 or 20 minutes of your time. I was wondering what works better for you, morning or afternoon?� This example is in response to the question, �If you could change one thing about how efficiently your office runs, what would it be?� When you get the appointment, if you say that you would only need 15 to 20 minutes of their time, you need to honor that. If it will take you longer, ask for permission at that point (during the appointment) to continue as needed. You can say something like: �Suzi, when we set your appointment, I told you that I would only need about 15 to 20 minutes of your time. I really want to honor that commitment, so I will only be giving you some basic information and leave a moment for any questions you may have. If you decide that you would like a more in-depth demonstration on any of our features after seeing the basic information, I will be happy to do that for you.�This example is in response to the question, �If you could change one thing about how efficiently your office runs, what would it be?� When you get the appointment, if you say that you would only need 15 to 20 minutes of their time, you need to honor that. If it will take you longer, ask for permission at that point (during the appointment) to continue as needed. You can say something like: �Suzi, when we set your appointment, I told you that I would only need about 15 to 20 minutes of your time. I really want to honor that commitment, so I will only be giving you some basic information and leave a moment for any questions you may have. If you decide that you would like a more in-depth demonstration on any of our features after seeing the basic information, I will be happy to do that for you.�

24. �Seven Steps� in Real Life Tried out on 7 PMDs (72 recruitment attempts) before staffing changes put tests on hold Results: Industry Average: 33% (1 in 3) Our Results: 57% (> 1 in 2) We were only able to use the technique for a short time before staffing changes and vacancies put our test on hold. However, the early results were promising. We had made 74 unsuccessful recruitment attempts with 7 providers before initiating the 7 step approach. 4 of the 7 enrolled (only 1 needed all 7 steps). Our success rate was 57% - better than the industry average of 33% (1 yes for every 3 asks) The technique was also used successfully with a provider office that had been avoiding attempts to schedule an appointment to discuss their implementation plan We were only able to use the technique for a short time before staffing changes and vacancies put our test on hold. However, the early results were promising. We had made 74 unsuccessful recruitment attempts with 7 providers before initiating the 7 step approach. 4 of the 7 enrolled (only 1 needed all 7 steps). Our success rate was 57% - better than the industry average of 33% (1 yes for every 3 asks) The technique was also used successfully with a provider office that had been avoiding attempts to schedule an appointment to discuss their implementation plan

25. �Seven Steps� in Real LifeNew Provider Enrollments We have also begun to use this approach for provider retention as well, if an office seems to be reluctant to schedule appointments to discuss implementation of the registry.We have also begun to use this approach for provider retention as well, if an office seems to be reluctant to schedule appointments to discuss implementation of the registry.

26. Conclusions Adapting sales techniques for immunization information systems can facilitate provider recruitment When properly applied, the Seven Step approach helps counteract the pre-programming that everyone has to say �NO.� Seeking �yes� responses to increase receptiveness Can help move past �gate keepers� to present the IIS to decision makers This approach seeks to counteract the pre-programming that everyone has to say No; it sets the tone by seeking yes responses in the beginning. Asking permission to speak with the staff demonstrates respect for the person�s time� No one likes the �pushy sales type� By showing you respect their time, they will be more likely to work with you. Contacts are likely to be more receptive to your message.This approach seeks to counteract the pre-programming that everyone has to say No; it sets the tone by seeking yes responses in the beginning. Asking permission to speak with the staff demonstrates respect for the person�s time� No one likes the �pushy sales type� By showing you respect their time, they will be more likely to work with you. Contacts are likely to be more receptive to your message.

27. Conclusions Using sales techniques does not make you the �sales type� Asking permission to talk demonstrates respect for the person�s time Makes them more likely to do business with you These techniques allowed VaxTrack to experience a 57% increase in the number of difficult-to-recruit providers who enrolled in VaxTrack This approach seeks to counteract the pre-programming that everyone has to say No; it sets the tone by seeking yes responses in the beginning. Asking permission to speak with the staff demonstrates respect for the person�s time� No one likes the �pushy sales type� By showing you respect their time, they will be more likely to work with you. Contacts are likely to be more receptive to your message.This approach seeks to counteract the pre-programming that everyone has to say No; it sets the tone by seeking yes responses in the beginning. Asking permission to speak with the staff demonstrates respect for the person�s time� No one likes the �pushy sales type� By showing you respect their time, they will be more likely to work with you. Contacts are likely to be more receptive to your message.

28. Questions? Letty Cherry Kreger, MHA lcherry@co.riverside.ca.us 951.354.1400