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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 . Blogs Podcasts Social media DTC ads PR

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the search for strategy lessons from the front lines

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
Blogs

Podcasts

Social media

DTC ads

PR

SOCIAL Media

Websites

“Webinars

Buzz marketing

And social media

Brochures

Celeb spokespersons

Special events

Social Media

Billboards

Mobile vans

Refrigerator magnets!

SOCIAL MEDIA SOCIAL MEDIA SOCIAL MEDIA . . . . .

Today, it seems it’s all about TACTICS
but as sun tzu wisely said

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

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
So today, in this room . . . .
  • 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
These are serious times
  • 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 recession-proof . . . . . not what we’re hearing from CEOs and CMOs and CPROs
our e inboxes read like this
Our E-inboxes read like this:
  • “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
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
The news is bleak andAMCs 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
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
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
The good news??
  • 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
Other findings: Few information sources are seen as credible

Analysts 47%

Biz mags 44%

Friends/peers &

Company employees 40%

Media stories 36%

Free Internet portals 27%

Corporate sources 19-26%

Other blogs 16%

Social media 15%

Ads 13%

and yet the hunt is still on
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
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
Reality: In a time of chaos, sustainable strategies are essential
  • 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:
    • 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
How do people think we attract patients?
  • Marketing
  • Advertising
  • Ratings and rankings
  • Gorgeous facilities
  • Glitzier websites
  • Direct mail
  • What else?
the reality
The reality:
  • Where do you go for information & recommendations on what hospital to use when you need a procedure?

My doctor 74%

Another doctor 15%

Friends/family 10%

Health plan 7%

Internet 2.5%

Media 2%

Ctr. for Health System Change - 9,400 households

the reality21
The reality:
  • Where do you go for information & recommendations on selecting a specialist?

My PCP 69%

Friends/family 20%

Another doctor 18%

Health plan 10.5%

Internet 6.8%

Media  4%

slide22
AND:
  • 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%

slide23
AND . . . .
  • 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
The implications for strategy?
  • 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 strategy25
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
LS&T’s recommendations for Sustainable Strategies
  • 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
reputation is real and has impact
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
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
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
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
And in just past six months . . .
  • $13.5 awarded in hospital death; Jury faults doctors at Dana-Farber (Boston Globe)
    • “Dana-Farber did not issue an apology”
  • 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.”
slide33
And . . . . . .
  • 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
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 Buffet

To Salomon Brothers employees

Warren Buffett

to Salomon Brothers employees

reputation can be managed
Reputation can be managed
  • 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
The Reputation Equation

Reputation = Perception

Perception = Reality + Awareness

Reality = E2 Personal Experience +

Trusted Endorsements

in healthcare e 2 rules because reality reigns
In healthcare, E2 rules because reality reigns
  • 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
The HCO reputation management track record: C-
  • 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
Flash forward to 2009:
  • 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
  • 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
This is significant because without trust . . .
  • The bond that is essential for human service organizations broken
  • The impact can be massive
    • 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
A good reputationis like money in the bank
  • 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
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

Reputation

The AMC reputation in a complex universe

Donors, grantors

Prospective employees, faculty

Influencers

Employees

Patients

Residents, students

Families/

Visitors

Faculty

Media

Government

Referring MDs, health pro’s

Alumni

Volunteers

Community

reputation basic 1

Reputation Basic # 1:

An Integrated Process

reputation basic 1 an integrated process
Reputation Basic #1– An integrated process
  • 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
An integrated reputation plan  fighting for CONTROL
  • 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
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
Once we know the objective . .
  • 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
The KEY question:
  • What do we want this audience/individual to DO?
from there we can develop
From there, we can develop:
  • 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)
  • Implementation responsibilities based on expertise, experience and interest
then execute the plan not each other
Then execute (the plan, not each other)
  • 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 mid-course corrections, evaluate, revise plan
reputation basic 2

Reputation Basic # 2:

The Good Old-Fashioned

A.R.M. Approach

reputation basic 2 the arm approach
Reputation Basic #2:The ARM Approach
  • ARM = Audience, Research, Message
  • Works for all audiences, and for:
    • Reputation management
    • Donor communications
    • Alumni relations
    • Marketing, and more
a rm audiences who are those guys
ARM:Audiences: Who ARE those guys?
  • 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

Governance

Payors

Medical students, residents, fellows

Med school alums

Donors, grantors

Non-MD referral sources

Media

Community

Civic, business leaders; neighbors, organizations

Start with:
and don t forget
Volunteers

Vendors

UNIVERSITY

Faculty, staff, students/families, alumni

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)

And don’t forget:
while all audiences matter
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
Three key audience questions:
  • 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
Q1: Who makes the final decision?
  • 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
Consumer role varies widely
  • 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
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
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
  • Donors influenced by peers, reputation
  • Doctors influenced by patients, KOLs
slogging through the audience id process can be a struggle
Slogging through the audience ID process can be a struggle
  • 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
Q3:How will other audiences react?
  • Never forget that any marketing or organizational decision is observed by “non-targets”
  • 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
Above all else, key audiences must not only knowyou . . . . .

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
a r m r esearch helps us discover
ARM: Research helps us discover:
  • 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
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
Research has special rolein 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
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
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 mix71
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
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
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!!!

ar m oh yeah the message we ll get to that after we decide on ads vs twitter vs stadium signage
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
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
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
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
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
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

Reputation Basic # 3:

Effective Crisis Management

cpr advanced media relations
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 pre-existing negative stereotypes
and cpr is needed because
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
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
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
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
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
What organizations want from PR: The 4 C’s
  • 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
What’s needed
  • 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
And there are two responses to managing crisis comms:
  • 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
The Basics: Anticipate and Rehearse
  • Issues anticipation
    • The predictable and generic
    • The “that could be US” opportunities
  • Routinely (at least quarterly) put the team through a crisis drill with a scenario “torn from the headlines”
scenario drills deliver
Scenario drills deliver
  • “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
CPR: The crisis is NOW
  • 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
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CPR: The crisis is NOW
  • 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
  • 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
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CPR: The crisis is NOW
  • Get to your internal audiences BEFORE they see the coverage and stay in touch
    • 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!!!!
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CPR: The crisis is NOW
  • 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
It’s now a brand new world
  • 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
our core work patient care and caring
Our core work: Patient care and caring
  • 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
  • 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
Patient satisfaction(still a work in progress according to HCAPS)
  • 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
  • Requires coordination with all operating units – rarely does a problem have a single owner
patient satisfaction is a mission not a program
Patient satisfaction is a mission, not a program
  • 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
  • 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
The marketing/public relations role begins at the top
  • 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
      • 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
  • 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
The marketing/public relations role also includes:
  • Culture management
  • Keep the platform burning
  • Provide measurement tools
    • Manage the survey
    • Shoppers
    • Other feedback mechanisms (Web, callbacks)
  • Spread the message
    • Successes AND failures/challenges
    • Metrics outcomes and benchmarks
  • Keep it on top management’s agenda
make it stick even though you re big complex decentralized
Make it stick - even though you’re big, complex & decentralized
  • Clear vision, definitions and standards
  • New processes to support new cultures
    • HR policies and practices critical
    • Reliable tracking systems
    • Accountability mechanisms
  • Disciplined, methodical rollout plan with standardized communications
  • Benchmark against AMC peers AND your own market competition
the ritz carlton formula
The Ritz-Carlton Formula
  • Make management visible
  • Imprint the standards
  • Lineups: everyday, everyone (more on that)
  • Put employee satisfaction first
2 create a highly satisfied and motivated workforce
#2 Create a highly satisfied and motivated workforce
  • 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
Workforce communications
  • Requires multiple channels
    • Education/literacy variations
    • Employee preferences
    • Repetition important
  • 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
The Huddle: A breakthrough communications tool
  • Systematic process for assuring group discussions every day
  • Case in point: Oakwood Healthcare, Detroit MI
the vanrinsven formula for victory
The VanRinsvenformula for victory
  • 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
physicians matter in many ways
Physicians matter in many ways
  • 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 relation ships
Physician relationships
  • 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
Physician communications 10.0
  • 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
  • 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
Two special challenges:
  • 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.
  • 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
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-of-mouth endorsements that enhance AMC’s powerful, positive reputation . . . . .

stay in touch
Stay in touch
  • 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

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
Out there in the community, are:
  • 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
It’s back to our roots
  • “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
Back to the very basics
  • 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
  • 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
CR 101 begins with the basics
  • Advisory Boards are foundational strategy
    • IF you use them effectively
      • 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
And the old stand-bysstill work!
  • 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 work123
And the old stand-bysstill work!
  • 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
Outsiders IN: The Influentials Program
  • 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
Insider influencers
  • 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-on-ones, 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
Insiders Out:The Ambassadors Program
  • Community liaisons can be the best communications channel ever!
    • Takes time and careful management, but pays huge dividends
  • 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
Outside ambassadors
  • 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
  • Invite participation, outline role clearly, provide incentives
    • Most important incentive is feeling of “contribution”
    • “Ambassador” title and a plaque also help!
outside ambassadors128
Outside ambassadors
  • 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
  • When needed, liaisons can also deliver messages – but must be done without compromising their status in the group
inside and outside partnerships
Inside and Outside:Partnerships
  • Sponsorships -- $$ in return for a logo (one among many) on a 5K Walk T-shirt
    • ROI negligible
  • 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
The Partnership Paradigm: It takes hard work
  • “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
Partnership principles
  • Pick the problems that you are most suited to address
    • The AMC can provide brains, or brawn or bucks – or all three
  • 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
  • Manage the partnership like a business – measurable objectives, biz plan, monitoring and evaluation
and make sure the board is involved too
And make sure the Board is involved, too
  • 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
  • And finally – don’t neglect health education/prevention programs
    • Whether inside out, or outside in, they impact reputation and market share