Word of Mouth and Patient Testimonials

SpectrumSociety for Healthcare Strategy and Market Development®
March/April 2011
SpectrumSociety for Healthcare Strategy and Market Development®
May/June 2012
To view current career opportunities,visit us at baystatehealth.org/jobs.Baystate Health is an equal opportunity employer committed
to an inclusive and diverse workforce. EOE/AA
Yes, that means you.A promising career starts with being accepted for who you are. At
Baystate Health, we call this inclusion. Baystate Health is one of only
six health systems in the country to be honored with the Human Rights
Campaign Foundation's “Leader in LGBT Healthcare Equality” award.
For having specific policies and nondiscrimination standards, Baystate
Health is recognized as a leader committed to creating a culture that
promotes diversity and inclusion.
At Baystate Health, each and every one of us has a unique contribution
to make to the field of health care. We'd be proud to include yours.
includes everyone.
Liz, Baystate Health employee
Finding innovation can be as simple as including everyone.
(Continued on next page)
I’m proud to say that my orga-
nization has done some excellent work
for Baystate Health in western Massa-
chusetts. As a result of our success with
earlier projects, Baystate’s chief diversity
officer, Visael “Bobby” Rodriguez, asked
to partner with us to promote Baystate
Health’s diversity initiatives.
Now, as a white male of European de-
scent living in rural Pennsylvania, I’m all
about diversity. The truth is, I had no idea
what to expect when I first met with Bobby.
My perception of diversity was very limited,
revolving around skin color and religious
practices. But Bobby’s presentation blew
me away. He challenged my attitudes on
everything from race to age and led me to a
major epiphany: Innovation happens only
when new ideas are brought to the table,
and happens only when everyone—regard-
less of who they are—is given a voice. And
Need to
Innovate?
Diversify.
that’s what diversity is all about.
It’sonethingtoclaimadiverseworkforce
or patient population. It’s another thing to
nurture a genuine culture of inclusion—
one in which everyone feels welcomed and
valued, one in which everyone can contrib-
ute to his or her fullest potential to achieve
organizational objectives. This is where the
rubber meets the road. Organizations that
understandandaddresstheuniqueperspec-
tivesheldbytheirentirepatientandemploy-
ee population can gain significant ground.
Of course, everyone likes to do the right
thing, and we all know including people
and fostering diversity is the right thing
to do. But organizations don’t make deci-
sions based on “feelings.” They look at the
bottom line. In 2000 a midsize health-
care services company asked Gallup to
design a survey to measure inclusiveness
(Ludwig and Talluri 2001). The results
showed that attitudes about inclusiveness
varied across the organization, and that
workgroups with the lower inclusiveness
scores had lower productivity and reten-
tion scores than those with higher levels
of inclusiveness. Studying the measurable
links between inclusiveness and positive
business outcomes (retention, profitability,
and productivity) reveals the business value
of workforce diversity.
Are you struggling to understand how
this can affect your organization? Health-
care is notoriously conservative, and di-
versity may not be a priority during this
time of ACOs and physician shortages.
But it should be. Bobby provided me with
several studies and data points that proved
this point. The Gallup Workplace Study
referred to above showed that a culture
of diversity and inclusion provided a
39 percent increase in patient satisfaction,
a 22 percent increase in productivity, a
22 percent decrease in employee turnover,
and ultimately a 27 percent increase in
profitability. Your organization can’t afford
to disregard these numbers.
Changing the Culture
So how does one employee go about chang-
ing an organizational culture? It starts with
understanding and learning. Each of us
needs to realize that even though we feel
most comfortable being around people
similar to ourselves, it’s not always best
for our team, department, or organization.
We’ve all heard the expression that if we all
looked the same, the world would be a very
boring place. Well, if we all took the same
direction when trying to solve challenges,
some challenges would never get solved.
The second thing we need to do is
care. We need to go beyond understand-
ing the importance of diversity and an
environment that promotes inclusion
and genuinely care enough to make it
W O R K F O R C E

2 Spectrum | May-June 2012
Society for Healthcare
Strategy and Market
Development®
President
Maria Royce
Senior Vice President,
Planning and Community Development
WellSpan Health
York, PA
President-elect
Holli Salls
Vice President, Public Relations, Marketing, and
Physician Services
Northwestern Memorial Hospital
Chicago, IL
Immediate Past President
Tess Niehaus
Marketing Strategy Consultant
St. Louis, MO
Executive Director
Lauren A. Barnett
Society for Healthcare Strategy and
Market Development
Chicago, IL
Editor
Karen W. Porter
Society for Healthcare Strategy and
Market Development
Chicago, IL
Design and Layout
Spectrum is the bimonthly newsletter of and a
membership benefit for members of the Society for
Healthcare Strategy and Market Development®
.
SHSMD welcomes unsolicited manuscripts, which
will be used on a content and space-available basis.
Preferred article length is from 1,200 to 1,500
words, and graphics (figures, tables, photos) and
suggestions for sidebars are welcome. Please e-mail
articles to kporter@aha.org.
The editorial office is located at:
155 North Wacker, Suite 400
Chicago, IL 60606
Phone: 312.422.3888
Fax: 312.278.0883
E-mail: shsmd@aha.org
Website: www.shsmd.org
Opinions expressed in these articles are those of the
authors and do not necessarily reflect the opinions
of SHSMD or the American Hospital Association.
©2012, Society for Healthcare Strategy and Market
Development. Reprinting or copying is prohibited
without express consent from SHSMD.
Need to Innovate? Diversify
(Continued from page 1)
happen. We need to realize that if we don’t
start the process internally, it will never get
started externally.
Finally, and most important, we need to
act. It’s not enough to understand and care if
we are not willing to put that understanding
and caring into action. When you’re putting
together a team to solve a problem, take a
little more time in selecting its members.
Make sure to add different age groups,
people with different backgrounds, men
and women. Make sure to instruct them
to solve the problem as a team and to start
off with a brainstorming session in which
everyone’s opinion and ideas are welcome.
No wrong ideas, only great input.
We’re all looking for people who can
do great things—but do they all have to
achieve them the same way you did, or
can their diverse backgrounds and unique
challenges and victories benefit your de-
partment and organization in ways you
never could have seen?
In short, innovation happens when you
combine ideas from intersecting fields of
study, disciplines, and cultures. Break-
throughs occur when different people from
different fields come together to find “a place
for their ideas to meet, collide and build on
each other” (Johansson 2004).
Innovation can be elusive, but it’s the life-
blood of successful organizations. Are you
simply falling in line and wondering why
the direction never changes? Then maybe
it’s time to review your attitudes and poli-
cies about diversity.
Written by:
Shawn Kessler, Senior Strategist
Aloysius Butler Clark
Bloomsburg, PA
570.784.9604
skessler@a-b-c.com
www.a-b-c.com
Another Thing (blog): blog.a-b-c.com
References
Johansson,F.2004.The Medici Effect:Breakthrough Insights at the
Intersection of Ideas, Concepts Cultures. Boston: Harvard Busi-
ness Press.
Ludwig, J., andTalluri,V.S. 2001.“To Leverage Diversity,Think In-
clusively.”[Online information;retrieved 3/20/12.] gmj.gallup.com/
content/778/leverage-diversity-think-inclusively.aspx
The Story Behind Baystate’s Diversity Campaign
Baystate Health’s Bobby Rodriguez and ABC’s Shawn Kessler (Baystate Health’s provider
recruitment agency) were featured speakers at last year’s SHSMD Annual Conference in
Phoenix,AZ. Everyone wanted to know how Baystate Health’s sensitive, open-minded
“diversity” campaign became so successful.
“It all started with a culture of inclusion—a commitment to creating a healthcare
environment in which employees and patients of all backgrounds, genders, orientations,
nationalities, and cultures can feel welcome and have their voices heard,” says Bobby
Rodriguez.The risk-taking campaign featured more than 30 real employees. It spoke honestly
about Baystate Health’s appreciation for, and outreach efforts to, the diverse communities
from which its prospective employees come.
The recruitment campaign harnesses the diversity of current employees by featuring them
in ads aimed at their own communities. For example, LGBT employees can be found in ads
appearing in The Rainbow Times, an LGBT publication, while African-American employees
are featured in ads in Point of View news magazine and Urban League sponsorship ads. In
addition, the ad has been translated into Russian, Spanish, and Vietnamese for use with those
audiences.“The response has been staggering and inspiring, exceeding our expectations in
both the number and the quality of job candidates,” Shawn Kessler says.
Baystate Health isn’t shy about sharing its views on diversity with potential providers and
patients, too, encouraging them to treat others and expect to be treated with dignity, respect,
and acceptance.The health system has been honored two years running by the Human Rights
Campaign Foundation, earning the top award as “Leader in LGBT Healthcare Equality” in 2011.
The recognition is not lost on Bobby Rodriguez.“It validates our belief that being an
organization that supports diversity gives us a significant advantage over other healthcare
systems in our area.” It’s a story that continues to have happy endings for Baystate Health
patients and caregivers alike.

May-June 2012 | Spectrum 3
More-sophisticated questions
adapted from the packaged-goods
industry can help healthcare
marketers discover the “why”
behind the “how” when measuring
likelihood to use again and to
recommend to others.
Traditionally, likelihood to
use again (i.e., loyalty) and likelihood to
recommend to others (i.e., advocacy) have
been measured using a simple 5- or 10-point
rating scale. But do these metrics provide
useful information beyond how a hospital
scored? That is, do they provide any insight
into why the hospital received the score it did
and what it can do about it? Typically not.
We have explored how other industries view
loyalty and advocacy and have developed a
different way of asking these questions that
uncovers the “why” as well as the “how.”
Share of Wallet: A New
Way to Measure Loyalty
The traditional method of measuring hos-
pital loyalty is an interval-level scale (for ex-
ample, “On a 1–10 scale, where 10 means
very likely and 1 means very unlikely, how
likely are you to use this hospital again?”).
So when your organization gets a mean score
of 8.2 (on a 1–10 scale) on likelihood to use
again, is that good? What exactly does it
mean? What can you do with that?
Packaged-goodscompaniesrefertoloyalty
as share of wallet. They look for how many
timesoutofXtimessomeonepurchasestheir
product(forexample,“Thinkaboutyournext
10purchasesofcereal.Howmanytimesoutof
10willyoupurchaseBrandX?”).Theresulting
score tells the company’s marketers not only
thelikelihoodthecustomerwillpurchasetheir
brandagainbutalso,quantitatively,howloyal
customers are to the brand. They can also ask
what other brands the customer is buying to
understand who their competitors are and
how many are in the choice set.
This is not even close to the typical like-
lihood-to-use-the-hospital-again scale. We
have attempted to integrate this thinking
into a new type of loyalty question, one that
measures not just “will you use us again” but
also “for how many types of situations.” Here
is the wording of the question:
Q: When you think of all the reasons why
you would use {HOSPITAL} in the future,
would you say you have good reasons to use
this hospital again for____ ?
Table 1 illustrates just how different
“share of wallet”–type loyalty is and how
useful this type of information can be.
Clearly, Hospital F has the strongest level
of loyalty, with six in ten recent patients
Loyalty
(Total)
Hospital
A
Hospital
B
Hospital
C
Hospital
D
Hospital
E
Hospital
F
Every medical
situation (20%)
38% 36% 9% 10% 4% 61%
Most situations,
but not all (39%)
30 52 39 32 64 20
Some medical situations
(25%)
24 9 25 28 11 12
A few specific
situations but
that’s it (11%)
4 1 17 18 11 7
Nothing/would not use
hospital again (3%)
5 1 5 10 6 0
Not sure (2%) 0 1 6 2 4 0
Table 1. Patient Responses
to L0yalty Questions by Hospital
(Continued on next page)
Recent utilization
Source:Klein Partners
M A R K E T R E S E A R C H
New Ways
of Looking at
Loyalty and
Advocacy

Source:Klein Partners
saying they would use the hospital again for
everything. But while the same proportion
of recent patients of Hospitals A and B
say they would use them again for “every”
medical situation, patients of Hospital B
are significantly more likely to say they
would use it again for “most” situations,
while Hospital A’s patients are more likely
to be more comfortable using it again for
some or just a few specific situations.
What is different about these two hos-
pitals? Is it the patient mix? The patient
experience? The hospital’s reputation for
certain procedures? The real power to make
specific improvements comes when two
key follow-up questions are asked:
●● Why are you not comfortable using this
hospital again for every medical situation?
●● For which medical situations would you
not be comfortable going to Hospital X?
Advocacy
(Behavior vs. Intentions)
The traditional method of measuring advo-
cacy is an interval-level scale (for example,
“Ona1–10scale,where10meansverylikely
and1meansveryunlikely,howlikelyareyou
torecommendHospitalXtoothers?”).Such
scales have one thing in common: They all
askaboutfuturebehavioralintentions—that
is,howlikelyapersonistorecommendyour
hospital in the future. But with so many
things that can happen between now and
then, how confident can we be in a future
number like that? If your organization has a
recommend-intentionscoreof8.4ona1–10
scale,isthatgood?Whatcanyoudowithit?
Our experience in the packaged-goods
industry led us to develop an advocacy
metric that brings actual behavior into
the equation, blended with reasons
people would not recommend (people
are able to tell you in a more concrete
fashion why they will not do something
than why they will).
Here is the wording of the question:
Qa: Have you ever recommended
{HOSPITAL} to anyone?
1.Yes
2. No (GO TO NEXT QUESTION)
3. Not sure
Qb: Have you NOT recommended
{HOSPITAL} because…
1. you just haven’t had the opportunity but
definitely would if it came up, or
2. you don’t want to recommend
this hospital because you don’t like
something about it, or
3. you’re just not someone who recom-
mends companies to others whether
you like them or not
4. not sure
Table 2 illustrates how useful this infor-
mation can be. Eight in ten recent patients
have already recommended Hospitals B
and F to others. By contrast, Hospitals
C, D, and E have much lower levels of
recommendation. But there are big differ-
ences among them. Four in ten patients of
Hospital E just aren’t the type of person
who recommends companies to others (yes,
there are many folks like that out there, and
the traditional scale question does not ac-
count for them!), while Hospitals C and D
have a real problem—about one-third of
their patients have not recommended them
because they specifically do not want to.
Instead of having a scale question that gives
us one aggregate number—the mean, for
example—we have several key categories of
respondents we can profile. For example,
what do the 36 percent of Hospital C’s
patients who didn’t like something about
the hospital look like? What about their
experience didn’t they like? See how use-
ful this type of advocacy question can be?
Market Barriers: When Life
Gets in the Way of Preference
Oftentimes, preference does not lead to
utilization. Why not? If someone prefers
your brand, why wouldn’t they choose you?
Let’s take a look at what we call market bar-
riers and see how they can get in the way
of preference’s connection to utilization.
First, a few definitions. Brand strength
can be thought of as “pulling” the brand
through distribution channels, while mar-
ket strength can be thought of as “pushing”
the brand through distribution channels.
What do we mean by push/pull?
Pull. A strong brand creates interest
in itself through marketing, communi-
cation, and experience efforts that make
Table 2. Patient Responses to Advocacy Question, by Hospital
New Ways
Advocacy (Total) Hospital A Hospital B Hospital C Hospital D Hospital E Hospital F
%Yes (53%) 65% 83% 25% 36% 30% 82%
Didn’t recommend because didn’t
like something about hospital (15%)
7 2 36 30 10 0
Didn’t recommend because not the kind of
person who recommends (10%)
12 4 10 5 41 10
Didn’t recommend because haven’t had the
opportunity to,but would (9%)
6 4 5 8 11 2
Didn’t recommend and not sure why (13%) 10 7 24 20 8 6
Recent utilization

people want to use it (again). Joel English,
managing director of a healthcare mar-
keting communications agency based in
Milwaukee, calls the resulting preference
brand craving. Essentially, with this strat-
egy, consumers “pull” the brand through
distribution channels with their interest
or satisfaction. Brands accomplish this by
creating a strong brand promise and expe-
rience—that is, through brand strength.
Push. Consumer attraction to a hospital
brand can be undermined if the service
or facility is not readily available or some
other hurdle gets in the way of consumer
interest and behavior—that is, if there is
some market barrier. For example, physi-
cians without a strong relationship with
the hospital in question can undermine a
brand in which consumers are interested;
likewise, a hospital that isn’t in key insurer
networks or has inconvenient locations
can cause people to go elsewhere. These
examples of lack of market strength are a
major reason consumer preference doesn’t
always lead to increased market share.
Althoughpreferenceandutilizationques-
tionshavebeenaroundforalongtime,met-
rics to assess the impact of market barriers
have been underutilized. When preference
doesnotlead tomarket share,itmaysimply
be a matter of “life getting in the way.” The
best intentions of any organization can be
undermined when barriers emerge at the
time of hospital choice. Your hospital can
createstrongbrandcravingamongconsum-
ers, but when a patient goes to his or her
physician and says, “Doctor Smith, I would
like to go to Hospital A,” and Doctor Smith
replies, “I think you would be better off
at Hospital B because…,” most often that
patient still says, “OK, you’re the doctor.”
We have developed a series of ques-
tions addressing the impact that market
barriers can have on preference. For the
hospital that is most preferred among
nonpatients, we ask:
Q: If you wanted to go to {HOSPITAL}, are
there any factors—such as inconvenient loca-
tion, health insurance restrictions, physician
not admitting there, scheduling hassles, or
anything else you can think of—that could
hinder you in using this hospital?
If the respondent says yes, we ask:
Q: What would you say is the single biggest
barrier to using {HOSPITAL}?
Figure 1 illustrates how market barriers
can have an impact on people’s preference.
For example, Hospital B has a much larger
market share than Hospital A, even though
Hospital B’s overall preference among
nonpatients is much lower. Notice that
barriers-to-use for Hospital A are much
larger than those for Hospital B, contrib-
uting to a lower market share.
Conversely, a lack of market barriers—
that is, market strength—can positively
influence market share even when prefer-
ence is low. In Figure 1, Hospital C has the
largest utilization share in this market, yet
its overall preference among nonpatients is
the lowest of all competitors. For Hospital
C, having almost no market barriers—for
example, it is the most conveniently lo-
cated—creates market strength, which can
overcome weaker brand strength. However,
over time, competitors can combat market
strength and use weaker brand strength
against you. Successful brands create both
market and brand strength.
Written by:
Rob Klein, President
Klein Partners
Orland Park, IL
630.455.1773
rob@kleinandpartners.com
www.kleinandpartners.com
Even with less brand appeal, Hospital B has a larger market share than Hospital A because it has much lower perceived barriers to use.This
illustrates how location-sensitive people in this market are. Hospital A’s barrier is mostly location driven, while Hospital B’s barrier is more
insurance driven. Source:Klein Parners
Perceivedbarriersinusing
Most preferred hospital among nonpatients of that hospital
Figure 1. Impact of Market Barriers on Correlation
Between Performance and Utilization
Bubble size = market share
(i.e., hospital most recently used)
0
10
10 20 30 40
20
30
40
50
60
70
80
Hospital D; 11
Hospital E; 10
Hospital C; 28
Hospital B; 23
Hospital A; 13
Location,location,
location sometimes
beats a lack of
brand strength.

How to create favorable word of
mouth by using patients’ own words
in believable video testimonials.
Whenpatientsareaskedhowthey
learnedaboutahospitalorsurgicalprocedure,
mostsaytheyheardaboutitthrough“wordof
mouth.”When patients say they heard about
something by word of mouth, they either
heardsomeonetheyknowtalkaboutahealth-
care provider, or they asked someone they
respect and trust to recommend a hospital, a
physician,aphysicianpractice,atreatmentor
procedure, a medication, or a medical device.
Two-way, face-to-face word of mouth
cannot be bought or packaged. It comes,
unedited, from the mouths of people who
had a very good experience or a very bad
experience with a hospital, practice, or doc-
tor. As much as we might like to control it,
the only control we have over most word of
mouth from patients is by ensuring that we
have doctors who work together as a team,
trained supporting staff, and consistently
positive clinical and functional outcomes.
Quality of word of mouth is directly re-
lated to the quality of the product. Market-
ing and hospital participation in social media
may support positive word of mouth, but
it does not produce it. The patient’s own
hospital experience, good or bad, has a sig-
nificant potential for powerful positive—or
negative—word of mouth.
A Hierarchy of
Word-of-Mouth Effectiveness
The most effective form of word of mouth is
face-to-face, where a discussion on a topic
can be conducted complete with body lan-
guage, facial gestures, and the senses of sight,
touch, hearing, smell, and taste. Face-to-
face is a rich interactive experience. It is no
wonder we want to see and hear physicians,
friends, and loved ones face-to-face rather
than having to settle for a telephone call or
other means of communication.
As a substitute for face-to-face interaction,
the second most effective word of mouth
is via two-way video with voice telecon-
ference or Skype conversation, where you
can see a person’s face and hear his or her
words. One-way video with voice can be
created for transmission one-on-one to a
specific recipient.
The third most effective word-of-mouth
experience is by two-way voice phone,
which allows voice inflections and vary-
ing emphasis on words, although the
visual component is noticeably lacking.
One-way voice phone is, for example, a
voice-mail message.
Less effective is the written word in a
message transmitted from one person to
another, whether in a letter, an e-mail,
or a text message. No voice, facial, or
body cues are communicated, sometimes
leading to misunderstanding as to what
the author intended.
To compensate for the lack of voice or
body cues, one-on-one written word mes-
sages often are accompanied by punctuation
marks, such as !, or emoticons, such as , in
an attempt to express a feeling. Cursive writ-
ing in a letter conveys complex feelings that
the typed word in an e-mail or text cannot.
The written word can also be broadcast,
as in a blog, an entry on a social media site,
or an electronic or paper document, such
as an e-book or a printed book.
Other surrogates for face-to-face are voice
and video broadcasts —radio, television, or
video messages that are broadcast to many
rather than transmitted to one.Testimonials
may be broadcast on radio andTV, in pod-
casts, and on sites like YouTube, although
broadcasts are less likely than one-to-one
transmission to be perceived as presenting
believable and reliable information.
One of the least effective surrogates for
word of mouth, as well as the most socially
and physically distant, is Internet social me-
dia. Over half of Internet users say little or
noneoftheinformationonsocialnetworking
sites is reliable, according to the 2011 Digital
Future Report published by the Center for the
DigitalFutureattheUSCAnnenbergSchool
for Communication Journalism.
Enter the Video Testimonial
One-way video broadcast testimonials
can be effective substitutes for face-to-face
word of mouth when the person speaks from
personal experience, is not paid, and is using
his or her own words.
Paid actors and celebrities are often used
to promote health-related products and
services in audio and video commercials as
well as print advertising. However, viewers
recognize these people are compensated to
promote a product or service, so their credi-
bility is lower than that of unpaid customers.
Many hospitals use patient testimonials in
promotingtreatmentprograms,buttheyoften
script the patients, have them say the name
Word of Mouth and the Patient Testimonial
Thumbnails of video testimonials featuring three former patients of Baylor Health Care System. Note that the viewer does not know which
hospital is sponsoring the testimonial until the last frame. No hospital name is given in voice or graphics during the testimonial.
M A R K E T I N G C O M M U N I C A T I O N S

of the hospital, or use so many production
values—for example, doing the patients’ hair
and make-up and having them wear clothing
they wouldn’t normally wear—that the pro-
duction itself lessens the credibility of the pa-
tient’swordsandlowersrespectforthehospital
sponsor. A testimonial should be perceived as
a personal message, not a commercial.
Creating Effective
Video Testimonials
The most effective testimonials are those in
which the patient wears everyday clothing
from his or her closet, uses his or her own
words and style of speech, and talks about his
or her personal experience without directly
promoting and naming the hospital. The
patient talks about the improvements in his
or her life. The only identification with the
hospital is in a tagline at the end of the video.
This is the approach used by Baylor
Health Care System in Dallas. The effect
on viewers is that of being dropped into an
intense conversation with a patient who is re-
counting his or her full experience, all in less
than 30 seconds. The patients are unscripted,
and the use of black-and-white video—cou-
pled with an intense focus on their faces and
hands—helps to build interest and drama.
The ads have the effect of word of mouth and
have measurably increased Baylor’s aware-
ness levels in one of the most competitive
markets in the United States.
Recently Baylor added the phrase “Real
Patients. Real Stories” to reinforce to view-
ers upfront that there are no actors and the
stories come from the patients, not an agency
scriptwriter. (Go to YouTube.com and enter
“Baylor Health Care” for examples.)
Videos of patients talking are best cre-
ated using any video camera and tested with
viewers before investing in full production.
The test is whether the viewer perceives the
patient as honest and unprompted, as close
in believability to a face-to-face experience as
possible.Tests are done one-on-one, letting
the viewer see the video, talk about his or her
feelings about the patient and the message,
and then complete a quantitative question-
naire on believability and the messages the
patient is conveying. Only after this is the
video professional produced.
Baylor tracks the effectiveness of the video
when it is on television or digital media, such
as YouTube and Facebook, by asking callers
to our 800 number how they heard about the
treatment, such as bariatric surgery; when
they heard about it; whom they heard it
from; and what they heard. We also track
whether callers provide unaided mentions
of having seen any videos on the topic on
television or the Internet.
Although a face-to-face recommenda-
tion is the most believable and perceived as
most reliable, this type of video testimonial
is next best to having a friend recommend
a procedure face-to-face.
Written by:
Emerson Smith, PhD, Medical Sociologist
Metromark Healthcare Research Center
Columbia, SC
803.256.8694
emsmith@metromark.net
www.metromark.net
Jennifer Coleman, Senior Vice President,
Consumer Affairs
Baylor Health Care System
Dallas, TX
214.820.1900
jennifco@baylorhealth.edu
www.baylorhealth.com
Ask Any Patient:
Another Way to Create
Word of Mouth
If more patients talked about their hospital
experiences and spread good word of mouth
in the community,there would be no need
for video testimonials.But so many who
have had excellent hospital experiences
tell no one after they have had a successful
inpatient or outpatient procedure.It often
takes someone asking a former patient
directly to get the patient to say anything—
good or bad—about a hospital,treatment,
or doctor.For many,it takes prompting by
their friends to get them to talk about their
experience.Otherwise,they are not talking,
not producing word of mouth.
Many hospitals have “ask-a-nurse”
programs that provide callers free answers
to health questions. Pharmaceutical
companies have had great success selling
prescription drugs by telling patients to
“Ask your doctor.” Patients are likely
to ask their doctors not only about an
advertised drug, but also about a hospital
or procedure. For a second opinion,
people often ask their friends, relatives,
or coworkers to recommend a health
provider, a medication, or alternatives
to surgery, especially for diagnoses such
as breast or prostate cancer for which a
variety of treatment options are available.
In addition to using believable
testimonials, hospitals should create and
promote “ask any patient” word-of-
mouth campaigns to get people to ask
former hospital patients to tell people in
the community about their experiences.
Patients are full of detailed information
and, when prompted, are ready to talk,
some using positive words and others with
negative comments.
Of course,if a hospital has safety,
infection,staffing,or operational issues,
those need to be resolved before inviting
community residents to“ask any patient”
about a recent experience there.How many
hospitals are prepared to have an“ask
any patient”campaign for the emergency
department?The maternity department?
Cardiovascular surgery? Or would the
hospital need to rely solely on handpicked
patients in a series of video testimonials?

Anniversary Dinner
QR Code
Scan the QR code to see
a short video about one
extraordinary act of service
celebrated
at monthly
employee
forums at
the Nebraska
Medical Center.
Outrunning
the Bear
Increased focus on internal
communication keeps Omaha
hospital a step ahead.
The call comes into the emergency
department: a rollover accident with mul-
tiple injuries. Patients begin arriving on
what is already a busy night. Staff spring to
action.Tests are ordered, results are returned
quickly. Operating rooms are booked. On-
call physicians are paged and arrive in record
time. In short, everything works the way it
should. It’s what we, as healthcare workers,
train for. After all, we must be at our best
during the most difficult of circumstances.
But what about the rest of the time?
Your communication strategy for ongo-
ing challenges—sustained financial pres-
sures, staffing model changes, even an
across-the-board IT upgrade—is just as
important. Imagine what could be accom-
plished if you could harness even 60 percent
of the teamwork, cooperation, and commu-
nication that occurs during an emergency
situation at your hospital and focus it on
everyday challenges.
A Time of Change
There has never been a time when the health-
care field has gotten more attention from
government, the media, and the public.
Additional cutbacks, greater performance
expectations, and lower reimbursement are
all we know for sure. Change is here, more
is on the way, and we must be ready.
The people you need to have working
together to overcome obstacles are looking
for a sense of direction, the latest informa-
tion, and, most important, reassurance. For
the Nebraska Medical Center in Omaha,
a strategic investment in internal commu-
nications during uncertain times has not
only rallied the troops, but enhanced the
organization’s competitive position as well.
The Nebraska Medical
Center’s Story
In 2009 the economic crisis was headline
news. Banking, real estate, manufacturing,
and, yes, even healthcare were affected. Al-
though the Midwest fared better than most
of the nation, it was not immune to layoffs.
Amid the turmoil, the Nebraska Medical
Center devised a simple communication
strategy. We said, “Let’s talk about it. Let’s
be open and honest about the challenges
facing us and enlist staff to help.”
When the first monthly all-employee fo-
rum was held days after the Nebraska Medi-
cal Center’s closest competitor announced
layoffs and another made the decision to
hold raises, you can bet attendance was
high. With a capacity of about 500 people,
the conference center was standing room
only, with staff backed into a hall and all
the way up a staircase.
Employeeswantedtoknow:Werejobssafe?
Wouldtherebecutbacks?Theywantedtohear
what President and CEO Glenn A. Fosdick,
FACHE, had to say. He told a story of two
hikerswhoencounterabear.Whenonehiker
sits down to put on his running shoes, the
otheronesays,“You’recrazy;youcan’toutrun
a bear!” The first hiker says, “I don’t have to
outrun the bear, I just have to outrun you.”
The story garnered a few laughs and even
more head nods as Fosdick continued. “It’s
tough,” he said. “When I started my career
over 30 years ago, there were 9,000 hospitals.
Now there are 5,000. I know one thing for
sure: Omaha will always need a hospital, and
as long as we are in the front of the pack, we
don’t have to worry.”
Each month staff on both day and night
shifts get the latest figures on market share
and patient satisfaction and talk about the
hot-button issues of the day, such as Joint
Commission survey results, new safety stan-
dards, and the ever-popular question, “Are
we getting raises this year?” “I tell them my
number one job is to protect your job,” Fos-
dick says, “but I can’t do that alone.”
Monthly forums at the Nebraska Medical Center draw a crowd of several
hundred employees. Sessions are offered during the day and at night.
C O M M U N I C A T I O N

Reorganizing and
Reemphasizing
A move to monthly employee forums was
just one of several bold moves made by the
Nebraska Medical Center to bolster commu-
nication efforts. “Three years ago, we made
a conscious effort to redeploy our existing
marketing budget and human resources to
place a greater emphasis on internal commu-
nications,” says Tadd Pullin, vice president
of marketing, planning, and network opera-
tions. “This included recruitment of a direc-
tor and assignment of coordinators who have
a dedicated focus in this area of expertise.
This comprehensive approach has resulted
in significantly greater engagement and has
differentiated our organization from others.”
Over the past three years, the internal
communications team has completed ap-
proximately 3,300 projects. The team has
become such an integral part of the hospital
that rarely will a major committee be formed
without a communications representative
included. “It’s ideal,” says Pullin. “By having
a seat at the table at the start of a project,
the internal communications team is able to
create a communication plan that takes all
things into consideration. Our chances of
success are a lot better than if we are brought
in at the last minute to ‘fix’ something.”
It’s a Two-Way Street
Communication doesn’t only mean telling;
listening is just as important. The internal
communications team has developed a num-
ber of feedback mechanisms to allow two-
way communication. Employees can submit
ideas for efficiency online through the “I’ve
Got a Good Idea” program. They can also
help shape the agenda for employee forums
by submitting questions ahead of time.
Recognizing that not every staff member
can attend employee forums, a number of
low-budget, high-impact alternatives are
used to reach employees, including:
●● Video podcasts: A three- to five-minute
taped interview with the CEO about the
monthly forum topics is prominently fea-
tured on the hospital intranet.
●● Live broadcasts to off-site locations:
Employee forums are filmed and broad-
cast live each month to five locations.
●● Streaming video: Set up with the help
of the IT department, a video streaming
system lets staff members watch forums
live from their work stations.
●● Night-shift pizza party: Serving pizza
at 11 p.m. in conjunction with monthly
forums ensures a full house and provides
a valuable link to night-shift staff.
Turning Burden to Opportunity
Increased focus on internal communication
has proved especially helpful with strategic
changes. Currently, a coordinator from the
team is dedicated full time to the hospital’s
electronic health record replacement project,
and another is assigned to an initiative to
reduce the operational budget by 15 per-
cent over three years. E-newsletters, talking
points, and standing agenda items at leader-
ship meetings ensure updates on strategic
goals are cascaded down to staff.
Fosdick says, “I want people to look at
these challenges and say, ‘If we can do this
better than other people, it is going to be a
differentiator.’ I want staff to look back at
this time and not just say, ‘I survived that,’
but say instead, ‘I’m glad I went through
that, I’m proud of how we handled that.’”
The Payoff
Although it’s hard to put a price on the value
of internal communication, it clearly is a con-
tributor to employee morale and satisfaction.
In the three years since investing in commu-
nication, the Nebraska Medical Center has
seen impressive results. Its annual workforce
engagement survey results—benchmarked
against 500 other hospitals—showed the
Tips for Drawing
a Crowd at
Employee Forums
1. Make it a regular event.Quarterly?
Monthly? Decide how often you want
to have employee forums, then make it
happen.
2. Talk it up.Send out web blasts with
save-the-date reminders and teasers for
the agenda items. Include reminders on
the intranet and in newsletters.
3. Lead by example. When leadership
takes time to attend forums, it sends the
message they are important.
4. Ask staff what they want to hear.
Include a “submit a question for forums”
button on your intranet, in e-newsletters,
and in web blasts. Enlist the help of
leadership from various areas to develop
complete answers.
5. Recognize and celebrate. Share
extraordinary stories of customer
service, and formally congratulate
the participants. Recognize quality
improvement efforts. Invite patients to
share their positive experiences.
6. Offer multiple ways to “attend.”
Options include broadcasting to offsite
locations, streaming the forum live on
desktop computers, and recording and
archiving the meeting on the intranet.
A “CliffsNotes” version that includes a
short interview with the CEO speaking
about forum topics is also a way for busy
staff to get key messages.
7. Combine with other celebrations
and launches. Hospitals are busy
places. Use monthly employee forums
to highlight awards and introduce
campaigns. If you are planning an event
to celebrate a recent accreditation or
national ranking, combine the two.
Launching a new ad campaign? Use
employee forums to explain the strategy
to your most important marketers.
8. Don’t forget the night shift.
Experiment to find a time that works best
during the shift. Offer refreshments. Send
out a special reminder to pagers at the
beginning of the shift, or round on units
beforehand to encourage attendance.
Dr. Nick Bruggeman shares a few remarks
at employee forums. He was featured in a
customer service video and recognized by
President and CEO Glenn A. Fosdick for
the extraordinary care he provided a young
patient with a limb-threatening injury. (Continued on next page)

The SHSMD
Advantage
Highlighting the benefits
of membership
SHARE SHSMD—Become a
SHSMD Member Ambassador!
SHSMD grows
stronger with each
new member who
joins. And there’s
no better way to
expand the com-
munity of SHSMD
members than by
spreading the word to
your peers in the healthcare
strategy professions: marketing, PR
and communications, and planning
professionals—even your colleagues
and friends at consulting firms and
vendor organizations.
We make it easy for you to SHARE
SHSMD. Go to www.shsmd.org/share,
and let us know who you think could
benefit from SHSMD membership.
We’ll handle the rest.
Here’s the best part: In addition to
helping to strengthen SHSMD, each
name you provide gets you one en-
try into a drawing this September for
these awesome prizes:
●● Complimentary copy of By the
Numbers: Benchmarking Study
on Healthcare Marketing/
Communications (4th edition)
($85 value)
●● American Express gift card
($150 value)
●● Complimentary registration
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Course of your choice
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($350 value)
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to SHSMD’s 2012 Annual
Conference in Philadelphia
($795 value)
Visit www.shsmd.org/share to learn
more, and SHARE SHSMD today!
organization outperforming the “Top
Box” benchmark in every category. In the
“Best in Class” category, the organization
outperformed the benchmark in 12 of 27
categories. Feedback about pride in the
organization was nearly 30 percent above
the industry benchmark. “I believe I am
working at Omaha’s best medical facility
and will look forward to a long relation-
ship with this company and its leaders,”
wrote one employee.
The feeling carries over into market
share. Since 2008, the system’s market
share has grown from 27.5 percent to
33 percent. Regional discharges have
increased more than seven percentage
points. But in perhaps the best indicator
of all of employee morale, employees are
literally buying the brand. An on-campus
store that sells hospital logowear does a
booming business of over $230,000
in sales per year.
Key to the Future
While there are many uncertainties in
healthcare today, at the Nebraska Medical
Center one thing is certain: Once a month
employees can expect an update straight
from the guy in charge. At a recent employ-
ee forum, the organization’s new external
website was launched, and employees got
a virtual tour of the new features.
“For me it’s like a pulse check on what’s
going on in the organization,” says Nicole
Deremer, RN. “It puts Glenn closer to the
average employee, like leadership is in this
right along with us.”
“You have the ability to control your
own destiny,” Fosdick tells employees this
particular day. “Other industries may not
have a choice. If you are a steelworker,
you can’t control the price of steel. But
you (as a healthcare worker) can impact
the care our patients receive and how
they feel about us.”
Written by:
Crista Madsen, Director of
Corporate Communications
The Nebraska Medical Center
Omaha, NE
402.552.2449
cmadsen@nebraskamed.com
www.nebraskamed.com
B R I E F S
Outrunning the Bear
SHSMD Datebook
May 14: Deadline for nominations,
2012 Award for Individual Professional
Excellence
May 14–25: SHSMD U online course:
“Healthcare Marketing Plans That Work,”
with David Marlowe
May 21–June 1: SHSMD U online course:
“An Introduction to Payment Reform
Models and Analytics,” with David Gray,
David Jackson, and Kevin Miller
June 4–15: SHSMD U online course:
“Mastering Marketing Communications,”
with Joel English
June 20: SHSMD U webcast:“Mission
Leads to Margin,” with Jonathan Goble
July 9–20: SHSMD U online course:
“Healthcare Market Research,” with Rob
Klein
“Segmentation Under New Payment
Models,” with Jennifer Marshall and Dan
Savage
“Social Media Beyond the Basics: Strategy,
Value, and the Future of Social,” with Ben
Dillon and Dean Browell
July 31: Deadline for early-bird Annual
Conference registration
August 25: Cutoff date for reservations
at the Philadelphia Marriott Downtown
(800.320.5744)
August 31: Deadline to vote for 2013
President-elect and Directors
September 19–22: “Connections 2012,”
SHSMD Annual Educational Conference
and Exhibits, Philadelphia Marriott
Downtown, Philadelphia
October 1–12: SHSMD U online course:
“Putting Your Strategic Plan to the Test,”
with Gita Budd
November 8–9: “2012 SHSMD Executive
Dialogue,” Conrad Hotel, Chicago
For more information on these and
other professional development
opportunities, go to shsmd.org.

T H E T I G H T R O P E W A L K E R # 1 2
Every issue Rick Wade presents a
real-life scenario much like one
you might encounter in your own
organization and asks how you
would handle it. Readers are
invited to respond on “The
Tightrope Walker” click poll on
www.shsmd.org/tightrope. Rick,
formerly senior vice president for
strategic communications at the
American Hospital Association,
works with hospital and health
system leaders who are coping
with change, innovation, or crisis.
Whose
Money Is It
Anyway?
It’s Friday. You’re about to leave a
little early when you are summoned to the
CEO’s office. His trusted assistant, Henri-
etta, is not at her sentinel spot when you
arrive. In her place is someone you vaguely
recognize from down the hall.
“Hi, I’m Lisa, the VP for communica-
tions. I was asked to come up right away.”
The assistant picks up the phone and a few
seconds later says, “Go right in.”
Four pairs of eyes hit you as you enter
the room: the hospital’s legal counsel, the
vice chair of the board, the chief financial
officer, and the chief operating officer.
“Sit down, Lisa,” the COO sighs.
“It’s going to be a long weekend. Fred,
as our attorney, you seem to have all
the pieces of the story in order. Why
don’t you brief Lisa?”
Fred sighs. “As you know, Lisa, our
campaign earlier this year to raise the fi-
nal $250,000 for the new pediatric rehab
center was a great success. The commu-
nity really turned out. Even after we paid
the fundraising consultant, we cleared
more than $300,000 for the project.
Your communications work on that was
terrific, by the way.”
You mumble a “thank you” as Fred
continues, his voice shaking a bit. “Un-
fortunately, we learned earlier this week
that there was a problem. It seems the con-
sultant was a cousin of our CEO, and our
CEO had a financial interest in his firm.
An anonymous source—we believe it was
his wife—called several members of the
board and told them of the relationship.
The board held a special meeting last night
to ask him about the conflict, and he has
resigned. We need a plan to communicate
that internally and to the community.”
You manage to stammer, “Let me take
some notes for a statement by the board
chair,” as you reach for your briefcase.
“The board, of course, was very upset
about this conflict of interest and the
fact they didn’t know.”
You nod. “Well, of course. That should
be in the statement.”
“Except that the chairman did know. He
told the board he approved the hire because
we needed to raise the money quickly or
we’d lose a matching grant. In light of the
situation, the board chair has resigned.
And we need a plan to communicate that
internally and to the community.
“That’s why Mrs. Marlowe is here,”
Fred continues. “She’s the new board
chair, and Victoria, our COO, is
the new acting CEO.”
You look up from your notes. “Uh,
do you think we ought to call everyone
together and tell them all this in person?
I’m afraid a statement may raise more ques-
tions than it answers.”
“I agree, let’s do this face to face,” Mrs.
Marlowe says. Delores Marlowe has been
involved with the hospital for 40 years,
first as a volunteer and now as a longtime
board member. “And the other thing
I worry about is, what do we do with
the money we raised?”
“Mrs. Marlowe, I don’t think we need
to go into that now,” the CFO interjects.
“Let’s sit tight and see what happens.”
“No, now. I think we should announce
that, given this terrible situation, we are
returning all of the money to every donor.
We raised it under an ethical cloud. If they
still want to donate it, they can.”
“Delores, if we do that we’ll lose the
matching grant and delay the pediatric re-
hab center by months, maybe even years.
We have the money, and the community
needs this!” the CFO says, rising from his
chair. “Don’t bring up the money. Just
tell everybody what we’ve done to deal
with the conflict and the board issue, and
keep moving ahead.”
“Lisa,” Fred says in an almost plead-
ing tone. “We have to get in front of this
fast. The hospital needs that pediatric re-
hab service. But Mrs. Marlowe may be
right—would the community feel as if
they can’t trust us? Everything hinges on
how we handle this.”
You roll your chair back. “What’s
more important to the community here?
That’s the issue.”
“So do we fess up but keep the money,
or do we start writing checks to the do-
nors?” the CFO says, her eyes narrowing.
If you were Lisa, which course of action
would you recommend?
Comment on The
Tightrope Walker #11
The scenario: A newly recruited phy-
sician in a concealed-carry state has
been observed packing heat on hospital
property. Some doctors and nurses are
demanding a ban on weapons in the hos-
pital. Community sentiment is divided,
and the issue is on the next board agenda.
As the director of community relations,
should you advise the CEO to ignore the
issue, push for a hospital-wide weapons
ban, or propose banning weapons in
the OR and ER only?
Rick Wade says: The poll was unani-
mous this time: 100 percent for the hospi-
tal-wide weapons ban—obviously, the right
answer for places whose mission is healing
and in light of the incidents of violence that
occur in hospitals. In the actual case this
column is based on, the hospital adminis-
trator (yes, that was his title) persuaded the
board to delay the discussion. He let peer
pressure from other doctors and nurses do
the job, and the surgeon disarmed. A few
weeks later, the hospital instituted the ban.

SHSMD
Register by July 31 and save $100.
$795 for SHSMD members ($895 after July 31)
$990 for nonmembers ($1,090 after July 31) (Nonmember fee includes
a one-year SHSMD membership.)
Reserve your hotel room now to
get the special SHSMD rate.
Reservations: 800.835.5744
Room rate: $223 plus tax single/double
Be sure to ask for the SHSMD rate when you reserve your room.
The rate will apply until August 25 or until the room block is filled.
Visit www.shsmd.org in April to view the complete program and register
online.Watch your mailbox in May for a print brochure and registration
form.
Make plans now to join the conversation at the SHSMD
Annual Conference—the biggest and best meeting of the
year for healthcare strategy professionals.
The Annual Conference Planning Committee is working
hard to make the 2012 meeting the best one yet. Here are
just a few of the presenters we’ve lined up to enlighten
and entertain you:
Thomas Goetz,
executive editor
of Wired magazine
and author of The
Decision Tree:Taking
Control of Your
Health in the New
Era of Personalized
Medicine.
Ari Fleischer, CNN
analyst and former
White House press
secretary to President
George W. Bush
The Capitol Steps, the
Washington-based troupe
of congressional staffers
turned songwriters
The SHSMD Annual Educational Conference and Exhibits
September 19–22
Philadelphia Marriott Downtown
Philadelphia, PA

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