|  Scott Regan

If you don’t think hospital advertising will ever be banned, think again. In Vermont, State Representative Steve Maier has proposed legislation that would prohibit hospitals from using money for advertising and marketing. Does it have any chance of passing? Doubtful, as the State would have to prove that such expenditures actually add to healthcare costs, and most economists would argue that advertising spurs competition, which actually leads to cost reductions instead.

But let’s play through on this one and assume Vermont passes legislation banning hospital advertising and the other 49 states follow suit. I, for one, relish such a scenario, as we will quickly see which hospital brands are built from a house of cards and which are built from brick.

No more smoke-and-mirror branding that lures in patients and physicians alike with false promises. No more hollow adjectives claiming to be the biggest, best, lovingest, most advanced, newest, most specialized, smartest, top-rated, and preferred hospital around. No more five stars this, Leapfrog that, JD Power here, Press Ganey there, Magnet praise, and Thomson Reuters accolades.

The brand for every hospital in America would rest solely, entirely, and 100 percent on the patient experience.

But that’s where the brand has been all along.

Savvy hospital communications executives have known for quite some time that what happens inside the walls of the institution is infinitely more important than what is communicated externally. Sure, a good brand communications campaign gives the organization a strong brand voice, but the voice can never be stronger than the brand experience itself.

And in the end, an organization that spends zero dollars on advertising, but has a great brand experience, will trump a poor-performing organization that funnels hundreds of thousands of dollars into marketing. Certainly, the most powerful brands do both – they invest in creating and maintaining a strong brand experience, and they also invest in communicating that brand to their stakeholders.

Still, I relish the day when we strip away all the gloss and let hospitals battle it out on brand experience alone. Only then will the truly brilliant marketers in healthcare get their due.

Despite advances in strategic planning methodology over the last 20 years, many healthcare organizations have yet to adopt a formal approach or process. The methodology used, if any at all, is often the whim of the person occupying the CEO seat.

Harvard professor Robert Kaplan advanced a five-stage strategic planning model two decades ago that has been refined and improved upon over the years. The Kaplan model, which is taught by most major business schools around the world, is used by many of the Fortune 500 companies. Yet, it is still relatively unknown in healthcare planning circles. Here is a crash course in Dr. Kaplan’s design:

Stage 1: Develop the Strategy

This stage includes the development or refinement of mission, vision, and values – the underpinnings of all strategic plans. Following a formal review of MVV, the organization then conducts strategic analysis and develops overarching long-term goals.

Stage 2: Translate the Strategy

This is where measurable objectives are set and strategies and tactics are defined. Strategies and tactics exist for the sole purpose of achieving a quantifiable objective, while the objectives define the goal. The organization’s balanced scorecard and key performance indicators are also developed during this stage.

Stage 3: Plan Operations

The strategic plan is driven through operations, with a focus for improving key processes, allocating resources, and preparing budgets – all of which funnel into dashboards and performas. Following the completion of these steps, the strategic plan is executed.

Stage 4: Monitor and Learn

During the execution of the strategic plan, strategy and operational reviews are held to determine progress. The balanced scorecard, key performance indicators, dashboards, budgets, and performas drive these reviews.

Stage 5: Adapt the Strategy

If necessary, additional strategy analysis is conducted throughout the plan’s execution, and emerging strategies are examined, all to determine if course corrections are required. No strategic plan should be carved in stone, and it is important that the organization is flexible enough to adjust when necessary. Stage 5 then feeds back into Stage 1, as the organization begins another strategic planning cycle in what is a perpetual process.

The Kaplan model is robust enough – and flexible enough – to meet the needs of any company, healthcare organizations included. If your strategic planning process is not as bullet-proof as the Kaplan methodology, your organization might do well to adopt this design.

In case you missed it, in its March 1 issue, Time magazine reported on Martin Lindstrom’s groundbreaking research into neural advertising. This is important reading for anyone in marketing, but particularly for those of us in healthcare.

Lindstrom, a leader in neuromarketing research, has spent the better part of a career trying to ascertain which sounds evoke the most powerful emotional responses. And he believes he has figured it out. The sound that leads the pack – actually, the sound that blows all the other sounds away – may forever change the way hospitals approach television advertising production.

So what sound surpassed all the rest for its ability to generate viewer interest and positive feelings? A baby giggling, which far exceeded the positive responses generated by the distant runners-up, which included the hum of a vibrating cell phone, an ATM dispensing cash, a sizzling steak, and the sound of a soda can being opened and poured.
But let’s stick with the baby.

What hospital hasn’t used a baby in its advertising? In fact, if you go back to the birth of hospital adverting (no pun intended) in the early 1980s, it was mostly a race to see which hospitals could put the cutest babies on the most trafficked billboards. Babies were the kingpin of hospital marketing then, and to some degree, they still are now.
But after reading the Time magazine article, it dawned on me that I couldn’t recall a single time that I actually heard a baby in a hospital TV ad. At least not giggling. This is not surprising, as hospitals are notorious for overlaying soundtracks on their ads that are so syrupy sweet, they could make a diabetic wince.

We have tried so hard to evoke an emotional viewer response through our TV spots with powerful visuals, crisp copy, and heavenly music beds, yet the sound that is the most powerful of all has been masked. As we build our collective brands, it is important to use the tools that can help us craft the strongest, most sustainable brand possible. Who would have thought that the giggle of a baby’s voice would be the strongest sound of all?

There’s a lot of effort being wasted these days by healthcare marketers who are putting some very cool and sophisticated brand creative in the marketplace, all aimed at either creating a brand or changing a brand.

Here is a little bit of marketing heresy for you (and, no less, from folks who have made a career in healthcare marketing): All that money being spent on brand communications isn’t doing a thing to create or change your brand.

The sad reality is, you can’t decide what you want your brand to be today, and then change your brand tomorrow.
Brands don’t work like that. They are complex, intricate things. They are influenced by many factors, shaped by every customer encounter, and given a personality by every employee memo, patient billing inquiry, physician-nurse-patient interaction, and so on.

So while you can’t change your brand, you can change the things that can change your brand: the wait time in the E.D., the discharge process, the agendas for your management meetings, how you reward and recognize your staff, management involvement in the patient care process, pre-surgical testing, post-discharge follow-up, leadership training programs, employee orientation … well, you get the idea.

While brand communications are essential to your brand, brand communications are not the brand. All that very cool and sophisticated brand marketing is, indeed, necessary to communicate your brand to your stakeholders. Essentially, the brand communications are the external manifestation of the internal voice. And your brand voice needs to be heard.

However, the brand is what the brand is. And, ultimately, your customers will determine what the brand is and is not. If your brand communications reflect that reality and convey the true brand experience, and the brand experience is driven by how well you manage those dozens – hundreds – of brand factors, then yours will be a strong brand indeed.

So, change the things that can change your brand, and let the brand communications be used to project a brand voice that is heard loud and clear in the marketplace.

Is vision important? Based on the hospital vision statements that have come across our desks recently, we are beginning to wonder whether they are. So many are either vague, timid, or were actually accomplished by the organization years ago.

A vision statement is sometimes called a picture of your organization in the future, but it’s so much more than that. Your vision statement is your inspiration; the framework for all your strategic planning.

What you are doing when creating a vision statement is articulating your dreams and hopes for your organization. It reminds you of what you are trying to build.

While a vision statement doesn’t tell you how you’re going to get there, it does set the direction for your business planning. That’s why it’s important when crafting a vision statement to let your imagination go and dare to dream – and why it’s important that a vision statement captures your passion.

When writing a vision statement, be sure you don’t fall into the trap of only thinking ahead a year or two. Once you have one, your vision statement will have a huge influence on decision making and the way you allocate resources. Does your vision statement need a facelift? If so, here is a simple three-step process to get you going:

1. Gather your management team and tell them to think ahead 10 years from now. What will your organization be known for? Think big. Stretch yourself. Dream. Ten years is a long time. Consider this: John Fr. Kennedy’s vision of putting a man on the moon was realized in only eight years. You have 10. What will you accomplish?
2. The list of achievements that each person created probably has three or four really exciting ideas – maybe even more. Which one is the most inspiring? The one that can serve as a rallying point for the organization? The one that they are willing to commit to? Ask them to write it down.
3. After all of your team members have submitted their responses, review the various responses and then collaborate with your team to reach consensus on the vision of the organization. Then communicate that vision internally to everyone who matters.

Don’t underestimate the power that a strong vision has the organization, your strategic planning, and your brand.

There still seems to be much confusion in healthcare – and other industries – as to the difference between goals, objectives, strategies, and tactics. Confusion in understanding these terms often leads to muddled strategic plans.

Knowing the terminology creates clarity and focus. And with clarity and focus come a greater chance of success.

Goals are broad statements of what the organization hopes to achieve and are qualitative in nature. Although your organization can have short-term and long-term goals, it is important that each goal is clear and can be supported by measurable objectives.

Goals supported by measurable objectives become self-fulfilling. What’s more, strategic plans with four to seven over-arching goals to be achieved within three to five years are the most efficient to manage.

Very often, goals give further definition to the organization’s vision. If the vision is to become the most-respected hospital in North America, then the goals might focus on establishing a solid reputation in the areas of clinical quality, patient safety, satisfaction, and financial performance.

Objectives are the most critical component of the strategic plan, as they answer the questions, “How much? By when?”

Objectives are quantitative in nature. In fact, objectives are the only quantifiable elements of the strategic plan. Goals, strategies, and tactics are all qualitative and describe how things get done, but not how much will be accomplished.

To keep your objectives on track, a good rule of thumb is that every objective should begin with the word “increase” or “decrease.” After all, objectives define how much improvement will take place, and that improvement is either in the form of increasing a statistic (surgical volume) or decreasing a statistic (medical errors). If you are simply trying to maintain a statistic, it doesn’t belong in the strategic plan; it is better suited as a key performance indicator or for the balanced scorecard.

Strategies describe a major approach or method for attaining objectives and resolving specific issues. Strategies begin to answer the question, “How will we go about accomplishing our objectives?” Strategies describe a general approach or method; they don’t describe specific activities or projects – that’s the work of tactics.

For example, a strategy to increase surgical volume might be to expand the operating room. Tactics for that strategy would then include the design and construction of the additional operating suites, hiring and training necessary staff, altering the surgical schedule, assigning block times, and marketing the expansion to surgeons.

Tactics are the definitions for the strategies. They are the specific ways you do things in order to execute the strategies. As such, they are actionable in nature and are the “concrete” things your organization will do to implement the strategies and achieve the objectives.

Whereas objectives should start with the words “increase” or “decrease,” strong tactics should start with verbs. Tactics require action, and verbs are best-suited for identifying what that action is. But action isn’t enough. Tactics, like the strategies and objectives in their family trees, must also have due dates and people assigned to carry them out. Tactics assigned to individuals are always preferred over assignment to teams, as it adds a layer of accountability to your strategic plan.

Does your hospital’s brand have defined values — brand attributes — that drive your brand promise? Are brand values even necessary? Do they make a difference?

The short answer to both questions: Yes and yes.

Consider two hospitals, each anchoring itself to a brand platform of customer service. The first hospital identifies its brand values as excellence, compassion, and respect. The second hospital, meanwhile, defines its customer service experience around the values of responsiveness, accountability, and accessibility.

If each hospital operationalizes a brand experience and articulates a brand promise based on their respective brand values, then each will offer a unique experience that is distinctly different from the other — even though both hospitals are building their brands around a customer service theme.

The benefits of knowing your brand values are multi-fold.

First, it richly defines your brand promise, allowing your organization to inculcate those values into the organization — from back-office processes such as recruitment and retention to front-line process such as patient care.

Second, it provides your organization with a touchstone for making decisions. By asking the question, does this decision erode our brand values or strengthen them, you are assured of charting a much truer course.

And third, it gives you something to measure against. You want to “own” your brand values in the marketplace, and if your values are clearly defined, then it is relatively easy to determine if you do. For the hospital whose brand values are excellence, compassion, and respect, questions regarding these values can be included on patient, employee, and physician satisfaction surveys. Consumer preference surveys can ask, “When I say the word compassion, what is the first hospital that comes to mind?” Through these methods, you can actually quantify the strength of your brand.

And knowing the strength of your brand allows you to make it even stronger. After all, you can’t manage what you can’t measure. Having defined brand values allows you to do both.

Recently, I was working with an organization to craft a mission statement. How long should the mission statement be, the CEO asked?

My reply: Short enough to put it on a bumper sticker.

He looked at me quizzically. The CEO had an engineering background, and I sensed that he was looking for something more specific.

Eight words, I told him. I’ll give you eight words.

Some strategists may consider my advice somewhat draconian. Eight words? What can you possibly say in eight words?

The answer: Plenty.

When it comes to mission statements, short is always better than long. It is those rambling mission statements that drone on for paragraphs that become meaningless, as the essence of the organization is buried amongst so much rhetorical garbage.

Limit yourself to eight words, however, and you have to focus on the very core of what your organization stands for. With eight words, there is no time to expound on the 17 reasons why your organization exists. There is no room for every board member, committee chair, and executive with “chief” in their title to have their own contributory sentence. There are no comprises, no literary flatulence, and no hyperbole.

With eight words, you are forced to strip off all the excess layers and define what your organization really is.

Here are two of my favorite healthcare mission statements:

• We help people feel better (Memorial Health, Savannah, Georgia)
• We enhance life (LibertyHealth, Jersey City, NJ)

Imagine … two mission statements of five and three words each that not only are memorable, but also resonate within their respective communities and define what each hospital does. Walk around those facilities, and it becomes clear that each medical center truly lives its mission and that each employee deeply understands the impact his or her individual performance has on the mission itself.

Interestingly, for each of these organizations, the mission became the brand. Memorial Health’s branding efforts were anchored by the words “feel better” from 1999 to 2007. And LibertyHealth has been branding itself on the mantra of “enhancing life” since 2008. But that’s what happens when the mission is so clear; the mission becomes the brand, and the brand becomes the mission.

All by being able to reduce the mission statement down to the size of a bumper sticker.

The Achilles heal for most hospital brands these days is the fact that they are built upon statistics. The two most common brand platforms – customer service and clinical outcomes – are often reliant on patient satisfaction scores, core measure data, Healthgrades rankings, and the like. And why not? Objective, third-party data is always better than hollow claims of superiority.

But what happens when the market shifts? What is the impact to your brand when patient satisfaction falls, or the competition’s scores surpass your own? Where do you turn when your brand – based on clinical outcomes and medical staff performance – is suddenly under attack because of a headline-raising event?

These are issues faced by every company that built its brand around celebrity endorsements. Pepsi-Cola with Michael Jackson. Hertz with OJ. Kmart with Martha Stewart. And, most recently, Accenture, Nike, Gillette, and Gatorade with Tiger.

And they will eventually be issues faced by every hospital built around market data. At some point, the market changes, and your brand has to high-tail it out of town.

So how do you prevent this likely brand demise?

Simple. Build a brand that transcends market forces.

Sounds mystical, doesn’t it? But it is relatively quite easy. If the brand is built upon the organization’s personality, values, operational philosophy, or some other organizational attribute, it can make itself immune to market conditions.

Take, for instance, a hospital brand not build on clinical superiority, but on the experience and commitment of its people. This was a strategy deployed by Avis, which built a brand on its “we try harder” mantra. It didn’t matter whether Avis was No. 1 or No. 2 in the market, nor did it matter if it was ever awarded a single J.D. Power customer satisfaction trophy. Avis was laying claim to an organizational value that was elevated to a brand position. Only Avis could sabotage its brand, and it never has. The “we try harder” brand was launched in 1962 and will soon celebrate its 50th birthday. How’s that for market transcendence?

Now, imagine your own hospital brand being wrapped around the experience and commitment of your staff. No one – and no organization – can strip you of these attributes. Commitment and experience are yours to own or give away. They do not rely on market superiority to succeed, or volume supremacy, Magnet hospital status, nationally leading patient satisfaction statistics, or any other measure that the competition might claim.

Certainly, you have to deliver on the brand. But if you do, yours will be a brand that really does elevate itself out of reach of market forces.

Hopefully, your 2010 strategic plan is completed, approved, distributed, and communicated.

However, I suspect there are many of you who are still putting the finishing touches on your organization’s strategic plan, either because you are awaiting final year-end numbers to validate your 2010 objectives, your board didn’t meet in December to approve the plan, or the executive team got sidetracked by the budget process.

Regardless of whether you have finished the planning process, resolve to build accountability into this year’s plan. Assuming you use the standard business school strategic planning model of goals, objectives, strategies, and tactics, and that your organization has quantifiable and measureable 2010 objectives, as well as strategies and tactics designed to achieve those objectives, here then is a six-point plan for driving strategic plan accountability:

1. Make sure each 2010 objective is assigned to a single senior leader in the organization. Objectives are the lifeblood of the strategic plan; they should be “owned” by your senior-most executives — not middle managers. And they should be assigned to single individuals, not a team of executives. At the end of the day, you want to know who is ultimately responsible for an objective. Individual ownership breeds accountability; team ownership does not. And if you think that because yours is an integrated delivery system with 12 hospitals, 65 physician practices, 18 outpatient centers, etc., you are forced to have shared objectives, then understand that this is just the culture of your organization talking.
2. Make sure every strategy and tactic has a very specific completion date. Second quarter is not specific. Neither is June 2010. However, June 18, 2010, is. And unless your organization’s leadership team routinely works weekends and holidays (which I doubt they do), make sure completion dates don’t fall on any of these days. In addition, the completion date for any strategy should be the latest completion date of the tactics that make up that strategy. A strategy is nothing more than the sum of the tactics that comprise it. When the tactics are completed, the strategy is completed. Period.
3. Make sure every strategy and tactic is assigned to someone in management. Like objectives, they should be assigned to single individuals, not teams of people. Even if a team is required to execute a strategy or tactic, one person will be designated the team leader. This is the person who should have strategic plan responsibility. Don’t ever assign strategies and tactics to non-management staff or to physicians who are not employed by your organization (that includes physicians who receive a medical director stipend). This is a recipe for failure.
4. Monitor due dates. Develop a system for notifying people when they have a strategic plan strategy or tactic coming due. Let them know how to report the status of their activity, and whom to report it to. And when they are late, let the executives in your organization know. Implementing strategies and tactics on time should not be optional; it should be required.
5. Create an easy-to-understand dashboard system to monitor your organization’s objectives. Any such system should include early-warning flags that alert the organization when an objective is in jeopardy. This will help your strategic planning team assess whether the strategies and tactics were ill-conceived, or just poorly executed. Devise a scoring system that shows the success of the plan. My favorite methodology is to use a 100-point system in which meeting the objectives is 75% of the score and completing the strategies and tactics on time is 25% of the score. Scoring makes communications easy, as people inherently know that a strategic plan score of 88.5 is much better than a score of 72.6. And while you’re at it, establish a score you are aiming for — for instance, 90.0 (if you ever achieve a perfect score of 100.0, I would argue that your plan was soft).
6. If possible, incentivize your management team on the success of the strategic plan. Align management bonuses to the plan, either as a team or as individuals. There are pros and cons of each. Strategic plan incentives that are based on individual contributions to the strategic plan provide your team with intense focus, but it can also create silos. On the other hand, awarding the entire team equally on strategic plan performance might create a culture of teamwork and camaraderie, but it can also breed contempt, as the bottom performers receive rewards equal to the organization’s star achievers. I’ve seen both models work, depending on the organizational culture at hand.

Follow this six-point plan, and you will find that strategic plan accountability in your organization will become second-nature, and that your likelihood of success will be achieved.