|  Scott Regan

This blog may generate a lot of criticism. I know it going in.

So, which are the most powerful hospital brands in America?

Mayo? Cleveland Clinic?

No and no.

If a measure of a brand is volume and market share, then neither of these brands — or any other hospital brand, for that matter — makes the cut.

Of the two brands mentioned above, neither of them are even among the 20 largest hospitals in America.

If volume is a measure of brand strength, then the Big Two would be Florida Hospital and New York-Presbyterian Hospital, which have national market shares of 0.29% and 0.25%, respectively.* So, you say, it isn’t fair that I measure brand performance at a national level. Okay, then, let’s look at it regionally. In Orlando, which is essentially a two-hospital town, Florida Hospital is battling Orlando Regional with 53.2% market share. And in New York City, New York-Presbyterian — the largest hospital in America with 2,207 staffed beds — has but 19.8% market share.

I know what many of you are thinking right now. A brand cannot be measured solely on market share.

And I agree with you.

But my point is this: Whatever market you are in, you are not trying to position your brand against Mayo or the Cleveland Clinic (unless, of course, you happen to be in Rochester or Cleveland). Hospitals are local in nature and, for the most part, the vast majority of patients travel less than 50 miles to seek a hospital provider. This is not Nike vs. Reebok for world domination. This is Community Hospital vs. Memorial Medical Center for local market position.

The fact is, there are no powerful hospital brands in the U.S. (This is where the criticism begins.)

Even in Cleveland, the renowned Cleveland Clinic has but 33.8% market share and is battling Fairview Hospital, MetroHealth Medical Center, and University Hospitals for quality bragging rights, as all four have been named a top 100 hospital in recent years. (Check out the CMS Hospital Compare website and see which of these hospitals is the leader in core measure performance. Hint: It isn’t the Cleveland Clinic.)

Which is why branding is becoming increasingly important — not at the national level, but at the local level. More and more hospitals are figuring out they can create a brand that can be more dominant in their market than Mayo or the Cleveland Clinic is in theirs. The smart ones are even tearing a page from the Mayo/Cleveland Clinic playbooks by creating a customer experience built around quality and service.

After all, there is a reason that Mayo and the Cleveland Clinic are held in such high regard, even if their brands don’t translate into king-of-the-hill kind of market share numbers. They are both intensely focused on what their brands mean and work hard to deliver on their reputations. And they have been doing it for years.

The lesson here is that brands are not built overnight, and healthcare brands are not even built nationally. Which means that the most powerful hospital brand in America is, in actuality, the most powerful hospital brand in your own market.

The question is, is it yours?

*Market share is based on 2007 data

We are dealing with a paradox of sorts. At a time when most hospital emergency departments are dealing with issues of overcrowding and wait times in excess of an hour, we are simultaneously trying to cram more and more patients through the E.D. The idea actually makes sense to me. After all, the emergency department is the front door to the hospital; some of our clients report that as much as 60 percent of their inpatient admissions come through the E.D.

It’s the strategy that is often lacking.

The very survival of many hospitals resides in the emergency department. Drive E.D. volume, and you also drive inpatient admissions, surgical procedures, average daily census, contribution margin, and net revenue. It’s pretty simple, right?

Yes, if you have an E.D. sized and staffed for 60,000 visits per year, but currently only have half that number. That’s probably not you, is it?

Hopefully, you are not the type of organization that thinks you can simply launch a slick E.D. campaign, despite 60-minute wait times and a left-without-being-seen rate of 6%, and all your problems will be solved. To the contrary, such an approach will make matters worse, as initially more patients crowd into your already overcrowded waiting room, more patients walk out, and more patients tell their family, friends, and neighbors about their horrific experience in your emergency room.

If you want to own emergency medicine in your market, there is only one way to do it: Reduce door-to-doc time to less than 10 minutes, eliminate LWBS, and then — and only then — communicate a brand promise that cannot be matched by your competitors.

This is brand-building from the inside-out — at its best. Create a brand-busting experience first. Commuincate a brand-busting promise second.

I know what many of you are thinking right now. Door-to-doc in less than 10 minutes? Hah!

If you think this can’t be done, think again. New models of emergency care are being implemented that are completely overhauling the E.D. experience. One client, with a door-to-doc time of 47 minutes and a LWBS rate of 4%, decided on a Thursday to implement a new model the following Monday. The results were astounding: On the very first day, the door-to-doc time was eight minutes and not a single person left the E.D. without being seen. The hospital has sustained this improvement for the last two months, during which time their E.D. patient satisfaction scores have shot up from the 9th percentile nationally to the 75th percentile nationally.

At the same time, their point-of-service collections have improved, E.D. volume is on the rise, and E.D. admissions are up — and they still have yet to launch any type of E.D. campaign; this is all through word of mouth.

They are not alone. Hospitals in New Jersey, Pennsylvania, Ohio, and Florida have all recently reported similar results. So what are they all doing that is yielding these kinds of results? Eliminating nurse triage, eliminating fast-track, and moving to an immediate-bedding system that includes a rapid decision unit.

If you want to learn how to execute this kind of a brand-busting E.D. strategy, drop me a line. We also have a great little Excel app that does a thorough cost-benefit analysis of your E.D. opportunity. And it’s free for the asking.

If you toss and turn at night wondering about the strength of your brand, well, you probably should. There are a handful of organizations shaping your brand, whether you know it or not. And if you pretend that the big four reporting organizations – CMS, HealthGrades, The Joint Commission, and Leapfrog – aren’t having a public impact, then your brand gets what it deserves.

Our research over the past three years has identified eight primary brand platforms that the vast majority of hospitals anchor themselves to. Currently occupying the top spot on that list is “clinical outcomes,” as hospitals in every major market fight to claim the title of “quality leader.” (The other seven brand platforms? Customer service, medical staff reputation, physician relationships, technology, teaching and research status, financial stewardship, and facilities.)

If you haven’t poked around CMS’s Hospital Compare website lately, then you are already in a dangerous place. The site(www.hospitalcompare.hhs.gov) provides a plethora of comparative information covering all the core measures and then some (such as, likelihood to recommend the hospital – how is that for a brand maker or breaker?) So, if you were selecting a hospital for you elective knee replacement surgery, would you select the hospital that provides the right antiobiotic at the right time for the right duration 72% of the time, or the hospital that got it all right 98% of the time?

No billboard, no matter how good the location or how great the visuals, will overcome a deficiency such as that.

Experience = Brand.

Brand = Experience.

There is no getting around it. Data reporting has matured to the point that hospitals MUST monitor its publicly reported data and focus intensive resources on improving its scores. What makes data reporting even more tenuous is the length of time it sometimes takes to improve your scores. HealthGrades, for instance, uses a rolling three years of data. Thus, if your most recent year had some clinical anomolies that might be negatively impacting your brand, you have to live with those anomolies for three years.

All of this means that the marketing function in hospitals has to take on a bigger role than it currently has. Marketing professionals have to move beyond communications strategies and be involved in operational improvement strategies. They have to data mine various web sites to understand the true implication of publicy reported data, and then craft strategies to integrate that data into their organization’s brand.

This is not easy work. But for those who decide to manage their brand, despite what public data shows, they will certainly be better off for it. Let CMS manage your brand for you, however, and you put your entire organization at risk.