|  Scott Regan

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.

For nearly two decades, I have heard hospital marketing executives complain about their exclusion from discussions of hospital operations. Either they are invited to their organization’s ops council to listen and learn, or they are excluded from these meetings altogether.

Smart hospitals are realizing that the people charged with watching over and protecting the brand must be included in operational discussions, because the brand and hospital operations are one. And, in an effort to better marry the brand experience with the brand promise, the really, really smart hospitals are going one step further by including marketing executives in ongoing quality improvement efforts.

Sound crazy? Think about it.

Every day, hospital brands are being more defined around quality. Report cards are everywhere: CMS, Leapfrog, HealthGrades, and J.D. Power, to name just a few. Top hospital lists are abundant, including rankings published by Modern Healthcare, Hospitals & Health Networks, and U.S. News & World Report. And then there is the high-profile quality curriculums offered up by The Joint Commission and Institute for Healthcare Improvement, which are constantly in the news.

That’s not all. Payers are moving toward reimbursement models that reward quality and penalize mistakes. Patients can look up readmission rates, infection rates, and mortality rates. And detailed physician information is available with the click of a mouse.

Quality is fast becoming the most dominant brand platform in healthcare. Which is exactly why marketing executives must get involved in quality improvement. As guardians of the brand, marketing executives represent the brand promise in the marketplace – which means they are now obligated to help fix the brand experience. As such, marketing executives must now, more than ever, roll up their sleeves and dig their hands into the muck of mire of hospital operations.

The brand should not be left to chance. And marketing executives should not be left on the outside of hospital operations looking in.