|  Scott Regan

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.

Last week, we conducted a poll on the eight most common brand platforms for hospitals, and 135 of you responded. The results: 60% of respondents listed “customer service” as their hospital’s primary brand platform, followed by medical staff reputation (13%), clinical outcomes (13%), teaching and research (7%), and facilities (7%).

Those categories without a single mention: Technology (surprise!), physician relationships, and financial stewardship. So maybe the Big Eight is really the Big Five, although every category with the exception of teaching and research was considered to be a secondary brand platform by at least six hospitals.

Quite a few hospitals also provided their own secondary brand platforms that were not on the list of eight. Among those that were included were compassion, affordability, accessibility, trust, and world-class. The question is, are these really brand platforms? Or are they brand values?

Dictionary.com lists the sociological definition of values as is “the ideals, customs, institutions, etc., of a society toward which the people of the group have an affective regard. These values may be positive, as cleanliness, freedom, or education, or negative, as cruelty, crime, or blasphemy.”

If you are searching for a home, the home itself has a certain brand platform: wealthy, poor, urban, rural, etc., depending on where the home is. And depending on the location of the home and how it is constructed, it can also carry specific values: clean, cost-efficient, warm, drafty, and secure, to name just a few. But these are attributes of the home that help convey the home’s brand. They are not the brand platform itself.

You can purchase a home in a down-trodden neighborhood whose brand platform is under-class by virtue of the neighborhood that surrounds it, and elevate the brand platform by adding a Florida room, re-landscaping the yard, and adding exterior lights. By focusing on the brand’s values, you can strengthen, weaken, or even change the brand platform.

A hospital I worked with a few years back focused on clinical outcomes as its primary brand platform and customer service as its secondary brand platform. It had a single brand value it wanted to own in the marketplace, that value being “trust.” The hospital felt that unless the community really trusted the hospital, it would never fully develop their brand platforms.

That single value of “trust” was imbedded in every internal and external communication. Hospital executives obsessed on this value. The external marketing communications conveyed images of trust and had the word unobstrusively included in every message that was released into the marketplace. Within five years, the percent of people who mentioned this hospital by name when asked what hospital they trusted the most went from 32% to 74%.

And market share went from from 37% to 51% during this same time.

All by understanding their brand platforms, brand values, and interweaving them together.

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.

Brand and strategy share a strong bond in that they both derive their roots from the same place. In a way, they are twins, with the same basic DNA structure. Or, perhaps more accurately, they are two sides of the same coin.

If you trace brand and strategy back to their origins, you arrive at the same place: Mission.

The foundation of all great healthcare brands is mission, which determines what the organization is. For a brand to provide a true, pure brand voice that resonates in the marketplace, it must embody the mission of the organization.

A brand that ignores the mission is a brand that will eventually fail. Why? Because the mission dictates why you exist, how you govern and manage the organization, what you pursue, who you hire, and so much more. The mission is, essentially, the brand promise. If the brand experience doesn’t measure up to the brand promise, the brand withers and dies.

Similarly, the foundation of all great healthcare strategic plans is mission, as the singular purpose of a strategic plan is to link together mission and vision. The goal of any strategy is to fulfill the mission and achieve the vision. Without mission, strategy wanders around aimlessly, trying to accomplish things that may or may not be important.

In order to strengthen both brand and strategy, it then makes sense to strengthen the organization’s mission. Is your mission statement clear? Is it stated in eight words or less? Can every staff member, physician, and administrator easily recite it? And do you train for it, so that every person on staff knows how his or her job impacts the mission every day?

If you answered “no” to any of these questions, you may have a strong mission, but it can be stronger still. Spend the time necessary to get the mission right, and you will forge a much stronger sisterhood of brand and strategy.

I was recently facilitating a management retreat for a healthcare organization when an executive asked me when “brand conception” occurs. If a brand has a “Big Bang,” then when and where does it happen?

It’s an interesting question. One which I am sure will invite many answers.

I’ll explore some of the more plausible Big (Brand) Bang Theories.

Perhaps the easy answer is that brand conception begins with the name. Without a name, the organization doesn’t exist. And if the organization doesn’t exist, the brand doesn’t exist. But does the mere presence of an organization provide the sparks needed for the Big (Brand) Bang? I don’t think so. Consider two hospitals built and opened within days of each other in the same market. One is called Community Hospital and the other is called General Hospital. That’s all we know about either. Is it enough to set them apart from each other? Is there anything in their names that might differentiate their brands?

You might argue that I gave these hospitals names so vague as to carry my argument. Let’s rename them Community Cancer Hospital and General Heart Hospital. Or Starbucks Hospital and Apple Medical Center. I don’t think it really matters. Because as the age-old question asks, “What’s in a name?” The answer: Not much.

So, if the name is not the point of brand conception, then what is? How about the mission? In the mission we begin to see differentiation. Community Hospital’s mission is to serve the poor, ensure healthcare access for all people, and deliver health services to those in outlying impoverished areas. General Hospital’s mission is to advance technology to create an efficient and effective healthcare delivery system with the highest levels of quality attainable.

We begin to see brand differentiation, or do we? Are the mission statements powerful enough to create a catalyst for a brand? I’ve seen many mission statements that were strong in ideas, but weak in application. The organization may have birthed a mission, but it was not even a distant third cousin to the brand.

Let’s look at the vision. Community Hospital’s vision is to redesign the healthcare delivery system so that all people have equal access to every level of care, regardless of their ability to pay. General Hospital’s vision, on the other hand, is to create the highest quality, safest, and most profitable hospital in the world. Is this the point of the Big Bang, with the creation of a vision so unique, so energizing, that it single-handedly explodes into a brand?

I don’t know.

What about strategy, that omnipresent link between mission and vision. Can brand be conceived without the correct strategy that pulls it all together? And then, of course, there is leadership. Their role in the conception of the brand is critical, as without someone actually parenting the brand, the brand may never make it to full term.

Strong arguments can be made for any of these Big (Brand) Bang Theories, and I am sure many will. If I had to put one under the microscope for further study, it would be the mission. I suspect that the mission is where brand conception occurs. If not the mission, then it would have to be the vision. Or, perhaps it is a combination of the two, with conception occurring with the mission and the Big (Brand) Bang occurring with the vision.

It’s tough to say.