With all of the data that hospitals have at their disposal, it’s not too difficult to measure your brand. If you subscribe to the notion that a hospital’s brand is largely experientially based, then there are many metrics that can help you illuminate the power of your brand.

Here is our list of brand indicators that deserve a watchful eye:

• Physician Satisfaction: If I had to select a single metric to correlate with brand power, I would choose physician satisfaction. If the physicians don’t like your hospital, they won’t refer or admit patients to your facility, and worse, they will tell patients who actually want to use your hospital exactly why they shouldn’t. What’s more, with so many hospital ranking surveys based, to some degree, on physician preferences, not having this group tightly aligned with you can spell brand disaster. Metric to watch: Overall physician satisfaction.
• Patient satisfaction: Ultimately, your brand hinges on patient satisfaction. The word-of-mouth advertising that results from a patient’s experience is more powerful than any TV spot, billboard, print ad, or direct mail piece that you can produce. Metric to watch: Overall patient satisfaction.
• CMS Likelihood to Recommend: This is the ultimate question in the CMS HCAHPS survey. More than likely, patients who are not willing to recommend your hospital are telling their friends and neighbors why they shouldn’t use your hospital. Metric to watch: Likelihood to recommend.
• Employee Satisfaction: The ability to turn your employees into brand ambassadors is a powerful strategy that has not been leveraged by many healthcare organizations. For a mid-sized hospital with 2,000 employees, their potential market reach is dramatic. And because they work for you, what they tell people about your hospital is taken as gospel. Unhappy employees who are bad-mouthing you away from the hospital can destroy brands faster than a couple of ill-advised Tiger Woods text messages. Metric to watch: Overall employee satisfaction.

So, if you take the four factors above (overall physician satisfaction, overall patient satisfaction, CMS likelihood to recommend, and overall employee satisfaction), all of which are on a 100-point scale, and multiply them together, you will get an indication of your brand strength.

For example, Hospital A has the following metrics: 72.6 overall physician satisfaction, 81.5 overall patient satisfaction, 67% likelihood to recommend, and 56.9 overall employee satisfaction. Multiply all four scores and divide the product by 1,000,000 (to convert the score back to a 100-point scale), and you discover that Hospital A’s brand strength is 22.6.

Comparatively, a hospital that scores 90 in each of the four categories would have a brand strength of 65.6, and one that scores 80 in each of the four categories would have a brand strength of 41.0.

While this might not be the perfect solution to rating and ranking hospital brands, it’s not a bad place to start.

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.

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?

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.

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.

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.

Tiger Woods is, arguably, the world’s biggest brand. On any level. In any country. In any industry. Period. Even if you want to debate that point, it’s hard not to agree with the premise that his brand is sizeable and robust.

And infallible. Or so we thought.

As the first athlete to earn $1 billion, his brand was once sterling. He was a Golden Boy. And now, his brand is fast approaching rubbish. Accenture has already severed ties with Woods. As the scandal continues to unfold, there will certainly be others. So what can you learn from this debacle that might save your own brand? Plenty. Here’s five lessons that will serve you well.

1. Brands are often tied to people, as organizations take great strides to personify their brands. Your hospital’s brand is inexplicably intertwined with the CEO, the physicians on your medical staff, and your employees. Woods only needed to manage himself. You have to manage 500 to 50,000 individuals, depending on the size of your brand. And any one of them can destroy your brand as quickly as Woods destroyed his. If you are going to manage your hospital’s brand, you have to also manage the reputation of your team — because they are a critical component of your brand.
2. Hubris almost always sinks a brand. It certainly sunk Woods. Because of his own arrogance and overbearing presumptions, he believed that he could behave badly without retribution. When hospital CEOs begin believing their own press releases, trouble is on the horizon. And when those same CEOs believe they are bigger than the organizations they serve, trouble is just around the corner. Hubris has killed many an executive — as well as the brands they were charged to protect and oversee.
3. It takes five to 10 years to build a brand. It takes five to 10 minutes to destroy it. We need brands. They serve as a trust mark, a sorting device. We make conscious and subconscious decisions all day long based on brand trust. Ever purchase Advil for $9.99, when the generic next to it sold for $3.49 and had identical ingredients? Maybe it wasn’t Advil. Perhaps it was Philadelphia Cream Cheese versus the generic. Or maybe it was the physician who was the recent subject of a Medicare fraud investigation that you passed by in favor of a doctor a mile further away. My point is this: The next time Tiger Woods talks about the values that was inculcated in him as a child (although I can’t believe this will happen anytime in the near future), how much of his rhetoric will you actually believe? Now take your answer and apply it to your collective community next time your hospital is trying to defend its brand and the values associated with it.
4. Even in times of utter and total brand turmoil, brands can survive. However, pulling this off takes skill. And speed. Tiger Woods displayed neither as he cocooned in his home, forgoing an appearance at his own charity golf tournament and hiding behind the “private matters should stay private” comment. Had Woods stepped forward into the white hot spot light and bared his soul, showing remorse for what he had done, and pledging to take steps to rectify his sins, many would have raised his pedestal even higher. We all fall at some point. Individuals and institutions. It’s not the fall that is unforgiveable. It is not rising up after the fall and soaring even higher.
5. It’s better to take all of your medicine in one dose, that have it administered to you over several weeks or several months. Woods is learning this lesson the hard way, as new stories emerge nearly every day. With each new story, the Woods brand continually erodes, and Woods has more to answer for. When your brand is in trouble, it is better to assume that the things you are hiding will eventually emerge, rather than hope they are never uncovered. Step forward, put it all on the table, and be done with it. Not only is this brave, it shows that you have taken responsibility for your actions — even those that have yet to be disclosed. It’s easy to forgive someone who tells the whole truth, shows remorse, and pledges to do better. It’ hard to forgive someone who does otherwise.

You’ve worked hard to develop a strong hospital brand. Take a minute to think about how fast it can come tumbling down, should your hospital accidentally kill a patient, the Justice Department launches an investigation into billing fraud, your purchasing manager is accused of taking bribes, or your CEO is charged with sexual harassment. Now think about what you will do to save your brand from ruin. The time you spend planning now could save your brand in the future.

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.

When was the last time you gave any thought to the platform your hospital’s brand was anchored to? Was the brand platform a deliberate choice, or did it “just happen”? Even more important, do you know what your brand platform is and whether that platform is effective?

After conducting extensive research over the past 10 years, I have found that 95% of all hospitals anchor themselves to one or more of the following eight brand platforms.

1. Customer Service
2. Clinical Outcomes
3. Teaching and Research
4. Technology
5. Medical Staff Reputation
6. Physician Relationships
7. Financial Stewardship
8. Facilities

The two that dominate hospital marketing is customer service and clinical outcomes. Hospitals usually make up their minds to win the war for patients either by providing excellent personalized attention and creature comforts or by leading the marketplace in clinical indicators. It’s a fight between “we’ll love you” and “we’ll save you.”

The second tier of brand platforms includes teaching and research, technology, and medical staff reputation. Often, two of these are naturally coupled together. Teaching and research hospitals tend to migrate toward their strength, laying claim to the belief that because of their status, they are simply better and more sophisticated. But it’s not uncommon in markets where there is a major teaching institution to see a community hospital build a brand around technology and medical staff reputation. Consistent messaging is the key.

Finally, the third tier consists of physician relationships, financial stewardship, and facilities. While not as likely brand platforms as the first five on the list, they are still common, and are often a secondary brand platform for hospitals. The difference between medical staff reputation and physician relationships is that the latter is grounded in the collective pedigree of the medical staff (board certifications, fellowships, specialized training, awards and recognition, etc.) while the latter uses the medical staff to provide professional references for the hospital (physician testimonials, physician practice patterns, where physicians receive their own care, etc).

Financial stewardship is — and will probably always be — a stronghold of sorts for safety net hospitals, which must maintain a public dialogue about the need foir public funding. Integrated delivery systems, on the other hand, have given rise to the facilities brand platform, as they try to win market share by having a hospital, physician’s office, urgent care center, and/or imaging facility on every corner in town.

Any one of these brand platforms can be successful, if executed correctly. Where hospitals get into trouble is moving from platform to platform, creating diffusion as well as confusion. To create a strong, sustainable brand, define your platform — whether it’s on the above list or not — and use it to create a strong foundation for everything that you do, from operations to communications.

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