|  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.

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.

Your brand is like a small stone tossed into a pond. As it splashes into the water, it radiates ripples outward along the surface, each band growing increasingly larger than those preceeding it.

Rippling water is a wonderful metaphore for brand building. Consider the stone your mission and vision statements. The first ripple in the water is your executive team. The second ripple is middle management. As the ripples continue to gain momentum, we move on through your medical staff, employees, patients, and the community at large.

The fact that the ripples grow in size is not important. The key learning here is that the ripples have an order to them. In other words, there are a series of concentric circles that envelope your brand and eventually become your brand. And to give your brand strength, you have to move through these circles in a logical order.

Should you do much brand building with your patients if your senior leadership team does not represent the brand in their day-to-day actions? Is it worth your while to invest on an external brand-building campaign if your front-line employees don’t understand what the brand stands for? And should you train your staff on the critical components of your brand if middle management is not first serving as a strong brand ambassador?

The answers: No, no, and no.

To build a successful brand requires that you first have a stone to throw into the pond. Having meaningful mission and vision statements are first and foremost in brand building. Second, you then have to work through your concentric circles — one at a time — ensuring that each circle is entrenched in the brand before moving to the next outward ring.

Do this, and your brand has a much higher chance of success. But if you fail to pay attention to the logical order of your concentric circles, your brand will likely have a rocky childhood. If your brand is currently struggling, review your concentric circles and see if one or more was left out of your brand-building process. Chances are, you will find the source of your struggles somewhere within the ripples.

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.

How many words are in your organization’s mission statement? Go ahead, count them. More than 20? More than 50? Two full pages of 10-point type? If it takes that many words to explain the essence of your organization, then how do you possibly convey that essence in your brand?

Great mission statements are the brand. They allow you to hire, train, promote, and fire. They are the touchstone for every decision, strategy, brand extension, and policy. And they are imbedded in the vision, values, strategic plan, and operations.

Tightly weaving together your mission and brand creates a powerful organizational dynamic that provides perfect structural alignment. While this is difficult work, it is far from impossible – unless you are unwilling to jettison the four-paragraph mission statement that currently adorns your lobby walls. To create the kind of mission-brand integration that elevates organizations to market dominance requires short, succinct mission statements – eight words or less – that resonate with both internal and external stakeholders.

In 2000, Memorial Health in Savannah, Georgia, adopted a five-word mission statement: “We help people feel better.” The organization carried that mission statement into its branding, with the simple, two-word tag of “feel better.” After tightly aligning its mission and brand, the organization rose to market dominance, which included four consecutive years on Fortune magazine’s list of “100 Best Companies to Work For,” as well as record margins.

In 2008, LibertyHealth in Jersey City, New Jersey, adopted a three-word mission statement, “We enhance life,” and a two-word brand tagline, “Enhancing life.” Since then, the organization has made tremendous strides culturally, clinically, and financially, and is emerging as the market leader in New Jersey’s highly competitive Hudson County.

It takes a great deal of thought and reflection to define your organization’s mission in eight words or less. Doing so requires you to strip away all the extraneous stuff you think is organizationally important and home in on the purity of your existence. However, when you are able to do this, amazing things happen. At Memorial Health, every employee not only knows the organization’s mission, but also how his or her job helps people feel better. And at LibertyHealth, they all implicitly understand how what they do everyday enhances the lives of those they serve. In other words, they live the mission while also living the brand.

For these two organizations, is the mission the brand? Or is the brand the mission? The simple answer is that they are both the same, which is as it should be. Mission and brand — inextricably linked as one.