Short Paper

In today’s increasingly competitive healthcare industry, it is imperative that mission-driven healthcare organizations—whether hospitals, physician practices, long-term care facilities, durable medical equipment distributors, or pharmaceutical companies—be able to achieve and maintain a clear, identifiable reputation; name recognition; and competitive advantage. What, if anything, distinguishes one hospital from all other hospitals, one pharmaceutical firm from another, or one group of physicians from any other group of physicians? For many decades, this need to set one’s organization apart from all other organizations of a similar nature was greatly hampered by the healthcare industry’s misunderstanding of—and disdain for—marketing. Indeed, a 2005 study of hospital mission statements found that nearly all contained similar language and claims regarding their commitment to the provision of high-quality care (Bolon 2005). In a 2008 study, researchers searched a random sample of hospital mission statements for key words associated with interest in and commitment to education and found that the missions of 21 of the 81 (26 percent) teaching hospitals examined made no reference to teaching or education. More

More than 25 percent of teaching hospitals’ missions were indistinguishable from nonteaching hospitals’ missions (Wiggins, Hatzenbuehler, and Peterson 2008).

Certainly all healthcare organizations and providers are committed to providing quality care, but when their mission statements are homogenized and interchangeable, they cannot build a unique reputation or communicate a competitive advantage. Thus, if an organization’s strategies must align with and actively support its overarching mission, and if its mission statement is indistinguishable from the missions of other healthcare organizations, how can marketing strategy adequately and ethically steer the organization’s limited resources to the most appropriate opportunities for attaining and sustaining competitive advantage and achieving its mission?

An organization’s vision statement is similar to its mission, but it extends beyond

What the organization is into the realm of what the organization wants to be. An organization’s vision is its ideal future state. It is the best that an organization can aspire to be. It describes the direction an organization wants to take and the desired end result of that journey (McConnell 2007). Put another way, if an organization were a person, what would it see when it closes its eyes and dreams? Healthcare organizations’ visions can be inspiring and, perhaps, audacious. Consider, for example, the vision of a small community hospital in southern Idaho to “be a standard of excellence and cooperation in making Mountain Valley the healthiest place in America” (McGinnis et al. 2003). Seeing itself as the healthiest place in America certainly is an audacious dream, but it is a worthy vision to work toward.

It is not marketers’ place or responsibility to badger their organization into redrafting and rewriting its mission and vision statements, although from a marketing point of view it might be a useful and productive endeavor. However, whether or not an organization’s mission is bland and similar to those of other organizations of its kind, and whether or not the organization’s vision is exciting, specific, and dynamic, it is the responsibility of the marketer to dig deeper into the statements and examine the organization’s values.

There is a lot of talk in healthcare about values. Organizational values are standards that govern the behavior of individuals in an organization. In an enterprise that encompasses almost innumerable professions, patients, providers, and customers, one needs to under- stand that each of these constituencies, as a group and as individuals, has its own value system. Without a common understanding and acceptance of established values, health- care organizations would have to conduct business and deliver care while immersed in a veritable sea of opposing, contradictory, overlapping, and clashing values.

Values can be very personal and deeply held. In an industry in which each profession has its own code of ethics and patients and consumers have vastly diverse ethnicities, religions, backgrounds, and cultures, it is imperative that health organizations be clear, internally and externally, about the values on which they stand. In addition, healthcare leaders must understand that simply writing or posting a code of values does not mean that the people in their organization will actually embrace and live those values. Thus, it behooves healthcare organizations to become perfectly transparent value-wise as they strive to achieve their mission and fulfill their vision. The Teal Trust, a former leadership organization most known for its leadership style indicator, suggested that the following five activities encourage people to uphold behavioral norms that support the achievement of their organization’s mission and vision:

1. Communicate values clearly and constantly both within and outside of the organization. Everyone inside and outside the organization knows what you represent.

2. Enroll new members of the organization in the culture of values immediately. Value-focused information and indoctrination should start with the selection process.

3. Revisit and refresh your values periodically. Healthcare is constantly changing; you must ensure that your organizational values have kept pace.

4. Confront contradictory behavior. Provide feedback to those who do not live the organization’s values.

5. Periodically solicit feedback. Ask people, both inside and outside the organization, what they believe the organization’s values are.

Clarity of values and a mission and vision that clearly delineate and set the organization apart from others of its kind are the lenses through which marketing can look to understand and align itself with the organization’s internal and external environments.

Healthcare Success and Marketing Research

Healthcare marketing is driven by the need for current and accurate information crucial to achieving an organization’s mission and vision. Strong marketing research guides health- care organizations to make sound decisions in all areas (Fell and Shepherd 2008, 1):

Good market research defines areas of concern for a healthcare organization, helps frame strategic decisions, and connects the management team with its customers and stakeholders . . . . If making good business decisions is the key to market growth and sustainability in healthcare, then market research should be considered a critical element in that decision-making process.

Two fundamental conditions in the healthcare industry are constant change and increasing competition. For most of the twentieth century, healthcare was internally focused, paying attention primarily to the needs of physicians, hospitals, and payers. The assumption was that when the needs of these three groups were met, the needs of patients also were met.

A healthcare organization’s survival now depends on having a clear understanding of both its internal and external environments. Furthermore, a successful healthcare organization differentiates itself—separates itself from the pack, as it were—not only to attract patients but also to recruit and retain high-quality employees. No longer is a hospital just a hospital; no longer is a physician practice just a group of doctors that might as well be any group of doctors. Healthcare organizations need to understand, nurture, and trumpet their distinct competencies.

Healthcare organizations must be consciously competent—no luck or accident is involved. They need to know what works, with whom it works, and why it works. In addition, a successful organization understands that healthcare provides two kinds of value: visible and invisible. In this sense, value does not refer to the cultural standards of behavior discussed earlier. This time, value refers to the economic concept of worth, of cost versus benefit. Visible value is value that a customer can see. Invisible value is value that a producer builds into its product (Berkowitz 2011, 53). Both are fundamental to aligning an organization’s marketing efforts with its mission, vision, and values. When conducting market research, the healthcare marketer needs to determine what customers/patients need and desire. What will make their experience with the health- care organization memorable and make them want to return? Interestingly, it is not always what marketers think it will be. Internally, organizations know they add value by using electronic medical records, credentialing caregivers, and providing continuing education for all staff—but most patients don’t care about those things. Patients that do care about these features assume they are givens; their value is invisible. Patients want high-quality care, compassion, respect, and convenience—all visible values. Only by deeply under- standing their organization’s patients, customers, markets, and internal and external environments can marketers support and align their efforts with its mission, vision, and values.

Marketing that Supports the Mission

Healthcare organizations need to be both mission based and market driven; the two concepts are intertwined. Mission-based, market-driven organizations (Brinckerhoff 2010, 17-18)

◆ understand their markets;

◆ treat everyone like a customer;

Include everyone on the marketing team;

◆ ask, ask, ask, and then listen;

◆ innovate constantly;

◆ promote and protect their brand; and

◆ use every communication medium available.

These characteristics are not as straightforward in healthcare as they are in other industries. For example, healthcare markets comprise not only customers, consumers, and patients. They also include insurance companies; equipment and technology interests; and a huge assortment of health professionals, from physicians and nurses to accountants, lawyers, suppliers, and vendors. In an industry that is often uncomfortable using the word customer, how does an organization treat everyone as such? How can it treat physicians as customers? Healthcare professionals traditionally think of themselves by discipline, not by employer. A nurse is a nurse who happens to work at St. Rita Hospital, not an employee of St. Rita who happens to be a nurse. And almost universally, health professionals don’t see themselves as marketers in any sense of the word.

The principal–agent relationship may no longer rule supreme in today’s health- care industry, but it still exists: The principal (patient) gives consent for the agent (care- giver) to have the authority and power to make appropriate decisions on her or his behalf (Berkowitz 2011, 52). It is assumed that patients rarely understand their own healthcare wants and needs, and thus the idea of ask, ask, ask, and then listen may be a foreign and perhaps frightening concept for caregivers. After all, regardless of what patients may think they want or need, providers have care protocols, regulations, and professional standards they must uphold.

In a world where most hospital mission statements are incredibly similar, what is a hospital’s brand? Does the word brand even have meaning in healthcare? These questions are rhetorical, of course, and are addressed in later sections of this book. The point here is that market-driven concepts such as those presented in these questions must be at the core of a mission-driven organization, and healthcare organizations present unique challenges in this respect.

In particular, it is important to understand that marketing in healthcare is far more than just advertising or attracting patients and customers to a facility. Some experts argue that marketing has evolved through three stages. Marketing 1.0 was product-centric and focused on sales, and Marketing 2.0 was focused on corporate positioning and satisfying and retaining customers. Marketing 3.0 emphasizes that consumers are no longer isolated individuals; they are empowered and connected via any number of media channels, and their knowledge and behavior change organizations and products (Kotler, Kartajaya, and Setiawan 2010). Consider the urban clothing store Gap. When Gap made minor changes to its original logo, the negative customer outcry via social media was so strong that Gap quickly returned to using the original (Parr 2010). Another example is the Susan G. Komen Foundation’s decision to change its funding of Planned Parenthood. Like Gap’s experience, the strong negative pressure exerted through social media caused the foundation to reverse its funding decision (CNN Wire Staff 2012). The cautionary tale and les- son learned are that any organization that does not know its environments and markets, does not listen to its customers and stakeholders, and acts as if its business decisions are best made in the vacuum of the corporate offices often suffers and finds itself retrenching.

Peter Drucker (1989), who is often called the father of modern management, said that successful businesses don’t start their planning with financials; they start by defining their mission, and performing their mission brings financial returns. Thus, the understanding of markets and customers garnered through marketing research is the foundation on which mission-driven, mission-achieving organizations are built.