Last fall, a Midwestern medical clinic moved from the cramped, nondescript, one-story building it had occupied for more than 30 years to a new two-story building. The move wasn't far; not 20 miles, not 10 miles, not even two miles. Just several hundred feet. Yet before the clinic opened its doors to patients at its new facility, market research was instrumental in making sure that short move was a smooth one.


The clinic's concerns were legitimate. If and how would the public's perceptions of it change? And, how could it remain a competitor in a highly competitive medical market?

To address these concerns, the clinic sought the help of Minnesota Medical Services Corp., (MMSC). MMSC was organized by the Minnesota Medical Assn. to help physicians cope with the new realities of medical practice.

The MMSC consulting team is a group of professional consultants dedicated to helping physicians strengthen their practices' management and succeed in today's competitive medical marketplace.

One of MMSC's consultants is Elise D. Jamison, president of MedFocus, a market research, market planning and consulting firm for medical organizations located in St. Paul, Minn. Jamison was asked by MMSC to be lead consultant for the clinic's study. Lorman L. Lundsten, Ph.D., associate professor of marketing management at the College of St. Thomas in St. Paul and also a consultant with MMSC, assisted Jamison in the project.

All in favor

To her surprise and delight, Jamison found that the physicians at the clinic were all in favor of conducting market research prior to developing and implementing a marketing plan. They had a good understanding that "jumping into" a marketing and advertising campaign prior to doing research would be an ineffective and inefficient route for getting their clinic off to a good start.

When Jamison began consulting physicians in general three years ago, these were hardly their sentiments. Marketing, to most of them, was a sign of a "practice in trouble" and a procedure they mistrusted because of the cost and what its results might be.

"Physicians didn't have an understanding of what marketing was," explains Jamison. "They weren't sure why clinics did it. They thought of chiropractics and lawyers, less 'professional' occupations, as those who engaged in marketing. To them 'professionals don't need to advertise.'"

But today, physicians look at marketing differently, continues Jamison.

"Physicians are now much more sophisticated in their understanding of what marketing is. They understand that it's more than placing an ad or making up a brochure. Physicians are going through an evolution in which they are now seeing marketing as an important and often times necessary aspect of their practice."

Research methods

There were four research efforts conducted to find out how the clinic was perceived: Staff interviews with physicians and nurses; mall intercepts in a nearby shopping area; focus groups using the clinic's patients; and, one-on-one interviews with physicians and patients using a technique called Kelly's Repertory Grid.

The technique, named for the perceptual psychologist who developed it, is frequently used in packaged goods research. It was used in this study for medical services research, primarily as a tool for questionnaire development. According to Lundsten, it's intended to show how people perceive things.

The grid requires respondents to use adjectives or attributes to describe the stimuli in question. In this case, the respondents were asked to describe their perceptions of eight Midwestern medical clinics, one of them being the clinic referred to in this article. With the exception of one of the clinics, all of them were competitors of this particular clinic.

The intention of the study was to discover how the respondents (the clinic's physicians, patients and non-patients of the clinic), perceived the clinics and how their perceptions of this particular clinic rated or compared with the other clinics.

Kelly's Grid

Each respondent was given a deck of eight cards with the competing clinic names on each card.

Next, the respondent was asked to put each card into one of these stacks: Not familiar at all; only slightly familiar; familiar; and very familiar. Any clinic which the respondent considered "not familiar at all" was withdrawn. Next, the interviewer assembled three stimulus cards from the remaining stacks and asked the respondent, "Which two of these are similar to each other and different from the third? How are they similar? How is the other different?"

The interviewer was instructed to continue probing the respondent to build a list of adjectives that consumers used to differentiate between clinics.

The interviewer then picked another set of three stimulus cards. Again, the respondent was asked to describe how two of them were similar and the third was different.

The interviewer continued to offer new sets of three cards until no new adjectives emerged.

Next, the interviewer put one set of bipolar adjective cards on opposite ends of a seven-point scale and asked the respondent to rate each clinic or physician's office (s)he was familiar with. The respondent was asked to sort the cards with the names of the clinics and the physicians' offices on them into the categories listed. The closer the respondent put the card to the end of the scale, the more it indicated the respondent's opinion that that particular clinic or physician's office had that particular quality.

Once all the attributes were obtained, the list was "cleaned" to isolate just those attribute pairs that truly differentiated one clinic from another and were truly important to the respondents (such as, a clinic was "close" or "not close" to a respondent's home) and that would potentially determine whether or not that respondent, or a potential patient, would visit the clinic. This helped the clinic see what its strengths and weaknesses were.

Lundsten says the attribute pairs (between 50-60 were obtained), were then "boiled down" to 25 questions and these became a questionnaire which was fielded in the market area.

Study findings

What the exercise revealed was that the clinic had a lot of positive and important attributes that people didn't know about and that should be put in the questionnaire. It also showed that there were some differences between the physicians and patients. Here were some of the findings:

  • Only physicians mentioned that a clinic near its hospital was something they thought was important to a potential patient.
  • Only physicians mentioned the importance of high-quality physicians; patients, on the other hand, weren't able to judge quality in the same way.
  • Physicians felt quality of care was an important concern with patients; patients didn't consider it a factor which varied between clinics.
  • Patients differentiated between the high-technology clinic and the more "conventional" clinic, the former being the most desirable, as an important characteristic in choosing a clinic. Physicians, however, did not see this factor as a major practical difference.

When the questionnaire was fielded, the respondents emphasized the importance of a clinic being close and convenient to them. The results showed that the respondents were familiar with the Midwestern clinic, felt it was well-known and established and also convenient. They also knew the staff was experienced and gave high-quality care. What they didn't recognize, however, was that the clinic has specialists for whom they have easy access.

Results at work

Jamison says the results of the findings have prompted some internal changes, helped set a direction for brochure development as well as further communication with the market.

Additionally, a report was packaged for the clinic describing a communications and marketing strategy.

The clinic also hired a communications consultant through MMSC to handle all of the advertising changes. New brochures are being developed and a new identity treatment of the clinic's name is also being produced.

"The new identity is more sophisticated, more professional and emphasizes that the clinic is one of specialties," explains Jamison. "It will be balanced with pictures of what these specialists do, while showing the attitude that the clinic is caring, friendly and close and convenient to people.

"Media advertisements will be more consistent and more standard now than they use to be," says Jamison. In the past, the clinic's ads did not have a consistent format or appearance."

Although a full-scale market research follow-up project is not slated until next year, the clinic is keeping tabs on how its changes are affecting patients' perceptions and satisfaction with the clinic with an on-going patient satisfaction survey. In the meantime, the research conducted thus far is expected to produce immediate positive results and a new direction in marketing efforts.