Finding the right message

Editor’s note: David Kay is president of Research Dimensions, Toronto. There are two reasons to re-brand a hospital.

1. The hospital has changed. It has expanded from being a local community hospital to a regional hospital. It has amalgamated with other facilities. It has added services or specialities. It has become a teaching hospital or a research center in various areas. It has begun a significant outreach program. Most important, it can no longer be defined by its past history. Its reputation doesn’t encompass its abilities.

It has to re-brand. The “product” must be redefined in the minds and hearts of the many internal and external stakeholders. And it has to be done correctly.

2. The hospital has a poor reputation in the community at large or among specific important sub-communities - for example, potential employees or donors. The reaction to the name Hospital X is negative - on a rational basis and on a visceral basis. If the hospital deserves its poor reputation, hopefully it will improve operationally before attempting to re-brand. But it must re-brand. It may also need to be re-named.

Complex expectations

A brand is a complex set of images and expectations that a user has of a product, service or company. It is defined by an emotional relationship between the consumer and the brand. The brand generates a set of attitudes that is not always articulated or understood by the consumer. Consumers don’t always know why they reach for Coke rather than Pepsi, Nike rather Reebok or choose one hospital over another. But they internalize images. They have preferences. A well-branded organization is a trusted organization. It is the one to which the user turns first.

Re-branding a major hospital presents a series of unique challenges because its stakeholders are so varied and its importance to the community dwarfs almost any other branded product or service. The commitment or occasionally the hostility or mistrust toward it is unparalleled. Hospitals save lives. They are unique. Large hospitals are massive, complex organizations whose scope is barely understood by the public, or even by most of its employees. And like any other organization, hospitals rise or sink on a sea of dollars.

Why re-brand?

Why bother? Why go through the re-branding exercise? Why not accept a misunderstood, mis-branded hospital?

A hospital cannot afford to be mis-branded. A hospital needs a strong but credible image. Because the commitment to and the involvement of the hospital’s diverse stakeholders is intense and is vital to its health and well being. Misunderstanding of what the hospital is and who it serves can lead to a damaging loss of commitment. Staff, volunteers and donors can be difficult to recruit. Patients can avoid the hospital. Morale and patient care quality can suffer.

A successful re-branding typically requires communication of a believable and consistent image through all communications vehicles. This includes general and targeted advertising, public relations, all printed and electronic information, the sign over the entrance, the look of the lobby, and the way receptionists answer the telephone. Even the organization’s name should reflect the hospital’s brand. Most important, the new brand message and image must be the correct one. It must be built on the correct platform. And it must resonate with the stakeholders.

Five steps

There are five steps to follow to ensure that the re-branded message is correct.

1. Know the hospital, its capabilities, history and plans. The brand must be based on reality.

2. Determine the views of the different stakeholders. How do they see the brand? How do they use the hospital?

3. Identify the gaps between the images held by different stakeholders. Also, identify the gap between what the hospital really is and how its stakeholders see it.

4. Determine the hospital’s “believability potential,” i.e., where can the hospital be realistically positioned in the minds of the different stakeholders? Just declaring that a hospital is like the Mayo Clinic or Johns Hopkins won’t make it so.

5. Determine what image and communications vehicles will be effective in re-branding the hospital.

1. Know the hospital
Knowing the hospital requires reading published and private reports, but particularly it involves interviewing key senior-level staff, department heads, planning personnel, etc. These internal information-gathering sessions can provide unexpected learning. We conducted an internal focus group among senior members of a major hospital’s satellite facility (a smaller ambulatory care center, located some blocks away from the central facility). A member of the central hospital’s planning department was part of the group. We learned about the true capabilities of the satellite facility. But, to the amazement and chagrin of the planning manager, we also learned that the senior staff knew little about the hospital’s plans. The facility was rife with rumor and the staff was suspicious and hostile.

2. Determine the views of the different stakeholders
At least seven stakeholder groups have to be understood, accommodated and persuaded. They are: patients; potential patients, i.e., local non-patients who live in the community; staff; donors; volunteers; the board of directors; and outside stakeholders such as politicians and media. And each stakeholder group is comprised of different sub-groups with different views and needs.

Following is a brief discussion of each stakeholder group and the information required from it.

  • Patients and local non-patients who live in the community

Patients come first. Their needs have to be accommodated. There are two critical branding issues among patients.

First, who does the hospital serve? The patient population has to be compared with the hospital’s catchment area population in terms of demographics and other characteristics. A significant part of the local population not using the hospital suggests a problem - or an opportunity. Is the hospital seen as welcoming to all people in its catchment area? Do some ethnic groups or some economic groups feel that this is not a hospital for them?

We discovered in one hospital study that a hospital with an excellent reputation was seen by many as being the hospital to which they go only if they have a very serious medical condition. For simpler, non-life-threatening issues they go elsewhere. This was a problem. It is usually positive to be seen as a premium brand - but not so premium that customers stay away. The hospital had to change its brand image.

Another hospital was seen as unwelcoming by a number of non-native English speakers. After learning about the problem, the hospital had to change how it dealt with these populations. Then it had to change its image and re-brand itself among those “rejecter” populations.

Second, how aware are patients and the community at large of the hospital and its offering, and how do they rate the hospital in practical-rational terms as well as emotional-image terms? How is the hospital viewed in terms of: service/medical quality; program offerings (areas of excellence); responsiveness; attitudes toward patients; efficiency/waiting time; leading-edge equipment; knowledge and professionalism of staff; reputation, brand-name leaders; cleanliness of surroundings; quality of food, etc.?

These are a few of the elements that make up the hospital’s reputation, i.e., the public’s expectations and image. These are the building blocks of the hospital’s brand. These perceptions have to be explored. If perceptions are out of line, they have to altered.

One hospital with which we worked had developed a dozen areas of excellence in addition to its general community hospital range of services. It had become a teaching and research hospital with deep resources, technology and staff in areas such as cardiovascular conditions, genetic screening and neurological disorders. But we learned that many of its patients and potential patients thought of it as a hospital more suited to setting a broken leg than to handling serious medical problems.

These same issues apply to non-patients who live in the community but go elsewhere for treatment. It is imperative to understand their reasons before re-branding.

  • Staff

Staff includes: medical staff, doctors, nurses and others; non-medical staff and non-medical professionals such as social workers, administration, assistants, catering, maintenance; and part-time as well as full-time staff.

Each of these groups has its own views and interests and has different ideas about what the hospital is and what it can and should be. These disparate views have to be understood.

Why bother? Because how staff sees the hospital is critical. Attitudes toward the hospital influence morale, which in turn significantly affects quality. It is difficult to imagine another business where quality is so crucial.

In addition, the contact level between staff and patients is very high. And staff attitudes affect the hospital’s ability to recruit new employees.

To simplify, a hospital wants its staff to feel proud of the organization. Pride must be part of the brand. The hospital wants all potential staff to want to work there. When we asked one well-respected hospital department head about shortages in a medical speciality area that were causing difficulty for many hospitals, he replied, “We are not affected. [These specialists] want to work here. We have no shortages. We have no difficulty filling any positions.” Good branding counts.

  • Volunteers

In many ways, volunteers are the backbone of the hospital. Most of the comments made about staff also apply to volunteers. Volunteers, however, while appreciated, are sometimes ignored except with an annual Volunteer Appreciation Day. This is not enough. High morale among volunteers is very important. They save the hospital money. And they are a direct link to the community. Resentment among volunteers can be a problem. Their view of the hospital must be understood and become part of the re-branding exercise.

  • Donors and the board of directors

The importance of donors to hospitals is self-evident. But there are different types of donors who often have totally different perceptions of the same hospital.

Community donors - that is, the local population who are also the hospital’s patients and volunteers - tend to give cash to show their support. Their involvement is personal. It is their hospital. And the better they feel about their hospital, the more support they will provide.

There are also large donors, who generally also view the hospital as the one they use. They are motivated by loyalty. But they need special treatment and their views may be influenced by how they are treated as a donor. The hospital had better understand how these donors view the hospital before it re-brands.

Then there are the mega-donors who are typically the economic and social leaders of the region. They donate MRI machines or build hospital wings. They are also the supporters of the local opera or ballet company. They are on the board of major charitable organizations. They count in the community. And they contribute significantly to the charitable organizations that they support. They may never use the hospital themselves but they believe that supporting it is part of their responsibility, especially because the other community leaders also support it. Status and networking are part of their motivation for supporting the hospital. The hospital, however, has to be seen to be worthy of this type of support. This too must be part of the hospital’s brand message.

These same issues apply to the board of directors, many of whom are also donors.

  • Outside stakeholders

And finally there are the outside stakeholders, such as politicians and the media. Their views are critical because they can assist or obstruct the process of re-branding. As with the other groups, their views must be heard.

3. Identify image gaps
In various hospital branding projects, we inevitably find gaps between what the hospital is and how it is viewed by many of its stakeholders. And we inevitably find major differences between the different stakeholder groups’ views. These have to be brought into line so that consistent, believable and relevant communications can be carried out.

The first step is to determine what is important to all or most stakeholder groups. What is of interest to the accountants may not be of interest to the patients or to the donors. Then it is necessary to see how the different interested parties view the hospital in those areas.

A series of image grids can be a useful starting point, with the vertical axes being positive to negative, and the other axes being image/performance factors.

General image grids can be based on:

  • Customer satisfaction measures for all aspects of satisfaction, at all stages in the hospital stay process. How long did the patient wait to check in, to have an x-ray and blood test taken; to see the doctor, etc.?
  • How caring are the medical staff and volunteers?
  • How comfortable is the facility - is it welcoming or intimidating, does it speak the language of the patient if English is not their first language, etc.?
  • How organized is the hospital? For example, do records “flow” from one department to another? Does the patient give his or her information only once or every time a different specialist or department is encountered?
  • How complete were the discharge instructions?
  • How complete was the follow-up?
  • Perceived success: is the hospital seen as up to date, growing, first in terms of adding services, first choice for patients, first choice for staff, etc.?

Technical image grids can be based of perceptions of quality-specific areas of excellence, i.e., how well is the hospital perceived in terms of: its oncology department; neonatal department; emergency department; geriatric research facilities; reputation as a teaching facility, etc.?

The list of image/performance factors is extensive. Nevertheless it is important that all of the stakeholders’ views are determined and if there are discrepancies, they must be resolved.

In one study, we found that a hospital’s professional staff believed that its treatment of patients and of care-givers (parents, spouses of patients, etc,), was exemplary in human terms. They saw themselves as being informative, caring, nurturing, sympathetic and willing to go out of their way to make the patient feel comfortable. The patients were reasonably satisfied on this count but the care-givers unfortunately tended to be ignored and they were decidedly not satisfied. Changes in procedures were obviously required.

In another hospital, we found that senior staff believed that the technical excellence of the hospital wasn’t known to potential professional hires. They were mistaken. The hospital was well-known for its excellence among medical students and staff who were beginning their careers. This had a major influence on recruitment efforts and communication plans.

4. Determine the hospital’s “believability potential.”
When talking with these groups, it is also important to determine what they will believe and what they will accept. One hospital mentioned above had far outgrown its origins. We learned that the community was barely aware of its new services and improved levels of excellence. More important, many didn’t want their hospital to be “improved.” They wanted their hospital to remain a small, local community hospital (despite occupying six buildings). They equated “local community” with “friendly and responsive,” and saw it as “a hospital where the nurse will hold my hand if I am frightened.” They associated large, world-famous teaching hospitals with terms like unfriendly, unresponsive and distant - places to go to if you need a heart transplant but not if you are “merely” ill.

When speaking with these groups, one must determine what they will accept and what they will believe. Then the branding strategy and if necessary the re-naming strategy must be written within the limits of what the stakeholders will believe.

When asking stakeholders how they view the hospital, it is also important to ask them how they would respond if they and the public were told that their hospital is a leader is diabetes research, or has the largest trauma center in the region or whatever. Stakeholders, including the general public - which is not involved in a daily basis - will inevitably accept certain claims and resist others. Communications plans and all branding plans have to take this into account.

5. Determine what image and communications vehicles will be effective in re-branding the hospital.
Our hospital clients have told us that they tend to rely more on PR rather than on paid advertising, perhaps because public media is more receptive to hospital news than to other corporate news. But this should be decided by the hospital communications staff.

Hospitals, however, generally have direct access to their stakeholders. Staff, volunteers, patients and donors can usually be reached with newsletters, and with direct mail or e-mail communications vehicles. These are usually less costly than other media. And it is fairly simple to determine which internal, controlled media is most effective.

Reaching the wider community is more difficult. But branding efforts must be made in concert with other communications efforts such as fundraising campaigns, and the efforts must be long-term.

No small task

Re-branding a hospital is certainly no small task. As we have discussed, there are many audiences and stakeholders to consider when undertaking such a project. And talking with and listening to each of them can be time-consuming. But doing so will provide the most complete picture possible and give the re-branding effort a wealth of crucial information from which to draw.