When the question of growth comes up in hospital boardrooms, all eyes usually turn to the marketing leader. How can we increase volume on MRI scans? What do we do to grow our open heart program? The dialogue often progresses quickly to solutions. What we need is another billboard on the East side of town to capture that market. Someone will likely propose something they’ve seen elsewhere: When I was at Valley HealthCorp we did a promotional spot with the local TV stations…
What’s the big deal? Hospitals have a right compete just like any other business, right? There’s a saying in catholic healthcare which has found its way into the vernacular of most not-for-profit providers: no margin, no mission. As the thinking goes, generating positive margins (more revenue than expense) enables hospitals to fulfill their mission to their community. You’ll get no argument from me there. The basic math holds, an organization has to sustain itself and its workforce.
But is there a point at which the never-ending quest for profits and growth run counter to the mission of a provider organization?
Whenever I see marketing campaigns for healthcare providers, I pause and think. Do they really care more? Are they really more compassionate? Is being a top hospital award winner really better for me? And, I imagine, Dr. Don Berwick would ask, do any of those claims help achieve the triple aim?
Despite failing to be named to a full time appointment, Don Berwick’s time as acting administrator of the Centers for Medicare and Medicaid Services (CMS) had a profound impact on the entire industry. Berwick introduced the concept of the triple aim - a combined focus on improving quality, reducing costs and improving patient experiences. Although Dr. Berwick’s time at CMS was short, the triple aim endures. It is a hallmark of how CMS evaluates innovation projects. The triple aim is baked into the Patient Protection and Affordable Care Act (PPACA). New payment methodologies such as value based purchasing and accountable care organizations are predicted on providers’ ability to deliver higher quality care at lower costs while maintaining patient satisfaction scores.
What concerns me about the state of modern healthcare promotion is not so much the quest for profitability and growth. In fact, I believe in the manifest destiny of high quality, mission-focused providers. What keeps my skepticism meter pegged at cyclical is the reductive thinking which trivializes actual people and their needs to volume, visits, encounters, scans, scripts, and cases.
Whenever a man does a thoroughly stupid thing, it is always from the noblest motives. - Oscar Wilde
I’m particularly bothered by the productization of health services. Social media has, regrettably, given rise to things like Groupon, and contests for Facebook page likes. It’s one thing for a local business to give away an iPad for their 1000th Facebook fan. But is it really the kind of thing a healthcare provider should do?
The question of tact aside, what about the triple aim? Do we want to sell health services? Every test does not need to be ordered. But, every time a test is ordered, someone pays and another notch is cut into the totem marking our ever-expanding health costs.
I’m not so jaded (one hopes) as to be agnostic to the devil’s advocate in this argument. What’s wrong with promoting health, wellness and screening services? They save lives! Of course, some screenings produce life saving outcomes. Where I take exception is with all the blatant productization which turns patients into commodity consumers.
There is a fine line between a screening and self-serving promotion. Consider the following excerpt from a report released this week by the US Preventive Services Task Force:
“Though screening guidelines differ for men and women, these findings illustrate a clear distinction in attitudes toward routine health screening,” according to Truven chief medical officer Ray Fabius. “Women and patients who have a personal physician are better health care consumers in general.”
According to NPR’s Scott Hensley :
The researchers also found that consumers with higher income and education were more likely to be screened (Hensley, “Shots,” NPR, 9/6; Truven Health Anayltics 2012, NPR, 9/5).
Consumer. Doesn’t that say it all?
A person who purchases goods and services for personal use.
Inevetably, the outcome of studies like these, is an increased bravado around promotion, fuled by a financial motives, not mission motives. Billboards will go up, featuring diverse groups of middle aged women. Fliers get mailed, generically heralding women’s health. Tests will be taken, screenings will happen and, thankfully, disease will be caught. For that, I am grateful. It’s the insincere motives with which I take objection.
Pardon me while I tilt at windmills Actions speak louder than words. My kindergarten teacher said it, my mother told me hundreds of times and the voice in my head reminds me of that axiom daily. Sigh. I’m a flawed person and I don’t always live up to that credo. Neither do many organizations.
Flaws and all, I cannot help but believe, if healthcare providers spent as much effort focusing on their why as they do in promotion —that core, driving part of their mission statement which talks about serving their community —they’d get a lot more flies with that honey.
Part of becoming a physician is the physician’s oath. It may surprise some to learn the phrase first, do no harm is not part of the oath —although it is part of most medical ethics curriculum. Included in the modern oath is the affirmation: The health of my patient will be my first consideration..
I wonder, should healthcare business development, strategy and marketing leaders have a similar credo? Is it part of our obligation to consider if pushing more bone density scans is a good thing for our community? Are we telling the truth when we promise we are the most patient-focused provider in town? Perhaps we need to pause and think about a campaign: is the patient my first consideration?