Presentation at the 2009 Society for Healthcare Strategy and Market Development Conference

1. Customer Advisory GroupsAnother way to listen to the marketplace William (Bill) R. Gombeski Jr, MPH, MBA Director Strategic Marketing UK HealthCare 859-257-2296 bill.gombeski@uky.edu Jason Britt, MBA Senior Manager, Market Research UK HealthCare 859-257-5563 jason.britt@uky.edu Christy Harrison Administrator of Oncology Service Line Tallahassee Memorial HealthCare, Inc. 850-431-5038 christy.harrison@tmh.org 07-21-09

2. Definition Customer Advisory Groups are formal groups of customers who meet regularly to share their ideas and to provide feedback to proposed or existing clinical, operation or marketing strategies, programs and activities. 2

3. Why CAGs? Marketers, clinicians and administrators are always looking for ways to listen better to customers and potential customers CAGs have been around a long time in other industries Survey of 550 CMOs across all industries showed 25% used CAGs (CMO Marketing Council 2006 Study) Began in health care with use of family advisory groups within Children’s Hospitals 3

4. Possible Customer Advisory Groups Referring physicians Patients Health insurance brokers Consumers/prospects Tobacco users Employees Owned physicians Neighbors 4

5. Major Advantages of CAGs Through the education of a consistent group of customers and by building their trust with the organization, over a period of time, deep and more honest conversations are possible and more insightfulopportunities can be identified. Brings customers into the marketing or clinical operations meeting room so that better customer-friendly and customer-focused strategies are developed. 5

6. Objectives Today Familiarize you with Customer Advisory Groups and a disease specific Patient Family Council Learn the advantages and disadvantages of CAGs compared to other customer feedback/input techniques Understand how to recruit, operate, manage and use CAGs to improve your marketing, customer experience and your organization 6

7. Have Regular Marketing-Sponsored Advisory Groups? Doctor Advisory Group (3) COO, Dean, Hospital Director Internal Advisory Group Website Advisory Group No Yes (5) n=39 Source: Feedback from 39 CMOs, July – September 2007 from Academic Medical Centers 7

8. Other Common Approaches to Obtaining “Customer” Input and Feedback n Patient Advisory Groups (Children’s Hospital, Cancer, etc.) 7 Community Advisory Groups 5 Fund Raising Advisory Groups 2 Business Leaders Advisory Groups 2 Employee Advisory Groups 1 Source: Survey of 39 AMC/CMOs 8

9. Not enough time Advisory groups can micromanage marketing’s efforts, Hard to keep attendance up/members motivated, Groups got off tract/not that helpful, Need new members to maintain freshness. 9 Reasons Offered for Marketing not Having CAGs

10. Interesting Approaches Internal PR/Fund Development/Marketing Council Website Committee – 3 Board and 3 Physicians Trustee Marketing/PR Committee Recruitment Committee (Marketing, Human Resources, Nursing) External Legislative Advisory Group Use Hospital Auxiliary Business Leaders Advisory Group Civic Leaders Advisory Group Annual Meeting with Brokers/Insurance Agents Annual Meeting with Employers Annual Interviews with 25 Physicians, 25 Patients, 25 Payers and 25 Employees Editorial Board for High-end Publication Sensing of Paramedics Survivor Groups 10

12. Major Referral Center for Kentucky/West Virginia/Tennessee/Ohio

13. One of Two Trauma Centers in State

15. Marketing Department Structure Marketing Department Strategic Marketing Bill Gombeski Bill Gombeski Strategic Marketing Director Physician/ Hospital Liaison Service Line Management Call Center Customer Service Market Research & Database Marketing Communications & Advertising Jan Taylor Tanya Wray Karen Riggs, RN Jason Britt Wanda Adkins, RN Suzanne Springate 13 13

16. UK HealthCareMarketing Review Process CEO/COO Final Decision Customer Service Executive Group Review and Approval Senior Administrative Group UKHC Executive Committee Input and Consensus Marketing Department Recommendations and Implementation Employee Marketing Advisory Group Medicare Patient Advisory Group Physician Advisory Group Consumer Advisory Group Main Campus Employee Advisory Group Input/Advice/ Coordination Referring Physician Roundtable Email Advisory Group Tobacco Free Advisory Group 14

17. Physician Marketing Advisory Group 15 physicians Chaired by senior physician/Co-chaired by Director of Marketing Two year commitment COO has joined as permanent member Third Monday evening from 5:00 – 6:30pm Have had CEO, VP Health Operations and Chief Medical Officer attend 15

18. Examples of Physician Marketing Advisory Group Agenda Topics Improving patient satisfaction with UK physicians Physician behavior expectations Market share discussion Growing internal familiarity with all UK docs Review of publications aimed at referring physicians Advertising concepts and campaign direction Improving service to referring physicians Clinical annual reports as a direct mail piece to referring physicians Review of dress code Influencing patient/referring physician decision-making Increasing referring physician satisfaction with UK doctors Growing numbers of medicare patients Developing patient satisfaction tips for UK physicians 16

19. Key Accomplishments Physician section to Standards of Behavior Testing of patient satisfaction quarterly report format Patient Access standards set Reports to referring physicians decreased from 30 days to 10 days “Killed” marketing message to local physicians Helped select key ad campaign theme Input into Clinical Annual Reports US News & World Report Analysis Physician/Employee Feedback Patient Satisfaction Cause for Physicians Professional Appearance Policy 17

20. Referring Physician Roundtable Object of monthly meetings were to discuss issues of importance to the referringphysician with pediatricians and surgeons at Kentucky Children’s Hospital. Physician champion at Kentucky Children’s Hospital and physician liaison support were keys to success. First meeting consisted of five community physicians, physician champion and two physician liaisons as facilitators. Roundtable participants stayed fairly consistent from month to month. One or two UK faculty physicians were invited to the table by our physician champion. Invited faculty were made aware of community physician concerns before the meeting. Concerns identified during discussions were researched before the next meeting. Participants were notified of university hospital’s ability to correct or mitigate the issue before or during the next meeting. 18

21. Criteria for discharge from NICU to home Hospitalists role with inpatient pediatric patients Evaluation and treatment for congenital malformations of the heart Advanced radiology service available When to refer diabetic children New surgical capabilities Improving communication regarding referred patients Access to laboratory and radiology test results 19 Examples of Physician Roundtable Agendas

22. Key Accomplishments First year of meetings focused on referring physician concerns. During the second year meetings focused on new specialty services or process improvement. Day of discharge fax form which includes, diagnosis, medications, lab results and follow up needs. Copy of form given to caretaker and faxed to referring provider. Improved discharge process for NICU patients. Access to laboratory and discharge summaries made available to referring pediatricians through new web portal. Created “Community Pediatric Division”, led by a community pediatrician who participated in roundtable discussions. Improved relationship between pediatricians , KCH physicians and physician liaisons. Pediatrician who would often send patients out of area increased referrals to university hospital. Referrals to new pediatric subspecialist increased. 20

23. Employee Marketing Advisory Group 15 employees Chaired by Director of Communication and Manager of Internal Communication Two year commitment Noon to 1:30 monthly 21

24. Examples of Agenda Topics with the Employee Marketing Group Advertising concept review Marketing overview and suggestions Employee appreciation day feedback Feedback on Medicare patient records binder 100 Top Hospital campaign idea feedback Ways to capitalize on county extension agents Employee shuttle bus communication Physician liaison program feedback Advertising plan review Marketing outcomes Internal and external communications regarding new parking options Tobacco Free campus implementation Feedback on promotional items Market research findings and what they mean 22

25. Key Accomplishments Fine-tuning communications and marketing plans Improvement of social media policies that apply to internal users Better insight into the needs of employees not located in main campus facilities Increase in accurate word-of-mouth communications via members 23

26. Main Campus Employee Advisory Group 12 employees not affiliated with UK HealthCare Chaired by Senior Manager of Marketing research 12 month commitment 11:30 to 1:00 on the last Tuesday of every month 24

27. Agenda Topics Employee medical guide New patient care facility communication Perceptions of UK HealthCare and Anthem Blue Cross Blue Shield negotiations Online advertising concepts Website usability testing 25

28. Key Accomplishments Employee medical guide refinement Radiosurgery icon Kentucky.com web site ads 26

29. Tobacco Free Advisory Group Chaired by Director of Marketing/co-chaired by Director of Communication 11 current/recently quit tobacco users Represented most facilities and grade levels Met biweekly for six months and monthly for a year Met Fridays noon-1pm at Chandler Hospital 27

30. Agenda Topics Awareness of coming Tobacco Free Campus Concerns How best to communicate to employees, visitors Tobacco Cessation and Management Enforcement Patient issues 28

31. Key Accomplishments Changed focus of campaign from smoke-free to tobacco free to be more inclusive/less inflammatory Helped create more compassionate messaging Created tobacco-etiquette for smokers/non smokers Selected les offensive no tobacco sign Influenced leaving campus policy discussions Influenced decision to only have managers responsible for policy enforcement Avoided using of guilt in messaging 29

32. Medicare Patient Advisory Group 15 patients 65 to 81 years Chaired by Director of customer Service/co-chaired Director of Marketing Meets 4th Thursday of each month 12-2pm at Malone’s restaurant Two Year Commitment 30

33. Examples of Patient Advisory Group Agendas HCAHPS awareness, use Quality measures patients would like to see What makes a good volunteer experience Issues/frustrations patients face with healthcare Tobacco-free campus initiative Use of UK Website Medical Binders – How to improve Has consumer/patient power changed How to capitalize on World Equestrian Games Sponsorship Emergency Department patient guide – How to improve 31

34. Key Accomplishments Helped sell patient infection prevention campaign to senior leaders Helped hospital nurses rework Family Assisted Activated Response hotline material to be clearer Helped with decision to produce consumer Medical Guide catalog Helped pick more appropriate radio surgery ICON Provided early insight into social media Provided input into proposed new hospital patient rooms Improved on-call waiting messages Improved patient daily feedback form 32

35. Consumer Advisory Group 29 Consumers Chaired by Senior Manager of Marketing Research Meets as needed, averaging once every 2 months, in the Marketing conference room from 5:30 to 7:30 33

36. Examples of Consumer Advisory Group Agendas Newspaper banner advertisement assessments Yellow pages usage Creative/copy testing Web site usability testing Health care purchase habits Tag line feedback Advertising concepts Organizational outreach clinics Health lectures Attributes of a good or bad physician Familiarity with Hospital Consumer Assessment of Health Providers and Systems (HCAHPS) and likelihood of use. 34

37. Key Accomplishments Input into brand advertising campaign Input into surgery advertising campaign Usage of online resources for hospital and physician comparisons Fine-tune tobacco free communication for patients and families 35

38. 36 Email Advisory Group Approximately five to six times a year specific topic questions are identified and sent out to a growing population of 2,000+ members. Response rates vary based on topic but are between 9.4 percent and 12.5 percent. No more than three questions are sent at any one time. Questions are usually open ended. Chaired/managed by Senior Manager of Market Research

39. Agenda Topics Medical campus terminology: academic medical center vs. regional referral center Advertising concept evaluation Web site usage habits Awareness of and suggested uses for children’s hospital mascot New Hospital construction and traffic issues Consumer driven health care Difference between ambulatory and outpatient 37

40. Key Accomplishments Refined icon for the Radiosurgery department Initial reaction to brand campaign concepts Awareness, understanding, and usage of KY Children’s hospital mascot, Stitches Web usage behavior for health care information 38

41. 39 Advisory Group Information

42. Patient and Family Advisory Councils (PFAC) Christy Harrison, RN, MS Administrator Tallahassee Memorial Cancer Center Tallahassee, Fl

44. Structure

45. Maintaining Participation

46. Development as Faculty

48. So You Want to Create/Operate a Customer Advisory Group? Recruitment Orientation Process Management Participation/Retention Issues 43

49. Recruiting Observations Diversity vs opinionated/knowledgeable Interested/motivated Scheduling Chair/VP/Director/Supervisor Blessing Replacement Link to Decision-Making Group Trial Opportunity 44

50. Sources of Recruits * Patient Satisfaction/Employee Surveys * Name in newspaper * Complainers * Attendees at lectures/events * Word-of-mouth referrals from current members * Organizations * Marketing employees * Current members 45

51. Orientation Short overview of UK’s marketing plans/objectives Takes about three meetings before a group begins to become comfortable Small breakout groups encourages interaction Do some group building exercises 46

53. Group development

54. Minutes

55. Homework

56. Orientation

57. Appropriate agendas

59. Food

60. Gifts

61. Minutes

62. Final results shared with members

63. Visits from Senior Leadership

65. Participants who have personal agendas

66. Trying to tackle world hunger topics

67. Time dominant individuals

69. Other Uses Uses of CAGs outside of marketing include input to design new facilities set hiring standards interview job candidates design clinical trials evaluate hospital equipment review medical safety measures help train medical students Improve clinical and operational processes 51

70. Advantages of CAGs Insights generated are higher quality as there is more comfort disagreeing and sharing one’s position on a topic leading to more open discussion. Members often share delayed reactions and ideas leading to many more new and good ideas. New agendas/topics introduced that were not on the marketing department’s radar screen often surface eg. patient advisory group – financial; Identification of operational side effects both positive and negative from a proposed marketing recommendation. 52

71. Advantages of CAGs CAGs tell management that marketing is listening. Having CAGs lets the public and community leaders know that the organization is including community input into its efforts. Avenue to make sure marketing is included at the organization’s decision-making committees. A tactical benefit is the word-of-mouth marketing and communications that takes place between members and other similar customers Advisory groups can help you acquire resources Help decisions happen more quickly. 53

73. Social Media Strategies

74. Medical Services Catalogue

75. Patient Satisfaction Ideas54

76. Tactical Benefits of CAGs Many new ideas leading to effectiveness and efficiency of UKHC marketing efforts Increased UK physician and employee awareness, understanding and support of marketing efforts Growth in number of referrals, transfers, new patients, image, market share 55

77. Tips for Success Have senior leadership come CEO COO VP for Medical Operations CMO VP for HR Opportunity for managers and other marketing employees to get feedback, presentation experience Go around the room and ask each member to comment - - allows less confident to get involved and more opinions 56

78. Disadvantages Recruiting participants can be difficult and time consuming. Managing the groups requires time and resources. Groups often raise issues that require follow-up and significant effort. Because CAGs are usually comprised of current customers (patients, referring doctors, health insurance brokers), obtaining ideas on how to attract and acquire nonusers or prospects can be difficult. 57

79. Lessons Learned First, get buy in and approval from management. Invite them to use Work CAGs into your marketing plans so that your organization understands their role and importance. Recruiting internal members is most effective when the members’ supervisor has approved and helped select the participant Reach out and include planning, HR, Operations, PR in your CAGs. 58

80. Conclusions CAGs are now becoming more important as the growing consumer movement continues to empower health care consumers. CAGs are also becoming bigger and moving online and the “hawthorne effect” of being involved in an organization’s marketing can lead to significant positive word-of-mouth marketing. Physician/patient/family advisory councils should be part of a marketing strategy to understand customer needs. 59

81. Conclusions For marketers wanting to listen more closely to customers and prospects, becoming more involved in CAGs is one way to get new insights. To generate a competitive advantage health care organizations need to bring their customers into the marketing conference room to develop the most customer-focused strategies. Having CAGs provides strong evidence to the organization that marketing management is providing market leadership. Sends signal to employees that customers are number 1 Eases management buy in when they know it has passed the customer test. 60