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Building Referring Physician Loyalty: OSUMC Gelb-PAN

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This presentation by Gelb Consulting performed during the annual NACCDO-PAN conference outlines howto manage referrer relationships. In this presentation, the case study revolves around OSUCCC-James …

This presentation by Gelb Consulting performed during the annual NACCDO-PAN conference outlines howto manage referrer relationships. In this presentation, the case study revolves around OSUCCC-James - The James began an initiative to seek insight on the experience provided to referring physicians as well as glean key drivers for referrals and satisfaction. The James' goals included an action-based physician relations management program and ultimately increasing referrer loyalty.

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  • 1. Building Referring Physician LoyaltyNACCDO-PANApril 2013
  • 2. PAGE 2Agenda1. Background2. Approach3. Insights4. Insights to Action5. A Sustainable Process
  • 3. BACKGROUND1
  • 4. PAGE 4OSUCCC-James Background• NCI-designated Comprehensive Cancer Center• The James Cancer Hospital and SoloveResearch Institute was the Midwest’s firstfreestanding cancer hospital• New hospital currently under construction – 1Msf with 276 inpatient beds, 14 ORs, 7 Rad Oncvaults, 40 chemo bays
  • 5. PAGE 5Situation OverviewManaging Referrer Relationships• The James began an initiative to seekinsight on the experience provided toreferring physicians as well as glean keydrivers for referrals and satisfaction• Goals included an action-based physicianrelations management program andultimately increasing referrer loyalty
  • 6. PAGE 6Experience MappingWhy We Chose This Approach• Evaluates the entire experience – fromthe moment a decision is made to referto the state of transitioning care backto the provider• Creates a framework for an action planand accountability• Gives insight into marketing andcommunications strategies for referringphysicians• This framework can then be used toassess and monitor the experienceover time through a PRM system
  • 7. PAGE 7Gelb: The Basis of Their InsightsWorks with Nationally-recognized Institutions:• 5 “Honor Roll” institutions• 3 out of the top 5 cancer programs• 2 out of the top 4 pediatric hospitals• 2 out of the top 4 cardiovascular programsConducts National Benchmarking Studies:• Patient experience• Marketing• Physician relations• International programs
  • 8. PAGE 8IMPACTDESIGNANALYZEDISCOVERALIGNOverview• Kick off Meeting• Document keyinsights• QualitativeResearch –ReferringPhysicians• Day in the Life• Touchpointassessment• Define the idealexperience• Create action planswith leaders andstaff• Touchpointprioritization• Developimplementationplans• Dashboards tomonitor progress
  • 9. PAGE 9Selecting Interviewees• When selecting physicians we want to capture as many“unique” experiences as possible• Identified physicians who have / have not referred to The James• Determined which physicians made referrals to multiple areas ofinterest in this study (GI, Hematology, Breast Cancer and Headand Neck Cancer)• Developed a sample pool representing those who refer to at leasttwo areas of interest• Completed 44 interviews
  • 10. PAGE 10Discussion AreasA customized experience map was used to focus their input onthe steps during which they have the most involvement• Perception of and knowledge about The OSU and The James• Referral decision-making process and assessment of the referralexperience• Methods of receiving progress reports (electronic, phone calls, etc.)and analysis of touchpoints• Coordination of patients’ on-going care• Prescriptions for growth and increasing referrals
  • 11. APPROACH2
  • 12. PAGE 12PhilosophyCulture and your brand promise arelinked through the experiencedelivered.Leaders translate customerexpectations to the organization andreinforce desired employee behaviors.This alignment creates an exceptionalexperience and a sustainablecompetitive advantage.We call this desired stateenchantment.EXPERIENCEEXPECTED BEHAVIORSCulturalAlignmentTransformationalLeadershipBrandPromise
  • 13. PAGE 13Difference in DriversWhat We Do• Services offered• Clinical outcomes• Transfer efficiency• Scheduling delaysFunctional NeedsHow We Do It• Inclusion in treatment• “Feel” of the interactions• Subjective quality judgments• Feeling valuedEmotional NeedsNUMBERS STORIES
  • 14. Enchantment CycleListenDefinePromiseDeliverReinforcePhysicianListen to customers, theirinfluencers and otherstakeholdersDefine how yourorganization will meet orexceed needsCommunicate a resonantPromiseDeliver flawlessly on thePromiseReinforce the promise inall communications &interactions
  • 15. PAGE 15Referring Physician Experience MapAwareness• Perceptions of TheJames• Knowledge aboutThe James• Marketing oreducationalresources• Ideal relationshipwith The JamesNeed• Evaluation andselection oftreatment providers• Discussion withpatients (diagnosis,referral options)• Preparing patientsfor what to expectScheduling• Initial contact withThe James• Timing and ease ofprocess• Resources forpatients and theirfamiliesTreatment• Coordination of carewith oncologist• Progress notes andmethods ofcommunication• Patient feedbackabout clinicalexperienceTransition ofCare• Discharge summary• Coordination ofon-going care• Ongoing patientcare/support• Call-backs forassistancePrimary Experience Stewards• Faculty/Staff• Patients and theirFamilies• Front Desk Staff• Faculty/Medical Staff• Faculty/Medical Staff• Support Staff• Faculty/Medical Staff• Support Staff• Faculty/MedicalStaff• Support StaffKey Touchpoints
  • 16. PAGE 16Experience Mapping is an in-depth qualitative research technique that utilizes avisual cue (the experience map) to help physicians, patients, staff, and otherinfluencers recall specific episodes in their journey. It provides:Assessment of the total experience• Expectations- before first encounter• Activities and Touchpoints• Changes in attitudes, if anyFramework for action• Experience stewards who are responsible for delivery• Steward can appreciate the relationship of their actions to the rest of the journey• Interactions or “touchpoints” are categorized at each stepExperience Mapping:Fitting it All Together
  • 17. INSIGHTS3
  • 18. PAGE 18Video / AudioRecordingsPhysicalEnvironmentCommunicationsFrom Data…PhysicianInterviewTranscripts1.2.
  • 19. PAGE 19…to InsightsDetailed Findings:• Key themes• Verbatim comments• Strengths and barriersDay in the LifeTouchpoint Assessment:• Key Recommendations• Illustrate with pictures• Enrich with clips3.4.
  • 20. PAGE 20Imparting the InsightsThe James provides the best care and communicationThey are experts, but I need more communication aboutmy patientI prefer other referral options because my patients areunhappy and I am left out of the loopHigh performance Moderate performance Low performance“The James is the best option for my patient”Ideal Outcome:Day in the Life:Touchpoint Performance:Icons for each stage:Electronic communications, telephonecommunications, facility, written communications,interpersonal communications
  • 21. PAGE 21Persona: Primary Care ProvidersPrimary Care ProviderGOALS• Grow their patient base• Strengthen reputation throughexcellent care for their patients• Build lasting relationships with theirpatientsBEHAVIORS• Employed or affiliated PCPs referto their institution• Refer locally for less complicatedcases, believing their patients wantconvenience• Refer to The James for manytypes of cancer and to other areasof The OSU“My patient’s satisfaction with care directly impacts thesuccess of my practice. When my patients are happy,they stay with me and refer me to their friends and family.When I refer a patient, my reputation is at stake.”NEEDS• Know what their patients canexpect at The James so they canprepare them in advance• Secure timely appointments• Referral process that does not taxtheir resources and staff• Stay informed about their patient’streatment and care• Have their patients perceive themas being engaged and involved intheir care
  • 22. PAGE 22Persona: SpecialistsGOALS• Grow their patient base• Strengthen reputation throughexcellent care for their patients• Building lasting relationships withPrimary Care PhysiciansBEHAVIORS• Refers to sub-specialist at TheJames for complex cases• Manages more common cancer-related issues and screenings“I am an expert in my specialty. Almost every case I refer iscomplex. For rare cases or those that require specialtechnology, I need a physician at the top of their field withvery specific expertise- distance to travel is less important.”NEEDS• Ability to identify oncologists atThe James based on expertise• Knowledge oftechnique/technology available• Have the patient referred back forspecialist-level care when possible(such as common surgeries)Specialist
  • 23. PAGE 23NEEDIdeal OutcomeActivitiesEvaluation and selection of treatment providersDiscussion with patients (diagnosis, referral options)Preparing patients for what to expectKey Touchpoints“I trust The James to handle themost complex cases andprovide a smooth experience.”Need
  • 24. PAGE 24Most split referrals, selecting The James for themost complex casesThe James is a tertiary center that offers top notch physicians andcutting edge technology; I can send them my most complex cases(such as head and neck cancer)I know The James is a NCI designated center, but their reputation andpatients’ experiences are most important for referral decision-makingAlthough I prefer The James to other tertiary centers like ClevelandClinic, local options like Riverside do a great job for common cancercases (such as breast cancer) and provide a more personalizedexperience for patientsAs a primary care doctor, it is common for me to refer first to a localoncologist, who then might refer the patient to The James if their caseis complexSometimes The James wants a confirmed diagnosis before they willaccept a patient, which can be difficult if we are unable to perform abiopsy – I wish there was an advanced diagnostic center at TheJames to which I could referCommonly-mentionedlocal competitors:1. Ohio Health - Riverside2. Mount Carmel St. Ann’s3. Genesis Health-Zanesville4. Ohio Health –GrantMedical Center5. Ohio Cancer CenterThe ZangmeisterCenter
  • 25. PAGE 25Patient requests and referrers’ relationships withThe James oncologists increase referralsMy biggest barrier to referring to The James is lack of knowledge abouttheir individual oncologists and what they do better than localproviders; especially for common types of cancer, I need to know whypatients should drive a longer distance and navigate a larger centerthan what is available locallyIf I have a personal relationship with an oncologist at The James, I ammore likely to refer there regardless of the complexity or cancer typeMost patients follow my referral advice, but if they do make a request, itis almost always for The JamesI don’t routinely recommend second opinions, but if patients ask for it, Ialmost always direct them to The JamesI anticipate that a freestanding cancer hospital would improve parkingand staff’s sensitivity to cancer-related needs but would want assurancethat patients would have easy access to the main hospital if needed“When referring I takeinto account if I know aphysician there (whichmakes me more likely tosend a patient), how farthe patient is willing totravel, if they have adoctor at another system,and their overallpreference.” (022 A)
  • 26. PAGE 26The James is on a large campus and intimidating to many patients. Navigatingtravel, parking and the large facility are often reported as reasons that referringphysicians and patients may choose a local provider if the patient’s case is notcomplex (for example, if they will be receiving standard breast cancer treatmentprotocol). However, a stellar reputation promotes referrals for the most complexcases and also promotes patient-requested referrals, especially for second opinions.Relationships, prior experience and word of mouth recommendations are often ameans for selecting a physician to refer. However, The James is so large that it ischallenging for referring physicians to develop relationships with faculty and staff.Physicians find it difficult to identify who would be the best physician for theirpatient’s specific condition. This is amplified by many referrers having relationshipswith local oncologists to whom they send the majority of their cases.High performance Moderate performance Low performancePreferred for complex cases, but smaller, localproviders are competition for common cases
  • 27. PAGE 27Translating Insights into ActionCommunication Coordination CareAwareness Need Scheduling TreatmentTransition ofCare
  • 28. PAGE 28CommunicationI am aware of OSU and The James, as they have a reputation for top notchclinical treatment - but I have never visited the facility and would like to knowmore about what my patients experience when they arrive forcareCommunication CoordinationCareCommunication
  • 29. PAGE 29CommunicationI am aware of OSU and The James, as they have a reputation for top notchclinical treatment - but I have never visited the facility and would like to knowmore about what my patients experience when they arrive for careMy biggest barrier to referring to The James is lack of knowledge abouttheir individual oncologists and what they do better than localproviders; especially for common types of cancer, I need to know whypatients should drive a longer distance and navigate a larger center thanwhat is available locally“The biggest issue that I have is not knowing the physicians specifically...Ioften don’t know if there are particular cases where one doctor is trulythe regional expert...In comparison to the community hospitals, I haverelationships with surgeons.”Communication
  • 30. PAGE 30CommunicationI am aware of OSU and The James, as they have a reputation for top notchclinical treatment - but I have never visited the facility and would like to knowmore about what my patients experience when they get thereMy biggest barrier to referring to The James is lack of knowledge about theirindividual oncologists and what they do better than local providers; especiallyfor common types of cancer, I need to know why patients should drive alonger distance and navigate a larger center than what is available locallyI receive mailed resources from OSUMC, but am in need of printeddirectories with information about specialists for each type of cancer(including their pictures and direct contact numbers) so I can refer mypatients to an oncologist by nameCommunication
  • 31. PAGE 31CommunicationThe OSU and The James are well known throughout the regionand farther. Advertising adds to positive perceptions. However, fewhave recently visited The James and are unsure what their patientsexperience. They suggest on-site CME offerings with the opportunity for a“backstage” tour and meeting the faculty.Communication
  • 32. PAGE 32CommunicationThe OSU and The James are well known throughout the region andfurther. Advertising adds to positive perceptions. However, few haverecently visited The James and are unsure what their patients experience.They suggest on-site CME offerings with the opportunity for a “backstage”tour and meeting the faculty.The website is reported as a valuable resource, but should notreplace mailed materials. Printed referral directories to The Jamesare sought.Many are unaware that The James offers advanced diagnostic options, sorefer undiagnosed patients elsewhere although they wouldprefer The James. They need information about how and where to referundiagnosed patients.Communication
  • 33. PAGE 33CommunicationThe OSU and The James are well known throughout the region andfurther. Advertising adds to positive perceptions. However, few haverecently visited The James and are unsure what their patients experience.They suggest on-site CME offerings with the opportunity for a “backstage”tour and meeting the faculty.The website is reported as a valuable resource, but should not replacemailed materials. Printed referral directories to The James are sought.Many are unaware that The James offers advanced diagnostic options, sorefer undiagnosed patients elsewhere although they would prefer TheJames. They need information about how and where to refer undiagnosedpatients.Providers at The James stand out as exceptional for their expertise andcompassionate care. However, most referring physicians do not havepersonal relationships with oncologists at The James, providing acompetitive advantage to local providers.Communication
  • 34. PAGE 34CoordinationI have my staff contact The James via the main line to make an appointment;I hear few complaints and they are able to direct my staff to wheremy patient needs to be seenCoordination
  • 35. PAGE 35CoordinationI have my staff contact The James via the main line to make an appointment;I hear few complaints and they are able to direct my staff to where my patientneeds to be seenIf the normal referral resources are inadequate, I need to get in touchwith a person – usually an oncologist – but am unsure how to do thisunless I already have an individual’s phone number“It is almost impossible to speak to someone if you don’t know them personally...wewill leave a message...Usually we don’t get call-backs when we leave messages.”Coordination
  • 36. PAGE 36CoordinationI have my staff contact The James via the main line to make an appointment;I hear few complaints and they are able to direct my staff to where my patientneeds to be seenIf the normal referral resources are inadequate, I need to get in touch with aperson – usually an oncologist – but am unsure how to do this unless Ialready have an individual’s phone numberThroughout the continuum of care, I consistently receive a fax almostimmediately after patients are seen or treatments are completed; faxes areideal because they are easy to scan into my EMR system“We primary care physicians are the quarterback and we have toknow what is going on.”Coordination
  • 37. PAGE 37CoordinationI have my staff contact The James via the main line to make an appointment;I hear few complaints and they are able to direct my staff to where my patientneeds to be seenIf the normal referral resources are inadequate, I need to get in touch with aperson – usually an oncologist – but am unsure how to do this unless Ialready have an individual’s phone numberThroughout the continuum of care, I consistently receive a fax almostimmediately after patients are seen or treatments are completed; faxes areideal because they are easy to scan into my EMR systemThe James returns patients to my care and is willing to coordinate withme to provide on-going care to minimize patient travel, which becomesmore important if my patients travel over an hour to The JamesCoordination
  • 38. PAGE 38CoordinationMost report satisfaction with the main referral line, although attimes the process takes longer than they would like. However, they aredirected to the right department and can make appointments quickly whilepatients are still in the office. Those who have direct numbers tooncologists at The James highly value this as a resource.Coordination
  • 39. PAGE 39CoordinationMost report satisfaction with the main referral line, although at times theprocess takes longer than they would like. However, they are directed tothe right department and can make appointments quickly while patients arestill in the office. Those who have direct numbers to oncologists at TheJames highly value this as a resource.Those who do not have contact information for an oncologist at The Jamesfind it difficult to speak with the right provider when they have scheduling-related problems or questions about unusual cases.Despite the faxed updates, phone calls initiated fromoncologists at The James would be appreciated –especially if the situation is unexpectedly taking a turn for the worse.Community providers regularly call referring physicians, which theyappreciate.Coordination
  • 40. PAGE 40CareI am happy with the clinical outcomes; The James gives options andhope to patients when other providers have nothing to offerCare
  • 41. PAGE 41CareI am happy with the clinical outcomes; The James gives options and hope topatients when other providers have nothing to offerPatients are often overwhelmed about the large size of the campus andlong wait times – but report positive feedback about their treatmentexperience; they understand their treatment plan, feel the nurses are caringand recall their doctor takes the time to listenCare
  • 42. PAGE 42CareI am happy with the clinical outcomes; The James gives options and hope topatients when other providers have nothing to offerPatients are often overwhelmed about the large size of the campus and longwait times – but report positive feedback about their treatment experience;they understand their treatment plan, feel the nurses are caring and recalltheir doctor takes the time to listenSince I trust The James’ expertise, I would like cancer treatmentprotocols so I know best practices for cancer screening, at what point torefer my patients and how to conduct tests so The James does not need torepeat them after my patient arrivesCare
  • 43. PAGE 43CareI am happy with the clinical outcomes; The James gives options and hope topatients when other providers have nothing to offerPatients are often overwhelmed about the large size of the campus and longwait times – but report positive feedback about their treatment experience;they understand their treatment plan, feel the nurses are caring and recalltheir doctor takes the time to listenSince I trust The James’ expertise, I would like cancer treatment protocols soI know best practices for cancer screening, at what point to refer my patientsand how to conduct tests so The James does not need to repeat them aftermy patient arrivesI have a physician liaison from other hospitals, but not The James; I wouldlike a relationship with someone who can give me information andaccess to The JamesCare
  • 44. PAGE 44CarePatient satisfaction with their experience is the mostmotivating factor for continued referrals to The James.Although there is room for improvement in personalizing the experience,patients and referrers alike feel they received the best outcome possibleand understand their treatment plan.Care
  • 45. PAGE 45CarePatient satisfaction with their experience is the most motivating factor forcontinued referrals to The James. Although there is room for improvementin personalizing the experience, patients and referrers alike feel theyreceived the best outcome possible and understand their treatment plan.In general, referring physicians describe the transition of care backto referring physician as rather smooth. The transition isfacilitated by faxes with instructions for on-going care and patients beingwell-informed of their care plan. Despite satisfaction with faxes, somewould like more detailed instructions for on-going care.Care
  • 46. PAGE 46Building Referrals• Help them feel valued as medicalprofessionals• Enhance their reputation with patients• Emphasize why and when you are thebest option, including advanceddiagnostic options• Simplify the patient’s experience• Create meaningful relationships• Pick up the phone“A way The James could build referralswould be (for The James doctor) to just callmy office and just talk for five minutesabout the patient.”“It is my lack of knowledge of what theyhave at The James that makes me not wantto refer there for the non-complicatedcancers. The basic breast cancer protocol isthe same everywhere.”“Whatever The James can do to be morecustomer-oriented would be helpful.”
  • 47. PAGE 47Today’sBusinessModelFutureBusinessModelThe Red ZoneRed Zones Require Concurrent ActionRunEmployeesTransformationalLeadersManagers“We must continue doingbusiness today whilesimultaneously changingthe way we do business.”
  • 48. INSIGHTS TO ACTION4
  • 49. PAGE 50Strategic Questions• Will we promote usage as a tertiary center for complex cases (mostcurrent usage) or a preferred provider for all cases? If we want tochange perceptions, how will we do this?• What is the emphasis on clinical care v. research? How can we continuestellar research while enhancing patient-focused clinical care?• How can we coordinate care for more geographically distant patients?• What are consistent ways we can build emotional connections withreferrers to which our oncologists and staff will agree to adopt?• How can we motivate oncologists to call referrers more often despite thetime investment?
  • 50. PAGE 51Results to Date• Results communicated with organization-wide physicianleadership to develop awareness• Hired a Cancer Specific Referring Relations Coordinator• Goals to increase communication between the James and thereferring community• Liaison for operational concerns between referring MDs andJames. Takes action plans back to the referring docs• Host one CME per quarter to bring referring MDs to the James• Coordinates and hosts referring physician meets for ourphysicians to go to the community
  • 51. PAGE 52Results to Date (cont.)• Referring MD communication strategy and operational accessplan has been drafted• Cancer MD cell phone numbers are being collected andorganized for communication to referring MDs• Developed a paper referring physician directory that is organized bydisease service line• Information from the findings is being used in the James AmbulatoryStrategic Planning process
  • 52. PAGE 53Marketing Communications Plan• FY2014 goals include• Increase awareness among targeted referring & non-referring physicians• Grow relationships between James physicians andreferrers/non-referrers• Increase awareness among office managers and referralcoordinators• Position The James as a resource for information andconsultation for referrers/non-referrers
  • 53. A SUSTAINABLE PROCESS5
  • 54. PAGE 55DataInformationKnowledgeAction -- Profitable-- Useful-- Educational-- InterestingTranslating data into action through CRM
  • 55. PAGE 56Sources of Information & FeedbackReferringPhysicianSurvey• Deployment• Response• Escalation• ReportingPhysicianRelations• Physician Call Center• Liaison Specialists• Local• National• InternationalOtherSources• Physicians/Staff atLocal Offices• Regional CareCenters• FacultyReferring PhysicianReferringPhysicianSurveyPhysicianRelationsOtherSources
  • 56. PAGE 57InputDataSourceFrequency Objective/DataCollectedData TransferMethod toSalesForceCMS Monthly • Contact info• Flag new ProvidersOne-way, Upload viaNPI Daily • Contact info• Specialty, privilegedOne-way, Upload viaEPIC Weekly • Referral tracking• Financial DataOne-way, Upload viaSalesForce As needed • CampaignManagement• Physician Visit Reports• Call Center DataUser entered andmaintainedSatisfactionsurveysTrigger based,as deployed• Physician satisfactionsurveys• Post referral follow-up• Other surveysCollected viaSalesForce integratedsurveysHCAHPS Monthly • Track scores andcompare topcompetitorsOne-way, Upload viaIntegrating Data SourcesProcessed throughcustomizedSalesForce programCustom, user specificreports and dashboard
  • 57. PAGE 58Internal ProcessesKey ActivitiesScheduling First Visit Treatment Follow-upNeedPhysician contracts callcenter for additionalinformationPain Points• Calls not returned• Provided incorrect information• Need to repeat their “story”How can CRM support/improve process? Are we improving?Information Needs• What is currently collected, needs migrated• What needs to be collected• How should that information be organizedAssessing, Monitoring and Tracking• Surveys• Key Metrics• Reports and TrendsLIaisonPain Points• Incomplete records• Information needs• High volume of calls
  • 58. PAGE 59Next Steps• Implement communications plan• Implement a CRM solution• Development and implementation of a complete line of materials forservice lines• Continue migration to single phone number for each service line• Continue development of JamesLine product – nursing information andtriage line to help with access• Evaluating referring physician access line and "ask a doc" solution for ourcancer experts
  • 59. PAGE 60Lessons Learned• Perceptions were actually better than we thought• Reinforced focus on areas we already knew were a problem• Enabled us to put emphasis on relationship development• Allowed our physicians insight into perceptions and give us an actionableapproach
  • 60. PAGE 61Contact UsTheresa DiNardo-BrownChief Communications Officer(614) 293-5079Melissa ChildressAssociate Executive Director(614) 293-5079John McKeeverExecutive Vice President800-846-4051jmckeever@endeavormgmt.com
  • 61. PAGE 62Endeavor Management is a strategic transformation and managementconsulting firm that leads clients to achieve real value from theirinitiatives. Endeavor serves as a catalyst by providing the energy tomaintain the dual perspective of running the business while changing thebusiness through the application of key leadership principles andbusiness strategy.The firm’s 40 year heritage has produced a substantial portfolio of provenmethodologies, enabling Endeavor consultants to deliver top-tiertransformational strategies, operational excellence, organizationalchange management, leadership development and decision support.Endeavor’s deep operational insight and broad industry experienceenables our team to quickly understand the dynamics of client companiesand markets.In 2012, Gelb Consulting became an Endeavor Management Company.With our Gelb experience (founded in 1965) ,we offer clients in-depthinsights in the healthcare industry and unique capabilities that focus theirmarketing initiatives by fully understanding and shaping the customerexperience through proven strategic frameworks to guide marketingstrategies, build trusted brands, deliver exceptional customerexperiences and launch new products.Endeavor strives to collaborate effectively at all levels of the clientorganization to deliver targeted outcomes and achieve real results. Ourcollaborative approach also enables clients to build capabilities withintheir own organizations to sustain enduring relationships. For moreinformation, visit www.endeavormgmt.com and www.gelbconsulting.com2700 Post Oak Blvd., Suite 1400Houston, TX 77056+1 713.877.8130www.endeavormgmt.com/healthcare