10 Customer Acquisition and Relationship ManagementDmitry .docx

10 Customer Acquisition and Relationship Management
Dmitry Kalinovsky/iStock/Thinkstock
Patronage by loyal customers yields 65 percent of a typical
business’ volume.
—American Management Association
Learning Objectives
After reading this chapter, you should be able to do the
following:
• Identify how organizational growth is best achieved by an
HCO, and state the effect of the product life cycle
on an organization’s revenues.
• Discuss several approaches that an HCO can use to attract
new customers, or patients.
• Delineate the premises upon which customer relationship
management is based.
• Explain the advantages of database marketing, and
identify ways for an organization to use a marketing
database.
• Provide examples of how an HCO can effectively manage
real and virtual customer interactions.

Section 10.1Organizational Growth
Introduction
This chapter focuses on how to attract and keep patients through
understanding and meeting
their needs. The long-term success of an HCO depends on its
ability to attract new patients
and turn them into loyal customers who not only return for
needed services, but recommend
the HCO’s services to others. This is especially important
because of the nature of the life cycle
for products and services, from their introduction to their
decline. Attracting new customers
and keeping existing ones involves interacting internally and
externally with patients, analyz-
ing data on current patients, and managing real and virtual
interactions with patients. Manag-
ing relationships with patients helps to ensure that patients stay
informed and feel connected
to the HCO through its internal and external customer
relationship efforts.
10.1 Organizational Growth
Most organizations have growth as a basic goal. Growth means
an increase in revenue and
a greater impact on the communities served. Growth also creates
opportunities for staff to
advance and take on new responsibilities. While many activities
can help an HCO grow, the
most important is the development of an effective marketing
plan to provide a consistent
platform for the organization’s visibility and to brand the HCO
as an attractive option for
medical services. The development of an effective marketing
plan was stressed in Chapter 8
as a basic marketing need for an HCO: that is, to inform new

and existing customers of the
organization’s services and to persuade them to continue using
or to try using these services.
Product/Service Life Cycles
Like people, products and services have a life cycle. The term
product life cycle refers to the
stages that a product or service goes through from the time it is
introduced until it is taken
off the market or “dies.” The stages of the product life cycle,
illustrated in Figure 10.1, usually
include the following descriptions:
• Introduction—The stage of researching, developing, and
launching the product or
service.
• Growth—The stage when revenues are increasing at a fast
rate.
• Maturity—The stage when revenues peak, and the rate of
growth slows down.
• Decline—The final stage of the life cycle, when revenues
start to decline.
For example, a pharmaceutical manufacturer introduces a new
cholesterol drug, and it is pro-
moted by sales reps and possibly promoted directly to
consumers during the product’s intro-
duction stage. As more and more physicians prescribe the drug,
sales grow at a fast pace, and
the drug enters the growth stage. As time passes, sales begin to
slow as the drug reaches the
maturity stage. Then, newer drugs are introduced, and sales of
the older drug start to decline.
In an attempt to maintain sales of the older product, the
manufacturer may decide to sell the

older product as an OTC drug, but at a much lower price than
when it was a prescription drug.
Of course, not all products reach the final stage and may instead
continue to stay at the matu-
rity stage for a long period of time. Regardless, attracting and
keeping new customers is critical
Section 10.1Organizational Growth
because of the nature of how products evolve from their
conception to extinction. When the
revenues produced by the product or service begin to decline, so
do profits. To boost or main-
tain revenues requires keeping existing customers, but also
attracting new ones.
Figure 10.1: Product/service life cycle
Some products stay in the maturity phase for a long time. Other
products move quickly through the cycle.
f10.01_MHA 626.ai
Introduction Growth Maturity Decline
Time
R
e
v
e
n
u

e
Source: Adapted from Product Life Cycle Stages at
http://productlifecyclestages.com/
Individual Adoption Stages
A critical element in attracting new customers is to understand
the stages that individual
consumers move through when adopting a new product as it
moves through the product life
cycle. These stages, shown in Table 10.1, are referred to as the
individual adoption stages.
Of course, promotional messages must be aligned with these
stages to carry the consumer
through them. In the introductory stage, promotional messages
must inform potential cus-
tomers of the offering. In the growth stage, promotional
messages must encourage potential
customers to use that specific offering, or product, rather than
competing products. At the
maturity stage of the product, customers are reminded of the
product to build repeat usage
and referrals. Thus, messages stressing the firm’s competitive
advantage must be developed
to answer consumers’ questions at a given stage in the
individual adoption process and to
reflect the nature of the product at a given time during its life
cycle.
Section 10.2Attracting New Customers
Table 10.1: Individual adoption stages and information needs
Stage in Individual Adoption Process Questions Consumers

Want Answered
1. Awareness: Consumer first learns of the product, ser-
vice, or organization.
Who are you?
What are you all about?
What do you do?
2. Interest: Consumer is stimulated to get more informa-
tion about the product or service.
Why would anyone use your services?
What benefits would they get?
3. Evaluation: Consumer considers whether to try the
product or service.
Why should I buy your organization’s
services?
4. Trial: Consumer tries the product or service. Will it really
deliver those claimed benefits?
Can I risk trying the service?
5. Adoption: Consumer decides to use the product or
service, becoming “your” customer or patient.
Did I make the right decision?
6. Repeat: Consumer may reevaluate his or her decision to
continue using the product or service.
Should I continue to use the same service
provider or are there better alternatives?

Consumers will be at various stages in their individual adoption
process of a product and will
have varying levels of knowledge and experience. Therefore, a
variety of promotional mes-
sages, conveying different types of information about the
product, service, or organization, is
usually necessary to communicate effectively to them. While
most consumers are concerned
about the benefits received from a product, some are interested
in the detailed information
that produces those benefits. Such detailed information should
be available to consumers
who request it.
Information from the marketing plan’s consumer analysis is
vital in making communications
decisions on promotional message content. The needs and
motives of consumers become the
center of such content decisions. If time and money permit,
promotional messages should be
tested before use, and measures indicative of consumer
responses to those promotional mes-
sages should be evaluated in the decision-making process to
finalize the message content.
10.2 Attracting New Customers
New customers, or patients, can be attracted to an HCO in
several different ways, some at
a relatively low cost. One source has identified four low-cost
approaches (Guerrero, 2013),
which follow:
1. Create an online presence with a website because people
search for information, and
sometimes ratings, online.

2. Use social media to create a profile of your business and to
get feedback. Using
social media increases visibility and presence, and shows
potential patients you are
up-to-date.
3. Increase community involvement, which is an age-old
technique, but it works. Clubs,
churches, speaking engagements, and so forth all increase name
recognition and
awareness.
Section 10.2Attracting New Customers
4. Make it easy for patients to contact you. This can be done by
creating a link on your
website for customer contact or by using text, tweets, and email.
Some hospitals have started using animated videos to attract
new patients. These videos can
be linked from your website, or emails can be sent to provide
links to videos on YouTube.
This allows potential and existing patients to view the videos at
their leisure and provides an
interesting interface, which can serve to present useful
information (PRWeb, 2012).
Another approach for increasing patients/revenues is to offer
additional services. Dr. Clint
Long of Long Eye Clinic in Sherman, Texas is a board-certified
ophthalmologist who has added
new services to his practice to attract new patients and increase
revenues from existing
patients. The clinic offers BOTOX® Cosmetic, a proven

prescription medicine that is injected
into muscles to temporarily improve the look of moderate-to-
severe frown lines between the
eyebrows in patients from age 18 to 65. The clinic also offers
CO2 laser treatment for skin
rejuvenation. This treatment can help diminish brown spots and
wrinkles while firming and
toning facial skin.
L O N G V I S I O N C E N T E R : D R . C L I N T L O N G
Long Vision Center in Sherman, Texas cares about your vision.
In fact we believe that it is
very precious, and Dr. Long is here to make sure you have
superior quality eye care. Here
at Long Vision Center, we provide general eye care, medical
eye care, surgical eye care,
laser eye care, as well as Botox Cosmetic, Laser Skin Re-
surfacing, and Lasik to patients in
Sherman, Texas and the surrounding North Texas area.
Dr. Clint Long, a State of Texas Board Certified Licensed
Ophthalmologist, performs gen-
eral eye examinations for eyeglasses and contact lenses,
examinations for cataract and
cataract surgery, lens implants, corneal surgery and transplants,
diagnosis and treatment
of dry eyes, laser vision correction & surgery such as LASIK,
diagnosis, medical, laser and
surgical treatment of glaucoma and provide eye examinations
and laser treatment for dia-
betic retinopathy and treatment for age related macular
degeneration.
Source: http://www.longvisioncenter.com/ Retrieved November
13, 2013(continued)

While Dr. Long’s initial interest was in helping patients with
skin issues around the eyes, he
soon learned that patients also wanted the treatments for other
areas of their face. His invest-
ment in additional training and certification in those procedures
has paid off through an
expanded customer base and increased revenues (Long Vision
Center, 2013).
Patient referrals are a cost-effective way of getting new
patients. However, patient referrals,
like other aspects of a marketing plan, must be managed. This
means evaluating the pro-
cess of new-patient referrals; that is, who is referring new
patients, how is this information
being obtained and kept, and how are new patients treated by
staff and made to feel welcome
and valued.
Many doctors will actually set up an appointment for a patient
with another doctor and have
the referred doctor’s office confirm the appointment. A record
of each of these referrals
Section 10.3Customer Relationship Management
should be maintained and the referring doctor thanked for the
referral. A short note or call
can show appreciation and lead to more referrals.
The cross-selling of services within a clinic is a valuable tool
for referrals. Cross-selling means
referring patients to other doctors or services offered by the
clinic. It is important that each

doctor be aware of the services and qualifications of other
medical staff at the clinic and con-
tinually reminded of the need to cross-sell, because it works
both ways: I refer someone to
you, and you refer someone to me.
10.3 Customer Relationship Management
In addition to attracting new patients, HCOs must effectively
manage their existing custom-
ers to support long-term profitability. Customer relationship
management (CRM) further
analyzes a targeted segment by addressing each customer’s
potential for profitability. CRM is
based on the following four premises:
1. Customers are a key asset of the organization.
2. Customers vary in their preferences and behaviors and their
value to the
organization.
3. Understanding customer needs, preferences, and behavior can
improve a
customer’s value.
4. Relationships with customers must be managed.
While many companies have operated on the premise that the
best customers are loyal ones
and have focused on segmentation by frequency of purchase,
traditional loyalty programs
have neglected to analyze their profitability (Mason & Young,
2003). Instead of focusing on
loyalty alone, CRM goes one step further in finding ways to
measure the company’s “cost” to
maintain that customer relationship. Many companies now offer
software for CRM programs,

which, if implemented appropriately, can provide a competitive
edge for an organization
(Kotler, 2003). These software programs involve the use of
database marketing, which will be
discussed in the next section.
The All About Smiles dental practice in Durant, Oklahoma has
learned to use several
approaches to CRM. At All About Smiles, CRM begins with
new patients at the front desk,
where they are greeted by office staff and made to feel welcome
and appreciated. Everyone
else’s job is to ensure that customer appreciation continues
throughout the whole treatment
and payment process. The office layout is unusual for dental
practices. For example, the Egypt
room has murals of pyramids; the Jamaica room has scenes of
beaches and palm trees; and a
game room complete with PAC-MAN® entertains the younger
patients.
New patients are asked for their email addresses and mobile
phone numbers so they can
be sent reminders of their next appointment and also have an
opportunity to evaluate the
services through an online survey, which is sent to patients a
few days after their dental visit.
Email reminders are sent the day before the upcoming
appointment, and text messages are
sent the day of the appointment and two hours before the
appointment time. Patients can opt
out of both of these contact methods and request phone calls
instead, if they prefer that type
of reminder. The office manager reports that the texts sent on
the day of the appointment
have significantly reduced the number of no-shows.

Section 10.4Database Marketing
A L L A B O U T S M I L E S D E N T I S T R Y , D U R A
N T , O K L A H O M A
At All About Smiles Dentistry, we value our patient
relationships, making it our priority
to deliver gentle compassionate care that you deserve from a
dentist in Durant. We work
hard to make you feel at ease by providing exceptional patient
care in a relaxed, convenient
atmosphere. We strive to develop lifelong relationships with our
patients by combining the
latest dental technology with a professional and compassionate
staff. The result is a beau-
tiful, healthy smile that lasts a lifetime.
We also believe that patients should have sufficient information
to make educated deci-
sions about their oral health, treatment options and choice of
dentist in Durant. You’ll find
all of this important information on our website, including
directions to our Durant office,
service descriptions, patient forms, patient education resources
and more.
Not only are we a leading dentist in Durant, we are a full-
service practice providing for all
of your dental needs. Our services include:
• General Dentistry
• Teeth Whitening
• Crowns
• Preventive Care

• Periodontal Exams
• View a Complete List of our Dental Services
Should you ever need additional information about our practice,
we are always available to
answer your questions. Let us care for your entire family! We
look forward to meeting you.
Source: http://www.durantsmiles.com/ Retrieved November 13,
2013
10.4 Database Marketing
True database marketing creates customer intelligence that
contributes to the development
of profitable customer relationships. Database marketing is an
organizational process that
is customer research driven. The information base is dynamic
and evolving, preferably with
two-way dialog with the customer (Berry & Linoff, 2000). It is
a measure of the importance of
creating and maintaining a good database of market information
that Business Week devoted
the cover story of its September 5, 1994 issue to the subject of
database marketing, calling
it “one of the biggest changes in marketing since ‘new and
improved’” (Bloomberg Business-
week, 1994, para 5). Since that time, the concept of database
marketing, coupled with new
technologies, has grown to the point that a new generation of
marketing professionals has
been created. Basic information on age, gender, lifestyle,
occupation, and so forth can easily
be captured by HCOs through additions to the regular patient
forms filled out annually or by
new patients. This information must then be entered into a
software program by staff or an

outside marketing agency. The data can then be analyzed for
commonalities and trends.
Advantages of Database Marketing
The new generation of database marketing professionals offer
skills in four primary areas:
(a) secondary data acquisition, including analysis of the value
of lists; (b) database-build-
ing, including the understanding of computer hardware and
software; (c) target marketing,
including maximizing database record use; and (d) one-to-one
marketing, which involves
managing and refining the targeting process to customize
contacts for every customer (Kot-
ler, 2003). The popularity of database marketing is grounded in
the belief that marketing
planning begins by understanding the customer—his or her
buying and consumption pat-
terns, location, interest, and other aspects of buying behavior
discernible from databases—
and then formulating plans that attempt to weave the firm’s
product or service into the con-
sumer’s pattern of behavior. The basic idea behind the use of
databases is this: If that is what
the consumer is doing, how can we make consumers want to do
that more often and with our
product? This approach to satisfying customers adheres to the
belief that the best indicator
of future behavior is past behavior. Thus, if American Express®
sees its card frequently used
by a cardholder to purchase works of art, then it assumes an
advertisement for artworks in

that cardholder’s monthly bill will generate a better response
than it would with a cardholder
who uses the card for travel in the Caribbean (and receives
advertisements for travel specials
to that region). In fact, by monitoring card members’ shopping,
travel, and eating patterns,
plus the economic and weather patterns in which they live, the
database may trigger an ad
to be sent to someone who has traveled in the past to warmer
climates during a particularly
inclement winter month, in a calculated effort to strike while
the iron is hot.
If an HCO learns that more and more patients are accessing its
website before a visit, then
ensuring that the website is up-to-date, and that links to
departments and services are all
working, is an essential part of the use of data mining, which is
discussed in the next subsec-
tion. Patient forms can simply ask about visiting the website
and any additional information
patients would like to be able to access on the website. Patients
can also be asked whether
they want to receive email or text updates of changes to the
website.
Data Collection and Manipulation
The process of data collection and manipulation, which allows
such powerful tactical market-
ing actions to occur, consists of several steps:
1. Consumer action. The process begins with the consumer
taking some form of
action—they use a coupon, fill out a warranty card, make a
purchase, enter a sweep-
stakes, place a toll-free call to request information, fill out a

business reply card,
order from a catalog, and so forth. This behavior is combined
with other information
in public records to identify a broad profile of each consumer in
the database.
2. Digesting the data. Sophisticated statistical techniques are
used to merge data on
the consumer into a coherent, consolidated database. Other
software allows the
marketer to “drill down” into the data to reveal patterns of
behavior for classes of
customers.
3. Profiling the ideal customer. Neural networks that “learn”
from the data are used to
identify a model consumer, that is, the common characteristics
held by the high-
volume customer. This allows the marketer to find customers or
potential customers
who share those characteristics in common with the high-
volume customer.
4. Using the knowledge. This data can be used in many ways: to
determine who gets
which sales promotions, to develop attributes for new products
or services with a
targeted list of customers for new-product introduction
announcements, to tailor ad
messages and target them by customer groups, and so forth.
5. Sharing data with channel members. For consumer package-

goods marketers, it is
possible to merge the manufacturer’s database (described in
item 2 of this num-
bered list) with an individual store’s scanner data to help plan
local promotional
mailings, fine-tune shelf displays, and design store layouts
(Berry, 1994).
Modern technology has made it possible for marketers to do
extensive searches through a
large database, essentially mining the data. Data mining is the
process of sorting through the
data to find hidden patterns, potential trends, and correlations
between customers or within
a single customer’s data. Data mining is predominantly
accomplished through mathemati-
cal and statistical processes and is typically done using software
developed for this purpose
(Mason & Young, 2003). However, great care must be used in
healthcare-related data mining
because of the privacy concerns of patients and the need to
safeguard access to patients’
medical information.
While modern technology, including neural network software
and parallel processor hard-
ware, makes the use of such database marketing possible, it is
old-fashioned objectives that
drive the interest in databases. Marketers seek to know their
customers so well that they
can anticipate their needs and provide them with desired
products and services before the
customers themselves know what they want. This is relationship
marketing, which is now at
its most efficient evolutionary stage. Computer technology
allows the marketer to acquire

knowledge of the purchasing habits of millions of individual
customers and to weave relation-
ships with them by anticipating their needs and informing them
of need-satisfying products
specifically suited to their situation. By successfully weaving
these relationships, the mar-
keter makes it inconvenient or costly for the customer to switch
to a competitor.
Using the Data
To some degree, the marketing plans of companies actively
engaged in database marketing
are driven by the desire to maximize the use of their databases
and the technology that allows
the manipulation of those databases. In other words, the ability
to use the database in certain
ways means that those uses will become the implementation of
the marketing plan (that is,
the marketing plan conforms to fit the technology available).
This is not necessarily an inap-
propriate or backward approach to marketing, as long as
marketers do not lose sight of this
fact: The ultimate goal of any technology usage or marketing
plan objective is to identify how
an organization can gain a competitive advantage in satisfying
customer needs and wants.
Jackson and Wang (1994) have identified 15 ways to use a
marketing database. These uses of
a marketing database are described in depth in their book and
are listed as follows to illus-
trate the spectrum of possibilities for the use of databases in
data-based marketing planning:
1. Identify your best customers.
2. Develop new customers.

3. Deliver a message consistent with product usage.
4. Reinforce consumer purchase decisions.
Section 10.5Managing Real and Virtual Customer Interactions
5. Cross-sell and complementary sell products.
6. Apply three-tiered communications.
7. Improve delivery of sales promotion.
8. Refine the marketing process.
9. Increase the effectiveness of distribution channel marketing.
10. Maintain equity.
11. Establish a management resource.
12. Take advantage of stealth communications.
13. Conduct customer, product, and marketing research.
14. Personalize customer service.
15. Provide program synergy and integration.
10.5 Managing Real and Virtual Customer Interactions
Patients develop a service script in each healthcare setting. A
service script is the expected
sequence of events and outcomes for that particular setting.
When the actual experience
departs from the script, the patient may be uncomfortable
(Solomon, 2013). For example,
a dental patient may expect a visit to the dentist to include
reading out-of-date magazines
in the waiting room, experiencing pain while a cavity is filled,
and hearing the high-pitched
sound of the drill. This may not be perceived as a pleasant
experience, but it is, traditionally,
the patient’s expectation.
A problem now faced by many HCOs is that patients gather

information from social media
outlets before contacting a healthcare provider (Kane, Fichman,
Gallaugher, & Glaser, 2009).
The information gleaned from the Internet and social media
sites determines, at least in part,
the patient’s service script. A new dental patient can search the
Internet or interact with
friends on a site such as Facebook to find a dentist who has a
big-screen TV in the waiting
room, guarantees little or no pain, and uses a quieter laser drill.
This information dramati-
cally alters the patient’s expectations of the dental appointment.
Several popular healthcare
social media sites are listed in Table 10.2.
Table 10.2: Healthcare social media sites
Website Purpose
PatientsLikeMe.com
DailyStrength.org
Allows patients to share real-world health experiences to
help themselves and other patients.
angieslist.com
healthgrades.com
RateMDs.com
All of these allow patients to rate healthcare providers.
CaringBridge.org Helps people who have significant health
problems
connect with friends and family, making the experience
easier.

Sermo.com Exclusively for MDs and DOs to post observations
and
questions about puzzling cases.
The following subsections will discuss the use of social media
by patients, the management
of online community relations, gaps in expected and delivered
service, and service recovery.
Social Media in Healthcare
Sixty million people in the United States read or contribute to
blogs, wikis, and/or social
networks about healthcare (Kane et al., 2009). Often, social
media is the first place patients
search for information concerning specific illnesses or
recommended healthcare providers.
This use of social media provides opportunities as well as
possible pitfalls for HCOs and indi-
vidual healthcare providers.
The opportunities offered by social media include the ability for
the HCO to communicate its
mission, vision, and products or services as well as health
education. HCOs also can use social
media to advertise and post patient testimonials. Finally, social
media can be used to manage
customer experiences by helping to create realistic service
scripts.
The biggest challenge for any organization involved in social
media is the ability to control
the conversation (Forbes Insights, 2013). Threats to a firm’s

reputation may be internal or
external. Internally, a disgruntled employee may post
information damaging to an organiza-
tion, such as protected health information about a patient. Even
an act of kindness may be
damaging to an organization. For example, a nurse may post a
request on Facebook for her
friends and family to keep a particular hospitalized patient in
their thoughts and prayers.
Depending on the amount of information revealed by the post,
patient confidentiality may
have been breached.
Controlling the external conversation is more difficult. Online
communities spontaneously
appear, often with different contributors taking the lead.
Further, as patients, the participants
are free to discuss personal medical information without
violating privacy law (Kane et al.,
2009). This allows the participants to be very specific about
their experiences with an HCO
or a healthcare practitioner. Often, the HCO cannot respond to
such posts without violating
patient confidentiality. Nonetheless, it is imperative that HCOs
have personnel who constantly
monitor and respond to social media conversations—both
positive and negative. Elements of
a social media policy are outlined in Table 10.3.
Table 10.3: Social media policy
Develop a Formal Social Media Policy
• Activate network settings so only designated staff can
access social media.
• Define inappropriate use of social media and ramifications
for policy violations.

• Encourage employees to report the inappropriate use of
social media by others.
Monitor External and Internal Online Communication
• Use Google Alerts, Twitter Keyword Tool, and other tools
to monitor online communications.
• Deputize employees to augment the team’s efforts for
internal communication.
Engage Online Communities
• Create compelling social media.
• Use online community leaders, such as well-known
bloggers and journalists, to ensure that your message
is understood.
• Communicate internally—marketing to employees unifies
the organization’s message.
Act as First Responders
• React quickly to negative comments, but use a team
trained in public relations triage.
• Acknowledge legitimate criticism and mistakes.
• Respond forcefully to unfounded rumors.
• Do not engage every online community—pick and choose
those with which you want to be associated.
Managing Customer Service
In a recent survey, more than 300 chief marketing officers
(CMOs) from a broad array of indus-
tries, including healthcare, reported that customer experience
was their most important pri-
ority. Customer experience was viewed as more important than

new products or services,
branding, or need identification. Interestingly, pricing, as a
concern, came in last. To achieve
an outcome of excellent customer experience, CMOs believe
that marketing, strategy, finance,
information technology, and social medial need to all
collaborate. As the CMO of one pharma-
ceutical company stated, “We don’t have a silo-driven culture at
all. We are highly integrated
across sales, marketing, R&D, and finance” (Forbes Insights,
2013, p. 8).
As noted earlier in this section, social media now drives the
service script, or customer expec-
tations, of the healthcare experience. The difference between
the service expected and the
customer’s perceived service quality is known as the service
gap, and the management of
this difference is known as gap analysis (Loudon, Stevens, &
Wrenn, 2005). Management
needs to constantly monitor customer service expectations and
the customer’s perceived
service quality. Actual gaps in service need to be addressed by
the appropriate personnel.
For example, a stand-alone urgent care center may advertise a
no-waiting policy. However,
patients actually experience a 15- to 20-minute wait, and they
perceive that wait to be much
longer. In this case, the person in charge of the promotional
message can close the service gap
by advertising “short wait times.”
Frontline employees, such as admissions clerks, receptionists,
and triage nurses, are also
in a position to manage service gaps. Frontline employees, as
well as other personnel who

initially interact with the patient, are the first experience the
patient has with the HCO and, in
the patient’s mind, these employees represent the HCO. Thus,
part of the employee’s job is to
communicate a favorable impression of the organization to the
patient.
In addition, the frontline employee who initially engages the
patient also has valuable infor-
mation that can be used to manage patient expectations. For
example, an emergency room
admissions clerk can communicate the expected wait time to a
patient. Then, the triage nurse
can explain the steps that will be taken to care for the patient’s
illness or injury, and provide
some information about what the patient can expect the
emergency room doctor’s examina-
tion to include.
However, even in the best of organizations, service failures will
occur—those instances when
customer expectations clearly were not met. While some
patients who experience a service
failure will not complain and not return, others will complain.
How those complaints are
handled is crucial to patient retention for the HCO. Once a
service failure is identified, the
lowest-level employee possible needs to be empowered to
resolve the problem. For example,
frontline employees at The Ritz-Carlton® hotels, including desk
clerks and housekeepers,
have $2,000 dollars per year to use to satisfy customer
complaints (Kotler, Bowen, & Makens,
2014). Once the service failure has been addressed, management
needs to analyze the failure,
look for trends within the organization for that type of failure,

integrate information about
service failure into operational planning, and follow up with
customers or patients to support
continuing good relations (Kotler, 2003).
Interestingly, service failure can be an opportunity to strengthen
patient relationships. In one
study, customers who experienced a service failure but felt the
organization had successfully
resolved the situation were found to be more loyal than the
customers who had never expe-
rienced a service failure. This is known as the service recovery
paradox (McCollough, 2009).
Therefore, it is crucial that management constantly anticipates
and attempts to control cus-
tomer service expectations, analyzes service gaps, and has
effective policies in place for ser-
vice recovery.
Using a Marketing Agency
Given the increased use of technology and the need to find new
ways to attract and keep
patients, contracting with a marketing agency may be a solution
for an HCO as a means
to outsource many of its marketing activities. For large
organizations that have a marketing
administrator, the use of an external supplier to handle event
planning and other marketing
activities avoids the need to hire additional staff, and it may be
a more cost-effective solution
for the organization. For a smaller organization, outsourcing the

marketing operations of a
busy medical practice allows physicians and staff to concentrate
on serving patients and the
marketing specialist to design, update, and manage the
marketing side of the business.
Website design, patient surveys, social media, blogs, and so
forth can all be outsourced to
marketing agencies that specialize in healthcare marketing. Not
only do these agencies bring
their marketing expertise to the organization but also their
knowledge and experience with
other healthcare clients, enabling the HCO to find and use what
is new but also what is tried
and true in marketing services in its industry.
For example, DiD is a boutique healthcare communications
agency in Pennsylvania. This
agency’s Services content on its website explains that
“Healthcare marketing is about finding
the right mix of what’s new with what’s tried and true. We
excel at creating integrated cam-
paigns. Our insights and honed healthcare instincts keep us
ahead of the pack. We shorten the
distance between insight, idea, and execution. Simply put, we
don’t waste time chasing our
tails” (DiD, 2013, Services, para. 1). This agency offers a
complete line of services for health-
care marketing, including strategy (research, analytics, and
measurement); planning (brand
positioning, trends, and marketing); and creative (print, video,
digital, mobile apps, and social
media) services (DiD, 2013).
It is important for an organization to select the right marketing
agency for its marketing

needs. An organization needs to decide whether its primary
target market is patients or other
HCOs, and then find a marketing agency that focuses on
healthcare marketing. One source has
suggested evaluating the following criteria when selecting a
marketing agency:
1. The agency’s knowledge of legislation
2. The agency’s use of its expertise in their own business
3. The agency’s references, and how they will bill you (Fawcett,
2013)
The criteria should include an agency that the organization can
build a relationship with—an
agency that understands the organization and has the expertise
to perform tasks effectively
and efficiently. The agency should share, with the organization,
the metrics for assessing a cli-
ent’s results, which will determine how well the marketing
activities performed by the agency
for that client are working.
Summary & Resources
Website Design
In today’s digital world, it is extremely important to have an
effective website. An increasing
number of consumers are using the Internet to search for health
information and healthcare
providers. This is especially true of younger consumers. The
following list offers several sug-
gestions for creating an effective website design (Clow &
Stevens, 2009):

1. Decide on the objective of the website. The objective dictates
how the website will
be designed. Possible objectives include the following:
a. E-commerce; that is, selling services over the Internet
b. Information for clients or patients
c. Means for clients or patients to contact the organization
d. Public relations communication tool
e. Advertisement of services
2. Hire a professional web designer. It will be worth the
money.
3. Make the site user-friendly. Use the language of the target
audience, not technical
jargon.
4. Use photos, which speak louder than words.
5. Create an easy-to-follow menu.
6. Include FAQ as a topic to provide ready responses for the
end user.
7. Promote benefits, not attributes.
8. Have easy-to-find contact information.
9. Keep the site simple so that it will load quickly. If videos
and lots of photos are used,
then put those on page links so the front page will not be slow
in loading.
10. Consider creating links or advertisements on other websites
that are related to the
organization or that would be a good source for referrals, such
as municipal and
local chamber of commerce websites.
11. Use a URL that is easy to remember, but connected to the
name of the organization’s
service. Do not use a strange URL that no one can remember or

that has nothing to
do with the organization’s professional service(s).
12. Test the website and every link on the website before it is
promoted or launched.
The technical problems that marred the launch of the federal
government website
for the Affordable Care Act’s healthcare exchange marketplace
was an embarrass-
ment to the U.S. government, and initially limited the website’s
purpose to provide
consumer access to the selection of health insurance coverage
and enrollment in a
health plan in a federally facilitated marketplace.
Summary & Resources
Chapter Summary
In this chapter, we discussed how to attract new customers to an
HCO and a private health-
care practice. Also discussed were the product life cycle and the
stages consumers go through
in choosing a product or service. Social media can be used to
attract new customers as well
as to manage customer expectations and help with customer
retention. Key to determin-
ing consumer behavior is database marketing, which is the
process of data collection and
Summary & Resources
analysis concerning consumer actions. Finally, HCOs may
handle advertising and social media
in-house or hire an outside marketing agency; there are pros and

cons to both approaches.
Key Points
1. Attracting new customers or patients is important for both
HCOs and healthcare
practitioners in private practice. Growth means increases in
revenues and a greater
impact on the communities served by the organization. Growth
is best achieved with
an effective marketing plan that provides a consistent platform
for the organization
to be visible and an attractive option for medical services.
2. The term product life cycle refers to the stages a product or
service goes through
from the time it is introduced until it is removed from the
market or dies. The stages
of the product life cycle are introduction, growth, maturity, and
decline. In the intro-
duction and growth stages, revenues increase quickly as there is
little competition.
As competitors enter the market, products or services advance
to the maturity stage
of the life cycle, and revenues begin to flatten. In the decline
stage, new products or
services replace old ones and revenues decrease. The goal of
marketers is to keep a
product or service in the maturity stage for as long as possible.
3. Organizations must effectively manage existing customers to
support long-term
profitability. Customer relationship management (CRM)
analyzes a targeted seg-
ment by addressing each customer’s potential for profitability.
CRM is based on four

premises: (a) customers are a key asset of the organization; (b)
customers vary in
their preferences and behaviors and their value to the
organization; (c) understand-
ing customer needs, preferences, and behavior can improve their
value to the orga-
nization; and, (d) relationships with customers must be
managed.
4. Database marketing creates customer intelligence, which
contributes to the develop-
ment of profitable customer relationships. With database
marketing, marketing pro-
fessionals use data collected from consumer activity to better
understand consump-
tion patterns, locations, interests, and other aspects of buying
behavior. The basic
idea behind the use of databases is this: If that is what the
consumer is doing, how
can we make them want to do that more often and with our
product? The process of
data collection consists of four steps. First, customer action is
collected (credit card
purchases, website visits, etc.). Next, the data collected from
consumers is analyzed,
using sophisticated statistical techniques. Third, neural
networks “learn” from the
data and identify the model customer. Finally, the knowledge
gleaned is used for
targeting customers with promotions and information that are
tailored to their
interests and behaviors.
5. Consumers interact with an HCO both in person, as patients
or consumers of prod-
ucts, or online through websites and social media. Often, the

customer’s first inter-
action with the HCO is online, and it is at this point that the
HCO is in a position to
manage customer expectations and educate patients about
products and services
offered. The biggest challenge when dealing with patients
online lies in the HCO’s
ability to control the conversation. Information posted by
people other than the
HCO’s designated employees may be misleading, false, or
defamatory.
6. Eventually, patients will interact with the HCO or healthcare
practitioner in person.
As with online interactions, healthcare employees need to
manage patient expec-
tations and educate patients about processes in which they are
about to become
involved. In any organization, there will be service failures
where patients clearly
did not receive the promised care or did not receive the care in a
timely fashion. This
Summary & Resources
difference between service expectations and actual service
delivery is known as the
service gap. HCOs need to have procedures in place to satisfy
and retain patients for
the future consumption of their products and services.
7. As previously noted, the first interaction a potential patient
has with an HCO is often
through the HCO’s website. Thus, it is extremely important for

an HCO to have an
effective website that is easy to navigate and provides
information helpful to the
patient. This chapter lists twelve considerations for creating an
effective website.
The two most important considerations for an HCO are deciding
on the objective of
the website (drive customers to call the HCO, educate patients,
build image, and so
forth) and hiring a professional web designer.
Key Terms
customer relationship management
(CRM) Managing relationships with existing
customers to support long-term profitability.
frontline employees Personnel at an HCO
who initially interact with a patient, such as
admissions clerks, receptionists, and triage
nurses.
healthcare social media sites Social net-
work sites that are dedicated to the display
and exchange of healthcare information.
individual adoption stages The stages that
individual consumers move through when
they are adopting a new product.
marketing agency An external supplier
that functions as an outside contractor for
its clients’ marketing activities, such as web-
site design, promotional campaigns, public
relations, etc.
service gap The difference between the

service expected and the customer’s per-
ceived service quality.
service script The expected sequence of
events and outcomes in a particular setting.
social media policy Guidelines set up
to develop and monitor postings in social
media of both organizational and per-
sonal data that may be detrimental to the
organization.
website design The process of developing
and maintaining an organization’s website,
including the information displayed on the
website and the links that connect to addi-
tional information or websites.
Critical Thinking Questions
1. Explain the product life cycle concept. How does the need to
attract new customers
influence promotional messages about a product during the
stages of its life cycle?
2. How would an organization go about establishing a CRM
process?
3. Why do most promotional media used by an HCO try to drive
the patient or potential
patient to that HCO’s website?
Final Project Guidelines
Throughout the semester, you have been researching a complex
problem from multiple disciplinary perspectives. The goal for
your final project is to synthesize and integrate the most

relevant insights in order to produce a new or more complex
understanding of your topic.
· Basic expectations of a research essay
· 8-10, double-spaced pages (not including the works cited
page)
· One-inch margins and 12 point font (e.g. Times New Roman)
· Works cited in MLA (let me know if you’re using a different
style guide)
· 1 page summary of your research essay (can be used for class
presentation)
· At least 8 sources
· Note: 5+ should be scholarly, peer-reviewed sources
· You can also include journalism or popular sources to
supplement your findings, if useful to your project
· Upload as a Word document (not a PDF or Pages)
Evaluation criteria:
· Disciplinary integration (40 points)
· Integrate insights from at least two relevant disciplines
· Use integration techniques featured in the text (e.g. add,
adjust, connect) to establish common ground (can also use
techniques from the Ardvison article)
· Relevance and use of evidence (40 points)
· All sources are carefully analyzed, evaluated, and assessed for
their quality and relevance to the topic and their appropriateness
for the assignment
· Featured sources help contextualize and inform the argument
· Evidence counter to the argument is effectively addressed
· Sources are cited appropriately (MLA or APA)
· At least five of the sources are scholarly, peer-reviewed
· Organization (25 points)
· Project is logically organized and easily followed
· Transitions, intro, and conclusion are effective and logical
· Professional format (spacing, margins, font type and size)
· Project meets length expectations (pages or runtime, e.g.)
· Clarity/professionalism (20 points)

· Appropriate spelling, grammar, mechanics, diction, and free of
typos
· only some of these may be relevant to your chosen format
· Class presentation (25 points)
· ~5 minute overview of your project
· You may read a paper, use a PowerPoint (or something
similar), etc.
· Respond to questions from classmates about your work
· Ask relevant questions of your peers when they present
In this research paper I want to state the problem and determine
possible solutions.
I want to state the problem or potential consequences/effects
about the lack of African
American voters followed by solutions that I believe will help
engage/promote African
Americans to vote. I also have to Incorporate an
autoethnography and two relevant disciplines
pertaining to my topic like Political Science and Sociology or
History and Political science. I have
to incorporate two disciplines by finding the similarities
between them and how it can help me
solve the problem or how it may help in determining the
problem or consequences.
In this paper my main goal is to generate potential solutions
which will encourage African
Americans to vote.

The scope of African American voters is too broad of a subject,
so it needs to be focused on a
smaller group of African Americans. For example, in a specific
region of the United States, a
specific state or a specific age Group in the United States etc.
**This paper should not read like a paper comprised of facts.**
Below are scattered Facts about why Voting is important in my
family to help incorporate the
autoethnography aspect of the paper
Father
My dads father was a carpenter and built stages for Malcom x
and Martin Luther king in the
1960’s which inspired him to campaign to try and get people to
vote and not be afraid of the
potential consequences that may occur. Black people were
afraid to vote due to the potential
terrorization from Caucasians. When my grandfather returned to
his car after one of his
campaigns they sprayed the word Nigger on the back of his
pick-up truck. My father learned the
importance of voting from his parents because before he was
able to vote his parents took him
to the poles where he would watch them vote . My dad learned
from his father that no matter
what anyone does to you to try and convince or scare you away
from voting ignore it and try to
look past it because the white man wants African Americans to
stay in oppression.
Mother

The right to vote was instilled in my mother from her parents
constantly reminding her of the
many lives that were lost for her to have the right to vote. And
how its important for her to
exercise her right to vote because my mothers grandparents did
not have the right to vote.
When my maternal grandparents went to the poles they told her
that they were voting for their
parents who did not have the right to vote.
Me
My parents taught my sisters and I that it is vitally important to
know our history because the
black vote has and continues to be suppressed. They also taught
us that the black vote is
powerful because they believe that brown people are slowly
becoming the majority and if
everybody of voting age stood up and exercised their right to
vote we would have a more equal
opportunity to succeed in society through the change of
policies. Growing up They made sure
we knew our history through the watching of old black films
and continuously taking trips to
museums about the suffrage of African Americans. When we
vote my parents tell us that it’s
more than just one individual vote. It’s a vote for our ancestors
as well. They want us to think
about voting as a way of honoring our ancestors. It’s like
standing on the shoulders of our
ancestors who fought and died for us to have the right vote.

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