Chapter 8: A Social Marketing Approach to Increasing Adoption of Continuous Quality Improvement Initiatives Outline Background and Definitions Hallmarks of Social Marketing Overview of Social Marketing Applications to CQI in Healthcare Organizational Impacts on Social Marketing Applications Program Evaluation of Social Marketing Applications Creating a Social Marketing Strategy and Plan for CQI in Healthcare Recent Developments in Social Marketing: Journey Mapping A Scenario for How to Apply Social Marketing to a Healthcare CQI Initiative Conclusions Background and Definitions Social marketing is a process that uses marketing principles and techniques to change target audience behaviors to benefit society as well as the individual Social marketing as a field emerged in the 1970s and has undergone continuous growth and refinement Often confused with social media marketing or communications-only campaigns Social marketing methodology can be used in conjunction with traditional CQI initiatives Hallmarks of Social Marketing Social marketing focuses on positive behavior change by understanding the individual’s perspective Uses fundamental concepts from commercial marketing that have been shown to elicit change Central concept is exchange – desired actions are more likely when barriers are removed and benefits facilitated Best practices include employing the 4 Ps (Product, Price, Place and Promotion) of commercial marketing Aim is making behavior change easy, fun and popular Box 8.1: Basic Marketing Principles Know your AUDIENCE (really!) and put them at the center of every decision you make. It’s about ACTION. There must be an EXCHANGE. COMPETITION always exists. Keep ‘THE FOUR P’s of Marketing [PRODUCT, PRICE, PLACE, PROMOTION],” and policy, in mind. (SOURCE: Social Marketing National Excellence Collaborative, 2002) Overview of Social Marketing Applications to CQI in Healthcare Why adopt social marketing approaches for CQI? Both social marketing and CQI focus on building a framework to implement change CQI recognizes that individuals contribute expertise to develop managerial processes Social marketing uses individual and group behavior change models to develop and design initiatives Social marketing complements CQI’s emphasis on qualitative and quantitative customer data in planning and evaluating outcomes at regular intervals Organizational Impacts on Social Marketing Applications CQI and social marketing address improving behaviors at the organizational level Upstream audiences are policymakers, corporations, and healthcare organizations Social marketing emphasizes understanding the needs of individuals and the organization to get agreement that gradual change (continuous improvement) is both needed and achievable Program Evaluation of Social Marketing Applications CQI asks if a change is an improvement Social marketing relies on data to design the program goals and evaluate outcomes Social marketing data includes ...

1. Chapter 8: A Social Marketing Approach to Increasing Adoption
of Continuous Quality Improvement Initiatives
Outline
Background and Definitions
Hallmarks of Social Marketing
Overview of Social Marketing Applications to CQI in
Healthcare
Organizational Impacts on Social Marketing Applications
Program Evaluation of Social Marketing Applications
Creating a Social Marketing Strategy and Plan for CQI in
Healthcare
Recent Developments in Social Marketing: Journey Mapping
A Scenario for How to Apply Social Marketing to a Healthcare
CQI Initiative
Conclusions
Background and Definitions
Social marketing is a process that uses marketing principles and
techniques to change target audience behaviors to benefit
society as well as the individual
Social marketing as a field emerged in the 1970s and has
undergone continuous growth and refinement
Often confused with social media marketing or
communications-only campaigns
Social marketing methodology can be used in conjunction with
traditional CQI initiatives
Hallmarks of Social Marketing
Social marketing focuses on positive behavior change by

2. understanding the individual’s perspective
Uses fundamental concepts from commercial marketing that
have been shown to elicit change
Central concept is exchange – desired actions are more likely
when barriers are removed and benefits facilitated
Best practices include employing the 4 Ps (Product, Price, Place
and Promotion) of commercial marketing
Aim is making behavior change easy, fun and popular
Box 8.1: Basic Marketing Principles
Know your AUDIENCE (really!) and put them at the center of
every decision you make.
It’s about ACTION.
There must be an EXCHANGE.
COMPETITION always exists.
Keep ‘THE FOUR P’s of Marketing [PRODUCT, PRICE,
PLACE, PROMOTION],” and policy, in mind.
(SOURCE: Social Marketing National Excellence
Collaborative, 2002)
Overview of Social Marketing Applications to CQI in
Healthcare
Why adopt social marketing approaches for CQI?
Both social marketing and CQI focus on building a framew ork
to implement change
CQI recognizes that individuals contribute expertise to develop
managerial processes
Social marketing uses individual and group behavior change
models to develop and design initiatives

3. Social marketing complements CQI’s emphasis on qualitative
and quantitative customer data in planning and evaluating
outcomes at regular intervals
Organizational Impacts on Social Marketing Applications
CQI and social marketing address improving behaviors at the
organizational level
Upstream audiences are policymakers, corporations, and
healthcare organizations
Social marketing emphasizes understanding the needs of
individuals and the organization to get agreement that gradual
change (continuous improvement) is both needed
and achievable
Program Evaluation of Social Marketing Applications
CQI asks if a change is an improvement
Social marketing relies on data to design the program goals and
evaluate outcomes
Social marketing data includes formative research and use of
secondary data from literature and focus groups
Formative research aligns with CQI’s Plan, Do, Study, Act
approach
Creating a Social Marketing Strategy and Plan
A social marketing plan begins with strategic brainstorming and
collecting formative research data (Smith and Strand, 2008)
What problem do I want to solve?
Who/what is to blame?
What actions do I believe will best address the problem?
Who is being asked to take those actions?

4. What will they want in exchange?
Creating a Social Marketing Strategy and Plan (2)
Why will they believe that what we offer will be real and true?
What is the competition offering?
What marketing methods will increase desired benefits? How
much will it cost?
What is the best time and place to reach them?
How often do we need to market to them?
What is the best way to integrate a variety of methods
(including CQI) to achieve change
over time?
Creating a Social Marketing Strategy and Plan (3)
1. Describe the plan in detail – issues, background, purpose, and
focus
2. Conduct a situational analysis (SWOT)
3. Select target markets
4. Set objectives and goals
5. Identify competition, barriers and motivators
6. Develop a positioning statement
Creating a Social Marketing Strategy and Plan (4)
7. Develop a strategic marketing mix (4 P’s)
8. Outline a plan for monitoring and evaluation
9. Establish budgets and identify funding sources
10. Complete the plan for implementation
Implement your social marketing plan!

5. Recent Developments in Social Marketing: Journey Mapping
Social marketing practices evolve by integrating new strategies
from other areas
Journey mapping is borrowed from human-centered design
Human-centered design helps develop understanding about
problems encountered in a work flow (pain points) through a
mapping exercise to generate solutions
Journey Map for Cleaning Patient Rooms
A Scenario for How to Apply Social Marketing to a Healthcare
CQI Initiative
Application of social marketing methods are well-accepted in
public health but fairly new in improving patient outcomes and
healthcare customer satisfaction
A surgical scenario focusing on reducing medical errors
illustrates the use of social marketing and a staple CQI tool - a
checklist
If a new drug had the effect surgery checklists do there would
be a national campaign to use it (Gawande, 2007)
The checklist, along with other quality measures, are proven to
be effective in addressing medical errors
Sample Evaluation Plan
Sample Evaluation Plan

6. Sample Evaluation Plan
Conclusions
Social marketing shares synergies with CQI
Social marketing is applicable not just to public health issues
but adoption of improvements in healthcare and health care
systems
Like CQI, social marketing takes a customer-focused approach
and is evolving over time
The surgery scenario shows how social marketing supports
clinical, systemic and patient safety goals
Social marketing supports CQI diffusion
and adoption
Chapter 7: The Role of the Patient in Continuous Quality
Improvement
Contents
Introduction and background
Patient involvement in healthcare improvement overview
Rationale for Patient Involvement in CQI
Methods for Involving Patients in CQI
Factors Affecting Patient Involvement
The MAPR Model of Patient Involvement
Partners to Owners
Conclusion

7. Introduction
The primary function of health systems is to care for the health
and wellbeing of populations in an effective and efficient way.
A range of mechanisms exist for measuring the quality of care
provided by health systems
The role of the patient, family, and caregivers is much less clea r
History, policy, and causality are conflicted on the role of and
outcomes from the patient in CQI
Background
Most CQI systems value the involvement of the client in
systemic change and development
Patient safety inquiries show that patients and carers often
flagged problems first but were ignored
These inquiries were not isolated to one part of the health
system – problems are diverse in type and location of
occurrence
How can CQI help avoid these problems, halt their recurrence
and improve systemic approaches?
Patient Involvement in Healthcare Improvement Overview
Patients are expected to be involved in health care as health
systems have developed – CQI is a part of this
Social and health sector changes have contributed to the call
for patient involvement
The dominance of medicine has been questioned by patients,
advocates and health practitioners
The HIV/AIDS epidemic has been a major force for change in
traditional health system approaches
Technological shifts have/are having a huge impact e.g.
knowledge base, global contacts, volunteers for trials etc.

8. Rationale for Patient Involvement in CQI
Greater knowledge of health has increased knowledge of errors
in the media and public domains
High profile cases continue to get major news coverage e.g. The
Shipman Inquiry in the U.K.
Health systems have been forced to acknowledge the
patient/client/carer perspectives
CQI is part of the shift to patient-centered health care e.g.
Insurance systems, co-payments etc. also make patients
customers
Methods for Involving Patients in CQI
Three important levels of patient involvement in CQI:
Micro-level involvement – active patient involvement as
acknowledged in the concept of the self-managing patient;
Meso-level involvement – patients involved in health service or
even whole system planning, management and evaluation;
Macro-level involvement – here patients are involved in
national/international safety activities e.g. The WHO London
Declaration
Factors Affecting Patient Involvement
The evidence base for patient involvement is small but growing
Patient willingness to participate is affected by several factors
e.g. self-efficacy in the role, health literacy, shift/changes
required in role
Inhibitory factors include e.g. type/severity of condition, SES
factors (minority social position), the health setting and issues
around power relations
Clinician attitudes are also a factor including training, personal
beliefs and organizational issues such as time

9. Measuring Patient Involvement in CQI
Patient satisfaction surveys (like customer satisfaction surveys)
have become widespread in healthcare
Satisfaction is a problematic measure for a range of reasons e.g.
Individual patient/carer reactions to error versus health care
provider/system responses
Data collection needs to more closely reflect the kind of
knowledge we are trying to produce in patient safety CQI – not
just surveys because surveys are the common tool
The MAPR Model of Patient Involvement
The MAPR model aims to canvas all three levels of patient
involvement and span most types of health system
Two dimensions of involvement are addressed – (1) active-
proactive and (2) passive-reactive
Dimension 1 involves direct patient involvement in identifying,
confronting and addressing the sources of error prior to events
Dimension 2 involves responses from patients after error events
have occurred e.g. Complaint letters, participation in root cause
analysis etc.
The MAPR Model
Dimension of Patient Involvement in Quality Improvement: The
M-APR Model
The MAPR Model (continued)
Dimension of Patient Involvement in Quality Improvement: The
M-APR Model

10. Partners in Health: Kaiser Permanente
The program is now more than 10 years old with a focus on
chronic disease self-management
Based on the Stanford CDSMP model and research on patient
outcomes
The Healthwise Handbook and related resource supports both
low and high intensity interventions
Research and RCTs showed a range of positive outcomes for
both patients and providers
Kaiser indicated that many of these interventions could be
implemented by smaller organizations lacking Kaiser’s resource
base
National Patient Safety Goals in the United States
The Joint Commission (TJC) accreditation agency has National
Patient Safety Goal 13 to involve patients in their own (safe)
care; in 2010 this goal became part of TJC’s standards for
accreditation
In 2007 TJC published a Patients as Partners toolkit to support
patients and carers in identifying safety issues
TJC has emphasised the role of diversity as a key issue in safety
e.g., meeting patient/staff language needs and effective
communication more broadly
Patients as Partners Program
Impact British Columbia, an NFP, implemented a patients as
partners program based on the BC Health Charter
The focus was chronic disease patients who are English-
speaking emphasising diversity effects on health care design
and provision
Outreach activities target both health care recipients and health
care providers

11. From Partners to Owners
The SouthCentral Foundation (SCF) in Alaska took on
management of all Native health services in its area in 1999
Ownership and control caused a shift in the design and delivery
of services
Native people were consulted about their ideas for service
delivery and fit
This new model shifted from patient-centered to patient-owned
Conclusion
Patient involvement is now an accepted part of health systems
development
In spite of this, error rates have not yet fallen much The key
issue is to identify how patient involvement can have a positive
impact on this situation
Each system in each country is likely to have a unique response
to this problem
The important thing is, whether exclusively unique or similar,
that effective responses have a positive impact through CQI
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12. Finding Academic Scholarly Articles
Academic literature is very important to your graduate work.
You will want to limit the use of the Web, and instead increase
the use of scholarly literature. Note: Wikipedia is not an
acceptable source for graduate-level work.
All of your opinions should be backed-up with academic
scholarly peer reviewed articles whether they be in discussions
or in papers. Your textbook alone as a source is never enough.
To find this academic literature all you need to do is go to your
online library. The link and instructions on how to log in are
located under Course Home. I would suggest you begin with
ProQuest database at the LIRN area of the online library.
Within the ProQuest database you will want to be sure that you
check the two boxes at the bottom of your keyword search: you
want to check full text and you want to check the box for
scholarly peer-reviewed work (these are academic). On the
ProQuest site you'll see a little graduation tassel to indicate this
will render academic scholarly journals and literature.
ProQuest says of academic articles:
"Scholarly Journals, including peer-reviewed
A publication is considered to be scholarly if it is authored by
academics for a target audience that is mainly academic, the
printed format isn't usually a glossy magazine, and it is
published by a recognized society with academic goals and
missions.
A publication is considered to be peer reviewed if its articles go
through an official editorial process that involves review and
approval by the author's peers (people who are experts in the
same subject area.) Most (but not all) scholarly publications are
peer reviewed. Some trade publications are actually peer

13. reviewed, but ProQuest does not consider them when filtering
on peer reviewed. This is because getting results from trade
publications instead of academic journals can be frustrating to
researchers. Instead, ProQuest excludes these peer reviewed
trade publications and only considers publications that are
scholarly in terms of content, intent, and audience."
Enjoy exploring the library. It is one of the great joys of
academic research!