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Getting Your House inOrder with InternalMarketingJeffrey P. Winter MBA aa Hospital Administrator, Republic HealthCorporation, Dallas, TXPublished online: 18 Oct 2008.

To cite this article: Jeffrey P. Winter MBA (1985) Getting Your House inOrder with Internal Marketing, Health Marketing Quarterly, 3:1, 69-77, DOI:10.1300/J026v03n01_09

To link to this article: http://dx.doi.org/10.1300/J026v03n01_09

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Getting Your House in Order with Internal Marketing: A Marketing Prerequisite

Jeffrey P. Winter, MBA

Hospitals all across our country are raising the priority of marketing in their strategic plan as competition and market place forces continue to rob hospitals of their formerly complacent share of the market. The message of the eighties is not who will be doing marketing, but who will be doing it well and better than the hospital down the street. Most boards and administrators have takcn this message to heart, counting heavily that their marketing and planning efforts today will be successful, allowing them to move into the nineties with confidence and financial certainty. Even those hospi- tals categorized as "Sole Community Providers" understand that they can no longer be complacent about such heretofore foreign con- cepts as service mix, market research, competitive pricing and product packaging. Rural, as well as urban hospitals, are budgeting thousands of dollars annually to launch major marketing campaigns in an effort to recapture and increase lost levels of service utiliza- tion. Many case studies have appeared in the literature recently out- lining creative approaches to the promotional end of the marketing cycle. Color brochures, media advertising and special discount or cost war strategies are examples of promotional tools essential to a successful marketing campaign, however, all are doomed to failure or at best disappointing results if the products and services hospitals are promoting are not packaged and delivered in a way that reflects and supports the message of the hospitals promotional strategies.

Marketing is an activity that extends to greater depths than just the promotional copy or television script. Marketing is a process that aims to create a perception or image of an organization and its ser- vices or products to a targeted consumer market. It is a process that aims to facilitate an exchange of resources, whereby through new

Jeffrey P. Winter. Hospital Administrator. Republic Health Corporation, Dallas. TX.

@ 1985 by The Hawonh Press, Inc. All rights reserved. 69

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70 HEALTH MARKETING AND CONSUMER BEHAVIOR

and regenerating business will lead to increases in an organizations market share. Many hospitals, eager to jump into the competitive flash and sizzle of a promotional campaign, have failed to realize the full cycle impact of marketing. A well done promotional campaign will attract consumers to your doors, but upon arrival, will they find a reception area as brightly lit, comfortable and reassuring as the pre-conceived one painted in their minds by a skilled brochure copy writer? Will all of the nurses be as pleasant, caring and concerned as the models portrayed in the hospital's television advertisement? When they call for an outpatient appointment, will they find helpful, eager clerks, or will the phone ring thirty times before being an- swered by a cold, rushed and impartial appointment clerk? Market- ing comes full cycle, and unless your own house is in order, promo- tional efforts will be defeated.

It is our responsibility as managers to assure that our organiza- tions are consistent throughout the marketing cycle. The many hours spent in Board Marketing Committees discussing the objectives of image development and community perception must have their foundations solidly based throughout our institution hallways.

The full cycle concept of marketing speaks to a "systems ori- ented" understanding of the essential phases of an effective market- ing program. As in other management endeavors, a global per- spective, whereby there is a clear understanding of the relation and sequence between steps of an operation, will foster a smoother and more efficient implementation.

A simple analogy to illustrate the concept of full cycle marketing is Newton's Theory of Gravity-what goes up must come down. Similarly, when a promotional campaign and image development efforts are injected into a market place, there will normally be a reaction (hopefully the desired one) in terms of new business. To further the example, if we throw a glass bottle (marketing) in the air and are not prepared to catch it, it will fall to the ground and shatter. The forces of gravity in a marketing campaign operate the same way. By understanding the full cycle concept of marketing, hospi- tals will be prepared "to catch" the results of their promotion ef- forts and reap positive benefits for the organization.

Figure 1 illustrates the full cycle nature of a well orchestrated marketing effort. Beginning with quality research and planning which will focus and direct the institution, it can then move on to the process of "Internal Marketing" and aligning, educating and moti- vating staff towards institutional objectives. The next stage is prod- uct development and promotion and finally to the point of sale or

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Research & Planning

Service ----7

/->Internal D e l i v e r y M . ~ r k e t i n g

I" Proluot ion 3

P r o d u c t D e v e l o p n c n t

FIGURE I. Full Cycle Marketing

service delivery where internal marketing and development will serve to aid in the successful close of the sales (exchange) transac- tion.

The marketing cycle is a process that speaks directly to generat- ing repeat business; a concept ingrained in the minds of industrial and retail managers, it speaks to the most effective measure of client satisfaction and fosters an ongoing trust and alliance between the organization and its consumer market. In order to maximize market- ing efforts towards this objective, hospitals must assure completion of the marketing cycle. Every point of contact with the organization, from receipt of the promotional brochure in the mail, to the ex- perience of calling for an appointment, to the clients actual visit to the hospital, must be well orchestrated such that the initial percep- tion of the hospital from the promotional campaign will be consis- tent with the actual experience and thus achieve client satisfaction. By maintaining this global perspective of the marketing process, managers can be assured better control and increased chances for success of the marketing campaign. The organizational injection of a consumer service attitude is termed internal marketing.

A strong focus on internal marketing will continue to pay healthy dividends in all areas of operations. Internal marketing can be de- scribed as that process by which hospital personnel understand and recognize not only the values of the hospital marketing program, but their place in it. It is the process by which staff have internalized a client service attitude and have been trained in the tools and skills necessary to implement it. Internal marketing's objective is to reach a level of client and s6ryice oriented consciousness among hospital personnel that creates an environment of pride, caring and concern

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72 HEALTH MARKETING AND CONSUMER BEHAVIOR

for client satisfaction that translates verbally, as well as non- verbally. The looks, actions and even the smallest of gestures are often more important than the spoken words. The extra seconds of eye contact of a pleasant admitting clerk or a security guards assis- tance across the street can make the difference between "just a visit to the hospital" or a very special businessthuman transaction that builds a customer oriented alliance that will not only yield repeat business but critical to any public relations effort, successful word of mouth.

Clearly, then our most valuable marketing asset in health care is the people who deliver the service: the hospital staff. Hospital per- sonnel are perhaps the single greatest element that can make or break a successful marketing effort. No employee is in a better posi- tion to insure success of the campaign than the Chief Executive Of- ficer. The active and visible leadership of the marketing effort by the Chief Executive Officer is as critical to success as board leader- ship is to a fund raising campaign. It is the Administrator and only the Administrator who can embrace the marketing concept in such a way that will provide a message of complete institutional commit- ment to client service and a marketing consciousness.

Much has been written about the CEO's role in marketing. The alignment of employees personal and professional objectives with the overall objectives and mission of the institution is a desirable goal that many CEO's strive for. This organizational goal is a paral- lel process to achieving success in internal marketing. As an exam- ple, the hospital has set as an organizational objective the provision of high quality care and customer service. In line with this objective the admitting clerk must be able to translate this objective in a way that meets personal needs and goals. In addition, the hospital man- agement should make clear the reward system available to employ- ees in order to motivate and reinforce positive employee behavior. The reward system may vary in scope from a kind word or a pat on the back to employee of the month programs or merit increases. Less important than the kind of reward system is its consistent and obvious use. Without a readily identifiable rewardheinforcement system, positive, organizationally aligned behavior will not be main- tained. In this regard, internal marketing constitutes a valuable per- sonnel relations tool. The internal marketing process must be care- fully orchestrated and designed and to be successful must take into account the informal as well as the formal organization.

In order to gain a clearer perspective on how the personnel hier-

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Jefrey P. Winter 73

archy of an organization fits into internal marketing, four levels of a typical hospital structure have been identified.

LEVEL I: SENIOR MANAGEMENT TEAM: MARKETING EDUCATION AND COMMITMENT

It is imperative that the entire senior management staff feel com- mitted to the priorities of marketing. It is these individuals that must resound the marketing message throughout the organization and ex- emplify, as well as fortify, customer oriented behavior in them- selves and the staff under their responsibility. For example, when the assistant administrator responds personally to handle a patient billing problem or goes out of his way to assist a patient who has a heating problem in his room, hospital personnel will role model and begin to glean these traits as the "acceptable" and appropriate behavior and even subconsciously, will work towards a more con- sumer oriented attitude if only because role models are constantly available to them. It is the Administrator's responsibility to align the priorities of marketing within the organizational schematic, impart and back these priorities to senior management and support the Di- rector of Marketing's authority as a key member of the management team. Education on this level may be done by either the Director of Marketing or an outside trainer, but key to this phase of internal marketing is a complete understanding of the full marketing cycle and how senior managers are instrumental in insuring the comple- tion of the cycle's flow. Initial success imparting the principles and understanding of marketing and customer service at lower levels in the organization will not thrive long if top management does not reflect a marketing consciousness in their own actions and work ethics.

LEVEL 11: MIDDLE MANAGEMENT TRAINING AND EDUCATION

Middle Managers represent the "second tier" of role models able to develop and fortify a marketing consciousness in the hospital. Not only are these managers in an excellent position to exemplify a cus- tomer oriented approach but most often it is they who are in the po- sition of most swiftly acting upon and diluting a problem at its earli- est stage. In this regard, they are not only preventive agents to sources of consumer problems, but are also managements primary

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74 HEALTH MARKETING AND CONSUMER BEHAVIOR

line of offense in acting quickly and decisively before small con- cerns become larger problems.

Middle management is also in an excellent position to make a ma- jor impact on stafftinstitutional goal alignment. Managers must be trained to internalize that verbal and action oriented support of in- stitutional goals and objectives are a primary responsibility of their management position. This is not to say that managers should not disagree with objectives set by the Board or senior management, and proper channels should be developed to voice disagreement, but conscious support of institutional goals by middle management is critical to proper stafftinstitutional objective alignment. It should be noted that senior management has a major role in assuming the re- sponsibility for objective alignment by providing the leadership for a professional, communicative and team oriented management struc- ture. If employees feel good about their jobs and their place in the organization, objective alignment and support will be readily at- tainable.

LEVEL 111: STAFF EMPLOYEES- THE HEART OF CLIENT RELA TlONS

Personnel at this level; the admitting clerks, the housekeepers, the cashiers, etc., represent the "soul" of the organization to your consumer market. These individuals represent the highest point of contact with your clients. The goals of personallinstitutional objec- tive alignment, client service attitude, etc., must not merely "filter down" to this level, but must be woven into it.

The internal marketing campaign will discuss techniques by which this can occur, but foremost is an attitude presented by senior and middle management that everyone from clerks and laundry per- sonnel to the administrator are all members of the same team. Al- though each member may have different tasks to perform, everyone is contributing to the same institutional goals and objectives in their own unique and valued way.

LEVEL ZV: INFORMAL ORGANIZATION- THE SUB-ORGANIZATIONAL CULTURE

The informal organization is that group of employees that create the "behind the organizational chart culture". Most savvy man- agers can readily identify these individuals in their departments.

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Jeffrey P. Winter 75

These are the individuals that when the manager of the department is gone, everyone else looks to for direction, or the people that are always directing various employee related functions, or the individ- uals that everyone else looks to for "the inside information". This group of people are potentially one of the institutions strongest as- sets in developing a marketing consciousness among the hospital staff. The recognition of this group and the forces it embarks on the organization represents a management opportunity in every organi- zation, small or large, and through careful and creative management can be utilized to yield positive organizational benefits. Manage- ment's ability to recognize, understand and develop effective tactics to make this organizational entity work positively for the hospital may mean the difference between an internal campaign that only reaches the surface or one that is blended throughout the fibers of the hospital to reach the core of the employee culture.

Internal Marketing Campaign-The campaign is the major "tool" which injects a high level dose of marketing consciousness and client service attitude. The principles embarked upon during the campaign must be continued and reinforced as a part of the normal operating milieu, but the campaign will provide the initial "boost" towards creating an aligned, responsive employee culture. In one in- ternal marketing campaign engineered by the author in a 1500 em- ployee hospital, a committee of fifteen people were assembled, carefully chosen from both the formal and informal organization, from management and staff ranks to "steer" the internal campaign. This carefully interwoven committee represented a highly visible example of employees working together towards a common goal (marketing consciousness) without the barriers normally imposed by the organizational hierarchy. The committee should, of course, be voluntary and made up of individuals who are by and large al- ready, positively disposed towards the institution and willing to carry and strengthen this new message. If structured properly this committee will closely represent the personalities and dynamics of a hospitals multidimensional nature. It is this committee that will lend credibility to the effort and access to pools of employees that a more formal, management oriented committee could not achieve. The committee facilitator or "staff" should be a staff individual with easy access to administration, however, should be someone organi- zationally aligned with middle management. An administrative as- sistant or perhaps a competent professional from the public relations office would do well. The right individual in the staff position is

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76 HEALTH MARKETING AND CONSUMER BEHAVIOR

key, as well as the selection of a chairperson and related officers of the committee. Given the proper support, motivation and guidance, this committee's efforts will help to create an internal atmosphere of good will and employee spirit that will naturally lend itself to positively receiving the education and training necessary to yield a finely tuned consumer responsive organization.

The internal campaign, led by the steering committee, is a "con- ditioning process" that is used to help employees feel good about themselves, their jobs and the organization. From there, specific client service training and education will be accepted and easier to implement. Synonomous with any election campaign, an initial in- ducement of enthusiasm and esprit de corps will pay off handsomely in "votes" for the organization, again helping to align institution- allstaff objectives.

The internal campaign should have a theme, easily internalized by staff, such as " XYZ Hospital, we're the Best!" or "Our family is special, at XYZ Hospital". The point is to help employees reach towards a readily identifiable objective that can be understood and easily internalized, and a stated objective that once achieved will lend itself to a more focused objective of marketing consciousness and client service.

A number of the following strategies for the campaign may prove useful, tailoring them, of course, to the hospitals unique culture:

High administrator visibility at employee gathering areas during the campaign.

*Round the clock administration meetings with employees to discuss topics of employee concern and provide education about the hospital's future and direction.

*Ice cream socials at lunch hour and reward mechanisms for customer service actions, such as hospital banners, coffee mugs, key chains, etc., can provc very successful.

*A special campaign newsletter discussing the hospital's direc- tion and beginning to address client service issues. Perhaps highlighting recent outstanding employee actions as related to client service. (The role model concept.)

*Take a manager to lunch day offering free cafeteria meals to employees who ask a manager to lunch.

*Special informal department meetings facilitated by trained members of the steering committee to begin to discuss on a very non-threatening level the importance of client service, etc.

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Jeffrey P. Winter 77

*Encouragement and opportunities for employees who desire special assignments to participate at hospital marketing func- tions (open houses, etc.). Regular informal updates in paychecks or by other means from the Administrator about the hospital's external marketing suc- cesses. (People always feel good about working for a winner.)

*Special employee previews or tours of new hospital services prior to public openings. Special employee "at home" mailings from the steering com- mittee discussing the campaign and its direction.

The campaign must, of course, be followed by very thorough and carefully delivered training to all employees on client service; however, the campaign will have readied employees for the training and should be done in such a way as to complement the campaign.

"Closure" is a necessary aspect of this type of organizational ef- fort which will send a message that we have reached our objective, and should feel great about it, that it's time to move on and service and care for our clients in new ways that we are comfortable with and feel good about. The closure may be provided in the form of a special employee luncheon, with the opportunity to pay special thanks to the employee steering committee or simply in the form of a special letter from the Administrator, but closure must occur if employees are to recognize that they have now obtained the skills and attitudes necessary to reach a new level of working harmony be- tween their employer, themselves and their clients.

Lest we never forget the medical staff as a primary "customer" of the hospital, these concepts can also be enlarged upon to help your staff to become more physician responsive as well. The sample strategies suggested may or may not apply to your institutions cir- cumstances, but the concepts of full cycle marketing are universal and must not be overlooked or left to chance. Just as in physical plant and capital equipment acquisition, external prom~tional cam- paigns are major investments of dollars and staff effort, protect your investment and assure maximum return by-making sure that your house is in order.

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