Understanding Marketing in the NHS

1. Understanding Marketing in the NHS Ginette Camps-Walsh HSJ CONFERENCE Fundamentals of Marketing for the NHS

2. Understanding Marketing in the NHS • What is marketing? • Why does the NHS need marketing? • Marketing at the heart of your Trust • Marketing guidelines • Securing Customer Loyalty • Case Studies - areas for improvement • Case Studies - examples of good NHS marketing • Summary

3. view of marketing • BMA comment on hospital advertising (issued Monday 20 Nov 2006) • Commenting on plans to allow NHS hospitals in England to advertise their services, Dr Jonathan Fielden, chairman of the BMA’s consultants’ committee said:“The Government has created a market-based system to deliver health care which means the NHS is forced to compete against new private providers in delivering NHS services.NHS hospitals will have no option but to invest in marketing tactics, such as advertising, if they are to surviveagainst private firms who will already have large marketing budgets and considerable expertise in selling themselves. This is all the more galling when the independent sector receives advantageous rates for less complex work on guaranteed contracts when compared to the NHS.It is a sad indictment of government policy to consider spending public money on advertising NHS services when hospitals are having to make cutbacks in patient care and compulsory redundancies in order to save money.” Ends

4. Advertising - as BMA sees it A posh word estate agents use for selling Persuading people to buy things they don’t want or need PR and spin! Glossy brochures You can’t use words like that in the NHS! Brainwashing people to buy things Branding & logos Campaigning and T- shirts Manipulation & misinformation What is marketing?

5. What is marketing? definition The management process responsible for identifying, anticipating and satisfying customer requirements profitably • Or Satisfying your customers profitably [making a surplus] / where profit means a health gain [HEA] • Social Marketing “the systematic application of marketing alongside other concepts and techniques, to achieve specific behavioural goals, for a social or public good”

6. What is marketing? • Marketing is a strategic process involving the whole organisation • Marketing includes - • Strategic marketing planning • Market & competitor intelligence & analysis SWOT, Boston analyses • Strategic Alternatives - Ansoff • Market & customer research - patient satisfaction surveys • Implementation - 7 Ps • Product, Place, Price, Promotion, People, Process, Proof [Evidence]

7. THE MARKET PLANNING PROCESS IN OVERVIEW 2. SITUATION ANALYSIS 1. GOAL SETTING Environmental Audit Corporate Mission SWOT Corporate Objectives Assumptions 4. RESOURCE ALLOCATION AND CONTROL 3. STRATEGY FORMATION Marketing Objectives Budget Marketing Strategies Control Mechanisms Tactical Plan Estimated Results

8. THE MARKET PLANNING PROCESS IN OVERVIEW - 2. SITUATION ANALYSIS • Environmental Audit • PESTLE Analysis [political,economic, social,technological, legal, environmental] • Competitor Analysis • Assumptions • SWOT Government/ DoH/Monitor

9. Tactical Plan - 7 Ps Product/Service Place Price Promotion People Process Proof/physical evidence Services for customers How it is delivered Fixed - Little scope Communications, advertising, brochures Resources, training, empathy with customers Designed for patients? Health outcomes THE MARKET PLANNING PROCESS IN OVERVIEW - 3. STRATEGY FORMATION

10. Government/DoH Local Authority A Patient Centred NHS SHA What do patients want? GP Monitoring Developing patient-centred services Influencing Patient What do patients want? Monitoring PCT Developing patient-centred services Acute Hospital Trust

11. A Process Centred NHS Patient?? =targets =processes SHA GP Government DoH/Monitor TARGETS Acute Hospital Trust PCT

12. Why does the NHS need marketing? All organisations need marketing Every organisation needs to satisfy its customers to be successful • Only possible exceptions! • TV Licensing Authority! • London Underground • Her Majesty’s Revenue & Customs? They have no competition, but even they need to satisfy someone

13. Why does the NHS need marketing? • NHS staff want to deliver the best for patients • The NHS is a competitive market • Patients have choice • Income /Financial necessity- PbR (payment by results) • There is oversupply in secondary care • Patients are more demanding & better informed • Healthcare is a politically emotive subject • PCTs need to influence patient life styles If you don’t do it your competitors will

14. Marketing at the heart of your Trust For success NHS marketing needs - • Support from the Chief Executive & Board • Professional Marketer at a senior level [preferably Board level] • The resources to carry out a marketing programme • An understanding of marketing by Trust staff • Cultural change to accept competition & patient choice • Involvement from everyone to become patient focused Patient focus from - Board to ward & GP practice

15. Marketing at the heart of the NHS • A Director of Marketing @ DoH • A Director of Marketing on NHS Board • Open consultation with patients • Feedback & open questions on patient surveys • A proper market for healthcare - full patient choice, uncontrolled pricing • Sufficient quality information for patients to make informed choices • Targets on results & health outcomes • Consideration of costs to patients, their families/carers & the economy as well as NHS

16. Marketing Guidelines • All promotion must be • Legal • Decent • Honest • Truthful • DoH Guidelines to ensure NHS adheres to law & promotion does not bring NHS into disrepute • Based on pharmaceutical industry guidelines although less stringent

17. Marketing guidelines • All claims must be honest & have evidence to back them up • Knocking copy not acceptable • Don’t take bribes or inducements • Don’t mislead or give false information

18. Securing Customer Loyalty • Who are our customers? • How do we find out what customers want? • Ask them! - • Patient,GP, PCT questionnaires - • Focus groups • Patient groups, Royal Colleges, NHS Confed • Formal surveys • Informal feedback • Complaints - should be welcomed!

19. Government/DoH Local Authority A Patient Centred NHS SHA What do patients want? GP Monitoring Developing patient-centred services Influencing Patient What do patients want? Monitoring PCT Developing patient-centred services Acute Hospital Trust

20. What do patients want? • Limited value for marketing • Little feedback from patients - closed questions • Avoids many controversial areas that could give competitive advantage • Untrue picture • Measuring gratefulness not satisfaction

21. Customer Satisfaction Surveys • Are a very useful management tool • Ideally should be a continuous process • Should be measured after treatment [otherwise measuring gratefulness!] • Include open questions & feedback • Ratings for each service - measurement over time • Should be taken seriously by all staff - part of appraisal • Should be acted upon

22. Securing Customer Loyalty • Customer segmentation e.g.Patients - • Most want to stay within their comfort zone • Most want local services • Concerned about MRSA & other infections • Waiting times • Better educated more discerning • Will research & choose their treatment • Want best clinician - research outcomes • May want superb hotel services • Will not be kept waiting • Prepared to travel for treatment

23. MARKET SEGMENTATIONPROCESS IN CONTEXT • Market Segmentation • Identify bases for segmentation • Determine characteristics • Market Targeting • Evaluate attractiveness • Select one or more segments • Product Positioning • Develop product positioning • Develop marketing mix Lancaster and Massingham 1988

24. SOMESEGMENTATION VARIABLES • Behavioural • Benefits sought • Purchase patterns • Purchasing behaviors • Psychographic • Lifestyle • Personality • Beliefs and perceptions Segmentation Variable Choice • Geodemographic • Age and gender • Life cycle • Geography • Income

25. Patient Choices you can’t rely on this for patients to choose your hospital!

26. Case Studies - Areas for Improvement 1. Inadequate car parking • More anxious patients • Patients arriving earlier and exacerbating the situation 2. Inadequate access to MR for mental health in-patients • Unnecessary CT to prove MR necessary • Longer in-patient stays awaiting diagnosis

27. Case Studies - Areas for Improvement 3. Senior surgeon retired • PCT decided not to refer to new surgeon • Trust reaction - anger! 4. After major surgery cancer patient threatened with taxi to empty home with no notice as hospital needed the bed 5. Elderly patients not being able to open their sandwiches

28. Case Studies - Good NHS Marketing 1.Telephone confirmation o/p appointments - pilot study - Ryl Brompton • Objective • Make it easier for patients to attend o/p • Reduce missed appointments • A win-win situation: • Patients get a better service - can change their appointment • Reduced Do Not Attends.

29. Case Studies - Good NHS marketing 2. One stop heamaturia diagnosis for high risk patients - Churchill Oxford Dr Nigel Cowan • Diagnosis of urinary cancer can take up to 6 months as patients go backwards & forwards for a battery of individual tests • High risk group for urothelial cancer • Macroscopic haematuria • Age > 40-yr • Smoking • Occupational exposure

30. US+CYS+IVU dx / tx / fu ? CT Urography dx / tx / fu ? RP dx / tx / fu ? URS + BX dx / tx / fu Imaging investigation of urothelium • MBUR 5 2003 Guidelines • In most cases both IVU and US should be used either together or in sequence p79

31. CT Urography+CYS dx / tx / fu ? RP + BX dx / tx / fu “One-Stop” Imaging investigation of urinary tract < 14 days Cowan et al ESUR 2005

32. CTU & CYS normal 46% TCC bladder 18% TCC kidney & renal pelvis 3% TCC ureter 1% Renal Cell Cancer 1% AML (angiomyolipoma) 1% MSK (medullary sponge kidney) 1% Renal stones 9% Ureter stones 0% Bladder stones 4% Ascites 1% Abdominal aortic aneurysm 3% FT Results for Year 1 (2004) n=143

33. Painless micro- & painless macroscopic haematuria Lowest Low Medium High micro<40-y macro<40-y micro>40-y macro>40-y CYS CYS CYS CYS US US US CTU watch & wait if –ve, IVU if US & CYS –ve & symptoms continue IVU if US & CYS –ve & symptoms continue Clinic Referral Possible Pathways for Investigation of Haematuria

34. One stop haematuria diagnosis Benefits • Patients & GPs • Immediate diagnosis • No long waits worrying • No travelling backwards & forwards for tests • Better outcome • Hospital • Better outcomes • Less expense • Shorter waiting times • 18 week patient journey before its time!

35. Case Studies - Good NHS Marketing 3.Telemedicine Post-op o/p follow up- Ryl. Brompton • Children are followed up at their local hospitals in o/p after cardiac surgery • Direct video, voice, diagnostic test links Benefits • Children & parents can gain expert medical opinion locally • Cardiologist can view all tests & speak to patients/families • Clinician can be more efficient & effective • Can increase patient base while making maximum use of consultant’s time

36. CREATING CUSTOMER VALUE Product Benefits Price Purchasing Effort (Time/Effort) Service Benefits Perceived Benefits Customer Value Perceived Sacrifice Psychological Costs Relational Benefits +ve -ve Service Costs Psychological Benefits Value = perceived benefits - perceived sacrifice

37. HOW PURCHASERS PURCHASE Marketing Focus Peer Influence Purchaser progress PR Susceptible Need Advertising Interest Demonstration Promotion Purchase Reference Reassurance Loyalty Support

38. Summary NHS in a competitive market • Trusts need marketing to thrive Objectives of Marketing • To build a sustainable competitive advantage so you organisation can succeed and grow by Identifying the needs of your customers - patients, GPs, PCTs etc and finding creative ways to satisfy them offering advantages over competitors

39. Useful Marketing Links • CIM web site - marketing definitions http://www.cim.co.uk/cim/ser/html/cover.cfm • CIM Medical Marketing Group - www.cimmmg.org.uk & info@cimmmg.org.uk • Social Marketing web site -http://www.nsms.org.uk/public/default.aspx • DoH Code of Conduct - http://www.dh.gov.uk/en/Consultations/Liveconsultations/DH_063280 Ginette Camps-Walsh