The Way to Better Solutions, Results and Respect: A Case for the Marketing Process.
Nearly three decades ago, Phil Smith and I founded Prairie Dog and set out on a mission to bring more marketing discipline to the health care category. We saw a category that was grounded in communications but not necessarily marketing. In general, the advertising in the category came across as internally driven, often imitative and reactive. It all seemed very tactical and similar.
Health care marketing has come a long way in the last 30 years. But the struggle is still real. Marketing remains the most widely misunderstood function in the category. And health care marketers continue the fight for internal respect and resources.
Nearly 30 years later, Prairie Dog remains strong in its conviction that health care marketers will never be fully appreciated for the value we bring to our organizations if we don’t commit to the full power of marketing.
So this white paper is intended to be a refresher. A motivator. A reboot of the marketing discipline. Because, hey, we all get caught up in the day-to-day doing.
Someone you should discover, if you haven’t already — Mark Pollard, author of “Strategy Is Your Words,” shared a story that serves as a reminder of the power of the marketing discipline.
It goes something like this. Andrea Pirlo, at the end of his legendary soccer career on the international stage, made his way to New York to play American soccer.
When reporters asked him about his unusual style of play, Pirlo first described American soccer. He summed it up as very physical with constant movement — in his words, “A lot of running … too little play.” Pirlo’s approach was to watch the play develop, read the field, let the ball and competitor run, and then act with purpose.
We see this all the time in our work with health systems and health care organizations around the country.
A lot of running … too little play.
A lot of tactics … too little diagnosis and strategy.
A lot of advertising and communications … too little marketing.
A lot of the hot trends … too little understanding.
Let’s take the last one first. Performance advertising (advertising focused on driving short-term results, such as immediate sales or leads, through highly targeted campaigns) remains a popular tactic in every marketer’s arsenal. But too much of a good thing can be not so good. In their famous study “The Long and Short of It,” UK marketers Les Binet and Peter Field showed us that advertising effectiveness was on a downhill trend. Their modeling revealed that the massive shift to performance marketing (the short of it), largely fueled by digital marketing, was the culprit. And why not? Digital was less expensive and more targeted and came with what appeared to be easier attribution. The investment in brand-building (the long of it) dropped considerably.
Binet and Field’s modeling showed that brand-building investments were much more effective in driving growth, share and profits compared to performance advertising. In fact, they found brand-building even boosted performance advertising effectiveness. The error, according to Binet and Field, was not performance advertising (it can be highly effective in the short term) but that marketers had abandoned the most important driver of growth for the shinier new object. Their modeling recommended a more effective balance of the two, with a 60/40 brand-to-performance mix as a rule of thumb.
Adidas was one of the early U.S. adopters, although it took a bit of serendipity. A breakdown in Google AdWords stopped their paid search activity for a period of time. The fact that they saw no drop in their sales or website activity raised a few eyebrows at Adidas. At the time they were spending 77% of their media budget on performance advertising and only 23% on brand-building advertising. The CMO had heard of Binet and Field’s effectiveness modeling and decided to try it. The resulting model showed that 65% of Adidas’ overall sales were driven by the 23% spent on brand-building. According to their CMO, “A reliance on last-click and ROI metrics led us to over-invest in performance marketing and under-invest in brand-building.” This understanding moved them to flip their advertising mix to be more in line with Binet and Field’s 60/40 Rule. Interestingly, Adidas’ modeling also showed their individual service line marketing was not driving service line sales. You guessed it. The overall Adidas brand-building advertising was the primary driver of service line sales.
While this has obvious applications to health care marketing, let’s consider a few all-too-familiar and real-life examples of too much running and not enough play closer to home.
The folks in charge of MyChart for a large health system placed a call to their marketing team. The problem: Registration is stagnant. In fact, it has stalled at around 30% of eligible patients. We want you to develop a consumer and patient campaign to boost enrollment.
Here’s another. The imaging department of a pediatric hospital reaches out to marketing requesting a brochure to communicate its superior value. The problem: Freestanding outpatient diagnostic imaging centers are stealing our business — even in the form of referrals from our own doctors.
And finally, a nationally respected competitor is planting its flag in our part of the community. The request: We need marketing to produce a consumer campaign to get ahead of them.
These requests say a lot about how the marketing function is understood by many in our organizations. If you will, stop for a minute and ask yourself, “How would my team and my advertising agency respond to these requests?”
Let me suggest that simply taking the order and developing the campaign or collateral is not the right answer. That is not marketing. Advertising is not marketing. Content is not marketing. These are only tactics. They could be the right tactics but how do we know? They could very well be too much running.
We know we’re running in the right direction in the right way at the right speed when we turn first to the discipline of the marketing process – Diagnosis/Strategy/Tactics/Measurement.
So, let’s do a quick refresher on the marketing process. It begins with a mindset — market humility. As legendary marketer Peter Drucker said, “Marketing … is the whole business seen from the point of view of its final result, that is, from the consumer point of view.”
This mindset naturally leads us to diagnosis. Diagnosis is a search for the truth. It’s always there. It’s just hiding. Diagnosis is the way we find it. This is where we learn. Where we listen to our audience and discover their attitudes, behaviors and their job to be done. Where we understand the business. Where we consider the context. Where we find the real problem behind the problem — the dots that matter most.
It takes a bit of science and a bit of creativity. It takes looking at the situation from all angles. What’s there and what’s not there. This is not about checking the boxes. We get our hands dirty. We’re in the groups. Scouring the data. We do what needs to be done to get to the bottom of things.
The tools we carry are quantitative and qualitative. In-depth interviews. Listening tours. Digital and physical ethnography. Focus groups in many forms. Desk research. Data analysis. Online reviews and forums. Even conversations in the beauty salon and local coffee shop.
Sometimes we will have budgets for formal, comprehensive research. Sometimes, well, oftentimes, we will not. This shouldn’t deter us from our process. We simply lean even more into our creativity and resourcefulness — always eager to know what we don’t know. To find the right problem to solve and the insight that will unlock the problem.
My favorite Strategy guru, Roger Martin, defines strategy in so many words as a choice about where to play and how to win. As I’m sure you’ve heard at one time or another, it’s also a choice about where not to play. The late Michael Porter said strategy creates a competitive advantage “by deliberately choosing a different set of activities to deliver unique value.”
Strategy is fueled by diagnosis. It emerges from the insights and the choices diagnosis reveals. It’s what connects the dots that matter and makes them make sense. It leverages the truth. It is the punchline that defines direction. And establishes the audience, positioning and objectives.
There are a lot of frameworks that can help in the process of defining strategy. Roger Martin’s Strategy Choice Cascade is widely acclaimed. Early in my career I learned the Problem: Resolution approach from EY. But my go-to is the Four Points framework, which I learned from Pollard’s book and workshops.
None of these frameworks solve the problem for you. They serve as tools to help you make sense of your findings. And, most importantly, help you to connect your thinking. As Pollard says, “The process is the scaffold. We decorate it with what we learn.”
Four Points is quite simple. Like the marketing process, the four points build on themselves to create the strategy story. At the top is the Problem. Pollard stresses the importance of not stopping with the business problem but pushing to define the human problem behind it. From here, the left point of the framework forces you to articulate the Insight that unlocks the problem. Pollard calls it the unspoken human truth that sheds light on the problem.
The point on the right side of the framework, Advantage, gives you the opportunity to identify the truth that makes your brand, product or service unique and motivating to your audience. This step requires brutal honesty.
At the bottom is the Strategy — a new way of winning based on all you’ve learned and processed. It is the solve. Well, at least one possible solve. Remember, the framework is a thinking tool. Sometimes you get it right with one pass. I recommend trying different inputs to challenge your thinking and the words you choose to express it.
Tactics are the way we carry out our selected strategy. Strategy drives and connects tactics. Tactics are the expression of strategy, and the workhorses of the marketing process. As Sun Tzu said in The Art of War, “Strategy without tactics is the slowest route to victory. Tactics without strategy is the noise before defeat.”
The three health care marketing requests mentioned earlier not only jumped past diagnosis and strategy to tactics, but they also eliminated the opportunity to consider all 4 Ps of the marketing mix: price, promotion (marketing communications), place and product.
Let’s revisit to illustrate the pitfalls of skipping the process and jumping to tactics.
Remember, the folks in MyChart wanted a campaign to move them past a stagnant 30% share of eligible patients. Instead, we turned to diagnosis. To make a long story much shorter, we found that flaws in the online enrollment process were the culprit. People were attempting enrollment, only to fail. With no resources or avenue for assistance, they simply gave up and abandoned the process. The correct marketing action was a fix to the process and a new commitment to user support. A campaign would have only intensified the problem, wasting precious marketing budget.
Take the request for a brochure to counter the loss of imaging business to an outpatient competitor. Diagnosis showed a significant price difference that even the hospital’s own doctors struggled to overcome. The brochure would make little if any difference. This was a pricing problem, not a lack of knowledge regarding quality.
As for the request to launch a consumer campaign to preempt the formidable new market entry, the client agreed to diagnose the situation first. One-on-one interviews and data analysis revealed people, process and product issues, as well as significant referral leakage from the organization’s large, employed physician network — the system’s marketing priority. Further market analysis showed the organization’s program was no match for the expanding competitor. Instead of going head-to-head with a $1M consumer advertising campaign, the organization focused on addressing its people, process and product issues to secure the full potential of its employed physician group’s referrals. This included recruiting new physicians, revisiting affiliation agreements, pulling referring physicians into efforts to design physician- and patient-friendly processes, and focusing marketing communications on the employed physician group and its patients. The result? The marketing activations resulted in an incremental increase of 700 patient visits in the following year.
Many of the marketing textbooks you will encounter limit the marketing process to Diagnosis/Strategy/Tactics. They tend to handle Measurement separately. Let’s not. It is much too important. After all, we don’t market for the fun of it. We market to accomplish business objectives.
If we establish S.M.A.R.T. objectives during strategy development, what we are measuring becomes clear. A S.M.A.R.T. objective is specific, measurable, achievable, realistic, and time-based. Take, for example, the MyChart solution, “Reduce enrollment abandonment by 90% within the next 12 months.” The measure is clear — compare the current abandonment to the future abandonment.
This is an example of what you might call a strategic measure, addressing growth and purchasing funnel components. There are also tactical measures that measure the efficiency of tactics such as click-through rates, ROI and impressions. Always keep in mind, the C-suite is most concerned with the former.
While the C-suite is focused on big business effects like growth and share, they often struggle with evaluating the impact of marketing in moving these business effects. Using the proper measures is critical.
As Binet and Field’s work points out, it is important to break your marketing measurement into two categories: 1) brand-building and 2) performance, or activation, marketing. The former is long term (multiyear) and the latter is short term (within this year). Brand-building creates brand equity and performance advertising converts brand equity. One reaches all potential buyers and the other targets those who are likely or ready to buy now.
As mentioned above, at the strategic level performance marketing is measured by incremental growth and purchasing funnel impact. Because it is targeted, short term and campaign-oriented, it is easier to measure with limited assumptions.
Measuring brand-building efforts is a bit more challenging for health care marketers. While the work of Binet and Field and cases like Adidas have shown brand-building to be the primary driver of big business effects, this requires significant data, expertise and investment in modeling. Companies like Analytic Partners and Ipsos MMA are used by some of the world’s most advanced marketers.
For most health care marketers, introducing their C-suite to the modeling and science in support of brand-building can be effective, along with establishing these primary brand measures:
- Market Penetration — The number of unique patients (all types) to utilize your organization in a defined period divided by the total population (see Byron Sharp’s How Brands Grow for more on the importance of market penetration). Market share of specific volumes and/or connected or covered lives should also be considered.
- Share of Mind — The foundation for any brand performance program is a quantitative consumer brand-tracking survey. This tool queries a market representative sample of consumers by service area to measure a brand’s mental availability, along with consumer perceptions and attitudes relative to its competitor set. The survey should include a) brand funnel components — awareness (aided and unaided), familiarity, consideration, likely to recommend, preference, and utilization; b) brand associations — emotional and function associations, or brand attributes; c) brand connection — selected sub-brand/entity familiarity and association with the master brand; and d) ad recall — awareness and message recall. Measurement of the brand identity and assets for association and distinction should also be considered.
- Share of Voice — Share of Voice has long been considered a key metric for monitoring brand performance. Based on empirical data showing a correlation between share of brand media spend and market share, Share of Voice is a helpful tool in monitoring a brand’s position relative to its competitors and in setting appropriate brand spend levels to achieve brand-build goals.
- Organic Branded Share of Search — A newcomer to brand performance measurement, Organic Branded Share of Search has been found to have a high correlation to market share, as well as aggregate mental availability. This tool is free and simply involves the monitoring of search queries for the master brand as a proportion of all organic branded search queries for brands in its competitive set. You can also simply monitor the volume of organic branded search activity for your brand to monitor change. Tools such as Semrush, Google and Bing Search Consoles can be used to generate Share of Search comparisons. As a newer tool, more exploration and validation is needed. There are currently limitations related to defining demographic parameters and problems that arise when brand names are not particularly unique.
As legendary advertiser Dave Trott said in one of my favorite presentations, “In advertising, we’ve got a lot of smart people doing stupid things. We’re learning the words and we are not doing the thinking. Everybody has missed the basics of what we’re supposed to be doing. If you go into an agency today and ask them what’s their job, they’ll tell you it’s content curation … big data, native advertising, storytelling … rich media. Or they might say SEO, CRM … CTR, CMS … KPI or ROI. For me, the only three letters missing are WTF.”
Take a minute to ask your team and your agency this same question: What’s your job? We hope it’s not a list of tactics or buzzwords. We hope it’s more along the lines of using the marketing process to first determine the right problem and then to craft a strategy and set of tactics to solve it.
Internal and external forces will always try to push you to jump in and generate tactical activity. Resist. Find the time to diagnose the problem. Make an informed strategy choice of where to play and how to win. Then, turn to the tactics to make it happen. Use them all. Finally, measure, learn and repeat. Don’t skip a step. Complete each in order.
Whether defining your brand or marketing strategy, the discipline of diagnosis/strategy/tactics/measurement is the path to better solutions, results and internal respect.
Jerry Hobbs is a marketing strategist and the president of Prairie Dog, a health care marketing group headquartered in Kansas City.
