Submitted by Tom DeSanto
Executive Vice President
Aloysius Butler & Clark
Wilmington, DE
302-655-1552
tdesanto@a-b-c.com

Ratings are multiplying like rabbits. Companies that evaluate healthcare quality—and the awards they give—are popping up everywhere. Some marketers build entire strategies and campaigns around ratings. Others simply insert rating references into their existing marketing campaigns. The most cynical avoid them as much as possible. Where do ratings fit into your marketing efforts?

In theory, using ratings as a marketing tool makes a lot of sense. Ratings provide a third-party, data-based endorsement of your organization and its services. And they enable you to offer patients objective information that can help them make effective decisions. In practice, however, ratings can create more questions than answers.

How much trust do consumers place in quality ratings? Do consumers really understand what the various ratings mean? Are ratings truly helpful in creating differentiation in the marketplace?  

The answers to these questions are far from definitive. Working with a variety of hospitals and health systems, I’ve found that consumer reactions to quality ratings vary widely by situation and marketplace. In some focus groups, consumers quickly conclude that they place high value on ratings and in others they dismiss them as worthless marketing gimmicks. Sometimes both views are represented. And as participants discuss their opinions, it often becomes clear that they are unclear about who produces the ratings and what the various awards actually mean. 

Regardless of the level of understanding—or misunderstanding—among consumers, ratings have become a factor in healthcare marketing. Depending on the level of competition, health systems tend to line up on one side of ratings or the other. They either promote them proactively to build market share or apply them defensively to protect it.

In this article, I’d like to present several strategies for ratings used by healthcare marketers and then offer a guide for assessing how you might use ratings in your own marketing efforts.

Expressing Culture

Many health systems have committed themselves to using quality enhancement programs so they can build exceptional performance from the inside out. Their CEOs embrace the vision of an organization worthy of a J.D. Power and Associates Distinguished Hospital award or a Malcolm Baldrige National Quality Award designation. Once this vision is realized, CEOs expect their marketing departments to promote the accolades either as a cornerstone of the organization’s branding or as part of its overall messaging.

One regional health system, having won recognition for service excellence from J.D. Power and Associates, took a subtle approach. After announcing the award, the marketing department created banners with the J.D. Power and Associates award medallion and hung them in key locations. This was complemented by congratulatory internal communications as well as mentions in external communications. The strategy was to use the rating to provide solid reinforcement of the health system’s success in partnering with its community to foster good health. In this case, the ratings were more about building the culture of the organization than directly creating marketing opportunity.

Proving Improvement

Some health systems use ratings to make their case for having achieved major quality improvements. Several years ago, the new CEO of a small health system conducted Gallup research that confirmed it had a poor reputation throughout its community. Using Press Ganey patient satisfaction measures, management immediately embarked on a quality improvement campaign to address the problems raised in the research. The strategy was to achieve success and then use marketing communications to deliver proof to its disillusioned public.

The marketing director carefully monitored results and built an ad campaign around two inarguable propositions. First, he featured nurses, physicians and other employees who talked about the sweeping changes and their dedication to make their hospitals the best they could be. Then, as the hospitals demonstrated a solid upswing in basic ratings such as overall patient satisfaction or in a specific service line, he created other ads that reported results and then rotated them into the series. The combination of staff testimonials and higher ratings worked well. A repeat of the Gallup research eighteen months later revealed a significant positive shift in public opinion.

Building Value

Hospitals in crowded marketplaces are always looking for new ways to build value by differentiating their services. Recently, a community hospital with four local competitors used quality ratings to set itself apart. After the hospital earned five-star ratings from Health Grades in several service lines, the marketing director envisioned a smart way to leverage them. Her strategy was to promote the multiple awards in a single ad and then follow up with educational advertising related to the award-winning service lines.

Avoiding a mere “brag and boast” approach, she created an advertising campaign that fit the personality of the hospital well. The initial ad presented the ratings as indicators of the hospital’s focus on its patients’ health. Subsequent service line ads offered ways to avoid risk and detect signs of possible illness. They included the five-star rating at the bottom of each ad to confirm the expertise of the hospital. In this case, the ratings were combined with a consumer-education approach to create goodwill and subsequent new marketing opportunities.      

Defending Turf

In fiercely competitive marketplaces, some health systems go head-to-head on their ratings. In one urban market, several academic medical centers produce advertising touting their US News & World Report America’s Best Hospitals ratings. They also shoehorn their ranking into print and radio ads, even if it doesn’t exactly fit into the copy flow. The strategy seems to be to stake their own claim and fend off others.

I’ve found that consumers tend to understand and reference the USN&WR ratings more than many of the others. This may be the result of the magazine’s marketing of its “Best Hospitals” issue or because the consumer-friendly ratings reflect service line and geography. It’s easy to latch onto a medical center being, for example,  “the third-best hospital in the U.S. for cancer care” or “the best hospital for heart care and heart surgery in Illinois.”

The problem is that ratings come out only once a year and they fluctuate. If the release of the rankings induces a whirlwind of advertising about who’s been rated best, consumers may tune out. Those who are tuned in can start to develop expectations. It’s not uncommon to see a highly regarded health system slip significantly in the ranking of one of its services. Is it the result of a drastic decline in the quality of care? Not likely. But that’s how consumers may perceive it if a health system has promoted its ranking too heavily.

In our sound-bite-oriented, everybody-loves-a-winner culture, healthcare ratings can be a bit like the standings for baseball or football. Even if you’re not a fan, you like to see your home team near the top. After all, who wouldn’t be happy to know that a local hospitals rates highly among its peers nationwide? Wouldn’t that make people more likely to choose it? Much like sports, it really is about winning: making the list and being the best.

As a result, communications about ratings often are executed on a knee-jerk basis. Situations arise and the marketing department is pressured to take action. The CEO receives the accolade and wants to leverage it immediately. A competitor promotes a high ranking in your health system’s most important service line. A marquee specialist is recognized as a “top doc” in the regional lifestyle magazine and demands an ad. In the real world, marketing can be synonymous with reacting. Sometimes you can be the voice of reason; sometimes it’s impossible.  

Planning Your Approach

The best approach to any marketing strategy or tactic, of course, is to take the time to carefully consider its role in your overall marketing objectives. If you can step back from the pressure to react, I’d like to offer a simple tool to help you make decisions and defend them. By determining the relative importance of ten factors, you can assess how much or how little your organization could benefit by featuring a particular rating in your advertising. Use a separate worksheet for each quality rating you are considering.

The worksheet will give you a score on a scale of 1 to 100 that measures the value of promoting the rating. If your organization has earned several ratings, the scores can be compared to see which ratings are most important. A low score for a rating can also be used to make your case for not promoting it when pressure arises to take action. I’ve also included an overall strategy for each scoring tier to use as a general guide, but how you proceed will depend on specific situations that can’t be covered by a simple assessment tool.

In my opinion, the promotion of healthcare quality ratings is multiplying far more rapidly than consumers’ ability to understand their true meaning and value. By jumping into the ratings game too quickly or too often, marketers risk jading their audiences and diluting the power of their messages. Ratings are an asset. Consider their use wisely.
 

Healthcare Quality Ratings: Decision-Making Worksheet

Name of Rating ______________________

Carefully evaluate each of the following factors and then rate its impact on a scale of 1 to 10. 
To what degree is the rating:
important to your CEO, board and physicians?  _____
able to help you reach your marketing goals?  _____ 
compatible with your overall marketing messages? _____
an effective way to differentiate from competitors? _____ 
meaningful to your patients and community?  _____
worthy of the resources required to promote it?  _____
valuable in motivating staff and employees?  _____
reflective of your mission, brand and culture?  _____
essential for promoting a specific service line?  _____
likely to be sustained in the near future?   _____
Total score: _______

Scoring
Based on the total score, you’ll have added insight about how the rating might fit into your overall marketing communications strategy.

Score  Overall Strategy  
90–100  Give the rating a major role among your marketing messages
80–90 Weave the rating into your marketing messages
70–80 Mention and display the rating prominently in your marketing communications where it makes the most sense
Below 70 Display the rating in appropriate places

The scores are guidelines. Your strategy may vary based on your specific marketing environment.

©2005 Aloysius Butler & Clark