The Four Questions of Hospital Positioning

A central part of the Passover Seder – the traditional meal during which Jews around the world tell the story of Passover involves asking "The Four Questions." Traditionally asked by the youngest participant at the Seder, the questions are framed around the broad question of "why is this night different from all other nights?" The four questions traditionally asked are as follows:

  • Why on all other nights do we eat leavened or unleavened bread, but on this night we eat only unleavened bread?
  • Why on all other nights do we eat all kind of herbs, but on this night we especially eat bitter herbs?
  • Why on all other nights do we not dip herbs at all, but on this night we dip them twice?
  • Why on all other nights do we eat in an ordinary manner, but on this night with dine with special ceremony?

Right around Passover, while conducting research for a client, I made the connection that creating positioning for any entity, including hospitals and health systems, also revolves around answering four questions. They are:

  • Why do our prospects want/need the types of products/services we offer?
  • What are the purchase decision drivers they analyze in determining whose products/services to use?
  • How do we as an organization rate on those drivers?
  • Where do our prospects go to get the information they need to make decisions?

Knowing the answers to these questions is critical, according to Larry Stanley, vice president of marketing and business development at Vista Health System in Waukegan, Ill. "If you do not know what the market thinks of your organization and you try to position yourself too far from what they perceive of you, it could be a major waste of time and money. If the market thinks of you as a Days Inn, [consumers] may not believe you if you try to position yourself as a Ritz Carlton. So it follows that you need some unbiased research to get what he market thinks of you."

Obviously, there is much more involved than just answering these questions. And we'll get to that. But before we do, let's set the stage on what we must do before asking and answering those questions. Note that this article focuses on consumers; but the same approach can be used for how you position yourself to physicians and other professionals.

Setting the table prior to the questions

The four questions need to be asked about the target market. The foundation for a customer interaction set of questions is to make sure the right customers are the subject of the questions. For hospitals and health systems, there is greater success for those that, in the words of Linda MacCracken, vice president at Truven Health Analytics, "take the 'ready, aim, fire' approach and don't risk using hope for the customer engagement approach."

  • Target the best-suited consumers via knowing your market for current and future consumers in demographics. Target using MAGIC attributes (Marital status, Age, Gender, Income, and  presence of Children), with ethnicity and payor mix. All these items drive utilization.
  • Integrate utilization of health services by demographic and payor-access factors. Be ready to identify current service use under fee-for-service and needed services under fee-for-value by conducting a gap assessment. Profile the continuum of care in terms of services, staff and coordinated care to meet your need.
  • Hit the financial targets. To make money on your services, integrate margins and revenue targets in targeting customer acquisition and attention priorities. Prioritize customer engagement (and marketing) around the viable procedures and cases that integrate payor mix and the revenue impact.
  • Differentiate to get and keep customers. Knowing the actual and virtual competitors helps to position capabilities that make your services stand out. Outpatient services are dominated by the private physician more than other acute-care hospitals and private ventures. Identifying your value to consumers ahead of competitors is  hallmark of successful market leaders.

"Building this foundation saves money and time by focusing on the right target market to achieve your business goals," says Ms. MacCracken. "This lets your teams deploy scarce resources on services to meet local needs, build your bottom line while bringing out the magic of your services that matter to consumers but may be less available among your competitors."

We are now ready to ask the questions.

Question 1: Why do our prospects want/need the types of products/services we offer?
This is the easiest of the questions. The main reason people use an airline is to get to a destination. Implied in that is that they will get there. If there are safety concerns about an airline, they aren't even in the conversation. Similarly, the main reason a person uses a hospital or health system (and a physician) is to maintain health or restore good health. If a consumer doesn't think you can do that, you aren't in the conversation. 

While this is the easiest question to answer, it is important to understand the language prospects use in expressing this. For example, even a simple, open-ended question such as "under what circumstances would you use an emergency room?" can reveal interesting language. 

    "Only if my life is in danger."
    "If my physician is not available."
    "If I am in extreme discomfort."
    "If my child is not feeling well."

By asking the question, even though you know the general answer, you can pick up on language that will be helpful in messaging.

Question 2: What are the purchase decision drivers they analyze in determining whose products/services to use?
Preferably, it is important to do both qualitative and quantitative market research to get at this information (If you can only afford one, do quantitative). It is important to understand quantitatively how people select hospitals or health systems (through use of any number of quantitative techniques). But it is also important for messaging purposes to get people to respond in their own words in focus groups or individual interviews to the qualitative question: "How do you select a hospital?"

Quantitatively (through telephone interviews, online surveys, etc.) you will want to understand how important numerous attributes are. Just a few factors could be:

  • Hospital reputation
  • Hospital rating
  • Physician referral /physician is in the network
  • Friend referral
  • Have the services I need
  • Cost/insurance
  • Location

There are a couple of different quantitative methodologies you can use. 

  • A straight survey, where you can ask respondents to rate each attribute on, perhaps, a five-point scale (very unimportant to very important), and also ask them to tell you which one is most important.
  • A more sophisticated (and expensive) methodology such as discrete choice where respondents are shown several stimuli, each with several attributes, and then asked their reactions to each stimuli. By using statistical modeling tools, one can then identify how important each individual attribute is in the overall decision. A sample is shown below:

  • Your physician is on staff
  • The hospital is out-of-network
  • The hospital is 10 miles away and the third closest to you
  • The hospital is top-ranked for this service
  • The hospital only has private rooms
  • The hospital has Wifi in all its rooms
  • You know people who have stayed there and were satisfied with it

Question 3: How do we as an organization rate on those drivers?
Using the same attributes, identify how prospects in your marketplace perceive your organization and your competitors. These are natural follow-up questions to be asked right after you have answered Question 2. Some hints:

  • Ask about both your organization and your competitors, so you can get a feel on absolute perceptions and perceptions relative to the market.
  • Distinguish between people who have been patients and people who have never been. The differences can be quite revealing and also important to understand, especially if your goal is acquisition or retention.
  • If possible, do not reveal that you are sponsoring the research. If the participants do not know the sponsor, they are more likely to provide honest answers.

Answering these three questions should help you determine positioning and messaging. What you are looking for are those attributes that are both important to your target market and for which you rate high.  

Question 4: Where do your prospects go to get the information they need to make decisions?

The final question helps you determine where to deliver the messages. Quantitative research again is the best way to go. You can simply ask what information sources people use in making their decisions, and which ones are most important. There are numerous possibilities, and list as many as you can.  These may include (and for each general category, be specific):

  • Physicians
  • Friends/relatives
  • Newspapers
  • Magazines
  • Television
  • Radio
  • Hospital websites
  • General health websites
  • Social media (an example of being specific: ask specifically about Facebook Twitter, Google+ Pinterest, etc.)
  • Hospital ratings
  • Websites dedicated to a particular condition

Leigh Ginther, director of marketing and community relations at Swedish Covenant Hospital, said conducting research of this type was helpful when the organization launched its Facebook page. "We learned that consumers would welcome us in that environment. But they wanted helpful information; not a hard sell and not every day."

Some final thoughts

  • This type of positioning research can be done for both the organization in total or for specific service lines or customer segments (i.e., seniors). If this is for a specific service line or segment, it is important to remember that the positioning and messaging you create need to be consistent with your organization's overall branding.
  • You cannot transfer results for one service line or customer segment to another. What people tell you about cardiology services may be completely different from what you will learn about OB/GYN services.  
  • Finally, once you create your positioning and messaging, it is important to conduct further research to test the positioning, messaging and creative concepts. But that is another story.

Les Stern in President of L. Stern & Associates, a marketing firm providing strategic marketing, tactical marketing and marketing management services to the healthcare industry. He may be reached at (847) 205-1936, or at

More Articles on Hospital Marketing:

Hospitals — They Don't Market Like They Used To
6 Strategies to Engage Physicians in Hospital Marketing
Incorporating Patient Experience Into Healthcare Marketing

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