Practice Culture: What Internal Marketing is Really All About

Internal marketing simply doesn't work without a patient-centered culture that fosters relationships and genuine patient satisfaction. An effective culture evolves by design, from the top down and needs training, practice and teamwork. There's no need for internal marketing tactics without an emotional connection.

When we consult with a hospital, an established healthcare practice or even a new practice, the concept of internal marketing has an easy-and-low-cost appeal to the doctor, owner or office administrator. What could be better than having existing patients make referrals or seek additional services?

Typically, the discussion immediately turns to tactics. "We have a practice newsletter," or "We always answer the phone with a smile," or some other tactical device to winning patient satisfaction.

The trouble is that an effective Internal Marketing strategy doesn't begin with a newsletter. Tactics are important, but without a foundation of great relationships, the tactics don't matter.

Delivering an exceptional patient experience...or not

The term "patient-centered practice" is often over-used and under-achieved. The new healthcare marketing vocabulary has embraced "patient satisfaction," "customer service," "patient experience," "loyalty and retention" as popular buzzwords. But some practices that say (and believe) they are patient centered fall short of delivering it.

Consider the culture that propels these two patient experiences. We stress that these are true stories. Observe how the provider—probably the dominant personality in the practice—drives the office culture and the patient experience...for good or bad.

One patient writes:

"I was referred to a 'pain management specialist' for a back pain consultation at a local hospital. Pretty good parking, but otherwise an aging and dingy facility inside and out. My medical records had been faxed from out-of-state, but nobody had read them. Three different people asked the same questions about the same information that was both in the records and in the forms that I completed upon arrival.

"I waited in the aptly-named 'waiting room' for about 40 minutes, and then alone in the treatment room for another hour. The exam room was filthy, nobody knew where some of the instruments were, and—by now needing a drink of water—the faucet delivered brown tap water. When the 'pain management MD' raced into the room (also not having looked at a chart), he asked why I had come in.

"Since he didn't seem to know my name—disrespectfully addressing me as 'Hon'—I refused to continue the 'exam' and demanded a new appointment at his office, and not at the decay-laden hospital.

"The make-good office consultation was great, on-time, 20 minutes of actual face time, and a discussion of treatment options for a pain injection with fewer risks and no discomfort. Confidence restored.

"At the third appointment for the treatment/injection, the clinical assistant advised that the burning and stinging pain of the injection was not going to last 'too long.' The doctor's reassuring comments were erased, my anxiety goes through the roof and all trust evaporates.

"And then the dog starts barking. It was the doctor's cell phone...a barking a ringtone. In the operating room, during a treatment, he took a personal call while I lay there sweating and scared. An anxious patient is an unhappy patient. On the bright side, he was able to talk with his landscaping contractor.

"'Perfect,' I said. Okay guys, I'm bailing.' I told them all that I'm not doing this. They just stared. Dazed them, I guess, but the MD never stopped talking on his cell. (I concur; stone is probably better than brick.) I left and called my GP for a different referral."

Contrast that tale with the WOW experience that Dr. Stephen Wilkins wrote about in his blog recently. We'll link you to his entire post, How One Doctor Creates a "Great Experience" for His Patients, but the essential story goes:

"As some readers may know, [my wife] is being seen by specialists at MD Anderson Medical Center in Houston for Stage IV lung cancer. She has not had a local oncologist for the past 6 years...but she does now. And we both love this guy!

"You need to understand that I have been underwhelmed by the local oncologists I had met up till now. I am sure they were clinically proficient...but as a group not a one could muster a smile...or any sense of interest or curiosity in my wife's medical condition. I held out little hope that this new doctor would be any different.

After a clinically thorough and gently empathetic conversation with a PA, "Now enters the doctor. He has a warm smile while he extends a hand to my wife and me. He says enough for us to know that he has talked to the PA." The doctor asked many thoughtful and probing questions and "seemed to value her opinion of what was going on with her care."
"He empathized about being treated in a world-class academic medical center...often long on experience, but sometimes short on bedside manner. He volunteered that, given my wife's situation, he saw his role as collaborator with her primary cancer care team in Houston. And I was worried that this guy's nose would be out of joint given her continued relationship with her docs in Houston.

"The visit ended with a hug between my wife and her new doctor. What we like about my wife's new doctor is his 'mindfulness.' Specifically we liked the doctor's attentiveness, curiosity, flexibility, and presence...

"The doctor's flexibility was evident from his willingness to play 'second fiddle' to my wife's doctors in Houston. Finally this doctor was 'present' at all times. He listened, picked up on cues from my wife and I, anticipated my wife's needs and never looked at his watch.

"So the next time you visit your doctor...or you visit with a patient, you might think about 'mindfulness.' It doesn't take any more time I suspect...but can make all the difference to patients and their caregivers."

Both stories illustrate a strong emotional connection, but with opposite outcomes. In the first story the practice culture lost "the sale," the GP referral source may also be gone, and no amount of internal marketing will make a difference. In the second, the patient-centered culture gained a lasting patient relationship and satisfaction.

Internal marketing is really all about relationships

Establishing and maintaining positive relationships is more than keeping up with the daily schedule and being clinically proficient. Here are some of the essential considerations for achieving a patient-centered practice.

• Culture evolves by default or by design. What's it going to be? In most practices, it's "culture by default." Where there is no strategy, no focus, no deliberate pathway to achieving goals, the culture emerges spontaneously. Take an unbiased audit of your business culture. (Looking from the inside isn't always easy to do, so talk with us if you'd like an independent perspective.)
• The cultural tone is usually set by the strongest personality. Is that you? (Hint: It's most likely the doctor.) You can take the lead or designate a leader, but leaders need a deliberate plan. The staff will follow an example based on what the leader does, not what they say.
• Do you have a team (and teamwork), or a collection of individuals? When the whole is greater than the sum of the individual parts, it's teamwork. Is the patient the focal point of every interaction? Nothing short of consistent and seamless teamwork will produce a patient-centered environment.
• Is your team training, practicing and winning? A patient-centered practice doesn't happen by accident. It requirestraining, coaching, mentoring and monitoring in an ongoing effort. Do you have all the help you need for the team to stay at the top of their game?

When you closely and realistically examine the patient-centered issues in your practice, you'll be examining the business culture. Individual practices, physician groups, hospitals and health systems all have a culture, and it can make or break the patient experience.

With a patient-centered culture in place first, you can move to the strategies, tactics and tools of internal marketing. We can offer an impartial perspective if you like.