Response hierarchy models and their application in health and medicine: understanding the hierarchy of effects.

BACKGROUND: Successful patient engagement pursuits naturally require healthcare providers to possess a detailed understanding of their target audiences, with one of the most important processes to comprehend being the manner in which they learn about particular establishments and decide to extend their patronage. While health services patronage pathways vary between and among consumers, general patronage patterns exist which can provide enlightenment regarding this important process. Achieving knowledge on this front can help healthcare providers maximize opportunities to engage audiences and acquire all-important market share. DISCUSSION: The discipline of marketing, in part, focuses on customer engagement practices and, in describing the patronage process, it often uses what are referred to as response hierarchy models. Also known as hierarchy of effects models, these representations can help healthcare providers to understand the course through which individuals become customers of given establishments, aiding them particularly in devising appeals that can accelerate the patronage process. This particular article describes response hierarchy models, presents examples, and discusses the benefits that they offer healthcare institutions in their efforts to engage patients. CONCLUSIONS: As institutional viability and vitality are predicated on abilities to successfully attract and retain patients, healthcare establishments must direct keen attention toward developing associated skills. This necessitates that health and medical providers possess a detailed understanding of their target audiences, notably including the stages through which they pass on their way to becoming patrons. Response hierarchy models present the patronage process, depicting given stages, permitting insights which can assist healthcare providers in their quests to hasten desired exchange and capture market share.

Reflecting on "Marketing communications in health and medicine: perspectives from Willis-Knighton Health System": understanding the big picture.

BACKGROUND: Willis-Knighton Health System's special supplement in BMC Health Services Research, "Marketing communications in health and medicine: perspectives from Willis-Knighton Health System," focuses on advertising, public relations, sales promotion, and related communicative avenues, associated theory, and more. Across the supplement's articles, insights from the institution's experiences are presented, addressing the components of the marketing communications mix, foundational elements of communication, the patronage process, and the necessity for integrating marketing communications. DISCUSSION: As an understanding of the big picture is crucial in marketing communications, especially given that many of its components must be effected simultaneously, this particular article takes the insights provided in the supplement and presents them in an operational framework, demonstrating the marketing communications process. This framework concisely summarizes the facets profiled in the associated articles, permitting readers to see how these pieces work in concert with one another in health and medical settings, providing a basic communications structure which healthcare establishments can use to advance their patient engagement initiatives. CONCLUSIONS: Health and medical providers must ensure that they possess a detailed understanding of core marketing communications facets, but as they acquire associated knowledge, they also must direct attention toward understanding the interrelationships between and among these facets, permitting a global perspective of communicative operations. This particular article summarizes insights from Willis-Knighton Health System's special supplement in BMC Health Services Research, providing a pathway toward realizing big picture marketing communications perspectives.

Integrated marketing communications: a strategic priority in health and medicine.

BACKGROUND: Healthcare establishments portray themselves to their patient populations using many communicative mechanisms. Perhaps the first avenues that come to mind are the outward conveyances of the marketing communications mix, including advertising, personal selling, sales promotion, public relations, and direct marketing. But other prominent communicators also exist, including the people employed by healthcare institutions, the places in which services are delivered, and the brands that represent given establishments. This wide variety of communicative mechanisms is somewhat of a mixed blessing, affording myriad options, but also necessitating extra care and attention in developing associated marketing communications. DISCUSSION: Now more than ever, health and medical establishments have at their disposal communications options capable of addressing most any conveyance want or need. The marketing communications mix, once somewhat limited due to industry tradition, is now fully accessible and widely used in the health services industry, providing immense opportunities to connect with patients. Options for signage, building designs, servicescape amenities, employee uniforms, and the like also are teeming, providing myriad avenues for making positive impressions. But burgeoning options while beneficial also intensify obligations for ensuring that marketing communications are properly integrated, with this particular article describing this imperative need and its implications for communicative success in the healthcare industry. CONCLUSIONS: By integrating marketing communications, health and medical providers are able to create synergies between and among selected conveyance mechanisms, amplifying performance and increasing the likelihood of reaching communicative goals. Achieving such cohesion requires devoted planning in an effort to coordinate verbal and visual manifestations to express desired imagery and appeals to target audiences. As extensive benefits are derived from integrated marketing communications, healthcare establishments should consider associated pursuits to be a strategic priority.

Foundational elements of communication in health and medicine: avenues for strengthening the marketing communications mix.

BACKGROUND: When one thinks of opportunities to engage patients, the marketing communications mix often is the first thing that comes to mind. Its five components of advertising, personal selling, sales promotion, public relations, and direct marketing represent tried and true pathways for establishing productive dialogues with customers of healthcare institutions. But in formulating and deploying the marketing communications mix, health and medical establishments must not neglect foundational elements which play vital communicative roles, impacting the perspectives of patients and influencing associated patronage. DISCUSSION: Many things communicate on behalf of healthcare organizations, including the people employed by them, the places in which they deliver services, and the brands that represent them. As foundational elements of communication, these must be addressed prior to formulating the marketing communications mix, as they influence and impact an institution's entire communicative potential. Their initial development, however, is just the beginning, as these elements must be managed and maintained continually over the course of organizational life. This article profiles foundational elements of communication and discusses their importance in healthcare marketing, generally, and marketing communications, specifically, providing useful insights for maximizing communicative synergies. CONCLUSIONS: Given the importance of engaging current and prospective patients, healthcare establishments must take steps to ensure exceptional prowess in this area, with communicative skills and abilities being of paramount importance. Proficient deployment of the marketing communications mix is essential, but healthcare providers must also be certain to direct attention toward foundational elements, ensuring that given institutions realize their full communicative potential.

Timely, consistent, transparent assessment of market access evidence: implementing tools based on the HTA Core Model® in a pharmaceutical company.

OBJECTIVES: Evidence requirements and assessment methods access differ between health technology assessment (HTA) agencies. The HTA Core Model® provides a standardized approach to HTA, targeting evidence sharing and collaboration between participating HTA bodies. It is fit for purpose from an industry perspective and was used by pharmaceutical company Roche to develop a framework for internal assessment of evidence required for market access and coverage/reimbursement ("access evidence"). METHODS: Tools were developed to systematically scope, assess, plan, and summarize access evidence generation. The tools were based mainly on the first four HTA Core Model® domains and rolled-out in selected development teams in 2017. Five months after full implementation, the impact of tools was assessed in an internal survey. RESULTS: Systematic access evidence generation started with the Access Evidence Questionnaire, to scope evidence requirements and identify evidence gaps. Findings were summarized in the Access Evidence Metric, which assessed the alignment of available/planned evidence against HTA bodies' requirements and developed scope mitigation strategies. The Access Evidence Plan was then used to plan and document (additional) evidence generation. Once generated, evidence was summarized in the Access Evidence Dossier. A survey of twenty-seven Roche employees involved in evidence generation showed that the tools made discussions around access strategies and evidence more efficient and transparent. CONCLUSIONS: The HTA Core Model® provided a useful framework around which to optimize internal evidence generation and assessment. The benefits of using a standardized HTA approach in industry mirror those expected from implementing the HTA Core Model® in HTA agencies.

India's family planning market and opportunities for the private sector: An analysis using the total market approach.

The private (commercial) sector in India can complement public sector for family planning services, but the roadmap to engage these two sectors remains a challenge. The total market approach (TMA) offers a strategy by understanding the comparative advantage of public, commercial, and nonprofit sectors. We estimated TMA indicators using data of four rounds of the National Family Health Surveys: 1992-93, 1998-99, 2005-06, and 2015-16. The contraceptive prevalence of modern methods in India did not increase in recent years, but the number of users increased, and so did the market size for the commercial sector. In rural areas, the current market size in 2015-16 (75 million) failed to reach its potential size in 1992-93 (84 million). In urban areas, the market of modern contraceptives is mostly composed of the users from higher wealth, and a high percentage of users obtain contraceptives from subsidized sources. The family planning market of northern part of Bihar and Uttar Pradesh and of Northeast India are in the "early" stage and need more demand generation; "matured" markets are mostly concentrated in and around big metros. Subsidization in urban areas should be offered to the targeted population who need family planning products and services at low cost.

FPwatch: Facility-based Survey Data for Family Planning Market Analysis in Five FP2020-focus Countries.

This article describes datasets for the FPwatch Project, a comprehensive facility-based family planning survey conducted by Population Services International in five countries in Africa and Asia from 2015 to 2017. Contents cover research design and background, methodology, sample selection, data collection, an overview of FPwatch indicators, and quality assurance measures taken. These datasets from the Democratic Republic of Congo, Ethiopia, India, Myanmar, and Nigeria complement other facility-based family planning surveys and are unique in their large-scale, standardized methodology, and comprehensive sampling approach. In addition, all datasets but Myanmar (private only) include both private and public facilities, a feature that gives a more complete picture of the family planning supply environment. Because of these factors, the data is well suited to inform global family planning efforts.

Driving brand equity in health services organizations: the need for an expanded view of branding.

BACKGROUND: Branding-the assignment of names, logos, slogans, and related elements of identity to institutions and their product offerings for the purpose of conveying desired images to target audiences-is of paramount importance in the health services industry. Associated initiatives traditionally have centered on developing verbal and visual brand expressions, but opportunities abound to drive brand equity by supplementing traditional pursuits with new, different, and unexpected expressions that afford highly memorable experiences. DISCUSSION: Willis-Knighton Health System has possessed an expanded view of branding for decades. While the system has directed thorough attention toward traditional brand expressions, additional identity opportunities outside the bounds of traditional branding thought have been pursued vigorously. There perhaps is no better illustration of Willis-Knighton Health System's expanded approach to branding than that of Willis the Bear, the institution's iconic teddy bear mascot developed to promote labor and delivery services. This article presents the origins and development of this brand expression, particularly emphasizing the need to address nontraditional elements of identity for purposes of driving brand equity. CONCLUSIONS: Given the importance of brand management and extraction of associated value, health services organizations must diligently direct attention toward branding initiatives. Traditional approaches, when executed well, deliver excellent results, but enhanced value can be derived by addressing nontraditional brand elements which afford unique opportunities to differentiate given establishments from their competitors, facilitating institutional viability and vitality.

Formulating productive marketing communications strategy: a major health system's experience.

BACKGROUND: Healthcare establishments serve as key community resources, bringing into locales a wealth of resources aimed at enhancing and improving health and wellness. Without effective communications, current and prospective patients will remain unaware of available offerings, foiling opportunities for mutually beneficial exchange. Today, healthcare organizations engage audiences by selecting from among the components of the marketing communications mix, but this wasn't always the case. There was a time not long ago when communications options were limited due to industry traditions, creating associated challenges. DISCUSSION: Willis-Knighton Health System faced a communications dilemma in the 1970s when, as a small healthcare provider desirous of growth, it could not achieve a satisfactory media presence via the usual and customary route of the day: submitting press releases to news media organizations, requesting conveyance of associated stories to their audiences. This forced the institution to explore other possibilities, ultimately leading it to experiment with and embrace advertising at a time period when its use was generally shunned in the industry. Willis-Knighton Health System's pioneering deployment of advertising helped the institution achieve its intended promotions goals, supplying mutual benefits and affording insights which influence its communications approach to this day. CONCLUSIONS: Deploying advertising years in advance of its widespread acceptance and use in the healthcare industry, Willis-Knighton Health System forged new pathways and acquired experience which fostered provider-patient engagement initiatives, affording an enduring marketing communications approach. Challenging situations are quite common in the healthcare industry and the one faced by Willis-Knighton Health System was no exception, but it supplied an immense opportunity to innovate, leading to communications prowess, resulting growth, informed audiences, and lasting mutual benefits.

Am I seeing things through the eyes of patients? An exercise in bolstering patient attentiveness and empathy.

BACKGROUND: Modern marketing thought heavily emphasizes the need for healthcare providers to possess a customer orientation, placing patients at the focal point of attention within health and medical establishments. This has motivated significant investments in tools and techniques that foster outstanding service, attention, and support. Such investments in isolation, however, offer no guarantees that a true customer orientation will emerge. Proper implementation also is required-and that falls on the shoulders of health and medical personnel. DISCUSSION: The most innovative and expensive of customer-oriented tools and techniques mean very little unless they are placed in the hands of capable individuals possessing the ability and desire to serve patients well. But the rigors of industry life complicate matters, resulting occasionally in lost focus, compromising the patient experience. One of the simplest and most effective methods for encouraging patient attentiveness rests with a reflective exercise that encourages staff members to see themselves and their actions from the perspective of patients. Asking the operative question, "Am I seeing things through the eyes of patients?" serves as an effective reminder of priorities, building empathy and motivating personnel to continually deliver their very best. CONCLUSIONS: Viewing one's actions from the perspective of patients can be very revealing, opening eyes wide and permitting opportunities for any necessary improvements, making for a simple but powerful learning experience. The "Am I seeing things through the eyes of patients?" reflective exercise helps well-intentioned staff members avoid tendencies which can lull them into states of complacency, ensuring that they remain focused on those in their care.

Healthcare establishments as owner-operators of digital billboards: making the most of excellent roadside visibility and high traffic counts to better connect with patients.

BACKGROUND: Given the importance of communicating effectively with current and prospective patients, healthcare institutions must direct considerable energies toward achieving associated excellence. Pursuits usually center on addressing the marketing communications mix properly, but in order to maximize communications prowess, attention also should be directed toward incorporating emerging communications innovations, when and where possible, to bolster opportunities to connect with patients. DISCUSSION: In pursuit of communications excellence, Willis-Knighton Health System's executives reflected on campus dynamics in the context of modern outdoor advertising technologies, namely, digital billboards, which present electronic advertisements on-demand, around-the-clock. They surmised that, with Willis-Knighton Health System's campuses being positioned in highly-visible fashion along highly-transited roadways, the institution could deploy this relatively new roadside advertising innovation to better engage audiences. This particular train of thought ultimately led to the installation of digital billboards at several of its locations. This article profiles the development of Willis-Knighton Health System's new marketing communications asset and offers advice for healthcare establishments desirous of placing digital billboards onsite to better connect with patients. CONCLUSIONS: Opportunities affording enriched communications with patients should continually be sought by health and medical entities. Digital billboards, institutionally-owned and operated, supply one such opportunity, pairing a state-of-the-art, uniquely-capable advertising medium with the excellent locational characteristics possessed by many healthcare establishments. As Willis-Knighton Health System has observed, digital billboards offer an exceptional mechanism for engaging audiences, affording mutual benefits which ultimately foster patronage and prosperity.

Three Pink Decades: Breast Cancer Coverage in Magazine Advertisements.

Breast cancer advocacy has experienced tremendous success since the 1980s. Yet, the quality and authenticity of breast cancer information in the media are sometimes questionable. Using a content analysis, we examined the informative (donation information, breast cancer advocacy content, etc.) and persuasive (appeals used, cues to action, etc.) contents of magazine advertisements relevant to breast cancer. While ads offered minimal informative content about the disease or about ways by which sales will contribute to the breast cancer cause, they integrated "breast cancer appeals," such as the color pink, the pink ribbon, and mostly positive depictions of survivorship and hope, into the ads. Breast cancer thus took center stage in the persuasive content of the ads, but a back seat when it came to their informative content. We discuss the implications of those findings in light of the meanings and purposes of cause-related marketing campaigns.

Relationship marketing strategy.

Purpose The purpose of this paper is to explore how strategies are put in place to formulate policies regarding the introduction and implementation of relationship marketing (RM) in the health sector, and how RM strategies are designed as part of the curricula for the training of prospective health professionals in Ghana. Design/methodology/approach Data were gathered using interviews and documentary review. A purposive sampling technique was used to recruit policy makers and health educationists in Accra for in-depth interviews. Qualitative interviews were analysed using framework analysis. Findings The findings revealed that, currently, there is no policy framework on RM in the health sector nor included in the curricula of health training institutions in the country. Research limitations/implications Due to limited time and funding constraints, the study could not include many policy makers, educationists, health providers, facilities and regions outside the Greater Accra region of Ghana. This means that the authors missed out on useful insights from other relevant policy makers/educationists who would have added to the knowledge that this study contributes. There were still some areas that this study could not cover, including the lack of an exploration of the perceptions of health providers and patients. Practical implications Evidence from the current research provides the basis for scaling up of a similar study to the whole country to address the perennial RM or quality of care/patient satisfaction issues persisting in health facilities in the country. The outcome of this large-scale study would help to confirm the findings of the current study on the adoption and incorporation of RM into both policy framework and curricula of health training institutions in Ghana. The findings would culminate in the preparation and utilisation of guidelines on RM for client-centred service delivery in the health sector of the country. Social implications This paper argues that RM orientation could enable health professionals to improve upon their healthcare service performance and quality of care so as to enhance patient satisfaction. Originality/value The study recommends that RM should be adopted by health policy makers and designers of curricula for health training institutions.

Developing social marketed individual preconception care consultations: Which consumer preferences should it meet?

AIMS: Preconception care (PCC) is care that aims to improve the health of offspring by addressing risk factors in the pre-pregnancy period. Consultations are recognized as a method to promote perinatal health. However, prospective parents underutilize PCC services. Uptake can improve if delivery approaches satisfy consumer preferences. Aim of this study was to identify preferences of women (consumers) as a first step to social marketed individual PCC consultations. METHODS: In depth, semi-structured interviews were performed to identify women's views regarding the four components of the social marketing model: product (individual PCC consultation), place (setting), promotion (how women are made aware of the product) and price (costs). Participants were recruited from general practices and a midwife's practice. Content analysis was performed by systematic coding with NVIVO software. RESULTS: The 39 participants reflected a multiethnic intermediately educated population. Product: Many participants had little knowledge of the need and the benefits of the product. Regarding the content of PCC, they wish to address fertility concerns and social aspects of parenthood. PCC was seen as an informing and coaching service with a predominant role for health-care professionals. PLACE: the general practitioner and midwife setting was the most mentioned setting. Promotion: A professional led promotion approach was preferred. Price: Introduction of a fee for PCC consultations will make people reconsider their need for a consultation and could exclude vulnerable patients from utilization. CONCLUSION: This study provides consumer orientated data to design a social marketed delivery approach for individual PCC consultations.

Brand trust and image: effects on customer satisfaction.

Purpose The purpose of this paper is to investigate brand trust and brand image effects on healthcare service users. Nowadays, managers and health activists are showing increased tendency to marketing and branding to attract and satisfy customers. Design/methodology/approach The current study's design is based on a conceptual model examining brand trust and brand image effects on customer satisfaction. Data obtained from 240 questionnaires (310 respondents) were analyzed using path analysis. Findings Results revealed that the most effective items bearing the highest influence on customer satisfaction and on benefiting from healthcare services include brand image, staff sincerity to its patients, interactions with physicians and rapport. Research limitations/implications This study needs to be conducted in different hospitals and with different patients, which would lead to the model's expansion and its influence on the patient satisfaction. Originality/value Being the first study that simultaneously addresses brand trust and brand image effects on customer satisfaction, this research provides in-depth insights into healthcare marketing. Moreover, identifying significant components associated with healthcare branding helps managers and healthcare activists to create and protect their brands and, consequently, leading to an increased profitability resulting from the enhanced consumer satisfaction. Additionally, it would probably facilitate purchasing processes during the service selection.

Perspectives of key stakeholders and experts in infant feeding on the implementation of the Australian National Breastfeeding Strategy 2010-2015.

Breastfeeding is widely accepted as an important public health issue for babies and their mothers. Yet, despite this, Australia continues to struggle with reaching global targets for breastfeeding indicators. In 2007, the Best Start Parliamentary Inquiry Report was released and set the stage for the Australian National Breastfeeding Strategy [2010-2015), which was announced in November 2009, with the vision to increase Australia's breastfeeding rates of infants at 6 months of age and beyond. The aim of this research project was to explore the perspectives of key stakeholders in the field of infant feeding in Australia on the implementation of the strategy, barriers and enablers to its successful implementation and actions that were still needed. Using qualitative research methods of in-depth, semi-structured interviews and thematic analysis, this study identifies main themes of these perceptions about the strategy implementation and some recommendations for future strategies and further research. The main themes identified were initial opinions of the strategy as a blueprint for action, the strategy as a driver for action, lessons learned and recommendations for the future. For success in improving implementation of national breastfeeding strategies, it is recommended that Australia establish an independent breastfeeding/infant feeding committee, increase the political prioritisation of issues surrounding infant feeding and strengthen the regulation of the marketing of breastmilk substitutes.

The changing face of the English National Health Service: new providers, markets and morality.

INTRODUCTION: One significant change in the English National Health Service (NHS) has been the introduction of market mechanisms. This review will explore the following questions: should we have markets in healthcare? What is the underlying philosophy of introducing more market mechanisms into the NHS? What are the effects of this and does it change the NHS beyond anything Bevan might have imagined in 1948? SOURCES OF DATA: The review will use empirical studies, philosophical literature, bioethics discussion, policy and NHS documents. AREAS OF AGREEMENT: The NHS is facing unprecedented challenges at the beginning of the 21st century, with funding levels not meeting the increase in demand. AREAS OF CONTROVERSY: The extent and appropriate role for market mechanisms in the NHS is hotly debated. It will be argued that we are moving towards a more market-based NHS and the possible effects of this will be discussed. GROWING POINTS: Rarely are the policy changes in the NHS evidence based in any meaningful way and they are often driven by ideological considerations rather than clear evidence. There needs to be a greater reliance on evidence of what works and a continuing commitment to healthcare as a societal good. AREAS TIMELY FOR DEVELOPING RESEARCH: There needs to be a discussion of what the NHS should be-a funder and provider, a funder or a partial funder? How the balance of power between regulators, different types of provider, commissioners and ultimately patients will play out in this changing environment are also areas for future study.

Devolution and health in the UK: policy and its lessons since 1998.

INTRODUCTION: Since devolution in 1998, the UK has had four increasingly distinct health systems, in England, Northern Ireland, Scotland and Wales. SOURCES OF DATA: Secondary literature and authors' own research since 1998. AREAS OF AGREEMENT: From a similar starting point, there has been a considerable distancing of the four health systems from each other in policies, priorities and organization. AREAS OF CONTROVERSY: The comparative efficiency and quality of the different systems as well as the wisdom of their greater or lesser reliance on integration and competition. GROWING POINTS: Better and more comparable public data would be useful, as would consideration of potential devolved lessons for UK policy. AREAS TIMELY FOR DEVELOPING FURTHER RESEARCH: Comparisons of organization and performance at levels more detailed than whole systems; analysis of the resilience and management of different systems in a context of budgetary austerity; analysis of the politics behind policy decisions.

Using direct mail to promote organ donor registration: Two campaigns and a meta-analysis.

BACKGROUND: Two direct mail campaigns were undertaken in Rochester and Buffalo, New York, with the goal of enrolling adults aged 50-64 years into the state organ and tissue donation electronic registry. Meta-analytic methods were used to summarize the body of research on the effects of direct mail marketing to promote organ donation registration. METHODS: In the first study, 40 000 mailers were sent to targeted adults in Rochester, New York, and varied by brochure-only, letter-only, and letter plus brochure mailing conditions. A follow-up mailer using letter-only was sent to 20 000 individuals in Buffalo, New York area. In a second study, campaign results were combined with previously published direct mail campaigns in a random-effects meta-analysis. RESULTS: The overall registration rates were 1.6% and 4.6% for the Rochester and Buffalo campaigns, and the letter-only condition outperformed the brochure-only and letter plus brochure conditions in the Rochester area campaigns. Meta-analysis indicated a 3.3% registration rates across 15 campaigns and 329 137 targeted individuals. Registration rates were higher when targeting 18-year-olds and when direct mail letters were authored by officials affiliated with state departments. CONCLUSION: Use of direct mail to promote organ donor registration is an inexpensive method to increase enrollments in state registries.

Effects of market, e-marketing, and technology orientations on innovativeness and performance in Turkish health organizations.

This article investigates the effects of strategic orientation on innovativeness and performance in health organizations in Turkey. We test hypotheses that market, e-marketing, and technology orientations positively affect innovativeness and performance. Market and technology orientations are found not have a significant effect on performance, but e-marketing orientation and innovativeness have a significant and positive effect. We also investigate indirect effects on innovativeness and performance. The analyses of direct and indirect effects are an important contribution to understanding relationships among research variables.