Managing a palliative oncology program: the role of a business plan.

Today's health-care environment demands that palliative-care programs operate in a businesslike manner. This report summarizes the business plan and the process followed to develop the Palliative Care Program at the Cleveland Clinic Foundation (CCF). The benefits generated from this effort and the lessons learned that may be helpful to other program managers are described. By disciplining itself to focus on financial, marketing, and operational issues, the Palliative Care Program is in a better position to advance its clinical services within the organization and in its market area, and can thereby serve its patients more effectively.

Mortality of patients transferred to a tertiary care hospital.

BACKGROUND: Seriously ill patients are often transferred from community hospitals to tertiary care hospitals. OBJECTIVES: To review the numbers, sources, and outcomes of patients transferred to the Cleveland Clinic Hospital from 1989 through 1992. METHODS: Retrospective analysis. RESULTS: Compared with the Cleveland Clinic's overall hospital mortality rate of 3.09% (3760 of 121,014 patients) during this period, the mortality rate among transferred patients was 8.26% (1092 of 13,226 patients). Although transferred patients accounted for only 10.9% of the total admissions, they represented 29.0% of the deaths. Transfers from other hospitals in the Cleveland Health Quality Choice (HQC) program, a community-wide quality-assessment project, increased 40.2% in 1992 (during the initial data collection period for the HQC program), while those from non-HQC hospitals increased only 0.9%. CONCLUSIONS: Patients transferred to a tertiary care hospital from other acute care hospitals have a 2.7-fold greater chance of dying in the hospital than nontransferred patients. Public scrutiny of quality may increase the likelihood of transfer of seriously ill patients to tertiary care centers.

The effect of do-not-resuscitate orders on length of stay.

In 1988, a new do-not-resuscitate policy aimed at assisting professional staff, nurses, patients, and families in end-of-life choices replaced the existing policy at The Cleveland Clinic Foundation. We conducted a retrospective chart review to examine the effects of the new policy on length of stay. Data were collected on demographics, clinical information, length of stay, and the frequency of do-not-resuscitate orders for expired Medicare patients in 1987 (n = 125) and 1989 (n = 135). Length of stay for patients who received a do-not-resuscitate order was significantly reduced in 1989 compared with 1987, partly because the orders were issued earlier in patients' stays in 1989. The number of days from writing the order until death did not change significantly from 1987 to 1989. We conclude that a well-defined do-not-resuscitate policy can reduce length of stay.

A marketing matrix for health care organizations.

Irrespective of the formal marketing structure successful marketing for health care organizations requires the input on many people. Detailed here is the Marketing Matrix used at the Cleveland Clinic Foundation in Cleveland, Ohio. This Matrix is both a philosophy and a tool for clarifying and focusing the organization's marketing activities.

Effective internal marketing: the challenge of the 1990s.

Results of a recent public opinion study suggest that health care provider organizations are not taking advantage of several important public relations and internal marketing channels to educate the public through their employees. As increasing pressures on health care providers from other segments of the health care industry result in reduced revenues, lower margins, and downsizing, health care marketers and public relations managers should reassess their internal marketing efforts.

Overnight assessment of marketing crises.

The Cleveland Clinic Foundation received significant negative publicity in 1987 when a surgical resident was reported to have AIDS. The resulting pressures from senior managers for immediate market information stimulated development of an overnight market research capability through prenegotiated contracts with market research suppliers so that studies could be implemented on short notice. Contracts have been signed with three market research companies and the overnight market research methods have twice been used successfully with only minor modifications.

Providing services to obstetrical patients: an overview and implications.

Obstetrics is one of the few hospital services with the potential for developing favorable client relationships resulting in increased market share, repeat purchase behavior, and referral of other patients in a direct marketing environment. To determine what qualities women find appealing in an obstetrics service and if women's preferences for a specific type of birthing arrangement had been examined and reported, a review of the literature was carried out. After reviewing the extant literature, the article provides strategic implications for health care marketers.

Influencing decision-making of referring physicians.

As marketing budgets for physician liaison departments increase, health care marketers are being held more accountable for their efforts by managers. Market researchers at The Cleveland Clinic Foundation (CCF) have developed a health care organizational information dissemination model that provides an understanding of how referring physicians choose a referral center for their patients. Interviews with 89 new referring physicians show patient influence and interpersonal media to be the two most influential channels of information. Financial analysis of referrals shows that a true physician referral generates significantly more revenue than a patient-influenced referral. CCF managers and marketers have used the data to understand better the effectiveness of their current programs targeted at physicians.

Measuring the effects of street pole banners on consumer awareness and preference.

The authors used a relatively new advertising medium to increase public awareness of their children's hospital. They found that street pole banners, a form of outdoor advertising, made a measurable, positive impression on consumer consciousness. Banners effectively supplemented a product awareness campaign that included more traditional media. This study is the first documentation of the use of banners to market health care services. Using a two-phase approach, respondents were surveyed via telephone before and after exposure. Results of the follow-up survey show significant increases in levels of awareness and preference. The authors hope their report on the successful use of street pole banners will spur further research on the use of this innovative media.

How physicians make referrals.

The physician is an important gatekeeper in the "buying" process for many health care services. Consulting physicians and tertiary care hospitals depend on physician referrals for much of their patient volume. A field survey of more than 1,000 physicians uncovered their attitudes and choice criteria pertaining to referrals. Physician referral attitudes are used as a basis for creating four physician segments. The authors explore attitude and behavioral differences among the four segments and discuss several physician marketing implications.

Selection of a hospital for a transfer: the roles of patients, families, physicians and payers.

OBJECTIVE: This study investigates the reasons for hospital transfers and the role patients, their families, physicians, and payers play in the choice of a referral center. DATA SOURCES: A thirty-three item questionnaire and clinical data from the hospital's discharge database. STUDY DESIGN: A study of all 307 hospital transfer patients admitted between November 9 and December 3, 1993 was conducted to understand the factors contributing to the increase in transfers and the reasons patients were sent to CCH. Data on the transfer decision were collected by interviewing patients 48 hours after admittance to the hospital or by telephone if they were discharged before an interview could be completed. Two hundred and sixty-two (85%) patients were interviewed. PRINCIPLE FINDINGS: (1) Almost 58% of transfers were patient-initiated or -influenced; the remainder were physician- (38%) or payer-directed (4%); (2) More than 78% of the patients identified lack of clinical expertise/technology at originating hospital as the main reason for transferring. Other reasons included: established CCH patient status (43%), CCH marketing (31%), and concerns regarding quality of care at originating hospital (10%). Financial and quality dumping were not identified as reasons for the transfer. New patients to CCH were more likely to indicate that marketing and lack of clinical resources at originating hospital were reasons for selecting CCH than previous patients. CONCLUSIONS: Patients significantly influenced the transfer decision and the transfer decision-making process can be influenced by marketing. The opinions of the consumer should not be underestimated, especially by those seeking non-marketing solutions to health care reform.

An approach to improving hospital advertising.

Newspaper ads from hospitals in Ohio were rated for their effectiveness and explicit use of marketing principles. Analysis showed that the advertising could be improved by increasing the motivation for action, emphasizing how the organization's products and services are different from competitors and more thoroughly identifying the benefits the consumer would receive. Use of the two forms in the study can contribute to improved health care advertising.

Impact on retention: comparison of two CPR training programs.

CPR trainees who completed 8-hour, 3 session and 4-hour single session courses were studied for skill and cognitive retention one year after certification. Knowledge and performance scores were significantly higher for trainees from the long course, but performance skills for both groups were below certification level when compared to American Heart Association standards. The findings suggest the need for further evaluation of course components which could improve retention levels for all trainees.

Professional shopping of physician services: an extension of the simulated patient technique.

Health care researchers have recently begun to use professional shopping to evaluate physician services. The results of two studies conducted by The Cleveland Clinic Foundation indicate that: (1) such studies are easily conducted; (2) physicians are comfortable with the use of professional shopping to obtain patient feedback; (3) the technique is a valuable research tool for improving medical services from a patient's perspective; and (4) there is potential value in using professional shopping as a quality assurance technique.

Physician peer review surveys: a management tool for improving quality of patient care.

An increasing number of patients are presenting multiple medical problems requiring the collaboration of two or more physician specialists or subspecialists for effective treatment. The quality of care delivered to multiple-problem patients depends greatly on how well the physician specialists interact with one another. The Cleveland Clinic Foundation (CCF) has developed and implemented a physician peer review survey that enables physicians to receive anonymous feedback on the service they provide to their colleagues. The survey has been implemented in both medical and surgical departments. Colleagues have identified areas for improvement to increase collaboration and enhance effectiveness in treating multiproblem patients. The data have led to a variety of specific service-related improvements and changes in physician behavior. Though originally conceived as a quality improvement technique, the physician review survey has become an internal marketing and management tool for physician managers.

Marketing impact of health education programs.

A study evaluating whether a lay public education program caused initiation of health-related behaviors was conducted at the Cleveland Clinic Foundation. Attendees of three individual "Health Talks" were surveyed: endometriosis (n = 78), men's health (n = 62) and cancer (n = 57). Participants were surveyed at three points: (a) before the talk, (b) immediately following the talk and (c) six weeks after the talk concerning their knowledge and health behaviors. The results indicated that community health education produces a substantial improvement in health-related knowledge and after attending the seminars, 81.3% of respondents initiated a positive health behavior. Of interest to health care marketers are the 30.8% of attendees who initiated health behaviors which have marketing implications.