Marketing is a fluid term in health care. There are as many definitions and styles of marketing as there are marketers, because there are so many different kinds of health care products, services, and end users.

They all have one thing in common, though, and that is marketing divisions in proportion to their size. Big hospitals and HMOs, for example, have the largest marketing departments, with someone always ready to jockey for media attention or design and mail brochures. These large oranizations have the most money to lavish on promotion, too. TV, radio, newspapers, magazines—always effective and never cheap—are within their reach. Plus, the big guns have the added advantage of that if-you-build-it-they-will-come insurance. It is pretty tough to overlook a place like UCLA Medical Center or Massachusetts General Hospital; even if they never advertised, someone would show up there eventually.

But what about not-so-big facilities? Or facilities specializing in services aimed at narrow markets? Or brand-new facilities, starting from scratch? Out of necessity, they must be a tad more inventive, a bit more aggressive just to get on the public’s radar. Sometimes they must even take bold chances. But as a young shepherd named David once discovered, all it took to keep up with the giant Goliath was one extremely well-aimed nugget and a fistful of attitude.

Country Hospital, International Audience
North Hawaii Community Hospital (NHCH in Waimea, Kamuela) might be small in square footage, but it more than makes up for that in ability and atmosphere. People around the world are noticing.

A lot of that has to do with Jonathan Guilbert, NHCH’s team leader of marketing and development. He puts everything in perspective when he says, “We’re a small, single-story, beautifully decorated, beautifully designed hospital on the Big Island. We are a community hospital in many ways, because we’re 35 beds. But we have some of the best people here, as well as some of the best equipment. So with the combination of location, technology, and people, we are marketing ourselves as a destination hospital for imaging and heart care as well as surgery in the future.”

NHCH is a 24-hour, acute care facility that serves 30,000 residents and visitors on the Big Island yearly. It has a new imaging pavilion with a Symphony 1.5 Tesla rapid MRI, spiral CT with 3D recon, and dual-head nuclear medicine camera, all from Siemens Medical Systems (Malvern, Pa). The facility also has 3D panoramic ultrasound, a Dexascan bone densitometry unit, and a women’s diagnostic center with mammography and ultrasound. NHCH has a sophisticated teleradiology system using a high-speed, state-sponsored network; it is used for telemedical surgery and teleconferencing both statewide and beyond, and offers a 24/7 radiology reading service.

“It’s a lot for a small place,” Guilbert admits. But NHCH is not like most small places.

Amenities for patients are resort-like: Rooms open onto lanais; imaging areas feature calming nature murals; and the lobby is dressed with art. Patients may receive acupuncture, chiropractic, and Healing Touch (an Asian massage/touch therapy that reduces anxiety). According to a 1999 national survey by Solution Point (Dallas), NHCH ranked first in patient satisfaction with hospitals up to 350 beds. Modern Maturity magazine named NHCH one of its 15 “Hospitals with Heart.”

Guilbert says there’s another thing that differentiates NHCH from big, sometimes impersonal mainland hospitals: “They’re really tied in to the technical aspects and scientific approaches of health care. We are too, but we believe we can talk about spirituality as an important aspect of healing. And our size actually helps us with that, in that we’re not a monolithic, 18-story concrete structure” in an urban center. Sick people, he says, “want to get assured from physicians scientifically, but they also want and need the arm-around-the-shoulder kind of thing.”

Residents and visitors alike who have other options often choose NHCH. Guilbert credits that to good press and word of mouth. “Hawaii is a very small market,” he says. “It’s easier for people in the state to get to know where the good places are, and they don’t think too much about flying between island and island. People will come over from the other islands to make use of the best imaging capabilities in the state. We also have a very strong tie with Earl Bakken, our president emeritus of the board.” Bakken, a co-founder of Medtronic Inc (Minneapolis), invented the first human heart pacemaker.

“His ties are international,” Guilbert says, “so we get a lot of people coming from the Pacific Rim for tours and educational seminars. They, in turn, talk to their friends, so there’s a lot of synergy.”

Bakken’s ambassadorship, a deluxe imaging facility, exotic scenery, and glowing international press add up to a can’t-miss formula. NHCH is an acute-care hospital in a jewel box, well on its way to a destination of fame.

Crowded Market, Tough Audience
“The market that we’re in, New York City, is very competitive,” Ron Sohn says without the tiniest trace of sarcasm. Sohn is the director of marketing for St Vincent’s Comprehensive Cancer Center in Manhattan, an area where more than 20 hospitals offer cancer services.

“We’re in the same backyard as Memorial Sloan-Kettering. They have a very big marketing program. New York-Presbyterian [affiliated with Columbia and Cornell universities] also has a very big advertising budget, and some of the other hospitals that are still larger than us do a good amount of advertising,” Sohn explains. So how does St Vincent’s avoid being an also-ran? Simply, he says, by focusing selectively on medicine and experimenting freely with marketing. “People will travel across the world for the right sarcoma or multiple myeloma physician,” two types of cancer in which St Vincent’s specializes. They only need to know that the services are there.

One of the newest cancer centers in the city, this $50-million facility opened 4 years ago. Sohn says, “What we promote is the new technology here from Varian Medical Systems [Palo Alto, Calif]. We’re the only Varian Learning Center on the East Coast, so we always have the latest advances in radiation oncology—linear accelerators, IMRT [intensity-modulated radiation therapy], and respiratory gating,” as well as doctors intensively trained by Varian to use those advanced technologies.

While St Vincent’s has no trouble luring top doctors, radiation therapists, and medical physicists with its hot technology, winning patients sometimes requires a personal approach. “Our print ads, for the most part, are for lung, prostate, and breast cancer,” Sohn says. “We try to go on an emotional appeal visually, but the text is very technological. For example, a print ad head says, ‘I have prostate cancer.’ Then the subhead says, ‘IMRT lets me get on with my life.’ In essence, that’s saying your quality of life is better after having this treatment, without saying you’re cured forever. We don’t make those kinds of promises.” (St Vincent’s, like all cancer treatment providers, stops short of asserting it can cure cancer; legal advisors discourage such claims, even though some patients do remain cancer-free after treatment.)

“We do a lot of media testing, in terms of which radio stations and newspapers are better,” Sohn explains. “For lung cancer, print works best, primarily because people who’ve been diagnosed with it are usually late-stage and have to make a decision very quickly as to what to do. We can say more in a newspaper ad than we can in a 60-second radio spot. Very often, patients come to our cancer center with our ads in their hands.

“Prostate cancer’s a different situation, because it’s a much slower-growing cancer,” he continues. “Most men who have it take up to 6 months to make a decision about treatment. So radio is better, because a one-time ad isn’t going to convince them. You have to keep reminding them. For breast cancer, it’s kind of half and half between radio and print.”

St Vincent’s has its own Web site (www.svccc.com) that logs a good amount of traffic, too. Sohn says, “Once people come to our Web site, there’s an email request for information or a consult. It comes through me in the marketing department, and I forward it to the appropriate doctor’s department. I track that in terms of revenue we get from search engine searches. It’s definitely a sizable amount for a very small investment.”

Sohn says he’s had less luck reaching target audiences through cable TV and Internet advertising, though he’s considering an email campaign for next year. That one’s a bit tricky, he says: “When you’re talking about 499,000 people getting cancer messages, they might be turned off by that. It’s a scary thing.”

Fresh Face, Jaded Audience
St. Vincent’s and NHCH have had time for marketing trials and errors. Both have found methods that, although quite different, work successfully for them. But what happens if you have a brand-new facility that does not enjoy the benefit of marketing hindsight?

You improvise, of course. That’s exactly what Advanced Imaging of Michigan is doing right now. Located in Troy, Advanced Imaging is the first health care provider in Michigan to get Siemens’ new SOMATOM Sensation 16-slice spiral CT. The center uses it for diagnostic and preventive scanning, including CT angiography (CTA), virtual colonoscopy, cardiac imaging, lung cancer screening, and full-body scans. Advanced Imaging has two kinds of 3D recon workstations for volumetric reading: Aquarius from TeraRecon (San Mateo, Calif) and Leonardo from Siemens.

All these progressive technologies mean the center can promise its customers easy access, speedy patient throughput, and fast report availability in addition to quality imaging and variety of service. That is why Roger Fenton, DO, FAOCR, medical director of Advanced Imaging, is confident about winning new business. “We’re going to do the whole gamut of what 16-slice CT can do,” he explains. “Our big plan is that we’d like to successfully market our services to physicians.”

The difficulty with that? “Most physicians, when they hear you have a CT center, automatically think you have a screening center. They’ve heard a lot of the cons with screening [ie, false positives and reimbursement difficulties],” Fenton says.

The solution? “All of our literature is now pointing to us as a diagnostic CT center,” he says. “I’m trying to let physicians know what we have so they understand that when they have a diagnostic CT dilemma, they can go to us. We have the ability to do it better than most places.”

The result? “We’re getting terrific response on CTA,” Fenton claims. “I had a call from a vascular surgeon. He had scans from a hospital that did slices at 7-1/2mm. He said, ‘I need 3mm slices. Can you do that?’ And I said, ‘I can do submillimeter slices!’”

Also among Advanced Imaging’s customers are orthopods unable to get their patients admitted to the nearby 1,000-bed hospital. Fenton says those doctors were blown away by his “spectacularly, spacially correct CT images” of fractures that were hard to see on X-ray. Trouble was, doctors thought they were looking at MRI.

“We’re trying to educate them,” he says. “CT scanning with 16 slices is a major difference from 4-slice scanning.” Among other improvements, it is faster and provides finer resolution. “[Doctors] don’t understand what that really can mean to them. I wrote a three-page question-and-answer sheet that we’re sending out in a direct-mail campaign. We’ve done print advertising. We’ve got press kits going out to the local media. And we go out with a loose-leaf binder containing the type of pictures we do, both black-and-white and color in 3D, to give them the concept of it. We talk about CTA.”

Fenton even hosted an open house so that 700 doctors could view firsthand what he does. Seeing, he says, is believing. “All of a sudden, they go, ‘Gee, this is cool!’ It’s very difficult to get doctors out if you’re not giving them something. We’re giving them calcium scoring scans. I want them to see the CTA and how you can follow the vessels.

“Physicians hear about 16-slice CT, they know about it, but until they get involved with it, they really don’t understand.” But they will. Fenton says, “Once we sell them on the technology and convenience, they’ll see us as the solution for all their CT scanning diagnostic needs.”