by Daniel Fell

As health care ratings, rankings, and awards continue to grow in popularity within the industry, many marketers are feeling the pressure to help their organizations get better results. Whether the objective is strategic or reactionary, the conversation has clearly shifted from one of whether the ratings are important to how to go about getting better ratings.

This achievement could mean being awarded a specific honor or designation, moving up on a list of top-rated facilities, or simply getting on a list for the first time. The good news? There is no shortage of published health care quality measures today, and even more are on the way.

Not satisfied with being passive participants in their organizations’ national rankings and quality scores, Beth NeCamp of Ohio State University Medical Center (OSUMC) in Columbus and Donna Teach of Nationwide Children’s Hospital, also in Columbus, are examples of the type of health care marketing professionals who are taking a proactive role in improving their institution’s standing.

But their experiences also shed more light on the fact that there are no easy marketing fixes, hospital systems have to be committed to the task, and results come over time. More important, to their credit, both NeCamp and Teach are championing thoughtful approaches that involve analyzing the various ratings programs, building internal understanding and consensus, and developing formal reputation-building processes that maximize their efforts over time.

Analyzing the ratings
A quick review of the vast array of health care ratings out there reveals the majority fit into one of several subject types. There are clinical ratings that are typically divided into clinical process and clinical outcomes measures, service-related ratings that evaluate or rank providers on any number of fundamental service quality scores, financial and operational ratings that look at the efficiency and financial strength of an organization, and finally, a hodgepodge of other awards and ratings. In that last category are best-place-to-work awards and specialty measures, such as a charitable strength score for non-profit foundations.

Which ratings are most important will vary with the organization. Their importance may depend on your long-term objectives, the service lines targeted for financial support and growth, your balance of internal and external needs, how your competitors are marketing themselves, and a host of other factors. Being able to align business objectives with relevant third-party measurements is essential.

Another way to classify the ratings programs that may influence how you approach them is by structure – or how they are organized and promoted and what it takes to be included. While some ratings are produced by third-party companies on their own (100 Top Hospitals by Thomson Reuters is an example), others such as the Magnet Recognition Program for nursing excellence and the Malcolm Baldrige National Quality Award typically require a significant investment of time and resources. Some require an application fee or, like J.D. Power and Associates, charge a fee as part of an evaluation. Still others, including the Most Wired program from Hospitals & Health Networks and some of the popular top-hospital magazine lists, only require the completion of an application for consideration or inclusion.

While programs such as the America’s Best Hospitals list from U.S. News & World Report are more heavily promoted, others may be limited to certain subscribers (Consumer Reports is an example) or have little to no marketing behind them. Hospital Compare and similarly mandated quality data programs have public websites, but in reality there are no funds to educate the public or promote the rankings in any meaningful way, so awareness and understanding of these ratings are much lower.

Finally, although some awards and recognition programs can be used in marketing programs free of charge with few restrictions, others may have very strict guidelines on the appropriate citation of the award and use in marketing. Still others may require a licensing fee for the rights to use the rating company’s name and the rankings in advertising. HealthGrades is the quintessential example of a rating system in the last category.

Building consensus
Perhaps the most important part of improving any organization’s national rankings is framing the discussion with internal stakeholders and building consensus on what matters, what doesn’t, and what to pursue. In fact, simply setting a goal and putting forth a concerted effort can yield significant results, as Children’s Healthcare of Atlanta found several years ago when it decided to proactively pursue better rankings among several national pediatric ratings programs. Within a couple of years, the organization had moved up in ranking on the list of top children’s hospitals in Parents magazine and received several other national awards it had sought.

NeCamp, who is chief communications officer at OSUMC, points out that health care ratings are just one part of a marketing plan that, in turn, is one part of a larger, multifaceted national reputation plan the institution developed as the guiding framework for everything it does.

That philosophy of focusing on reputation frames everything in such a way as to place certain ratings programs within the context of a more meaningful and practical approach to marketing the institution. “Reputation influences rankings, which in turn influences everything from recruitment and research funding to consumer awareness and quality of care. And all that influences our reputation and so on,” NeCamp explains. “As we see it, it’s all interconnected, which means we don’t have to spend time debating methodologies but instead can focus on our reputation and quality.”

As an example, OSUMC’s goal is to be a top-20 academic medical center in the United States, and 25 percent of its internal scorecard is tied to the U.S. News & World Report rankings. In many ways, the ranking is a validation of what OSUMC is doing, not an end in itself. That is an important distinction. As NeCamp puts it, “We’re not chasing rankings, we’re chasing quality.”

Teach, who is vice president of marketing and public relations at Nationwide Children’s, says the hospital has a similar shared platform of understanding and focus among the leadership team. “We know, for instance, that certain things are important and we agree on these,” she says. “Magnet is important to our nurses, national rankings are important to the subspecialists we’re trying to recruit, and being on the Philanthropy 400 is very important to our donors and hence to our foundation.”

Both organizations also point to the critical importance of having physicians vested in the effort and have put physicians at the center of their efforts. OSUMC has three physician leaders on its national reputation panel, which helps drive the efforts of other doctors. Nationwide Children’s has a medical director who oversees all its ratings submissions, in addition to a medical director for each of its major ratings programs.

“We don’t have any meetings on ratings where a doctor isn’t present,” states NeCamp. “And many of these physicians are also working on their own individual rankings at the same time.”

Formalizing the process
To improve their rankings, hospitals such as OSUMC and Nationwide Children’s are implementing specific strategies and tactics that aim to enhance the quality, accuracy, and relevance of their organization’s information when it is compiled or submitted for review.

“Understanding and maximizing the surveys is essential,” says Teach. “You have to read them carefully and fill them out completely. The fine print is very important as well. If the survey asks for three ways [in which] you enhance the customer experience, you better give three examples.”

She adds that interviews with survey managers and publication editors can be helpful – both before the submission process, to glean insights about completing the information accurately, and then again once the survey is out, to help understand how the data was interpreted. Over time, Nationwide Children’s has been able to enhance its applications and fine-tune what it submits for some of the ratings programs.

For other types of third-party information, such as the MEDPAR data that HealthGrades and Thomson Reuters use to rank hospitals, marketers have sometimes found that incorrect coding can result in low scores. A detailed analysis of clinical or operational data over a certain period of time can often uncover problems and help an organization correct data reporting errors that can cause it to rank lower than it would otherwise.

For measurement programs such as the HCAHPS patient experience scores and similar customer service ratings, some hospitals have found that simple operational changes can have a significant impact on their grades. One frequently cited example is the use of pre-op and discharge phone calls to patients. Studies have consistently shown that hospitals do better on customer surveys from patients who have received these types of calls versus control groups who did not.

Providers that are increasingly dependent on pay-for-performance programs, where as much as 25 percent of the calculated reimbursement incentive may be tied to patient experience measures, should find the cost of the added initiatives well worth the investment.

Communications is also a critically important component of any national reputation-building program. OSUMC created an annual accomplishment report to market its heart program and mailed the report to more than 30,000 cardiovascular medicine and surgery specialists around the country. Along with other nationally ranked leaders, OSUMC hosts cardiac CME courses.

Using good old-fashioned media relations tactics, such as having specialists travel to meet with medical writers, and then leveraging story opportunities with new media can have a powerful impact as well. NeCamp found a news opportunity with a study that looked at the way in which wireless heart monitors were keeping patients out of the hospital.

Measuring success
Many hospitals that take a strategic approach to managing their national reputation and proactively work to improve their scores among certain third-party ratings firms are finding success. In fact, both OSUMC and Nationwide Children’s have seen tangible results from their efforts – particularly in the past two years.

With its heart program, OSUMC went from being absent from the U.S. News & World Report America’s Best Hospitals list to ultimately increasing its ranking 17 spots – from 37 in 2009 to 20 in 2010. Nationwide Children’s has moved from 14th place on the Best Children’s Hospitals list of Parents magazine, its ranking in 2001, to 6th place in 2009.

But as Teach points out, “Validations are just the price of admission to move the target audience into awareness and consideration. The real question is whether you are ready for that shopping experience. How is your customer service? What is the patient experience like? How are you facilitating word-of-mouth?”

Indeed, good health care marketing doesn’t end with the next award or better rating. It’s merely one component of building a stronger reputation and maintaining that distinction over time.

Smart health care marketers are not sitting idle while third-party ratings firms simply rank their institutions in a vacuum. They are creating strategies and processes that help their organizations maximize potential on multiple levels – including getting better scores over time.

Daniel Fell is executive vice president at Neathawk Dubuque & Packett. Fell heads the marketing communications firm’s Chattanooga, TN, office and is a frequent speaker on health care marketing, particularly relating to quality issues. He can be reached at dfell@ndp-agency.com or 423/752-4687 ext. 300.