The Ireland Report on Succeeding in Women's Health, 1999
© The Ireland Corporation, 1999. All Rights Reserved.

Whether you're managing women's health for one hospital or for a whole system, it's a complicated business. It takes savvy - about people, about money, about selling.

Helix Health consists of seven hospitals covering a complex geographic area. We perform about 9,500 deliveries and 25,000 gynecology surgeries a year. The numbers sound impressive, but many of the challenges are the same as those faced in smaller systems and single hospitals.

Structure

Helix Women's Services is one of three service lines in the system, along with cardiovascular and oncology. The biggest value of our service line structure is that it adds coordination. If you need something regarding women's services, you don't have to call a million people. You can call me, and I'll probably have a pretty good idea of what's going on.

You also have one source for the all the decisions. Delegation is great, but in the end, someone has to be responsible. In the Helix system, everything having to do with women's health comes under my umbrella, from obstetric services and three breast health centers, to a women's surgical unit that even includes plastic surgery. I have an OB coordinator, a community coordinator, a marketing coordinator and a doula coordinator.

Structurally I'm on par with the hospital presidents. Basically we have a matrix women's services system - some might liken it to a spider's web. Even the marketing dollars are allocated to me, and I'm accountable for their use.

A key element of the women's services strategy is our product development committee. The committee is growing rapidly, with a wide variety of organizational elements represented. We have representatives from legal and risk management, the hospital operations directors and vice presidents for patient services, home health and physician development. It's rapidly becoming a women's services quality team. We've recently added the case managers and quality indicator people to the committee, because we're standardizing quality indicators across the system. We're also standardizing our obstetrics documentation system, which ties into our fetal monitoring system. So now we've included information systems.

To help manage our complex physician mix, which includes private physicians, Helix physicians and hospital physicians, we also have a active practice development committee.

Planning is Essential

I started at Helix a little less than a year ago and hit the ground running. First, I put together a list of data I needed, from demographics, primary service area and market share leaders to historical providers of various services and specific budgets within the hospitals. I looked at physician productivity indicators and presented each stakeholder with a structured questionnaire, which I used as a qualitative study. Finally, I interviewed nearly 50 key people, including the community and public relations directors at each of our hospitals. My efforts generated a truckload of data.

The process was a lot of work, but I was able to identify some credible reasons for the system's loss of obstetrics market share for the past eight years. It also allowed me to identify other services within my primary areas that were losing ground and helped me peg who was getting our market share. Most importantly, it gave me the chance to identify what our competitors were doing right and to start generating some ideas on ways to recapture those customers.

Probably the most powerful information I discovered from this process was that our marketing efforts were falling short. Simply put, we weren't reaching our three main target audiences: the internal audience, which includes employees and physicians, the external audience, which consists of consumers and community leaders, and the managed care entities.

The need to reach consumers appears to be a no-brainer. But the other two audiences are equally important. First, your internal audience creates and sells the product. If they don't believe in your institution, no one will. And since we're in a stage three or four managed care market, we certainly can't afford to ignore that audience. It's where the money is, and consequently, to some extent it's where our future lies.

Business Means Selling

Let's backtrack for a moment. I said reaching the consumers appears to be a no-brainer. But the truth is, it's very complex. For a very long time - longer than we should have - those of us in the healthcare profession refused to call heathcare a "business." We've finally managed to whisper that term in the boardrooms, out of earshot of the patients, or "customers." Now I know this will ruffle a few feathers, but successful businesses sell things. In our case it's healthcare, and a lot more.

To sell, you need a sales force, and that's what we have. Headed by my marketing coordinator, who works closely with the system's marketing department, we have women's services community representatives at each of our hospitals. Their sole job is direct sales. Like most sales teams, they have specific territories and are tasked with both cold and warm calling. They may visit a school one day and a beauty salon the next. They deal with physicians, employers, universities and high-profile organizations within the community. They're also responsible for alignment of the staff at their individual hospitals as well as obstetric patient satisfaction calls. But their biggest responsibility is getting the best of the competition.

Good sales people need top-notch sales support products, from brochures and newsletters to print and broadcast advertisements. My marketing budget is $1.9 million, which represents almost half of the entire Helix marketing budget. An organization wouldn't throw that kind of money at something unless it can bring in significant revenues.

A strong retail orientation is also important. At two of our hospitals, Union Memorial and Harbor, we feature centers that specialize in appearance enhancement. They focus on women who have had cancer, scarring or facial disfigurement, as well as those dealing with body image issues such as pregnancy or lactation. The centers are staffed by therapeutic cosmetologists - image experts who deal with everything from wigs and makeup application to prosthetics and specialized clothing.

Make the Patient's Experience Valuable

A core tenet at Helix is that in a competitive market, consumers look for added value. It's often the one sure way to differentiate yourself from the competition. Giving that little extra tells customers - whether they're patients, physicians or managed care entities - that you truly care about and respect them; that you want the best for them. If you can establish that type of relationship, you'll own them.

Doulas are a good example. They aren't mandatory, but they virtually guarantee great patient satisfaction, and we know patient satisfaction is critical in women's health. A satisfied woman will tell five to seven people about her experience; a dissatisfied woman will tell 20. I talked a moment ago about having a sales team, but the fact is, your customers are your best sales representatives.

Free doulas are a way we differentiate ourselves. In addition, we've put together a system-wide birthing plan that mothers and their partners fill out with the help of one of our 45 part-time doulas before they go into labor. We were able to show it was a $500 retail value. It's one way we demonstrate our commitment to providing the very best personalized care.

We also offer obstetrics personal service coordinators - OB registered nurses who answer questions, help with birth planning, and deal with fertility, pregnancy, postpartum and breastfeeding issues.

Not every women's services consumer is pregnant, so we also make sure we offer goodies for women in other stages of life, as well. We're currently partnering with several progressive fitness centers that offer psychiatric services, counseling services, acupuncture, herbal therapy, massage therapy and gourmet kitchens for healthy cooking classes. We're bringing a multispecialty female group to the table. They'll provide special sessions and serve as permanent OB/GYN or female primary care providers on site. It's a very economical way to cross sell and offers something for everyone without a lot of overhead.

Make the Community Your Home

Successful businesses don't happen in a vacuum. You have to be a presence in the community. In addition to "Baltimore's Biggest Baby Shower" (see related story), we sponsor all kinds of activities to capture potential customers' attention. In addition to the standard health fairs, maternity fashion shows and community relations programs, we get creative. We've hosted tours of Baltimore Harbor, sponsored a Women's Health Legislative Day and offered a "Meet the Doctor Night" to attract pregnant women considering other hospitals. We transitioned 100 percent of those patients. Helix also gives away a "Day of Beauty" for

The key to any community-based program is cross-marketing. Not every program is going to bring in direct revenues, but they still have to pay their way. Therefore, it's important to track your conversions - how many people came to your event, and how much did they spend at your institution. In the end, if they're not using revenue-producing services, you haven't done your job.

We register everyone who attends our events and put that information into our database. It's huge, but it allows us to generate mega-mailing-lists targeting some very specialized groups.

Manage People, Not Programs

Programs are things, and great things are produced by great people. The key to successful programs is to get the right people and manage them in ways that bring out their best.

Personally, I'm surrounded by people who are a lot like me - real Type A's. They're very goal-directed, and that generates a lot of energy. It's very contagious, but my staff members' goals don't always mesh, so I also have to be adept at managing change and conflict. In addition, I make it a point to get a lot of face time with people up and down the line. It's not uncommon for me to visit three or four of our facilities a day.

Alignment is a core strategy. I've implemented a bonus program designed to spur alignment among all women's services employees throughout the system. We've based it on four performance standards. We have three system-wide targets to meet in terms of volume, customer satisfaction and consumer preference. Then each employee has to volunteer at a community event every quarter to get their bonus.

I've also been doing a lot of mentoring with department directors to teach them about incentive management. I recently put together "tool kits" for each of my managers. They're packed full of goodies - thank you cards, movie tickets, microwave popcorn. When employees do something good, the managers can go to their tool kit and have thank you notes and gifts at their fingertips. Then I have them keep a log of what they give out and fax it to my marketing coordinator each month. That way we can also acknowledge good work in our monthly newsletter. It creates trust and pride, essential tools for getting the best out of people.

Docs at the Front Lines

We all know that nurses are the backbone of the healthcare industry, and support staff are indispensable, but when people think of hospitals, they think of doctors. So you've got to keep the physicians happy, and also ensure they buy into your program.

Right now we're doing a lot of physician contracting, and I'm creating value-added services to enhance their practices, to tie them to us. Physician development is a huge piece of what I do. Each of our hospitals have physician relations representatives.

We treat our docs well, but we expect some things in return. We've implemented performance standards for all physicians in the system. For instance, I expect 120 to 140 deliveries a year, 60 to 80 major GYN cases, 80 to 100 minor cases and 30-40 patients per day in the office. I analyze their capacity based on that.

In one of our critical counties we're creating a "virtual women's health group." We have several solo practitioners with private offices in that county. They have a lot of overhead, but they don't want to be in a group together. The virtual women's health group is like being in an office building, but the services are all coordinated, and they'll have access to equipment they couldn't afford on their own.

I've made it an easy sell. I do an analysis right in their office. I show them what they pay and then what we can do. We've been able to save them money every time. They also get a lot of value-added incentives in terms of marketing support, visibility and managed care credentialling as a Helix provider, but they retain full control and ownership of their practice. It's a good deal for everyone.

And when they're ready to give up their practice, we help them with that too. We've proven that in most cases it's more advantageous for physicians to donate their practice to us and take it as a tax right off, since Uncle Sam grabs 65 percent of the purchase price anyway.

Lessons Learned

* Leadership means leading. It often means identifying the right people and then giving them the power and authority to do the job, but it also means taking charge when guidance is needed. Don't be afraid to step out in front of the crowd. That's where leaders belong.

* Overhead can crush you. It's great to offer a lot of free programs, low-cost services and special events, but such overhead can weigh a ton. If you don't have revenue sources to counterbalance overhead (think services that payors actual pay for), you're probably destined for failure.

* Develop cat-like reflexes. Learn to constantly scan the environment for change and react quickly.

* Like hats - especially thinking caps. If you're managing women's health well, you're probably going to be wearing many different hats, so you'd better have the knowledge base to wear them well. Not knowing how to do something or who to turn to for help can waste a lot of time, and time is often your most valuable resource.

* Make technology work for you. Most people fall into one of two categories. Those who fear technology and rarely use it to their advantage, and those who let technology rule them. Databases, computers, communications - they're tools. Use them . . . wisely.

* Let the right hand know what the left hand is doing. Being part of a system is a big advantage, but without coordination and integration, it can quickly become a nightmare of finger-pointing, recrimination and miscommunication.

* Make meetings "meetingful." Too often meetings drag on for hours but communicate so little new information, people feel free to skip them. Good meetings should be as long as necessary - but no longer. And they should be packed full of information. If no one has anything new to say, there's no sense in taking two hours to not say it. In our organization, people don't miss meetings, because they'll be out of the loop.

* Get the best out of others. You can't do it all, so motivate those around you with rewards, incentives and sincere and selective recognition.

* If you're in a system, learn to work as a system. Investments are system investments, and profits and losses are the system's, not just individual institutions'.

* Decide what to focus on. No matter how hard you try, you can't be all things to all people. If you do, you'll lose money. Identify your organization's strong points, and use them to differentiate your program from your competitors'. Build a niche in an area where a need is going unmet.

* And make more friends than enemies. One-on-one relationships are critical. They're where sales happen, reputations develop and deals get done. So pick your battles carefully, because win or lose, they will probably have long-term consequences.

Vicki Lucas, Ph.D. is Vice President of Women's Services, MedStar Health, Baltimore, MD.

© The Ireland Corporation, 1999. All Rights Reserved.

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