The NHS and healthcare marketing

David Thorp, Director of Research and Professional Development at the Chartered Institute of Marketing, describes how healthcare marketers can help NHS trusts to achieve their own marketing goals.

The recent White Paper from the Chartered Institute of Marketing Measure for measure: Metrics and marketers in the NHS makes a strong case for greater awareness in the NHS of the value of evidence-based marketing. The paper places emphasis on metrics as the basis of marketing, and suggests that marketers from the private sector have much to offer NHS trusts.

Beyond the actual products or services they are promoting, what can healthcare marketers bring to the NHS?

Healthcare marketers tend to work broadly in one of two areas: communications or social marketing. For social marketing, the benefits of commercial marketing tools and techniques are increasingly recognised by the NHS and central Government – consider the huge number of new campaigns rolled out in recent months to address issues such as obesity, responsible drinking, smoking cessation and the need for integrated diet and exercise programmes.

Commercial marketing techniques such as segmentation are enormously helpful. Firstly, they save the NHS money as they avoid a scattergun approach that diffuses resources. Secondly, they make a campaign more effective, because segmentation is about reaching the right person, in the right place, at the right time, in the right way. Thirdly, a marketing approach can tailor campaigns in ways that resonate with the target audience, and make take-up of a desired behavioural change more likely to succeed. The Change 4 Life programme, for example, tries to see the barriers to lifestyle change from the viewpoint of the ‘customer’ and to address them in the ways that are most likely to motivate change. It avoids the word ‘exercise’, for instance, because that sounds a bit boring and like a chore. Instead, it talks about ‘getting active’ – and makes the activity seem fun by showing the interesting and easy ways that you can do it. A key to effective social marketing is to make things fun.

All this is the ‘marketing’ part of ‘social marketing’. It’s the opposite extreme from an authoritative figure in a white coat waving a finger and saying “Do this because it’s good for you.” Social marketing analyses what makes the patient tick and what might prevent them changing their behaviour, and finds ways of helping the patient to buy into the process. If you want to stop teenagers smoking, for instance, it might seem appropriate to emphasise the health benefits to them. However, the average teenager can’t identify with their potential early death: it seems so distant. Instead, focusing on areas that have immediate meaning for the teenager – your teeth will be whiter, you’ll smell nicer and you’ll be more attractive to the opposite sex, as well as having more money to spend – could be a far more effective approach. The ‘figure in a white coat’ approach just makes smoking seem ‘cool’, and so is counter-productive.

In communications, the benefits that marketers bring go beyond merely promoting products or services. A marketing approach can, for example, help managers and clinicians to work more successfully together, because it focuses them more effectively on the patient as the end user. Also, more robust internal and external marketing can help to erode the negative media perception of the NHS, and communicate the positive and successful organisation that the NHS frequently is in reality.

Showing staff the damage they cause by criticising or complaining about the service when in public, for example, is a marketing tactic that could have a large impact, but be simple and cheap to achieve. Word of mouth is an under-recognised but important part of how the public learns about an organisation of the NHS’s size. Instead of communicating its faults, much more could be done to emphasise the good work that takes place.

Why does the Institute’s White Paper place so much emphasis on metrics as the key aspect of NHS marketing?

It’s a business cliché to say that what doesn’t get measured, doesn’t get done. This applies to the NHS: in fact it’s even more pertinent, because ‘marketing’ as a concept is still treated with a certain amount of suspicion in many parts of the NHS. There’s the view that ‘Every pound spent on marketing is a pound not spent on a patient’ – and so there is a need to prove that marketing creates value, rather than being a cost. The clearest way to do that is to have a set of metrics that isolate the value created by marketing, so it can be proved transparently that the cost is less than the gain.

For example, consider a social marketing smoking cessation campaign. If you measure the number of calls you receive for the campaign, the number of people who enquire about patches and advice, the take-up of those patches and advice, and the number of people who set a date to quit, and then measure the number of people who have still quit after (say) six and twelve weeks, then you can calculate how much each quitter is likely to save the NHS over their lifetime, compared to the total cost of the campaign. The problem that marketing often has is that because the visible end of the process is advertisements, the marketing cynic thinks that is all there is to it. Social marketing influences behaviours over a much longer period of time, and measuring this is difficult (but not impossible). Later, when a culture of marketing is more accepted, rigorous measurement won’t be so vital – we are aware of the risk that calling for more measurement seems like another call for ‘targets’.

Metrics bring their own problems. Some areas are important, but hard to measure; others are simpler to measure, but less relevant. This means that measurement can end up being skewed towards the areas that are easier to measure, rather than the most important elements. One of the arguments our White Paper expands on is the value of having a ‘metric of metrics’ that can go some way towards addressing this issue.

A specific problem with healthcare metrics that NHS marketing can encounter is that to measure the success of a social marketing campaign, you need to create your data from information patients give you. Variations in self-reporting are a problem long known to the NHS. For instance, a healthy eating campaign can appear to be more successful than it was in reality due to people over-estimating their intake of fruit and vegetables when they fill in a survey. So, though we call for more measurement, we also want to emphasise that it’s important not to get too hung up on metrics. They have their uses; but you need to be aware of the ranges of possible scenarios they can project, and not necessarily read the results too literally.

A sceptical NHS customer might argue that marketing is about ‘spin’ and not real outcomes, or about ‘competition’ and not teamwork. How can private sector marketers best demonstrate their value to NHS trusts?

While the suspicion of marketing is lessening, this perception that marketing is about spin or creating competition needs to be addressed. The first issue, we would argue, is relatively simple to resolve: marketers working with the NHS need to avoid using marketing jargon, and find ways of describing their activities that clinicians and NHS managers identify with.

The second issue is harder, because it is inevitable that with patient choice, the customer is helped to choose where they are treated. That means a PCT has to persuade the patient to come to them, rather than someone else. That can, in extreme cases, lead to trusts competing. One way to prevent this is to try to develop the NHS brand more effectively: to show patients that it’s not a question of competition between trusts, but of them having the right set of choices to suit their particular needs. Sometimes the patient can go round the corner to be treated locally; at other times it’s best to travel for specialist treatment. Communicating that in the right way shows that the NHS has the patient’s best interests at heart, and goes some way towards changing negative media perceptions of the NHS.

There are two key ways in which marketers can demonstrate their value to NHS trusts. Firstly, by instilling the need for metrics into their daily activities – our White Paper expands on how to do this. Secondly, by using internal communications to demonstrate that what they do is not about designing pretty posters and spending public money on setting trusts against each other. Marketing is about finding ways to extract more value from existing budgets, not demanding more budget for marketing purposes. It’s about balancing the needs of different stakeholders (in this case, managers, clinicians, GPs, patients and overlooked but important stakeholders such as patients’ relatives) and finding the optimum solution that helps patients while meeting the restrictions of budget and government policy.

However, a marketing culture will never be established in the NHS without top-down support. The trust Chief Exec needs to recognise the value of marketing, and communicate those benefits to the rest of the organisation. If the leadership believes that marketing is only equivalent to promotion, marketing will always face an uphill struggle to prove its worth. Our research would seem to indicate that at the moment, some Chief Execs are very supportive of marketing and understand what it does, and that the tide is definitely turning in a positive direction.

How important is the concept of ‘patient-centred care’ to the marketing needs of NHS trusts?

For the marketer, ‘patient-centred’ means ‘customer-centred’. Placing the individual at the heart of the process is essential to successful marketing – not in the sense of doing just what the customer ‘wants’, but rather understanding their needs, wants, motivations and dislikes. What a GP does – looking at a patient’s history, understanding what the problem is, making a diagnosis and deciding on the best way forward – sits in a direct line with good marketing practice.

What ‘patient choice’ means in practice is that patients can choose. That inevitably means that, whatever the pros and cons, the NHS needs to adopt a marketing approach because patients will ‘vote with their feet’. If they don’t have an experience that satisfies them, they will go elsewhere. This has a direct influence on your emphasis when measuring the effects of marketing. Patient satisfaction – what the reception service was like, how staff spoke to them, the quality of food etc – may seem very low on the list of priorities when compared with survival rates. However, because it is the tangible end of the service, its importance becomes disproportionately large. Patients will measure their experience based largely on these elements.

So if you get this essentially straightforward measure right, you give yourself a considerable advantage when it comes to sending the patient away satisfied and an advocate of the service. It’s not too much of an exaggeration to say that getting such measures right can be the tipping point between a thriving trust and a failing one. The fact that clinical excellence can usually be taken as a given makes a rod for the NHS’s own back in a sense: it means the ‘customers’ judge the service on other, seemingly lesser issues.

While this could run the risk of making trusts ‘compete’ with each other, the NHS has to take this bull by the horns and find the mutual benefits that patient choice brings, rather than dwelling on the problems it creates. One of the difficulties the NHS faces is that it has to divert resources into Government requirements (e.g. collecting waiting list data) even when the public’s attention has moved on to other issues (e.g. cleanliness and HCAIs have largely supplanted waiting times as the focus of public concern).

Additionally, offering the patient more choice can be problematic because the patient is not always the best judge of their own needs. In both Measure for Measure and our first paper, The Real NHS: the benefits of a marketing approach (2008), we emphasise that patient-centric intentions should never override clinical judgement.

What can healthcare marketers do to connect the products and services they are promoting to the marketing needs of NHS trusts?

The example of pharma is useful here. More interaction between pharma marketers and NHS managers could highlight gaps in the market that can be filled with new products and services, and give insight and detail to companies seeking to improve and modify their products. At the moment, much pharma marketing inevitably becomes sales-focused: the marketer finds a manager who will talk to them, and then succeeds or fails in selling their product. More genuine dialogue would help marketers to connect their products and services to the marketing needs of the trusts. The barrier, as always, is lack of time rather than unwillingness to interact.

David Thorp

“What ‘patient choice’ means in practice is that patients can choose. That inevitably means that the NHS needs to adopt a marketing approach because patients will ‘vote with their feet’. If they don’t have an experience that satisfies them, they will go elsewhere.”