Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate, American College of Healthcare Executives
There are ONLY three ways to increase practice revenues: 1) get more new clients, 2) get more money from each client encounter, or 3) get clients to return more often each year.
Dr. T. E. Catanzaro
There is marketing, and there is advertising. Some people even add public relations to this list of outreach programs. But in veterinary practice, we have centered on gimmicks and one-shot attempts, then wonder why we have failures. So let us look at the difference, from least offensive to most offensive, as seen by our colleagues.
PUBLIC RELATIONS --Those things that we do to improve the image of the profession, such as: volunteer for church committees, host Scout tours of our facility, speak at the local schools, judge science fairs or support a local welfare agency.
MARKETING -- A three-step process based on making a client aware of a preexisting need, informing the client that the need can be filled with today's technology, then telling the client that we can provide that service in a caring manner.
ADVERTISING -- The methodology to convince clients that they need a service or product for the benefit of the seller (but that service or product should do no harm).
There are some who would disagree with the brevity of the above definitions, such as those who make their living by selling advertising or public relation services, because the clarity is designed for the consumer and not the seller. But the real fact of the matter is that it doesn't matter. In reality, clients don't care what you call it, and your staff is not impressed by the definitions, it is the perceptions that must be addressed in a veterinary practice. Perceptions are simply the view of the client to what is being offered, for instance:
Does the consumer buy coal, or do they buy heat?
Does the reader by a newspaper, or do they buy information?
Does a family purchase a new water heater, or do they just want more hot water?
Does a pet owner want preventive healthcare, or do they want a healthy, happy, well family member?
These perspectives are the basis of marketing, and in some cases, the basis of advertising. In the advertising field, they talk about "selling the sizzle," which comes from the original bacon advertising scheme. How can you market a product that clogs arteries and is basically just the fat from a pig? On television, they let you hear the sizzle, not see the product; they talk of how it goes with eggs or BLT sandwiches, not how it balances the nutritional needs of the consumer. They sell the senses, not the product.
To make any client marketing effort work, internal marketing must precede any external effort, but this means more than selling services or products to existing clients. Any marketing effort must be sold to the staff members before ANY effort is expended toward clients. The training of clients requires leading by example, walking the talk rather than just talking the talk. If you want an increase in nutritional sales, then EVERYONE in the practice must be feeding those premium products to their pets. In an Illinois practice where we consulted, the veterinarian was not feeding the premium products to their own pet; by just converting the feeding habits of the veterinarian and staff, the nutritional sales increased by 19 percent during the first quarter. We must sell ourselves and our staff before we set about selling the clients.
In a practice we work with in Michigan, every employee is required to have a pet, and have regular wellness care, to include brushing the teeth of their pet. Once this became an established and accepted expectation, dental hygiene marketing efforts automatically increased. If we don't do it, the staff won't either. It is a basic principle of leadership applied to marketing; you must lead by example. What the leader does speaks so loudly, the followers cannot hear what they were told.
Computerized practices are data heavy, reams of paper that say what has happened. Some practices use this data to beat the staff into submission, comparing average transaction by veterinarian, comparing over-the-counter sales by receptionist, or creating similar internal conflicts. This method has an initial shock value, but team members are pitted against one another rather than toward a client-centered goal, so the benefit loses value quickly through justification and excuses. Once this data goes through the cause-and-effect analysis process it becomes information. Training bridges the gap between the leaders perceived information and belief by the staff. Internal marketing means training our staff in the WHY of the OUTCOME, not in the BECAUSE of the sale. Outcome is the perceived benefit; because is only the process.
Managing Public Perceptions
A common marketing perspective is "What is in it for me?"; this seems to be the common attitude within our society today. In "Veterinary Healthcare Services: Options in Delivery", February 2000 release from Iowa State University Press, we shared persuasion marketing and sample marketing programs; these were all INTERNAL programs, since that is where the profit really lies for a veterinary practice. Internal promotion means increasing a client's veterinary I.Q., and it is an important aspect of any quality veterinary practice; in the lack of knowledge, all decisions are based on price. It was never high costs, it was low perceptions of value; quality practices have staff-centered client education programs. The subject of public perception is often different from just bonding the client to your own practice. Public relations is doing something for no personal reward while subjecting yourself to the slings and arrows of the public and your peers . . . you have to love it!
If one were to judge the condition of the nation's veterinary healthcare services by front page and evening news headlines, the prognosis would likely fall somewhere between awful and nonexistent. Yet that is precisely how the public, with less than half being regular veterinary healthcare consumers, forms its opinions. It is an exceptional veterinary practice which understands that it needs 5 to 6 positive exposures to get a knowledgeable client to say "yes", and an uninformed client requires more than twice that many exposures before accepting a new service or program.
Media sources have always played a significant role in molding public opinion. Veterinarians used that to their advantage in the "good news" era that was marked by announcements of a veterinarian finally coming to a previously void area of town. Those stories focused on the facilities, the veterinarian, and the success and miracles that mark the history of veterinary medicine. But now a new veterinarian is not usually considered newsworthy and the news columns and air time need "sensationalism" to keep their "market share"; the result is generally negative stories or comedy relief inserts that no longer persuade the public of our worth. There is a secondary problem emerging, and that is the veterinary medical "averages" being published in the literature. The survey samples, which are generally statistically invalid, often include many struggling new practices, therefore the data reported is expense heavy and income light. An average has been defined as "the best of the worst" or "the worst of the best" in the past, but with a poor sample, an average may just as likely be substandard and contradicted.
Every veterinarian owes it to his/her practice, their clients, and the public to become a spokesperson in their local market area. This opportunity may be speaking to a women's club, a Lion's group, Rotary, at schools, to PTAs, or in any other public forum. The lessons learned by others are invaluable and some are listed below to help you and your staff improve public perceptions of veterinary medicine.
Formulate your communication objectives before you seek an interview. An interview is your opportunity to make a case or a point. Prepare single objectives with alternative points and use the interviewer's questions as opportunities to return to your own agenda.
Learn as much as you can about the audience, or the media source and the interviewer, before going into any meeting. If possible, link yourself to one of their vested interests by identifying a positive personal fact or story.
Anticipate opposing points of view and expect the audience or interviewer to play "devil's advocate"; conflict sells in the media, especially on sensitive and emotional issues. Work out your responses to difficult or controversial issues during your pre-interview research.
Avoid being suckered by a sensationalizing interviewer or heckler. Be insistent about finishing your answer if you feel interrupted. However, maintain a professional demeanor and avoid exploding at stupidity or rumors. Since the public is a "feeling" audience, they will usually forget those informative answers and remember only the inappropriate behavior.
Never say "no comment". It is a red flag for reporters to delve deeper into a story. For the public it is sometimes viewed as an admission of guilt. Instead, offer to get back to the group or interviewer at a specific time with an appropriate response.
Don't be afraid to ask questions -- especially of print reporters. Find out what kind of story is being developed; what is the angle, approach, or objective? In which publication or section of a publication will the article appear? Are other persons being interviewed about the same subject and who are they? What are the deadlines?
Be brief and succinct -- broadcast news is offered in small components. A good "sound bite" captures the idea and heart in ten seconds. Keep your points to a few brief sentences and make sure that your main points stand out clearly. Try to use your interviewer's name in your responses.
Speak in clear, direct, concrete language. Veterinary medicine has its own jargon and while your colleagues may understand it, the general public will not. Always explain abbreviations and terms in context.
Tactfully refute misinformation and falsehoods but do not attack or take affront. There is nothing wrong with saying "Excuse me, Harry, but I believe there is another way of looking at that issue." Make sure that you correct a misleading statement in an informative and helpful manner.
Avoid a litany of statistics. Very few people can deal with number after number, especially when there is no interpretation of the data. If you offer a statistic, be sure to round it off and be willing to interpret it for the interviewer.
Avoid defensive responses. If the facts point a dark picture, don't deny them. Keep your communication objectives in mind. Think through a non-defensive answer and know the details fully. If the issue is technical, do not revert to a professional vocabulary but rather be ready to simplify the issue to terms that will persuade the public opinion toward your point(s).
Know your position. As veterinary issues emerge, evaluate how each local market medium will treat an issue. Past history and national trends will help determine the media's position. Decide how you want to position yourself on each critical issue.
Proactive media relations demand time and commitment. It requires the veterinarian to become a public figure. It forces development of a point of view which almost certainly will elicit opposing opinions. It is not without risk. Safer media relations that are less risky include scheduling speakers into the local association meeting that have a public interest topic (e.g., Lyme Disease, Feline Aids, Restoring Puppy Kisses, etc.) and just inform the media that a nationally known speaker will be in the community addressing a issue that is of interest to the general public. Even this is risky because the presentation may cause embarrassment to local veterinarians who do not participate in the local professional organization, or to those practitioners that are not willing to match the state of the art which the media will report to the public.
There are also significant rewards. Media awareness translates to increased visibility for the profession and any practice willing to "go on the record"; the financial cost is virtually free. Each interview is an opportunity to put forth a positive message and increase the public awareness toward veterinary healthcare. Spokespersons who prove to be available, reliable, and quotable become valued media sources. The interviewers are more likely to listen to trusted sources and call on people they know when it is time to tell the good news or local position.
Most important, the proactive professional spokesperson can have an enormous influence on how the news is reported and, therefore, what the public hears and reads. Perceptions can be changed. The degree to which they will rests with the local veterinary leadership in each media market area. Paraphrasing a famous past president, "Ask not what your Association can do for you, but rather, proactively seek what you can do for your Association."
Selling The Sizzle
Advertising sells the "sizzle" of the bacon, not the fat content. In public relations, it means selling the excitement or security of the benefits to the community provided by the veterinary profession. In a specific veterinary practice, "selling the sizzle" means ensuring every staff member believes in the new program. They can see how the pet will benefit, and in some cases, how they will benefit for supporting the new practice effort. Internal marketing means creating the awareness in the staff member of the preexisting wellness need, convincing them that the service or product is really contributory to the animal's wellness, and then ensuring they believe that the practice's delivery of the service or product is a real value to the client and pet.
The training program should not be dictated; it needs to be facilitated. The discussion needs to start at where the staff member's mind is at, not where the veterinarian's perception may be. The best way to start this discussion is to create a "discovery" situation for the staff. A well planned discovery serves two functions:
First - creates the awareness of the need,
Second - determine where the staff's awareness really is.
Let's look at a simple example, such as the staff meeting question of, "What is visceral larval migrans?" If an adequate response comes quickly, a follow-up inquiry can be made, such as, "Does anyone know what percentage of intestinal flu in children was misdiagnosed because of visceral larval migrans?" The Center for Disease Control has shown that over 25 percent of some past intestinal flu children groups were actually caused by visceral larval migrans. Now for the kicker questions, "what causes visceral larval migrans?" and "What can we do to help prevent children from becoming infected?" You will be surprised by the replies, since they usually encompass public relations (e.g. school presentations) as well as marketing commitments (e.g. more fecals) by the paraprofessional staff. Why do you think the Center for Disease Control and Prevention did such a major public relations information push on strategic deworming a year ago?
Discoveries do not have to be proactive questions, they can be retrospective experiences that need staff evaluation, such as, "The cash close out hasn't balanced once this week, what can we do to get better consistency?" or "The AVMA says good practices have over 60 percent of their new clients each month coming from direct referral, where are we?" If the answer does not match, the next question can be, "What have we done or not done that we need to change to modify this trend?" and "How can we measure this without a great amount of extra paperwork?"
The discovery process, and the internal marketing techniques discussed above, take longer than TELLING the team what to do. This is initially a fact of life. The subsequent fact of life is that a discovery discussion leads to belief and the need for RETELLING is minimized. It sometimes is also the cause for a staff request for additional training and information, but this also cements the belief into position for the practice's success. Take the time to internally market and train and the long range benefits will follow. Try it, you'll like it!
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