Marketing for the millenium: in search of professionals.

A Nursing Homes/Long Term Care Management Series

As the long-term care industry approaches the millennium, it faces many challenges, not the least of which is reimbursement. Although the Medicaid rate has not been cut or frozen in recent years to the extent it has been in the past, it still remains a source of worry. It provides the lowest payment for the majority of in-house residents. What will happen when and if the economy goes into a tailspin is anybody's guess - but this much is certain: the inadequate Medicaid rate is always subject to political and legislative game-playing.

Meanwhile, the specter of Medicare's PPS casts a shadow over the bottom line of every facility - proprietary or nonprofit. Its full effect will not be known for a year or two. Managed care and HMOs have not turned out to be the bonanzas nursing facilities thought they would be. As a matter of fact, insurance companies, citing rising costs and reduced Medicare and Medicaid payments, have pulled out of many markets altogether, leaving almost 700,000 seniors without coverage. All of these factors play havoc with a facility's revenue stream, not even considering what happens due to vacancies and census problems.

Because "marketing smarter" is becoming ever more critical in this environment, long-time marketing guru George E. Molloy was asked to prepare an exclusive series for Nursing Homes/Long Term Care Management on the realities of effective marketing. Molloy has been active in the industry for over three decades, from managing a 120bed extended care facility in 1966, to a 570-bed facility in the early 1980s. He founded his own marketing consulting company, M & M Associates, in 1983, and has since written three books on long-term care marketing: Marketing Success (1991), Selling Success (1993) and Smart Marketing (1998). His colorful, no-nonsense style of communicating is well known.

In this first installment, Molloy addresses the basic question confronted by any marketing department: Who should do it? The answers aren't what they used to be....

Many individual nursing facilities and chains began this decade with high hopes and lofty dreams of market success. Unfortunately, today those hopes and dreams are gone. Those facilities will not be around when the new decade begins because they went out of business. Why? Because they ran out of revenue. Their marketing was not good enough, strong enough or professional enough.

Marketing success in the next millennium will depend upon two factors: more marketing professionalism and better marketing teamwork. Almost every facility in the country has someone on staff with the responsibility for marketing. Many facilities even have someone on the payroll with the actual title of Marketing Director. Nevertheless, I still believe the industry needs more marketing professionalism.

What is a "professional"? My dictionary defines professional as:

Someone who possesses specialized knowledge about a particular subject or field of endeavor after long and intensive preparation including instruction in skills and methods of doing as well as knowledge in the scientific, historical, and scholarly principles underlying such skills and methods and who is personally committed to continued study in that subject or field.

When you analyze that definition, you find that a professional has five characteristics:

1. Possesses specialized knowledge about a subject or field of work.

2. Has undergone long and intensive preparation.

3. Preparation has included instruction in skills necessary for the work and methods of doing the work.

4. Has knowledge of the scientific, historical and scholarly principles underlying those skills and methods.

5. Is personally committed to continued study in that field.

With that definition in mind, do you think we have enough professionals carrying out the marketing and sales functions in our facilities? I don't.

As we enter the new decade, I believe the industry must take a long, hard look at the qualifications of those performing the marketing function. When an administrator hires someone outside the facility and even outside the industry for a marketing position, that candidate should have bona fide marketing expertise. Industry leaders should remember the words of warning from Kolter and Clark in their book Marketing for Healthcare Organizations: "Hiring someone for a marketing position without qualifications has serious consequences. Simply handing someone the responsibility does not mean the function will be carried out successfully."

There is a two-step process in hiring someone from outside the facility for a marketing position:

One: Hire carefully.

Building a business is like casting a Broadway show. Do it right or you will have a flop. A successful play begins with selecting the right cast; a successful business depends on selecting the right people. With so much at stake, never rush the casting in show business. Never rush the hiring in any business.

Two: Provide direction.

Tell the cast what you are looking for. Tell them their roles so they can play their parts. Don't start hiring people in a vacuum or plunge into the selection process before you know what you want. Then make sure your employees know what you expect from them.

And as for what not to do, did you notice this ad that appeared in the Help Wanted section of The New York Times last December?

What was this facility looking for - an assistant administrator or a marketing person? If they wanted a marketing person, why not specify marketing and sales experience as "essential"? Why look for an individual with nursing home supervisory skills? Why not look for a marketing director instead of an assistant administrator?

Kolter and Clark had such a situation in mind when they wrote, "No additional marketing expertise has ever been gained simply by adding marketing responsibilities to an existing job description!"

Nevertheless, many long-term care facilities constantly attempt to fulfill two functions at once: social service and marketing. Many facilities have, right at this very moment, someone on the payroll with the title Social Service Designee. Whenever I go to a facility on a marketing consultation, I always ask to see the job description of that individual. It is a very revealing document, especially if the facility is suffering from census and vacancy problems. The social service designee is the one who usually gets blamed for vacancies because that individual is also responsible for marketing. Where is the real marketing expertise or specialized knowledge so necessary to make the marketing work?

In January 1998, I did a consultation at a 70-bed facility in Indiana. The day I was there the facility had 22 vacancies and was losing about $2,000 a day in revenue. The administrator indicated that the social service designee was responsible for the marketing. I asked for the job description. It identified the position's primary function as "being responsible for identifying the health-related psychosocial needs of the residents and their families." Then the job description outlined 12 specific duties. For example, #5 was "to coordinate care plans," #6 was "to document progress towards care plan goals" and #8 provided that the employee "shall be engaged in discharge planning to ensure continuity of care. "After #12, and listed under "marginal functions," was notification that the social service designee "shall carry out all facility marketing efforts."

This is not the kind of "marketing professionalism" the industry requires in these volatile and competitive times. Marketing is an awesome responsibility. It is difficult and demanding and requires skill and expertise. It is not a marginal function; it is a critically important function because it protects the facility's entire revenue stream. Marketing cannot be considered as a marginal function in any nursing facility except those that want to go out of business quickly!

Not convinced yet? Here's another example of how some facilities today find themselves with hybrids attempting to carry out functions that require specialized knowledge and expertise. Consider how many of today's healthcare centers are dependent upon a "marketing liaison nurse." Here is another ad from the Help Wanted pages of a large metropolitan newspaper:

"One of the city's leading healthcare providers is now seeking an RN with 5 years' nursing experience preferably in rehab case management, training care, and/or equivalent activity to coordinate all patient admissions from point of referral through discharge.

"Candidate will also coordinate patient care plans, handle reimbursement issues, conduct weekly team meetings, report recommendations to program director, lead training sessions on clinical issues and oversee all marketing. Candidate must possess BSN degree, CCM credentials, and strong public-speaking skills."

Obviously the position is for a case manager, but that individual, in addition to her primary duties and responsibilities, is expected to be in charge of all the marketing. What skills, experience or expertise does this facility deem necessary for successful marketing? Strong public speaking!

Reality check: To be effective in marketing subacute care to managed care executives and discharge planners, niche marketing expertise is required. This marketing liaison nurse would, in addition, have to be capable of preparing a very powerful script describing all her products and using positioning techniques to make them stick in the discharge planner's mind. Finally, when and if the marketing liaison nurse would actually go face to face with a decision maker, she would have to know the four critical closing questions (to be covered in a future installment). You will note that none of this involves public speaking.

Depending upon the facility's number of post-acute beds and its specialty services, I think this facility would be better off if it filled two positions: case manager and marketing specialist. The nurse could coordinate care plans, handle weekly team meetings, lead training sessions and be involved in reimbursement assessments. The marketing specialist would handle daily marketing activities. In short, if the job involves marketing, look for a candidate with marketing expertise. That's the only way the marketing function can become more professional and effective.

But there is more to it. Look at the #5 characteristic of a professional: "someone personally committed to continued study in the field." The core knowledge essential for success must be enhanced with additional study. Marketing professionals look for new ways to apply old techniques to new situations. The marketplace doesn't stand still. Marketing is not a destination where everybody arrives; it is a continuous journey of self-improvement and self-study, and a willingness to try new things.

Do we send the social service designee to marketing seminars? Do we require the marketing liaison nurse to study marketing manuals? Okay, so the facility can't afford to send a lot of people to seminars or buy expensive books. What about the public library? There are wonderfully informative books on marketing and selling. Unfortunately, many employees believe that they have nothing more to learn because they have 10 years of longevity in a position. True professionals never stop learning, no matter how many years they have been on a job.

Even after hiring the right people and training existing personnel in better methods and techniques, one other job remains to be done. The marketing and sales people need all the help, assistance, cooperation and support they can get from everybody and every department in the facility. Marketing is not a solitary game played by the marketing director. Marketing is a team endeavor. One individual cannot make marketing successful in a long-term care facility today. Actually four teams must play together to assure marketing success:

The Ownership Team

Owners, operators and corporate officials must have a marketing attitude. Marketing must be given the support and funding it needs to accomplish the facility's goals and objectives. Without the support and involvement of the owner or corporate officials, there is really not much a facility can do on its own to market successfully.

The Facility Team

Administrators need the support and cooperation of each and every department head. Marketing will be unsuccessful if the Director of Nurses has an antimarketing attitude. Department heads shouldn't grumble about the amount of money in the marketing budget, or suggest that the money could be put to "better use." This attitude is particularly visible with regard to refurbishing and remodeling projects. Some department heads resent any attempts to remodel, and they maintain that the monies could be better spent on salaries or enhanced benefits. If the facility is allowed to deteriorate, it could suffer serious loss of business, particularly in today's competitive market. That means the staff will not be looking for new benefits, but new jobs!

The Sales Team

We must have personnel properly trained and more motivated to sell. There is nothing "unethical" about sales, nor is there anything "unprofessional" about it, provided you understand selling and are not blinded by the stereotypes and caricatures. Professional salespeople do not force people to buy things they don't want or need. Professional salespeople educate customers about the strengths, benefits and advantages of their products. Salespeople are educators. Educators provide information that will benefit customers. In long-term care, you teach families about the qualities of your facility and its services.

The Delivery Team

What good is it to have dynamic marketing and powerful selling if you don't deliver the product promoted and sold? Every department plays an important role in delivering the care, treatment and services the patient contracted for. In this sense, every employee delivers and contributes something to marketing success, if only in small ways - a smile, a friendly greeting to the family passing in the hallway.

In conclusion, you should by now be convinced that marketing requires professional qualifications, as much as any specialized position in the facility. Sometimes, though, it takes a real disaster to drive the point home. Please read the next installment: "The Worst Marketing Mistake a Facility Can Make."

Assistant Administrator

Position available for 120-bed skilled nursing facility located in the Rockaways. Position will include marketing and admissions. Applicant must have nursing home supervisory experience and be available for alternate weekend coverage. Excellent benefits including pension.

George E. Molloy, president of M & M Associates, heads a marketing consulting firm for long-term care providers. He is the author of the recently published Smart Marketing Manual. For additional information, call [phone].