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Promotional health screening as a marketing tool.

A small hospital lab fought big-city competition by offering its community a 25-test chemistry profile with a cardiac risk panel.

A highly competitive marketplace within a tightened economy has enlarged the laboratory's responsibility as a profit center. Now the lab plays a greater role in determining whether an institution will remain viable or fall to the lengthening list of DRG-induced hospital failures.

The hospital with fewer than 100 beds must struggle even harder than larger facilities to survive. Small facilities must not only adapt to lower reimbursement and compete with larger ones. In some cases they must cope with the additional burden of overcoming problems stemming from a lack of community support.

Our 40-bed community hospital in northeast Colorado was in just that position five years ago. The public took their business to the large medical centers in nearby Greeley and metropolitan Denver. Reasons included general apathy, ignorance about what we had to offer, and residual anger-- anger--first, over corporate mismanagement at the hospital, then by a couple of poor years as we attempted to be independent. We were in bad enough shape, close to a million dollars in the red, that we almost had to close our doors.

The situation began to turn around in June 1986 when hospital administration signed a contract with a new management firm. Our fight for survival was under way.

* Strategies. Several marketing strategies were devised to get the community on our side. Simultaneously, we wanted to raise the quantity and quality of our services to a level that would keep us financially secure.

For the laboratory, new emphasis would be placed on outpatient services--an area that was previously untouched or, at best, a sideline. Yet while most of the medical staff agreed that we needed to do more in that regard, they weren't much help. They did use our lab for inpatient testing, but most of them sent their outpatient specimens to large referral labs in Denver by courier or mail rather than to us. Besides developing prices and services that would be competitive with those of large referral labs and attractive to our physicians, we had to take a direct role in the effort to regain community support.

* Plans. One of the most effective tools we used to enhance the hospital's community relations was to sponsor health promotion fairs. Working closely with our team of consulting pathologists and a referral lab we use in Denver, we developed a program that would bring people into direct contact with our lab and the services we provide.

Administration and most of the medical staff greeted our idea with enthusiasm. We then had many decisions to make: what kinds of testing to do, how to handle the increased volume all at once, how to turn around test results quickly enough to be meaningful, and how to avoid having to answer endless calls from people asking for an interpretation of results. Most of all, could our understaffed laboratory perform a large public health screen, yet keep hospital inpatients our top priority?

After studying some of the health fairs that had been held in the metropolitan Denver area, it was decided that the more comprehensive the profile we offered, the better. Holding such a fair would allow us to give the community a great deal of information and compete with the large health fairs that had become increasingly prevalent and popular.

* First fair. In August 1986, at our invitation, a Denver television station sponsored at our hospital one of its 50 to 100 summer health fairs held throughout the area. The station gave us the necessary supplies and took care of advertising--in which it promoted itself more than the hospital. We did the work, and they got the credit. After that, we decided to retain full control of our health fairs.

For ideas about what tests to offer, we spoke with people at some referral labs, including one in Nebraska, that had held similar fairs. Finally we chose a 25-test chemistry profile with an accompanying cardiac risk panel that included high- and low-density lipoprotein (HDL and LDL) and a cardiac risk ratio. With this mix, the more common procedures, such as cholesterol assays, would benefit everyone and be familiar to the public. The less common ones would be of special value to those already under medical care--potassium levels for those on medication for high blood pressure, for example, and BUN and creatinine for persons with kidney disease.

* Problem solving. Trouble-shooting saved us a great deal of potential grief. Collaboration with groups outside the lab made all the difference. For example:

[paragraph] Tests normally sent out. How could we do tests that were not ordinarily performed in-house? We found an enterprising solution. The Denver referral lab we use agreed to provide the testing on a one-time basis. The lab even offered a discounted rate that would keep our prices lower than those of other health fairs in the area. All test results would arrive at our lab, it was promised, no more than 24 hours after the referral lab had received the specimens.

[paragraph] Interpreting results. What would our lab staff do when people they had tested asked for more information about their results? Simply referring them to their physicians seemed inadequate. A system was devised whereby our consulting pathologists grouped possible results into four categories (Figure I). In a cover letter accompanying the mailed results, the pathologists gave a general interpretation of each category of findings. Tested persons would thus be advised whether follow-up with their personal physicians was indicated.

[paragraph] Staffing. Our three-employee lab (including me) was under-staffed by 1.5 FTEs. How could we supply enough laboratorians to perform an undetermined amount of outpatient draws without reducing the quality of services for our inpatients? Administration to the rescue. Since the hospital had recently undergone extensive remodeling, it was decided that the screening would be held in the redone areas to show them off.

This step would serve two purposes. First, it would bring people into the facility who hadn't been inside the building for several years, if ever, where they could admire our new look. Second, it would allow our staff to remain in the hospital, where they could be available to perform inpatient procedures as needed.

[paragraph] Clerical tasks. Our goal was to have results in patients' hands within two weeks of the blood draws. If the lab staff had to perform all the clerical tasks as well as the testing, we could never meet that deadline. To solve the dilemma, we enlisted the hospital auxiliary, a group of dedicated volunteers, to help out. Their assistance was invaluable as they gave tours of the hospital, collected money, coordinated the collection of final results, and mailed results to patients with the explanatory letters.

[paragraph] Fees. We charged a flat fee of $10 per person. Although that amount would barely cover our costs, we felt a low price would attract more people.

* Setting a date. We decided to hold our first health screening from 8 a.m. to noon for one week in April 1987. Statistics from previous health fairs held in our area led us to believe that our first weeklong program would draw approximately 250 people. We advertised the program on the radio and in the local paper for a week before our first draws, doing all the publicity ourselves, since the hospital had no public relations department at that time. We must have done something right, because attendance topped our estimate by far, for a total of 680 people. To our amazement, our first follow-up program two months later drew 790 people in one day. Thus, by the end of our first two outings, approximately 10% of our entire local community had participated.

* Physician response. At first, some physicians were unhappy with the fairs, saying we were taking work away from them. When their waiting rooms started to fill with patients following up on abnormal test results, however, they changed their minds.

Other outpatient departments began to benefit. People who came to the hospital to give a specimen tended to ask for other services as well, such as x-rays and pulmonary function tests.

* Effect on workload. Outpatient laboratory workload grew by 50% in six months, as compared with an increase of only 14% during the six months before the program began. Our outpatient workload has continued to boom ever since (Figure II). Although the gain may not be entirely attributable to the lab's health screenings--other marketing efforts have been made, and the hospital now has a true public relations department--it is generally felt around the facility that the screens have been one of the most important factors in increasing outpatient business. Administration must have thought so; they gave the lab staff substantial raises at a time other employees were hard pressed to get raises at all. Furthermore, the attention in the local media has been flattering. Another benefit to us: having the lab remodeled twice since the fairs began.

Tested persons' requests to their doctors that their lab work be sent to our facility have encouraged the medical staff to use our laboratory for their other outpatients as well. In fact, since our health screening program began, overall laboratory workload has increased by 437% and 8.5% FTEs have been added to the staff to accommodate it. This summer we plan to add 2.5 more. * Subsequent fairs. Each screening since the first has occupied one full day at intervals during the year. The first three were held in the hospital. We then tried something different, holding two--buttressed by big promotions--on the front lawn. An ophthalmologist screened for glaucoma. Emergency room nurses held "teddy bear clinics" at which they put casts on the arms of battered stuffed animal "patients." The first of the outside fairs was blessed with a beautiful day. The second was cold and drove us inside most of the time. We'll stick with the predictable weather indoors in the future.

We held the most recent of our eight screenings in March of this year at a large trade fair among several hundred booths from businesses of all kinds. Nestled into a large unused entranceway, we remained in clear sight but out of the way. It was successful, but we plan to keep our fairs at the hospital itself from now on. The next one will be in the late fall of 1991 or early spring of 1992.

The cardiac profile has remained much the same as the first one we gave five years ago. From time to time we add a test at the physicians' request. We still charge $10, but with our updated equipment at the laboratory, we are now able to make two or three dollars' profit on every profile. * Expansion. Impressed by the fairs' positive effects on their patients, members of the medical staff have asked us to offer other programs like these. Partly as a result, twice-yearly hospital-sponsored health fairs now involve many departments besides the laboratory.

We have ventured outside the hospital as well. With all our testing now being in-house, we have contracted with the local school district to provide the chemistry profile and cardiac risk panel to employees and their families every March. The school nurses collect the blood specimens and send them to us. We provide similar services to several local industries annually, testing 50 to 100 employees in each. * Goals realized. With the community, hospital administration, and medical staff involved in our efforts, our outpatient services continue to grow and flourish. Laboratory relations with the hospital, community, and medical staff have improved dramatically. Patient census is up; the public thinks of us when a hospital is needed. We are part of our community again, providing high-quality testing and other health care just around the corner. Patrick A. Roche, MT(ASCP), CLS(NCA) The author is laboratory director at Fort Morgan (Colo.) Community Hospital.
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Author:Roche, Patrick A.
Publication:Medical Laboratory Observer
Date:Jul 1, 1991
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