Internal Practice Promotion Ideas

Thomas E. Catanzaro, DVM, MHA, FACHE, Diplomate, American College of Healthcare Executives

He who is not busy being born is busy dying.

  - Bob Dylan

Internal promotion is another term meaning a set of practices, processes, and activities designed specifically to develop motivated personnel within an internal environment who will build service and support of the client consciousness while increasing access to healthcare services. R.E Tallon, Florida Power and Light, in Creativity in Services Marketing, stated: "We can only accomplish our goals through the efforts of our staff . . . their work, their ideas and their commitment." In the early 1990s, this same organization lost their market edge because their staff-centered approach lost sight of the client needs!

In veterinary healthcare delivery, I believe in one pure fact: "As a healthcare provider, we only SELL peace of mind; the client is ALLOWED TO BUY the services we state as needed." When we state a "need" in the consultation room, we must become silent and listen for the response; research has shown it will come in about 17 seconds, maximum. Please stop "recommending," when stating a need, record it as an "action/service" followed by a box "�," as with "X-ray "�," then put a code letter into the box to show the clients response: W = waiver (no way - never), D = defer (maybe later), A = appointment (after payday), X = do it. If any provider must break the silence that follows a "need" statement, the question should always be, "Is this the level of care you want for Spike today?"

I do believe in offering only two "yes" alternatives to resolve the initial need, as with, "Would like us to do it all today, or should we just start the screening tests today?" I also believe in allowing the client to question further. I don't believe in "competing to win" or other forms of hard sell tactics. In fact, regardless of the course of action a client selects for their animal, I recommend validating their position FIRST, then give them what you will need to do next based on what they have said. For instance, "I can understand why you don't want a dental today, but you don't mind if I mail you a "no strings attached reminder" when we run our next special dental program, do you?"

Staff Buy-In

To effectively conduct an internal promotion, a practice needs a paraprofessional staff who are client oriented AND sales minded. A client-centered, sales-minded staff member remembers the following four tenets:

•  Clients can only judge the technical and medical competence of a veterinary practice by the amenities to which they are directly exposed. If the plants are dead, how can they heal animals? If they mix up the charges, how do they keep the lab work straight?

•  Clients can only judge the competence of the professional staff by the staff they contact most often and first hand. If the receptionist is gruff or unhelpful, why should they believe the healthcare is caring and compassionate?

•  Clients today, whether buying veterinary services or home appliances, are interested in and demand value for their money. Gone are the days of blind acceptance because there was only one veterinarian in town. Today, clients question the need for care provided, treatments recommended and even the costs incurred. The veterinary facility that can't adequately justify itself and provide a value-added image will not survive.

•  Clients are suspicious of advertising that does not deliver the promised results. This includes the conflict that occurs when various members of the staff explain the same service in different terms. This conflict of information will cause erosion of the patient base.

To encourage a paraprofessional staff to be sales minded, which is vital to any internal marketing program, remember that:

•  New services, strategies, and approaches have to be sold to the staff BEFORE the clients are ever offered the service. If you can't sell the concept to the paraprofessional staff, the clients will never access your offerings.

•  If clients can tell the staff more about what you are planning than what has been discussed in staff meetings, you will probably not achieve the customer consciousness you want.

•  When staff members are in the dark about a change or service, clients will notice and wonder about the effectiveness of the healthcare delivery plan.

•  Confused staff confuse your clients. Clients don't like to be confused, especially in healthcare, so they won't want to give you their business.

•  Staff members are the ones who implement and maintain the plans and services of a practice. Plans and services do not implement themselves, ever!

•  In a bond-centered practice, whenever some client defers (D) needed healthcare, or a patient receives only symptomatic care, then the nursing staff INCREASES surveillance to ensure the condition is resolved in the time prescribed.

Without information, a paraprofessional staff feels demoralized and discounted. They must be informed if you expect them to have a stake in supporting and promoting the practice. Internal marketing is therefore a combination of client consciousness and sales mindedness. Regardless of how we define or look at internal marketing, the bottom-line is simple: by satisfying the needs and wants of a practice's internal clients, that is, the paraprofessional staff and associate veterinarians, a practice upgrades its ability to satisfy the needs and wants of its external clients and the pets they bring to the practice.

Internal marketing boils down to seven truths:

1.  The human resources of a practice are the first market for the practice. If you can't get the staff on your side, the clients will not become satisfied users of the services offered.

2.  The staff must understand why they are expected to perform in a certain manner and why you need their support inside and outside the practice.

3.  You must convince your staff of the value of the services offered if you want them to support the services. Clients believe employees have the inside scoop.

4.  Employees deliver your services. As a team, they need to grasp your expectations or the intended services will never reach the client's level of perception.

5.  Personal selling to staff members is a prerequisite to personal selling by employees. They must share in the dream, the vision, and the beliefs of the practice.

6.  You must continually motivate and train the paraprofessional staff to extend to clients the communication, compassion, respect, courtesy, and attention they deserve and expect.

7.  You must strive to attract and keep excellent staff members if you want to attract and keep loyal clients.

SPECIFIC IDEAS

There are more ways to increase business than to hire a band and hold a parade down Main Street, but sometimes the frustrations become so large in our veterinary practices that it seems the only alternative. This following is designed as a list of ideas which are short memory joggers that require you to take the ball and let your staff run with it to success.

PRICING - competitive for common services, higher for unshopped services, discounted to fill in slow times, discounted packages of services/series/products. Conduct an annual survey, raise prices at least quarterly for cost of living, and stay competitive.

CREDIT CARDS - encourage credit cards to cut receivables; front desk MUST promote usage. Run multiple charge slips (under $50 does not usually require pre-approval) and spread submissions over multiple weeks. Be careful of the emerging "8% programs" for medical-specific credit cards; some practices are adding this "service charge" to the bill to ensure they recoup the lost monies.

IMAGE - turn stationary and business cards into promotions of the practice; encourage staff to participate in spreading the image by adding their title to their card at their one year practice anniversary. The practice decor must communicate modern, avoiding the too cheap, too sterile, too expensive, or too old attitudes.

REFERRALS - ask for them from existing clients...provide introductory offer cards to referring clients for the NEXT client they refer...use reinforcing and shaping recognitions and rewards for those referring; track heavy referrers and acknowledge them in a special way. Patient Appreciation Day/ Friend-Help-A-Friend/Bring One Week can provide a free premium for someone referred or any patient who hasn't been seen recently; limited time, promoted internally, and have the staff ready to talk it up for at least 30 days in advance.

REACTIVATION - should be a minimal problem if the clients are called as soon as vaccinations expire or when they miss their first appointment, but many practices have not been proactive and start already behind the power curve. For these late starters, a letter with a certificate to those clients not seen within the last two years...follow up the letter with an evening telephone call (5-9pm) to those who did not reply to the mail.

THANK YOU - create a welcome to our practice letter, thank you for the referral, commendations for community involvement postcard, and a method to remember to thank them personally when they visit next. A special reception area bulletin board for recognizing those who have referred encourages others to refer. An annual thank you letter to these clients is appropriate.

RECALLS - precondition the importance of the recall and specifically the consequences if they don't respond...postcard addressed in client's handwriting with a similar message, confirming recalls, two letters to those not responding to message, conditioned in quarterly information preconditioning/prospecting letters.

SURVEYS - new client or exit client surveys work well on a continual basis; an alternative is the once-a-quarter survey sample of existing clients to uncover and correct problems in a specific area of interest (e.g., practice access).

RADIO - late-night radio spots are inexpensive but generate image of radio-endorsed expert, use editorial format.

NEW CLIENT PROFILE - know the social and family profile and ask about other pets at home; determine how they FIRST heard of your practice.

SIGNAGE - clear and professional, large enough to be seen, sell the benefits of the product or service; electronic message bars do work in the retail display area.

POSTCARDS - repeat postcards to clients, referrers, and media; pre- and post-event postcards to clients to retain image of caring expert. Mail before and after speeches, interviews and articles. Holiday cards are not cost effective and birthday cards are at best a maybe.

ONE-MINUTE MESSAGES - rehearse 30- to 60-second messages that promote the practice or new services, which close the sale, or set the "information hook." These messages can be recorded into the practice's hold button elevator music source for mixing subtle sales with music.

RECEPTION AREA - framed resume, practice history, behind-the-scenes photo stories to educate public on capabilities and background.

INVOICING - always list all the services performed, even those done at no charge (track "no charge" services monthly by provider); itemize whenever possible to reflect the detail in healthcare delivery and the level of expertise and dedication.

HOURS - extended hours test (summer hours or winter hours) with adequate promotion, look at drop-off day care, evening specialty clinics and weekend convenience hours.

CLOSERS - convert shoppers with a script ("Is this the level of care you were looking for...?"), take time to develop and train on "closers" that the staff endorse. Tape record the individual staff members for feedback to them.

NEWSLETTERS - a new client newsletter which highlights key staff, special practice packages/bundles of services, practice philosophy, and critical procedure(s) such as OHE, declaw, and/or neuter in a step-by-step quality statement. Quarterly letters to generate repeat business, to establish an image as an expert to generate referrals, bulk-rate metered but first-class feel, letterhead, multi-page, coupon your own clients to induce use of low volume services and track response to avoid non-performing formats.

MOTIVATION - get the staff involved with role playing, seeing the big picture, having responsibility for small successes within their control, and contesting specific procedures that haven't been well advocated in the past to clients.

BUNDLE SERVICES - a health maintenance service or new family pet plan based on prepayment or multiple animal presentation at the same time. The FeLV series, puppy/kitten vaccination/laboratory series, or even the heartworm series can also be bundled at a total visit rate.

PRACTICE BROCHURE - designed specifically to solidify relationships, sell the practice and services, and be a value-added benefit. Asking clients to pass on the brochure to a friend (you could even add a coupon for an inexpensive visit inducement), leaving them at local motels/trailer parks for travelers, or providing them to realtors for their advanced information mailings are also distribution methods.

WHICH ONE IS FOR YOU

The best answer for your practice is not a single solution. The answer is beyond just being a client-centered, high quality practice; most clients have just enough knowledge of the profession to only perceive the quality that we tell them. The competition must be evaluated, the practice philosophy stretched and the staff (both the professional and paraprofessional members) retrained. The importance of each function is relative to the practice needs, but on a national scope, they are relative to each other in effectiveness. There is an attached "action payoff" list attached.

One factor that is constant with internal promotions is the practice philosophy of continuous quality improvement (CQI). This has been illustrated in other articles by Catanzaro & Associates, Inc., relating PRIDE as an input and QUALITY being the perceived outcome by the client (The "L" in Quality Stands for Leadership). It means letting go of management and becoming a leader, letting people be accountable for success and change rather than just "doing a job."

The degree that a practice is willing to stretch is usually inversely proportional to the net income; the lower the net, the greater the willingness to stretch. While maintaining the core values of the practice philosophy, the secret is to have the staff stretch with the practice. The new efforts of the practice promotion will find some of the staff members (professional and paraprofessional) unwilling to change; they will have to be addressed in other methods other than those provided within these internal promotion ideas.

ACTION PAYOFF

Every marketing effort has a potential payoff for the veterinary practice...or should have. Public relations gives the least immediate return and external marketing (advertising) gives the quickest return. Internal promotions lie in between these two extremes, and as such, have gained popularity within the profession. The lists provided below are not all-inclusive, but they are indicative of their relative practice success when compared to each other at the national level. The most effective is at the top of each list, and the effectiveness decreases the farther down the list you go. It must be pointed out that certain items low on the list may be best for a specific practice, at a specific time, in a specific community, so personal evaluation and practice integration is critical in the selection process.

INTERNAL PROMOTIONS

Full service hospital (with after-hours on-call system)

Client and patient base on computer

Caring, compassionate and empathetic staff attitude

Practice image (sight, sound, smell, voice tones, etc.)

Emergency (urgent care) services, 24 hours per day/7 days per week, on premises

Friendly, intelligent, knowledgeable staff

Three vaccine reminders (bi-weekly mailing)

Evening hours (at least two nights per week)

At least two credit cards accepted

Schedule recheck visit before client departs

Location accessibility (easy in/easy out)

Health Alerts (followed by "action card" for services within three weeks)

Sunday hours (seven-days-a-week appointment times)

Clearly visible signage (2.5-second read time)

Every client leaves with something in their hand (handout, brochure, etc.)

Client recalls (lab results, missed appointments, follow-ups on care, etc.)

New client information sheet (with multiple pet area)

Hospital brochure with color pictures and white space

Web page electronic brochure with hot links to referring specialists

Appointments kept within 5 minutes of appointed time

Continuity of care between providers (confidence factor)

Twenty minute appointments (plus 10 minutes extra for new clients)

Target mailings offering quality service at convenient times:

Annual Life Cycle Consultations (out-of-sync with vaccine cycle)

Behavior Management (Behavior Counselor)

Dental reminders (after exam room agreement)

Over-40 Surveillance Programs (1 dog year = 7 people years)

Golden years program (arthritis care system)

Parasite Prevention and Control Specialists (nurse technicians)

Obesity (nutritional counselors)

Multi-cat households (two-fur-one screening programs, feline friendly)

Traveling With Your Pet Parasite Screening (e.g., Giardia, Lyme, etc.)

Species/disease specific

Professional products retail sales area

New client newsletter (sent to all phone shoppers)

Early drop-off services

State "Walk-ins Welcomed" in Yellow Pages (2^nd room in high density schedule)

Credit to established clients (carriage trade)

Examination room videos (followed by people programs)

Behavior management services (e.g., Gentle Leader/Promise head collar system)

Client education in exam rooms (with white board diagram capabilities)

Feline friendly programs (announced and promoted)

Itemized receipts (value-added total adjustments without line item "no charge")

Boarding, bathing and respite care (veterinary supervised = no medication fees)

Avian and exotic pet care services

Referral thank you notes (with chart documentation)

Offer house call support (pet ambulance services) for shut-ins

Children pet loss books to local libraries (public and school)

Grief counseling, sympathy cards, pet loss follow-up

Comfort Room with consultation room row

Board certification/qualification

Animal identification services (tattoo, implants, registry, etc.)

Cater to kids with balloons, books, stamps, coloring books, etc.

Quarterly practice newsletter

Client's Senior's Club (e.g., AARP discount can be extra doctor time mid-days)

Boarding brochure, two-color, pictures, with white space

Business cards for doctors AND tenured staff (self-select title)

Friendly forms when to be completed by client

Free puppy/kitten/first visit examination

Invoice messages

Special professional interest (equipment supported)

Pet selection assistance

Newspaper advertising

Waiting room videos (short messages)

Veterinarian for a pet store

New homeowner mailing

Intern program in facility

Free first exam for pet store purchase

Stationary appearance (continuity of image)

Pets by prescription (Delta Society program)

Reception room reading related to current patient advocacy concerns

Lectures to breeder groups

Flyers, promotion and delivery dependable

Target mailing to breeders

PUBLIC RELATIONS (Goodwill)

Radio/television show (regular host)

Radio/television show guest

Publish a local newspaper column

Conduct local seminars

Participate in health fairs

Send press release

Radiograph candy at Halloween

Offer free puppy club classes

Practice appearance (staff uniforming, facility image, etc.)

Have a practice open house/offer hospital tours

Advise and lead a youth organization (Scouting, 4-H, FFA, etc.)

Sponsor a youth organization rabies vaccination clinic

Belong to a service club

Assist humane society

Sponsor a sports team

Offer donations to community programs

Have a calling card display in a church bulletin

Support the local school yearbook

Pet Partner Program Instructor/Evaluator (Delta Society)

DISTRACTORS (mixed messages, so don't do these)

Appointed client/patient seen greater than 15 minutes late

Not addressing the client's concern FIRST

Poor appearance of staff (e.g., holes in knees or frayed shoes)

Poor approach (signage old and worn, grounds not kept-up well)

Poor appearance of facility (e.g., orange counters & dark paneling)

Coupon discount services

Over-selling to drive up the ACT (instead of sharing new ideas at recheck)

Referral "bounty payments" to clients

Low-end the community fee standards

Calling after 2 to 3 years absence to see if they are still a client