Developing a Strategic Marketing Plan for Physical and Occupational ...

Health Marketing Quarterly, 30:263–280, 2013 Copyright © Taylor & Francis Group, LLC ISSN: 0735-9683 print/1545-0864 online DOI: 10.1080/07359683.2013.814507

Developing a Strategic Marketing Plan for Physical and Occupational Therapy Services: A Collaborative Project Between a Critical Access Hospital and a Graduate Program in Health Care Management BITA A. KASH Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, College Station, Texas

A. A. DESHMUKH Department of Health Services Research, MD Anderson Cancer Center, The University of Texas, Houston, Texas

The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program. KEYWORDS marketing, critical access hospital, strategic planning, occupational therapy

INTRODUCTION Critical access hospitals (CAHs) play a key role in providing health services in rural America (Ricketts & Heaphy, 2000). The primary purpose of CAHs Address correspondence to Bita A. Kash, PhD, MBA, Department of Health Policy and Management, School of Rural Public Health, Texas A&M Health Science Center, TAMU 1266, College Station, TX 77845. E-mail: [email protected] 263

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B. A. Kash and A. A. Deshmukh

is to provide outpatient, emergency and limited inpatient services in communities where local demand no longer supports a full service hospital. To qualify as a CAH, the hospital must be in a rural area, operate only a small number of inpatient beds, keep inpatients no more than of 4 days, and be remote from the nearest full service hospital or designated as a necessary provider by the state. CAHs receive reasonable, cost-based reimbursement for Medicare services (Reif & Ricketts, 1999). Various attempts at the state and federal levels have been taken to improve standards of care in CAHs. Recent developments include the 1997 Critical Access Hospital Program (CAHP) by the federal Balanced Budget Act as a safety net device to assure Medicare beneficiaries have reasonable access to health care services in rural areas. Consequently, there has been notable growth in the number of CAHs since then. As of June 2006, there were 1,384 CAHs in the United States, compared to only 884 in 2004. The conversion of rural hospitals to CAHs has been associated with increases in some patient safety indicators although challenges still exist (Li, Schneider, & Ward, 2007). Despite of the cost-based reimbursement system under prospective payment system, some CAHs struggled to complete the transitioning as a result, payments they received from cost based reimbursement system have fallen short (Fogel & Watt, 2007). Challenges such as low occupancy rate, high operating expenses, high Medicare utilization, high accounts receivable, pricing with respect to their competitor, slow collection rates, and outdated facilities and equipment affected payment level of CAHs. To survive and thrive in this health care market, it is necessary for CAHs to plan and operate as a business, including the development of service line specific strategic marketing plans (Fogel & Watt, 2007). Today, marketing and planning in the health care delivery industry, including CAHs has become an important tool to develop public awareness of specific services, improve public perceptions of these services, develop and retain a referral base, and serve local community efficiently and effectively in a growingly competitive health care market. Even acute care hospitals are facing competition from either larger hospitals or affiliated hospitals when it comes to services such as physical and occupational therapy, lab and radiology services, other outpatient services, and hospital admissions. In this article we describe the process and the results of a strategic marketing process for a CAH in rural Texas, focusing specifically on services provided by the CAH’s PT/OT department. Strategic planning primarily determines a hospital’s future direction, improves hospital performance, helps in providing high quality health care services, optimizes resource allocation, and finally, helps the hospital achieve its mission and realize its vision, while meeting accreditation and regulatory requirements and maximizing its chances for success (Michael & Kaye, 2005). Although strategic planning and marketing for hospitals requires a sizable investment of organizational time and human resources, it is believed to be important for the effective functioning of the health care organization and

Strategic Marketing for a Critical Access Hospital

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often is believed to be necessary in a competitive climate, including the unique competitive and demographic environments that CAHs face today (Kaissi, Begun, & Hamilton, 2008). Recent studies indicate a trend in the use of strategic planning and marketing for departments such as physical therapy and occupational therapy (PT/OT). Fogel and Watt (2007) explained strategic planning as a process to assess existing status, ultimate goals, and tactics to reach those goals in order to improve financial margins of CAHs. The authors also defined strategic planning as a dynamic action planning and monitoring tool for CAHs (Fogel & Watt, 2007). Comprehensive strategic market planning requires the full time-attention of professional and administrative staff (Thomas, 2004; Clarke, 1991) and the use of an entire array of modern marketing functions and tools. These tools include market data collection and analysis, strategic planning, communication, public relations and promotion, customer service and relationship management, and actual promotion and sales of services (Kash & Miller, 2009; Calhoun, Banaszak-Holl, & Hearld, 2006). CAHs have limited resources to devote to strategic market planning and therefore a collaborative project between the university team and CAH’s administrative staff can be rewarding learning experience for both the parties.

REVIEW OF LITERATURE In our detailed review of studies published in peer-reviewed journal, we found significant information emphasizing the need for strategic marketing and planning for services such as physical and occupational therapy but we did not find any similar studies that offer a structured marketing plan for such services. The first study in this area dates back to 1986 when Gordon Brown stressed the need for internal and external planning and marketing for PT/OT services. Internal marketing addresses the manner in which the patients visiting the facility are treated both clinically and personally (Brown, 1986). Brown (1986) stressed that the function of external marketing is to place the appropriate services in a given geographic area. The directions and recommendations covered by Brown (1986) are similar to such concepts as “market orientation” and acknowledging employees as the best advertisers of services, such as PT and OT. Since the 1980s many researchers, hospital administrators, and health care leaders have attempted to explain the need for marketing PT/OT services. One of the significant research endeavors in this area was by Sheppard (1994), who introduced specific implications of marketing and the need for marketing campaigns to enhance public perception of physical and occupational therapy. This study concluded that there is very little awareness among patient that physiotherapist provide specialty care to women and children (Sheppard, 1994). This study also covers the importance of physician referral

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patterns explaining it as the most prevalent form of selection of physiotherapist (Sheppard, 1994). A more recent paper stresses television advertisement and the Internet as a critical factor for promoting such professionals as physical and occupational therapist (DeGray, 2006). Also, the American Physical Therapy Association emphasized the need for marketing, especially mini seminars, blogging, newsletters, and strengthening referral patterns (Magazine of Physical Therapy, 2009). To be competitive, it is necessary to develop organizational characteristics like low cost and high technology that separate the PT/OT department from its competitors (Brown, 1986). Recent developments in this process include the 1997s Critical Access Hospital Program (CAHP) by the federal Balance Budget Act. Consequently, Fogel and Watt (2007) explained strategic planning as a process to assess existing status, ultimate goals, and tactics to reach those goals in order to improve financial margins of CAHs and defined it as a dynamic action planning and monitoring tool for CAHs. Thus, there are several prior studies that emphasize the need for marketing PT/OT services and some make recommendations. However, none of these prior studies attempted to provide a systematic approach to developing a marketing plan or develop strategic marketing goals for physical and occupational therapy services in CAHs. While developing strategies and goals for this CAH facility, we considered all strategies from the aforementioned research. We took a systematic strategic planning approach by first analyzing relevant information in the external and internal environment, evaluating several strategy approaches and positioning strategies. Our analysis allowed us to make an informed decision about what direction to take, and finally, develop specific marketing strategies that were actionable for this particular CAH.

FRAMEWORK OF ANALYSIS Purpose of the Project The CAH’s PT/OT department experienced a significant drop in patient caseload since 2006. Four local physicians could potentially refer patients to the PT/OT department, but three of these rarely referred patients. Recently, a new PT facility had opened in this rural community, creating direct competition for the CAH. Additionally, the close proximity to a health care hub has proven to be problematic because a larger community from the CAH’s county are employed in the adjacent county, and might prefer to receive treatment close to their work place. Other issues identified early-on included a negative public perception about the PT/OT facility and disparaging attitudes within the hospital. This article summarizes the findings of the university team’s work with this CAH in Texas. We describe our approach by understanding


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and analyzing the overall community and health care environment within this rural area and the problems faced by the PT/OT department, and the development of a strategic marketing plan to resolve those problems. Our primary goals for this analysis were: (a) to classify, order, and analyze salient factors from within and outside the CAH; (b) to identify and analyze current important issues that would affect the organization; (c) to apply relevant strategic planning evaluation tools to the data analyzed; and (d) to formulate specific and actionable strategic marketing goals relevant to CAH.

Analytical Approach EXTERNAL ENVIRONMENTAL ANALYSIS The practice of evaluating the external environmental acts as a “window” to the outside environment from the perspective of a health care provider such as a CAH (Swayne, Duncan, & Ginter, 2006). General external environmental issues, such as demographic trends, government regulation, and competitive forces may shape the entire health care sector and directly impact the health care organization. The scanning of the external environment for this study involved moving this window across an array of external factors in search of current and emerging issues that might be relevant to PT/OT services. Issues such as decrease in patient load since 2006, regional competition, new local competition for PT, community perceptions of the CAH, and lack of awareness about the PT/OT department were identified by surveying local community members and physicians. Survey. In order to identify key issues related to perceptions of external customers and their understanding of services provided by the PT/OT department, we talked to community members. The survey was administered partially by phone and partially face-to-face with community members at local retail outlets. We interviewed 50 local community members, which included 15 telephone and 35 face-to-face conversations held at local retail stores. Survey response rate was relatively low. For telephone questioning, we called about 95 local community members. Most of the people phoned were unresponsive and were receiving health care out of town. During the face-to-face interviews, we were faced with the same response rate issue. Most community members seemed to care least about the local hospital. The survey asked three simple questions addressing: (a) whether or not the person was aware of PT/OT services at the local CAH; (b) where they would choose to go for PT/OT services; and (c) rating the services at this PT/OT department (if applicable). The second approach to understanding the dynamics of how patients become a customer of the PT/OT department was to study the referral patterns within and outside the CAH’s system. In order to accomplish this we

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developed and administered a short physician survey. This survey measured the level of awareness of PT/OT services among seven physicians who were identified by the hospital administrative team as physicians serving this rural community. This group of physicians included four family practitioners located within the rural county. The survey helped us understand, which physicians regularly refer patients to the PT/OT department, whether or not they have ever referred to the PT/OT department at this CAH, and their perceptions of the services provided. Internal environmental analysis. The project team first consulted with the vice president for strategic planning and development at the hospital system level, as this CAH is part of a regional health system and among three other CAHs within that system. Goals that were formulated for the CAHs a as whole and for this hospital specifically were reviewed and understood in more detail by speaking with administrators at the system level as well as this CAH’s administrator. We conducted a detailed internal environmental assessment of the CAH by evaluating functional areas such as clinical operations, information system, marketing, clinical support, human resources, financial administration, and other areas (Swayne et al., 2006). For this study we focused on a better understanding of payment distribution and admission trends over the time period 2007 to 2008 using data from the Texas Health Care Information Council (Texas Department of State Health Center). Data analysis. Our primary source of data was the Texas hospital inpatient discharge public use data file (PUDF) of The Texas Health Care Information Council (THCIC). All hospitals that provide inpatient care, unless exempted, are required to participate in this data collection effort quarterly. We used the PUDF data set from the first quarter of year 2007 to the third quarter of year 2008. We retrieved and extracted quarterly admission for seven quarters for the time period January 2007 through 2008 from the PUDF data files. First, we merged all inpatient admission from each quarter of 2007 and three quarters of 2008 to one data set. The final data set included 583 admissions for year 2007 and 375 admissions for first three quarters of year 2008. The data for each quarter was useful in understanding admission trend from 2007 to the third quarter of year 2008. TOWS analysis. The mission, vision, and the internal and external factors identified in the previous analysis were combined to develop and evaluate specific adaptive strategy alternatives using the TOWS (threats, opportunities, weakness, and strengths) matrix (Heinz, 1982). The TOWS matrix allows for the development of alternative strategies and strategic directions as one combines relevant factors from the external and internal environment. It uses the information that was analyzed to start the strategy formulation


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process. The TOWS matrix is designed to help determine the potential areas of growth to improve the position of the organization, specifically the PT/OT department at this specific CAH (see Table 1). Strategic alternatives were developed by matching the organization’s relevant strengths with external opportunities, strengths with threats, competitively relevant weaknesses with opportunities, and weaknesses with threats. We focused on developing strategic goals that are actionable, measurable very specific to the needs of the PT/OT department, while staying in alignment with the overall mission and vision of the CAH and its larger health system. The TOWS matrix facilitated the formulation of these specific goals, which are presented in the results section. Strategic Position and Action Evaluation (SPACE) analysis. The SPACE analysis tool was used to determine the appropriate position relative to competition and other market forces and the general strategic direction for the organization, specifically for the PT/OT department of the CAH in this study (Swayne et al., 2006). The SPACE analysis defines the posture of the organization with regards to the organization’s service category strength, environmental stability, the relative competitive advantage, and financial strength. We prepared a SPACE chart by listing each of the four dimensions and factors with individual numeric value ranging from 0 to 6. The averages for each of the four dimensions were plotted on appropriate axis on a SPACE chart and connected to create a four-sided polygon that indicates the strategic direction to be followed by the hospital (see Figure 2).

RESULTS External Environmental Analysis: Results of Community Survey According to the first question, 40% of survey respondents were aware of the PT/OT services offered by the CAH. The second question addressed, whether the respondents would chose the PT/OT department of this CAH if they needed treatment. 40% of respondents stated that they would go to the PT/ OT department at this CAH. The other 60% noted that they would most likely go to an out of town provider for service. When discussing the reasons why they would chose a different provider, we found that reasons were mostly linked to the people who commute to work in the adjacent town who would like to receive treatment close to their workplace. Not a single respondent answered that they would choose another in-town provider, leading us to believe that the in-town competitor had not yet reached as many members in the community as we originally thought. The third and final question in the survey asked the respondents to rate the services received at the PT/OT department at CAH, if applicable. Over 80% of people responding to this

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question rated the service as average or below average. These results were somewhat alarming leading us to believe that there might be some issues with the image of the PT/OT department, potentially as an actual low quality of patient service issue, or a low quality of service issue as perceived by the local community consumers.

External Environmental Analysis: Result of Physician Survey Physicians were surveyed in the community and surrounding areas. In response to the first question, “are you aware of the PT/OT services offered at CAH for your patients who might benefit from this location,” we found that four (three primary care and one orthopedic) out of seven physicians were aware of services. This result was identified as a key weakness as there were a significant number of local physicians unaware of what the PT/OT department can offer to their patients. It also presented us with an opportunity for growth as the CAH had a lot of room to network and engage in relationship building with this specific group of physicians. This opportunity helped us with the formulation of physician-specific strategies in order to capture new patients referred to the PT/OT department. Our next question was: “If aware of the PT/OT services, have you ever referred patients to PT/OT services at this CAH?” Results showed that physicians who were aware of the PT/OT services at the CAH do have the trust and confidence to refer patients. We identified this as a key strength that needed to be stressed in the strategy formulation process. We inferred that if this group of physicians who do refer patients to the CAH’s PT/OT department could somehow transfer this awareness and trust over to the other physicians who have been previously unaware, the CAH’s PT/OT department could potentially grow its referral base dramatically. Our last question was: “What is your perception of PT/OT services provided at the CAH?” Only one physician (an orthopedic surgeon) rated the services as excellent, while four physicians (one orthopedic surgeon and three primary care physicians) were neutral about the quality of the service and two said that service offered is above average. This shows that there is extensive room for improvement in terms of the perception of services provided at the PT/OT of CAH; both at the community and at the referring physician levels.

Internal Environment Analysis: Result of PUDF Data Analysis Statistical data from Texas hospital inpatient discharge PUDF of The Texas Health Care Information Council (THCIC) was analyzed and presented in the form of graphs. The following two graphs show inpatient admissions


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(related to PT/OT) trend across year 2007 and year 2008, and sources of payment. TRENDS IN ADMISSION As mentioned before, the CAH’s PT/OT department was experiencing a decrease in caseload since 2007. Many reasons were stated behind this decrease from discussions with the CAH’s administrative team. An increase in competition over the past 5 years, prevailing stereotype image of the PT/ OT, and a perception that rural PT/OT services are associated with being “hick” were the major perceived reasons for this decrease in referrals. The following graph shows the declining trend in inpatient admission related to PT/OT since the first quarter of 2007 to the third quarter of 2008. Clearly, though PT/OT managed to improve inpatient visits in the third and fourth quarter of year 2007, there is an overall decrease in caseload throughout the observed time period (Figure 1). As already mentioned most of the patients fell into the 65 years and older age group; very clearly indicating that the majority of payments come from Medicare.

Internal Environment Analysis: Result of the TOWS Matrix Using the TOWS matrix, we developed adaptive strategies by matching the organization’s competitively relevant strengths with external opportunities, strengths with threats, competitively relevant weaknesses with opportunities, and weaknesses with threats. We then developed future, internal, external and survival strategies by matching all four quadrants. We developed strategies considering four trends: future quadrant trends, external fix-it trends, internal fix-it trends, and survival trends. Various strategies such as advertise wellness program to physician, partner with local ISD, were developed in Table 1.

FIGURE 1 Trends in PT/OT-related admissions for 2007 to the third quarter of 2008. Note. The “Y” axis represents the number of patient visits.

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TABLE 1 TOWS Matrix Internal External

Strengths 1. Strong relationship with local physician 2. Teamwork 3. Fast outpatient care

Opportunities 1. Build stronger relationships with referring physicians 2. Improve their image to move away from “hick” 3. Open up facilities to the community as a wellness center Threats 1. Network hospital takes many referrals 2. Physicians referring away from the CAH

Weaknesses 1. Negative public perception 2. Specialists are unaware of PT/OT 3. Image; perceived as “hick” 4. Not seen as a place for sports therapy 5. Therapist shortage

Future Quadrant

Internal Fix-It

• Advertise wellness program to physician • Partner with county ISD to treat sport injuries

• Educate physician about skills, facility and qualification of referral • Acquire an additional PT • Integrate professional clues to reduce “hick” perception

External Fix-It

Survival

• Advertise wellness program and its price • Communicate with local physicians and physician from health care hub in adjacent county • Work to reduce negative public perception with high quality care and community relations

• Maintain lower cost for wellness program • Communicate with all new practices about services as they develop

Result of Strategic Position and Action Evaluation (SPACE) Analysis In the SPACE analysis, we have presented factor scales for each dimension for our hospital. We studied: financial strength, competitive advantage, service category strength, and environmental strength. Data used to scale these four dimensions is presented in the Appendix. Normally, the resulting shape of a polygon can be used to identify any of the four strategic postures: aggressive, competitive, conservative, or defensive. The quadrant with largest area is the most appropriate general strategic position (Figure 2). Based on the SPACE diagram the CAH should adopt a conservative posture in a growing health care market. It is financially stable (financial strength axis) in a service category that is not growing and has no major competitive advantage (competitive advantage axis). It should use financial resources to create status quo position.


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FIGURE 2 Strategic position and action evaluation (SPACE) diagram. Note. Supporting data are presented in Table A2 of the Appendix.

STRATEGY FORMULATION It is evident from our internal analysis (Figure 1) that this CAH was experiencing a continuous decrease in PT/OT caseload since the first quarter of year 2007. Taking into account results from the SPACE analysis, it was determined that the PT/OT department should take a conservative strategic position in order to turn around this observed decrease in case load and bring about growth in the PT/OT department. The conservative posture is typically recommended in a stable market with low growth (Swayne et al., 2006). The market of this CAH is not changing rapidly and has only a few competitors but, at the same time, the PT/OT department itself has no major competitive advantage that we could identify from the internal environmental analysis. Within the conservative posture, the organization needs to focus on financial stability (Swayne et al., 2006). The critical factor is product competitiveness. Looking at the PT/OT services as a product line, one should theoretically prune the product line, reduce costs, focus on improving cash flow, protect (or develop) the competitive advantage, potentially develop new products, and gain entry into more attractive markets. All these options were considered as we developed specific strategic goals for the PT/OT department. Finally all strategic marketing goals and recommendations were held accountable to the system’s overall strategic plan by reviewing the plan as strategies were developed for the CAH and asking the system administrator contact person to review and comment on the recommendations as the strategic marketing plan was finalized. Results of the TOWS analysis combined with the situation analysis were also considered while developing specific strategies and building this

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prospective conservative approach. Our primary focus in formulating strategic goals was on two key issues: (a) the negative public perception of the CAH’s PT/OT department and (b) the lack of local physician referrals. We formulated the following strategic marketing goals to prevent further downfall and to bring about growth within the PT/OT department of this CAH. Fortunately, the CAH was financially stable enough to be able to implement the recommended strategies over a 1-year timeline.

Strategic Goals and Recommendations for PT/OT Department DEVELOP A MORE INTERACTIVE AND INTEGRATED WEBSITE As discussed in the results of our survey, there is a negative perception of the quality of PT/OT services provided at the CAH among both community members and physicians. Awareness about the existence of local PT/OT services amongst community members, particularly among youth, was minimal. The majority of the current PT/OT customers were age 65 and above. As part of improving the image of and perceptions about the quality of services provided at the CAH’s PT/OT department, we recommended that the development of an interactive and informative website should be the first objective. For any health care provider, having a presence on the web helps potential and current consumers learn about what the provider has to offer, what they do best, and how their services may ultimately prove beneficial to a large segment of the population targeted. As already mentioned, the CAH in this study is part of a larger health care system, which has its own website but the CAH’s presence on the web was restricted to a single webpage depicting only the address and contact information. The development of an interactive website listing the facility staff bios, services, wellness program, hours of operation, and printable paper work is what we considered as a primary tool to attract the younger population segments, working adults and help improve physician referrals. IMPROVE PERCEPTION OF PT/OT SERVICES In health care, visual clues of an institution’s core values and quality of care are particularly difficult to separate from actual service because people spend significant time in the facility and judge services based on staff and facility appearance and personal interactions with staff members. Our second objective was to integrate effective clues in professionalism and quality that will help improve perceptions about PT/OT’s quality among consumers. We developed a few simple but effective policies based on theory of evidencebased management and studies of customer satisfaction and perceptions of quality among such model hospital systems as the Mayo Clinic (Berry & Bendapudi, 2003). It is evident that the physical environment is connected to medical outcome (Berry & Bendapudi, 2003).


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Further, clean and uniform scrubs, professional nametags that include qualifications and certifications of professional staff members, and overall cleanliness communicate respect to patient and their families and high quality of service. One of our recommendations was to assure that PT/OT staff members always wear clean and new looking athletic shoes and invest in new scrubs and name tags. The staff at this CAH’s PT/OT department was highly skilled and qualified and their appearance needed to match their skill set and qualifications. DEVELOP CLOSER RELATIONSHIPS WITH PHYSICIANS From the physician survey it was evident that about half of the local physicians were unaware of services offered by this PT/OT department. This presented us with an opportunity to grow for both inpatient and outpatient PT/ OT utilization and visits at the CAH. We discussed this opportunity with the administrators and found that there was lots of room to develop an even closer relationship with the physicians who are very likely to send their patients to the PT/OT department once they knew more about the qualified staff and services. To create a large enough local referral base, to move away from the current hick image, and to educate physicians about the quality PT/ OT services, facility, and qualified staff, we concluded that it was necessary to develop partnerships with both local physicians as well as surrounding counties. One way of doing this was to create a slideshow (including pictures of facility, list of services, wellness program and qualifications of staff) and present it to physicians at various hospital events, and by distributing it via email. Another recommendation was to invest in a part-time staff member with public relations/communications or marketing background that would visit at least four physician’s offices a month to distribute flyers, develop a relationship with the office staff, and communicate the list of services and qualifications of the PT/OT department. The current marketing development committee of the CAH was considered as the responsible party to implement this strategy. PARTNER WITH THE LOCAL INDEPENDENT SCHOOL DISTRICT (ISD) TO PROVIDE PT/OT SERVICES FOR THEIR STUDENT ATHLETES

From the results of the TOWS matrix, it was clear that the PT/OT department was not really seen as a place for sports medicine and therapy by any group of respondents. During our surveys and interviews with community members and school officials, we found that local sports injuries were referred to the health care hub in the adjacent county. To cover youth athletes and children from the local school district, it would be necessary to acquire an additional physical therapist specializing in kinesiology or sports therapy. To implement this goal, our primary objective was to develop a job description for this new PT position which can be then later

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posted as a job opening on the health system’s HR website. Before posting the job opening the first step was to approach the ISD superintendent and share information about professional PT services offered at the CAH. The Texas law requiring each ISD to have their own in-house or contracted PT services for all athletic programs was to be the key negotiating point leading to a contract with the local ISD to provide PT services to all their student athletes. ADVERTISE THE WELLNESS PROGRAM AT THE PT/OT DEPARTMENT The strategy to advertise the wellness program was also retrieved from the results of the TOWS matrix. Recently the PT/OT department had started a wellness program, which would provide an opportunity for community involvement, as community members would use the outpatient facility for recreational purposes and regular exercise at minimal cost. We suggested that advertising the Wellness Program and its low cost in the local newspaper, sports programs at the local ISD, and in the hospital informational materials and website would help build a favorable image of the PT/OT services among community members by allowing them to experience the quality of services and state of the art equipment at this local CAH outpatient facility. RAISE AWARENESS OF PT/OT BENEFITS AMONG PATIENTS WHILE AT THE CAH The negative public perception that the CAH faced and the lack of referrals to the PT/OT department were determined to be most critical and needed to be further addressed in our strategy formulation. Simple strategies were formulated to address the aforementioned issues. We recommended the use of whiteboards in each patient room for PT/OT use. This board would be used to list objectives of PT/OT treatments as related to each patient, and specific therapies, outlining the benefits of these therapies for the patient. These whiteboards could also be used for daily updates and recording practices such as writing names of attending physicians and nurses on the whiteboard to help patient and families keep track of multiple caregivers and activities. Mostly the whiteboard would be used to educate the patient and patient family about the importance of PT/OT while hospitalized and after discharge. The responsibility of keeping these whiteboards populated with relevant and useful information was handed over to each PT/OT therapist. A second objective to improve public perception related to the whiteboards was to establish a follow-up system with patients upon discharge. The process of scheduling appointments if recommended by the physician and calling the patients to checkup on progress after discharge was outlined. This second objective would help create a strong consistent message of “we care” to the patient as well as be associated with a high quality and professional PT/OT department.


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CONCLUSION The PT/OT department was fortunate to possess several unique strengths, such as being a part of a larger system, having a highly skilled and qualified team of professional staff, and short wait times for current customers. However, there were also problem areas that continued to negatively affect the PT/OT department. These problems were related to the negative image of the PT/OT department and the lack of awareness of the services among referring physicians and the community. Luckily these issues were not too complicated to be addressed. We used information collected from internal data sources, state admissions data, and two surveys to formulate simple, actionable, and cost effective strategies and goals to improve the position of this PT/OT department. Goals were evaluated and selected based on the amount of time and resources they would consume. Further, the university team recommended that the CAH’s administrative staff host a strategic planning meeting with the PT/OT department and discuss each of these strategic goals and objectives in detail. The goals should be examined and discussed critically and assessed from the perspective of the PT/OT employees. Any suggestion made by the PT/OT staff to the recommendations was considered valuable in the implementation of these goals and the detailed action planning and timeline for the goals. After the conclusion of this project we were happy to observe the CAH administrative team and PT/OT department pursue the strategic marketing plan on their own, taking initiatives to make these changes happen. The nature of these goals was such that they did not need to all be implemented at the same time to be successful. Our final recommendations addressed how to prioritize strategic goals, define how to implement them, and the development of a timeframe. The PT/OT department of this CAH was better able to make educated and informed decisions about what actions to take using the recommended strategic marketing goals.

REFERENCES Berry, L., & Bendapudi, N. (2003). Clueing in customers. Harvard Business Review, 81(2), 100–106. Brown, G. D. (1986). Changing health care environment—Implication for physical therapy research, education, and practice. Physical Therapy, 66(8), 1242–1245. Calhoun, J. G., Banaszak-Holl, J., & Hearld, L. R. (2006). Current marketing practices in the nursing home sector. Journal of Healthcare Management, 51(3), 185–200. Clarke, L. (1991, February). Issues and answers: Marketing to attract private-pay residents. Contemporary Long-Term Care, 28–72. DeGray, B. J. (2006, December). Take advantage of Internet. Magazine of Physical Therapy, 14(12), 8. Fogel, L. A., & Watt, J. M. (2007). A critical cause: 10 steps to improve CAH financial performance. Healthcare Financial Management, 61(5), 80–85. Heinz, W. (1982). The tows matrix: The tool for situational analysis. Long Range Planning, 15(2), 54–66.

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APPENDIX TREND ISSUE IDENTIFICATION In order to determine how the external environment is affecting PT/OT department of our CAH and its ability to attract new patients, we performed a Trend/Issues and Opportunity/Threat analysis. Some of these issues are considered opportunities and some are threats for CAH, but the trends that TABLE A1 Trend Issue Identification and Evaluation by Physical and Occupational Therapy (PT/OT) Department of Critical Access Hospital (CAH)

Trend/issue

Opportunity/ threat

Evidence

Impact on CAH

Probability of trend continuing

Negative public perception

Threat

From our survey

9

7

Lack of referrals

Threat

Survey

9

8

Busy patient schedule

Opportunity

PT/OT dept. sees 16 patients per day, on an average

8

6

Local competition

Threat

Presence of local competition

5

8

Community involvement

Opportunity

Wellness center

4

9


279

are both a heavy impact and likely to continue are the trends that should be addressed in the future. Figure A1 shows which opportunities and treats in the external environment that are impacting PT/OT at CAH the most and have a probability of continuing. The impact of these trends is best understood when viewed as points plotted on a graph. The assumption behind plotting trend/issue plot is that the issues to the right of the curved line have a significant impact (high impact) on the organization and are likely to continue or occur (high probability) and should be addressed in the strategic plan. Three of the five points have a high impact on the PT/OT department, and two of those three have a high probability of continuing. It is recommended that strategies be formulated based on of the points that have the highest impact and probability of continuing. Those points include the negative public perception that a critical access hospital faces, and the lack of referrals especially coming from network providers.

FIGURE A1 Environmental trend/issues plot. (color figure available online) TABLE A2 Strategic Position and Action Evaluation (SPACE) Chart Factors determining environmental stability Technological changes Many Competitive pressure High Rate of inflation High Barriers to entry into market Few Price elasticity of demand Elastic Demand variability Large Average = 3.33, 3.33 − 6 = −2.66

0 0 0 0 0 0

1 1 1 1 1 1

2 2 2 2 2 2

3 3 3 3 3 3

4 4 4 4 4 4

5 5 5 5 5 5

6 6 6 6 6 6

Few Low Low Many Inelastic Small

Factors determining service category strength Growth potential Low Profit potential Low Financial stability Low Resources utilization Low Productivity, capacity, Low utilization

0 0 0 0 0

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 6

High High High High High (Continued)

280


TABLE A2 (Continued) Flexibility, adaptability Technological know-how Average = 2.57 Factors determining competitive Market share Product quality Customer loyalty Vertical integration Competition capacity utilization Average = 3, 3 − 6 = −3

Low Simple

0 0

1 1

2 2

3 3

4 4

5 5

6 6

High Complex

advantage Small inferior Low Low Low

0 0 0 0 0

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 6

High Superior High High High

0 0 0 0 0

1 1 1 1 1

2 2 2 2 2

3 3 3 3 3

4 4 4 4 4

5 5 5 5 5

6 6 6 6 6

High Balanced High High Little

Factors determining financial strength Return on investment Low Liquidity Imbalance Capital required Low Cash flow Low Risk involved in business Much Average = 4.2

Note. The bolded numbers indicate the ranking that was assigned to that question/item.

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