The Marketing Plan

BY

GEORGE SAMIR SAAD

Introduction:

My department is "AlSalam Nephrology department", in which I am the senior doctor and the responsible for patients and the subordinates –doctors, nurses and workers-.
This department one of the most famous oldest unit in Egypt, in which renal transplantation done successfully and legally.

The unit has:
* 8 renal dialysis machines,
* 2 outpatient clinics,
* 20 inpatient beds,
* 3 professors,
* 1 senior doctor,
* 5 doctors,
* 3 head nurses,
* 5 nurses,
* 4 assistances,
* 2 workers.

Situation analysis:

Current service:

- AlSalam nephrology department, responsible for many services, like:

* Renal transplantation, * Follow up renal-transplanted patients, * Renal dialysis for chronic renal failure patients, * Outpatient clinic for kidney diseases; and * Teaching and practicing place for new doctors who care with nephrology.
- The unit in AlSalam hospital, which present in ElMohandseen area in Giza, Egypt, which is a famous, commercial, crowded, rich area.

- The hospital accredited with ISO 9001 in 2004.

-Background information

-Date of opening the unit: 1983
-Average No. of outpatient/Day: 60 patients
- No. renal failure patients/Day: 20 patients
-Costs /outpatient: 40 LE
-Revenue /out patient: 120 LE
-Net profit /outpatient: - 80 LE, which is good.
-Costs / renal failure patients: 200 LE
-Revenue / renal failure patients: 250 LE
-Net profit / renal failure patients: 50 LE, which is very low.

- My unit is the only private unit all over the country, which produce services 24 h/7 d.

- My unit has two types of services:

• ACUTE this is for new comers and for emergencies.
• CHRONIC this is for the regular patients. - Our reputation gives us the promotion from accurate, good, timely services.
- We have best doctor-patient relationship; good public relationship; follow up service by home visits or telephone.

Current Target Market:
The unit offers its services through private or governmental insurance coverage.
The same services given to both, no differentiation between one of them over the other one.
The aim of this strategy:
# to attract new comers,
# to give good psychological feelings to all of patients which is good.

Market demographic: The profile for the unit target customers consists of the following geographic, demographic and behavior factors:
Geographic
• The immediate geographic target is ElMohandseen, Giza.
• A 6 Kilometer distance from down town in Cairo; however, its highly commercial rich area, which is, crowded with coffees multiple stores.
• The total targeted population is just over 100.000 plus the visitors from Gulf area.
Demographics
• Male: female- no large discrepancy, which is not important in our market.
• 40% have an income exceeding L E 100,000\ year that make big deal to our business
• 75% of the target populations have graduate degree, 25% have an undergraduate degree, it makes difference in what categories will we deal with and who will understand treatment plan!?

Behavior Factors

• Individual and family image is personified by the type and condition of the type of service and care about quality instead of cost.

Market Needs

The unit is providing the market with a premium health service for Cairo and Giza community seek to fulfill the following benefits that are important to the customers:

• Exemplary customer service- The target customers have money and are used to having excellent customer service. They will not regularly deal with the unit unless they receive excellent service.
• High quality service - The target market value a higher quality service.
• Convenience- the best hotel service for the inpatient type and easy not longstanding waiting for the outpatient.

Service usage:

- Kidney patients use the service.
- Because they are patients
- When they feel sick
- With outpatient or inpatient service
-

Service positioning:

Through questionnaire done monthly, we positioning our services.
Questionnaire
Please read every point and choose the most acceptable choice

WE DO RESPECT AND APPRECIATE YOUR OPENIONS AND COMMENTS

Personal data: - (if you do not want to write it, we respect that) Name: Title: Age: ID #:

What do you think about?
• The surrounding environment of service □ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

• The co-operation of the team you serviced with □ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

• Pharmacy □ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

• Nurses □ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

• Security □ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------
• Porters □ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------
• Clerks
□ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

Any other comment or point --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
• The service hours
□ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

• The availability of equipment & supplies
□ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------ • The availability of data about my condition
□ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------ • The facility to report to top doctor
□ Excellent □ V. Good □ Good □ Accepted □ bad

If you choose badly please write why? ------------------------------------------------------

Any other comment or point ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
• Money paid

• You paid
□ Excellent □ V. Good □ Good □ Accepted □ bad
If you choose badly please write why? ------------------------------------------------------

Marketing mix:

1- product: Our service is intangible, core product; which introduce health services for renal patients.

Product Life Cycle (PLC)

Introduction.

The service was immediately getting profit when there were few competitors.
Growth.
Competitors are attracted into the market with very similar offerings. The services become more profitable.
Maturity.
Those products that survive the earlier stages tend to spend longest in this phase. Sales grow at a decreasing rate and then stabilize.
Decline.
At this point, there is a downturn in the market. For example, more innovative services are introduced or consumer has changed.
Then it stabilized due to strong services, which we introduced.

2- Price Premium Pricing

We use a high price where there is uniqueness about the service. This approach is used where a substantial competitive advantage exists.

3- promotion
We use public relations and sponsorships in our promotion.

4- place
Highly commercial rich area.

Market share:
Fair market share:
The unit serves about 100,000 persons where they live in elmohandseen, and there are other 9 units around us, and the unit has capacity and facilities enough for 10,000 / year, so, the fair market share is 10% (10,000/100,000)

Actual market share:

-actually the unit yields service by rate to around 8,000/year
-So Actual market share 8% /year

SWOT analysis
The following is SWOT analysis for my unit:

Strength

- Good relationships with customers.
- Human resource availability.
- Highly professional doctors.
- Well trained nurses.
- Presence in famous area in Cairo.
- Strong name in the market

Opportunities

- Nephrology targeted a highly sensitive disease.

- Advanced technological dialysis machines

- Good place for teaching new doctors.

Weakness

- Crowded area so lost time for patients.
- No park.
- Young doctors salary is low, so they may left work at any time.
- Nurse's salary also is low, so they may leave work at any time.

Threats

- Competition increases quickly because its very profitable business.
- High cost for service.
- Any hospital-acquired infection has bad reputation.
- Any failure or death to any patient.

SWOT for competitors

Strength
- Steady not crowded areas so no lose of time for patients.
- Easy for parking
- Young doctors salary is quiet good, so they may left work at any time.
- Nurse's salary also is fairly high, so they may leave work at any time.
Opportunities

- To attract new comers, no High cost for service.
- There is no audit so, no hospital acquired infection has been recorded
- No highly critical patients are admitted so, small no. of deaths has been recorded.
-
Weakness

- - Not well trained nurses.
- - They have no Good relationships with customers.
- Not Presence in famous area in Cairo.
- Weak name in the market.

Threats

- Targeted patients are not of high no.
- Old dialysis machines
- Not Good place for teaching new doctors.
The BCG Growth-Share Matrix

The four categories are:

• Dogs – "WORKERS" has low market share and a low growth rate and thus neither generates nor consumes a large amount of cash.
• Question marks – "ASSISTANCE" they are growing rapidly and thus consume large amounts of cash, but because they have low market share they do not generate much cash. The result is large net cash consumption. A question mark
• Stars –"KIDNEY PATIENTS" Stars generate large amounts of cash because of their strong relative market share, but also consume large amounts of cash because of their high growth rate; therefore, the cash in each direction approximately nets out.
• Cash cows – "DOCTORS AND NURSRS" cash cows exhibit a return on assets that is greater than the market growth rate, and thus generate more cash than they consume.
Objective:
Increase number of patients in the unit 25%, from 8,000/year to 10,000/year to be reached to fair market share, which is 10,000/year, within 12 months.

Is it a SMART objective?
Let's check!!

SMART Meaning Examples
Specific – Objectives should specify what they want to achieve. Increase number of patients 25% in 12 months.
Measurable – You should be able to measure whether you are meeting the objectives or not. 25% increase means 167 patient/month, it could be measured
Achievable - Are the objectives you set, achievable and attainable? It could be achieved.
Realistic – Can you realistically achieve the objectives with the resources you have? It is not a dream to do that, by increase recourses and finance.
Time – When do you want to achieve the set objectives? It is a period of 12 months to achieve the 25% market share target.

Customer segmentation:
This is patient segmentation according to financial background, Group A: very rich patients, where they entered "V.I.P." sweets. It makes' 20%
Group B: private cases, It makes' 30%
Group C: International insurance companies, It makes' 30%
Group D: national insurance companies, It makes' 10%
Group E: economic cases, It makes' 10%
To increase market share from 8% tobe 10%
From 8,000/year to 10,000/year.
We have to make scenarios, and weigh them to choose the best we can start with, to achieve our objective.
We have to act on one of three items:
1- quality,
2- cost,
3- Time.

We have to put in mind the customer segmentation when we choose one item,
1-quality:
Group A: very rich patients, where they entered "V.I.P." sweets. They are deeply interested with quality, so it weights: 90% from the 3 items
Group B: private cases, They are interested with quality, so it weights 80% from the 3 items

Group C: International insurance companies, They are interested with quality, so it weights 70% from the 3 items
Group D: national insurance companies, They are moderately interested with quality, so it weights 30% from the 3 items
Group E: economic cases, They are not interested with quality, so it weights 5% from the 3 items

2-cost:
Group A: very rich patients, where they entered "V.I.P." sweets. They are not interested with cost, so it weights 0% from the 3 items
Group B: private cases, They are not interested with cost, so it weights 10% from the 3 items

Group C: International insurance companies, They are mildly interested with cost, so it weights 20% from the 3 items
Group D: national insurance companies, They are moderately interested with cost, so it weights 65% from the 3 items
Group E: economic cases, They are deeply interested with cost, so it weights 90% from the 3 items

3-time:

Group A: very rich patients, where they entered "V.I.P." sweets. They are mild interested with time, so it weights 10% from the 3 items
Group B: private cases, They are mild interested with time, so it weights 10% from the 3 items

Group C: International insurance companies, They are mild interested with time, so it weights 10% from the 3 items
Group D: national insurance companies, They are not interested with time, so it weights 5% from the 3 items
Group E: economic cases, They are not interested with time, so it weights 5% from the 3 items

So, if we make a table to list all previous groups with their weights, it will be like that:

A B C D E calculate
QUALITY 90 80 70 30 5 = 275
COST 0 10 20 65 90 = 185
TIME 10 10 10 5 5 = 40

When every row from the above table is calculated together;
It gives that QUALITY is the highest score, so it is the best scenario from the proposed three scenarios,

The top scenario is QUALITY

The key elements of a successful strategy can be organized into the following categories:

1. Developing the right culture for quality;
2. Attracting and retaining the right people to promote quality;
3. Devising and updating the right in-house processes for quality improvement; and
4. Giving staff the right tools to do the job.
Also at play are external influences, such as local market competition, and public or private health quality initiatives and standards.

Developing the right culture for quality

Top-performing hospitals have a striking degree of motivation and commitment to ensuring high-quality care and fulfilling the QI mission. They are not just going through the motions or conducting QI activities because they are under outside pressure to do so.
This commitment is reflected in and nurtured by active leadership and personal involvement on the part of the CEO, other top managers and other staff.

By include the following features:

1. Establishment of a clear quality-related mission, and performance measurement and targets consistent with the mission.

2. Strong leadership from Board and CEO. Specifically, this involves:

• Regular reporting of quality reflecting select performance indicators to senior management and Board of Trustees;
• Setting targets for improvement and follow-through via monitoring
Progress;
• Leading by example and personal involvement;
• Making QI part of employees’ daily functions, rather than an extra burden on top of routine responsibilities; and
• Holding senior staff accountable for meeting quality goals and making appropriate improvements.

3. Leadership and QI buy-in among department chiefs, with expectations that they will work with physicians in their departments to change practice patterns where necessary and ensure that certain practices are followed.

4. Supportive organizational structures such as standing and ad-hoc quality-related committees.

5. Clear communication and rules that encourage physicians, nurses, and technicians to report errors. This requires ensuring that those who report errors may remain anonymous and not be penalized.

Attract and Retain the Right People

High-quality physicians, nurses, administrators, and assistant staff are critical to producing high-quality outcomes and effective quality improvement. Top-performing hospitals stressed the need for selective hiring, credentialing. Successful recruitment and retention of nursing staff was tied to an absolute respect for and empowerment of nurses—who must be treated as full collaborates in patient care and given opportunities for advancement. All are expected to be good team players, able to participate in multi-disciplinary teams for both QI and patient care management.
The following specific features of successful strategies:

1. Selective hiring, credentialing, and retention of physicians and nurses, even in an era of shortages. This includes monitoring of doctors on staff (or with privileges) and ensuring that they must continue to meet certain performance and practice standards to retain credentials.

2. Ability to attract and employ an adequate number of high quality nurses through specific approaches to human resource management such as:
• Generous staffing levels that ensure a reasonable caseload; this includes setting minimum staffing ratios and abiding by them (e.g., closing down units if there is not adequate nurse staffing).
• Competitive salaries;
• Deserved reputation of respect for and empowerment of nurses;
• Residency programs and relationships with nursing schools to ensure an ongoing supply of nurse trainees and graduates; and
• Opportunities for continuing education and advancement, as well as opportunities to be true partners with physicians in caring for patients.

3. Establishment of multi-disciplinary teams to manage and coordinate patient care and to conduct QI analysis and projects with IT support. Nurses are often given a key role in the QI process as team leaders with authority and accountability. All staff is expected to be team players.

Develop Effective In-house Processes

The best hospitals not only collect data on outcomes and cost, but also pull apart the numbers on surgeries, tests, and other procedures to identify each step in the process where less-than-optimal medicine is practiced. QI departments are adequately staffed, have credibility with physicians, and are trained to facilitate the problem-solving process.
Deficiencies in outcomes are not hidden or ignored, but instead are used to inspire an iterative process of discovery followed by corrective actions and accountability. Effective problem-solving leads to the development of evidence-based protocols and critical paths, and enhanced efficiencies such as reduced turn-around time for test results and reduced errors related to standardization of supplies and procedures.
Another important process involved team-based care management. A key to success involves making sure physicians and other caregivers accept the case manager has or team leader’s role in coordinating and facilitating care. One hospital studied promotes such acceptance through a physician-based model where physicians are assigned case managers who work with all of their patients.

Keys to doing it right include:

1. Selecting a reasonable number of measurable quality indicators.
2. Dedicating qualified staff to work with and analyze the data.
3. Comparing indicators with evidence-based medicine and benchmarks within and outside the hospital. This involves developing reliable data and learning how to slice it in different ways (e.g., across hospitals in a multi-hospital system; by service line, such as all thoracic surgeons in a hospital compared to the Society for Thoracic
Surgeons national database; by individual physicians compared to their peers).
4. Identifying medical practice variation and outliers, and distinguishing between temporary blips and more chronic areas of sub-optimal care.
5. Reporting performance data both up and down the administrative and clinical ladders.
Once performance improvement opportunities are identified, problem-solving techniques are employed. Key components of this process that drive success include:

1. Developing multi-disciplinary teams that include representatives of all clinical or administrative areas that play a role in the problem being examined.
2. Enabling the team to question, drills down, and pull apart the data, and helping them use the data to identify and explore possible factors contributing to suboptimal performance. The depth of this process was particularly striking at the case-study hospitals.
3. Developing and implementing an action plan (e.g., a plan to reduce variation and to change the practice patterns of physicians who are shown to be outliers in the data analysis) with timetables and goals.
4. Continued monitoring to ensure the intervention was successful, and holding appropriate department chiefs or staff accountable for implementing the plan and improving outcomes.
5. Incorporating successful interventions into processes and policies, such as:
• Protocols and critical paths, based on internal experience and expertise as well as best practices;
• Policies that enhance efficiency, (e.g., improved patient flow, reduced turn-around time for test or lab results);
• Standardization in medical devices, procedures, and supplies, which reduces errors, saves space, and reduces costs;
• Communication about successful interventions across departments to extend the impact beyond the original QI initiative.

Provide the Right Tools to Do the Job
The best hospitals also give their physicians, nurses, and other staff the tools and support they need to practice high-quality medicine on a daily basis and to identify and investigate quality problems when they do surface. This includes investments in Information Technology (IT) as well as QI/Performance Improvement departments with qualified staff who abstract medical records, analyzes data, and facilitates the QI process. It also includes access to guidelines and protocols, and support to physicians in developing a consensus around their own evidence-based best practices so they have tools they are actually willing to use. Other tools involve external training, peer networking, and conferences.
Information and data tools play a critical role. successful IT strategies employed by the top-performing hospitals studied involves four main commitments: a willingness to invest in IT; working with physicians and others to customize an information system to meet specific needs and culture of the institution (e.g., some of the hospitals studied had IT directors who were physicians themselves as well as IT experts); nurturing and encouraging buy-in so that new systems will be utilized and their benefits realized; and devising IT systems that provide real-time feedback to providers (including access to patient history, test results, computerized reminders/alerts, etc.) as they are caring for patients.

Top-performing hospitals involve four main commitments:

1. A willingness to invest in IT;
2. Working with physicians and others to customize an information system to meet specific needs and culture of the institution;
3. Nurturing and encouraging buy-in so new systems will be utilized and their benefits will be realized; and
4. Devising IT systems that provide real-time feedback to providers, as they are caring for patients.

The main ingredients of a real-time system involve its timeliness. Hospitals want to develop a system that allows all caregivers to have access to relevant information as soon as it is available. To that end, the case study hospitals have or are adopting applications that do the following:

1. Reduce time lags in getting lab and imaging results. This can reduce length of stay and may reduce iatrogenic disease;
2. Deliver information on test results, history, health status, etc. to the bedside while providers are treating patients so that treatment decisions can be made based on the latest information; and
3. Make user-friendly guidelines and recommendations readily accessible to physicians, based on the latest medical research on specific conditions, procedures, medications, etc.

Ingredients for Hospital Quality Outcomes
Culture: Internal Tone & Policies

• Clear mission, goals & targets
• Strong QI emphasis from CEO & Board, leading by example
• Standing and ad-hoc quality committees
• Regular QI reporting
• Dept. chiefs buy into QI and direct staff, accountable for performance
• Safe environment for reporting errors

People: Staffing & Roles

• Attract & retain high quality physicians & nurses; selective hiring/credentialing/re-credentialing
• Nurses respected & empowered to play key role, adequate staffing, positive work conditions, growth opportunities
• Multi-disciplinary teams for QI and patient care management

External Forces & Resources

• Standards, reviews (JCAHO)
• Best Practices
• Competition in market

Investment in/Adoption of IT Tools

• Customized to meet needs & culture of hospital
• Involve MDs,
• Real-time access
• Management tools to monitor/compare performance
(e.g., e-medical records & progress notes, bar coding, alerts regarding drug reactions, on-line X-ray & test results, e-medical literature reviews)

Processes

• QI Process: Constant measuring and comparing performance indicators, etc.
• Team-based care management.

High-Quality Care, Improvements in Quality Indicators, Adoption of QI
Mission across unit.

ACTION STEPS FOR HOSPITALS

To help hospitals around the country incorporate the lessons learned from studying these top-performing hospitals, we developed the following set of actions steps:

1. Develop clear mission statement that incorporates quality and back up that mission with structures and resources.
2. Develop and use performance-related criteria for hiring, credentialing, and retaining physicians and nurses.
3. Establish relationships with nursing schools for workforce supply and improve working conditions for nurses This should include training and advancement opportunities, adequate staffing, empowerment, and respect for nurses, with real consequences for non-compliance.
4. Establish team-based case management and work to ensure that physicians and other caregivers accept the role of team leaders or case managers in coordinating and facilitating care.
5. Emphasize QI in new staff orientations (e.g., directly from CEO) and regular staff meetings; establish QI training and activities as part of daily responsibilities rather than an extra burden on top of other tasks.
6. Incorporate QI into strategic plans, involving nurse leaders, department chiefs, and key staff in process.
7. Using a participatory process, select a few broad quality indicators that are measurable and for which there are benchmarks or standards.
8. Establish regular, periodic reporting on quality to the Board of Directors.
9. Set specific quality goals at the Board and CEO levels and hold staff accountable for progress toward these goals.
10. Select departmental leaders who buy into, champion the QI philosophy, and can influence staff physicians. These clinical chiefs are the enforcers who must ensure that new policies designed by committees. are implemented.
11. Establish multi-disciplinary working quality committees and the ability to create ad-hoc committees to address quality issues when they arise.
12. Use dedicated data analysts to monitor quality indicators, identify outliers and variations within the institution, and compare performance with evidence-based standards and regional and national benchmarks to determine areas needing improvement (e.g., individual physicians who need to change practice patterns).
13. Allow clinicians to question, debate, and disaggregate the data that indicate possible problems.
14. Use multidisciplinary teams to conduct root-cause analysis to identify sources of deficiencies, develop specific plans to correct deficiencies with timetables and goals, and continuously monitor progress towards these goals, with consequences if improvements are not realized.
15. Develop internal protocols and critical paths. Physicians favor—and are more likely to adhere to—home-grown protocols and standards, albeit those that are guided and informed by literature and external best practices.
16. Manage human resources (e.g., nurses, technicians), equipment and devices, and physical plant to improve safety, reduce errors, enhance efficiencies through standardization, and streamline supply chains and procedures.
17. Incorporate IT when feasible. IT should support clinicians in providing high quality care on a daily basis through timely access to relevant data and by providing reminders or alerts based on evidence-based protocols.
18. In designing IT for a hospital, emphasis should be placed on ensuring that the system:
• Is adapted to the specific culture and priorities of the institution;
• Builds value for the physicians (e.g., allows them to do things more quickly and efficiently);
• Incorporates the input and participation of hospital physicians;
• Includes a process for educating and obtaining buy-in from staff;
• Is integrated, flexible, and secure.
CONCLUSION
This report identifies and categorizes the factors and ingredients driving selected top performing hospitals to provide high-quality care and to perform successful quality improvement. Most hospitals are committed to reducing inappropriate care, improving patient
Safety and achieving good health outcomes for patients while holding down costs. By observing the leaders in the field, we have identified a series of best practices. The quality problems in the health care system highlighted at the outset of this report, can only be reduced if the best practices of the leaders are more widely disseminated and adopted. Hospitals and other providers who are not adopting these best practices should be encouraged to do so with information, technical assistance, incentives, and pressures.
One such method of encouragement would involve financial incentives in the form of reimbursement policies that reward, rather than penalize, hospitals for improving quality. Government could play a role not only as the largest purchaser (i.e., of Medicare and Medicaid services), but also through continued activity in standardizing quality measurement and reporting mechanisms. Government could also invest more resources in providing technical assistance to hospitals and supporting their investments in quality related IT.
As discussed in this report, the case study hospitals were generally not feeling much pressure from private purchasers—employers, insurers, managed care organizations—to improve quality. In this area, performance-based reimbursement and quality partnerships could make a difference. However, hospitals need not and should not wait. They can begin to take a number of action steps on their own—establishing the right culture, people, processes, and tools to move in the right direction.