Ethical Marketing of Ophthalmic Practices

Prof.Dr. Ashok Thiakarajan Ph. D., Prof. Dr.R. Chandrasekhar Ph.D., *

 

Bioethics tries to define the medical activity and any other related activity needed to maintain the function of a health institution, through the development of principles and moral values. Bioethics is quite broad and has a background that combines various disciplines such as medicine, philosophy, law, sociology, and theology. Advertising and promotion are part of the strategy aimed at developing and maintaining relationships with the targeted audience (patients). To regulate this activity, it was necessary to develop ethical rules of healthcare marketing. The content of promotional messages must be truthful and should not create unjustified expectations. The doctor or the healthcare unit must be able to provide the services claimed in the advertisement. From an ethical point of view, marketing communication should be more consistent with reality, even if its purpose is to shed light on more attractive issues. In this context, the categories and groups vulnerable to certain content of the advertising message should be mentioned. A patient with a serious suffering will be easily influenced and will tend to trust any promise easily, with the desire to heal. Ethically, the information presented must not alter the reality and should not give false hopes to patients.

Those responsible for marketing in the healthcare field must keep in mind the ethics code of the medical profession, must maintain an honest marketing communication, which does not create inaccurate expectations, must not denigrate other colleagues, and must use a message whose content should respect the dignity of the profession.

Keywords: medical ethics, advertising, promotional message, healthcare

Bioethics is quite broad and has a background that combines various disciplines such as medicine, philosophy, law, sociology, and theology. Internationally there are many institutions, committees, and courts charged with identifying ethical principles to underpin the activity in the medical field, principles, which take into account values such as human dignity, right to life or autonomy. This write up attempts to explore the nuances of marketing ethics in the light of current complexities in the world of marketing especially in the eyecare practices

Hyper competition

The evolution of medical activity performance forms has inevitably led to the emergence of chronic and hyper competition, which in turn led to the emergence of healthcare marketing. Thus, a health institution requires the application of various marketing strategies in order to maintain itself on the market field. Advertising and promotion are part of the strategy aimed at developing and maintaining relationships with the targeted audience (patients).

To regulate this activity, it was necessary to develop ethical rules and regulations of healthcare marketing. More so when the worst hit services are the hospital services wherein the normal process of OPD, elective surgeries and radiological procedures are completely left to a great uncertainty gripping the fear of incessant infections which goes unscathed.

The ever-changing evolution of life has inevitably affected the healthcare systems pushing to significant changes and imposing healthcare marketing as an indispensable element of health care facilities, in particular hospitals, be it clinic, Nursing homes, single speciality hospitals and Multi-speciality corporate hospitals. Healthcare is a segment in a constant evolution, the plethora of opportunities stimulating creativity, enthusiasm, and will exploit the specialists in the field. The emancipation of different types of health care services like Single or primary health services, Tertiary care services and recently the super speciality hospitals with high end interventions are being performed.

Healthcare Marketing

As the philosophy and marketing techniques in other fields is hard to find applicability in the hospital segment as they need their own approach and present certain features that are scarce in the marketing of healthcare services differs primarily through the nature of demand for health services. Secondly, the beneficiary may not be the target of the marketing campaign, the physician being the one who decides what, where, when, and how much will be provided for a particular service. The decision-maker may be the doctor, the health plan representative, a family member.

Ethical marketing

One of the most frequent discussions that arose with the development of healthcare marketing was due to the concern that advertising will lead to a situation in which the medical activity will turn into an overly commercial one. Of course, this is quite difficult to avoid, considering that the medical units providing services and healthcare have the right to make their own activities known and inform consumers on the health services they provide. In the past, it was considered that advertising and promotion were below the dignity of the medical profession and that the only way to gain new patients was by recommendation from satisfied patients and other clinicians’ positive assessments. Such thinking is no longer compatible with the current patients’ requirements, which want to be more and more informed

Today, it is considered ethical for health institutions or individual clinicians to promote their work as long as the information is truthful, honest, non-discriminatory, and not misleading. The biggest challenge is often represented by the message sent, which is not sufficiently detailed because of the selected multimedia format. In advertising purpose, various media can be used, such as newspapers, Internet, billboards, brochures, audio-visual means, etc. In any case, it must be kept in mind that ethics requires that any paid advertisement should be identified as such.

Conventional promotion tools in Eyecare

Over the past years, hospitals have experienced many marketing trends that have fundamentally altered the basic characteristics of the conventional marketing. These trends are the follows:

1.      Mass marketing approach to a 2 Ps approach.

2.      Service Marketing to Servitude

3.      The General approach to product bundling and disease-specific.

4.      Mere visit of a patient to an establishment of a long-lasting relationship

5.      From “ignoring” the market, to ‘market intelligence’ or Market analytics.

6.      Switching over from conventional to Conceptual (Digital)

Very often these two concepts are being misunderstood and the proper sales apparatus was not developed for several years. It was always the decision of the promoter or owner of the clinics/nursing home or the hospital to decide on the marketing instead of a professional to manage the same. The role of Service Line Managers who plays a defining role to convince the customers for a specific procedure or surgery based on the recommendation of the treating physician. 

The doctors are generally finding it difficult to spend more time due to the various clinical engagements like OPD, procedures, surgeries, ward rounds, writing down clinical notes and then academic activities. In this context, the role of service line managers who are well trained about the various technical details and data are put in to the task of providing confidence to the patients who are often confronted with fear and expenses incurred in the treatment process.

Internal ‘promotions’ in the hospitals especially the Eyecare institutions

Eye care institutions take care of the patients more emotionally while compared to other specialities by virtue of its applications and scope. The effectiveness of this approach depends on how the hospitals has an effective communication with patients, exhibit a correct image of the health service, and delivers the promised service properly, and portrays a permanent concern for the continuous improvement of the service provided to exceed the expectations of the patients. In a nutshell this process is known as “SERVITUDE” (in short, service with a positive attitude) and the entire gamut of the hospital staff should be trained to focus on this area.

The counsellors or service line managers are able to explain the duration, quality of life post procedure or surgery, the various types of medical devises with the cost and benefits and finally the tariff. Multiple modes and options like insurance, TPA, state Government and central Government schemes and for those needy patients the free surgeries like cataract is also being recommended by these managers. This important process helps the customers to arrive at the decision based on the facts provided to them and also minimise the precious time of doctors to concentrate on their mainstream of work i.e. patient care. In short, the hospital becomes customer centric.

‘Payor Mix’ and ‘Market intelligence’

The word ‘payor mix’ depicts the various routes or channels through which customers are stepping in to the hospital. It is broadly classified as cash patients, insurance and TPA patients, Corporate patients, from Government schemes and finally the international sources. The contribution of each segment on the above segments vary from area to area, hospital to hospital and market to market. Better the understanding on the changing market dynamics, economics and socio-political situation by a sales and marketing manager would be able to navigate the revenue streams in order to get the steady flow the patients.

Leveraging the ‘feedback apparatus’

For hospital administrators, the use of informative blogs or service feedbacks reported in the website or social media can be effective to get the pulse of the customers. Though there are always some negative comments from the irritated customers due to the cost or the delay in the services, which should also to be addressed in a diligent manner. The promotions through the social media like FB, twitter and Instagram are to be the effective ways to stay relevant to patients, especially to update them with the latest campaigns, health days and the important milestones achieved in the medical technology.

The positive feedback on response from the patients after receiving the wonderful service is sacrosanct for the organisation. Moreover, continuous efforts to upgrade or modernise the SEO by infusing targeted keywords into the content would be of greater significance for the marketing “star burst”. For making the branding to be effective, the digital platforms in which the hospital and the patients’ interface or will operate on must be identified, the target audience will have to be segmented correctly, and tailormade communication will have to resonate.  

Target Marketing or disease profiling

Focus should be towards building a sustainable relationship, then in ensuring a single transaction. Major aim is to create a high level of consumer satisfaction in terms of service deliverance (servitude) so that they return to the same service provider i.e. hospital/clinic. Sales and Marketing heads are incorporating many methods that include marketing research, product design, Target marketing, pricing, advertising, promotional sales, social media marketing and most importantly the sales management.

These methods are often supported by the modern tools related to new technology and new concepts, to attract customers through strong brand promotions and classification of target groups and market segmentation.

Ethical communication to the customers

A special attention should also be paid to the used language. The available advertising space is often limited. This leads to the need of shortening and compressing the message and it can lead to an extremely different version of the original message, thus, advertising misleading by providing information that is different from that intended.

The content of promotional messages must be truthful and should not create unjustified expectations. The doctor or the healthcare unit must be able to provide the services claimed in the advertisement. A special attention should be paid to experimental procedures that have not yet proved the desired results in order not to misinform the patients

Ethical Promotion

Vouchers offering various services at reduced prices or even given for free are included in the category of marketing strategies designed to promote healthcare units, in order to attract patients and retain them. Based on this, an ethics dispute raised because it was possible that this practice undermined the medical component of the unit favouring the commercial aspect. Also, in such cases, the quality of services at a lower price should not be inferior to those offered at the initial price.

In the same context of commercial appearance of the medical activity, the public perception of the medical profession should also be mentioned. This perception can easily be negatively influenced by unethical marketing strategies. Doctors and healthcare units have an important duty of practicing marketing with responsibility.

Ethical Marketing communication

From an ethical point of view, marketing communication should be more consistent with reality, even if its purpose is to shed light on more attractive issues. In this context, the categories and groups vulnerable to certain content of the advertising message should be mentioned. A patient with a serious suffering will be easily influenced and will tend to trust any promise easily, with the desire to heal. Ethically, the information presented must not alter the reality and should not give false hopes to patients.

Also, promotion by mentioning the success rates is considered unethical in general because, most often, these results are not representative when the selection/ exclusion criteria of eligible patients are unknown. These criteria could lead to a high success rate only for some selected patients. Prospective patients are easily impressed by such high rates and could form inaccurate expectations.

Finally, yet importantly, the attitude towards other colleagues should be mentioned. When a doctor or a health organization promotes its competence by denigrating the work of other physicians through marketing material, the marketing activity becomes unethical.

Contemporary views on ethical practices

But good business and good ethics don’t have to be mutually exclusive, argues Penny A. Asbell, MD, MBA, professor of ophthalmology at Mount Sinai School of Medicine and director of its Cornea Service and Refractive Surgery Center. Her case commentary tackles the challenges ophthalmologists face in defending their practices from the encroachment of online contact lens purveyors and other practitioners; she advises physicians to focus on improving and expanding the services they provide to attract and retain patients.

Thomas A. Oetting, MD, professor of clinical ophthalmology at the University of Iowa, also emphasizes the importance of going above and beyond to provide high-quality care in his case commentary about how residents can work to offset the elevated risk they bring to patient surgeries. Helping keep the physician informed about the latest developments in the care of the eye are Usha Rao, MD, senior resident in ophthalmology at Baylor College of Medicine, who provides an overview of the recent advances in understanding and treating glaucoma, and Michael Hughes, BCO, who introduces the reader to artificial eye makers—ocularists—and how they tailor their creations to the patient.

Ophthalmologists’ duties to society are explored in the health law and medicine and society sections. Paul Steinkuller, MD, of Baylor College of Medicine and Texas Children’s Hospital discusses the physician’s responsibility to impaired drivers to protect them and others on the road. Dr. Steinkuller cites and we reprint the AMA Code of Medical Ethics opinion on the physician’s duty to impaired drivers and society. Kiran Motaparthi, MD, from the department of dermatology at Baylor College of Medicine, raises questions about the social and ethical import of cosmetic blepharoplasty to alter the characteristically Asian eyelid.

In conclusion,

To improve the competitive advantage, by increasing the visibility in order to create an undisputed reputation among patients and to understand the service deliverables and gaps from the patients.

The customer experience management is going to be only difference which could be felt by the patients and can make them to revisit the hospital for all diseases, at all times.

Understanding the customer experience journey

The customer journey includes interactions and touchpoints through traditional channels, such as website purchases, phone calls and live chat as well as social media, text and other emerging communication mediums. With more communication channels comes greater complexity. A customer journey map allows companies to identify customer touchpoints throughout the customer lifecycle. This helps a company to create a customer experience based on predictable customer needs and behaviours. This approach also enables a business to review and streamline its processes throughout the customer journey, which can improve customer satisfaction.

Those responsible for marketing in the healthcare field must keep in mind the ethics code of the medical profession, must maintain an honest marketing communication, which does not create inaccurate expectations, must not denigrate other colleagues, and must use a message whose content should respect the dignity of the profession.

Today advertising has become a field with an unprecedented dynamism; therefore, marketers must recognize trends and understand them correctly. The media today uses the audience measurement techniques, which are much more efficient, more interactive and therefore experience a similar condition.

Executives empowered with advertising in order to attract the targeted audience should be aware of the new trends, should be ready to apply them, should be malleable, but regardless of established goals, should have an ethical attitude and conduct.

Authors

Prof. Dr. Ashok Thiakarajan is a student of Prof Philip Kotler and a versatile health care administrator with hands international on experience in the field of sales, marketing and operations with leading multinational organisations like Johnson & Johnson, Beiersdorf AG, Fortis Health care, KIMS group, HCG cancer hospitals and currently the CEO of Westminster health care, London a part of Lyca health care based at Chennai.

Prof. Dr.R. Chandrasekhar Menon is a distinguished academician and the Founder Director of “SERVITUDE” a training organisation exclusively dedicated to healthcare soft skill training and carrying international experience in working with top notch institutions like B. Braun AG over 40 years. He is now based out in Coimbatore and a regular invitee to various management schools like IIMs and international forums in this domain