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St. Luke’s Hospital
Hospice:
Connecting Earlier
Market Strategy
May 2005
Lindi Roelofse Gary Gu Gabriel Hansen Myungkyu Noh Lauren Olson
Agenda
I. Abstract
II. Analysis Overview
III. Market Segments and Sampling
IV. Results
V. Recommendations
VI. References
St. Luke’s Hospice
Abstract
The objective of this study is to suggest
strategies to facilitate earlier enrollment for
hospice eligible persons. Structured interviews
from a broad base of hospice constituencies
and quantitative Press Ganey data analysis
suggests that there is a general misconception
and stigma associated with hospice.
This report will provide five low cost strategies
to address this problem.
I St. Luke’s Hospice
Analysis Overview
Social Issue
• Offer more caring for people who have a terminal illness;
Campaign Focus
• Increase patients’ awareness of hospice service, including specific
service benefits, financial requirements, and decision-making options;
• Increase doctors’ likelihood of connecting with patients sooner to
discuss hospice as an entitled option for end-of-life care;
Campaign Purpose
• Provide referrers, family members, and those who are in their end-of-life
phase with the necessary information to enroll in the hospice program
earlier
II St. Luke’s Hospice
Analysis Objective
Average Length of Stay Average Daily Sensus • Actual
numbers
100 70
60
• SLH
80
50
60
Days
40
Days
40
expectations
30
20 20
0 10 • More
2000 2001 2002 2003 2004 2005 0 conservative
2000 2001 2002 2003 2004 2005
trend estimate
Campaign Goal
Increase the average length of stay from 48 days in 2004 to 77.7 days in 2005. By
implication, this should also result in an increase in the average daily census from 49.6
patients in 2004 to 66 in 2005
II St. Luke’s Hospice
Market Segments & Sampling
Quantitative Qualitative
Press Ganey and internal statistics were analyzed Structured interviews were conducted to
to understand the current internal and national understand the different perspectives of the
situation. SLH constituencies. Convenience sampling
was used.
constituency n
Physicians 6
Long-term care facilities 4
Past users 4
Non-users 8
SLH Staff 4
Competitors’ Staff 4
Legal Professionals 2
III St. Luke’s Hospice
- quantitative
ResultsDuration of Service
How long did you use hospice How long did you use Hospice
(Last Period) (This period)
1-3 days
>6 mths 10%
1-3 days
10%
17% 4-7 days
>2 mths to >6 mths 10%
6 mths 39%
4-7 days >1 week to
24%
22% 1 mth
>1 mth to 2 19%
>1 week to >2 mths to >1 mth to
mths 1 mth 6 mths 2 mths
13% 14% 12% 10%
Less than 10 days : about 40% Less than 10 days : about 10 %
Less than 1 month : about 30 % Less than 1 month : about 30%
Over 1 month : about 30% Over 1 month : about 60%
Compared with last period, the average duration of care has been increasing. This
data shows that effort to increase the duration of care does work. Further, 39% of
over 6 months is a good sign. But St. Luke’s Hospice has to find a way to maintain
this trend as long as possible.
IV
- quantitative
ResultsAppropriate Time
Was referred at appropriate time Was referred at appropriate time
(Last Period) (This Period)
No. Too No. Too
early early
NO. Too NO. Too 2%
1%
late late
1% 12%
Yes, Right Yes, Right
time time
98% 86%
This data shows that there is a conceptual gap between customer perception and actual
hospice service. Hospice patrons think that they were referred to hospice services at the
appropriate time (86% of this period). SLH should utilize this result to improve the
general concept. The sooner patients are referred to the service, the more they show
preference to hospice service.
IV
Internal vs. Patient Priorities
Correlation Coefficient
Internal
Independent Variables Priority Correlation
Coord of care among hospice team 5 93
Hospice staff's concern for privacy 93 • This data indicates that there are
Efforts to include you in decisions 91 some gaps in general priorities
Concern keep you informed about cond 89 between St. Luke’s Hospice and its
Overall quality of care provided 89 patients. Patients regard the
Honor given to religious traditions 3 89
coordination of care among the
hospice team and the staff’s concern
Likelihood of recommending 89
for privacy as the top priorities, but St.
Staff's sens to persnl difficulties 6 89
Luke’s Hospice treats responsiveness
Rspnsvness evning/wknd on-call svc 1 85 with evening and weekend on-call
Helpfulness employee made arrngmnts 84 service as the most important priority.
Staff addressed spiritual needs 4 83
How well nurse taught you to care 8 82 • This indicates that St. Luke’s
Educ and training about how to care 82
Hospice can re-organize priorities to
satisfy patients and their families e.g.
Approp of Hosp servcs to meet needs 79
“coordination of team,” “privacy” and
Nurse' concern for comfort 79
“inclusiveness” are generally more
Control of other symptoms 2 77 important than the expected “on-call
Ease of changing the care schedule 76 response”, “control for symptoms,”
Staff addressed emotional needs 75 and “religion customization.”
Helpfulness of bereavement program 75
Info provided hospice mission 6 74
IV Dependent variable : Overall Satisfaction
of Stay
Average Lengthcomposition
Average Length of Stay
Customers
VOLUME STATISTICS 2000 2001 2002 2003 2004 AGE 2000 2001 2002 2003 2004
Number of Referrals 281 288 318 344 425
0-30 years 0 3 2 4 1
Number of Admissions 216 213 238 275 357
31-40 years 6 3 4 4 1
Percent of Referrals
Admitted 77 76 75 80 84 41-64 year 37 20 39 36 41
Average Daily Census 28 40.6 49.66 37.5 49.65
65-80 years 81 100 92 96 118
Average length of Stay
(Days) 37.2 50.3 68 57.7 48 80+ years 91 87 101 135 196
2000 ~ 2001 ~ 2002 ~ 2003 ~
2000 ~ 2001 ~ 2002 ~ 2003 ~
VOLUME STATISTICS 2001 2002 2003 2004
AGE 2001 2002 2003 2004
Number of Referrals 2% 9% 8% 19%
0-30 years 100% -50% 50% -300%
Number of Admissions -1% 11% 13% 23%
31-40 years -100% 25% 0% -300%
Percent of Referrals
Admitted -1% -1% 6% 5% 41-64 year -85% 49% -8% 12%
Average Daily Census 31% 18% -32% 24%
65-80 years 19% -9% 4% 19%
Average length of Stay
(Days) 26% 26% -18% -20% 80+ years -5% 14% 25% 31%
• Overall criteria show positive results as number of referrals and admissions are growing.
• However, average length of stay decreased. This result might come from the medical
process or the character of diseases.
• Finally, older patients are getting more involved in hospice service.
IV
Disease/Referrals/Discharge
Disease/Referrals/Discharge
Diagnosis 2000 2001 2002 2003 2004 2000 ~ 2001 ~ 2002 ~ 2003 ~
Diagnosis 2001 2002 2003 2004
Cancer 153 147 139 148 160 Cancer -4% -6% 6% 8%
Non-Cancer 63 66 99 128 197 Non-Cancer 5% 33% 23% 35%
PHYSICIAN TYPE 2000 2001 2002 2003 2004 2000 ~ 2001 ~ 2002 ~ 2003 ~
PHYSICIAN TYPE 2001 2002 2003 2004
Family Practice 96 112 120 137 190
Family Practice 14% 7% 12% 28%
Oncologist 70 51 66 66 84 Oncologist -37% 23% 0% 21%
Internist 26 47 52 72 103 Internist 45% 10% 28% 30%
Other 24 3 0 0 0 Other -700% #DIV/0! #DIV/0! #DIV/0!
DISCHARGE DISCHARGE 2000 ~ 2001 ~ 2002 ~ 2003 ~
Disposition 2000 2001 2002 2003 2004 Disposition 2001 2002 2003 2004
Number of Deaths 186 186 222 237 309 Number of Deaths 0% 16% 6% 23%
At home 174 177 191 181 237 At home 2% 7% -6% 24%
In-Patient (hospital) 12 9 31 56 72 In-Patient (hospital) -33% 71% 45% 22%
• Importance of non-cancer patients: As time goes by, the number of non-cancer patients has been increasing. St.
Luke’s Hospice should utilize a marketing plan for improving the reputation of service for non-cancer patients. The aim is
to counter Amenity Hospice’s marketing plan regarding non-cancer care.
• Strategic concept of distributional factor: From 2001, the importance of family medicine doctors as a referral has
been increasing. It is important to cultivate opinion leader groups in the family medicine field for early reference.
• Number of patients: Trend of in-patients at hospitals has also increased. St. Luke’s Hospice should find a way to
advertise its strength in this area.
IV
Results – qualitative
Common behavior and beliefs about hospice
• People generally do not have a lot of knowledge about hospice
care. If they are aware of it, they know hospice handles pain
management issues toward the end of a person’s life.
• The general public does not think about hospice as an option for
them to consider independent of a doctor’s recommendation.
• Even though enrolling in hospice is a major decision, it is
typically treated with what might be considered routine problem
solving behavior: the doctor says hospice is needed and the
patient does little or no research to choose an appropriate
service.
IV St. Luke’s Hospice
Results - qualitative
Common social misconceptions related to hospice that need to be
eliminated:
• All patients fight to the end: At some point, relationships and comfort may become
more important and that is normal.
• Doctors should never stop trying to find a cure: Doctors should consider the all
options, especially when it becomes apparent that he/she can not stop the
deterioration process.
• Don’t talk about death when it is not relevant: Discussing end-of-life issues before
entering the actual phase is both normal and important so that people know how to
better support a loved one.
• Hospice is only for poor people: Many believe that a 24-hour nurse fulfills the same
service as hospice. This is not true. Hospice offers an expert support team that goes
beyond the functions and resources available to a nurse.
• Enrolling a loved one in hospice proves that you are incapable of taking care of
your own family: Especially in the Midwest some families prefer to handle difficult
situations with “pride” (internally and behind closed doors). In actuality one would be
able to take better care of a loved one during the end-of-life phase if the family and
friends also receive support form hospice experts.
IV St. Luke’s Hospice
Conclusion
Estimated position
of the hospice
market today
growth
time
• SLH finds itself in a growing market
• Early stage of the market development
• Professionals are unable to differentiate the services
• Customers are unable to differentiate and identify what
hospice they use
V St. Luke’s Hospice
Service Differentiation
Some specific messages to communicate the differences of
SLH compared to competitors:
Legacy: SLH provides personalized activities to provide a therapeutic outlet beyond
what others offer. For example, pet therapy, massage therapy, music therapy, notated
photo albums, genealogy charts and legacy packets
Convenience: It is possible to ask for a specific service from SLH, such as easy
check-in/check-out procedure and access to relevant information about SLH via
telephone, guest speakers, and the internet
Trust: That SLH can offer the high quality service each patient needs as corroborated
by high satisfaction scores
Dignity: Respect for patient privacy at all times and during all services
V St. Luke’s Hospice
Factual Knowledge to Disseminate
Hospice in General St. Luke’s Hospice Specifically
• Location: Patients remain in • Customization: To individual needs
home, hospital, and/or LTCF
• Cost: No person should be turned • Length of enrollment: Start at 6
away because of a lack of month life expectancy. Longer
insurance to cover the cost enrollment translates to greater
• Services: Go beyond the comfort and better customization
physiological to include emotional, • Satisfaction: Extremely High (97%)
spiritual, and social benefits
• Patient: Non-cancer as well as • Tradition: Longest history of
cancer patients in last 6 months hospice service in the area
• Expertise: Hospice offers • Specializes: In promoting dignity
expertise that a 2-hour nurse would and purpose for non-cancer and
not have
• Why: These services would be cancer patients
important to a person during the • Referrals: From any doctor or
end-of-life phase hospital within a 50 mile radius
V St. Luke’s Hospice
Price: Benefits
There are major financial benefits to enrolling in hospice
since Medicare and/or insurance covers all expenses.
Every person has a right to this service if they qualify
based on a doctor’s prognosis of their life expectancy.
There is no price differentiation between competing
hospice organizations.
V St. Luke’s Hospice
Place: Convenient Access
Because hospice-eligible patients generally experience decreased
mobility, the ideal place to administer services are in their own homes,
long-term care facilities or hospitals. Further, response time is important
which supports the 50 mile radius of service as a good policy.
There is a major need for additional initiatives to increase access to
information through the internet and at community engagements which
address issues related to the end-of-life stage.
Additionally, informational exhibits inside St. Luke’s Hospital would be a
good way to reach all levels of the target audience. This would allow hospital
staff, visitors, and patients to have access on a daily basis.
V St. Luke’s Hospice
Promotion: Strategies
Key Messages:
To the General Population To Physicians
1. There are two decisions you need to consider 1. Patients are unaware of the full range of
regarding hospice care: services that hospice offers.
• When is hospice care appropriate for 2. Patients do not understand that they are
you? entitled to the hospice benefit.
• From whom do you want to receive 3. We’re not asking you to recommend hospice
your hospice care? services earlier. We’re only asking that you
2. You are entitled to hospice care. introduce the hospice option early on so
3. Hospice decisions should be discussed well in patients and their families can ask questions
advance of when you actually have to make the and do research well before the actual
final decision (i.e., engage these topics now!). decision needs to be made.
4. There are benefits to hospice care that reach far
beyond pain management and comfort care:
Financial Advice, Family Support, Speech
Therapy, Music Therapy, Pet Therapy
V St. Luke’s Hospice
Promotion: Strategies
Style and tone of messages:
To the General Population To Physicians
• The current style and tone is
• Clear, specific, unambiguous terms probably appropriate.
must be used for all • Professional and honest
communication. Avoid the use of
phrases like palliative care or social communication must be used at all
worker without specifically times.
explaining the meaning of them. • Try to instill the idea that you are
• Use an informative tone, but note working as a team within the medical
that the audience is not only a community by using a cooperative
patient, but also a customer whose tone while offering assistance in a
primary need involves a painful tough subject area.
subject. As such, in addition to
information, hospice customers are
also looking for comfort.
V St. Luke’s Hospice
Promotion: Strategies
Copy, format and graphic recommendations
• Copy for all marketing materials should focus exclusively
on the specific message objectives. Detailed information
can be delivered using other means.
• Graphics and formatting should be uniform throughout
the campaign. Use the official St. Luke’s Hospice
trademark on all written media.
V St. Luke’s Hospice
Media Vehicles
Strategy Vehicle
Advertising PSA, TV, radio, newspaper, magazines, internet, blogs,
support chat forums
PR Stories on TV and radio, articles in newspapers and
magazines, videos, exhibits, meetings, conferences
Printed Material Brochures, newsletters, calendars, booklets, mouse pads,
flashlights, hangers
Signage and Road signs, signs, and posters on government property
Displays
Personal Face-to-face meetings, presentations, conferences,
Selling workshops, seminars, training sessions, telephone calls.
V St. Luke’s Hospice
Recommendations
Primary Target Audience: families who currently need hospice service or
may need it in the future. The St. Luke’s Hospice current service area of a
50 mile radius around Cedar Rapids will serve as the primary target area.
• Education of the full range of hospice services is needed for this
group, so they may be better informed when faced with a life-
threatening illness.
Secondary Target Audience: physicians and medial personal who would
refer potential service takers
• Distribution occurs primarily through physicians and medical
personnel in the form of referrals
• Encourage conversation about hospice at an earlier stage
VI St. Luke’s Hospice
Objectives
Change Behavior
Develop strategies to influence
potential patients and
health care professionals to inquire
about or to recommend SLH earlier.
Change Knowledge Change Beliefs
Patients who enroll in hospice at an Enrolling in hospice will improve the
earlier point of eligibility quality of patients’ lives
experience specific benefits. Many and those who care for them. Those
patients have who discuss and/or enroll in
misconceptions about hospice. This hospice earlier rather than later will
must be corrected. not be viewed negatively.
VI St. Luke’s Hospice
Recommendations
Recommendations
Brochure: Revise to include more basic marketing message and theme.
Emphasize full range of services and differentiation.
Website: Re-design to become a comprehensive, one-stop information
source about St. Luke’s Hospice. People at all stages of readiness should
be able to find the information they need from the website.
TV and/or Radio PSA: This will target the secondary audience and
should serve as a way to raise awareness about hospice in general, as
well as a way to affect attitudes and perceptions about hospice service.
Rotating Exhibits at St. Luke’s Hospital: Use hospital space to educate,
raise awareness and affect attitudes of secondary target audience.
V St. Luke’s Hospice
Recommendations
Recommendations
Legacy Pamphlet: This could be used two ways, depending upon which
way St. Luke’s Hospice thinks it would be most beneficial, and upon
budgetary or volunteer hour constraints.
• Distribute to LTC facilities for residents’ use. This method of use
would serve to raise awareness about St. Luke’s Hospice, and may
serve as an entry point into some facilities. This use can also help
shape brand attitudes regarding St. Luke’s Hospice.
• Use with St. Luke’s Hospice patients. Volunteers could work with
patients, helping them create some of the ideas in the pamphlet. This
use would be a point of differentiation in service between St. Luke’s
and other hospice services in the area.
V St. Luke’s Hospice
Recommendations
Recommendations
Form a strategic alliance with other non-profit hospices: There is a
great opportunity to increase the number of people in Iowa who use
hospice service. In order to accomplish this, a large educational
campaign needs to be undertaken, which most non-profit hospices could
not afford to do on their own.
• Alliance could be regional or state-wide
• Other hospices have expressed an interest in working together
• Other benefits besides resource pooling could include: information
sharing, increased innovation, better service(s) to patients, and
establishment of local best practices
V St. Luke’s Hospice
Implementation
BROCHURE
1. Sample (link)
2. Message strategy
– Offering basic and necessary information about SLH for target
audience
3. Action
– Redesign and reproduce the brochure
– Deliver to target audience and distribution channels
4. Monitoring & Evaluation
– Monitor feedback from target audience through interviews, focus
group and questionnaire, etc
– Monitor feedback from distribution channels, such as doctors and
social workers
V St. Luke’s Hospice
Implementation
LEGACY PAMPHLET
1. Sample (link)
2. Message strategy
– Convey LEGACY message for primary target audience
3. Action
– Produce the pamphlet
– Delivery to primary target audience through health fair and exhibition,
etc
4. Monitoring & Evaluation
– Monitor feedback from primary target audience
– Participation ratio among patients
V St. Luke’s Hospice
Implementation
TV/RADIO COMMERCIAL
1. Sample (link)
2. Message strategy
– Promote SLH services by focusing on dignity and value
3. Action
– Produce a 30-second video/radio commercials in a uniform style
– Negotiate with local TV/Radio stations about air time and frequency
4. Monitoring & Evaluation
– Timely airing report from local TV/Radio stations
– Monitor feedback from target audience
V St. Luke’s Hospice
Implementation
ROTATING EXHIBIT
1. Sample (link)
2. Message strategy
– Promote hospice service with more accessibility for primary target
audience
3. Action
– Produce the rotating exhibit frames
– Negotiate with relevant hospitals and agencies for timely exhibition
– Update concept and location on a quarterly basis
4. Monitoring & Evaluation
– Monitor feedback from target audience through focus group and/or
surveys
– Monitor feedback from participating hospitals and agencies
V St. Luke’s Hospice
Implementation
WEBPAGE
1. Sample (link: http://www.stlukescr.org/body.cfm?id=84)
2. Message strategy
– Create a full information resource about SLH services
3. Action
– Add specific hospice service items, including specialized items
– Link with 30-second video commercial about SLH services, focusing on new message of
Legacy for target audience
– Add an animation of regular service process for target audience, particularly those older
patients more than 60 years old
– External link with a community site, much like eBay’ site so people sharing the same
interests can easily get together
– Move the Read about one family's experience with St. Luke's Hospice to the right column,
redesign the text and change the hyperlink to an external one
4. Monitoring & Evaluation
– Add a recorder to monitor the number of visitors on a monthly basis
– Collect feedback from target audience through online surveys or questionnaires
V St. Luke’s Hospice
References
1. Tapke, Melissa. St. Luke’s Hospice Application Letter, January 2005
2. St. Luke’s Hospice Agency Evaluation FY2004, February 2005
3. Tapke, Melissa. Email Interview, March 21, 2005
4. Tapke, Melissa and Cindy. Personal Interview, February 17, 2005
5. http://www.stlukescr.org/body.cfm?id=84, April 3, 2004
6. http://www.amenityhospice.com/, April 3, 2004
7. http://www.mercycare.org/services/hospice/index.aspx, April 3, 2004
8. http://www.dhs.state.ia.us/dhs2005/dhs_homepage/index.html, April 3,
2004
9. Tapke, Melissa and Cindy. Personal Interview, February 17, 2005
10. "Hospice Service Report - 2004", Press Ganey
St. Luke’s Hospice
