Hospital Branding and Name Changes: How Data Reveals Expectations [Podcast]

By Stewart Gandolf, Chief Executive Officer

[Healthcare Success Leadership Podcast] In this installment of our continuing educational series, Healthcare Success CEO Stewart Gandolf talks with Rob Klein, founder and CEO of healthcare marketing research firm Klein & Partners.

A prospective name change, branding or rebranding, will dramatically impact every aspect of a hospital system…image, operation and culture. Here’s how research can provide decision support for a branded house, or a house of brands…and create a sound Architecture Strategy. Stewart and Rob discuss:

the primary elements of a brand’s strength
the role of a name as a memory trigger
the influence of memory telescoping
revealing patient expectations, and
how to avoid bad decisions and creating “logo soup”

Stewart Gandolf: We’re talking about an actual client that is considering a change of everything throughout the entire hospital system. There are medical centers, hospitals and medical systems; this would be a top-to-bottom adjustment. Consequently, it’s a decision that is not to be taken lightly because, with a wrong choice, a lot of bad things can happen quickly.

While most people know me as a creative person, the reality is that I was originally trained as an engineer. And when I got into marketing, I still believe in and respect data. In fact, I just returned from the Google campus, and one of the take-away ideas from that meeting was: “In God we trust. Everybody else, bring data.”

So Rob, for this discussion, imagine our audience of doctors, hospitals and corporations—but today we’re primarily talking about an entity that already has a brand, and they are considering making a change. Maybe the world has changed around them…maybe they acquired a new system…maybe they feel they no longer represent the brand they want to be…and they are considering changing their name, or rebranding, even if it’s the same name.

That’s a big, scary decision. So, let’s discuss how data plays a role in finding the right answer.

Rob Klein: Stewart, thank you very much. I really appreciate being with you and I enjoy the conversations that we have. And, you’re right. It is a very important, and potentially life-long decision.

Think about when you have a child. You give that child a name that they are going to carry with them throughout their entire lifetime. If it’s a bad name—as I’ve known a few…family members and friends—when the child becomes an adult, they change their name. And that change also has big implications.

Hospital name change and primary elements of a brand’s strength…

So, let’s back up and consider what gets someone to the point where they want to have a name change. Something precipitates that decision. So, backing up, let’s talk about what makes a strong brand.

There are three components of brand strength. There’s the:

Brand Promise
Brand Experience
Brand Architecture

Think of these elements as a three-legged stool. All three components have to be in sync.

A strong Brand Promise creates interest in your brand from consumers.
The strong Brand Experience delivers on the promise and the expectations that it created.
The Brand Architecture includes the name and how well all the brand family members are organized (something like the rules of engagement) and how well they work together.

So if you are a system, and your Brand Promise is (hypothetically) “we are a well-coordinated delivery system.” Yet you act like individual hospitals and the participants are siloed, your Experience will fail the Brand Promise and the expectations that it has created.

That also impacts the naming. If you want to be a branded house, for example, as “System A” with the hospital names or ancillary services following it, that implies a master branded organization. Contrast that with “Hospital A, a member of System A.” That would imply an endorser brand or subservient master brand.

The name in a brand is a trigger…

Naming is an identity element or expression of the Brand Architecture. It’s a visual or verbal cue of your brand that tells people who you are. The sole purpose (the words and/or the symbol) is to act as a triggering stimulus. When someone sees that brand name, it triggers the thoughts, images, emotions and behaviors that you want to trigger in that person’s mind.

For example, Nike is such an iconic brand that they no longer use their name in commercials…they just show the (iconic graphic) “swoosh.” The “golden arches” for MacDonalds…the same thing. It’s iconic in our minds. But in healthcare, for the most part, we need to have our names to trigger… “this is ‘Brand-X’…this is what I feel about it…this is where I know it’s located…this is the experience that I will have…and, I like this brand.”

So, changing your name includes a lot of unintended consequences. Typically, when there’s a name change, it can have good reasons and bad reasons.

Stewart Gandolf: Tell us about the research and how to avoid a re-naming disaster. Everyone has a creative opinion. If these executives came to you today, what would be your process to avoid a name-change debacle?

Rob Klein: Changing a name is very expensive. I always tell clients that naming, and the naming architecture is a chess match, and you have to think several moves out. Too many times we are playing checkers, and we don’t do Brand Architecture well. A lot of clients don’t have Brand Architecture and Naming Architecture guidelines.

And we all know, mergers and acquisitions (M&A) activity is through the roof. Everybody is either buying, being bought, merging, dating or something. Everyone is in a state of, at least, dating or looking. So that means there are brands coming together that were once competitors and they are now going to be brand family members. And so, there is some natural animosity or concern… “are we going to be swallowed up by brand-x,” or vice-versa.

Consequently, naming is a natural first discussion that happens. And changing a name in healthcare is very difficult and costly. But as it turns out, consumers are actually horrible at telling us ‘what is a good name?’ -- especially if it’s an empty vessel (completely new, no equity, name).

Even worse, is it a made-up (constructed) name that has no meaning. In that case, the focus is on how the name sounds and how it’s used in a sentence rather than what the name means. Is it easy to remember…is it a long name…is it a silly sounding name…or can it be misinterpreted?

Architecture Strategy – branded house or a house of brands…

So we have to think it out. Having a Brand Architecture strategy in place is important, but it is something that consumers don’t understand. It’s a strategy that the organization must put in place. For example, will this be a branded house (General Electric, for example has GE Lightbulbs, GE Jet Engines, GE Appliances)? All the brand equity is in the master brand, and the product names are the descriptors.

At the other end of the scale (opposite a branded house), is a house of brands is like Procter and Gamble (P&G). This is where all the equity is in the products that they manufacture…Tide laundry detergent company or the Crest toothpaste company.

So, in healthcare, deciding on your Brand Architecture will immediately dictate some of your naming options or at least the naming conventions. So the first questions that I would ask a client who was considering a name change would be:

What is precipitating the name change?
Is there a merger or acquisition going on?
Do you have “brand baggage” that is so bad that you need to change the name?

Too often, name changes happen come about in a flippant way: “We just want to change our name.” Unfortunately, that’s not recognizing the unintended consequences. When there’s no strategy behind a name change, it’s going to be disastrous.

The problem of Memory Telescoping…

A significant problem that we often encounter with name changes is Memory Telescoping, a term I coined years ago. What that means is, people have generational memories of hospitals, especially if it’s a bad experience.

In focus groups, whenever someone tells me about a bad experience, I ask how long ago did that happen? In one example, the gentleman said, “That actually happened 20 years ago. I know all the people are gone and it’s a better hospital today, so maybe I’ll give them another chance.” But he talked about that experience from 20 years ago like it was yesterday. Healthcare is the only industry that has Memory Telescoping to such a degree.

That also creates people who remember the name of a hospital from 20 years ago. If you change the name, those people will still call it by the name that they are comfortable with. So when I’m doing market research, I need to include all the old names. So with the research, I’m able to show the client that 20, 30 or 40 percent of your community calls your hospital by a name that hasn’t been in use for 20 years.

Use data for perspective and decision support…

So, having data puts in perspective where the name is [in the mind of the community]. Maybe you don’t want to make that name change unless theirs is a clear business reason for changing that name. Because you have a Brand Architecture that has been agreed upon, perhaps names have to be changed perhaps structurally. That’s not changing the name, but changing how it appears in the brand hierarchy.

That’s a business decision that consumers don’t have to come into. But if you are changing the name because two entities have merged and you are forming a hospital system, and you want the system to have an empty vessel name, that’s a legitimate business reason.

A lot of smaller community hospitals are getting together to form systems so they can appear bigger and harder to be acquired. And that’s an interesting strategy—perhaps to put them in the driver’s seat when M&A comes knocking at their door.

Stewart Gandolf: One of the things that we hear about is where you have several hospitals with completely different brand names, different brand histories and different community names. How do you make a decision where you could just create a holding company that keeps the [existing, individual] names and identities? How do you make the determination to keep those names or to create a new identity?

Research for experience expectations…

Rob Klein: This is where data and research comes in—to gain understanding from consumers. The first thing to do is to ask consumers. Ask: if, hypothetically, these organizations came together and became one, what are your expectations for an experience?

What would you expect as a patient, what do you expect to be different?
How would you want to benefit?
What would your concerns be?
What do you think might not go well?

If you asked these basic questions, you would understand the expectations of these facilities coming together. It might be, for example, “If I go to hospital-a and they send me to hospital-b, I expect hospital-b to be expecting me, to know who I am, and not have to repeat myself.

That’s what I would expect if they want to be a ‘master brand’ or a branded house.” Or, “I would expect a single billing system so that I get one bill regardless of where I entered the system.” Essentially, I would expect the left hand to know what the right hand is doing.”

However, if you want to remain independent, there is no discernable value-add for the consumer. So there’s no story in that. In fact, there are very few clients that I can think of that are remaining a house of brands. Even your national systems—Tenet Health, Ascension Health or Trinity Health System—they are all becoming branded houses.

They are changing. They are putting the corporate name in front of the local brand names. They are creating a national presence in their marketing and advertising and in the way they are presenting and delivering care at the local level. So you are seeing a major shift in the national brand, where they are bringing the master brand out to the forefront.

In doing so, they create a value proposition that says, “We are all a big national network. I’ve done a lot of research for clients who are considering this sort of change. Unfortunately, the level of expectations that this creates is very difficult for many organizations to actually deliver.

This is how the decision is more than “what’s in a name?” Everything is in a name because it’s going to convey what you do and that creates expectations. That’s what names do; they create expectations. And if you can’t deliver on those expectations, you’re going to fail.

Stewart Gandolf: I know of hospitals that can’t create common systems within their departments. And that’s just one hospital, and not within multiple hospitals.

The next question is about the terms “hospital” versus “medical center.” There was a rage a few years ago for everyone to change to the term “medical center.” But, when they finally checked, it turns out that “hospital” has more credibility. Can you share some examples—with or without specific names—of some things to avoid…things that we know are bad ideas?

How to avoid bad decisions and logo soup…

Rob Klein: For one example, when I see clients where they say “hospital medical center,” that’s redundant and has always baffled me. Another is where they try to get cute or fancy with urgent care. When you try to get fancy with the descriptor name, you take away the orientation from the audience thinking about the name brand.

It’s better to keep the descriptor simple, and don’t get cutesy with urgent care or immediate care. We’ve had clients who try to brand it as their own urgent care. But a new brand name in urgent care—something you want consumers to care about…think…and remember—two different names. They are only going to remember one.

In fact, brands take on a familial name. McDonalds is “Mickey D’s.” Kentucky Fried Chicken is “KFC.” When a brand has a strong following, they give it a nickname. We love short names, but in healthcare, we love to make really long names with a first name, middle name and a last name. And then we ask consumers to care about all three names. But consumers are going to pick the one name that they relate to, and we shouldn’t complicate things.

I call it logo soup where we throw everything into the pot. Like in advertising, if there’s white space in a print ad, some clients will want to add copy or a picture. We know that less is more, but to the untrained eye, more is more…and that’s rarely the case.

So with naming, you want the name to be short and sweet. You want to have only one name—if it’s compound words—where the brand equity rests. The other name should be the descriptor.

I tell my clients to move to a master brand or branded house orientation. This is where the equity is the system name plus the descriptor. For hospitals that have a hundred year legacy, they are using a dual system strategy. They present a system name and then a hospital name. These are followed by all the ancillary services. These hospitals will use the name, perhaps for a while, until people get used to the system name.

Another dual approach is where they are moving to “campus,” and use the name of the city. So the structure would be “health system name,” plus “city name,” plus “campus.” So they are keeping some of the legacy equity, but they are moving up to the system name.

That takes a commitment, and it takes time, to build the equity. But you want the equity in only one name. I have clients that have a national brand name, plus a local system name, plus they have the hospital name. And I ask them, if you can only have one of those names that people care about and connect with, which one do you want them to care about?

They are going to forget about the other two. They can’t answer that. That’s the challenge that we really face with a name and name change.

It takes a plan: research and data for understanding and decision support…

Stewart Gandolf: We’re kindred spirits here Rob, because we see this all the time. This is where the medical group wants their brand, the individual service line wants their brand, the hospital wants their brand, and the larger institution wants their brand…so this is really common.

What I’m really intrigued about is your process and how we can create data. So, without going into all your secrets, give us a sense of what you do. Focus groups, telephone surveys, Internet surveys…if someone were to call and want to work with you from this podcast, what are some of your processes? What are some of the things that you might recommend?

Rob Klein: The process that I developed about 15 years ago I call Brand Print. I wanted to be an architect when I was younger. You have to have a blueprint for building a house, and you need a blueprint for building a brand. It has four elements:

Where are we now?
Where do we want to go?
How do we get there?
Are we on track?

To answer those questions, each phase is a process of data collection and data assimilation. Probably the most important element of this process is to develop and convene a brand team. This is because, if you do all this work and it all resides only with marketing, it will fail. What will happen is that people in other departments and other groups will say: That’s just something that marketing is doing. It’s just going to be a tagline.

And that is a death knell for this because brand management is a strategy that is organization-wide. It is a way of life. And it is only as strong as the person that believes in it the least. I call it the weakest link in the chain theory. Your organization and every staff member have to hear it, believe it, and they have to live it. You have to create 100-percent brand ambassadors, or all you have done is to create a new ad, or a new tagline, or a new color scheme, or a new icon. And that is destined to fail.

So, the CEO needs to sanction and support this brand team. The team is cross-functional from throughout the organization. There’s the HR department, for example, because a strong brand strategy involves hiring. So, if this is just an exercise with marketing, it will fail.

One of the first things that I determine is if the CEO and the senior leadership have signed off on this. Do they agree to the expectations of a brand management process? Often, I will present a three-hour, Branding 101 workshop for senior leadership, in order to understand their brand IQ and their appetite for a commitment to brand.

So the steps include, putting a team together that’s cross functional and supported by the CEO. A brand champion will come out of that and be the person responsible for bringing the brand to life. That’s the first step. If that doesn’t happen, then the exercise is just an exercise.

After that, we have a process of Internal and External Data Collection. Too often the focus is on what consumers want and never ask staff what they are willing to get behind. The question is if this something that you can bring to life? Consumers can love it, but if the staff doesn’t bring it to life, it will fail.

The Internal and External research is absolutely key. And between each phase of research is convening the brand team to share the knowledge, assimilate it into the team, and have the team prepare for the next phase of research.

The organization must own and deliver the concept…

Stewart Gandolf: Rob, I love talking about this with you because it’s so consistent with the things that our organization does. One of the things that we talk about when we position a hospital or a practice is the branding. For us, positioning is the rational argument of “why you,” and the brand is the larger concept.

One of the things that we talk about is that some ideas are fuzzy. But sometimes you get the right brand where the team of the hospital or the practice can really get behind the concept. My favorite recent example of this my friends over at Cleveland Clinic, because their brand is all about “patient first.” And when you come up with that concept, everything else is easier.

We recently interviewed Paul Matsen of Cleveland Clinic and we were talking about how they came up with same day appointments. How in the world was that possible? Number one, it had CEO support. There’s no way on the planet that it would have ever happened without CEO support. Someone would think: “I can’t get a same day appointment with a private practice with two doctors, let alone with Cleveland Clinic.” But they make it work.

But the biggest thing beyond CEO support was the concept of “patients first.” If you really want to be “caring,” you can’t just say it, you have to be it, and you have to prove it. The public is so skeptical today. If you say that caring is our stake in the ground, this is the place that we’re going to be, this is what we stand for…but nobody has bought into the concept, it’s a disaster.

Different hospitals have different levels or respect for marketing. And if you don’t have the stakeholders involved, if you don’t have the doctors involved, if you don’t have the CEO involved, if you don’t have donors involved, if you don’t have employees involved—and everyone thinks it’s just marketing fluff—you’re right. It’s dead on arrival.

Data matters: Do it right or not at all…

The point that I would make is that data matters. Data is everything. Our firm is all about the creativity, and positioning, and doing the appropriate communications. But before we get there on a bigger project…for a hospital or a larger group, this is your reputation and your business that we’re talking about.

If your hospital been around for 40 years, how are you going to change that history on a whim? You can’t sit in a conference room and make a decision that will shape the practice or hospital for the next 40 years without context or evidence?

Rob Klein: To continue from what you were saying…to pick a name from a whim, it’s like throwing a dart at a dartboard as a way to pick investment stocks. Once you make a naming mistake like that, to undo it, and do the “just kidding” strategy—that has worse ramifications than if you did nothing.

So, a well thought-out strategy before hand is vital. The name itself is not a strategy. The name is an executional cue or presentation of the strategy. So you can’t do any naming until you have identified your strategy. Otherwise, you’re just guessing.

If you have proper strategy in place first, the naming tends to be simple. Often times, when I have a client that has a strong brand architecture and strategy worked out, then the naming happens by itself. You don’t need to bring in consumers because you already have the parameters set in your identity guidelines.

There are very few exceptions to this. Especially if you have a Merger and Acquisition, naming is very easy. If you go into that discussion with a M&A naming strategy, the options are defined. So having a strategy and having a strong brand allows you to say no.

But when you don’t have a strong brand, you go after everything. It’s like having a boat in the water without a rudder. You can floor it and you can get somewhere, but you may only go in circles. Think of the strategy as the GPS for your brand. You set a track, and you stay on that track, and it makes it easy to identify opportunities that fit. It takes the guesswork out of decisions.

And finally, everyone’s career is on the line. If you make a bad decision, especially with naming, that is a long-term “oops.” You have to live with it, but you might lose your job over it. Think about your career—do you really want to rename the baby without having strong data to support the decision.

Stewart Gandolf: As a last comment, sometimes there are situations where you might decide to keep the same name. But a re-brand and be a different look, a different feel, a different brand promise—and it comes down to understanding the essence. What do we stand for and how do we communicate things?

Plus, over time, things change. For a hospital or a hospital system, every two or three years they are different, and things have changed. Even if they have the same name, they are a different beast. So, how do we evolve, how to we grow, and how do these things with confidence.

Thank you Rob, and thanks everyone for listening.

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Rob Klein

ROB KLEIN, CEO, KLEIN & PARTNERS - For more than 30 years, Rob Klein has provided research and brand consulting to many leading hospitals, systems, and health plan brands. A frequent speaker at national healthcare conferences, Rob has served on the boards of the Detroit AMA (president), Chicago AMA (VP research), AHSM, and on the national board of SHSMD.