Pediatric Healthcare in the Digital Age: Insights from Leading Researcher Rob Klein.

Stewart Gandolf (Healthcare Success)

Hello, everyone, this is Stewart Gandolf, and welcome to another podcast, this time a returning guest. I don't know, you're in the top five, top two, three guests at least in terms of number of times, and one of my favorites, of course. So, Rob Klein has been a frequent, maybe the most, I don't know, he's been on this podcast and webinars a lot. We've done a lot together. Anyway, so Rob is a leading researcher. He's a principal along with his wife, Toni, of Klein and Partners.

And I've known Rob for a long time. We became buds because I saw, after I saw Rob speak at probably SHSMD, one of those things years ago, we had this sort of secret patient experience handshake, and we got to know each other. And it turns out we both love mid-century moderns. So now Rob is speaking to us live from Palm Springs, where I also have a vacation rental. I spent a lot of time there. Anyway, welcome, Rob. Good to have you. Oh, thank you. And I'm really excited to be here and share our latest National Consumer Insights study findings with you.

So great. So today, Rob, we are talking about your newest research. And it's a change of pace for you. It's about pediatrics. So, I don't remember you ever doing one like that. I think you said it was new. Why pediatrics? Why now?

Rob Klein (kleinandpartners.com)

Well, we've been doing our national study for 12 years, and it's always been about adult healthcare decision-making and perceptions and attitudes. And we have a lot of pediatric clients, and we just decided we've never done a deep dive nationally on how parents make healthcare decisions for their children. So, we just felt that it was long overdue, and we are so excited to share this groundbreaking research with your audience.

Stewart Gandolf (Healthcare Success)

That's awesome. Well, I'm excited to have you. So, let's just dive right in. would love, Rob, we talked about this. By the way, Rob, just so you know, in the audience, some of you are listening through streaming services, but if you go to dev2022.healthcaresuccess.com slash podcast, you'll be able to easily find Rob's deck on my website also. If just go to Klein and Partners, I'm sure you'll be able to find it there. So, you can actually find the deck on either website, along with contact information for Rob on my site. And Rob will share that again at the end, hopefully. But the information you'll be able to see today, obviously, a lot of our people are listening as opposed to watching. Some are viewing, so Rob just will be sharing slides, but just speak to them for the audience that, you know, can't see it.

Rob Klein (kleinandpartners.com)

I'll try to be as visual as I can.

Stewart Gandolf (Healthcare Success)

All right, without further ado, let's jump in in whatever order you like, Rob, and just share a concept, and we can talk about it.

Rob Klein (kleinandpartners.com)

Great. Thanks, Stewart. So, to your audience, what I'm going to do today is we're not going to cover every chart in the full report. You can get a copy of that. I'm just going to highlight each chapter. There's about 10 chapters, so I just want kind of give you the key takeaway from each chapter, and then you'll have the full report that you can download at a later date.

Rob Klein (kleinandpartners.com)

Okay. So, before we dive into the findings, let me give you a quick background on the methodology on how we conducted this study. So, it's an online survey of 1,000 parents nationally who are healthcare decision makers for the children in their household. And anywhere in charts that you see, if you're looking at it now or later, anywhere there's letters or arrows, that indicates a statistically significant difference between those two data points.

Also at the bottom of each chart is the actual survey question we're in. So, if you're curious how we ask the question, that will always be there for you. So, I'm going to jump in. As I said, I'm going to take chapter by chapter. I'm just going to highlight. I'm not going to go through every slide in each chapter. I just want to give you the highlight. Anybody who knows me knows about my Rob-isms. I'm full of them. And so, what I've done is for each chapter starts out with a Rob-isms. For us to think about. So first, we're going to talk about children and children's health segments. So, the battle for market share growth is going to happen at the top of the sales funnel to reach routine care across physician, outpatient, and urgent care settings. So, for pediatric brands, especially if you are a 100% focused children's hospital or health system, you're not a service line that's part of an adult health system. If all you do is children, you own the tertiary and quaternary care. But as we're going to see in a minute, most parents say their kids are healthy. So, they're using you farther up the sales funnel. So, if you don't have a strong pediatric and urgent care outpatient, really a primary care network, and you're really focusing on the bottom of the sales funnel, it's going be difficult over the coming years. Because as I said, that battle for market share is going It's going to happen at the top of the sales funnel because parents want convenience and access. You already own the clinical quality, but that's not enough for future growth over the next five or ten years. So, look on the right here, the children’s segments. 79% of parents said across all their kids, whether they had, you know, half said they had one child, 33% said they have two children under 18, they, most of them said, yeah, you know what, my kids are basically healthy. They have bumps and bruises, and they get sick, but only 11% said I have at least one child with a chronic medical condition that we have to manage medically. So, you're dealing with a majority of people around the country who say, yeah, my kids are pretty healthy. So that means that battle for market share is coming at that top of the sales funnel. So, let's talk about their preferred pediatric provider. So again, And there's really kind of three different structures that I have found within the pediatric brand family, if you will. You have independent children's hospitals where, like whether it's a CHOP or a Boston or Cincinnati Children's, those are 100% focused on they are a pediatric brand.

Then you have brands, maybe Advocate Children's, Banner Children's, Yale New Haven Children's, for example. I'm just picking a few out of thin air, where they are a pediatric sub-brand within a larger adult health system brand. But they are an Uber. They're not just a service line like Heart or Cancer. They are a step up, and they are kind of what I call a super sub-brand within that brand family. They have their own hospital as well. And then you have it where the children's pediatric is literally a unit or a floor within the hospital. So, it's truly just a service line. So those are the three kind of... major types of pediatric brands that we see around the country.

So, we asked people, do you have a preferred appearance? Do you have a preferred healthcare organization for your child? And 80% said, yes, I do. And then we said, we described the three that I just described to you and asked, which of these best fits your preferred healthcare organization for your child? I should note, if they have more than one child, we put the context of every question in: think about care for your youngest child, because there's no way we could have gone through for every child. The survey would have been too long. So, for expediency, if they had multiple children, we asked about the youngest child, just to put that in context for you. 47% of parents said, yes, my preferred organization for my children is a pediatric hospital or pediatric health system. 23% said an adult system that offers children services, and then 19% said an adult health system that has dedicated children's hospital. That's part of it. And so, what's interesting, if you look at the 19% and the 23%, if they have had a child with a significant acute, a recent acute situation, like they were really sick and they had to go to the hospital, they are significantly more likely to say their preferred organization is an adult system that has a dedicated children's hospital. If their children are all healthy, then they're more likely to prefer an adult system that just happens to have maybe a unit or floor with children's services.

What that's saying is, I've got healthy kids. I'm looking at it as a family. So, I'm looking at the health system that has services that say my spouse, or my partner and I like and for the children. So, they're looking at it more holistically from the family. If I've had a child with a sick that has something really serious that I want to know that that system that we use for all of us has a dedicated children's hospital within. And then everybody, regardless of their situation, that 47% is pretty consistent. The majority still want a children's hospital. Parents make very different decisions for their kids than do for themselves.

Stewart Gandolf (Healthcare Success)

But, Rob, it's really interesting for our own experience. We are fortunate to live next to CHOC, Children's Hospital of Orange County, which is a good children's hospital. It never occurred to go to us there until one night my daughter was so dehydrated from being sick. She said, Daddy, I can't see. Like, holy crap. We really panicked. And so, we took her to CHOC. So, it's like, but other than that, though, every time they had cuts or bruises or, you other kinds of things that they did as kids. We went to the ER a few times for asthma and different things. We just went to St. Joe's. But for something really serious, we went to CHOC. And it turned out not to be as serious as this. Certainly sounded, but that was a scary moment, and she was really well-treated at CHOC while she was there.

Rob Klein (kleinandpartners.com)

And that's the challenge that a pediatric-specific brand, like a children's hospital, that's the challenge they face, is they get kind of pigeonholed as a niche player, where if it's serious, I'm coming to you. But you don't have a lot of locations, so I don't think of you for routine care. I think of taking my child for routine care to a more convenient, maybe a place that we go for our care.

So that's why a pediatric brand, their competitive set, is multi-tiered, depending on how serious it is. That's why it's so important for them, especially pediatric brands, for them to work their way up the sales funnel. Or they are losing revenue because you just, you said you took your daughter to an adult hospital, if you will, because it's easier, more convenient.

Right. So, they get pigeonholed, so it's incumbent upon them to grow. Uh-oh. And to maintain brand strength, to be thought of, we take our child there for everything, not just serious care.

So, thanks for bringing it up.

Stewart Gandolf (Healthcare Success)

Great insight.

Rob Klein (kleinandpartners.com)

Communicating with parents. So, another Rob-ism. The health industry has really lost a significant amount of trust among Americans. I'll tell you, post-COVID, I feel like we've awakened into a slightly altered universe. People's post-COVID brain, it's affecting their memory, their attention span, their patience, and we have to adapt to that. And so, this is my, this is actually from my 2024 study, but I put it into this study because you'll notice that the highest and the most trusted healthcare type brand or related organization is children's hospitals. But that trust rating of 7.77, that's not any great shakes, but it's the only one that's actually going up since pre-COVID. Most everybody else, whether it's university, you know, teaching hospitals, nonprofits, WebMD, Google, U.S. News, look at U.S. News, their trust rating is almost midpoint. If it's in the red, that's really bad on a 0-10 score. So, this is just showing us collectively any organization or group that's somewhat affiliated within healthcare.

And I did a stretch with Apple and Walmart, Amazon, because they're all dabbling or getting into or have gotten into healthcare. And it just shows you trust is really bad among people, and it's down since pre-COVID. So, one of the most important things that we have to do as healthcare is we have to regain trust. Two areas where that's really being hurt most is what I call the trouble bookend children. Upfront pricing, back-end billing, we lose trust at both ends and then access. People can't get their kids in for care. You can't trust a brand. Brand that you can't use, and they're tired of our excuses. So, we have a lot of work to do operationally to build trust back with consumers..

Stewart Gandolf (Healthcare Success)

So, Rob, the Rob-isms, but you're famous for your Rob-isms I have a few Stewart-isms, as you know, but I think right there, there is about six quotes we can use, pull quotes from this podcast. I think that's really important to recognize trust. Sounds to me like a separate blog post we'll have to do together someday soon to drill down on that topic because it's so vital.

Rob Klein (kleinandpartners.com)

And some new questions we added, how much do you trust Children's Hospital's social media channels? And again, it's kind of average. It's only seven. It's not that great. They're most likely to look for health information on Facebook. And when we ask them about topics, look at the third topic down, Mental Health Tips.

We have a mental health crisis in this country, and it's not just with adults. It's with children as well. So, we have got to address mental health in a pediatric setting. Not just an adult setting. So, fun one, you know, Stewart's wouldn't be a nice ad call without talking about some advertising. You know, you have an agency. I have a master's degree in advertising. So, I tell friends like you that I have enough knowledge to be dangerous to you. But I've always been fascinated. Why does one ad work and another one doesn't? So, we asked folks, what types of healthcare ads that you see for children are most memorable? Meaning, you're most likely to remember them. And, no surprise, I've always been saying, it's still TV. Now, how TV is defined is different, of course. In I asked AI, Google AI, how do you define TV? So that's how AI defined it. So, TV still exists. It's just people may watch it, some type of video, whether it's YouTube channel, whether it's on their phone. But a TV-like experience is still where people find the most memorable ads because they're hearing it and they're seeing it. Look at number two, though, and three, respectively, Google searches and social media. So being where they are digitally, because remember, parents are younger by definition, so they're much more digitally native than maybe some older folks like me and maybe Stewart.

Stewart Gandolf (Healthcare Success)

No, not me. Haha.

Rob Klein (kleinandpartners.com)

So, I'll throw you in my boomer bucket, Stewart.

Stewart Gandolf (Healthcare Success)

Yeah. Rob, I'm still perpetually 28. That's where my brain is anyway.

Rob Klein (kleinandpartners.com)

So, the point is, and all of my ad tracking research also shows, the best recall happens when TV is part of, or some type of video is part of the media spend. When it's not, recall and brand linkage tend to be lower. That's just something I have found over the years with all of my ad tracking studies. Then we have some, what kind of themes are you most likely to kind of tune in to? And it's really about being authentic. Ads that score the highest in my ad testing database all have are testimonial-based, whether it's the parent, the patient, the adult, that is the case here. So, some form of testimonial and actual real patients are what make it authentic. Too many times, you see a pharmaceutical ad, actor portrayal, well, right there you've lost credibility with people.

Stewart Gandolf (Healthcare Success)

So, Rob, I have to jump in just because, you know, this has been the bane of my life for a couple decades. So, doctors logically feel like, ah, testimonials mean nothing. That's an anecdote. That's not a trend. But that's not how humans think. The rest of us love stories. They love samples. So, yeah, that may not be a trend, but, you know, testimonials are still one of the most underused, easy topics that we see. I can think of ad after ad we've done where we simply put together clips of patient interviews and made it into an ad, and it's so powerful compared to scripting something.

Rob Klein (kleinandpartners.com)

Absolutely. It's another reason physicians think, oh, just put me in the ad and it'll sell. That's not the case. People want to know what people like them have to say. That's why U.S. News rankings are dying on the vine, and people are more interested in online patient reviews. They want to know what people like them have to say about your brand. It's really the death of the expert is what's happening. It's that expert, whether it was the old newscaster, the Peter Jennings we used to pay attention to 30 years ago, that expert, that's going away because social media has made everybody an expert.

Stewart Gandolf (Healthcare Success)

That's so dangerous. We talk about misinformation with a lot of the hospital leaders I talk to, and it's so frustrating. Here they're just trying to be the good guys and share information, and they're viewed with suspicion and maybe sometimes rage. And, you know, like, not everybody can be an expert. It's just statistically impossible. It doesn't work that way. So, but, you know, we're in the world of, you know, well, my religion is as good as your religion. My science is your science. My political thoughts, you know, it's, there's, just because I said so. I may have no scientific background at all, but I just feel like, you know, jumping up and down 75 times is going to help me with my migraine or whatever. You know, maybe it will, but it's really challenging for sure.

Rob Klein (kleinandpartners.com)

Yeah, we could have a whole different discussion on, you know, the social media and the influencers and the lack of fact. And it's more just, if, I mean, with humans, the minute they find something that agrees with their moral stance, they stop learning.

Stewart Gandolf (Healthcare Success)

Right.

Rob Klein (kleinandpartners.com)

So, truth is meant to fit what I already believe. And it's, again. And it makes it very hard to be authentic in healthcare marketing, but it's absolutely critical. And it's about storytelling. People want to see what people like them have to say. I mean, think of a testimonial that's been around for a long time. That's no different than an influencer. An influencer is someone like you telling you how great a certain product is. That's just a modern-day version of a patient testimonial on a TV ad.

Stewart Gandolf (Healthcare Success)

Yeah, very good.

Rob Klein (kleinandpartners.com)

Another one of my, Rob-isms, is people can't love a brand they can't use. You make it hard to use you. How do they fall in love with you? If you are there, it takes a week or three weeks to get in to see their doctor. So, what's most important when choosing a primary care provider for their child? And, you know, it's about convenient location in my network. But also focused on health and wellness of children. We don't do a really good job on the Find a Doc page on our websites. And that's one of the first places where a potential patient becomes an actual patient or a parent becomes a customer choosing for their child. And so, they're relegated to saying, OK, who's in my insurance network? Who's close by? Who's taking new patients? That's not a great way to start a brand relationship when it's just three market factors.

Then if all those are taken care of, then it's like, OK, are we going to like this doctor? You know, what about the doctor? Do I, you know, what personal characteristics? But that's so far down the road. That's a big challenge. But one of the biggest attributes is focused on health and wellness. People are so afraid to get sick today because of COVID. So, they want their children healthy. So, again, this is another reason supporting that. What are you doing at the top of the sales funnel with routine care? That's where the competition is heating up. I can tell you from all my national referring physician work that physicians are telling me in surveys, look, over the next five to seven years, it's going to get harder and harder for me to refer outside my brand family, let alone outside the state. So, all this destination, you know, service lines we're trying to do, it's going to get harder and harder because every system is trying to stop leakage. So, if someone has a primary care physician elsewhere, there is so much pressure to keep them within that funnel. So, if you don't start out with a wide sales funnel for your organization at the routine care, your bottom of the sales funnel with tertiary and quaternary is going to get narrower and narrower and narrower. It's just that that change has already happened.

Stewart Gandolf (Healthcare Success)

Great insight, Rob.

Rob Klein (kleinandpartners.com)

So, what do we do if we can't get our child into our primary? 25% go to a pediatric urgent care, 19% go to the ER. Think about this. One in five are saying, I'm in an ER. I know I shouldn't be there, but my brand has done nothing to tell me what else I should do. We need to provide solutions. We can't just go out and hire a ton more pediatricians. They can't create them fast enough in med school. So, patients are open and parents are open to alternatives. We just need to provide them, whether it's seeing another physician within the brand family, seeing a nurse practitioner, a PA, having a virtual visit, going to one of our urgent care centers. But, you know, urgent care is plan B when the doctor fails to see my child. So how do we work within our brand family and our pediatricians so that if they can't see you, oh, sorry, Rob, we can't see your child tomorrow. But, the nurse practitioner can see them today, or the PA, or how about a virtual visit? Tell us what's going on. It's all about offering solutions as opposed to saying, sorry, Dr. Smith is booked out for a month.

Stewart Gandolf (Healthcare Success)

I want to pivot a little bit. I know this may not be in your research explicitly, but I'm just curious in your travels, have you seen many systems pivoting to, because as a parent, when my kids were little, there's a lot more healthcare stuff that comes up when they're little, right?

And whether it's, you know, laceration or this or that. And as a responsible parent, they used to have, our pediatrician had a nurse's line. It was after hours. You know, we had the main hospital, the children's hospital. Urgent cares, ironically, are usually closed at 8 o'clock, and the kids are never sick at 8 o'clock.

Rob Klein (kleinandpartners.com)

Or weekends, yeah.

Stewart Gandolf (Healthcare Success)

Yeah, yeah, exactly. So, are you finding, just experientially as part of your survey, health systems that have the whole package? Because from a parent's point of view, it's like, on the urgent care next to the ER, they can decide where to triage you to. And then have Telehealth available. From a parent's perspective, that would be magical. Are you familiar with anybody doing that? Because I'm not.

Rob Klein (kleinandpartners.com)

I'm doing a lot of research on just those things. I'm testing urgent care, the interest in urgent care hours, after hours, because children never get sick during 9 to 5. They wait until it's o'clock at night or Sunday morning. So, you know, urgent care has become – remember in the old days you used to hear the term banker's hours, which meant you didn't work very much? Well, banks got away from banker's hours, and now they're available 24-7. Urgent care needs to get rid of its banker's hours mentality. And virtual visits can solve a lot of that. So, a lot of my pediatric clients, they're focusing on virtual visits, and they're focusing on having a pediatric urgent care with extended hours. Because parents go to a pediatric urgent care than an adult urgent care that happens to see kids too. So, it's not only about the hours, it's about having a dedicated pediatric urgent care. I'll tell you, if want to win a mom over for life, you bail her out with a sick kid late at night or on the weekends, whether it's a personal visit or it's an urgent care with extended hours. You've got to be ready when that kid gets sick.

Stewart Gandolf (Healthcare Success)

Well, feel like it's not, it's still in so many systems I'm aware of, there's individual product lines, but it's not integrated. Like it could be the triages, telehealth, can we solve that here? Do we send you the ER right away or do we send you the urgent care, assuming it's open? I would just love to see more of that from a product standpoint. Remember, people, when they're thinking about marketing, are always thinking about the peep and promotion. I like to think about the product. What is the product we're offering? So that just seems intuitively to make sense.

And the other, just a fun fact before you go back to your research. Years ago, I figured out, okay, nine to five, what does that look like?

Well, that means you're closed. Like 70, I forget the exact percentage, was like 76% of the time you're closed. If you take nine to five, eight hours divided by seven days a week, 24 hours a day, it's about 74, 75, 76%. So that means you're closed, you know, three quarters of the time, basically. So, no wonder people get frustrated. And, of course, the kids get sick then. So, it's a thing. Anyway, continue with your research, Rob.

Rob Klein (kleinandpartners.com)

So, the point is having a strong, integrated, routine care strategy and network, think of what strain on the ER that it can alleviate. Because I can tell you my ER work. Most people that take urgent care to the ER, they know they shouldn't be there, but they blame you for not giving them an alternative. So, a lot of the ER overcrowding is our fault for not having solutions clearly explained and offered to whether it's an adult patient or a parent with a child. So, that's on us. I can tell you, fun side fact, the number one thing people are thinking when they're sitting in an ER waiting room, besides, oh, I feel terrible, is, oh, that person doesn't look very sick.

They don't need to be there. So, everyone in the waiting room is looking at everyone else, judging how sick they really are.

Stewart Gandolf (Healthcare Success)

Yeah, nothing is more fun than being non-urgent in an ER waiting three or four hours around people that are coughing and, you know, sicker than you.

Rob Klein (kleinandpartners.com)

And if you weren't that sick, you will be. But it's all about education. We can't assume everyone knows where to go for what. I've done a lot of virtual visit research. It's amazing how many people have no idea when to use it and when not to. We do a terrible job at educating people how to use this, when, where, and why. So, if they, you know, a majority of people said, I've had some problems, at least sometimes getting in for primary care. And the number one thing is, I can't get in, but also the wait time to see the physician once I'm there. You know, figuring out wait times in the office should be easy. Here's one solution I don't know why everyone's not doing is text them. Say, we're running an hour behind, Rob, don't bring your child in. I know you have a two o'clock. Don't come in till three. Because we value your time and don't want to waste it. So, whenever you do something that's a feature enhancement, put an emotional benefit on. Why am I doing this for you? Because I value your time. And you will make so many brownie points, it's unbelievable. So, people shouldn't be waiting in the waiting room anymore. We have the technology to almost virtually eliminate waits, unless someone really wants to come in and read your magazines.

Stewart Gandolf (Healthcare Success)

So, we used to work with them. An OB-GYN group that would give away Starbucks cards with that. They would say, we're running an hour late. Here's a QR code for Starbucks. Have one on us. Because, you know, with OB-GYN, you have, you know, pregnant moms that could screw the whole day's schedule up in an instant. And was such a – our feedback from our client was so big in terms of the client satisfaction, how that changed it from an angry confrontation to, oh, I understand. I might as well get a copy and hang out.

Rob Klein (kleinandpartners.com)

You know, it's those random acts of kindness that are – they go up – they go so far. So, I agree.

It's the little things. So, another Rob-ism, you can always make more money, but you can't make more time. So, COVID stole two years of our lives that we'll never get back. So, people are really conscious of their time and how they're spending it. And we are great in healthcare at wasting people's time. We hurt them like cattle and sit here, stand here, do this, don't do that.

And they're not going to take it anymore. And so, patients have lost their patience. We have got to figure out how to be more process-oriented. We asked people, how long was your most recent visit for your child? And five days. How long should it have been? Two days. So, we're two and a half days longer than people want to stay. And look, a good chunk of parents said, yeah, I would be open to seeing a nurse practitioner or a PA for my child if I can get in sooner.

So, yeah, it's not for everyone. But what I'm also finding is even if they don't take you up on the solution, they're like, you know what? I'll wait for Dr. Smith but thank you for at least trying to solve the problem. Now, you get brownie points for just trying. You don't even have to succeed at the solution, but you've offered. You've at least tried. You haven't said, hey, sorry.

Hands are tied, not my job. So, it's about trying, not just saying, sorry, they can't see you. So pediatric specialists, no surprise, the more serious the situation is or chronic for the child, the more likely they are to have a specialist. And we asked them what kind of specialist they had. Number two, virtually tied with number one, was behavioral and mental health specialists. One in five parents that have a specialist, it's for mental health for their child. That number is very sad to see that high.

Stewart Gandolf (Healthcare Success)

Yep.

Rob Klein (kleinandpartners.com)

When they chose a specialist, again, it's about expertise in the child's condition. When a child has a condition, even an adult, there's an ownership. People say, like, oh, this is my cancer, or my... issue or this is my child. Do they understand my child's cancer? So, it's very personal. So, messaging has to be about we understand your cancer because it's personal. So, again, I'm not writing exact copy. What I'm saying is when you're talking about a medical condition, especially a serious one, there is a personalization with it that that parent takes on that you have to understand. And your messaging should be focused on we're not good at cancer. We're good at your child's cancer because then you're addressing you're anticipating the question.

They're thinking, hey, do they get my kids cancer? And referred by the primary. Again, the pediatrician is the quarterback of care for most parents. So, wherever that pediatrician is saying, oh, I want you to see Dr. Smith specialist in this. Most parents are like okay, that's where we're going. That's why that top of the sales funnel is so critical. If you've got a weak pediatric or pediatrician network, you're going to struggle over time. Maybe not now, but eventually it's going to catch up. If you have a lot of independent pediatricians in your market, I know every state, every market's different. So, there's always exceptions to every rule. But for the most part, if they're independent now, chances are they won't be in a few years. Everybody's buying up docs as fast as they can. Hospital experiences. So, this is really important. This gets to what I talked about earlier. We asked them what were sources of information about the hospital that you chose? What did you look to? Online parent reviews, 20%. U.S. News, 4%. All my research, no matter what study I'm doing, who I'm doing it for, what market, U.S.

is just, they're dying on the vine, and it's what people are looking to is online parent reviews. I tell people, don't waste your money on buying access to the U.S. News badge. Spend your money on online reputation management, because that's where your parents, or if you're an adult hospital, that's where your adult parent patients, that's where they want to look at what people like me have to say. I had a focus group a few years ago, a young guy, probably a young millennial, and we were talking about U.S. News, and he said, I think that's the magazine my dad used to read. Well, if that doesn't reek of death by Buick, as I call it, or pick your brand, death by Sears, death by Blockbuster, death by Kmart, its better days, I think, are behind it.

I know I'm probably ruffling the feathers of some folks, but that's okay. I'm going out on a limb to say, I think in the next five to seven years, U.S. News won't even be a thing.

Stewart Gandolf (Healthcare Success)

Rob, it's our job to challenge people with facts.

Rob Klein (kleinandpartners.com)

That's what we do. I know.

Stewart Gandolf (Healthcare Success)

It's a wonder if we have any friends at all.

Rob Klein (kleinandpartners.com)

You know, you've got to be a little provocative or it gets boring.

Stewart Gandolf (Healthcare Success)

Yeah.

Rob Klein (kleinandpartners.com)

And, you know, most influential hospital choice factors, again, their position. This is really important for everyone. If you're listening as a pediatric hospital, 100% focused on children.

Absolutely one of the most important things. So, I have a client, we do all their ad recall research, and we've been comparing their campaign that they run over time. When they changed and just literally added in the line, 100% focused on children, they added that into their campaign. All of a sudden, their recall and their all-important brand linkage. Brand linkage means I recall your ads, and I know it's you. So, that, those scores went up significantly overnight.

Stewart Gandolf (Healthcare Success)

That's awesome. Yep.

Rob Klein (kleinandpartners.com)

And all, the only change they made was that. So, we have a nice kind of a pre-post test, because if you change a whole bunch of features in an ad, then you don't know which one worked.

But literally all they did was add 100% focus on children. That's the only change they made to the ads, and everything went up.

Stewart Gandolf (Healthcare Success)

Rob, that is, you know, storytelling. That right there is a fantastic tagline. Taglines are tough. They're really hard. But to be able to deliver a message that's concise in a few words is golden.

That's a great tag.

Rob Klein (kleinandpartners.com)

I like that one a lot. All you did was tell people and remind them what's important to them, and that you're that. You're that thing. Urgent care is Plan B when the physician fails to see my child. We've kind of talked about that. Again, urgent care too often is up to the parent to figure out as a Plan B when they can't get in to see the doctor. And, again, I couldn't see my child's doctor. It's easier to get in. And as I said before, you want to win mom's over? Bail them out with easy access with off hours. So, it will pay dividends. Too often, here's my P&L versus lifetime customer value soapbox I'm jumping up on. Too often we treat each service line as its own isolated P&L. So, each one has to make its own way. When retailers figured out 100 years ago about loss leaders and cross-selling, and so you've got to look at lifetime customer value.

We're going to talk about that in a minute with maternity, but we've got to start looking at the brand holistically. You may have one product line that doesn't make any money, but if it helps build several others for the next 10 or 15 or 20 years, then it's a loss leader. Nothing wrong with that. Retailers have been doing it for, as I said, 100 years. Okay, when I mentioned loss leaders and cross-selling, and especially to a C-suite, like the CEO and CFO, they're like, you've to be kidding me. Do we look like a retailer? They just, they bristle at those constructs that they should be embracing.

Stewart Gandolf (Healthcare Success)

And when you do that, you might as well put out the welcome mat for disruptors, right? It's like, we can't do it, so you guys figure out how to do that.

Rob Klein (kleinandpartners.com)

Disruption, here's another Rob-ism, disruption happens when an industry gets complacent. Blockbuster put itself out of business. Nobody put Blockbuster out of business. They dug the hole and jumped in and pulled the dirt over themselves. So, most innovation happens to us, not by us, and it's our own fault. We've proven that we can innovate with virtual visits during COVID. People went, brands and my clients went from not having any virtual visit to having a virtual visit platform up and running beautifully in a matter of months. So, what we told America was, you know what? So, it's not that we can't innovate. It's that we don't want to.

And that's the wrong message to send. Because when push came to shove, we did innovate. Now they're saying, well, why can't I have a single bill? Oh, why is your online scheduling such a mess? So, we've proven we can innovate. We're out of excuses now. In most healthcare companies need to become technology companies. We can do the clinical part. We got that down. We're spending so much money trying to get just a little better at cancer or a little better at heart when people are like, yeah, you're pretty good at that, but I can't even get into you. So, who cares if you're good at it? So, we have to embrace technology in healthcare. I'm not saying flippantly that we go away from the clinical. That's always going to be important. We want to get better. But if people can't use us, what good is being great if I can't get in? Brands have to invest in. People, before people invest in brands, that digital highway, especially, we've got to start investing and building relationships with Gen Z, even though they may not be the most profitable patients now, because they're healthier, they're going to make their brand choice eventually, and if we haven't started walking with them on a digital highway, then by the time we really want them for serious inpatient, they'll pick someone else. This is one of my favorite examples that I give. Back in the early 80s, when I was in banking, before I got into healthcare, one of my first assignments as a bank researcher in Detroit was investigating this new senior’s package that the bank was developing. So, I, excuse me, I was doing focus groups and one-on-ones with seniors. I'll never forget this one lady said to me, she said, look, young man, when I was young and poor, your bank wanted nothing to do with me. Now that I'm old and rich, they want my money. Forget you. You weren't there for me. I'm not going to be there for you. I've never forgotten that more than 40 years later, because the brand, the bank, did not invest in her when she was young and poor. She's not going to invest in them now. You can't ask for business before you build a relationship. Who in their right mind would ask someone to marry them on their first date? Now, I apologize if that worked out for anybody on this podcast. I love it first sight. I love it. I'm all for it. But for the most part, it would be a little creepy. It'd be a little too much too soon. Yet, with all the performance marketing that we're doing, we're asking people to click here and give us their business when we haven't even built a relationship with them. We're not doing enough brand-building advertising. We have so over-rotated on performance marketing, and it's going to bite us in the butt. So, we've got to be kids today, know, Gen Z, they can sit on their couch, investigate, they can do information searching on their phone. They can select a provider. They can have a virtual visit. They can get their medication sent to them. They can text the doctor. They can pay their bill online. And they haven't moved from the couch. That's today's healthcare for routine care and even chronic management. So, we've got to become digitally savvy in health care because they're not all wanting to come to us. COVID said you can have everything delivered to you. Now people want hospital at home. They want urgent care at home. And they want monitoring at home. So, I mean, if we look at 37% of parents said they're monitoring, they're using digital tools that interact with their provider to manage their child's health. Whether it's an Apple Watch or some other device. They are wired and we've got to get wired with them and walk with them on this digital highway. When talk about maternity, I talk about lifetime customer value. This is absolutely critical. The exceptional maternity experience can create strong lifetime customer value. In fact, I'm writing a blog just as we speak about how important the halo effect is for maternity. In the blog, I talk about you've got to play chess, not checkers. Chess, you think several moves out. Checkers, it's just whatever that first move is. And so, maternity has one of the strongest halo effects on lifetime customer value. Think about it. And I've done so much maternity work outside this study as well, qualitatively and quantitatively. Moms are like, if I have an exceptional maternity experience, I am significantly more likely to want to pick the pediatrician that's part of that brand family. If my child gets sick, I'm going to take him to that brand family for hospital care. And if I or my husband or my partner get sick maybe five or ten years from now, you get right of first refusal. So, the lifetime customer value for an exceptional maternity experience is huge. And also conversely, if I have a bad maternity experience, I'm done with you. Think about it. Maternity is the only reason you go to a hospital that's positive. Moms tell me in the focus groups all the time, look, stop treating me like a patient. I'm not sick. I'm having a baby. Do you know how they, again, in the work I did, you know what term most moms settled on? They want to be called a treasured guest.

Stewart Gandolf (Healthcare Success)

I love it.

Rob Klein (kleinandpartners.com)

I love it. In fact, moms, one of the most important things moms use to select a hospital to deliver is they want a tour. When else do moms have a tour? It's when they're getting married and they want a tour of the place where they're going to have the reception, the reception hall.

They want to go in and taste the food. They want to see what it's going to look like. Where is the band going to go? It is almost identical when they want a tour of the hospital. What are the amenities? What I'm looking for a Ritz-Carlton experience here. How are you going to treat my husband or my partner? What kind of menu do you have? Do you have 24-hour dining? Is there in-room coffee? Do you have someone that can come and fix my hair and get me gussied up after I had my baby? These are not clinically oriented types of features that moms want. Rob, we're almost done here, so we've to wrap it up pretty soon.

Stewart Gandolf (Healthcare Success)

But I want to just add to that comment, which is, I remember, I don't remember touring, or maybe I wasn't there, touring the venue. Now, if I do remember touring the venue, it's very vague, but I do remember touring the hospital when my wife was pregnant. Like, that was a high-impact emotional response. And the demographic trends today, I'm sure, much more, much, much more. So, it's such a great comment.

Rob Klein (kleinandpartners.com)

Yeah, absolutely. And I talked about the troubled bookend children. Real quickly, people are upfront pricing. And if they do choose, if they price shop up front, 62% are picking the least expensive option. And if we say, if we have a $1,600 hospital-based MRI, and then our outpatient's $800, they wonder what we're pulling on them. So, we've lost trust, and they haven't even had the experience yet. When it comes to getting a bill.

Stewart Gandolf (Healthcare Success)

All right, don't rush. We have about five minutes, but I think this is important. Like, so the, that, you know, did your survey show what percentage of parents are even aware they can't price shop? Like, how does that happen to the extent that your research shows? Because a lot of people assume it's a hospital, it's what it is. But, like, what did your experience show?

Rob Klein (kleinandpartners.com)

Well, we didn't ask them if they know, but people know they can ask. A lot of it, they're like, I don't bother asking because I'm going to get the runner-up. Right. So, price shopping is not going up because people are like, I don't get a good answer, so why bother? Yeah, understand. it's a frustration if they don't, right? Half a parent said that one bill, I should just get one bill.

And if I don't get it within a month, I shouldn't have to pay it. That's your new consumer. They're tired of being your accountant. And that's what they say to me in focus groups. I'm tired of being your accounting department. I know you have multiple people to pay. Not my problem. You pay them and send me one bill. Because when they get these multiple bills, they don't trust that you're smart enough to do the math correctly, and they feel like they're overpaying. And then they're like, why do I have to wait six months? I'm to leave you one last story on this that I've never forgotten. Pre-COVID, many years ago, I'm working with a client on their experience, and I'm doing focus. The lady's sitting to my right, and she waxes poetic of how beautiful and wonderful the experience was. I can tell the client's getting really excited. All of a sudden, she gets to the bill, and then she says, she turns to me and says, And then there's the bill. And I'm like, uh-oh, other shoes are dropping. And she said, I had my experience in the spring. I thought I got all my bills. I paid everything. Late summer, I do family planning and budgeting. So, I budgeted money for a vacation in the fall. Then I get this extra bill that I wasn't expecting. So, I researched it and found out that I did owe it. So, I legally had to pay it. She said, so I paid the bill, and I had to cancel our family vacation because we couldn't afford both.

Then she turns to me. She sticks her finger right in my face and says, and now I hate them.

So, she went from loving the experience and that bill, getting a bill six months later, she said, and now I hate them. And I went to the client afterwards and I said, do you see what just happened? It doesn't matter what you do from a patient journey, performance improvement in the middle. If you screw up the bill, you're done. It's game over.

Stewart Gandolf (Healthcare Success)

That is a terrific way to end. A little ominous, Rob, maybe, but a terrific way to end.

Rob Klein (kleinandpartners.com)
It's an opportunity to improve

Yeah, for sure. So, I would just say, Rob, I'm listening to you, and you and I have done these things for years, and we're friends and have very expensive dinners and cocktails together occasionally, but I love the way you bring this to life. Like the data, if you read the data here, and I welcome everybody to download the data, on Rob's website or ours. But, you know, you really have such a great way of bringing it to life, Rob. So, I want to say thank you very much and love working with you, as always. So, I appreciate the time today.

Rob Klein (kleinandpartners.com)

My pleasure, Stewart.

Stewart Gandolf (Healthcare Success)

So, tell the people how to contact you, what website, where to go.

Rob Klein (kleinandpartners.com)

Oh, yes. So, if everyone averts their eyes, I'll go to the end. And so, here's my contact information. So, it's just rob at kleinandpartners.com. That's right. Rob at K-L-E-I-N-A-N-D-P-A-R-T-N-E-R-S.com, and you can email me or just go to our website, which is kleinandpartners.com, and you can download it there. You can get it off of Stewart's site, many different ways. If you just have some questions, if you want me to present this data to your teams, I'm happy to do that. I do this study every year as a gift to give back to an industry that I have been in for 40 years, and I am so blessed to have had such a good time. And I've made so many good friends like Stewart and others, and so I get paid to have fun. And so, to show my gratitude, I give this study out to everybody for free every year. So, I'm happy to present to your team if you'd ever like. So, again, thank you for spending your time with us today.

Stewart Gandolf (Healthcare Success)

Very good. Thank you, Rob. I appreciate it.

Rob Klein (kleinandpartners.com)

You got it, Stewart. Take care, buddy.