The vital comeback of a 100-year-old healthcare brand

In this episode, I’m delighted to have Matthew Pinzur with us. It’s a special edition, which we’re calling The Healthcare Edition. It means that people are going to be super interested or some people are going to stop reading now. This is an interesting story and very applicable to whatever industry you’re in. Welcome, Matthew.

Thank you so much. We talk about healthcare as being a low-interest sector from a marketing perspective. One of the things that I do on the side is teach healthcare marketing at the University of Miami. I always have to explain to my students, especially the undergrads, that there’s nothing we can do that’s going to make somebody who’s driving on a Sunday afternoon think, “I just saw a billboard. Instead of going to the farmers market, I think I’m going to go get a kidney transplant.”

That’s a good setup for a lot of what we’re going to be talking about. Because healthcare is so local and you’re going to have people from across the country or even globally reading, we’re often aware of our local healthcare institution but give us a bit of background of Jackson Health.

Jackson Health System is the major academic hospital system here in Miami. We have an unusual structure and we’re part of Miami-Dade County government. We’re taxpayer-owned within the structure of the county government. We’re also independent of but very closely affiliated with the University of Miami Medical School. Especially at our flagship campus just North of downtown Miami, it’s a real international destination for things like organ transplants. It’s one of the largest organ transplant programs in the country. Also, neurosurgery, spinal rehabilitation, newborn intensive care, and complex pediatrics.

At the same time, because we are government-owned, we are a true safety net provider. In our charter and in fact, in our county ordinance, we have a requirement to provide the same level of clinical care to every resident of Miami-Dade County. That’s regardless of immigration, health, insurance, or financial status. We like to say that here at Jackson, everybody comes in through the same door. We’re a large system, one of the largest public hospital systems in the country. We’ve got seven hospitals.

We just opened our sixth urgent care center. We have about half a dozen primary care clinics. We have a very extensive footprint but are limited entirely to Miami-Dade County. All-in-all, about 70,000 discharges a year, about 300,000 outpatient physician appointments, about another 300,000 emergency room visits, and then lots and lots more when you start talking about things like X-rays, CT scans, and everything like that. We have 15,000 employees and about 1,100 physicians in training, residents, and fellows, which makes us all one of the largest academic programs in the country.

We’re going to get more into the Jackson Health brand evolution story. You started as a journalist and now you’re a Chief Marketing Officer. How did that happen? 

It was mostly by accident. As you said, I was a newspaper reporter for about ten years mostly here in Miami at the Miami Herald. I took a brief detour into government and I worked for the county manager and the mayor in Miami-Dade County. As my third year there was wrapping up, the Jackson Health System was in a financial crisis. The question around Miami was not whether Jackson would survive. The question was when Jackson was going to close.

The system was losing about $90 million a year. If it wasn’t for the full faith and credit of Miami-Dade County, it would have been a bankrupt institution. This was the beginning of 2011. The mayor and the County Commission made a decision to give it one more go to try and make this work. They reconstituted the Board of Trustees here into something much smaller and a little bit more focused. They did a search for a new CEO and they ended up recruiting an amazing leader named Carlos Migoya. His backstory is fascinating.

He had spent almost his entire career as a banker. He had started at a small bank in Miami where he was going to work as a part-time teller for six months so that he could pay his way through community college down here. Instead of staying for six months, he stayed for a little over 40 years. He got promoted a few times. He helped lead that bank through a whole bunch of mergers and acquisitions.

He retired effectively as the Chief Operating Officer for Wachovia. He helped negotiate that sale to Wells Fargo and retired before he was 60. I got to know Carlos because while I was working for the county government here in Miami, he was a Volunteer City Manager for the City of Miami to try and stave off bankruptcy there. He took this job as the CEO at Jackson when many people told him it was an unfixable situation. He did it because he felt it was a way he could start to repay everything that he felt Miami and the United States had done for him as a Cuban exile.

In fact, when he was much younger in 1978, his younger son’s life was saved at Jackson. He was born weighing 1.25 pounds and given a 1% chance of survival. We joked that other than having become a banker like his father, he’s now perfectly healthy. It was experiences like that that drew Carlos to take on this challenge. He and I knew each other a little bit. He knew I was ready to move on and he said, “What if you come for six months and work at Jackson? Come on my transition team. You’ve got some good community relationships. You can help with some of that stuff.”

I had no marketing background and experience, and now, many years later, we joke that he keeps getting to fire me and I keep forgetting to quit. It’s been an amazing ride from the minute that we got here. We knew that the clinical care at Jackson was very strong. It wasn’t something that required a wholesale rebuild. It was everything else here around the operations and the finance that did, to say nothing of the branding.

From the first year we got here, we stopped those losses and we started bringing the budget into the black, and it’s been that way every year for as long as we’ve been here. Also, because of the way we’re structured, there is no profit. Every dollar that we make goes back into either expanding our programs, expanding our facilities, or supporting our employees. That means that there’s always a challenge of making ends meet, but it also means that the people here are driven by that mission to the community and by that belief that everyone deserves that same high level of academic medical care.

Talk to us about the different phases that you’ve gone through then as you think about the twelve years that you’ve been there and the evolution of the brand. Also, the priorities that you set and the role that marketing and brand played in this turnaround story. 

The first few years were about firefighting. We say only half-jokingly that any time we would go to fix one problem, we trip over six others on the way there. Probably the hardest thing we had to do both from an operational perspective, from a human perspective, and certainly from a brand perspective is the health system was wildly overstaffed for the number of patients that it was serving.

Again, it was not about profits because we’re a non-profit government organization, but we had somewhere on the order of 10,500 employees, and based on the number of patients who were choosing Jackson, there wasn’t enough clinical demand or enough revenue coming in to support that model. We had to do a layoff and we thought it was probably going to be about 5% or 6% of the staff.

By the time we went through it, that ended up being closer to about 12% and we were down to 9,000 employees. That was all done through a very intentional process where the first thing Carlos did was turnover about 80% of the leadership team. He said, “What I’m not going to do is start doing layoffs in the staff with the same leaders that brought us to this situation in the first place.”

He went and found new leaders and then he said, “I’m not going to do an across-the-board cut where I tell you, ‘It’s got to be 5%. It’s got to be 7%. You’ve been brought into this organization because you’re an accountable and responsible leader. You tell us what you need to do with the demand that’s coming in now. We also want you to own it. Don’t go to your employees and say, ‘Corporate is telling me I have to do X, Y, and Z.’ This is going to be your plan. You’re going to own it.’”

It’s because we’re in Colorado, it’s good to make a joke. This is where Coach Prime got his strategy of replacing 80%. It is interesting how it’s a leadership lesson that can be applicable to different industries as well. There are some parallels. The Buffs were a 1-11 team, and for anyone who doesn’t watch college sports, CU had a football team that was 1-11 in the past year. They brought in Deion Sanders as the new coach. The first thing he did was tell the players, “Eighty percent of you are going to go because we need new people.” It sounds very similar. You were like a 1-11 team.

That’s exactly right. The thing that was so unusual about it and differentiates it from the sports analogy is our players were, by and large, doing the right thing. It was the coaching staff. If you were talking about a pro team instead of CU, it would have been with the ownership and the management is where the change needed to start. I very clearly remember having a reporter ask me, “When the economy turns around, are you going to be able to hire these people back?”

We said, “You don’t understand. This isn’t about the economy outside of our four walls. This is about what’s the demand inside of our four walls. If we do our jobs right, more people are going to choose Jackson over our private sector competitors, and that’s when we’re going to hire people back.” Indeed, that’s exactly what happened. Now, we’re at 15,000 employees.

I imagine then when you started, the brand perception of Jackson Health was low and it probably went down even further after those rounds of lay-offs. People say, “We understand that we need to turn around.” That’s funded by the public, now, you’re making a lot of people redundant. What did that mean for what you were doing from a brand and marketing standpoint? What did you start? What did you stop or have to immediately start doing differently?

From a perception perspective, the only thing we had going for us when we started in 2011 was that the brand couldn’t have gotten much weaker. We say only half-jokingly that the perception around this community was you go to Jackson if you’re too sick or too poor to go anywhere else because the only thing we were doing at the time was indigent care and highly specialized care.

In fact, even a lot of people who were working here at the time would admit that while the individual nurses, doctors, and techs all wanted to do the right thing, the culture of the patient experience was, “You’re here because you have no choice. We’ll get to you when we get to you the way we want to get to you and you’ll like it.” It was still a very dated approach to consumerism in healthcare and it was probably 25 or 30 years behind even then.

The first thing we did from a very tactical marketing perspective was we almost zeroed out the marketing budget. What we said is it doesn’t make sense to have a full-page ad on page three of the Miami Herald when page one is talking about what a disaster it is over here. Even if we could have afforded a substantial marketing budget at the time, we had so much earned media coming at us. Put yourself back in the mindset of many years ago where the local newspapers and TV news had much more credibility, reach, and influence. That was radically impacting the everyday clinical experience of people’s decision-making.

The Miami Herald would report that Jackson was on credit hold with its suppliers and patients started thinking, “If I go there, are they even going to have what I need to get my care?” It was an intensive couple of years of demonstrating that we could do almost the creative disruption that needed to happen in order to get to a better place on the flip side. There were two sentinel events that let us know that we had reached the end of that first phase.

The first one was a very macro event. As you can imagine, having lost hundreds of millions of dollars in the five years before we got here, there had been no capital expenditures. It’s just no expansion as my Miami-Dade County geographically grew but no upkeep of the existing facilities. We said, “The only way we’re going to be able to catch up is if we go to our voters and we essentially ask them for additional money.” We asked them for an $830 million bond repaid via property taxes.

Our pollsters had told us at the outset, “If everything breaks exactly right, if you work your tails off, you might be able to get 51% on that.” By the end of it, we were at 65% on election day. It’s because we were able to get past the perception of what was happening back in 2013 at Jackson and tap into the deeper feelings that people had about having a place this comprehensive and this academic with this kind of a mission. Also, what it meant to them as part of their community and even as part of their own family.

If they hadn’t been treated here, they have an aunt who was treated here. They have a grandmother who was treated here. They have a sibling who was treated here. In a community where so many people are immigrants and exiles, the idea of having a publicly funded, here-for-everyone high-quality institution resonated. When that passed with 65%, which was a massive branding and communication effort where we within the hospital had to stay apolitical, we’re doing our part to factually tell the story of what was going on.

Also, to try within the bounds of what was appropriate and stay coordinated with the campaign that was out there advocating for us. That was definitely point one where we knew we were at a new place. I said, “That’s your macro one.” There then was a micro experience that we had that was a real game changer. As you can imagine, bringing in a CEO who had no healthcare experience and who had retired before he was 60 quite comfortably, bringing him in rubbed a lot of bedside caregivers the wrong way. That is not someone who they’re necessarily going to outset see as a leader.

Illness feels an aftermath to healthcare overall that can be more far from the truth. It’s the polar opposites.

He took a huge pay cut from what the prior CEO of the health system had been making. What he did ask for was if Jackson was able to be in the positive financially that he wanted to gain sharing or a bonus structure around that, which people happily gave him because nobody believed it was possible. We had a lot of employees who believed at the time that all of those layoffs were not about structurally making the health system more able to compete but about lining his own pocketbook.

It was a very tense time. About 90% of our workforce is unionized. While now, we enjoy a very collaborative strong working relationship with all of our unions, that’s not how it was the first year. The way that we knew we had reached an inflection point was when Carlos was doing one of his quarterly town hall meetings. Every quarter in those days, we would go to every one of our hospitals and invite all the employees. We talked about what was going on and he would take questions for as long as people have them. We were at one of our suburban hospitals and two of the union stewards asked if they could say something in front of everyone before the meeting began. Carlos looks at me and I look back at him. We’re sweating a little bit, but we said, “Sure. Go ahead.”

They got up and they essentially said in so many words, “You came in a couple of years ago and you told us you were going to make these kinds of cuts and you were going to impact us in this way, but there was a light at the end of the tunnel. Also, your responsibility was to get us there. We didn’t believe you and we fought you every step of the way. It turns out we were wrong. You did what you said you were going to do and we want you to know that we’re here. We’re on your team. We’re moving forward together.”

I’ve worked for the man for many years. I’ve seen him cry three times and that was wonderful. We knew that we were at a point where at least we were one team rowing in one direction, even if the waves were coming against us. You were asking, what was that turning point? Those were the two things where we knew that now we were out of firefighting mode and we were into rebuilding mode.

When you were going through that first phase of trying to define, “What is our position? What role do we play and our importance to the community or the public?” that sounds very much almost like an initial thing. You talked about it in a very functional message. Were there certain messages or articulations of that story that broke out people that people understood?

There were two parallel paths that we took towards that. One was helping everybody, especially among the leadership team, understand that storytelling was probably going to be more effective here than hitting people over the head with numbers. You could tell them, “We’ve got this efficiency now and we’ve saved this much money.” That’s not necessarily the way that you’re going to change perceptions or that you’re going to create affinity and loyalty.

A lot of it was about finding those patient success stories and getting them to be our storytellers out in the community. As we were going around the community, whether it was talking to our own employees or talking to those voters before that referendum, it was creating opportunities for them to tell us their story. Inevitably, if you were in a room with more than ten people, at least one person had a jaw-dropping story about something that Jackson had done for them.

That was a crucial element in turning around the way people thought about it. The second part was we had to practice radical transparency. For better or for worse, Florida is a state where government agencies, which we are technically, has incredibly liberal public record and open meeting laws. If it doesn’t have personal health information on it, if it doesn’t have something else that is specifically excluded, everything is in the public record.

This means that if a reporter wants every email that I’ve ever sent to the CEO, other than redacting the things that might be violating HIPAA or something else, they’re entitled to all of that. A lot of public systems in Florida see that as an impediment. We tried to steer into that and we said, “How can we use that to our advantage?” The way we can do that is we can invite reporters in for tours of everything, and then when they have questions, we don’t have to sit and make the difficult strategic decision about how much we tell them because that’s already solved.

The question is do you want to be defensive about it or do you want to be upfront about everything? We prided ourselves, and we still do, on being incredibly responsive to those requests, on having experts available, and on producing documents. Also, by and large, when it’s feasible not to use our media relations team as a firewall, as a go-between, or as a translator, but as a facilitator that helps bring those experts into dialogue with the reporters as the stand-ins for the community we’re trying to serve.

We were having a conversation before the interview. You were also talking about this notion that there was an opportunity to position yourself as a bit of a Robin Hood story in contrast to others. Talk a bit about that.

It’s funny because when we were developing our first strategic plan, as somebody who was heavily involved in writing it, I can tell you it was very long and it was better than anesthesia for putting you to sleep. Carlos is the one who simplified it down to two sentences. He said, “We need to be Dr. Robin Hood. We need to get money from the people who have it so that we can pay for the people who don’t.” That served as a powerful rallying cry that, in the minds of those nurses, techs, and bedside caregivers could help crystallize that the money wasn’t about the money. The money was about the mission. The phrase, “No margin, no mission,” is a little bit overrated and is a place where it’s easy for some of us to hide some of the more business-minded things that we’re doing.

Helping people whose day-to-day focus is on administering medication, delivering care, and emptying bedpans, refocuses them on how all the things that are happening outside of the patient room connect back to what they’re doing. It is a critical part of internal storytelling, and if you do it right, then it bleeds out into external storytelling as well. Especially when you look at a health system as large as ours, again, 15,000 employees and their spouses, children, parents, and their aunts and uncles, it becomes the story that is in the community.

That’s a good segue into the next phase of this because if the goal is to get the rich people who can pay, now brand and marketing have to play a much more direct role. What was interesting when you were talking about the initial phase where you turned all of marketing off that you said, “When page one of the newspaper is talking about what an absolute disaster we are, then what’s the point in us then advertising on page five showing smiley faces?” That’s something that resonates with me. Having gone over that first bump, how did you make that transition back and how did you start telling that story?

 There were two prongs to that strategy. Now, we’re in 2013 and 2014. Prong one was unlike a lot of other hospital providers when it came to a marketing strategy, we had almost 100% name recognition in our market. We didn’t have to do general brand advertising because everybody knew where we were and everybody had an opinion of us. What did we do? We treated those service lines where people would still choose us. We treated each of those as if they were a separate client and we were an internal agency for them.

That meant some of them needed completely different strategies than others did, with completely different tactical plans and budgets. Even though we had a style guide that everything was hanging together on, the way that we approached marketing organ transplant or neurosurgery was very different than the way that we approached marketing high-risk maternity, for example.

We were very tactical and it became less about trying and change the way you feel about Jackson, which is like trying to boil the ocean. It became more about, “When you have this one very specific need, this is the place where you want to come for it.” We segmented the heck out of that audience and we got laser-focused on figuring out what the right message was for them and how we immediately generate some kind of call to action out of that.

For the people who aren’t in healthcare, this is where the concept of consumerism starts coming in because people only think, “How do you do marketing and branding within a health system where it’s not about trying to drive choice or share?” However, when you deconstruct it, there are some service areas or some specific areas where there is. Can you talk a little bit about that?

That’s such a good point and it’s something that even marketing students struggle to grasp when they first encounter the healthcare space. It’s changed radically in my few years in the business and it’s changing still very quickly now. A story that sums this up is very early in my time here, I went to talk to the head of maternity, the chief of OB. I talked about us wanting to do a campaign to get women to deliver here. He said, “That’s crazy. Women don’t choose the hospital. They choose their doctor and then they deliver wherever the doctor says to. They listen to their doctor.”

I said, “I completely understand what you’re saying, and if I had come to you a few years ago and said we should have a TV commercial for a prescription drug, you would say, ‘You’re crazy. Patients don’t choose their prescription drugs. They take the one their doctor tells them to.’” We all then remember what happened with things like Allegra and Cialis. It’s some of the first ones that were out there doing direct-to-consumer advertising. It looked crazy at the time. Now, we may think it’s crazy from a policy perspective, but from a marketing perspective, it’s a huge chunk of the healthcare marketing sector.

We’re still seeing the evolution of all that, but that also requires a different kind of audience segmentation for different types of healthcare marketing. What do I mean by that? As I said, Jackson is one of the largest organ transplant programs in the country, but as I said in the first example that I gave you when we started, nobody decides on a Sunday afternoon, that they want to go for a kidney transplant. That’s one where patients really will probably have very little to do with deciding what hospital they go to for a transplant because, by that point, they’re not working with their primary care provider.

Their primary care provider has referred them to a specialist who has probably referred them to a subspecialist, and that’s where the patient is putting all of their trust. From a marketing perspective, our job then is to make sure that those doctors who are making that final referral, that nephrologist or that pulmonologist that’s saying, “Here’s where you need to go for a liver transplant.”

We need to make sure that marketing is primarily focused on them. They’re the ones who are steering those patients, but we do still have to have some kind of consumer element to it. Why is that? It’s because when Gabriel, my doctor, tells me that I need to go to Jackson to get my organ transplant, I better have at least a neutral perception of that brand so that I’m open to that. Also, I better have the kind of mid-funnel stuff like the strong website, SEO, and reviews so that when the patient goes and does their own research, which we know is the first thing they’re going to do, they can’t be so turned off by it that they push back on that referral.

That’s one end of the spectrum. We talk about the more something is a niche service, the more something is a medical specialty the more that balance has to be focused on the referring doctor. The other end of that continuum are things like emergency rooms and urgent care centers where there probably is nobody who’s an intermediary in that at all. You’re probably just going to the urgent care closest to your house.

My job is, “How can I make you skip the one that’s closest to your house and go half a mile further to go to one of mine? How can I make you skip that emergency room that you’ve been going to for the last twenty years and go an extra three minutes to try one of mine?” That has a very similar approach to whether it’s restaurant marketing or streaming services or whatever it is. How does Netflix get you to subscribe to them instead of Hulu? How did McDonald’s get you to come to them instead of Burger King?

The Big Challenge in healthcare is in many cases, it’s less about trying to skip the competitive emergency room to come to yours. It’s, “Don’t come to me. Don’t go to the emergency room. Go to an urgent care to understand when you should be going to one versus another.” It gets even more complex and nuanced.

There’s an educational component to almost everything with healthcare marketing. Also, one of the things that I’ve been always interested in learning more about, and in fact, I mentioned that I teach over at the University of Miami. Every week, I ask my students the same two questions in a little poll they do on their phones. I say, “On a scale of 1 to 5, how effective is healthcare marketing? On a scale of 1 to 5, how ethical is healthcare marketing?”

The fact of the matter is that the community, whether it’s your patients whether it’s your other stakeholders, holds healthcare providers to a higher ethical standard than they will a fast food restaurant or a streaming service. We get into some great debates in the classroom and in the boardroom here at the hospital system about how far can we go on things that would be considered completely normal for a car dealership. Is it ethical to do that in the context of somebody’s healthcare?

They’re bringing examples in as well. It’s encouraging them to be looking out every week for examples of healthcare marketing.

Correct. For me, it’s trying to understand how different milestones along that educational path influence the way they’re thinking about it. They come in and, in many cases, some of my Master’s students are a little bit different, but especially the undergrads, they barely come in even thinking of healthcare as an industry or as a sector of commerce. They think of it more as a service. When they start thinking about it as a business, to what degree are they comfortable with profit maximization, with a revenue goal, with prioritizing marketing services not necessarily based on what the community needs most, but on what brings in revenue for the hospital system?

Those things are noddy and weighty things for somebody to wrestle with at that stage. One of the conversations that we have, I don’t think it’ll shock anybody who’s listening to this show that companies data mine their own customers for loyalty to try and resell and upsell. Healthcare providers are starting to do some of the same things. You remarket to your existing patients. These are folks who have already trusted you once. I always like presenting my students with a hypothetical.

We have a pretty robust weight loss surgery program in our health system. Would it be ethical for us to go through our electronic medical records and flag everyone who’s in a certain age group where we know that they’re good candidates for that kind of surgery, and people who have a body mass index that makes them unhealthy, at risk for all kinds of complications, and candidates for weight loss surgery? Would marketing to that universe of people be ethical?

We’ll have a good discussion on that for 3 or 4 minutes. Usually, it’s about a 50/50 split and then I’ll say, “Does it make it less ethical if instead of marketing to everyone who meets that criteria, I only market to the ones who have private health insurance where I can profit off of that surgery?” “That’s different.” We then get into a whole different discussion about that. I say, “Let me throw another monkey wrench into this discussion.”

It’s because we’re a comprehensive health program, do I have an ethical obligation to ask the electronic medical record, “Have any of these patients ever been treated in my behavioral health service for an eating disorder? Do I have a proactive ethical obligation to think about those things and exclude them from the marketing?” All these kinds of things don’t come up when you’re selling a streaming service, but they do come up when you’re serving healthcare services.

We have a similar discussion about marketing maternity services. Do we have an obligation to understand whether women have tested that they can’t have children and that’s somewhere that is in their medical record with us? Should we therefore not risk upsetting them by sending them maternity information?

What if they have had a miscarriage in the past? On one hand, those might be people who are eager to try again and have a baby. On the other hand, that could be something that’s emotionally upsetting for somebody depending on the timing. Nobody has that conversation about selling soda, but when you put it in a healthcare context, it becomes a much more lively debate.

How do you ever make a decision to do something when there is that thing? You could always argue that ethical concern. Can you ever do it when the burden of proof is so high?

It’s a great question and there doesn’t seem to be industry-wide any kind of standard approach to that dialogue yet. I’m lucky for a number of reasons here. Not the least of which is the faculty member at the University of Miami who founded their ethics program and is also the chair of the ethics committee for our health system and is genuinely a great guy. We can bring in him at any time and we can bounce these questions off of him. We can have a dialogue among my staff, the others on the executive team, and with this this great ethics thinker.

Something that he and I have always agreed on is even in these areas where there probably is no right answer or the wrong answer, the mere fact that we’re stopping, pausing, having the discussion, and second-guessing ourselves, all of that makes whatever final decision we come to inherently more ethical because you’ve gone through that process of thinking about, “What are your motives for something and how are different people being impacted?”

Matthew, maybe in the same way that there are a lot of former journalists who have become marketers. Maybe the growth impulse of ethics and data now, there’s a big career path for all of those Philosophy majors who are trying to figure out what to do with their lives.

That’s exactly right. I was a political science major so I’m glad I stumbled into something where I can pay the mortgage.

I want to make sure that we close the loop back on that second half of the story that you started to talk about now that we needed to start to attract the people who would be able to pay for the care and you started to do that across service lines. What lessons did you learn and were the future phases?

I talked about two parallel paths and we spent a long time going over what we were doing to focus on individual services rather than the brand itself. The other path that we were taking was trying to again steer into one of our challenges, which was even when we felt it was safe to go back into marketing, we never were going to have enough money to compete with the big private systems in this market.

Our biggest competitor down here is a not-for-profit but a private that has plenty of cash on hand. I like those folks. I respect those folks. I have friends over there but the fact is, they spend more money in one day as the big sponsors of the Miami Marathon than I can spend all year on my community outreach and sponsorship budget. What we said is, “How do we take advantage of that? How do we not try and beat our competitors at their own game?”

We can’t play the same song that they’re playing and just try and play it louder because we can’t afford the volume. What can we do that’s off left field? How do we find partners in this work? How do we find people who have emotional attachments to us and work with them on the storytelling? I’ll give you a couple of examples of that. We have some relationships at the public school system here. Something that folks outside Florida might not know is in Florida, public schools are organized countywide.

The Miami-Dade County public schools are massive. It’s the 3rd or 4th largest public school district in the United States. We spoke to the superintendent there who was a friend of mine and then we spoke to our partners at the University of Miami. We said, “What if, we tried to break the Guinness world record for the most people trained in CPR in a single day?” I will tell you, we did not break the record. I will tell you we had almost no intention of trying to break the record because we couldn’t have afforded to bring the Guinness people in to try and audit this even if we wanted to.

However, it became a great rallying cry. Everybody loved the idea because no matter how short you fall, you’ve still got more people trained to do CPR. We ended up launching CPR Day Miami. We opened up. Six public schools, the Red Cross headquarters, and the University of Miami campus with CPR trainers all on a Saturday. We trained hundreds and hundreds of people in the very basics of CPR in one day. It got a ton of media coverage and we were able to even go beyond who heard about it through the media because we were so organically reaching into the community.

When we’re at your neighborhood high school doing this right, when we’re working with the Red Cross, when we’re at the University of Miami, things like that made a big difference. Another partnership that we did with the school system is we tried to put health, wellness, and nutrition tips in a small newsletter. We did an elementary, a middle, and a high school version. The school district said, “As long as you pay for the printing, we’ll put it in every kid’s backpack in the whole school district.”

That’s hundreds of thousands of people we were getting right into their homes. Now, they are attaching something positive and constructive to our brand. We didn’t even have any calls to action. That was way before we were marketing our pediatric emergency rooms, for example. It was just a way to reintroduce the brand to the community. We were constantly looking for things like, “How can we punch above our weight? How can we use people’s natural affinity for this organization and its historic role in our community to make a big difference?”

It is interesting what you said, which is the importance for marketing and brand people to have a diverse set of experiences because if you work at a larger organization where you can play the scale game or you can play the traditional playbook, to your point, you have to zig when everyone else is zagging. Creativity is born by necessity and constraints are good sometimes because they force us to have to adapt, be creative, and rewrite the playbook instead of following the basic base scripts. Are there other examples where you’ve had to rewrite the playbook or maybe even talk about how that then connects to then how you address the brand question?

I then think the last milestone that we reached and the phase that were in now was getting a lot more strategic and understanding how our processes impacted the creative work that we were doing. That’s been a journey that we’ve been on for at least a few years now. Some of that was at the very basic blocking and tackling, to take it back to your college football reference.

One of the things you and I were talking about before this was how clients make sure they’re well-aligned with their agencies. We put in a very strict and formal timeline that we’ve now been adhering to where as soon as each of our internal business units, our hospitals, and divisions finish business planning for the next fiscal year, we have a series of meetings with each hospital’s CEO and business unit leader where my staff and agency are there. We say, “No forms. No scorecards. No nothing. Explain to us your business plan and strategy for the next fiscal year in your own words.”

We sit. We listen. We ask a lot of questions. From there, we make a very high-level finger in the wind guess at what kind of budget we’re going to need to carry that out because we’re going to be now requesting budget from our CFO at the same time as we’re developing a tactical plan for the New Year. Most of our spring and into the summer is spent with our agency and our staff working in concert.

By and large, they are asking themselves three questions. “What do we need to stop doing? What do we need to start doing? What do we need to continue doing?” When you ask those three questions, you’re putting a little bit more framework around the conversation than just a blue sky, “What do we want to do next year?” You’re being a little more responsive to your data because you’re seeing what worked and what didn’t work. You’re then bringing that into the conversation.

However, you’re still leaving things open enough that you’re not trapped in a, “We just have to do what we did last year, but 3% more.” Those conversations become important. In the room for those conversations are folks from those internal clients. Maybe not the CEO herself, but somebody who’s over business development there or somebody who’s over strategy there. They’re part of that conversation.

A strict end of that timeline too, which is by the third week of August, our fiscal year starts on October 1, we are now meeting back with all of those senior executives with a finished polished proposal both a full tactical plan but also a simplified, a one-pager that summarizes who the target is, what the new goals are going to be and what the major tactics are going to be. We pitch that to them and either they sign off on it right there in the room which happens about 95% of the time now or they have a couple of follow-ups that they want us to do to check on or to tweak. By Labor Day, our plan is done and that leaves us with a full 30 days to get stood up for an October 1 start date.

Getting that kind of rigor into our process has been an increasingly important part of it. There’s enough flexibility within that rigor that as the technology changes, as the different ways of reaching an audience change, and as our ability to gather and reflect on data change, we still have that structure that makes sure that we’re doing things in an intentional way. The way that we then live those plans over the course of the next 365 days, is every ten weeks, we have a meeting that is on the calendar forever that everybody knows about. A week before that meeting, we sent out a dashboard with all the key performance indicators. We also sent that original tactical timeline. We say, “Hold us accountable for it.”

We sat down for an hour and we said, “Here’s where we are. Here’s where we expected to be. Here’s what’s working well. Here’s what’s changed in the industry since we did this plan 4 months or 6 months ago. What do we all need to be doing?” We then leave that meeting with an action plan. That way, we’ve been able to 98% get rid of the thing that is the bane of a marketer’s existence, which is your client coming to you four months into a plan and saying, “I had this idea in the shower this morning. We should do X, Y, and Z.”

There’s no strategy behind it necessarily and there’s certainly no resources identified for it because they don’t want to cancel anything else that they’ve got on the plan. Everybody understands that there are opportunities in the course of the year to bring entirely new things to the table. Outside of that, we’re only making changes when things happening outside of our institution are driving that change.

It’s a great leadership lesson on how to create internal structure and process. I imagine it’s building the relationship with those internal stakeholders because they don’t see those who might have thought of marketing as a t-shirt and cups department see you as a strategic partner. To say all that doesn’t mean that it doesn’t happen. How do you deal with it when it happens you point them back to the product? How do you handle those without naming names?

Some from column A and some from column B. We make sure that there’s enough money in the budget every year that when the client does know their employees, know their patients, and know their doctors if they come to us with a request that’s relatively modest it’s going to make them feel good. It’s not going to do any harm from our perspective, let’s try and do it for them. Let’s find a way to get to yes. With everything else, usually what happens is somebody comes to us with a new tactic that they want to do.

Our attitude is, “We’re chefs. We’re not short-order cooks.” I understand you want this new plastic card to go behind the ID badge or you want this new clipboard or you want this new whatever. In service of what? What are you trying to get to? What are you trying to accomplish?” I need employees to remember you know this acronym or I need more patience to be changing their behavior in this way.”

Now, we understand what we’re trying to get to. We can now rely upon not just our own expertise as marketers, but let me show you some data from your service line or your hospital right now that shows you why this alternative that we’re suggesting is going to be a better way of getting where you want to be. I’ll give you a really small quick tangible example.

People who work in the hospital world know that every three years, you get a massive survey from an organization called The Joint Commission. It’s basically an on-site week-long audit of everything that you do in the hospital from a quality, safety, and regulatory perspective. It’s extremely stressful for everyone because if you fail it, you can no longer accept Medicaid and Medicare and you’re essentially on your way out of business. The stakes could not be higher.

A lot of energy goes into making sure that employees are ready to answer the right question if the surveyor asks it, they’re doing all the right things, and that we’re up-to-date on all of our regulations. We got a request going into one. We need a cardboard card that we can hand out to thousands of employees at this one worksite that gives them a cheat sheet for some of these things. We said, “I understand you’re trying to get ready for your big survey. You know that we built a digital version of this. It is not an app. It’s a very simple website. You can have terrible bandwidth, wherever you are. The employees can save it to their phones. It’s going to look like an app. Everything is very simple to navigate. Easy-peasy.”

They’re like, “That’s great. We know about that but nobody uses that. You need to understand. We love you guys, but nobody uses that. We think a paper card is going to be more effective.” I said, “Okay. Tell me how many visits a month go to that online version of it?” “It can’t be more than a couple of hundred.” I’m like, “Let me pull up the dashboard right here while you’re here so you know I’m not making anything up.” Look, “It was 15,000 visits last month to that site.” “I guess we want to be there. We want to paper card. Can you put us on there?” “Yes, we can.” “We’d be happy to do that. You get me the information and we’ll have it updated by tomorrow.”

One thing I wanted to cover is that you’re talking about these strategies and plans. Especially in healthcare, a lot of it isn’t just around an example you just described. It starts to feed a lot into the actual experience as well like things that aren’t necessarily traditionally owned or run by marketing.

I think the wall between marketing operations and what we like to call the patient experience has been eroding for a long time in hospitals and it’s happening faster and faster. Probably, you’re seeing that in other places as well. If you go into a Walgreens or a CVS, a lot about your experience walking through that place is being driven by some of the stuff that’s coming out of marketing. It’s not just signage on the walls but it’s what is that QR code letting you do. How are you signing up for a loyalty program so that we can be remarketing to you and better understand who our customers are?

That requires a lot of creativity from the marketers. It also requires a massive amount of humility. We need to go into all of these conversations. In fact, we had a big staff retreat. Most of my staff work remotely now, but every three months, we all come together. There’s about 35 of us now. We come together at one of the hospitals. We spend half a day or a full day together.

One of the themes of the last one is, “For the new fiscal year that we’re starting, I want you to have two keywords in mind that feed each other and can drive everything you do. One is data and one is curiosity.” When somebody comes to you with some off-the-wall request, instead of rolling your eyes and having a trot out the script that you’ve said 47 times about why we don’t do that, let’s get curious about why they want that and what they’re trying to solve for. Let’s meet them on their terms.

Let’s also not pretend that we haven’t been through this 47 times before because we have that data. Let’s use that data to help them accomplish their goals. When we’re looking at that data, let’s get curious about what’s driving some of those results. You and I had a conversation about an experiment that our digital agency has been doing where in one of our service lines they’ve had half of our digital ads written the regular way by their staff and half-written by a large language model, written by ChatGPT.

We’ve seen that the click-through rate of the ChatGPT ads is double that of the ones written by the staff, but it is only half as effective and generates any kind of follow-up action once people do click-through. Whether that means making an appointment or watching a video using one of our tools. You asked me, “Why do you think that is?” I said, “We don’t even have a hypothesis yet.” It’s only a few weeks old. We have to see if there’s any signal in that noise, but that’s an example of how the data can drive curiosity. Let’s then use that curiosity to act on it and then let’s look at the data to see what we can learn from it.

I love that example. How does that then extend into the work that you’re doing? You are talking a lot about the facilities or as we think about consumerism, a lot of it is the experience. You made some great analogies in comparing healthcare to other industries. If you think about the most basic thing in healthcare, which is booking an appointment.

I can order a Starbucks coffee in my app and go and pick it up. I can order something on Amazon and it’s being delivered. Imagine a busy father or a mother trying to book an appointment. All of a sudden, I have to phone and then wait on hold and press 1 and 2 when I’m in the car. Talk about that piece for a second.

That’s a great example. Online self-scheduling for healthcare is a little bit of the Wild West right now. It’s a fraught thing because they’re accustomed to being able to book a movie online to go to the theater and their seat is waiting for them. They certainly don’t have to talk to a ticket taker anymore but that’s also because they’re paying for that movie ticket out of their pocket. They don’t have movie insurance where the movie insurance company says, “Which theater they can go to? By the way, you have to talk to your primary movie critic before you can decide what kind of movie you’re going to watch. Are you eligible to watch Barbie or are you only eligible to watch Oppenheimer?”

It becomes an order of magnitude more complicated. Some systems or a lot of them are more sophisticated than we are on that front. My daughter texted from her middle school that she wasn’t feeling well. I wasn’t going to go yank her out of school in the middle of the day and take her to an emergency department.

Most likely, my wife or I are going to take her to an urgent care after school. What you can now do with ours is you can say, “It’s 2:04 now. By the time I have her in the car and can get to where the urgent care is, it’s going to be 4:30. I can go ahead and lock in a 4:30 slot at one of our urgent cares.” I can do that up to two business days in advance. That’s something where we know almost anybody who walks in the door is going to be eligible for that service. That’s a way that we’re trying to create that.

Now, let’s look at the back end of that encounter. We’ve piloted something in our urgent care centers and all so with some of our primary care doctors where when you are leaving your encounter, we’re going to hand you a card that thanks you for coming to see us. There’s a place for them to write if you have a follow-up appointment on there, but there’s also a QR code on it, “Scan here to let us know what thought about today’s experience.”

I’m not having that generated email to the CEO with that hospital or something in some proprietary database. I’m sending them to Google review because I know that a high volume of Google Reviews is going to help us and it’s a real incentive to the operations team in that facility. If they know that we are encouraging a public review, then we better be on point with everything that we’re doing.

In that example that you said, there are some physicians who might say, “Why are we getting reviews? I’m the expert. Why do we care what consumers think?” Are those real conversations and have you dealt with those?

We have not had that kind of pushback from positions, at least, not yet. I think they understand that consumerism is where the puck is going as Wayne Gretzky would say. That a great hockey player doesn’t go to where the puck is. They skate to where the puck is going. The physicians understand that. I think where you see a little bit more friction and rub is once you get past that urgent care or that primary care and you get to things that are a little bit more complex.

As I said, we have not entered the space of proactively pushing for reviews and that area yet but having talked to some of my colleagues who have and having this conversation with my students as well, you start to bump up against a real difference between healthcare and almost any other industry when it comes to marketing and when it comes to consumerism, which is when you go to a restaurant, you know whether that was a tasty meal or not.

On the healthcare side, people don’t always know what a quality healthcare experience looks like. They know if they were treated nicely. They know if they were listened to. They know whether their complaint was solved in that first appointment or not. However, if you’re deciding who to go to for heart surgery, is bedside manner most important? Is ease of getting an appointment most important or is having the lowest mortality rate most important?

What I think we’re still struggling with is how we bring all of those elements into the same conversation. How do we get on the same page about the fact that, “Do you want to know what?” The corporate bean counters in the back room like me better be making sure that we’re staffing that practice well enough that they can and do have time to be friendly. They are able to answer the phone. They are able to create those appointments.

Also, we have to make sure that that surgeon understands that almost no real-world patient who’s coming to see her is going to go on to the Medicare website beforehand to look at his PSI scores and his mortality rates and all that kind of stuff. They’re going to be relying on a whole bunch of other different influences. You can deliver what a physician would consider great care, and if it’s done in a way that is not consistent with what its consumer considers great care, you’re going to end up with unhappy consumers. In a world of consumerism where we are seeing Google Reviews or where we are seeing word of mouth help drive more of that, that entire package becomes relevant to where the business is going to go.

It has been a wonderful conversation around turnaround stories, leadership lessons, and trends that are happening in brand and marketing. However, I want to end with, “What is the current state of the brand? What’s next? What are you excited about?”

I think the thing that we’re excited about and terrified about in equal measure is right now, we still are not on a burning platform as healthcare marketers. It’s because the vast majority of the patients that we see in the areas that to be very frank make money for all hospitals are still at least somewhat influenced and driven by the same kinds of marketing tactics that were in use years ago. When you’re looking at the average age of people having heart surgery, people getting cancer treatment, or people having organ transplants, they’re still watching linear TV to some degree. Some of them are still reading newspapers. All of that kind of stuff is still very much at play.

When I look at the generation that’s coming in behind them, the question about how to reach and influence them, we’ve never had bigger question marks and fewer answers about that than we do now. We’re experimenting in that space. “This is the age of our patients in our maternity surface.” They do not watch linear television. When I ask my students, “How many of you have watched TV either over the air or on cable, but not on-demand, like at the time something airs. How many times have you done that in the last month?” It’s 0 to 1.

When I say, “How many of you have listened to an AM or FM radio station in the last 30 days?” It’s 0 to 1. “How many print publications do you subscribe to in print?” It’s zero. It’s not happening. I understand everybody’s very excited about things like advertising on Netflix, connected TV, influencers, Instagram, and all of that. That’s going to have to be a part of what we’re doing in the future, but for the big life-changing decision or for the person who you trust every single year to go for your annual physical or to go for your mammogram or to go for your colonoscopy, I don’t think people are going to make those decisions based on an Instagram ad.

Also, trying to understand where is that influence going to be pushed is the exciting and the terrifying thing about where we’re going. I would drive everyone to take a look at some new research that was done last year that’s in the annual trust survey that’s done by Edelman. In their last survey, they asked a fascinating question and they cut the results by age. They said, “Do you believe that a regular person doing their own research can be as informed on healthcare issues as a doctor?” When you look at people who are currently 55-plus, single digit, 5% agree with that statement.

When you look at the Millennial generation more or less, it was something like 30% something agreed with that. When you looked at younger than that, at the generation coming up behind them, it was getting close to 50%. When the physician is no longer the voice of authority or the voice that you trust, how does that impact the way that we’re marketing and the way that we’re telling our story? If people don’t think that they’re getting a straight and honest answer even from a doctor, then how do we embody our voice?

That’s fascinating and terrifying in equal measure. The final question is just to touch on one thing that’s the bridge between your personal and professional. You have alluded to a couple of times which is the teaching piece of it. A great example that you’ve shown is how you use your role as a professor in your marketing class as real-time subjects that inform the job that you do. Can you maybe talk a little more holistically about it? It’s because you see more and more now the same as your marketing leaders playing an adjunct professor role. Talk about why you love doing it and the benefits that it brings to you, maybe both personally and professionally.

Some of it is purely selfish. It’s a great place to tell the Jackson story. It’s a great place with the undergrads for us to identify future interns and entry-level staff. Also, to bring people out of that but I think a little bit less selfishly I guess is putting together a curriculum. Also, having to try and tell an educational story over the course of the semester forces you to ask yourself some difficult questions about the way that you do your work.

I can’t sit there and tell them, “Here’s how audience segmentation works,” and, “Here’s how brand identity works,” and then realize that in my day job, we’re not living up to any of that. We’re being a little bit loosey-goosey about things. We’re not being disciplined. We’re not following best practices. On one hand, I try and make sure my students are getting the benefit of understanding that sometimes the way the world works is very different than what’s in a textbook. However, the flip side ends up being true too, which is my staff and I sometimes need a reminder that some of the things in the textbook need to be applied in the real world if we want to be effective. It has helped us get more disciplined and more focused over the years.

That’s a wonderful story. Matthew, I feel like we keep going for hours but thank you so much for the conversation and for being on.

It was very much my pleasure. Thanks for having me.