Bill Klaproth (host): This is a special podcast produced onsite at SHSMD Connections 2023 Annual Conference in Chicago as we talk with keynote speakers and session leaders direct from the show floor. I'm your host, Bill Klaproth. With me is Sonal Ellison, Executive in Residence at Endeavor Management. We also have Amy Comeau, Vice President of Marketing at Emory Healthcare and Julia Yoder, Marketing and PR Director at Brookings Health System. And we're going to talk about their SHSMD session, Rolling With The Punches: Managing Tough MarCom Budget Decisions During Challenging Times. Uh-oh. Man, this is a hot topic, for sure. Amy, Julia and Sonal, welcome.

Amy Comeau: Thanks so much, Bill. Happy to be here.

Sonal Ellison: Yes. Thank you so much for having us.

Julia Yoder: Thanks so much, Bill. Enjoying this time here in Chicago.

Host: Absolutely. It's a great city. I'm telling you, a lot of fun here and great education at SHSMD Connections as always. So Amy, this is a very hot topic in the land of shortening budgets and staffs. These are tough decisions that have to be made. So, marketing and communications leaders are being hit with all kinds of budgetary decisions. So, how do you use data to keep your budget afloat? How do you wade through these challenging times?

Amy Comeau: It's a great question, and one that I'm actually dealing with exactly right now as we're working through our FY '24 budget forecasting. So, one of the tools that I've done and been most effective in the past, I would say in the past year, is doing some benchmarking. So, I did benchmarking last year in 2022. And then, I was able to redo benchmarking again in 2023. So last year, I did it more casually. I just reached out to about 10 or 12 of my colleagues across the country and asked them, you know, "Would you be willing to tell me what your budget size is, how many hospitals you have, what your NPSR is? How many staff do you have?" So, I ask them a lot of different questions and I made sure to include on there the companies that I knew our executive team benchmarked, so that I could see where we fell, where Emory Healthcare fell in the range of all those.

And that was very informative last year. It didn't lead to as many changes as I had hoped. But this year I was able to repeat that as part of Vizient Network Group that I'm a part of, which is the chief marketing officer's network. And we had actually done a formal org chart exchange and same thing, asked a lot of questions. And so, I was able to take those 13 companies do the same thing and share both of those with a new leader that I'm reporting to and was able to show where Emory actually falls at the bottom of all of those, despite the size of our organization. And so, that had a big impact with both him and then also our new executive leadership team. And so, fingers crossed, but I'm hopeful by the time I get back from this, I might get some additional resources, both in money and labor.

Host: So by using that data, showing where you're at as compared to other hospitals and healthcare systems, that really helped put it in perspective for your leadership?

Amy Comeau: Absolutely. And the other piece I was able to use was a data point from Deloitte Healthcare Consulting that basically says, on average, healthcare service organization, so like healthcare systems, delivery systems, spend 0.3% to 0.5% of their NPSR on marketing, and we weren't even at that 0.3 threshold. So, I was able to show not only that, but then also show the differences between the other systems and some smaller systems that were actually much higher than that. And then, systems like Cleveland Clinic and Mayo, where you would expect them to be--

Host: Big budget.

Amy Comeau: Big budget, but they actually fall somewhere within that range. They just have a larger overall budget to start from.

Host: Okay. Yeah. Well, thank you for sharing that tip.

Julia Yoder: Piggyback off of what she said, I know that SHSMD has been doing a number of benchmark studies around MarCom budgets as well, as well as FTEs in various size organizations. They published a report called SHSMD by the numbers. That can also be referenced as a tool. And I know many of my colleagues around the United States have referenced how valuable that was, with learning from their peer group how much of a budget is devoted to these departments and where it's being reallocated now, which pretty much segues into further discussion on this podcast today.

Host: Yeah, absolutely. So Sonal, how do you then juggle approaches to education, resourcing, balancing and, of course, reducing? How do you do that?

Sonal Ellison: Reducing is huge. Whether we're talking workforce or we're talking dollars, whether we're talking resources in the world post pandemic today. And what we're finding is a reallocation and a partnering between many departments and divisions within our hospital systems and healthcare networks. We're finding ways to get marketing and communications to the table with us when it's dealing with what is many times the number one issue, which is workforce retention. Utilizing their talents and doing a universal organizational communication strategy, working with them, not only to market the services and providers that we have in our organization, but our organization as a whole, ensuring that people out there in the community understand who we are, what our organizations offer and want to be a part of the mission, whether it's for their own care or whether it's for their own employment or betterment of the community.

Host: Absolutely. So then, I'm just thinking about this, Julia, what tactics do you use to protect and defend your budget and your position? And are there tools that we can use to help us state our case?

Julia Yoder: Yeah. So, one thing that we use again is data for that. And so, we actually use SHSMD's By The Numbers reports, that's all referenced. And so, that is something that we benchmark not just against organizations of our same size, because we're a small healthcare provider. We're a 49-bed hospital with a 79-bed nursing home, very small compared to some places like Emory. But we also want to take a look at those larger organizations too, and see how we're doing. So, our digital budget is something that I'm always like concerned about. And so, taking a look at those and just how do we compare to some of the other top dogs that are in our marketplace, if you will, and just, you know, "Okay. So, are we on track? Are we spending the same percentage amount as them to remain competitive?"

And so, that's kind of some of what I use for the justifications of, "Okay. This is where we have to spend in this area? And this is the reason why, is because we want to keep our market share that we have here in our area for us and not get it through outmigration or lose it to outmigration to someone else."

Host: So, you look at those percentages and then do you also factor in efficiencies too? Like, "Look how efficient this is or how efficient we're using our budget."

Julia Yoder: Yeah. So, I think one thing I've learned is that I do not actually ever go into my budget planning process with a cut in mind. Instead what I do instead of cutting that money, I might reallocate it somewhere else, someplace else that I know I need to spend. And so, I might present it as, "We're no longer going to be doing this. But instead, we're going to reallocate those dollars there." Because let's face it in this economy, nobody is getting huge budget increases or anything like that. And realistically with inflation, how it is, I mean, you get a budget decrease, even if you're going in flat staying the same. And so, it's like, "Okay. Where can I actually reallocate and put those dollars?"

Host: So, you want to hold on to what you have. They're not giving it up, right? Is that a consensus here, Amy and Sonal?

Amy Comeau: Yeah, absolutely. I'd just like to build on what Julia said, because that is so true. I mean, a flat budget is actually a reduction, especially in the inflation that we've been seeing. And we experienced that last year at Emory. And I had to say, "Look, my budget's flat. We need to redo the website. We needed to move it onto a more stable platform where we saw in the numbers that our website was outdated and needed to be moved. So, that meant we had less dollars to do traditional advertising with. And so, I had to come to the table and basically say, "All right, we used to market three service lines. We can only do two this year, because we can't not redo the website. Because if the website crashes, then all online business functions from the organization stops."

Host: Right.

Sonal Ellison: As the chief financial officer, this is what I want to hear from the teams. I'd like to hear that they're reallocating and reprioritizing what's strategically beneficial to the health system or the hospital, because we are going to cut off from the top. But we need to know that they're a step further and they're really looking to see what is core to our business, which would be in her case, revolutionizing their website and maybe not showcasing two more service lines, because it's going to have a better mission about the entire system as a whole.

Amy Comeau: I think another key though, that really the CEO, the C-suite, needs to understand is that when you're making these choices, there's going to be trade offs for that. So like in Amy's case, by not marketing another service line, well guess what? Maybe that third service line isn't going to see the uptick in volume that the C-suite wants. And so when we're talking about budgets, they need to understand that because it's unfair when they come back to you later and say, "Well, why isn't this service line performing well?" And it's like, "Well, we had to make different allocations within our budget dollars." And so, we determined, we had this discussion that it just wasn't there. It wasn't available. And so, this is the choice that we made, and this is what we're left with.

Julia Yoder: This is the benefit of working with leaders that have been through the times with budgets and to understand the ebbs and flows, and there are ready equipped to make these issues known from the beginning. So understanding that there may be a shortfall in this service line because we didn't mark it or communicate the services appropriately is big. So business development, there is huge too.

Host: Yeah. So, it's good to have leaders that don't have a cut-first mentality is what you're saying.

Julia Yoder: Yes.

Host: So, some really good thoughts there. I love how you said, Julia, when you're making changes, there will be trade offs. That makes a lot of sense. And Amy, when you said a flat budget is a reduction. So again, that really makes sense. So, thank you for sharing that. All right. So question for the group. When is it time to throw in the towel? When do you go, "Okay. Fine. You win. There's going to be a reduction. Fine." When is a time to throw in the towel? Amy, let me start with you.

Amy Comeau: So, I think all of us could answer this question. You have to read the room, right? And you can tell if you've tried a few times and given it your best college try to make the business case and you're just not getting through, you just say, "Okay. I'm not going to win this one. So, I'm going to make the best out of what I've got and then work hard trying to explain that to your team." Because they may be frustrated, they don't understand exactly where we need to grow. And I said, "Listen, it's not going to happen this year. So, here's how we're going to manage that."

Host: Yeah. Julia, how do you handle that?

Julia Yoder: I would agree with that too, that sometimes you get to admit, "Okay. We're going to lose the battle this time, but are we going to lose the war?" And sometimes it's a matter of others need to feel the pain. Like if you're predicting, okay, if we don't do this, this is the pain that we're going to feel like they need to feel bad until they're ready to come back and say, "Okay. You're right now" or there's like different things like, "Oh, so there's this new, regulation that's been passed. So yeah, now we have to do it," and it's like, "See, I told you this, but now your hand is being forced. And so, now you choose to invest."

Host: Right?

Amy Comeau: Yeah. I think the other thing too is having those executive leaders be ready to back you up, right? So, we may say, "Fine. We're not going to market heart and vascular." Well, then that CEO or that executive leader has to be prepared when those physicians are upset and come to them and say, "How can you cut us? And this happened to me, it wasn't with heart and vascular, it was a different service line. I just said, "Well, we need to be marketed." I said, "Well, I talked with this set of executives and they cut you off the list for this year, so you're not a priority." And that took the pressure off of me as being the decision maker. And so, they went back to those leaders and understood. Now, they had to figure out how to make a better business case for themselves the following year.

Host: Absolutely. That makes a lot of sense. Sonal, when it comes time to throwing the towel, what's your thoughts?

Sonal Ellison: Well, I encourage exactly like these two ladies are saying, is you've got to bring everybody to the table early on. If the executive board has a vision for the year or for the next two to three years, and they're wanting to grow in this area, we need to ensure that the budgets align with that mission. And with the constant turnover we've seen in C-suites and in board physicians and in VP and director level, these messages are getting lost into the air. And to make sure that everybody feels comfortable with voicing their department and their initiatives, as it aligns with organizational strategy is key. I mean, I lead from a leader at this area, please bring this to the attention because you understand, because we've communicated well, hopefully, that this is the strategic vision of our health system this year, or these three years or five years. And how is your part of it going to contribute to the success?

Host: Yeah. It's all tied in together. If we lose this, right, this is going to affect this part of our strategic plan.

Sonal Ellison: That's to further support these leaders in their departments and their divisions to understand, we hear you loud and clear. You've had to prioritize between the three that you wanted to do. And this is what it's going to do. And the executive suite has to be aligned with their departments and divisions to make sure it's the similar story going forward.

Host: So if there's one thing I've learned in this discussion, make them feel pain. Make them feel pain. Well, they have to understand, like you said, if we don't do this, here's the pain you're going to feel. There's the trade-off. You said that too. "Well, if I can't market heart and vascular, here's what's going to happen." So, understand that so that makes a lot of sense. Well, this has been a great discussion. Thank you so much. I've loved talking to the three of you, Sonal, Amy and Julia. Let's wrap up with final thoughts. Amy, let's start with you. Anything else you want to add?

Amy Comeau: When you're trying to make some of these decisions and especially relative to the flat budget is a reduction, also leverage your agency partners and take a look at what's happening in your market. So, one of the things that I did in the Atlanta market was asked our agency to take a look at what the cost per unit GRP is of broadcast TV and broadcast radio since pre-pandemic to now. And they found out over three years the per unit cost of GRP and TV had doubled in three years. And that Atlanta and Georgia is one of them hottest markets right now, politically. I'm not looking forward to 2024. And so, that raised rates. And so, what I was able to say, like, "Listen, if we spent a $100,000 last year to do a TV campaign for heart and vascular or cancer, to do the exact same thing now is going to cost me $200,000." And that really resonated. Again, didn't necessarily mean that we were going to change our budgets. But it helps again how you use different data points to tell your story.

Host: Yeah. That is a great point. So, thank you so much for sharing that. Julia, final thoughts from you.

Julia Yoder: Yeah. So, what I really think of is that when you're trying to like do marketing and advertising in these tough financial times, is that you got to look back at history and the education, the things that we all learned back in marketing and advertising 101 in college. And so, like the 1930s, the great depression, that was a time where we can look at case studies and examples of different companies, different brands that they didn't let up on the gas when it came to marketing and advertising. They doubled down. And that's how they survived the great depression. And a lot of those brands are still here today. And so, that's some like data and information and just reasoning that you really can take to your C-suite and be like, "Here's something to think about. We want to come out of this stronger than what we are now." And so, we really should consider this. Maybe we can stay flat, but do we really need to have a cut in actual dollars in addition to that.

Host: So when things get tight, the first thing that always seems to go is the marketing budget, but you can't survive if you're invisible.

Julia Yoder: Exactly.

Host: So, that is really a great point for any business.

Julia Yoder: Yeah. And so, you know, you got to fight for it at this time.

Host: And if your competitors are then shrinking and cutting the budget, but you're still there, that only helps you hope because their impressions are exactly right. This has been great. Thank you for that. Sonal, final thoughts from you.

Sonal Ellison: Absolutely. This is why we advocate exactly what these two ladies are saying for having a seat at the table and making sure that the executive team and the C-suite understand the value of having marketing and communications and strategic planning at the table when they're making these decisions. If we don't have them partnering with our other departments for clinical care, for business development, for even procurement reasons, then we are already a step behind. So having them at the table, that's also more information you can get from these benchmarking studies, is who else is involved in the process. So, very valuable information out there and very thankful for SHSMD for leading us in this effort.

Host: Absolutely. And you said as well, check out the SHSMD By The Numbers as well, which has been very important. Well, this has been great. Sonal, Julia and Amy, thank you so much for your time. This has been a pleasure talking with each of you. And once again, that is Sonal Ellison, Amy Comeau and Julia Yoder. And sign up for the SHSMD Connections Virtual Conference, October 20th, 2023 plus on-demand through the end of the year. The virtual conference will feature access to 50 plus sessions recorded right here from the September in-person conference plus all new live sessions. All you have to do is go to shsmd.org/annual to learn more and to get registered. And please join us at SHSMD Connections 2024. And breaking news, it's next October in Denver. So, make sure you join us there. And if you found this podcast helpful, please share it on your social channels. And to find access to over 100 podcasts chock-full of great marketing information, go to shsmd.org/podcasts. And as always, thanks for listening.