The heart of the matter

Editor's note: Jennifer Hirt-Marchand is vice president and director of research for Marcus Thomas LLC, a Cleveland advertising and public relations agency.

In late 2001, St. Elizabeth Health Center, a division of Humility of Mary Health Partners in Youngstown, Ohio, began planning an advertising campaign with Cleveland-based Marcus Thomas LLC for The Heart and Vascular Center at the hospital. While St. Elizabeth's rates highest among all competing facilities in terms of perceived quality of care for heart problems, the hospital faced competition from nationally renowned facilities in larger metropolitan areas nearby. The objective of the advertising campaign was to increase consumer preference for St. Elizabeth's and decrease out-migration for cardiac treatment.

Moving beyond left-brain logic

What messages would strike a chord with the consumer audience? What are the underlying emotional reasons people choose one cardiovascular care facility over another? To answer those questions, Marcus Thomas employed nontraditional motivational research techniques to detour around respondents' "left-brain logic" and uncover their underlying or unconscious motives. Our research team knew that traditional survey techniques would not yield the information needed.

Most often, when people try to put their feelings or impressions into words, they tend to relay logical and rational statements that protect their dignity, self-perception and beliefs about what others expect of them. But most decisions are made emotionally, not rationally. By trying to get to the root of a person's influences and factors, motivational research makes it possible to unravel the mystery behind consumer behavior as it relates to specific products or services. It tries to grasp and discover what consumers do not fully understand and/or realize about themselves. It attempts to identify forces and influences that consumers may not even be aware of, such as cultural factors and sociological forces. But most important, the insight gained from motivational research techniques gives a company a better understanding of its target audience and what needs to be communicated in order to influence that audience.

Non-traditional methodologies

To determine why consumers choose one cardiovascular care center over another and confirm prior research and anecdotal impressions, Marcus Thomas conducted more than two dozen in-depth, one-on-one interviews with target audiences.

Research participants were defined by one of two criteria - their likelihood to require cardiovascular care and their role in influencing patients on where to receive that care. The sampled audience included a mix of residents from St. Elizabeth's tri-county target area who were between 40 and 62 years of age. Half of the participants had previous experience in choosing a cardiovascular care program for themselves or for family members, and half did not. Participants also had used a mix of hospitals in the past for cardiac care.

The in-depth interviews were conducted during a seven-day period and lasted approximately 45 minutes each. Participants were asked to take part in a number of projective techniques. First, they provided top-of-mind associations with heart/cardiac care programs, including names of specific hospitals or care programs. Then, participants were asked which hospital or program would be their first choice for heart/cardiac care.

Next, participants were asked to direct their attention to an easel displaying incomplete sentences. They completed the sentences by verbally filling the blanks. This task forced participants to reveal their beliefs, value sets and/or past experiences that influence their selection of a cardiovascular care program.

They were then shown a series of 23 pictures or illustrations and asked to choose those that best characterized their ideal cardiac or heart care program. They were then queried about why they chose each one and asked to explain how it characterizes the ideal program for meeting their or a loved one's cardiac/heart care needs. If explanations were not clear to the interviewer, participants were asked to provide an example illustrating their association between the picture and what they want from a cardiac/heart care program. Selected pictures were then used to aid participants' recall of hospitals/programs they associated with each ideal characteristic.

Last, from the remaining pictures/illustrations that weren't chosen, participants identified images that were farthest from their ideal. In other words, pictures were identified that characterized a program/hospital they definitely would not want to go to for cardiac care. Again, participants explained their choices - providing examples of what they didn't want and/or naming hospitals/programs they readily associated with undesirable program characteristics.

During the in-depth interviews, our research team strived to create an empathic relationship with each respondent, as well as a feeling of rapport, mutual trust, and understanding. A climate was created in which we attempted to make participants feel free to express their feelings and thoughts, without fear of embarrassment or rejection. We constantly observed participants for non-verbal cues, and used follow-up questions to probe deeper into their beliefs and value sets. Insights obtained from these techniques provided key rational and emotional motivations, perceptions and potential barriers that affect the selection of a cardiovascular care program.

Audience insight

Competence and comfort (both physically and mentally) were identified as the two most important criteria for a cardiovascular center. Participants' top-of-mind associations with cardiac/heart programs were based more on personal experiences - focusing less on specific program names, services, equipment, or benefits. Further, there was consensus among participants regarding the fear that goes along with heart or other cardiovascular problems.

Pictures chosen by participants to convey competence included a brain, test tubes, gears, an oil can, a Swiss army knife, and folded hands. Characteristics participants associated with the pictures reflected their values as well as their beliefs about what makes a facility well qualified or competent. The ideal program would be up-to-date in terms of technology, procedures, and equipment or tools.

Though not the most determinant factor in the selection of a cardiac/heart care program, comfort - on both a physical and a spiritual level - is a mandatory element of the ideal cardiac/heart care program. Pictures that most often conveyed physical comfort were a warmly decorated living room and a comfortable armchair. Some participants described these pictures as bright, colorful, cheery, comfortable, warm, and homey.

On a spiritual level, pictures of hands and candles symbolized the comfort patients would like to experience in the ideal cardiac/heart program. The staff would have "caring hands," and all elements of the program (the people, the surroundings, the care) would work together to create a tranquil or peaceful environment for the patients. A chapel also characterized the ideal cardiac program for those who are spiritual in a religious sense.

The creative process

Research findings were incorporated into planning and creative brainstorming activities to assist in the development of an advertising campaign that created the emotional landscape supporting St. Elizabeth's desired positioning.

The objective was to develop an advertising campaign (television and print) to increase consumer preference for St. Elizabeth's as a place to have more advanced cardiovascular procedures like open-heart surgery. The research findings set the stage for all cardiovascular communications moving forward, and the television ad was the first in a series to introduce the Humility of Mary Health Partners' overall brand position.

Based on the motivational research findings, the advertising needed to convey an image of competence and comfort. According to Joanne Kim, a partner and creative director at Marcus Thomas, a high-tech component was necessary for the television spot to demonstrate the clinical expertise of The Heart and Vascular Center to the target audience.

The television spot visually communicates the high-end cardiovascular technology (competence) contrasted with an emotional Tony Bennett song, "So Beats My Heart For You" (comfort). The commercial takes place in a clinical setting where a medical team is conducting open-heart surgery. The lighthearted song draws the viewer's attention because of its extreme contrast to the serious, fast-paced visual.

Campaign evaluation metrics

Elements of the advertising campaign are being introduced in phases. The television spot was launched first, and a print ad is in development. Both ads will be running through June 2002 in St. Elizabeth's target market.

Consumer perception and preference will be measured by an outside research firm in 2002 and beyond, and Marcus Thomas will review targeted changes in out-migration and market share.