Communication Management in Hospitals

Table of Contents

  List of Abbreviations  I

  List of Figures and Tables  II

1  Introduction  1

1.1  Problem Formulation and Objectives  1

1.2  Course of the Investigation  4

2  Principles of Communication Management  5

2.1  The Concept of Communication  5

2.2  Communication Management and Integrated Communications  7

2.3  Aims of Communication Management  8

2.4  Methods of Communication Management  8

3  Hospitals in the German Health Care Market  10

3.1  Structure of the Hospital Environment in Germany  10

3.2  Trends and Developments in the Hospital Environment  12

4  Communication Management and the Hospital Sector  14

4.1  Aspects and Limitations of Communication Management in German Hospitals  

  14  

4.2  The Communication Management Process in Hospitals  15

4.2.1  Problem Analysis and Target Definition  16

4.2.2  Target Groups  17

4.2.2.1  Criteria for Target Group Definition  17

4.2.2.2  Analysis of Hospital Target Groups  17

4.2.3  Strategy Formulation and Communication Instruments  20

4.2.4  Budgeting and Monitoring  21

4.3  Forms of Communication Management and Their Application in Hospitals  22

4.3.1  Corporate Identity  22

4.3.1.1  Relevance of Corporate Identity for Hospitals  22

4.3.1.2  The Corporate Identity Mix for Hospitals  23

4.3.1.3  Corporate Identity Strategy in Hospitals  25

4.3.2  Internal Communication Management  26

4.3.2.1  Employee Communication  26

4.3.2.2  Personnel Management and Development  28

4.3.3  External Communication Management  29

4.3.3.1  Aims of External Hospital Communication  29

4.3.3.2  Hospital Advertising  30

4.3.3.3  Direct Communication  31

4.3.3.4  Multimedia Communication  31

4.3.3.5  Communication with Referring Physicians  32

4.3.3.6  Communication with Health Insurance companies  33

4.3.3.7  Public Relations  34

5  Conclusion and Outlook  36

  Reference List  38

  List of Appendixes  49

  Appendix  50

Communication Management in Hospitals i  

List of Abbreviations

ATL … Above-the-line  

BTL … Below-the-line  

CBT … Computer-Based-Training  

CI … Corporate Identity  

Deutsche Krankenhausgesellschaft 1  

DKG …  

DRGs … Diagnosis Related Groups  

Deutsches Rotes Kreuz 2  

DRK …  

DTC … Direct-to-Consumer  

DTP … Direct-to-Patient  

Eingetragener Verein 3  

e.V. …  

EPR … Electronic Patient Record  

Gesellschaft mit beschränkter Haftung 4  

GmbH …  

Heilmittelwerbegesetz 5  

HWG …  

IT … Information Technology  

JCI … Joint Commission International  

Musterberufsordnung für die deutschen Ärztinnen und Ärzte 6  

MBO-Ä …  

OECD … Organisation for Economic Co-Operation and Development  

OTC … Over-the-Counter  

Pflegedienstleiter 7  

PDL …  

PR … Public Relations  

Societas Europaea 8  

SE …  

Sozialgesetzbuch 9  

SGB …  

SWOT … Strengths, Weaknesses, Opportunities, Threats  

Gesetz gegen unlauteren Wettbewerb 10  

UWG …  

1 Translation: German Hospital Federation  

2 Translation: German Red Cross  

3 Translation: German Registered Association  

4 Translation: German Limited Company  

5 Translation: German Law on Advertising in the Health Care Sector  

6 Translation: German Medical Association’s professional code of conduct  

7 Translation: Head of Nursing Services  

8 Translation: European Company Statute of a European Company  

9 Translation: German Social Welfare Code  

10 Translation: German Act Against Unfair Practices  

Communication Management in Hospitals ii

WHO … World Health Organization

WOM … Word of Mouth

Communication Management in Hospitals iii

List of Figures and Tables

Figure 1: The Technical Model of Communication……………….…………………6

Communication Management in Hospitals 1

1 Introduction

1.1 Problem Formulation and Objectives

In recent years, the German health care sector underwent considerable structural changes. Up until a few years ago hospitals were still being considered as benevolent facilities providing medical care. Nevertheless, these medical facilities increasingly recognise that their resources are limited and that they are subject to mechanisms of other markets, meaning that they need to ensure the own position in the health care market more than ever (Schreyögg, 2000, p. 185).

Increased competition between hospitals, scarce resources, and amendments of legislation are forcing every provider of medical services to consider a sustained and efficient structure of the provision of their services over and above a strong customer orientation. On the part of the patient, this implies higher transparency of the medical service offers. On the part of the hospital, however, it means that it has to publicly present and vindicate its medical procedures and bear comparison with its competitors. Prior to this transition, the status quo of a hospital was independent from changing patient numbers and remained relatively constant. With several reforms (e.g., the introduction of Diagnosis Related Groups – DRGs) coming from the government, which were supposed to retain an eminent level of public health care and at the same time putting a halt on the consistently rising health care costs, the hospital was now heavily reliant on the number of patients treated. Thus, hospitals were faced with the challenge of retaining or gaining more patients, while concurrently having an unchanged or lower budget, which meant that the role of the hospital changed from being a mere renderer of medical services to having the function of an economic actor.

Concretely, this implied for hospitals adopting a strategic concept that is aligned to the market and to the heterogeneous target groups of this market, such as patients, health insurance companies or referring physicians. Clinics have to question themselves whether they consider the patient to be a customer, who is offered the service according to his needs, whether the general practitioner with a private practice is seen as a com-petitor, as partner for cooperation (i.e. in a sense of integrated supply of medical services), or as a customer in terms of being a referrer, and whether they meet the needs of

Communication Management in Hospitals 2

health insurance companies. All these matters have to be taken account of when developing an extensive communication concept.

The increased autonomy, owing to perpetual health care reforms, also entails a relocation of services to the ambulatory sector and reduced residence times of patients in hospitals. Moreover, patients are nowadays not only driven in their demand by the quality of the medical treatment, but by a function of several different factors, which include among others the communication of a positive image through advertising and public relations. Next to the original medical service offers of the hospital, potential yields can be created in various other areas, which lead to a realignment of the external communications. The patients have also become more responsible and cost-conscious, due to their obligations of financial contribution (e.g., through participation in health services through practice charges ¹¹ or the abatement of over-the-counter [OTC] drugs from the range of pharmaceutical products offered).

Nevertheless, business-like reasoning of the economist on the one hand and traditional Aesculapius professional perception of the physician on the other hand seem to be incompatible with each other, especially when having to make cost-benefit considerations for a treatment or in terms of hospital advertising. Frequently, ethical concerns stand in the way. However, it is inevitable that with the transition from a state-controlled to an autonomous health-care sector in a free-market economy, these concerns are put aside in the long-term, the more so as rising privatisations require economic thinking in hospital management. Oftentimes, the exigency of communication management is not understood and there is resistance amid the employees. An elaborate internal communicative structure is essential in this respect and has a decisive influence on logistic flows, and information exchange and transfer, especially when reorganisations or restructuring take place in large companies. Besides that, a holistic corporate identity approach can help to represent a comprehensive conception, which integrates and homogenises the entire communicative activities, internally and externally.

Hospitals are thus confronted with the defiance with the challenge of asserting themselves in the competition and acquiring sufficient demand for the medical services of-

¹¹ Translation:Praxisgebühr

Communication Management in Hospitals 3

fered. Nonetheless, the more complex corporate processes have become, the more indispensable are the adequate transmission of information, the dialogue between management and employees, as well as collective target agreement. In every corporate process, communication management is a decisive factor and it should be embraced whenever implementing new strategies or informing the internal or external public (Ströh & Jaatinen, 2001, pp. 143-168).

The aim of this Bachelor thesis is to provide a critical and systematic analysis into the diversified and expanding discipline of communication management, and the methods and instruments used. After analysing the German hospital environment, the objective in this thesis is put on the external and internal communications. The focal point here is laid on the inter-coordinated, communicative processes and operations in a German clinic.

These theoretical foundations of communication then form the basis for the empirical work, pertaining to the actual implementation of these instruments in hospitals. The investigation into the individual application of communicative measures is drawn upon expert interviews, which were carried out with hospital representatives from the public relations, communication, and marketing departments. The interviews should serve the purpose of gaining an insight into the subjective assessment of measures actually exploited and further potentials feasible, on top of the various possibilities outlined in the theoretical part of this thesis. Altogether the objective is to provide an explorative study into the field of communication methods in hospitals, and eventually outlining further improvements in this field.

As the paper focuses primarily on the German hospital market and betimes technical terms specific to this sector are applied, a translation or supporting explanation will be provided in the foot notes.

Communication Management in Hospitals 4

1.2 Course of the Investigation

The analysis of the communication methods in hospitals postulates an initial examination of communication management fundamentals. Thus, chapter two focuses on the principles of communication management and the concept of communication. Subsequently, the main research object, the hospital, is examined, and its environment, as well as general trends and developments are outlined in chapter three.

Following that, the foundations described are brought together to analyse the methods of communication management in hospitals in chapter four. The first step is to contemplate the aspects and limitations of communication management for medical facilities, whereafter it is investigated in chapter 4.2, how a conceptual framework in form of a communication process can be established in a clinic. The first stage of the communication process, being the problem analysis and target definition, is looked into in chapter 4.2.1. Successively, potential communication addressees are discussed in the chapter Target Groups (4.2.2), whereby criteria for target group definitions, as well as the actual analysis of the target groups and their expectations, form the two main constituents of this sub-chapter. In chapter 4.2.3, the strategy formulation, based on the target definition and the target groups, is enquired into and possible communication instruments are delineated. In the remainder of chapter 4.2, budgeting and monitoring aspects of communication management are studied.

Chapter 4.3 breaks down the forms of communication management and their application in hospitals, beginning with the presentation of corporate identity. Furthermore, the internal and external communication methods are dissected in chapters 4.3.2 and 4.3.3 respectively.

The concluding chapter seven subsumes all relevant findings and presents an outlook of potential future developments of communication management in the hospital market.

Communication Management in Hospitals 5

2 Principles of Communication Management

“One cannot not communicate” – Paul Watzlawick

As the quote in the book by Watzlawick, Beavin, and Jackson (2000, p. 53) suggests, communication is essential and almost every behaviour is a form of communication. Communication is a seemingly trivial phenomenon, which is carried out naturally. For day-to-day communications this explanation might suffice, but in organisations, failures and misconceptions can be the corollary of flawed communication. On account of this, this chapter analyses the theoretical foundations for the principles of successful communication and communication management, by elucidating the phenomenon of communication and how it can be explicated through concepts and instruments.

2.1 The Concept of Communication

The term communication originates from the Latin word communicare, which means “doing something collaboratively, sharing, participating, or notifying” (Kunert & Knill, 2000, p. 26). Communication has various views and significances in the literature; an initial definition was produced by Kals (2006), who defined communication as “…the exchange of information as meaningful messages” ¹² (p. 26).

Several models have been developed to describe the phenomenon of communication by allegorising the functions and connections of this interrelation. A frequently used model is the Laswell formula: “Who says what in which channel to whom with what effect” (Laswell, 1948, pp. 37-51). Many theories (which will not be analysed in-depth due to the scope of this paper) build on this framework, which is also commonly denoted as sender, message, medium, and recipient model or SMMR model. One of the primary models of communication is the transmitter-receiver-model or technical model of communication by Shannon and Weaver (1963, pp. 98-102), depicted below (Figure 1, p. 6). The model shows a source of information as the initial point, which sends out a message. The message is encoded by the sender into a signal and conveyed to the receiver via a communication channel. The receiver thence decodes the received signal and forwards the message to the target of information (Shannon & Weaver, 1963, p. 98).

¹² „Kommunikation…ist der Austausch von Nachrichten als bedeutungshaltige Botschaften“ (Kals, 2006,

p. 26).

Communication Management in Hospitals 6

Figure 1: The Technical Model of Communication

Adapted from: Shannon, C., & Weaver, W. (1976, p. 44)

The model was, however, only intended for telephonic communications and ignores important facets of human interaction (Fischer, 2006, p. 38). Nevertheless, it provides a starting point for further considerations, such as the marketing-theoretical model of communication by Schineis (1996, p. 111). In this model (q.v., Figure 2, Appendix, p. 57), the first constituent is the sender or transmitter, which is to be understood as an individual or an organisation that has the capability of emitting information (Mattmüller, 2006, p. 251). This information is then encoded by the transmitter and eventually decoded by the receiver. Forms of codification can for instance be simple binary dispatches or complex language or scripture. It is important that the receiver is able to translate this code, otherwise it could lead to misconceptions. Communication is normally carried out on two levels. The content aspect constitutes for the factual information of a message (e.g., facts and figures) while in the relationship aspect of communication the transmitter gives an advice (on top of the pure factual information), how he wants the receiver to understand his message and how he sees his relation to the receiver (Watzlawick et al., 2000, pp. 53-56). Depending on the emotional relation between transmitter and receiver, the encoding or decoding of the message is either easy or difficult. Schineis (1996) also adopts the element of feedback between the receiver and the transmitter, through which the receiver indicates whether he has obtained the message or not. The preceding analysis showed communication to be a transferable message, which is composed by someone and sent to someone else. Communication is thus a process initiated by the sender to achieve certain objectives concerning the receiver (Heise, 2001, p. 14).