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Bachelor Thesis, 2009
60 Pages, Grade: 1,9
List of Abbreviations
List of Figures and Tables
1.1 Problem Formulation and Objectives
1.2 Course of the Investigation
2 Principles of Communication Management
2.1 The Concept of Communication
2.2 Communication Management and Integrated Communications
2.3 Aims of Communication Management
2.4 Methods of Communication Management
3 Hospitals in the German Health Care Market
3.1 Structure of the Hospital Environment in Germany
3.2 Trends and Developments in the Hospital Environment
4 Communication Management and the Hospital Sector
4.1 Aspects and Limitations of Communication Management in German Hospitals
4.2 The Communication Management Process in Hospitals
4.2.1 Problem Analysis and Target Definition
4.2.2 Target Groups
220.127.116.11 Criteria for Target Group Definition
18.104.22.168 Analysis of Hospital Target Groups
4.2.3 Strategy Formulation and Communication Instruments
4.2.4 Budgeting and Monitoring
4.3 Forms of Communication Management and Their Application in Hospitals
4.3.1 Corporate Identity
22.214.171.124 Relevance of Corporate Identity for Hospitals
126.96.36.199 The Corporate Identity Mix for Hospitals
188.8.131.52 Corporate Identity Strategy in Hospitals
4.3.2 Internal Communication Management
184.108.40.206 Employee Communication
220.127.116.11 Personnel Management and Development
4.3.3 External Communication Management
18.104.22.168 Aims of External Hospital Communication
22.214.171.124 Hospital Advertising
126.96.36.199 Direct Communication
188.8.131.52 Multimedia Communication
184.108.40.206 Communication with Referring Physicians
220.127.116.11 Communication with Health Insurance companies
18.104.22.168 Public Relations
5.Conclusion and Outlook
List of Appendixes
List of Abbreviations
illustration not visible in this excerpt
List of Figures and Tables
Figure 1: The Technical Model of Communication
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 competitor, 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 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 charges11 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- 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.
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.
“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.
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).
Figure 1:The Technical Model of Communication
illustration not visible in this excerpt
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 (Matt-müller, 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).
Communication management comprises the entire integrated organisation, development and direction communication instruments of an organisation and is an essential aspect for every company (Will & Geissler, 2000, p. 21). Based on the fact that decisions are not predicated upon mere facts, but on the grounds of impressions made (Kirchner, 2001, p. 33), it implies for the communication management of a company to convey a positive impression to the various parts of the public. Changes on the market, in technology, as well as in society are leading to a reorientation of communication management. The seller’s market has become a buyer’s market, with customers significantly influencing the communication process. Therefore, unilateral communication is no longer effective, as customers have open access to information (especially through new media like the Internet). Modern perceptions, such as the integrated communication have evolved.
The integrated communication pursues the concept of synchronising the diverse communication instruments, so as to convey a perspicuous, unambiguous, and authentic image, which is easily recognisable (Kirchner, 2001, p. 35). It is a process of coordinated management of all sources of communication in order to establish and maintain beneficial relations between the organisation and its reference groups (Kirchner, 2001, p. 36). Moreover, the coordinated interaction of the single communication instruments results in higher efficiency and hence a possibility of reducing communication expenses (Bruhn, 1995, p. 13). Integrated communication can be understood as a holistic concept, which comprehends the management of the heterogeneous communication processes of an organisation with its external and internal surroundings and aims at systematically forming a predefined, uniform appearance that is given to the target groups (Schultz, Tannenbaum, & Lauterborn, 1993, p. 16).
Zerfaß (1996, pp. 290-298) established a model, where strategy formulation and planning, as well as concerted communication processes play a major role on three central layers of integrated communication. First, the communication is sectioned into organisational communication or internal communication (outlined in chapter 4.3.2), which occurs directly among the members of an organisation and comprises the entire process of value performance. The second layer of communication is market communication, which includes the coordination process with suppliers, consumers, and competitors. In the third layer, public relations, the integration of the company into the socio-political environment is managed and sustained. These two layers of external communication (analysed in chapter 4.3.3) form the foundation for the exterior communication of a company. Different addressees of external communication can be suppliers, public departments and authorities, as well as other companies.
The division of corporate communication into several layers reveals the different tasks to be fulfilled by communication. Similar instruments are used for different aims. Integrated communication subsequently increases efficiency and effectiveness for harmonising the instruments to the different aims (i.e., in terms of reaching corporate goals).
Communication is a process of generating meaning, which implies for communication management that there is no single corporate reality, but as many spheres as there are recipients, which have developed a perception of the organisation (Fischer, 2006, p. 24). Derieth (1995, p. 94) describes the aims of communication management as the creation of congeneric, positive corporate realities with a multitude of persons, social groups, and segments of the public that marks the intentionality of communication management. On top of that, concrete communicative aims can include the improvement of the awareness level, an amelioration of the corporate image, the motivation of customers to make a purchase decision, as well as the internal communication flows. The means to achieve these objectives are outlined in the consecutive chapter.
The methods of communication management are manifold and due to the limited scope of this paper only the most commonly applied instruments of internal (employee communication, personnel management and development) and external communication (advertising, public relations) in hospitals will be theoretically analysed. Other means of communication, such as sponsoring or product placement will not be specifically inquired into in this context. Moreover, corporate identity plays an important link between external and internal communication. This chapter lays the theoretical foundations of the various concepts for the later application to the health care sector.
The concept of corporate identity (CI) as a theory is defined differently in literature. On the one hand, it is seen as a system of orientation for marketing (Wißmeier, 1995, p. 397), on the other hand it is seen as an autonomous and comprehensive corporate concept (Kroehl, 2000, p. 80). Altogether, CI can be defined as a strategically planned and operatively used self-manifestation and behaviour on the basis of a predetermined corporate philosophy, a long-term goal setting process and a predefined target image with the joint aim of all entities of externally and internally representing the company (Birkigt, Stadler, & Funck, 1992, p. 18). Corporate culture reflects the values and norms of the company as well as perceptions of targets and behavioural patterns.
CI acts as a connector between external and internal communication management and incorporates the areas of public relations, marketing, and human resource management (Schwab & Zowislo, 2002, p. 34). Additionally, a well-developed corporate identity, which is understood as a strategic concept throughout the company, forms a frame of reference for the planning and realisation of the communication policy (Raffée & Wiedmann, 1993, p. 45). Often corporate identity is understood as the sum of all the characteristic traits of a company, which differentiate it from all other companies of identical size in the same industrial sector (Fuchs & Unger, 2007, p. 10). Birkigt et al. (1992, p. 19) consider the corporate personality as being the core of corporate identity. It is the manifested self-concept of a company and is perceived as a coherent interrelation between words and actions of a company with its character. Corporate identity is also often linked to corporate philosophy (e.g., fundamental beliefs, paradigms, visions, values, and norms) and corporate culture. The latter represents thereby a concretion of corporate philosophy.
The internal communication, sometimes denoted as employee communication, is an instrument (contrary to the external communication), which ensures dialogues between management and employees, and the transfers information by dint of clearly delimitated, regular or episodic measures. Through the internal communication, tasks are coordinated and the cooperation amidst employees and departments is enhanced.
In respect thereof, another criterion, namely Human Resource Management or personnel development, can be identified, as the employee is integrated into the system of the corporation. Successful integration and training leads to an identification of the employeewith the company, which is a quintessential presupposition of strong achievement motivation, initiative, and commitment.
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
11 Translation: Praxisgebühr
12 „Kommunikation...ist der Austausch von Nachrichten als bedeutungshaltige Botschaften“ (Kals, 2006, p. 26).
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