infertility marketing

Four Reasons the Tech Revolution Has Disrupted Fertility, and Why Practice Owners are Frustrated

By Griffin Jones

CHANGING TECHNOLOGY

Part 4 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

For some IVF centers, the change has already done them in. For others, it is the level playing field needed to thrive against massively funded competitors. No phenomenon presents a greater threat, nor a greater opportunity to today’s fertility centers than the technological revolution through which our society is living.

So far, we've deeply explored the four major implications of the following axiom: today's fertility practice is no longer a small, independent healthcare clinic, but an entrepreneurial venture. We talked about business structure, strategy and vision, and accelerated competition. These three tenets pale in comparison to our society’s rapidly changing technological and social behavior.

Eric Schmidt humanity doesnt understand internet quote.jpg

While all four of these elements have caused the tectonic shift from small healthcare office to entrepreneurial venture, none are more significant than this one, the drastic change of technology and society.

In this article, we mostly refer to consumer technology. Leave alone advances in medicine and laboratory technology, though their convergence may ultimately be indistinguishable. Rather than individually analyze various silos of the tech sector— such as social media, e-commerce, augmented reality, and artificial intelligence—we will examine how our relationships with our patients are changing, and more rapidly than we may realize, as a result of the speed of the changes happening in tech and society. These are just four implications of how advances in technology have changed our society, our patients, and consequently, our practices.

  1. Information exchange has accelerated at an uneven pace, which has led to

  2. Problems meeting needs and expectations which has contributed to the need to form

  3. Connected communities of patients who have both equalized and imbalanced

  4. Competitive advantages and disadvantages between large and small fertility practice groups.

And it’s only the beginning.

1). INformation EXCHAnge: Patients need more than providers can give

Travel back with me to the mid 1990’s. While today’s REI Fellows ran home from grade school to watch the latest episode of Saved By the Bell, the second generation of fertility sub-specialists left the universities to open their own fertility practices or start REI divisions at the hospitals. We’re referring to those who came after the pioneer generation of Howard Jones and Patrick Steptoe. Really, this class of baby-boomer REIs is the first generation of the fertility care provider whom we know today.

Now let’s imagine a couple from the same time period. They’ve been unable to conceive after two years of trying. How would they have found information on their

  • Diagnosis
    They could go to the bookstore. There was likely a book or two that offered good introductory information on infertility and/or how to get pregnant. But how is one supposed to keep a best selling thriller like The Fastest Way to Get Pregnant Naturally by Christopher D. Williams, MD on the shelves for long? Maybe there was a seminar in their area. But how would they have found out about it?

  • Support How would someone struggling with infertility have found professional or peer support? Could they just ask around town? RESOLVE was around, but it's not as though one could look them up in the yellow pages.

  • Treatment How did patients find their fertility provider? Would we have to hope that their OB/GYN or primary provider knew enough about emerging fertility care to direct them to the new sub-specialists in their area?

Think about the most powerful man in the world at that time, U.S. President, Bill Clinton. One of the most powerful supercomputers to which he had access was the Intel Paragon XP/140. Today, every one of your patients walks around with a supercomputer more powerful than that in their pocket. Because of that, our patients have access to more information than each of the world leaders from that time period as well. Information asymmetry is over, and it didn’t take long for these supercomputers to conquer our social habits.

The adoption of smart phones more than doubled from mid 2011 to late 2017 from 35% to 77%. 92% of adults ages 18-49 own a smartphone. You went to work one day and most of your patients did not have all of the world’s information at their fingertips. You came back to the same office six years later, and they did. The exchange of information has changed, but patients have outpaced their practices in their means to deliver and receive information, and that poses a problem in meeting patient expectations.

2). unable to meet patient expectation: not speaking the same language

“Not to use social media platforms is to be culturally incompetent. As a physician, we are supposed to give medical advice in a language the patient understands. Not doing so is considered to be medically inappropriate and can lead to adverse outcomes. If large segments of the population get the majority of their information digitally, isn’t it incumbent upon healthcare providers to provide information in an accessible, understandable way?”-Dr. Serena H. Chen, MD, REI

On a webinar that I conducted in August 2018, the most common challenge reported by fertility practice owners and managers was increasingly high patient expectations. Because patients have adopted the new methods of information exchange much more quickly, communication needs are frequently not met. This imbalance can negatively impact a fertility center’s relationship with its patients.

Patients are reaching out to practices through Facebook Messenger and Instagram at a quickly increasing rate. Patients spend most of their communication time on these channels, yet some practices don’t even have a contact form on their website. For younger patients, this is the equivalent of not having a telephone. On an average day, almost 40% of millenials interact with their smartphone more than anything or anyone else, including their significant other, according to 2016 research from Bank of America.

Practices are reporting challenges with meeting patient expectations, partly because technology has raised expectations of response time to a standard that staff cannot meet. Even if the expectations are unfair or unrealistic, fertility clinics are unable to reset those expectations if they are unable to effectively exchange information in balance.

  • Phone Calls
    Today's patients reluctantly call you to schedule an appointment. Tomorrow's patients simply won’t. Every year, the idea of making a phone call to schedule a new patient appointment is all the more foreign. When they are consumers, patients are accustomed to instant transactions, as with transportation, hotels, entertainment, and food. A survey from the United Kingdom found that more than 25% of smartphone owners never use their phone to make a call, up from only 4% 3 years prior.

  • Text Messaging
    Pew also states that Americans made over 12 phone calls a day in 2011. In 2015, however, a report by Informate shows that Americans make or answer only 6 phone calls a day, while sending and receiving 32 texts and spending 14 minutes on Chat. By the time institutes like Pew can even report their conclusions, the changes have already accelerated. 

  • Chatbots
    69% of consumers prefer interaction with chatbots for quick answers. Our prospective and current patients want (and expect) answers faster than we can respond to them. Think of the twenty most frequently asked questions that your front office staff has to answer over and over. They may even be answered as FAQs on your website. People expect these answers immediately, and the technology exists to meet that speed. See the example chabot flow below that can be used for your Facebook Messenger or website chat.

The future of chatbots for fertility centers

The future of chatbots for fertility centers

The data suggest that clinics are unable to set and reset expectations with patients because the information exchange is imbalanced in such way that is insufficient to the patient. If patients and centers are not communicating in the same media, they are not speaking the same language. Consider this data point from the same Bank of America study: “the majority (67 percent) of Americans feel the appropriate response time to a text is under an hour, with 43 percent citing under 10 minutes and 10 percent thinking it should be instantly”. Contrast this with how long it takes your already work-loaded staff to respond to patients who are anxiously awaiting their test results. So they turn to each other.

3). COnnected communities of patients…and a chance to lead them

With the information exchange so out of balance, how are patients meant to process their information overload? Technologist Alex Kouts argues that reasoning by proxy, is the reliance on other people or organizations to offload one’s cognitive load, for forming a conclusion on complex subjects. Many patients rely on the experiences and opinions of their peers to help them process the very complex information they receive about infertility.

Part of the reason behind a massive social behavior change in our patient population is that people are now starting to talk about infertility. In the past, how could patients have connected with others to talk about their experience with infertility? Today, many people still struggle with infertility in silence, but hundreds of thousands of people worldwide are changing that.

#TTC stands for “trying to conceive” on social media. As of July 2018, the infertility hashtag had been used over 580,000 times and the #ttcsisters hashtag has been used almost 330,300 times on Instagram. There are thousands of infertility support groups and pages on Facebook, hundreds of infertility blogs, and dozens of podcasts about fertility. 

The cat is out of the bag. Good!

If we want to encourage people who are struggling with infertility to pursue medical advice, then we want them to talk. People are now talking publicly about a very pressing problem which you are more qualified to address than virtually anyone in their area. By becoming the voice for people with infertility in your area, and the forum for which they can connect with information and support, we create a natural and honest referral system. To the extent that you can encourage this system by truly providing values to prospective patients, you will never want for new patients.

Smaller fertility practices have access to a word-of-mouth referral network that was never previously available to them. In Part 3 of this blog series, we discussed the major advantages that large, private equity backed practice groups have over independent fertility centers. Thankfully, large practice groups aren't so much better equipped to adapt to these changing habits as we are.

4). COMPETitive advantages and disadvantages: rigged game or level playing field?

Many patients don’t see a fertility specialist when they need to because they are scared and they have no idea what seeing a fertility doctor will be like. They don’t know who to trust, but they do trust their friends and relatives. In years past, most people would not have known that their cousin, co-worker, or college roommate struggled through many of the same problems which they currently face, much less that they saw a fertility specialist, whom, and how happy they were with him or her. Now, hundreds of people in a person's social network can see when they post a picture of their beautiful family to their fertility center's social media channels, and publicly thank their fertility doctor and care team.

Larger practice groups often spend more money on social media advertising, yes, that is true. Because of that they are taking patients from practices who are not active on social media. But those practices that constantly create content and engage their community are acquiring new patients by word-of-mouth faster than ever. In fact, some practices don't need to spend any money at all on social media advertising, because there organic reach is so high. If dozens to hundreds of patients refer your practice in a given month and help persuade strangers who are looking for social proof, you will never want for new patients again.

Large corporations can outspend your marketing budget. They will and they are. They can create referral programs for large OB/GYN groups. They can leverage better deals with insurance companies. But there is a kink in their armor: they have to keep up with patients' attention as much as you do. People struggling with infertility want to give you their attention. Many times, they think about nothing other than their problem and you have at least part of the solution. If you make the effort to build trust with them and help them where they spend the most attention, you can reach them in such a way that large competitors cannot.

The tech revolution and reproductive health

The tech revolution and reproductive health

ONLY the beginning

We are only at the very beginning of this technological revolution, which is greater than that of Johann Guttenberg and the printing press. Marketing for fertility clinics is only one facet of how consumer technology has changed reproductive health. Companies and products are invented every day that can change our field forever. Consider these breakthroughs and their potential ramifications in our field.

Think of AI in the IVF lab

Think of AI in the IVF lab

Artificial Intelligence

Error rates for image labeling have fallen from 28.5% to below 2.5% since 2010. On this specific test, AI is now more accurate than human performance. Imagine artificial intelligence being used to

  • Score embyro quality

  • Predict success of recommended prognosis

  • Real time diagnosis

virtual reality impact on Assisted Reproductive Technology

Virtual and Augmented Reality

Statista estimates that there are 171 million active users of augmented reality in 2018. A 2016 poll of consumers in the United States by ClickZ found that more than a third (37%) have now used either their own or someone else’s VR headset. In the not distant future, VR and AR may be used to

  • Provide initial consults

  • Tour the practice and IVF lab

  • Take CME lectures and courses

How will block chain affect Assisted Reproductive Technology?

Blockchain

Blockchain technology scopes far beyond the function of currency. Blockchain is the digitized, decentralized, public ledger of transactions of virtually any kind. The number of Blockchain wallets has been growing since the creation of the Bitcoin virtual currency in 2009, reaching over 25 million Blockchain wallet users at the end of June 2018. Accenture estimates that 30% of operating costs could be eliminated using Blockchain. Blockchain development is still in its very early life, but it could be used in reproductive health to

  • Replace electronic medical records

  • Finance treatment

  • Integrate systems such as billing, records, results, and treatment protocol

change is here

Whether we like it or not, the REI practice of 2019 can no longer be designed as a small medical clinic. Whether its motives are profit driven or in service to the betterment of humanity, or anywhere along that spectrum, it is an entrepreneurial venture. We’ve examined how the world has changed dynamically in the last two decades and will change even more in the next two. To succeed, fertility centers need to be structured as an entity that is led by a visionary, with a strategy and vision that account for powerful competitors and the ability to adapt as quickly to social and technological changes as quickly as our patients do.

The variables for which we need to account are infinite if we try to keep pace with our society’s technological revolution as a whole. If we manage to keep pace with our patients, however, we have access to a breadth of opportunity the likes of which the world has never seen.


 

 

A New Vision and Different Strategy for IVF Centers to Thrive Beyond 2018

By Griffin Jones

Part 2 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

We might criticize REI fellows for not wanting to take over existing IVF practices, but they are making the same decision that current practice owners have made for decades. They are deciding to be doctors and not CEOs. At the time, starting an independent practice didn’t mean launching a commercial enterprise. The difference is that new doctors know they can’t get away with that today.

Organizational leadership is an issue at many fertility practices

Organizational leadership is an issue at many fertility practices

In Part 1 of our series on the contemporary fertility practice’s shift from “small, independent healthcare practice”, to “entrepreneurial venture”, we discussed the traditional model’s outdated business structure. Now, in Part 2, let’s talk about how the leadership atop that structure dramatically affects a fertility center’s ability to do business today, leave alone tomorrow. We’ll discuss eight critical elements of vision and strategy, and we’ll deeply explore those with which IVF centers tend to have the most trouble.

A new vision and different strategy needed for fertility centers

We mentioned that the Practice Director is in charge of an IVF clinic, where the CEO is tasked with the overall responsibility of creating, planning, implementing and integrating the strategic direction of an organization. But what happens when infertility clinics don’t have a clear vision in place? Here are some real life examples:

  • One partner wants to sell his share of the practice to a private equity firm but his partner wants to remain independent.
  • The practice principal wants to increase fertility preservation, bur the rest of her team knows very little about this initiative.
  • Practices jump from one marketing venture to the next, wasting time and money because they aren’t making their advertising work toward their vision.
  • Business development projects are started and abandoned because practices have few benchmarks in place and consequently don’t accurately measure if they’re moving toward their goal.

“Hope is not a strategy,”—Rick Page

Do any of these problems resonate with your practice? We’ve accepted that the head of our company, Principal, Founder, CEO, President, or whatever we choose to call it, has responsibilities that extend far beyond the role of physician and even that of Medical Director and Practice Director. Now visionaries can lead their practices in ways that allow us to super-serve their patients and grow. The leader of a company identifies, articulates, and plans its

  • Core Values
  • Core Focus
  • 10-year target
  • High Level marketing strategy
  • 3-year picture
  • 1-year plan
  • Quarterly Priorities
  • Issues

All of these tenets are essential, with the priority starting at the top of the list. Some we will link to external sources for further reading, because we need to spend more time with the most common principals with which fertility clinics struggle.

1). Core Values

I’ll wager that your values are far more compelling than those of the average business. After all, you’ve devoted a career to helping loving parents create life. But how do you articulate your values to your team, to patients, and to the public? We work in a field that is both being changed by society, and changing society…rapidly. How do we stay true to who we are and what we believe while being able to adapt? When core values are true and defined, leaders make hiring decisions that allow them to unload responsibilities and feel comfortable that their practice is in good hands.

2). Core Focus

Your Why and Your What. Purpose, passion, and cause combined with your niche. The more closely aligned employees are with Core Focus and Core Values, the more prepared they are to make decisions in the best interest of the practice, and the less practice owners need to micromanage.

3). 10 Year Target

Where one wants to be in ten years is the destination from which the rest of the roadmap is drawn. This is where fertility centers frequently fall off track. Do you want to open more offices or labs? Do you want to attract patients from overseas? Do you want to pilot a technological solution? You may notice that we can’t move to the next core tenet of Vision and Planning, the High Level Marketing Strategy, until we have solid long term goals.

Original fertility marketing consultant, Yogi Berra, on strategic growth

Original fertility marketing consultant, Yogi Berra, on strategic growth

In the same week, I received two calls from two different fertility doctors who had the same question, “how much money should I spend on marketing?”

A million dollars. A couple thousand dollars. My answers to each of them were starkly different.

The first doctor was in his early sixties. He works for a larger practice group and does a little bit of marketing for himself. He’d like to perform seven or eight more egg retrievals per month. He plans to retire in the next two years.

The second physician just completed his REI board certification in the United States. He’s in his early thirties. He wants to move back to Latin America to start a large IVF center that draws patients from the United States, Canada, and Europe.

These are two vastly different long-term targets that dramatically impact who they will hire, how they will build from patient feedback, and how they will market. The 10 Year Target could be the most measurable differentiator between visionary entrepreneurs and independent physicians. Fertility practice groups without a defined long-term target are finding themselves directed by the demands of the day instead of concentrating their resources on becoming who they want to be. Entrepreneurial Operating System (EOS) founder, Gino Wickman, says that the 10 Year Target is not the time to be conservative. Dream big for the best version of yourself and your practice.

4). High Level Marketing Strategy

Do we know who we want to serve and what we mean to them? Is our 10 Year Target defined? Great. Our High Level Marketing Strategy involves doing whatever it takes to get there, within our core values and core focus. It details our

  • Goals (obtained from 10 Year Target, 3 Year Picture, and 1 Year Plan)
  • Benchmarks
  • Unique Marketing Position (obtained from Core Values and Core Focus)
  • Practice Brand
  • Content Strategy
  • Distribution Strategy (advertising)

Benchmarks

Many practices want to jump right into marketing without having reliable benchmarks or key performance indicators (KPI) to plan their strategy. Without them, money and effort may be wasted.  If you’ve ever spent money on advertising and aren’t sure of the results, revisit your KPIs. Do you have access to all or any of these Indispensable Indicators?

  • New Patient to IVF Conversion
  • Phone Call to New Patient Conversion
  • Online Contact Forms to New Patient
  •  Cost Per New Patient
  •  Patient Life Time Value
  • Cost Per Lead

We are data-driven marketers. Results must be measured as accurately as they can be. If you need help calculating your Indispensable Indicators, read Chapter 2 of The Ultimate Guide to Fertility Marketing.

Brand

If you feel like you can’t trust your employees or marketing partners with your message, you may need to document your practice's brand. At the Midwest Reproductive Symposium international (MRSi) in June 2018, I will be giving a branding workshop for fertility centers with branding expert, Mara Lucato. Here’s a glimpse of my thesis.

Brand is being known to the people we serve: how and why we help them with their problems. Logos, color schemes, and slogans, are relevant, or not, in so far as they help us achieve that end.

In our case, we have a community of people that desperately needs our help. In many cases, they don’t know who we are or how we can help them. Our brand and our high level marketing strategy involve providing them with as much value as we can, and then making it as easy as possible for them to do business with us. It includes

  • Connecting them with peer and professional support
  • Educating them
  • Encouraging them
  • Standing up for them

We are charged with making sure that everyone in our region knows that infertility is a common medical issue. That people struggling with infertility are human and their problem is human.
They need to know that we are the ones who will help them. That is a fertility center’s brand.

Content and Advertising Strategy

A fertility practice’s High Level Marketing Strategy activates its brand by delivering its message across the platforms on which patients spend their time and attention. The platforms, and consequently the methods, change. 15 years ago, creating an infertility support blog was a game-changer. 10 years ago, having a Facebook page was a tremendous way to reach new people. Three years ago, Instagram stories and Facebook Live didn’t exist. Today, they are among the best ways to connect with prospective patients. Four years from now, there will be new tactics, and some of our current marketing efforts will be less relevant. A High Level Marketing Strategy allows us to adapt our marketing efforts to the tactics that are relevant to the attention of the people we serve.

5). 3 Year Picture

The 3 year picture and the 1 Year Plan zoom in on the 10 year target. Where are we going to be in three years? What is our revenue? How many IVF cycles are we doing? How many physicians are on staff? In the same way that practices often lack a 10 year target, the three year picture serves the same importance, just getting closer to bridging Vision and Traction.

6). 1 Year Plan

Long term planning for fertility centers

Often fertility centers have annual volume goals, but are they committed before the start of the year? Are they realistic?

7). Quarterly Priorities

Again, fertility practices frequently fall off track here. Do we have three to seven quarterly priorities that must be accomplished this quarter? Are we accomplishing priorities that move our business toward its one year plan, its three year picture, and its ten year target? Or are we drowning in the issues of the day-to-day?

8). Issues

Just another REI practice manager

Just another REI practice manager

The image of Sisyphus pushing the rock up the hill for all of eternity resonates with many practice managers. Fertility centers’ staffs frequently burn out because they are working on the same issues with no resolution. Care teams spend so much time working on issues that are urgent, they may have precious little time to focus on important, big picture issues. Take a look at the Eisenhower Decision Matrix. 

The Eisenhower Decision Matrix applied to fertility clinics

The Eisenhower Decision Matrix applied to fertility clinics

As a fertility specialist, or a practice manager, you never have to deal with matters in Quadrant 1, do you? Yeah right. Fertility centers live in Quadrant 1. Employers that make their employees and managers work in quadrant 4 ought to go to jail, (joking…or am I?). Work of little importance and urgency robs human beings of their energy and happiness. Most of the responsibilities in Quadrant 4, by definition, can be eliminated. Let software do the rest.

Now we’re left with Quadrants 2 and 3. As the owner or manager of your practice, with your very limited time remaining from Quadrant 1, which do you prioritize between “urgent and non-important” and “important and not urgent”? It’s Quadrant 3, isn’t it? We often worry about issues that are not important but they have to be attended to right away. This isn’t to say that issues in Quadrant 3 don’t need to be addressed, but that’s exactly what we do, address them. By prioritizing issues in Quadrant 2, we solve them. Visionaries that focus their companies in Quadrant 2 make Quadrant 3 less relevant, and Quadrant 1 less overwhelming.

Paint the picture, chart the course

With a clear vision and strategy, fertility centers know exactly what their goals are and how to achieve them. Without them, practices frustrate their team members, exhaust resources, and find themselves losing market share to competitive IVF centers. Whether one wants to be the largest fertility preservation company in the world, or happily perform 150 egg retrievals per year and super-serve their patients, there’s no right or wrong answer. Their Core Values, Core Focus, and 10 year target inform their High Level Marketing Strategy, 3 Year Picture, 1 Year Plan, Quarterly Priorities, and resolution of Issues. When practices follow a strategy to a committed vision, they are prepared for the powerful competitors and challenges that pursue them. And just in the nick of time, because there are plenty. We’ll talk more about them in Part 3 of our series on the tectonic shift from medical clinic to entrepreneurial enterprise.

If you would like help building your practice’s High level Marketing Strategy, learn more about the Fertility Marketing Blueprint below.

Set Up to Fail: Fertility Clinics Not Structured for 2018

By Griffin Jones

Part 1 of a four part series on the main business challenges facing fertility centers because of the shift from "small clinic" to "entrepreneurial endeavor"

“Young doctors aren’t willing to work long hours,”

“Fellows today don’t have entrepreneurial chops,”

“New REIs don’t want to pay their dues.”

Millennial fertility doctors may sometimes be perceived this way

Millennial fertility doctors may sometimes be perceived this way

Have you ever made any of these comments or heard them said about your peers? It’s common to razz new subspecialists coming out of their Reproductive Endocrinology and Infertility (REI) fellowship. I often hear from recruiting physicians, that new REIs are not entrepreneurial. That they have no desire to take over a retiring doctor’s fertility center and run their own practice. It is said that fellows and new specialists want to work for someone else, clock their hours, and go home.

There may be valid points in this general perspective, but I see a much more comprehensive picture. Would you like to see what I observe from my semi-outsider’s vantage point? The radical statement to follow is the thesis behind the core business challenges with which so many fertility centers battle today.

The Tectonic Shift from "SMALL CLINIC" to "ENTREPRENEURIAL ENDEAVOR"

I don’t believe that many practice owners wanted to be entrepreneurs either. I suppose many physicians wanted to run their own fertility center and practice medicine the way they prefer. Is that unfair? Twenty to twenty five years ago, that may have been a tenable position. At that time, fertility specialists opened and operated small medical practices. Today, whether they like it or not, independent practices are entrepreneurial enterprises. We have sailed away from our calm cottage lakes, and onto the ocean of commercial venture. Here, our competitive threats come not only from other fertility centers, but from Wall Street, Silicon Valley, and a dynamically changing society. Canadian and European friends, this includes you too.

In this series, we’ll identify the main threats and challenges that fertility doctors, now accidental entrepreneurs, face in this new, unforgiving landscape.

  • Practice Business Structure
  • Vision and Strategy
  • Fierce Competition
  • Rapidly Changing Technology and Society

And we will force ourselves to answer the question we can no longer afford to avoid:

What is the plan?

Part 1: PRACTICE BUSINESS STRUCTURE

Independent fertility centers’ competitive challenges begin long before we even begin to think about marketing. Typically, they are inherent to the structure of the practice. If you own an IVF center run by fourteen employees, it may be tempting to ignore corporate structure. On the contrary, it is lack of structure that frequently keeps small practices from competing with large firms. Here we see the first differences between an REI practice, and a commercial endeavor.

A fertility clinic is run by a

  • Medical Director
  • Practice Director
  • Lab Director
  • Practice Administrator

Who runs the large corporations that are buying and operating fertility clinics across North America? Did you know that your new competitors are led by a C-Suite? They have a

  • Chief Executive Officer (CEO)
  • Chief Operating Officer (COO)
  • Chief Marketing Officer (CMO)
  • Chief Technology Officer (CTO)
  • Chief Financial Officer (CFO)
  • Chief Information Officer (CIO)
  • Chief Human Resources Officer (CHRO)
Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

Entrepreneurial Operating System (EOS) Accountability Chart applied to fertility clinics

This isn’t to suggest that a four physician, twenty five employee IVF clinic needs to have the same corporate structure as their large competitors. They don’t. They need to run their company on a business operating system (BOS) if they want to articulate a vision, agree upon a strategy, and enable their entire team to achieve their collective goals. Fertility Bridge is run on an operating system called the Entrepreneurial Operating System (EOS). To clarify, I am not an EOS consultant, nor do I sell their services at this time. You can find another BOS or you can build your own, though I have no idea why anyone would want to start from scratch.

One of the strongest arguments of EOS is that there are three core functions in any business. In our field, we might split Operations into Medical and Lab, or even Compliance, but the three core functions are

  • Operations
  • Finance
  • Sales and Marketing

In most independent IVF centers, instead of planning for the three core business functions for which someone must execute, they are often bundled into “other” and dropped in the lap of the practice administrator. Is she or he expected to run the operations of the practice, account for the finances, recruit and manage team members and write and execute a complete marketing plan? Is she or he an expert on digital media, law, technology, workforce development, and corporate strategy? Is that fair? Is that realistic?

How many seats are you in?

Rather than hire someone for each of these roles right away, which most fertility centers cannot do, EOS helps with the concept of “one person, one seat”. One person can hold more than one seat, but one seat cannot be occupied by more than one person. This helps small practices flush out capacity related issues and step out of roles as they grow.

Take a look at an example accountability chart below. How many seats are you in? How many seats are unclear as to who is accountable for them?

Example Accountability Chart for fertility clinics.png

As an REI physician, in just one very busy seat, you probably have to perform

  • 150+ egg retrievals,
  • Several dozen intrauterine inseminations (IUI),
  • All other surgeries

Oh, and you still have to spend time with and respond to your patients.

While infertility doctors at corporate-run clinics can devote all of their working time to their "REI seat", you’re the Medical Director or Practice Director of your IVF center and you have many other roles. As the head of an entrepreneurial venture, you now have additional responsibilities to properly delegate or do yourself.

  • Implement the vision of your company
  • Hire and interview every employee
  • Execute the marketing strategy
  • Account for the finances
  • Run the operations of the office
  • Manage every member of every team

Simply delegating each of these responsibilities can be a full time job, let alone sitting in each individual seat. Again, independent practices don’t necessarily need dozens of employees to run the business side. If they want to maintain or grow their practice, they need to eliminate, automate, and delegate. [A wink to those practice principals that are still signing paper checks].

Is "control" hindering your practice's growth?

Something stops fertility centers’ teams from taking ownership of each of these responsibilities and taking them off of the practice owner’s lap. As one writer says, “Want to drive your employees absolutely crazy? Give them responsibility without authority”.

If we hire a Human Resources Manager, but she doesn’t have the authority to choose the payroll company, negotiate salaries, or make the final decision on hires, then the responsibility of Human Resources continues to consume our time and energy.

If we hire a finance officer, but this person isn’t able to choose the bookkeeping software, set pay dates, and decide the terms of Accounts Payable and Accounts Receivable, then we haven’t delegated finance.

If a practice hires a marketing director, but the marketing director doesn’t have creative control and isn’t given a budget and goals for which they are responsible, then the load of marketing remains in our lap.

How does it impact the growth of your practice if you and your partners deal in every facet of the business without clearly defined roles in an operating system? How does it affect the way you practice medicine? How does it weigh on your relationships with your patients, your team members, and your loved ones?

SHIFTING from "practice owner" to "visionary"

If this describes you or your partners, is it because you're reluctant to pass on control? When practice owners feel that that they need to manage every movement in the practice, it may be because there is not a cohesive culture behind a clear vision. By acknowledging the tectonic shift that has happened in the field of reproductive health, that independent fertility practices are in fact commercial enterprises, practice principals can step into the role of visionary. In the next part of our series on the difference between fertility practices and entrepreneurial ventures, we’ll see when a company follows an operating system, practice principals are able to chart a vision and plan that allows them to pass responsibility to their team and adapt their practices to our changing world.

A Stern Warning for Fertility Clinics Who Complain About Patient Review Sites

By Griffin Jones

"Change is not painful. resistance to change is painful."

Consider this a gentle "love tap" from a friend. 

A direct warning from me is far milder than what the market has in store. If I don't speak up about this single issue now, then I am neglectful in my duty to help protect the field of reproductive health from cultural and technological shock, because the internet-led market has proven to be unforgiving.

easy part.jpg

When I entered the fertility world, I accepted the responsibility of preparing those inside the field from the disruption coming from outside. I built a company to help bridge the gap between the status quo of reproductive health and what's happening in the rest of the tech revolution. So that we're not dealing with contemporary business buzzwords, allow me to give this definition to what entrepreneurs and venture capitalists call "disruption":

  • Major enterprises losing double-digit market share or going out of business within 36 months due to brand new players who come from outside of their field. 

ONline reputation is hardly the tip of the iceberg

This article does not come in reference to any one particular conversation I've had (perhaps even with you) in the last few months...because I've had several. Some have been with clients, some with vendors, some with strategic partners; it's a recurring theme.

When I first started creating content for fertility practices, the topic of "online reputation" is what really piqued the interest of fertility doctors. Many of us are concerned with what people say about us online. We often find the comments to be unfair, untrue, or at the very least, unkind. As we explore, however, you may agree that the root of the issue has less to do with the comments of others and more to do with a strategically flawed grasp for control.

Technological and cultural change are sweeping through nearly every facet of society. We are dissecting online reputation in this instance, simply because it happens to be a very common pain-point. In this deep-dive, we closely examine

  • The cause behind the information shift of the last twenty years
  • Why patients have embraced it
  • The four principal reasons that practices have NOT embraced it
  • Why patients rely on social proof to make decisions
  • The real threat to a fertility center's online reputation
  • What to do once we've stopped resisting 

Many doctors tell me that negative reviews upset them to the point where they can't sleep. You've done everything you could, and if you could wave a magic wand, you would wish for nothing less than for your upset patient to have a healthy baby and a happy family. Before we separate your perspective from the patient's right to have and share a completely different perspective, let's first examine the informational shift that has happened over the last two decades.

the human need to move away from information ASYMMETRY

For any patient to think that she or he is more qualified to review her or his case after a few hours (or even hundreds) of internet research, must be insulting. If you're a fertility doctor, you've gone through four years of undergraduate studies, four years of medical school, four years of residency, and three years of REI fellowship. That's fifteen years of higher education, followed by some of the most demanding board exams in medicine. If you've grown accustomed to this legacy of information control, it's because you've worked extremely hard to do so. 

Information asymmetry, wherein the seller (provider) almost always has an information advantage over the buyer (patient) is wonderful...when you're the seller. Recall other pre-internet situations in which you have been the buyer. Call back to a time when you had to buy a car when only the car dealer knew the manufacturer's suggested retail price (MSRP) or its pre-owned history. Think of buying a house when only the realtor knew the last sale price, its home improvements, and recent sales in the neighborhood.  How did that feel? The best real estate agent in your market has a lot more experience buying and selling homes than you do. She may also be a very authentic and trustworthy professional. Does that mean she should expect you not to use Zillow and Trulia? You don't need me to explain the deep-seated human need to shift from information asymmetry to information parity. As consumers, we do it every day.

For over a century, virtually the only way for someone to obtain in-depth knowledge about any given medical condition was to attend medical school. Like our example of home-buying, patients had a scarcity of information, few provider choices, and no means to talk back. Contrast that with our very different world today.

The drive toward information parity

change coming for ivf centers

When I was a kid in the early 1990s, I wanted a million dollars so I could buy my own video game arcade. Now I have one on my phone (that I have never used). Every one of our patients walks around with a super computer in his or her pocket at all times. Within sixty seconds of being diagnosed with infertility, one can

  • Read various definitions of infertility
  • Study the most common causes
  • Research potential treatments
  • Compare providers
  • Watch video explanations from medical doctors from around the world
  • Find humor and relief from satirical and artistic content
  • Connect with thousands of other patients via social media

Information asymmetry is over. Forever.

patients often need to rely on each other 

Some of us are frustrated that just because our patients have access to virtually limitless information, that does not qualify them to make any diagnoses or prognoses. Correct; they are not medical doctors. They don't have to be. They are human beings with opinions and emotions and they have a right to share their experiences with each other. They frequently have to turn to one another for social proof to help them assess this information.

Also known as informational social influence, social proof is the psychological phenomenon where people rely on the actions and opinions of others to determine the appropriate behavior for a given situation. Talk about ambiguous social situations! What is the appropriate mode of behavior when someone learns that they've been diagnosed with infertility? When they've paid $18,000 of their life savings for two failed IVF cycles?

Social proof may be even more necessary for those dealing with infertility because of the tremendous social pressure to have children. When so few people in one's social network can relate to what they're going through, our patients frequently have to turn to the internet to find those who can empathize with their emotions and relate to their experience. 

information parity meets social proof meets technology

Imagine having to spend thousands of dollars of your own money on fertility treatment, and having no way of knowing which doctor or clinic could be the best fit for you. Along comes a fantastic user experience (UX), with sleek design and fields of search deeply relevant to those struggling with infertility. 

I don't own any equity in or have any commercial partnership with Fertility IQ at this time. Yet when I set myself free from my own desire to have perfect control over my paying clients' online ratings, and put myself in the position of the patient, it's easy to understand why they are using the platform in the hundreds of thousands. Instead of comparing apples to oranges on Google reviews, RateMDs, ZocDoc, Vitals, HealthGrades, or even Yelp, people with infertility read verified experiences from patients by their

  • Age
  • Diagnosis
  • Type of treatment(s)
  • Number of treatments
  • Success or failure of each treatment
  • Income level
  • Number of doctors seen

Complaining about Fertility IQ or any other review site is not as trivial as disliking a website. It's partaking in the exhausting struggle against what patients desperately seek. It is the hubris attempt to fight the human drive to move away from information asymmetry toward information parity. The market, whether through Facebook, Instagram, FIQ, Google, or any other platform will find a way to give it to them. It does not give a damn if we are inconvenienced.

the four main reasons for resisting patient reviews

Tech disruption in infertility field

I won't tell you to let go of control because we can't let go of something we don't have. If Muammar Gaddafi, the despot who antagonized western powers for decades, couldn't suppress social media, how could we? Why would we want to?

Well, after hundreds of conversations with fertility doctors, nurses, and practice managers, I've identified four principal reasons that we yearn to have control over what people say about us online, leading us down the path of most resistance.

  1. What we do is so hard and complicated. People don't have a right to criticize what they don't understand
    Consider the phenomenon of flight. What a magical experience. Distances that would have taken us weeks to travel a century ago, now take us a few hours. Instead of physical exertion, we're served snacks and alcohol while we enjoy unlimited entertainment on our personal supercomputers. The logistics, expertise, and technology required to provide this luxury to us are overwhelming.

    Left to my own devices, I would be lucky to mount a camel for a few miles. I still hate United Airlines, and so do you, and so do millions of our peers. Could we do a better job piloting, procuring maintenance for tens of thousands of aircraft, and maintaining schedules for tens of millions of travelers? Absolutely not. Should we have any right to complain when we're inconvenienced by what is still a tremendous luxury compared to the alternatives? Should is irrelevant; we do have the right, and we frequently exercise it. We are citizens of countries where free speech is (meant to be) protected by our constitutions. 

  2.  These reviews are fake
    Of the four reasons for resistance, this is the most legitimate, if the review is in fact illegitimate. False reviews are a real problem. Up to 15% of online reviews may be fake. If you are certain that a review is not from a patient at all, but from a competitor or an internet troll, flag it for review. I recommend flagging the review from more than one user account. At Fertility Bridge, we see fake reviews rear their ugly heads, and aren't always able to get them taken down. It's unfair and it pisses me off too. Because at least 85% of our reviews are authentic, let's focus on what we can control.

  3. Only unhappy people leave reviews
    A widely held assumption among fertility doctors is that IVF center reviews are overwhelmingly negative. This simply isn't true. In an analysis of 504 fertility clinic reviews, conducted by Fertility Bridge in 2015, 63% of reviews were positive and 37% were negative. Yes, there are reasons that people are motivated to leave negative and positive reviews about their practices. Someone may not have been able to become pregnant and want to take it out on you. Others may sing your praises because they were pregnant. Still, some centers are able to minimize their negative comments and maximize their positive ratings; that is our goal.

  4. Negative reviews use libel and slander
    If you'd like a good laugh with your morning coffee, read RateMDs' FAQs for doctors. In 12 paragraphs, they tell you how you can go pound sand if you think you're going to sue them. Vitals and HealthGrades do too, but RateMDs is the most humorous.
    Sometimes reviews violate the platform's terms of agreement by using hateful or vulgar language, and the site will remove them. Most of the time they do not.

the greatest threat to the accuracy of your reputation

Once we've moved beyond our four cardinal motives for resisting public feedback, we can focus on the real liability to the accuracy of our online reputations.

Last summer, in a summary of fertility doctors' responses to their online reviews, I corrected the old adage, "the customer is always right," to "the patients (plural, meaning the market) are always right". I'll use my own company as an example. Fertility Bridge served eight IVF clinics in 2016. If two of them were dissatisfied, one held a neutral opinion, and five were delighted with the service they received, I might be able to identify a few patterns. But what I would really want to do, is increase the volume of evaluation. Eight sources of feedback? Better than three, I guess. Thirty would be a heck of a lot better. 

The same is true for an IVF center's online reputation. When a fertility doctor has two scathingly negative reviews, one luke-warm review, and one glowing review, the public doesn't have enough information to accurately judge this physician. Very often, fertility doctors have unfavorable online profiles because they simply don't have a high enough volume of reviews on that particular platform. Forget these four motives for distrusting online review platforms; lack of volume is our worst enemy. The higher a clinic's volume, the more likely their reviews are to be positive. Period.

what to do now

Okay, Griffin. We've stopped resisting. We have a high volume of reviews but our ratings are still low. We still hate this. Make it go away.

disrupting the fertility field

If we've truly made it thus far, then we have the best road map for operational/personnel adjustments that we could ever ask for.  We have data to identify the most common problem areas in our practices and fix them. That's right, the same platforms that take control away from us give it right back...if we choose to act on it.

In my opinion, no review site makes it easier to evaluate customer service patterns than Fertility IQ. Clinics are rated by 

  • Operations
  • Scheduling
  • Billing department
  • Nursing Team

Physicians are rated by

  • Whether they treated their patient like a person or a number
  • Communication
  • How often they saw their patients at appointments
  • Response time

When we can measure how patients adore our nursing staff, and their disappointment in when their calls are returned, it's a lot easier to smoke out capacity-related issues that hinder the excellence of our practice experience. Of course we don't have to wait until patients leave our practice to listen to their stories. We can use tools like Press Ganey or Rep Check Up to solicit patient feedback, in-house. Public ratings are the final word, however, and in the eyes of the public, perception is reality.

a new review site is barely a baby serving of disruption

We've hardly seen the tip of the iceberg, my friends. If we cannot adapt to the reality of how patients use the internet to share their experiences, we are not long for what is to come. Regulation has sheltered healthcare from many of the market effects that have impacted other areas, but it won't hold forever. The executives of Zoc Doc, Vitals, and Health Grades are not worried about awkward run-ins at ASRM with physicians who subscribe to their premium offerings. They are interested in being the marketplace where patients find their providers.

FertilityIQ was started in the birthplace of many other innovative tech companies, the San Francisco Bay Area. It was started in the way most disruptive tech companies are, from outside. FertilityIQ doesn't receive funding from IVF clinics. They didn't need our permission to build their company and patients don't need our permission to share their experiences on their platform. This is what disruption looks like. Thousands of entrepreneurs are chomping at the bit to change healthcare in their own way. If we stay in the habit of yearning for control that we don't have, we will wistfully long for the days of unfavorable online profiles being our biggest pain in the neck.

Blockbuster Video chose to be nostalgic about the adventure of going to the video store. Netflix didn't. Marriott could have invented the world's most used lodging app; AirBnb was happy to do it instead. The largest taxi companies balked at the idea of hundreds of millions of passengers choosing to ride in a strangers' car; Uber bet the pot on it and became a multi-billion dollar company.

We are presented with an incredible moment in time to use new market opportunities to build the most successful versions of our practices. I started a company inside of our field, rather than outside, because it is far more agreeable to strategically adapt to technological and cultural change than to be rocked by the market. This is just advice, you certainly don't have to take it. Before you decide anything though, you might ask yourself if what you do now will make you right or wrong in the context of history.

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To learn more about how to improve your fertility practice's online reputation, and to adapt to new patient behavior, download your free copy of the Ultimate Guide to Fertility Marketing

Flipping People's Peanuts at MRSi 2017: Everything is changing, and it's just the beginning

By Griffin Jones
 

This is my third annual recap of the Midwest Reproductive Symposium international (MRSi) , so I'm going to have a little fun with this one. I don't feel like writing another list and I think there's a more valuable point I can convey to you. As of right now, MRSi holds the title for my favorite meeting in the field of reproductive health and I want to use it nudge other meetings to follow suit. I should be a fair judge, I go to almost all of them.

It certainly doesn't hurt that it's on Lake Michigan in Chicago in the summer time, and Dr. Angeline Beltsos knows how to incorporate an interesting theme. Those are pluses, but not enough to make a meeting my favorite. It's big enough to have a diverse range of programming and small enough to be very collaborative and social. People get to know each other and build meaningful relationships. I truly understand how important that is for the field. Louise Brown, the first baby ever born from IVF was a guest at the conference. As Louise put it,

"My parents were willing to advance science and try something that had never been done before because they felt their doctors were truly there for them."

These reasons not withstanding, do you know what I really think MRSi holds over our other meetings in the field? It's the most forward-looking.

Other meetings sometimes do a great job of exploring the latest science and the future prospects for assisted reproductive technologies, but they often stop there. I believe that's a mistake. Compared to some of the technologies that are being developed both inside and outside of our field right now, PGS looks about as complicated as tying a shoe.

A Change Gonna Come. Oh wait. It already did.

Several presentations detailed the incredible growth of technology across multiple facets of society, not just ART. My own talk was titled The Biggest Change Ever in Human Communication: the Tech Revolution and Our Patients. The title isn't hyperbole. I made the case that we are living through a bigger shift than that of the printing press, perhaps even greater than the written word itself. If you would like the slides from my presentation, I will be happy to e-mail them to you. Here's the punchline: the supercomputer in every one's hand, that we call a smartphone, has changed dating, parenting, conversation, and commerce, for us and our patients. We have hardly begun to adapt our operations accordingly. And this is only the beginning.

Bob Huff, Chief Information Officer of RMA of Texas, shared with us technology that is changing the way generalists refer patients, and even the way patients are diagnosed. Scientists have just created functioning mouse embryos through 3D printing

My co-speaker, Hannah Johnson, Operations Director of Vios Fertility, and I, had the pleasure to speak to the mental health professionals group as well as the practice administrators' Business Minds group. We desperately need more of this inter-disciplinary kind of discussion because entire industries are being radically and forcibly changed. You'll forgive me for not using the popular buzzword, "disrupted". I prefer to put it more bluntly. Large institutions and established companies are losing double digit market share or going out of business in periods of 12-36 months. How does that sound?

"We could be looking at widespread clinic closures within the next 5-10 years."--Hannah johnson

I don't want that for this field. I started my career in radio advertising. I watched wealthy and powerful stakeholders go bankrupt because they were comfortable or because they weren't willing to invest time, money, and energy to adapt. As Dr. Francisco Arredondo from RMA of Texas says, "we produce one new fertility specialist per 10 million people per year". A need of such titanic portions is one that is begging for more technological disruption.

how can we learn if every effort is required to produce a particular result?

Broad social and technological change isn't a frame of mind that we usually allow ourselves to explore at most of our regional meetings throughout the year, or even at ASRM. It's a bit more welcome at MRS to question the status quo, and test new platforms and processes, without the scrutiny of the exact result that any particular effort might produce at the given moment. Elizabeth Carr, the first baby born from IVF in the United States, is now a marketing data consultant who also spoke at the conference. "I wouldn't be standing before you today if my parents and their doctors weren't willing to try something that had never been done before."

Virtually every area of medicine and practice management is ready to be disrupted by technology. We can wait for pain, or we can put in the effort and patience required to adapt to these changes. MRSi is the first meeting in our field where we're starting to think and talk in these terms. I hope it serves as an example for the others.

 

Should I fire my fertility center's marketing manager?

By Griffin Jones

Fertility doctors frequently ask me, “Is it better to have an in-house marketing person or contract an outside marketing firm?” You might expect me to favor the choice of hiring the firm. I don’t. The two are not mutually exclusive; each role is critically important to the other. In fact, across the board, your staff are paramount to your fertility practice's efforts to recruit new patients. There are assignments that your in-practice marketer should and should NOT be tasked with to maximize effectiveness and cost-efficiency. The same is true of your agency. Depending on the size of your practice, it may seem redundant to have both an internal marketing person and an agency on retainer. When used correctly, they will each pay for themselves and then some. 

marketing manager or clinic liaison?

If the practice has only one dedicated marketing person, his or her greatest productivity may very well come from the assignment of practice liaison. This is a function that is extremely difficult to outsource. As a marketer, my focus on digital media is owed only to its powerful results in attracting new patients. Digital’s proven ability to grow fertility practices doesn’t make physician referrals any less meaningful. Even in 2017, OB/GYN referrals still count for a tremendous share of new patients. Having someone who can regularly schedule physician-to-physician lunches, deliver semen analysis kits and information about infertility support, and educate OB/GYN staff in your area is tremendously valuable to the practice. Markets differ widely on the return on investment (ROI) of MD referrals, but in some cases, it may be a fertility center’s fastest path to growth.

physician referral case study

I asked an expert on the topic to share her experience on nurturing relationships with referring doctors. Shirley Sinclair is the practice manager of the Fertility Center of Chattanooga.

"For over 10 years, we’ve tried to find the magic source of how to bring in more patients and one of the top ways is still through referring physicians.  This process has taken us some time to fine-tune, but it has proven to be very successful.  We know our physicians are very busy, especially OB/GYN’s, so it is critical to remember that every minute of their day is valuable.  With that in mind, we developed a few different ways for doctors to easily consume our message.
•    Distribute referral packets in a beautiful folder filled with
o    information about our clinics
o     fact-sheets about infertility and testing
o    semen analysis kit.  
•    Provide a referral sheet for the referring physician, in which they can
o    add the patient name,
o    check off the type of appointment they are requesting (such as semen analysis, consult, etc.)
o     Fax back to our office

"We contact the patient to set up the appointment, thereby freeing up the referral’s time.  We take these packets to each office about every 6 weeks, along with some type of goodie for the staff.  This is not the time to ask to speak with anyone!  They will remember you more if you do not become a nuisance.  Also, do not leave too many packets; the idea is to show consistency and for you to become familiar with the staff.   

"Another great tip is to set up lunches with referring practices.  While this can be time consuming, this is a wonderful tool to use, especially when you have a new program or new protocol that you would like to share with the doctors.  Always take one of your physicians and, in addition, it is helpful to take someone from your staff that is familiar with the clinical side, as well as financial.  Physicians are always curious about what insurance will pay for as it is one of the first questions patients ask their doctor when they are encouraged to see a fertility specialist.  

"Use this time to assure the physicians that you would like to set up a partnership in providing the best care for their patient.  In other words, remind them that your goal is to help the patient become pregnant and send them right back!  Also, educate the physician that referring a patient sooner, rather than later, will save the patient precious time, money, and especially undue emotional stress.  Hanging on to a patient 6 months longer could be the deciding factor of what type of treatment the patient will end up having, therefore, adding additional hardship to the patient.  

"While these tips are vital, they are worthless unless you track them.  We use an EMR that is designed for fertility clinics, called eIVF, to track our referral sources.  Keep track of which physicians’ offices refer to you! In addition, make sure your physicians follow a protocol to send letters to the referring physician after the patient’s visit. Then send a follow up letter when you send the patient, hopefully pregnant, back to her OB/GYN.  Keeping your referring physician in the loop about their patients will solidify a long, successful relationship that will not only be beneficial to each of you, but, most importantly, to the patients for whom you both care!"

WAYS YOUR MARKETING MANAGER CAN HELP YOUR AGENCY

If you have more than one practice marketing person, or you live in a market where physician relations is not a full time job, your marketing manager is irreplaceable for a number of tasks that need to be accomplished within the practice. 

hiring a fertility marketing agency

Content sourcing. I don’t fly a member of my team to Honolulu every time we want to post a picture of the Fertility Institute of Hawaii’s staff to Instagram. Homemade and frequent content is vital to any practice’s content marketing strategy. In-practice marketers can serve as “brand journalists”, collecting the necessary images, stories, and videos to be sent to the agency for editing and distribution.

Operational changes.  You may find that your online reputation is not as great as it should be, simply because of one or two common patterns. Patients might love your staff, but report your response time to be abysmal. The practice manager super-serves the practice when he or she is able to implement systemic changes that are needed to improve the marketing imprint of the practice.

Tracking. Your marketing agency will be able to tell you how many people RSVPed to your practice’s IVF informational session. Your in-practice marketer will tell you how many actually showed up. If using a CRM or not, the in-practice marketer is critical in measuring and reporting the volume and sourcing of new patients.

WAYS YOUR AGENCY CAN SERVE YOUR MARKETING MANAGER

Not the first time I've included a Jerry Maguire meme on my blog 

Not the first time I've included a Jerry Maguire meme on my blog 

One stop shopping. Your practice manager has enough to do without searching for a website developer, a photographer, a graphic designer, a writer, or a cinematographer every time your practice needs something. Your agency can provide that to you under one roof. 

Social Media and Online Community Management. It’s not a good use of your practice manager’s time to respond to every comment on social media or online review sources, or to have to scour for content to post every day. Your agency can handle online interaction and take the lead from your practice manager when specific questions arise. 

Content Development. Your agency can turn the raw text, photo, and video your practice sends into polished infographics, edited e-books, and maximize their distribution on social media and the web. The creative content and design that your agency helps you create doesn’t have to stay on your online properties, either. Digital materials like infographics and guides make for valuable resources that turn your clinic liaison’s visits into less of a sales call, and into more of a service to the referring doctor. 

Advertising. It’s possible to waste a lot of money on bad advertising. Does your team know how to target same-sex couples, who married within the last year, who recently visited your website and live within 25 miles of your practice? Mine does.

Tracking. Your business manager doesn’t have to be an expert in Google Analytics or using a customer relationship management (CRM) software. Your agency can be in charge of mastering your conversion system. 

THERE IS NO "I" IN aggregate TEAM MARKETING EFFORTS

A clinic liaison or marketing manager can be very effective for your practice. So can a hired agency. When they work in tandem, they return their investment exponentially. Studies find that marketing leads convert seven times more frequently when employees are fully involved in the process.  Patients often mention their favorite staff when they leave positive reviews about their fertility center, and the compassion of team members can be invaluable in the fertility journey. Some personnel may want to be the star of a video, and others may prefer a “behind the scenes” role. From contributing to blog posts, to planning events like the baby reunion to promoting support networks, there are plenty of ways to engage staff in the practice’s marketing strategy.

The 7 Worst Responses to Fertility Doctor Reviews on the Internet

By Griffin Jones

"The customer is always right"

Who knew this hyperbole, coined by Harry Selfridge in 1909, declaring his department store's commitment to customer service, would go on to become a thorn in the side of employees everywhere? It's a terrific internal mantra to aspire toward, but it can be very harmful when interpreted as a universal rule. Customers, or in our case, patients, may sometimes project their frustrations on to you or your staff and no one has the right to be abusive to your team members. Maintaining the notion that a single patient's point of view is infallible can put unfair stress on our employees. Gordon Bethune, former CEO of Continental Airlines, says that when companies don't support their employees when a customer is out of line, resentment results and service deteriorates. If we don't care for and support our staff members, how can they in turn care for and support our patients? 

I can't say I agree with the first part of this sentiment, but certainly the latter

I can't say I agree with the first part of this sentiment, but certainly the latter

In the case of public reviews of our practices, feedback isn't necessarily valuable when it comes from a focus group of one, but rather when we observe recurring themes from multiple people. The patient (singular) might not always be right, but the patients (plural, collective) are ALWAYS right. We should err in favor of the patient's perspective because it defines for us a higher standard of performance. But how do we respond to a negative comment when it's just plain unfair or untrue?  If you know in your heart of hearts that a particular reviewer is in the wrong, and you've truly done everything you can to make things right, you don't have to respond at all. If you're uncertain, or you want to publicly affirm your practice's genuine concern for every single patient, I have a better axiom for you:

"the patient might as well be right"

Remember, we're dealing with the court of public opinion. Miranda rights apply; anything you say can and will be used against you. For that reason, I'm concerned with the way many practices (cough, physicians) react to defend their case. Prospective patients reading our reviews have no way of knowing what really happened within the walls of your office. They can only judge us by how we respond in kind. Instead of winning the benefit of the doubt, we may say something to fall out of favor.  What's worse, physicians frequently disclose protected health information (PHI) when they attempt to argue their side of the story. To show you just how much our words can produce a completely undesired effect, I pulled seven real-life examples of how fertility specialists and practice administrators have answered negative public criticism. Warning: they go from bad to worse.

7 worst responses to fertility doctor reviews on the internet

7). Less is more

This response starts and ends just fine, but the physician gives into the temptation to make a correction. Responses to negative reviews are not the venue to discuss treatment protocol, or success rates, for that matter. The first two and last two sentences would have been fine for this response. Keep it short and take the conversation offline.

6). some battles aren't worth fighting

I didn't include the review here because it was very long. It was indeed an attack on the doctor himself. For that reason, it's better not to respond. We should respond to all negative reviews where we can at least offer a resolution, and none of those to which we cannot. When the commentary is a direct attack, nothing can be gained from turning the monologue into a dialogue, especially when it is the only response on the page.

5). Let your positive reviews speak for you...not the other way around

We don't get to determine if a reviewer's post is "excessively negative", our readers do. People browsing the page will notice when most people have a very high opinion of us. Pointing it out to them makes us look defensive. Besides, referring to this patients' initial consult and following correspondence discloses PHI.

4). Let it go, just let it go

As you can see at the top of this review, this doctor has a stellar online reputation. This is one of his only negative reviews. He doesn't need to defend his honor, his most delighted patients have already done that for them. Still, the response goes on to drag out the argument and include PHI. Very dangerous. 

3). No one can tell patients how to feel

"Just relax" or "stop worrying and it will happen" are two phrases that our patients unequivocally detest. Though likely not intended this way, insisting that a patient's bad news was delivered appropriately, when he or she feels the opposite, follows a similar vein. The practice's rapport is undermined and once again, more PHI.

2). No, seriously. let it go

Another REI, whose patients overwhelmingly love him otherwise. Responding to this single negative review in this way leaves a poor impression that is probably not representative of who he is as a physician. I don't see any of the 18 identifiers of PHI in this exchange, but it strikes me as an unnecessary risk.

1). I know it hurts, it's just not the place

I didn't include this review because the response is plenty long as it is. Besides, the doctor painstakingly recaps everything. I won't mince words, this is the worst response to a fertility center review that I have ever seen. I don't necessarily fault the physician for feeling this way. These comments seem to have really hurt him. He may have really cared about this patient and put forth his best effort to provide her with exceptional care. It sounds like he wanted to be completely transparent about the potential outcome. The patient didn't receive it that way, and that must be terribly disappointing. It's simply not the appropriate place to express one's disappointment. This response is one of the only accounts that prospective patients have to judge this physician's personality. Without knowing anything else about this doctor, fertility patients are left with a very poor impression.

hold your fire

You have three options when someone leaves negative criticism about you or your practice. You can

  1. Not reply at all
  2. Have a trained, neutral representative answer on your behalf
  3. Wait until your head is clear enough to leave a brief, solution-oriented response

I don't share these seven examples with you in jest. The way in which our words can betray us is a very serious concern. It's a threat to your brand and often, a legal liability. What may feel vindicating for a moment could be disastrous to your public image for a much longer time. Your time and energy are better spent on constantly adapting to collective patient feedback and delivering the best possible experience to the people you serve. You have my permission to give yourself permission to not be perfect. While it's necessary to devoutly heed collective patient opinion, there are times when you just aren't able to please certain individuals. Our goal in responding to negative reviews is not to defend our case in a particular incident but rather to show that we deeply care about how our patients perceive their interaction with us.

You can read my six critical rules for responding to negative reviews right here. If you want to reply to a negative remark that someone made about you online, and you don't want to make matters worse, just send me an e-mail or give me a call. We'll write a much better response that could make the patient feel better, will hopefully make you feel better, and will certainly make prospective patients feel better about you. 

 

Why Would Anyone Else Care About Infertility? How I Became an Ally to a Community I Had Nothing to Do With

By Griffin Jones

"Don't worry, you can always adopt"

I don't know if I ever had a conversation with anyone struggling with infertility (about the topic) before a few years ago. If I had, I probably would have said something silly like the above. I would have said it with the best of intentions, and hopefully, I would have kept an open mind. I knew nothing about infertility.  I had barely heard of IVF. I had no idea what a reproductive endocrinologist (RE) was. I am a young male with zero medical background and no personal connection to infertility. On paper, I was the least likely person to become an ally of the infertility community. And that's the very reason it seemed so important to become one.

caring about infertility

expanding the community

Whatever the issue at hand, progress will be limited if the consequences only apply to the people directly affected. This is true if we're talking about small issues at the local school board or large ones like repealing laws that ban same-sex marriage. Every community needs allies who are not "native" to their background for credibility and traction. I found infertility awareness to be an important concern that needed attention from more people than only couples struggling to conceive. It looked like they needed reinforcements, might be one way to put it. Still, there are infinite communities that I don't belong to that need support from the broader public. Why this one?

acknowledging the right to feel

There is a particular nuance in the way the infertility community is treated that piqued my curiosity. I still can't totally articulate it, but it has to do with we, as a society, not letting people feel what they need to feel. Responses like "at least you have one child already", or "stop worrying about it and it will happen" are pretty consistent with how we react to a lot of feelings that we don't totally understand. We jump to the "solution" because we want the feelings of hurt to end immediately. Sometimes out of compassion, sometimes out of laziness, and probably anywhere in between.

"You'll find someone else."
"You'll land a new job."  
"It's not so bad."

I wanted to shut up for a minute and allow people their right to feel.

ThAT blurry area between Sympathy and Empathy

Judging how other people should feel seems to stem from trying to equate someone's reality to our own. We often compare experiences as though they could possibly be the same, instead of drawing from them to imagine how someone feels. Dictionary.com describes sympathy as "feeling compassion, sorrow, or pity for the hardships that another person encounters, while empathy is putting yourself in the shoes of another".  The only way to know the pain of infertility (or cancer, or the loss of a spouse, or absolutely anything you could imagine) is to experience it personally.

Relating to imagine what people feel, not knowing exactly what they feel.

Relating to imagine what people feel, not knowing exactly what they feel.

We might not be able to fully understand someone's experience that we don't share, but we can usually empathize when we try.  I've never had to go through the "two week wait", but I know how anxious and frustrated I become when someone tells me to "just relax". People might not pester you about when you're going to have kids when that's what you want more than anything in the world. You may, however, know the soul-wrenching feeling you get when people ask you about a life goal that you're trying your best to achieve, and you have no idea when it will happen. Interacting with people with infertility has made me more aware of imagining what people might feel, in all kinds of scenarios, instead of judging what they should feel.

Playing for the team that drafted me

I noticed the community that emerges from this longing to be understood when I first started doing social media for fertility centers in 2014. Some people who had children because of assisted reproductive technology (ART) were so overjoyed that they wanted to tell the world about it. The emotional attachments they had to their doctors and care team was palpable. They exuded a sense of triumph that comes only from a prolonged period of hard times. I had worked with several other business categories in the past and never seen anything like it. Then I wondered about the people that haven't had success or are still on their journey. What do they need help with? So I took it upon myself to e-mail the group leader of every RESOLVE support group in America. You'll be able to read more about that in my memoir, The Unlikely Tale of How I Became Besties with the National Infertility Association. Turns out, you're not supposed to do that. Before the nice people at RESOLVE could contact me to say "hey knock that off, guy", I had already talked with dozens of people dealing with infertility over the phone and via e-mail conversations. Their reception of me sealed the deal that these were people I could get behind.

If you don't get this analogy, you're going to have to re-watch Jerry Maguire

If you don't get this analogy, you're going to have to re-watch Jerry Maguire

I was completely upfront about who I was. "Hi, I'm a marketer and I'm thinking about starting a business for fertility practices. I would love to know what information you really wanted from your clinic(s) that you just couldn't get". I'll translate this for you:

"Hey, I'm some dude that knows nothing about you, nothing about your problem, nothing about medicine, and I would maybe like to possibly make some money some day".

"Go f yourself" would have been a perfectly reasonable response. But I didn't get that at all (maybe once). Instead, people were generally very eager to talk to me. They told me a lot. They told me about a whole bunch of stuff I had never heard of before...stuff that most people would consider very private that I didn't even ask about. They even thanked me for doing my research. Thank me? A marketer? Didn't they know that marketer is just one or two rungs better on the scum ladder than investment banker? I had never been acknowledged like this before--why them? I realized right away it was because they were yearning to be listened to. I learned first hand how little they felt understood, even by their clinics. I felt armed.

I jumped on Instagram to engage with the #ttc (trying to conceive) community there. Same thing. "Hey everyone. I'm a marketer. I don't know your journey, but I promise I will out-listen anyone who tries to compete with me in the business I'm building". Once again, I've been totally humbled by the welcome I've received, both online and in person. I get occasional shout-outs, words of encouragement, and people keeping tabs on me. I've been a marketer for ten years now and I've never received that from any other segment I've worked with. That is a very rewarding thing about working with a population with whom the stakes are so high. Shit matters. People don't feel that way when they buy a Hyundai Sonata. Even though I work with clinics, and not directly with patients, it's the patients that get me excited about what I do.

Stay classy, #infertilitycommunity

My guardedly optimistic prediction for the future is that public awareness around infertility will grow significantly. When it does, I hope the discipline of listening to and trying to imagine the feelings of others wins over the comparison of struggles. Affording people their right to feel and the humility of using experiences to empathize instead of drawing contrast are amazing lessons in humanity. I realize that I am totally idealizing the values of a very diverse and massive population of people. But that's what they are--ideals. And those are what made me want to be an ally to a community I originally had nothing to do with. 

 

What 22 Infertility Bloggers Hated About Choosing Their Fertility Clinic

By Griffin Jones

"a prudent question is one half of wisdom"--francis bacon

Recently, someone who is very involved in the field of infertility reinforced what hundreds of patients have told me for two years; there's an astounding gap between the way many fertility practices deliver their services and what patients want and expect. That's exactly why our company has the word "Bridge" in its name. According to a study conducted in 2012 by Forrester, 80% of companies say they deliver superior service to their customers. Meanwhile, only 8% of those companies received a superior customer rating. If you're seeking treatment for infertility, the delivery of the services you receive should be nothing less than superior. No clinic is entitled to your selection. Even in states and countries where some rounds of IVF are covered, there are still many circumstances in which you could pay tens of thousands of dollars of your own money. If you live in a large enough area, or are able to travel, you have a choice. Your choice isn't an easy one to make, given how much is at stake. I don't own any fertility centers (...yet), but because we direct their marketing based on what you tell us, I'll speak about them in the first person voice.

Getting out of our own way

infertility blogger round up

As fertility practice groups, we sometimes spend a lot of money in an attempt to help you make that decision. Or at least we think we do. Sometimes we try to grow our practices without any strong understanding of what you need to feel comfortable (and eventually very satisfied) to move forward with treatment at our center or someone else's. We frequently forget that there is a simpler way of earning your choice. We could remove the unnecessary challenges, annoyances, uncertainties, and causes for anxiety that you face when you are searching for a fertility specialist. How do we build not just a proven marketing system, but an entire practice culture, around what goes through your mind when you debate coming to our clinic, another practice group, or seeking no treatment at all? This is a laborious and continuing process, but I had a crazy idea of where to start when I entered this field, and I decided to do it again.

I asked you.

In early 2015, I wrote a report from interviews with several infertility peer support group leaders. This time, I decided to ask over twenty prominent infertility bloggers to candidly answer the same short question. One question isn't enough to understand everything involved in how you decide which practice will play this instrumental role in your life, and what we need to do to make you feel very good about that decision. We need as much feedback as we can possibly get. We need to ask follow up questions, issue patient satisfaction surveys, read what you say anonymously about us online, take action on your collective input and repeat that process forever. Still, in their own right, the candid answers of several different people to the same question is very insightful. I chose bloggers because they have not only a wealth of personal experience, but also because they are each in contact with hundreds of other people who deal with infertility. They are on the pulse of the infertility community. As you'll read, there are several reasons why people choose clinics, and they're not mutually exclusive. 

20 infertility bloggers all answered one question

20 infertility bloggers all answered one question

What was the most annoying part about choosing your fertility clinic?"

OVERWHELMING OPTIONS

In Due Time , @caroline_induetime 
"There are too many clinics to choose from. It's so hard to choose one".

No Bun in the Oven @nobunintheoven 
"Choosing a fertility clinic is an overwhelming experience because it's an expensive process! The most annoying part of finding my clinic was finding reliable experiences about the doctors. Where is the Rate My Fertility Doctor website? Where can a couple go to find real life experiences on these professionals who are getting paid tens of thousands of dollars for treatment? It was hard to find and we were ultimately left shopping at several clinics before finding the 'right one' for us".

Hoping for a Best@hopingforbabybest
"Wondering if you made the right choice".

Anonymous 

"Just scared of making the wrong choice".

UNCLEAR COSTS/BILLING

Smart Fertility Choices, @SmartFertilityChoices
"It was difficult to understand the entire cost involved in doing a cycle".

Rad Kitten@RadKitten
"Cost first and foremost. Second is beside manner. I'm not just a paycheck, I'm a person".

TTC a Taxson Baby@ttcataxsonbaby
"The most annoying part about choosing my fertility clinic was finding out that they don't take either of our insurances! Annoying and frustrating"!

Happiness Glass@happinessglass_
"That insurance dictates where you can or cannot go. Also I chose based on location/convenience to me rather than quality of service".

Amateur Nester, @amateurnester
"I found it frustrating that most clinics didn't have their costs listed on their websites. It would have made planning much easier if we'd had this information up front".

Its Positive Living, @its_positive
"Insurance (not having many options to chose from in my network/being tied to my network ... I have an HMO)".

THE RIGHT FIT WITH THE RIGHT PERSONNEL

The 2 Week Wait, @the2weekwait
"It was finding both a doctor and suggested protocol I truly felt enthusiastic about. To me, success rates can be manipulated, other patient opinions can vary and ultimately - nothing is more reliable than your own gut. If a doctor clicks with you, if the treatment suggested makes sense and you feel good about, that's all you need".

PCOS Diva, @PCOSDiva
It is disappointing when doctors do not have a solid understanding of how to treat PCOS using lifestyle modification as first line therapy.

Expecting Anything, @expectinganything
The most annoying part for me was the "marketing" behind this process by doctors/clinics. I mean, I get that it's a business for them, but some doctors forget that we are human, and this is real life shit for us! They all have different "sell tactics". They either beat you down and make you feel really bad or depressed about your situation, or they try to be overly sincere and emotional. We just want some facts and compassion people! Is it that hard!? I don't need to see all of the trophies "ie, baby pictures" plastered on the walls or some premeditated sob story. Show me your success rates and that you give a shit. It's that easy!

Our Misconception@ourmisconception
"The gatekeepers. You know the receptionists. These are the first faces you will see and the first you speak to when scheduling a consult or an appointment. They will be the ones that set the tone for the rest of the patient/user experience. Having navigated a cacophony of medical offices, this is an area/industry where empathy, education of the patient and social etiquette need to be greatly invested in as it lacks in most cases. My husband once had to spell out craniotomy to the appointment scheduler of his brain surgeons office. True story".

Triumphs and Trials@triumphsandtrials
"The most annoying part was going in to it blindly. Not knowing what the doctors were like and if they would be a good fit".

Anonymous 
"I needed an individualized approach on my treatment and a specialist who is willing to spare time to answer my questions and stay on top of all the details about my case. Not every clinic can do that due to patient volume. I was glad I was able to find the clinic I dreamed for after trying a big center in bay area, CA".

A LACK OF ALTERNATIVES

Infertile Soil, @infertilesoil
"In Canada you need to be referred to a fertility clinic (sometimes clinics will charge you if you don't have a referral) and many times doctors will refer you to just one particular clinic.

SIFTING THROUGH COMPLICATED INFORMATION

Trials Bring Joy@chels819
"Navigating outdated SART data".

AN EASY CHOICE FROM A TRUSTED SOURCE

Secret Infertility@FranMeadows
"I had a transition with ease since my OB/GYN referred me over to a fertility doctor that they personally used. This helped me feel more confident from the moment I walked through their doors. There was nothing annoying about me choosing a doctor".

 Life Abundant@lifeabundant_jw
"Nothing. My OB is able to do everything except IVF and is very knowledgeable in infertility treatment practice after doing her residency in a fertility clinic, so I have gotten lucky and have the best of both worlds. If we need IVF, I'll have to go elsewhere, and I will connect with her residency clinic and the doctor she trained under".

LET'S NOT MAKE THIS ANY HARDER THAN IT HAS TO BE

Hilariously Infertile, @hilariously_infertile
Uhhh. Being freakin' infertile is the most annoying part about choosing a fertility clinic.

Waiting In Hope, @waiting_in_hope
Honestly the most annoying part about choosing a fertility clinic is having to choose one AT ALL. Having to acknowledge the need for a fertility clinic/reproductive endocrinologist is heart breaking. It’s an acceptance that something is wrong. You have to grieve the loss of having a baby the “normal OB/GYN” route. And that it just might not be "easy".

Give the people what they want

As much as it's a service to you to equip you with clear information to make your decision, really, it's in our own best interest. The most effective way to grow our practices is through the detailed execution of a very simple premise: give you what you want. You can't decide on a clinic because you have no idea how SART success rates are being presented? Guess we need to make a video explaining SART data in plain English. You can't compare IVF costs between our competitors because no one will give you a straight answer? Sounds like we need to make an IVF cost checklist that you can download to compare potential additional costs. You felt isolated during your time at our practice because we never told you about support groups in our area? Apparently we need to make sure all of our patients go home knowing about the online, professional, and peer support resources that are available to them. In the age of ubiquitous communication, there is no shortage of ways to be able to collect and validate your input. Some clinics will ignore you and tell themselves they do a great job of getting you the information you want. Others will heed your suggestions and grow because of it. These are the clinics that deserve your choice, because you deserve nothing less.

Do you have something you want to say about your experience with your practice? Good, bad, or neutral? Please leave a comment or send me an e-mail! I would love to hear what you have to say.