What you need to know:

• Piedmont Healthcare is the largest healthcare provider in the state of Georgia, US, operating 22 hospitals, 12,000 doctors, 65 urgent care centres and circa 1,900 clinics in a state that’s home to 11 million people.
• CMO Douwe Bergsma joined the firm in 2020, after almost three decades in consumer packaged goods giants, 18 years of which were with P&G.
• Bergsma had watched the industry run headlong into narrow segmentation and personas – and was guilty as anyone of drinking the big tech Kool-Aid. But he realised something was off.
• On joining Piedmont, there was a chance to start afresh. But Bergsma admits to being “almost overwhelmed” by building a marketing philosophy from scratch in a new category with a large team and an army of agencies.
• Luckily, he’s Dean of the Cannes Lions Brand Marketing Academy and unloaded his problems to Cannes colleagues. “They started laughing,” he says, and told him to get in touch with James Hurman at the Cannes Lions Advisory, pronto. “They’re onto something you might need’.”
• Hurman’s recommendation was to literally follow marketing science rules from the likes of Les Binet, Peter Field and Byron Sharp to the letter – and sketched out a proposal on the spot.
• Bergsma bought in – and sold it into the marketing team, the customer experience team – and crucially the CEO. Over the next two years, the marketing team and all of its agencies went through a series of 20 marketing science workshops, often building briefs off the back of them on literally the same day.
• The upshot? Bergsma got the biggest marketing budget in Piedmont’s history. All KPIs are up – most at record levels. And now “I hardly get any challenging questions. It's kind of like, what can we do to drive this further?”
• Next he’s applying Sharp, Binet, Field et al to recruitment.
• Here’s how they did it – complete with a cut-out-and-keep seven point recipe guide to marketing science effectiveness from Hurman.
• Get the full download via the podcast. It’s worth it.

US marketers are generally less aware of the marketing and ad effectiveness thinking prevalent in the UK, parts of Europe and Australia today. But Douwe Bergsma, a former FMCG marketer with P&G who flipped to healthcare three years ago, is a born again believer.

As with all overnight successes, Bergsma’s apparent Damascene conversion was ten years in the making. It started with the realisation that a lot of the stuff touted in the trade press, on the conference circuit and by the big platforms, is, er, bullshit.

After 18 years at P&G, Bergsma in 2011 joined the biggest consumer paper goods giant in the US, Georgia Pacific, just as the big tech platforms were honing-in on marketer budgets and the new, 'improved' recipe for highly targeted marketing and media was starting to find its way onto the menu. Bergsma says he was as guilty as anyone back then.

“We all took our trips to San Francisco, did the tours, and came back saying, ‘okay, I'm spending X. I've done this introduction with all these [tech] players, now I need to spend ten times X, because they all have amazing returns on investment and effect on our brands’.”

But around that time, Byron Sharp’s How Brands Grow was published, followed by Les Binet and Peter Field’s white paper, The Long and Short of It. “And the more we explored [those two things], the more we were convinced that there were some lasting truths, some laws of marketing that would apply to our businesses,” says Bergsma.

He’d just joined Georgia Pacific as CMO and was looking under the hood at what to change, what to keep. “There was a lot of noise in the industry, high need for some clarity that was driven by science and data. And we combined those two and said, ‘okay, we need to find our own path, because if we start chasing every hot new thing, we're going to drive ourselves over the edge’.”

Back to basics

In some senses, it was a return to basics instilled in the early nineties.

“The concept of extra share of voice [ESOV] is something I learned at P&G in my first year as a brand assistant, which lost its way during the entrance of the digital options where everything became more performance marketing, and we kind of forgot about the share of voice,” says Bergsma.

“Some other things were relatively new – such as the need for segmentation and specific consumer cohorts and personas, which, if you look at some of the work, is not always as necessary as we originally thought.”

But it was “very hard to cut loose” some of the shinier new things, “especially the segmentation approach and the narrow personas for your marketing approach” Bergsma admits. “'Busy soccer mom with two kids, she watches these TV shows and these networks, and she has lunch with her friends', et cetera, et cetera. And then you step back and it’s like, how necessary was it for my media buy or my metrics?

"One of the big ‘aha’ moments was within our ROI metrics, we couldn't separate those segments anyway, and from a media buy, it was very hard to buy against those personas. So we're like, 'why are we developing those if we actually don't act against them?'”

Start over

Leaving packaged goods for healthcare in 2020 provided “a clean slate to bring in a whole marketing approach and philosophy from the start, rather than trying to rebuild or renovate the house as we did at Georgia Pacific”, says Bergsma.

So upon joining Piedmont, a $7bn non-profit healthcare firm that operates across the US state of Georgia – operating 22 hospitals, 65 urgent care centres and circa 1,900 clinics – he took a broom to the narrow way of doing things.

“What we've done here is first and foremost, define our categories and define our service lines,” he explains.

“When we talk about Piedmont as a whole and as a provider of healthcare services, whether it's primary care or specialty services, urgent care or hospitals, we use a very broad segmentation. We got rid of the defined personas – the busy soccer mom and the elderly single person and the young starter. Now we actually apply a very broad media buy, with the exception of some ethnic groups like African Americans or Hispanics, in order to reach those areas in the state of Georgia where we have a very large multicultural population,” adds Bergsma.

“Instead of using personas, we define the market as 'the market for cancer', or 'the market for heart patients', or 'the market for neuro patients'. We have broad application, rather than saying within the neuro patient market, we're looking at A, B and C segments and adjusting our media to it. So we’ve got more exact and more precise in defining what segment we're after from a service perspective, less from a consumer socio demographic perspective.”

Brand rebuild

Circumstance enabled Bergsma to keep sweeping: Covid arrived within weeks of him taking the job, while the healthcare group doubled its footprint to 22 hospitals after completing a string of deals.

“So we had Covid and we had the largest integration in our history. During that same period, we also decided to expand our services. For example, we never operated in mental health or rehabilitation health;  we expanded oncology. So you have Covid-19, you had new regions and new hospitals that you integrated and you moved into new service lines,” says Bergsma.

All the while, with the pandemic and misinformation taking hold, people were desperate for help they could trust.

“Trust and brand go hand in hand. During the integration, we moved into markets that had never heard of Piedmont. So that was another reason we needed a strong brand.”

Meanwhile, the group’s brand awareness had been dropping for the prior few years. “We were down about 20 per cent … our favourability was nowhere near where we wanted to be from a consumer preference [perspective]. And we had pursued a lot of other metrics for several years that we had not been able to hit,” says Bergsma. “When you combine all of that up, you take a step back and say, ‘we need a different approach, we need to build our brand and we need a very different approach from what we have done so far’. And that’s what we’ve done.”

‘Almost overwhelmed … other marketers laughed’

Bergsma makes it sound simple. It wasn’t. He admits to being almost paralysed by the first task at hand – the new CMO coming in and aligning everyone behind an entirely new mission.

“We needed a marketing philosophy and approach that everybody would understand, everybody would buy-into, and everybody was able to activate. That was a massive challenge and at the time I was almost overwhelmed. How the hell am I going to do that? I’ve got a department of about 80 people. I’ve got four to five agencies, about 40 people there too…”

But then fate intervened – Bergsma unloaded his challenge to his colleagues on the Cannes Lions Brand Marketing Academy, of which he is Dean. “They started laughing,” he says, and told him to get in touch with the Cannes Lions Advisory, pronto. “’You need to talk to James [Hurman founder at Previously Unavailable, Auckland] because he's onto something you might need’.”  

Bergsma took the advice and made the call. “After the very first conversation, I was like, ‘that’s exactly what I need. Start sending me estimates and start sending me a plan, because this was the most timely thing’,” he says. “I don't believe that it was luck. I think it was meant to be. And that's how it started.”

Baking with Les, Peter and Byron

James Hurman, founding partner at Auckland-based Previously Unavailable, says while most organisations have some exposure to marketing science – the challenge is bringing everything together.

“If you think about the principle of excess share of voice or the principle of mental availability or any of these things … it’s like baking a [marketing science] cake. If we bake a cake with all of the ingredients, it turns out brilliant. If we leave a couple of the ingredients out, it either tastes disgusting or it's a big old mess,” says Hurman.

“I think that's the challenge that all sorts of organisations have: understanding all of those principles and how to bring them together around a brand to really drive effectiveness.”

Hurman isn’t one to let a perceived injustice slide (he compared Professor Byron Sharp to a particularly unwelcome party guest after the Ehrenberg-Bass principal last year had a pop at Les Binet and Peter Field’s brand to performance ratios). But he’s generally a big believer in Professor Sharp’s work. All the same, Hurman underlines that nobody has all the answers.

“The IPA's work [via Binet & Field] is incredibly valuable, but it's not complete; the Ehrenberg-Bass Institute’s work is incredibly valuable, but it's not complete. But when you put that work together, you end up with a kind of unified theory of marketing effectiveness. And all of those principles that each of those organisations has developed, they're very complementary, and they work brilliantly together,” says Hurman.

“So the work with Douwe and Piedmont was about bringing all of those principles together in a way that could be very actionable, very well understood by everyone, and [packaged] in a way that they could apply as a framework for their brand and marketing.”

And so the chefs began to blend the organisational ingredients into the mix.

“We basically had my whole organisation go through 20 training sessions over two years, which included everybody at the agencies,” says Bergsma.

“I literally said to the agency teams 'listen, this is what we're doing. Find people in your organisation that naturally gravitate to this approach. I don't want anybody to start arguing about I don't know if Byron Sharp is right and I don't agree with James. We're past that, right or wrong.' And they all stepped up to the plate – our PR agency, our creative agency, our media folks. Even the agency that manages our sponsorships, our research agency – we included a very broad team, which I had to convince James to broaden. And then most recently, he did a B2B session for my B2B department, which is a whole different element.”

Then Piedmont started work on the new brand and campaigns literally at the same time.

“Ideally, that would have been sequential – you go through the philosophy and then you apply the philosophy. But we would have a training session with James in the morning and then would have an agency briefing in the afternoon.”

In the end, though, “it actually worked out”, says Bergsma. “We didn't know that [would be the case] up front.”

Did Piedmont do everything Hurman advised? “Even if we did, I would never admit that to you,” laughs Bergsma. “But … we did 80-90 per cent of what we learned. I would say there are some areas that we know we should or could do better, but for pragmatic reasons or internal alignment challenges, we didn't get there.”

One such aspect is the role of emotion within its brand marketing. “In my opinion, we haven’t quite nailed that yet,” says Bergsma.  “But we're working on it, and the next round actually we’ll get there.”

Less purpose, more experience benefit

Part of that missing piece was initially intentional – healthcare industry marketing has been awash with emotion and purpose for decades, per Bergsma, while largely failing to communicate experience benefits. He says it’s almost an inversion of the path carved out by the FMCG sector.

“I came from consumer products, where everybody was talking about functional benefit for the longest time. Then they started adding emotional benefits. And then for the last five or ten years, it had to become more purpose-driven – and there's a lot of content on that. Then I go to healthcare and everything is purpose-driven. The whole industry is purpose driven, the people that work [in healthcare] do it because of their purpose, and almost everything was emotionally-driven. Emotional patient stories – before and after somebody got sick, got diagnosed, was saved...” says Bergsma.

“So our need was not to become more purpose-driven or more emotional. Our need was to highlight some of the experience benefit that we were offering – raising the standard to match other industries, such as airlines or hospitality. So you can find and book a doctor online, check in before you walk in, have all your information conveniently in one place. Those things were relatively new to the industry.”

So Piedmont's current ads focus on communicating functional and service benefits. The next step, says Bergsma, is to do that more emotionally “to get the best of both”.

Hurman suggests Bergsma is downplaying Piedmont’s approach to date. He says there is a level of emotion baked-in to its ads. “The work that he's done actually presents a lot of those things that could be viewed as slightly more functional, those aspects of the experience. But they've really done it in a way that is just miles ahead of what they were doing in terms of the humanity, the warmth, the kind of emotion with which those things are communicated.”

Effectiveness in application: The breakdown

Hurman believes advertising effectiveness can be boiled down to seven key components.

Basecamp, he says, is “are we spending enough money to grow? As Les Binet likes to say, ‘nobody wants to hear it, but still there's no real replacement for spending adequately’. That's the principle of excess share of voice [ESOV], a way of figuring out whether we are actually spending enough compared with our competitors to grow … Because if we don’t, everything else is kind of academic.”

Step two is working out the target market. Hurman says Bergsma’s observations around narrow segmentation and persona “rabbit holes” are spot on. Instead, Hurman backs Ehrenberg-Bass’ work that asserts most brands’ customer bases reflect the market at large and the aim should be to attract everyone who is in a category to buy. “So the really important thing is to target very broadly, stop trying to use advertising to drive loyalty [because] that doesn't work [and instead] use it to drive penetration; get new, lapsed light users into the category.”

The third plank is to balance both long and short-term growth – literally the kernel of Les Binet and Peter Field’s most famous work. “You’ve got to do both of those things brilliantly.”

Fourth is Ehrenberg-Bass’ principle of mental availability and distinctive assets, says Hurman. Mental availability is “just the idea of how do we keep our brand top of mind among a wide audience and make sure our advertising is being recognised so that it works to keep our brand top of mind.” Which is where distinctive assets come in – i.e. ads and brand assets that “make sure that our brand is one that's very easy to think of in a buying situation”.

Fifth is the role of emotion in advertising, “to make sure that when people make a decision that's based on feelings, that decision is toward us and our brand”.

Then comes a breakdown of the role of creativity, “which is the biggest lever that any marketer has to drive ROI increases”, per Hurman. That sixth step also wraps in ‘creative commitments’, which unpacks “the three variables of all campaigns – how much money is spent on the campaign; how long it runs for in market; and how many media it's spread across,” he adds. “There's a very clear correlation – which we call the principle of creative commitment – which says that as we spend more, spread our message out over more media and run it for a longer duration, it gets more and more effective.”

Even where budgets are reduced, if the campaign is run broad and long, effectiveness will grow, he says. The flip side is that “chopping up budget into tiny little bits and spending it on lots of little campaigns,” is less effective, argues Hurman. “So it's better to land on one big brand platform and run it over many media for a long time.”

The seventh and final step is around measurement of performance. “How do we make sure that we're setting the right objectives, measuring those and ensuring that we're meeting them and learning from the work that we're doing?”

Plus one more step: CX

Piedmont did all of the above and then blended-in another step, customer experience – at risk of all the marketing promises otherwise falling flat.

That responsibility fell to Chief Consumer Officer Katie Logan, “and she was the biggest fan of our campaign, because all of the things that she's built over the years were not being effectively communicated in the marketplace,” says Bergsma.

“So Katie was one of the first people to tell her team ‘Hey, this is what we're doing.’” Their response? “‘Wow, finally we have a marketing organisation that fully supports everything we've been building,’” says Bergsma. “So we became really strong partners throughout that whole process.”

The results, plus metrics of success

1. Brand building

The first things Hurman, Bergsma and ultimately Piedmont President & CEO Kevin Brown needed to define were metrics. They broke it into three blocks, with the first centred on brand building.

“We kept it very simple: top of line awareness and favourability among those people who are not yet a patient,” says Bergsma. “ We basically said awareness is literally 'what healthcare system comes to mind if you think about a healthcare provider and then whatever people say first'.”

On that measure, it’s powering. “It was in decline [previously], now it’s at a record high,” per Bergsma. He won’t divulge the number, but says “for top of mind awareness we are the number one in Georgia, outperforming all other [providers] by far. And when we started we were all about equal.”

Consideration is a little more tricky, because the more people Piedmont adds to its brand awareness bucket, the less those people actually know about the brand beyond being aware of it – getting Piedmont beyond awareness to consideration becomes critical.

“So we expected while our awareness was going up that our favourability or our brand preference would remain flat or down. But that actually that went up as well. So awareness and brand favourability are both at a record high – but since awareness is growing so fast we are adding a lot of people who don't know our system that well. So [favourability] is a slower burn.”

The PR function did – and still does – much of the brand heavy lifting.

“PR is by far the largest generator of impressions in healthcare. It's almost ten times more than my marketing impressions,” says Bergsma. “So the PR department went through the training with James as well. We gave them the numbers and said ‘you are responsible for brand building, awareness and favourability – don’t worry about activation and conversion, that’s not your job’. Which freed them up to focus on that.”

2. Activation

The second set of metrics are in activation.

“Les Binet calls it sales activation, we call it brand activation, because in healthcare, sales is not a preferred word.” Whatever it’s called, the activation numbers are also “at a record high,” per Bergsma.  “The number that we measure is called ‘office visits’, which is almost like store visits. It's measured through the appointments that are made, and then the patient actually shows up at the physician's office or a virtual visit. It's literally the part that we can bill.”

Then, for good measure, the CEO “threw in contribution margin” into the mix. “Our metric that is closest to profit, if we were a for-profit organisation. It’s literally the margin that we reinvest in our organisation,” says Bergsma.

3. Customer experience

The third suite of metrics was centred on experience – perhaps the hardest of the lot to accurately ladder back to marketing and CX, Bergsma admits.

“Our NPS [net promoter score] is very high, mostly driven by the interaction between you and your physician. So it's very hard to measure the NPS for the total experience. We're actually trying that next year. But as a marketing and an experience organisation, we have a hard time claiming credit for our extremely high NPS scores, because it's literally down to the interaction with your physician and the fact they just saved your life or they just help you deliver a baby.”

So instead, Piedmont decided to focus on the adoption of its digital tools as the key measure of success: “Whether people book online, whether they check-in before they walk-in, whether they open a MyChart account, which is literally your account where all your data sits – and all of those metrics are also at a record high,” says Bergsma.

“That was important because our campaign and our brand positioning was mostly about us being distinct in the marketplace, because we’d had this digital transformation at Piedmont that most healthcare systems haven't yet adopted – or at least to the same level … Therefore it was important that we measured them as well."

The upshot is that across the board “almost all of [those metrics] are at record high," says Bergsma. "Some of them are significantly ahead of where we are, some of them are slightly ahead of where we were, but not a single metric went down.”

CEO backing marketing science?

The CEO handing marketing the biggest budget in the organisation’s history suggests top brass and the board accept that the marketing science deployed is credible.

Bergsma says that’s true – but there is always a role to deepen the collective faith.

“On the adoption of the [digital] tools, I would say that there's a high acceptance and high level of credibility on the improvements, because you can deny those – you have more downloads, you have more enrolments, et cetera, et cetera. There's also a high acceptance between our efforts and the office visits,” he says.

“We show correlation dashboards between our emails, our website visits, our display ads, our paid media – we try to show correlations and we are trying to apply MMM analysis [market mix modelling] to show the impact of our activation efforts against the office visits.”

The hardest parts to correlate, he says, are PR and sponsorships. “Sponsorships are like a whole season, it's off or on. And PR, we literally are in the media every day, but it's very fragmented and hard to track.”

Meanwhile, the role of awareness and favourability, he says, has “mixed acceptance” with the powers that be.

“But almost everybody knows that having a strong reputation in the marketplace intuitively is important. In healthcare, you hardly talk about brand equity and brand awareness. You talk about brand reputation or physician reputation, or hospital reputation.

“In my mind it's the same thing. But if you switch the language, every hospital CEO we have will say, 'yeah, reputation in the market is extremely important. And yes, I do believe you guys are helping me to build a reputation',” says Bergsma. “But I would say that part is where we still have upside from a metrics perspective. The other ones, three years ago there was a mixed perspective. Today I hardly get any challenging questions. It's kind of like, what can we do to drive this further?"

Which is handy, because now Piedmont is taking the marketing science cake mix and applying it to new markets. Plus, to recruitment – all that growth means Piedmont needs more staff.

“So that's the next big challenge that we're working on,” says Bergsma. “And it’s pretty exciting.”

If you've read this far, you should definitely listen to the podcast. There's even more in it.