Marie M. La Fargue

Marketing a breast center is a challenge; it may be beset by unpredictability and unnecessary aggravation, but it can also be an empowering personal and professional calling for those on the breast-health team. Payors, referring physicians, and patients are best served when organizations engage in an honest, practical self-assessment of mission and purpose. The successful marketing of a breast center can be achieved by organizations that understand the purpose, financial characteristics, and development potential of the service line. Organizations that lack this strategic focus may be disappointed by their breast centers.

PROFITABILITY

Service-line leaders of breast-health programs must make an immediate connection with their colleagues in the areas of finance, decision-support services, and contracting. The benefits of the breast-health service line to the organization must be defined, and the degree of profitability required to support the program must be determined. Experience at St Joseph Hospital, Orange, Calif, has shown that education and advocacy can result in sustaining a program and positioning it for growth.

In 2000, mammography at St Joseph hospital was a huge money loser. Breast services were viewed as a community benefit program comparable to the institution's free community health clinics and vans that go into the community to help the poor and vulnerable. Under the umbrella of women's health services, St Joseph Hospital has remained committed to providing the full scope of care for women in the community. Working with a team of specialists from the finance department, however, brought the opportunity to reposition the breast center within the organization. Collaboration with experts within the hospital and selected breast-health consultants resulted in the magnification of the breast center's strengths and a more favorable view of the service. Analysis of key operations and financial indicators led to this repositioning. Organizations can duplicate the steps taken at St Joseph Hospital if they pursue the recommendations shown in the sidebar on page 16.

If, following financial analysis, the breast center still does not appear to be profitable, the value added by the program must be emphasized. It is important to promote the benefits of the breast center to payors, referring physicians, and patients. The service might be able to fulfill a payor's need for cost efficiency or better outcomes; similarly, it could meet the need for mammography access of a county, region, or state. While the program could be a loss leader, its might also generate more media coverage for the institution because of the substantial national advocacy forces generated by a growing number of breast-cancer survivors. Breast centers also attract major grants and gifts for organizations that focus on slowly, strategically nurturing relationships with major corporations, foundations, and individual donors.

Breast-disease management is complex and convoluted. Navigating the complete needs of patients can tax the time, energy, and resources of a primary care physician. The abundance of emerging technologies makes it difficult for referring physicians to keep abreast with the most appropriate, advanced breast-health management. A center of excellence in breast health that provides unique competencies; that participates in national and international clinical trials and other research; that offers CME and training; that is associated with recognized breast-health thought leaders; that has patient navigation systems, community prevention programs, and breast-wellness programs in place; and that shares its expertise for the common good will become a resource center for physicians and a haven for their patients.

TRAINING AND PARTNERSHIP

Breast centers should invest in the recruitment and development of staff focused on high-quality breast-health care. Leaders of breast-health programs must search for and apply the hidden strengths and gifts of each member of the team. In making staff the main priority of its program (after patients), St Joseph Hospital uncovered a master interior designer posing as an executive secretary, a surgery scheduler with the finesse of an ambassador, a fund-raiser disguised as a mammography technologist, and a host of other people with hidden talents for community relations, database management, and event planning. Unleashing these talents has resulted in outstanding customer satisfaction, employee relations, regulatory compliance, financial performance, and quality improvement.

Never underestimate the power of reciprocity. In targeting markets for advocacy, outreach, and community collaboration, it is best to seek less conventional sources of support. If the organization is even remotely related to women and breast health, it might gain from building bridges between industries, communities, and cultures. The St Joseph Hospital Comprehensive Breast Center has been able to reach out to women in its service area through the support and partnership of a diverse group of organizations such as Chevron, Vons, women's civic groups, colleges, the Vietnamese and Latino communities, Y-Me, the Susan B. Komen Foundation, and others.

PATIENT-CENTERED CARE

These strategies mean nothing if they are not centered on the most important element of a breast center. An organization is doing the patient more good by dropping a service line than by maintaining it if the facility does not intend to do its job properly. Women will flee to the competition if the breast center is patronizing. Patients should not have their treatment options depleted; even if the center lacks the necessary expertise, it should support the patient in seeking second opinions, clinical trials, and research (and, when all else fails, in dying in a comforting environment). Tolerance for the patient's cultural/spiritual approach to health care should be evident, especially as she might never previously have received traditional medical treatment. A bureaucratic environment should be avoided; in a frightening situation, the patient should not have to face endless paperwork, phantom charges, disgruntled or detached care providers and support staff, or unreasonably long waits for information and results.

CONCLUSION

Marketing a breast center is not rocket science; it requires conscience. Adapting these marketing strategies can help an organization to balance the demands of organizational resources, internal capability, and the level of commitment to high-quality breast-health services. The performance bar in breasthealth services continues to rise. With a growing focus on quality report cards and an increasingly savvy patient population backed by a strategically positioned advocacy army, this is not a business that can be undertaken in the absence of a quest for perfection.

FOR FURTHER READING

Harness JK, Oberman HA, Lichter AS, Adler DO, Cody RL, eds. Breast Cancer- Collaborative Management. Chelsea, Mich: Lewis Publishers; 1988.

La Fargue MM. Oncology Roundtable, Oncology Finances: Assessing Service-Line Trends and Opportunities, Strategies and Best Practices. Washington, DC: Advisory Board Co; 2003.

Parikh JR, Coleman CM. Building a better breast program. Decisions in Imaging Economics. 2002;15:60.

Marie M. La Fargue, MPH, is executive director, breast services, St Joseph Hospital, Orange, Calif, and a two-time breast-cancer survivor.