Brand drives growth when it directs where the money goes
In 1962, Avis ran a distant second to Hertz. In fact, it had not turned a profit in more than a decade. Robert Townsend, its new chief executive, hired the agency Doyle Dane Bernbach. Copywriter Paula Green gave Avis a tagline, a brand promise really, that would run for 50 years. Avis was only No. 2. So it tried harder.
The admission garnered attention while specific promises did the work. The ads promised clean ashtrays and prompt service, things any customer could check at the counter. Within a year, Avis went from losing $3.2 million to earning $1.2 million. By 1966 its share of the market had climbed from 29 to 36 percent while Hertz fell from 61 to 49.
The slogan was a commitment operations had to keep. An agent with a dirty car on the lot was now breaking a promise said out loud to potential customers. In my way of thinking, that is what a brand is. It is a short list of promises the people doing the work can keep and customers can check.
What does this mean for health systems? Most treat brand as something they say. Sit in on a health system's brand review and you will find a long deck, three versions of a positioning statement and an argument over "caring" versus "compassionate." Every competitor in the market is having the same argument. Consumers cannot tell them apart.
Most purchasers of healthcare never read the positioning statement. They experience the brand when they repeat their history to a fourth person, wait an hour without an update or receive a bill they could not have predicted and that they can't understand. The banks, airlines and retailers consumers deal with every week have taught people to expect better. Friction now reads as disregard at best, disrespect at worst.
In reality, a health system's brand is whatever it chooses to fix.
None of this makes positioning optional. Avis knew what it stood for before it knew what to fix: the challenger that has to earn every rental. The position told the company which promises to make. A health system that skips the position ends up fixing everything a little, alongside every competitor fixing the same things. The position decides which problems are its to solve.
Consumers and Physicians Still Make Enough Choices for Brand to Matter
A skeptic will say healthcare is different, especially choice. Avis customers chose on an app or at an airport counter. Healthcare consumers mostly go where their insurance, their physician's referral or the drive time send them. That objection has merit. It is wrong, though, about choices at the margins, and in healthcare the margins are wide.
Families pick a primary care practice. A woman chooses where to deliver her child. Someone with a bad knee asks a neighbor where she had hers replaced. After the procedure, she decides whether to stay in network for follow-up. Physicians decide where to refer. Employers decide whether to contract directly. And increasingly, on-demand virtual channels through retail providers like Amazon and CVS offer no-insurance-needed alternatives to traditional care delivery.
Each of those choices is made by a person who has just been through the system or knows someone who has. That is where preference turns into competitive asymmetry: an advantage a competitor cannot match by buying the same billboard. Advertising can only amplify it.
Physicians deserve a closer look, because their choice is often the easiest to win. Physicians who decline to refer to a system rarely blame the referral process. More often they cite its reputation. That gap costs the least to close. The fix is telling physicians what is already true, with proof they can check.
Consumers Experience Empathy as Effort Taken Off Their Plate
Consider the daughter coordinating her father's cancer care. She tracks the appointment dates, the medication list, the insurance calls and the questions nobody answered last time. The health system handed her that work. Each piece it takes back is empathy she can feel.
That standard turns soft language into promises a consumer can check. She will not have to repeat herself. She will know what happens next, even when the answer is that nobody knows yet and here is when someone will. She will understand what care costs and how to pay for it before the bill arrives. Someone will coordinate care so she does not have to.
Low friction navigation, care coordination and cost clarity are examples of specific capabilities consumers value most and describe least.
None requires fixing the industry. One health system can explain an estimate. It can assign one person to own each referral. It can tell a patient in the waiting room how long the delay will run. Call this organizational empathy: operational fixes that remove friction, paired with staff behaviors that make the fixes felt.
Every Capital Request Should Answer One Brand Question
In most health systems, brand belongs to marketing. Capital, staffing and technology decisions get made in different rooms by people who rarely see the positioning work. That separation keeps brand in the realm of messaging instead of actual strategy.
The fix is to carry the brand into those rooms as one question. Does this make it easier to give or receive care, in a way people would notice and we can measure? Every request to the capital committee answers it in writing. Only then does the committee open the spreadsheet.
Put two requests in front of a CFO. One adds a specialty service line whose new patients would wait most of two months for a first appointment. It fails the noticeable test until scheduling is fixed. The other funds navigators for complex referrals. It passes, and the system can measure it in kept appointments and referrals completed in network.
A CFO will also ask what marketing returns. Ask which return. Health system marketing ROI is usually reported on net revenue. Contribution margin can tell a harder story, and spend that amplifies a promise nobody keeps is the spend most likely to fail that test.
This is also why brand fits awkwardly inside annual planning tools. Most of them score opportunities against criteria. The brand question belongs in the criteria. Scored as one more initiative, brand work ends up competing for budget with the projects it should be judging.
Culture is what structure and incentives repeatedly produce. Brand works the same way. What a system funds year after year becomes what patients experience. That experience is the brand, whatever the tagline says.
Marketing Can Make the Promise Only If Operations Owns the Fix
The attributes that drag trust down most are usually the bill, the wait and the phone line. Marketing owns none of them. Revenue cycle owns the bill. Operations owns the schedule. Yet marketing is the function measured on trust. No team can be held accountable for trust while it is kept out of the decisions that determine it.
The workable split is simple. Operating leaders own the fix. Marketing sets the standard for what counts as proof, collects it and tells it.
A Patient Promise Holds Only When Staff Can Deliver It
Health system commitments tend to be written in adjectives like seamless, compassionate and world-class. Nobody can be held to an adjective. So nobody is.
About 20 years ago I worked in an organization with a pledge built from behaviors. If you saw trash in the hallway, you picked it up. If you met a lost visitor, you walked them to where they were going, even if it made you 15 minutes late for a meeting. Nobody needed a training module to understand it. Everybody could see who lived it.
Consumer promises need the same treatment. Write five or six behaviors specific enough that a colleague could name a miss. "We don't make you repeat yourself" becomes an intake form that pulls from the last visit, a handoff script between nurses and a front desk that greets a returning patient with what it already knows. Those are design decisions. Each one can be checked on a Tuesday afternoon.
A promise usually reaches the board deck a year before it reaches the front desk. Ask a nurse on the night shift what the system promises its patients. If she cannot say, the brand is still a marketing asset.
Behaviors last when they show up where careers are decided. Write them into leadership competencies. Ask about them in promotion decisions. The hallway pledge worked because everybody could see who lived it. Visibility gets a behavior started. Incentives keep it going.
Three Promises Kept Every Time Beat a Brand Delivered Everywhere
The most common objection to an ambitious brand sounds responsible. Leaders say they cannot promise to make the service experience easier because they do not deliver it everywhere. That is true. In reality, nobody does.
Avis built its promise on a few things an agent could control: a clean ashtray and prompt service. A health system can work the same way. Research which two or three moments signal the most to patients and to the physicians who refer them. Fund those first. Measure them every month.
Picking three also forces a system to name what is broken. I've written before about leaders who tell the truth about the current condition, and the same discipline applies here. Take the message a patient hears: we know scheduling is hard, here is what we are fixing first and here is how you will know. She will forgive a miss. Handled well, with an apology and a visible fix, a miss can leave her trusting the system more than before.
Twelve Months Is Enough Time to Know Whether the Brand Changed
None of this arrives in one planning cycle. Most systems will spend the first year building habits: writing the question into capital requests, choosing the three promises and turning commitments into behaviors. Judge that year by direction.
Twelve months is long enough to evaluate. Did the capital committee apply the brand question to the budget, and did it change a single decision? Which three promises got funded, and what do the outcomes show? Do the behaviors show up in how leaders spend their own time?
The monthly numbers need a source, and most systems already own the instruments they need. A brand tracker says what people believe. A patient experience survey says what happened. Physician and employee engagement data tells you something about culture, pride in work and what informal messages are being communicated in the community about your organization. Almost nobody puts them on the same page. The distance between them is the most honest brand metric a system can build.
An annual capital cycle is also too slow to steer by. Someone needs the authority to add, retire or resize a promise between budgets, or the brand question gets asked once a year and forgotten by spring.
Avis made its promise at a rental counter, where any customer could check it in a minute. A health system makes its promise in a waiting room. The patient is already checking.
