Situation Analysis for Hospital de Diagnóstico

Running head: SITUATION ANALYSIS, HOSPITAL DE DIAGNÓSTICO 1

Situation Analysisfor

Hospital de Diagnóstico

Alina AvalosChip LowePurvi Pandit

Taylor Ullman

Dr. Juan-Carlos MolledaJasper Fessmann

PUR 3801, Fall 2014University of Florida

Department of Public Relations

Tuesday, September 30, 2014Revised: Tuesday, November 4, 2014

SITUATION ANALYSIS, HOSPITAL DE DIAGNÓSTICO 2

Background of Situation & Problem:Opportunity Statement

Hospital de Diagnóstico is a private hospital system located in San Salvador, El Salvador. The first hospital, Hospital de Diagnóstico Colonia Medica was founded in 1978. Through the many services offered to the public, the hospital has continued to grow throughout the years. In 2001, Hospital de Diagnóstico expanded with another building at Colonia Escalon in San Salvador. Plans to continue the expansion are set for 2015, and in 2016 Hospital de Diagnóstico Sur will be open to the public, said Evelyn Obando, Communications Manager for the hospital.

The strategic key message is that although Hospital de Diagnóstico may be located in a third-world country, the hospital itself is considered a first-world hospital and a world-class institution. According to its fact sheet, Hospital de Diagnóstico includes institutes, centers and services for cancer, genetics, neuroscience, orthopedics and more. It has made much progress in the technological aspect through new machines essential in medicine today. In order to perform surgeries of high complexity, Hospital de Diagnóstico established a quirofano inteligente, or smart operating room. This project allows doctors to get a clear image of the surgery they are performing and connect it to a smart TV so they can get a better visual understanding of what needs to be done. The hospital also implemented the first center for radiosurgery in the region. With its infini machine, the center is able to focus on specific parts of the brain to treat tumors and malformations. The infini machine drew media coverage worth about $75,000 in publicity and international coverage. Organizations and media throughout the world have recognized the success of Hospital de Diagnóstico’s technology (Hospital de Diagnóstico, 2013).

As Hospital de Diagnóstico continues to grow in both size and medical advancements, it is imperative that the reputation of the hospital and clientele grow as well. Hospital de Diagnóstico is committed to excellence in medicine, medical technology and having prestigious specialists. According to the fact sheet, the hospital also has a foundation that helps fund patients who do not have the economic resources needed to access the care they need. The foundation of the hospital takes part in supporting the Salvadoran Archeology Society and has contributed to the establishment of a theatre in the city of Suchitoto. Hospital de Diagnóstico is also a green hospital, committed to the practice of eco-friendly activities like conserving energy, reducing carbon footprint and using “green” radiology.

These characteristics of excellence in medicine, technology and staff, along with the foundation of assistance in funding, commitment to the community and eco-efficient practices should draw in patients not only from El Salvador, but worldwide. Obando said the hospital specifically wants to bring in fellow Salvadorans that are living in different Latin communities throughout the United States. It wants to attract these Salvadoran-Americans to ensure that when they come back to visit family or their homeland, they will have proper care available to them. The hospital wants to gain recognition within its country and within its population, regardless of location, and it has the opportunity to do so with its department of communications established in February 2014, according to Obando.


Background of the Organizations:Internal and External Environments, Impediments and Public Perceptions

StrengthsHospital de Diagnóstico promotes medical tourism, an amenity to those around the world

seeking cheaper treatment for their diagnoses. This amenity has mostly been utilized by the United States (Turismo).

WeaknessesDue to the fact that America is the leader in that niche within Hospital de Diagnóstico’s

business, a concern legitimately arises that citizens of the US do not find El Salvador to be a safe country. One of the impediments hindering the hospital’s success is the civil war that occurred in El Salvador for 12 years, ending in 1992. The war left a broken infrastructure, and when the US went to investigate six high-profile murders, there had to be an international process to end the war (PBS).

Within the hospital itself, the amount of social media and web-based output is limited. The large internal stakeholders see these changes as frivolous in comparison to other forms of marketing. The stakeholders also need to be convinced of the weight of importance that social media has in reference, and the potential patients it can bring, to their hospital.

OpportunitiesHospital de Diagnóstico can market itself in a positive light to showcase its hospital as a

care facility of the first world, which happens to be in a developing nation.

ThreatsThis high-profile case is a large reason why Hospital de Diagnóstico will face an uphill

battle when trying to gain a larger market within the medical tourism niche. There are a large amount of international citizens who perceive El Salvador in a negative light, and see it as a third-world country without the everyday safety expectations that experience in their home country.By far the largest amount of skepticism toward traveling to El Salvador emanates from the U.S. Department of State. On April 25, 2014, the Department of State issued a travel warning to US citizens of the violent crime occurring in El Salvador. The warning stated that El Salvador has seen a heightened homicide rate of 10 people killed per day, surpassing their highest homicide rate from 2011 (El Salvador Travel Warning). According to the same document, 31 Americans have been murdered in El Salvador since January 2010. The report requests that all citizens travel with caution upon entering El Salvador.

Another report by the Bureau of Diplomatic Security states, “Medical care is limited. Emergency services, even in the capital city, are basic at best. Although many physicians are trained in the US, their staff and equipment are generally not up to U.S. standards.” The report continues to state that tourists should stay away from buses, the downtown area, unguarded parks


and public roads and advises against swimming in any public beaches (El Salvador 2014 Crime and Safety Report).

An increase in negative news coverage regarding El Salvador has occurred recently as well. An article was written on September 23, 2014, published by NPR, headlines, “Why a Teenage Mom Was Jailed in El Salvador After A Stillbirth” (Beaubien). The article describes that abortion is completely illegal in El Salvador, and assesses a child as a human being from the start of conception. Regardless of their beliefs, first-world citizens may perceive these recent headlines involving strict laws as dissimilar to their experiences and expectations within the first world. This could deter a potential patient of a developed nation from seeking treatment in El Salvador.

Another cause of for concern among citizens of developed nations is the recurring news on how the largest amount of illegal immigrants with credible-fear cases are from El Salvador (The Wall Street Journal). This means that they have, “credible fear of persecution or torture” (WSJ). Overall, it seems these threats are concentrated in safety and fear of the unknown. Existing Communication Techniques and Efforts:Strategic Key Messages

Existing communication platforms include a website, blog, and Facebook and Twitter pages, which are dedicated to establish the hospital as one of the most advanced cancer treatment institutions in the world. The department of communications created a logo in 2008, which is consistently used on each social media platform to increase brand recognition. Its key audiences include Salvadorans living in El Salvador and the U.S., so most of its content is written in Spanish to cater to this audience. Prior to its social media efforts, the hospital relied on traditional marketing techniques such as advertisements in newspapers, magazines and other printed material for distribution. It also broadcasted radio and television commercials and mailed fliers, brochures and letters to clients. It has decided to increase its social media presence because its goal is to attract the 1.6 million Salvadorans living in the United States and to gain international media coverage and recognition. Traditional marketing techniques cannot serve this international scope the hospital is trying to reach. A study published by the Journal Medical Internet Research (Year) found that "approximately 60 percent of Internet users report using the Internet to look for health information." (Top-Ranked Hospitals for Cancer, September 29, 2014). The overall strategy of the digital marketing strategy we have formed for the hospital include informing and reassuring potential patients that it is the hospital's mission to "provide the best specialists, the most advanced technology and give patients personalized attention and first-class quality." (Our Service Philosophy, September 29, 2014). Each platform produces informative content with a humanized voice. The website effectively describes how the hospital is unique with the proper facts and sources to credit the claims. The hospital is the "only one in Central and South America to provide radiation therapy and radiosurgery with TomoTherapy Hi-Art.” (Our Service Philosophy, September 29, 2014). The hospital also claims the best


chemotherapy facilities for those patients undergoing treatment or for those who require surgery. These positive statements, along with many others, will work to reassure potential patients that they will be taken care of with the best technology available in the world. Evelyn Obando is the director of the department of communications, which consists of an advertising agency, photographers and media relations practitioners. The department is responsible for the creation of all of the social media content. The department has acknowledged its lack of social media efforts, setting its priority to inform and engage with potential patients. The key message that it focuses on across all communication platforms is that the hospital is a “first-world hospital in a third-world country,” (Obando, personal communication, October 26, 2014). In order to spread this message, it has updated its website with pictures of new machinery, faces of happy people, testimonial quotes and emotional slogans. Slogans on the website say "together we can defeat cancer" and "warm care by your side in the fight against cancer." These messages strive to inform people that the hospital cares about its patients like family, especially because it's a family business. According to Forbes, whether it's growing your brand identity or improving medication adherence through visual instructions, images are key to interacting with, as well as informing and empowering patients. The default language of the website is Spanish, but Google translator can translate in English. It is organized and visually appealing with pictures of patients and an abundance of information about the services it offers. The website makes it clear that the hospital is a comprehensive care center, offering chemotherapy, radiotherapy, radiosurgery, emotional support, rehabilitation and more. It uses emotional appeals to captivate its audiences, such as recognizing that cancer doesn't discriminate who it attacks. The website combines professionalism and humanization, in order to make anyone feel at home. This sense of feeling at home is a key message of the hospital, because it wants to reassure El Salvadorans that not only is the hospital a safe place, but El Salvador is too. International patients are catered to through a link on the website that connects people to FlyMedicine. This is a program that connects patients with the leading healthcare facilities in El Salvador, and it plans medical tourism services for patients such as travel arrangements, lodging and surgery. Partnering with this program helps accredit the hospital, while also appealing to its targeted publics. Overall the website has many beneficial factors for viewers and potential patients, and Obando continues to research other effective hospital websites for consistent improvement. The Hospital de Diagnostico Colonia Escalon’s Facebook page currently has 40,657 likes, which has mores likes among other top ranked cancer hospitals in the United States. Memorial Sloan Kettering Cancer Center in New York is ranked number one. (Top-Ranked Hospitals for Cancer, September 29, 2014). It has approximately 39,200 likes on Facebook. While likes on Facebook don't necessarily determine a business's worth, it does indicate the awareness level of a business. The Hospital de Diagnostico Colonia Escalon’s Facebook page is being constantly updated with pictures of doctors and machinery, informative articles and videos and of medical tourism. People are sharing the content, commenting and liking posts, which means people are engaging, and international awareness is being achieved. While the Facebook account is effectively pushing the hospital's key messages to its key publics, the twitter account


is lacking in comparison. It was created in July 2012 and it currently has 371 followers, 1,291 tweets and has posted 21 tweets with pictures and videos. The cover photo of the Twitter account is a picture of a high tech machine that operates on the brain without scalpel radiosurgery with a gamma ray system. This picture and its description shows the audience the kind of advanced technology it has to offer and the supports the hospital's goal of hope of a world without cancer. Grandparents are the fastest growing demographic on Twitter, which is a great place to target an age population who consumes the majority of health services. (“10 Things”, September 29, 2014). The hospital also has a blog connected to its website, which can be viewed in English or Spanish. (Blog, September 24, 2014). The blog contains of posts about the myths about cancer, treatments for cancer and reasons why people should go to El Salvador for treatment. This is an effective technique, because 70 percent of people would rather learn about a company through articles rather than a direct advertisement. (Jarski, September 29, 2014). The YouTube account is the newest addition to the hospital's existing communication. Its account was created on September 23, 2014. It uploaded three videos between September 24 and September 30 and it has acquired 16 subscribers. It has a cover photo that matches the cover photos of its other social media accounts. The department decided YouTube was important to integrate into its digital campaign because YouTube traffic to hospital sites has increased 119 percent year-over-year. (The Digital Journey To Wellness, September 29, 2014). Also, the Google study found that 53 percent of patients who did not watch a hospital video were unaware the hospitals existed. This communication tactic will be extremely successful for increasing traffic, because it will help share the human element that the hospital has to offer. It will be able to show the hospital's facilities, share interviews, patient stories and insight from the hospital's employees. The hospital has a foundation that focuses on three areas. Funding, rescuing the Salvadoran culture and a green hospital, are all areas that can be boosted through social media efforts. As international awareness and a positive reputation increases, funding for medical treatment for patients with diseases who don't have access to economical resources will increase. This will give Salvadorians a chance to return back home for treatment and rekindle their Salvadoran culture. Through social media, people can experience the green hospital by looking at pictures, videos and blog posts about the solar panels, saving lights and other eco-efficient daily activities in the hospital. This green hospital supports the key message because it proves how technologically savvy this hospital is, while also expressing its dedication to the health of the environment and people. The communication department will continue to update its platforms with the main goal of engagement with its publics. Social media has become a vital tactic for hospitals to connect with their customers, clients and patients. Interestingly, few healthcare organizations are utilizing the two-way conversations that social media offers. (The Increasing Importance of Social Media in Healthcare, September 29, 2014). Also, only 26 percent of 5,724 hospitals in the country are using a form of social media, which puts Hospital de Diagnóstico at an advantage above other hospitals. A way for the hospital to increase its already inherent advantage would be for its social media platforms to have a strong mobile focus. The website, twitter, blog and and Facebook


account should be accessible on various digital devices such as laptops, tablets and smartphones. Description of Targeted Publics

Per the interest of our client, our campaign will focus on targeting the Hispanic population in the United States, particularly El Salvadorans. Since the goal of the campaign is to increase medical tourism and surgeries at the hospital and its partner campuses, our evaluation of the targeted publics includes demographic and pertinent information that will allow us to gain a comprehensive understanding of the groups we are developing strategies and messages to reach. Research Center’s Hispanic Trends Project 2011 report, there are about 2 million Hispanics of Salvadoran origin living in the US. The report analyzed data collected from the Census Bureau’s American Community Survey (Pew Research, September 29, 2014). The statistical profile used in the report is based on individuals who self-identified as Salvadorans, meaning they are immigrants themselves or are descendants of immigrants. More importantly for the scope of our strategic analysis, Salvadorans are the third-largest population of Hispanic origin living in the US. They account for 3.8 percent of all Hispanics in the US, only surpassed by the Puerto Rican population at 4.9 million, or 9.5 percent, of the Hispanic population, and the Mexican population with 33.5 million, or 64.6 percent.

Although Salvadorans are just 3.8 percent of the US Hispanic population, they are the third largest group in the US. This data begins to tell a story of how important the Salvadoran population is to the overall Hispanic population in the US. This therefore indicates the Hospital de Diagnóstico was correct in its assertion that many Salvadorans are willing to return home for medical procedures. Six-in-ten Salvadorans are foreign-born, or immigrated directly from their home country. Another study by the Migration Policy Institute in 2010 analyzed the reasoning for Salvadoran immigration to the US. (Terrazas, September 30, 2014) The report found that between 1980 and 1990 the Salvadoran population increased fivefold from about 94,000 to nearly 465,000. This massive shift of the Salvadoran population is attributed in the report to civil wars in Central America in the 1980s, followed by natural disasters, including earthquakes and hurricanes. These reasons are important because it describes an immigration group that was motivated by political and climate-related factors, as opposed to economic opportunity, religious freedom or exploratory motivators, which are other common reasons for immigration. This data continues to describe a population that is willing and able to leave the US for medical treatment.

In determining the geographic location for campaign strategies, the research showed that 40 percent of Salvadorans live on the West coast, with about 90 percent of those residing in California, and 41 percent in the South, mostly in Texas (14 percent of all Salvadorans in the US) and Virginia (7 percent of all Salvadorans in the US.) We will need to take this into consideration because of the social norms and cultural identities that separate the West coast and the Southern US states. Once we established a clear need and means for Salvadorans to return to El Salvador for medical purposes, our next research goal was to determine the best mediums for the


communications we plan to implement with the targeted publics. The hospital PR team has expressed a strong interest in Internet communication strategies, so we focused the beginning of our research on that medium. A 2013 Hispanic Internet Usage study by the Pew Research Center determined that Latino Internet usage was up 14 percent since its previous 2009 study. The research also revealed a considerable gap between English, bilingual and Spanish speakers and their Internet usage habits. As of the 2013 report, nearly 90 percent of English-speaking US Latinos use the Internet daily. That number drops to just over 80 percent for bilingual Latinos, and down to 60 percent for Spanish-only US Latinos. However, the data shows a stark upward trend for Spanish-speaking Internet users: In 2009, only 35 percent reporting using the Internet daily, and that number has almost doubled in the 2013 report. This report also detailed the profiles of Latino Internet users in the US. Ninety-five percent of Latinos online in the US make $50,000 or more a year; 93 percent are between the ages of 18-29; 91 percent have some college experience; 89 percent are native-born US citizens; 89 percent are English-dominant and 83 percent are bilingual. This builds a profile of the target audience we are achieving to reach via our Internet communications strategy. From this data, we can synthesize that our messages should be formed in a manner that addresses the wage range (above $50,000), is cognizant of the fact that many Latinos online expect to see English content and that we are reaching an overwhelmingly younger audience, between the ages of 18 to 29. The gender split is 51 percent males, 49 percent females for Latino Internet users, so there is not a large gender gap. Marital status is at 49 percent married, 50 percent unmarried, so we would want to draft messages for both groups. And three-fourths state they are accessing the Internet primarily through mobile devices, so our platforms of choice need to be mobile-ready. After our research, we are now able to clearly identify the demographics of Salvadorans and Hispanics that our strategies will aim to target, and we have specifically identified the profiles of Internet users within those demographics.

With the implementation of a strategic digital media plan and campaign to deliver it, Hospital de Diagnóstico has the potential to continue to thrive in not only medical and technological advancements, but also in communications.


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Situation Analysis for Hospital de Diagnóstico