Chapter 6: Leader/Manager Role

In addition to demonstrating strong clinical skills, establishing a successful WOC nursing practice requires that the nurse utilize business skills to market and manage the practice. This chapter addresses how to market professional services, introduces how to develop a proposal, provides suggestions for data collection, outcomes reporting, and establishing quality improvement programs, presents a few tips on organizing and conducting a meeting, and offers suggestions for maintaining a positive work atmosphere and attitude.

Marketing Professional Services

Health care in the United States is charged with containing cost, improving quality, and expanding access to high-quality care (Institute of Medicine [IOM], 2001; Owens, Qaseem, Chou, & Shekelle, 2011). The nursing profession has an opportunity to help transform the health care system to address these issues as a result of the passage of the Affordable Care Act in 2010, and the Robert Wood Johnson Foundation's initiative on the Future of Nursing (Hinkle, Sullivan, Villanueva, & Hickey, 2012; IOM, 2011; Robert Wood Johnson Foundation, 2012; Tomajan, 2012; Wilson, Whitaker, & Whitford, 2012).

Nurses have a long history of contributing to patient welfare by providing quality care in a cost-effective manner, but these contributions remain largely invisible to the public and policy makers (Mass, 1998; Tomajan, 2012). It is, therefore, critical that nurses identify and demonstrate the effectiveness of nursing interventions to improve patient care outcomes (Ellerbe & Regen, 2012; Mass, 1998; Needleman, Kurtzman, & Kizer, 2007; Tomajan, 2012; Wilson, Kane, & Falkenstein, 2008).

Marketing the WOC nursing specialty has the potential to effect changes in “…public and institutional policies at the national, state, and local levels” (IOM, 2011, p. S–2). WOC nurses can provide leadership within an organization to guide the delivery of care by providing straightforward advice to decision makers. However, to serve in leadership roles that positively impact patient care, WOC nurses must inform others about their experience, educational preparation, and clinical expertise and explain the value and benefits of WOC nursing services. Recently, the American Nurses Association (2010) provided formal recognition of WOC nursing as a specialty practice for the delivery of expert care to persons with wounds, ostomies and continence conditions. Marketing is a way to educate employers and the public about the WOC nursing specialty and what it has to offer.

What Is “Marketing”?

The American Association of Marketing defines marketing as “the process of planning and executing the conception, pricing, promotion, and distribution of ideas, goods, and services to create exchanges that satisfy individual and organizational objectives” (Bennett, 1995). The consumer and their satisfaction are key elements in marketing. The consumer may be an individual patient, physician, or organization (Berkowitz, 2011).

Five Steps in Successful Marketing

The following 5 steps may be used as a guide to help design a comprehensive marketing plan. Prior to marketing the services of a WOC nursing specialty practice, it is important to gather information and identify the “customers,” define the “product” or service (eg, price, place), determine/develop marketing strategies, develop and present a marketing plan, and continually reevaluate and revise the marketing plan.

Step 1: Identify the customers and gather information

A decision about which customers to target is a key consideration when planning the marketing strategy. Using a mix of strategies, you can target everyone, a single market segment, or multiple market segments. Market segmentation is a way of grouping customers with similar needs into clusters to provide tailored marketing strategies to meet their needs (Berkowitz, 2011).

Market segmentation

A market can be described as a group of prospective customers that has unmet wants and/or needs. According to Berkowitz (2011), markets may be segmented in 1 or more of the following ways:

• Sociodemographic. Identify the common characteristics of the potential markets (clients). Age, gender, and ethnicity of individuals are pertinent factors to consider in health care environments. The target market of individuals could be segmented by age, diagnosis, income, or insurance coverage. Facilities could be segmented according to frequency of ostomy surgeries, prevalence or incidence of pressure ulcers, the number of surgeons/colorectal surgeons on staff, the number of beds or visits, length of patient stays per admission, average costs, equipment and supply usage, etc. For example, health care facilities that have a colorectal surgeon on staff might represent a certain segment of the market.
• Geographic. Where are the potential markets (clients) located? A target market could be the general population in a city or cities, counties, townships, states, or divisions of each. The market could be segmented to include health care facilities in cities within 100 miles, or it could be as small as the facility where the WOC nurse currently works.
• Psychographic. What are the common behaviors of the prospective clients? For instance, what do they know about the type of service WOC nurses provide (ie, wound, ostomy, and/or continence nursing)?, what is their attitude toward the service (eg, too costly, not effective, high quality)?, how do the prospects use the service (eg, often, seldom, by contract, by consult)?, and what benefits are they seeking (eg, lower cost, higher quality, shorter length of stay)? For example, facilities that are familiar with WOC nurses and believe it is a cost-effective service could prove to be a lucrative segment.
• Usage. Grouping people based on needs or usage of a particular product or service is another way to segment the market. In this approach, the marketing strategy is directly related to the use of the product and needs of the group. When considering the extent and use of a service by a particular group, it is important to also assess customer loyalty and identify what services or benefits the members in the group want or need but are not currently receiving (ie, gaps in service or underserved segments of the group).

Determine the target markets

The specific target markets are those segments of the entire market that have been identified as needing or wanting a particular service. They can range from the entire market (ie, anyone needing or wanting the service), to a portion (eg, health care facilities in a given city), or to a very small segment (eg, a single hospital). After determining the target market, decide what type of services will be offered to which segment. The following 3 categories help break the marketing of services into manageable components:

• Undifferentiated. Market one type of service to all market segments. For example, design one wound care protocol and market it to all types of health care facilities.
• Differentiated. Offer different types of the same service to many segments of the market. For example, several different wound care protocols can be designed to meet the specific needs of a market segment (eg, acute care, home care).
• Concentrated. Provide a specific service to a single market segment. For example, specialize in providing wound care in the home setting.

Get to know your customers

After conducting a thorough market analysis and pinpointing your market segment, you can begin to identify the customers who would benefit most from your services. This can be accomplished through phone surveys, interviews, networking, and personal experience. Getting answers from prospects to the following questions can help determine how to obtain the best position in the marketplace:

• What do your prospects hope to gain from the type of service(s) you are offering?
• How often do they need the service?
• What is most important to them when considering this type of service (eg, cost, quality, timeliness)?
• How are they getting the service now?
• Do they know your service exists?
• What are they willing to pay?
• Who makes the decision to use the service?
• How would they like to receive the service (eg, employee, contract, consult)?

Identify and analyze your competitors

Competition is a normal part of marketing. When beginners develop a marketing plan and strategy, they often overlook the competition. Also, competitors are not always as recognizable as most inexperienced marketers might think. They can come in any of the following forms:

• Desire competitors. The consumer has identified a need and has any number of choices to make that will lead to the purchase of a product or service in order to meet the need. For example, a home care agency wants to start a continence clinic. The managers could train current staff, hire a consultant to set up the clinic, or hire a master's prepared nurse to set up and run the clinic. In this scenario, that the organization's managers decide the master's prepared nurse is the best idea.
• Generic competitors. Now the question for the home care managers is: What type of master's prepared nurse should we hire? They could choose a nurse educator, a nurse administrator, a nurse practitioner, or a clinical nurse specialist (CNS). For the purpose of this scenario, suppose that they choose a CNS.
• Product competitors. Once the organization decides what the need is, they then determine the hours and employment status required to fulfill the role. For example, the organization could choose a full-time or part-time employee or contract with the CNS. For this scenario, the organization decides to hire a full-time CNS to set up and run the clinic.
• Brand competitors. Finally, the managers must choose which type of CNS they want. They might choose a clinical specialist in medical-surgical, OB/GYN, or continence disorders. In this case, the organization chooses a CNS specializing in continence disorders.

As described earlier, there are many different competitors to consider. To assess your competition, there are a few simple questions you can ask yourself:

• How many competitors do I have? Keep in mind that there are different types of competitors, not just other WOC nurses.
• Is this number increasing or decreasing?
• Who are my principal competitors?
• Is competition based on price, quality, service, or experience?
• Where does the competition appear to be heading?
• Were my competitors first in the market?
• Do my competitors have a specialty niche?

Conduct a SWOT (strengths, weaknesses, opportunities, and threats) analysis

Once you have analyzed the market and clearly understand where and how to best position yourself, you should identify your major SWOT. A SWOT analysis will help you define what you will need to address in your marketing plan (Pearce, 2007):

• Strengths and weaknesses. This is an internal analysis of your business's strong and weak points. What do you have to offer that is new, different, or in a better form than your competitors? Are you certified to train others? What areas need development? Where can you improve?
• Opportunities and threats. This refers to outside factors that impact your service product. What opportunities are present in the current market? Is there an open niche you can fill? Is there an area that you could be first on the scene? Are customers asking for a new or different service? Are there new facilities moving into the area? On the other hand, consider what might be threats to your success such as a lack of data about outcomes or knowledge of the costs of services; or having other competitors in the area, such as in the following examples:
  • Case-managed companies are requesting information about valid outcomes and you do not have that data.
  • A major hospital in the area is negotiating for services and is basing its choice on a price/cost comparison.
  • Several physical therapists have moved into your area, and they are opening a wound clinic.

The results of the SWOT analysis should be prioritized and can serve as a guideline for identifying the issues that you will address in the completed marketing plan. For instance, developing outcomes, deciding how to compete with the new physical therapy group, or determining whether you are able to be the first to offer a wound care protocol, all might be issues that you should address.

Conducting market research

The market research process can be simple or quite technical and complex. The most important thing at the outset is to be clear about what information you seek and what questions you want answered. To benefit from the results, be sure to keep an open mind. If you need help deciding what research techniques will be most effective in getting the information needed that is within your budget and time lines, ask for advice and use available resources (Stern, 2001). There are several options available to you for conducting marketing research as described in the following examples:

1. Options for gathering market research information:
   1. Ask around. It is not the most scientific method, but sometimes a few well-placed telephone calls or interviews can set you on the right track. You may choose to take what you learn at face value or test the feedback with a wider audience.
   2. Look close to home. If your questions have to do with customer satisfaction, you can learn from the people you already know:
      • Regularly invite your customers or participants to recommend/suggest ways you can improve.
      • Follow up with people who show initial interest in your programs or services but do not follow through.
      • Conduct exit interviews with people who discontinued your services or severed their relationship with you.
      • Ask others who work with you for their observations.
   3. Check with known data collectors. There are many organizations that collect and report on varied kinds of data. These organizations include the following:
      • The United Way.
      • The Census Bureau.
      • Research centers and institutes.
      • Universities.
      • Research departments of advertising agencies.
      • Many government agencies.
   4. Conduct surveys. Written, telephone, and in-person surveys can provide information about your customers' opinions and attitudes. For a survey to produce reliable information, however, it must be well-designed. There are many commercial research firms. Check your Yellow Pages and references for assistance in designing or conducting a survey. Also, input and assistance are often available at no charge from the following sources:
      • Advertising and public relations agencies.
      • Business administration graduate students.
      • Corporate marketing departments.
      • Government agencies.
   5. Hold focus groups. A representative sample of a target audience (ie, 10–12 people) is brought together to participate in a discussion. Generally, these sessions last no longer than 1 hour. The session is designed to generate responses to a predetermined set of important questions and is facilitated by an outsider or a staff member not intimately involved in the subject. The format is carefully structured to elicit straightforward impressions, reactions, and opinions.
      • Information obtained in focus groups include the following:
        • What the customer values and why.
        • Specific barriers to “buying” your service.
        • Ideas for changes to remove barriers.
        • Product marketing ideas.
        • How to speak in the language of your audience, which can sometimes provide exact wording for promotional messages.
      • Drawbacks to focus group research:
        • The relatively small number of people included and the wholly subjective approach.
        • Focus groups lack the statistical reliability of larger samples. They may tell you quite a bit about what your customers want, but reveal nothing about size of the market.
      • Advantages of focus groups:
        • The major attraction of focus group research is that it puts you directly in touch with your customers in a way that allows the subtleties in their thoughts to be heard and you can establish a face-to-face relationship.
        • Focus groups are neither time-consuming nor costly. Facilitation of services is quite easily obtained free of charge from students in graduate communication programs or as pro bono contributions from advertising agencies and corporations. Even when you hire a professional, a modest focus group program is relatively affordable.
2. Side benefits of market research:
   1. There are additional benefits to market research. Surveying the community is an opportunity to engage people in a positive way and build relationships. Most people enjoy expressing their opinions and will think well of you for asking.
   2. It also may add to their interest or enthusiasm for your product or service.
3. Tips to maximize the opportunities associated with market research:
   1. Be well-prepared, gracious, and professional.
   2. Make the ultimate findings of the research available to all participants, and follow up on any individual questions or concerns.
   3. Provide additional opportunities, when appropriate, for research participants to be involved.
   4. Be sure to give research participants the opportunity to buy the product or use the service when it becomes available.
   5. Thank and acknowledge research participants directly and, when warranted, publicly recognize their contributions (ie, if consistent with confidentiality agreements) through newsletters, annual reports, or announcements to your board and staff.

Step 2: Define the product or service, price, and place

WOC nursing is a trispecialty practice, which is multifaceted and evidence-based. WOC nurses provide preventive care, health maintenance, therapeutic interventions, and rehabilitation for persons with disorders of the gastrointestinal, genitourinary, and integumentary systems. The Wound, Ostomy and Continence Nursing Scope & Standards of Practice (Wound, Ostomy and Continence Nurses [WOCN] Society, 2010) is an excellent resource when defining and describing the role and practice of WOC nurses.

Clinical proficiencies

Table 6.1 lists common clinical proficiencies of WOC nurses that can be used to describe and promote your services. You may add other areas of expertise that are unique to your practice.

Benefits of WOC nursing

Use the benefits of WOC nursing to promote and position your services. Table 6.2 provides a list of benefits that WOC nurses can offer to clients that are common to all settings. Add other benefits unique to your practice. Compare your service line portfolio with the benefits in the table to design a customized package of your services for individual customers.

Develop a service portfolio

A service portfolio is an important part of an effective marketing plan. The portfolio should include a full description of the product and services and the charges for the services.

1. What is the primary product? This is not always clear when marketing a service. The 2 obvious choices are the service itself (eg, wound care) or the provider of the service (eg, the nurse). If the nurse is well known, respected, and sought after, then the nurse is the primary product and the service is secondary. Most often, it is the service that the customer is seeking to purchase, and the nurse is perceived as the vehicle (ie, secondary) for providing the service. This does not imply that the nurse is not important in the overall product or critical to the customer's final decision. Without the service, it is unlikely that the nurse will be retained.
2. How is the product defined or described? The clearest way to define your service product is to analyze its components. Not all customers will want everything you have to offer, nor will all competitors offer the same portfolio of services. In addition, it is frequently necessary, when marketing services, to customize them to individual clients. Categorizing individual aspects or components of the service makes customization easier. Finally, services, unlike tangible products, cannot be seen, touched, or examined. A well-defined service portfolio makes it easier for you to clearly present the specific service(s) to your customer.

Position the service product

Positioning is not what you actually do to a service product; it is what you do to the mind of the customer (Berkowitz, 2011). In other words, you must develop strategies to position the product in the customer's mind. Strategies that are especially pertinent to WOC nursing services are as follows (Reis & Trout, 1993):

1. The law of leadership. It is better to be the first in the customer's mind. If you can be the first provider of services that the customer has experience with, it is much easier to market and maintain the account. That does not mean that you were actually the first provider on the scene; it means that you were the first one in the customer's mind. For example, Kleenex was not the very first tissue on the market, but it was certainly the one that positioned itself in the minds of consumers.
2. The law of category. If you cannot be first in one category, set up a new category in which you can be first. If someone else is already providing wound care services and is well established in customers' minds, then develop a new service category. For example, be the first to offer in-services to the staff, the first to have wound protocols, or the first to offer the service on a contractual basis instead of as an employee. Your service categories are limited only by your imagination and ingenuity.
3. The law of exclusivity. Two competitors cannot own the same word in the customer's mind. The word might be “quality,” “cost savings,” or “premier,” to name a few. You must decide what concept you want to position in the customer's mind for your service. A fatal error is when you use a competitor's word and try to position your service as the same—but better. If you have no competitors, so much the better; pick your word and run with it.
4. The law of success. As you experience success with a service product, the tendency is to want to expand and do more, to capitalize on the success. For instance, if the ostomy and wound care services are doing very well, you might want to expand into continence care. Perhaps your staff in-services are sought after and very successful, so why not go on the lecture circuit? Although these strategies may prove to be successful, they also can be a road to failure. Using the past success of one service product to launch another frequently ends in disaster. If you want to expand into a new area, you should treat it as a new service product, not an extension of the old one. Go back to step 1 and work through the entire process. The position that the new service takes in the customer's mind may be entirely different from the old successful service.
5. The law of failure. Some degree of failure is expected and accepted. Whether you are an experienced marketer or a novice, you are going to make mistakes. The secret to turning failure into success is to know when you have made a mistake, admit it, and move on. It is terminal to continue to try to fix something rather than to admit it just did not work and then try a new approach. Whatever position you choose to take in the customer's mind, be prepared to explain what the benefits (Table 6.2) of using your services will be for the customer.

Determine the price for your services

This is often where many nurses have difficulty and fall short in completing their marketing strategies. Money and professional services seem to be at opposite ends of the ethical spectrum. However, if you do not pay attention to appropriate pricing strategies, the entire service can fail. If the term price is not palatable, other terms such as fee, rate, retainer, or charge can be used. Even in a setting where a fee is not charged for the service (eg, in an acute care setting), it is still necessary for the WOC nurse to know the cost of the service. In reality, setting a price can be relatively simple by following these steps:

1. Determine the cost of the service. The cost of providing a service sets the floor of the price that you can charge. Determining the cost is crucial to long-term success. If terms such as fixed and variable costs, overhead, depreciation, and capital expenditures confuse you, this is the time to get assistance from an accountant.
2. Determine the demand for the service. If the demand for a service is high, you can charge more than if the demand is low. Take care, though, not to overprice at this point. Overpricing makes it much easier for a competitor to enter the market and be first in the customer's mind as the “reasonably priced” provider. On the other hand, underpricing can indicate to the customer that the service is not high-quality or worthwhile.
3. Find out what the competition is charging. If there is competition in the area, determine what they are charging. This should serve only as a guide in determining your fee structure. Do not think that your fee has to be identical or even less than a competitor's. If you have developed a good marketing strategy for positioning your service in the customer's mind, you can then develop a fee structure for your uniquely positioned service. If there is no competition, it is still wise to evaluate what others are charging for similar services. Examples might be other nursing services, other professional therapies, home visits, outpatient visits, and hourly rates of other professional services.
4. Set a pricing objective. Being the lowest priced service is not always the correct strategy to use. You have to decide what objective you are trying to achieve and what position you have chosen in the customer's mind. If “quality” is your word, a very low price would be counterproductive to that concept. However, if “cost savings” is your word, a very high price would be contraindicated. Determining the fees for your services is a balancing act between demand and competition while still maintaining the position that you have chosen.

Step 3: Determine and Develop Marketing Strategies

After information has been gathered about the customers and the target market, specific marketing strategies must be developed. There are multiple marketing approaches that might be appropriate.

Design a promotion strategy

Deciding what promotional tools you will use can be difficult and confusing. Rubright and MacDonald (1981) suggested that promotional tools should have certain characteristics and they should:

• Reflect marketing objectives and strategies.
• Be written for specific target markets.
• Reflect or suggest the service's benefits.
• Persuade or inform.
• Be concisely written and edited.
• Request or suggest specific action or participation by the customer.

Learn to negotiate for success

It is helpful when preparing to sell professional services to think of it as negotiating rather than selling. If you consider negotiating a form of selling, then it is important to prepare yourself to be a good negotiator before you set out to sell your services. Leo Reilly of KCR Communications (Reilly, 2004) identified several rules for negotiating. The fundamental principles are as follows:

1. Be prepared and organized. Gather information about the company and/or the person that you will be meeting. Use the premeeting information to develop specific questions to ask in the face-to-face meeting. Get to know the person's needs, perceptions, and motivations. Never start the meeting with what you can do or what you have to offer until you know more about what the prospect wants or needs. In other words, “Be patient.” The goal at an initial meeting is to test your assumptions, fine tune your information, and send up a few trial balloons. Find out what your prospective client would like most out of the service(s) you are offering. For instance, when do they need the service? Who is the person who will make the final decision? What would their response be to this or that approach? The virtue of patience in this situation will lead to better control of the negotiations and more satisfying and beneficial agreements.
2. Have a strategy for success. When the time comes to begin discussions about the actual provisions of the contract for service, whether it is a contract for employment or consulting, a few final rules will help make the negotiations successful. Never enter into negotiations without knowing your bottom line. What is the most you can offer and what is the least compensation that you are able to accept? If at all possible, get the client to discuss what they are seeking and what they are willing to pay for services. Even more important, ask the client to give you this information first.
3. Know your opening offer beforehand. It goes without saying, never open with your bottom line. The opening offer should be realistic, clear, and concise. Surprisingly, many clients will accept a fair opening offer when it is sincerely presented. Never try to open with outrageous or unfair offers. This will only decrease your credibility and might bring the negotiations to an abrupt close.
4. Follow up. Always follow up with the client after each meeting. If you promised to send information, find an answer, or call back in 2 days; be certain to do just that and do it promptly. This is frequently overlooked so that when you do what you promised, the client will be pleasantly surprised! Negotiation is a learned skill. By following these few simple but powerful rules, your next attempt at negotiating a mutually beneficial agreement is more likely to meet with a successful outcome.

Select promotional techniques

A variety of promotional techniques are at your disposal. Television, radio, newspaper, magazines, outdoor advertising, direct marketing, and Internet advertising are a variety of media from which to choose (Berkowitz, 2011). Choosing the right mix depends on many factors such as knowing who you are targeting, what the message is that you are trying to convey, and how much money you are willing to invest. The following list outlines some of the more popular promotional methods (Stern, 2001):

1. Advertising. Advertising can work well for special events but is generally not considered effective in small quantities (eg, one local TV spot). Conducting a focused advertising campaign requires thorough investigation and budgeting. Some newspapers and magazines make free space available; most TV and radio stations provide free time. Classified advertisements are a more affordable print advertising option in certain cases. Inserting flyers in community newspapers can help you reach a broad audience.
2. Annual reports. Annual reports can be effective promotional tools if you take a smart marketing approach. Annual reports can take the place of a brochure, especially if your organization changes a lot from year to year. Be sure to pay close attention to image, innovative approaches, and distribution channels.
3. Billboards. Billboards are an excellent way to mix your promotional media. Invest in a good design and use no more than 8 words. Individual companies can provide information regarding rates and availability.
4. Brochures. If writing and graphic design are not your areas of expertise, consider using professional services. Pay close attention to image and message. Keep distribution channels in mind. You may find that flyers, fact sheets, or other options may be more beneficial.
5. Celebrity endorsements. These types of endorsements can be fun and worthwhile. Although celebrity endorsements are a great attention-getter, they seldom “make the sale” in and of themselves.
6. Direct mail. Direct mail can be an expensive strategy and has wide variances in effectiveness. If you are considering using this extensively, take a 1-day seminar to learn the details. It is really a science. Two tips: (1) It works best once someone already knows who you are and has expressed some interest in you. (2) Good use of mailing lists is essential. Note: You can rent or buy mailing lists; keep them updated if you maintain your own.
7. Direct sales. Direct sales are one of the best promotional techniques; however, this strategy can be very labor intensive. It is most applicable when a “personal touch” is used. Essential ingredients for a successful direct sales approach are a clear message, good presentation skills, a thorough understanding of the sales process, persistence, and the time to really develop relationships.
8. Editorials. Newspaper editors are remarkably accessible and will consider well-thought-out, well-documented points of view. Make a phone call first and be prepared to send information right away if you receive a positive response. Editorials offer high visibility, they are an excellent positioning tool for your service, and they add to your credibility and are a real contribution to public debate on important issues.
9. Electronic media. Electronic marketing provides an avenue to reach a variety of care settings and locations. This realm includes e-mails, faxes, Web pages, social media, and online education. Costs vary and may include telephone lines, Internet access, and a computer. Consultative advice may be required. Be sure you understand the Federal Communications Commission rules concerning the use of these media. The Federal Communications Commission's “Do Not Call” list has sparked a flurry of restrictions on the use of “blast” e-mails and broadcast faxes.
10. Social media. Social media or social networking sites (SNS) such as Facebook, Twitter, LinkedIn, YouTube, and others are an innovative and inexpensive, if not free, way to reach a host of consumers. Facebook alone publicizes a membership of more than 500 million and LinkedIn reports more than 100 million. Professionals and consumers alike are using social media sites for networking, obtaining clinical information, and locating needed/desired services (Prinz, 2011). Most hospitals and professional organizations have some type of SNS. Accurate data for the exact numbers of social media users are not available, but it is safe to assume that a large portion of most targeted groups use some type of SNS (Boyd & Ellison, 2011).
    • Consumers today want and look for information to assist them in choosing services that meet their health care needs. Social media sites are an inexpensive and effective way to reach these consumers. Frequently, consumers use the Internet to seek information or to verify the validity or usefulness of a health-related service. Cone Communications (2011), a public relations and marketing company, reports 40% of survey respondents research a new product or service online prior to making a purchase.
    • Setting up a social media outlet for your service(s) can be as simple or as detailed as you choose. Hiring a professional information management service can be beneficial if a more complex system meets your strategic goals. Time spent maintaining the site depends on the type of site you desire and its complexity. Social media sites can help meet your strategic goals without adding significant costs.
    • It is important to set limits on the information posted or provided on social media sites. Unintentional violations of the Health Insurance Portability and Accountability Act of 1996 can easily occur from comments/postings made by yourself, staff, or others on your Web site. New laws have been established in almost every state regarding the use of social media and patient information. It is NEVER advisable to post health care advice due to legal restrictions and liability.
11. Feature stories. Reporters are always looking for timely, unique, interesting, or new stories. They like a fresh angle, are not afraid to say no, and may put you off repeatedly for months and then suddenly—on a deadline—want to talk to you at 1 am. Do not say anything to a reporter that you would not want to hear on the news or read in print tomorrow morning. Think through how to take advantage of this tool for maximum effect. Be prepared for a high-volume, short-lived response.
12. Letters to the editor. Timely, well-thought-out, well-written letters to the editor are often published. If you have a strong opinion or if your position is being attacked, undermined, or misrepresented by others, consider expressing your point of view. As with feature coverage, think through how to take advantage of this tool for maximum effect.
13. Networking. Who you know can mean everything in terms of access. Ask board members and friends to introduce you, host meetings, and otherwise convey your message to the people whom you want to hear it. People respond best to initial contacts from people they know.
14. News conferences. Press conferences should be held only for something very big, controversial, or out of the ordinary. If there is anything you can do to make it visually interesting, it will help extend coverage. Be sure to prepare your message carefully.
15. News releases. Press releases can be used for announcements and often will be run if you can get them to the right person in time. It helps develop contacts and know the deadlines of your local newspaper. Check any basic public or media relations textbook for the appropriate professional format. These can be used to announce classes, workshops, conferences, special events, awards, staff acquisitions, or other events or activities that are newsworthy. Costs are limited to paper, envelopes, and stamps or electronic media.
16. Newsletters. Well-written newsletters can produce loyal readers and a good response. Publish the newsletter on a regular schedule. Many people scan only newsletters, so use lots of pictures, headlines, subheadlines, pullout quotes, and white space.
17. Posters. As with billboards, posters are a great way to mix media. Remember that location is critical and pay close attention to image. A secondary benefit to attractive posters is their staying power. If suitable for framing, they can be around for years.
18. Public speaking. Public speaking is a good positioning tool and a great way to mix media. Handouts reinforce your message. Coaching or training may enhance your public speaking skills. Initially, you could consider speaking locally at places such as civic groups, churches, or synagogues to gain experience.
19. Publishing articles and reports. Publishing is an excellent positioning tool that is also sometimes a real opportunity to influence professional practice and public policy. When writing for publication, be sure to understand the audience and gear the article accordingly. Self-published reports should have crisp executive summaries, appear readable, and use a good marketing approach.
20. Radio public service announcements. This is an excellent way to mix media and costs you nothing but paper, envelopes, and stamps. Again, check a basic public relations text for the correct professional format. Most stations accept only written copy. Provide 30, 15, and 10 seconds worth of copy. There is often a 2-week lag time before the announcement is aired.
21. Special events. A good way to renew or maintain personal contacts on a large scale is to plan a special event. When planning, decide the type and purpose of the event, and then coordinate the elements. The invitation is a promotional tool.
22. Talk shows. Radio and network and cable television offer many opportunities for everything from offbeat opinions, to live public service announcements, and to serious discussion. Call and ask to talk to the producer of the show for which you have an interest. Think through your sales pitch—why this person should have you on his or her show. Write down ahead of time the 3 things you absolutely want to be sure to say and then, no matter what you are asked, find a way to say them. Depending on the popularity of the show, you can get a significant response (Stern, 2001).

Step 4: Develop and present the marketing plan

A marketing plan is a summation of the work and information that was collected in steps 1 to 3. Regardless of the setting or type of practice, a marketing plan should be written. Your marketing plan can be presented to administrators and used to obtain financial backing. The following are components of a marketing plan:

1. Executive summary. A brief overview of the marketing plan should explain the reason for the plan, list the major findings of your research, and conclude with recommendations.
2. Background information. If you have completed step 1, you should have all the necessary data to write an effective summary of all the work you have done. It should show you have conducted a thorough analysis of the market and that your program will respond to market needs. This section should include an analysis of your target market's characteristics, your competition, and a summary of your SWOT analysis. A summary of your service product (step 2) also should be included in the background section of your marketing plan.
3. Objectives and goals. The objectives and goals section should be a well-prepared report of your operational goals and how you intend to reach them. This is not a “wish list,” but a precise accounting of what you hope to gain from your marketing efforts. What are the intended outcomes of your hard work?
4. Marketing strategies. This section, based on the work you did in step 3, should describe the actual strategies that will be implemented, including a rationale for each strategy and the procedures necessary for carrying it out. In other words, how will these outcomes be achieved?
5. Budget. The budget is based on goals, objectives, and strategies. The budget should include direct and indirect costs, general and administrative costs, miscellaneous expenses, and estimated revenue from the project or program. Pricing strategy should also be included.
6. Controls. This section of your marketing plan should describe the system of controls that have been developed to ensure that the goals and objectives are being met (ie, the process for evaluation and revision as outlined in step 5 later).

Step 5: Continually reevaluate and revise the marketing plan

Marketing evaluation is not a single process. There are many things that should be considered when evaluating if your plan is on track and how to revise it. There are 4 distinguishable types of evaluation:

1. Plan evaluation. This examines whether the planned results are being achieved. Was service provided to the intended number of patients? Were new client contract goals met? Are clients, patients, customers all responding to the service as planned? The types of data that need to be collected during the year should be based on the objectives. The plan evaluation can then easily be completed quarterly, semiannually, and/or annually.
2. Profitability evaluation. This examines where money is being made and lost. Were revenues and profits as projected? Was the cost, length of stay, use of supplies, etc, within projections? What services are the most profitable? Which are the least profitable? Why?
3. Efficiency evaluation. This evaluates the efficiency and effect of marketing expenditures. What marketing strategies produced the most profitable response? What strategies did not produce the expected outcome?
4. Strategic evaluation. This examines whether the best opportunities are being pursued with respect to target markets, services, and promotion strategies. A periodic review of steps 1 to 4 is necessary to recheck your plan.

Revise the plan as needed

Marketing is a continual process. Developing a plan and expecting it to last forever is a sure road to failure. Marketing efforts must change with changes in the market, changes in your service, and changes in customer demand. Revision of the plan must keep up through continual, well-planned evaluation and revisions.

Proposal Development

A proposal may be necessary to convince an administrator that additional WOC nurses or support staff is needed to establish an outpatient clinic, support program, or to independently persuade a health care provider to purchase your services. A proposal is best approached from the perspective of trying to encourage another person (or group) to do something. A convincing argument requires clear communication of the following information:

• The current situation.
• The proposal's credibility relative to the situation.
• The benefits to the customer(s).
• An action plan.
• The resources that are needed.
• A budget.
• An evaluation process.

The proposal should be succinct—5 pages or less because lengthy proposals might not be read. Package the proposal to be aesthetically appealing. By taking the time to complete a well-thought-out proposal, administrators and business professionals will have a clear understanding related to the clinical services and financial implications of the proposal. For more detailed information on developing a proposal, see the WOCN Business Plan Template Workbook in Appendix S.

Data Collection/Outcomes Reporting

Data collection is an essential component of any successful professional practice. For collected data to be useful, there has to be an understanding of its relevance to outcomes and a perspective on how the data will be analyzed and interpreted. For example, assume that the number of clinic patients seen in a year is reported to be 575. Until this number is compared to the previous 2 years' clinic census of 300 and 427, respectively, the data are meaningless. These numbers become even more meaningful when converted to statistics and percentages.

Therefore, data collection should be purposeful and outcome oriented. It is no longer valid to attempt to justify a position on volume alone. For example, recording the number (ie, volume) of “specialty beds” that were denied, as a measure of cost savings, is valid only if those patients who did not use the beds did not develop pressure ulcers. The volume must somehow affect an outcome that reflects organizational goals, revenue, or quality. The following are examples of how to use data:

• Identify the number and type of patients.
• Document the number and types of visits or patient interactions.
• Identify trends.
• Justify current and/or new positions.
• Determine staff utilization patterns.
• Profile specific activities and scope of practice.
• Evaluate use of time.
• Demonstrate cost-effectiveness.
• Conduct quality assurance activities.
• Monitor patient follow-up.
• Track referrals and/or monitor utilization of resources.

Basic concepts for generating monthly reports

Categorize commonly performed tasks or procedures, and keep a daily record of procedures in each category. Also, keep a record of “nonclinical” procedures and tasks/responsibilities. This information can then be used to generate grafts and charts for a monthly report. Keeping daily records offers a key advantage because it minimizes the time required to generate accurate monthly reports that can be used to track activities and demonstrate key areas of service. Determine who will compile the final departmental data reports (ie, is secretarial support available?). Key components of a daily/monthly report include the following:

• A recording sheet (ie, Excel spreadsheet) that facilitates “tracking” of various activities with a minimal expenditure of time.
• A list of standard/commonly performed procedures and tasks with definitions and the average amount of time or relative value of the units required to complete the various tasks.
• The daily/monthly report form should be organized to reflect the time and/or number of each major encounter and/or procedure.
• The amount of time spent on nonclinical activities and an accounting of what specific nonclinical activities were included.

Commercial data collection tools and generic forms for record keeping are available. The WOCN Society (http://www.wocn.org) has developed templates for WOC nurses to record/collect productivity data in home health care (WOCN Society, n.d.-a) and acute care (WOCN Society, n.d.-b). The sample productivity templates (ie, Excel spreadsheets) are forms that can be used and adapted to record information about the type of clinical services provided (ie, number/type of patients/problems, services/care provided) and other relevant, nonclinical activities.

Continuous Quality Improvement/Total Quality Management Programs

An important aspect of the WOC nurse's managerial role is the establishment of a continuous quality improvement (CQI) program to measure and document the impact of the WOC nurse's activities on patient outcomes, staff knowledge and skills, and the organization's goals. In establishing a quality improvement program, it is usually helpful to collaborate with the CQI/Total Quality Management department in your organization.

Goals of CQI

The primary goal for any CQI program/initiative is to objectively assess the selected quality indicators for your practice and to utilize the data to initiate quality improvement. The CQI goals of the WOC nurse's practice/department should be consistent and compatible with expectations for other departments. A suggested target goal for CQI initiatives would be 2 to 4 studies per year.

Guidelines

A CQI initiative does not have to be complicated or time-consuming. Simple studies can provide valuable data and insights. Potential CQI studies relevant to WOC nursing practice include retrospective and prospective studies whenever a major new program or quality improvement project is initiated (eg, pressure ulcer prevalence and incidence study).

General tips

In selecting CQI projects, revisit your organizational and departmental goals and objectives for the year, as well as clinical practice areas that are high volume or high priority. The organization's CQI team can be a valuable resource for designing and implementing a program. Continuous quality improvement initiatives are an important part of marketing and role justification programs.

Organizing and Conducting a Meeting

In today's health care environment, meetings have become an essential part of nursing practice for the leader/manager. Meetings are held for a variety of reasons, including coordinating the efforts of individuals, collaborating on projects, gaining support for ideas, solving problems collectively, and making consensus-based decisions.

Planning and conducting a successful meeting is an important part of the role of a WOC nurse manager/leader. Skills for planning and conducting a successful meeting are acquired with practice. One of the most important aspects of conducting a successful meeting is to prepare, prepare, and then prepare again! Time is a valuable commodity, and a poorly planned meeting is a waste of everyone's time.

Meeting purpose

When planning a meeting, first determine the purpose for the meeting. What is the reason the meeting is being held? Determine the objectives for the meeting (Hadler, 2006; Rebori, n.d.):

• Why is the meeting being scheduled?
• What are the goals of the meeting?
• What decisions need to be made?
• What information will be shared?
• Who will be attending?

Meeting agenda

A specific agenda should be developed and distributed to the participants of the meeting no less than 3 days prior to the meeting. The agenda will clarify the purpose of the meeting. By distributing the agenda prior to the meeting, it allows the participants time to prepare so they can effectively participate in the meeting. The agenda will also allow for focus and direction during the meeting. See Table 6.3 for a sample meeting agenda. There are many styles of agendas. Effective agendas commonly contain the following elements:

• Title (eg, evaluation review meeting).
• Time (eg, 8–10 AM) and date.
• Location.
• Discussion items with the names of persons responsible for covering each item.

Tips for conducting a meeting

Running an effective meeting is equally difficult and important. There are several factors that should be taken into consideration when planning and conducting meetings. Table 6.4 provides a summary of key considerations and tips to help run an effective meeting (Hadler, 2006; Rebori, n.d.):

Parliamentary procedure

Parliamentary procedure may be necessary in certain meeting situations. Formal groups and organizations should determine the rules of order for conducting meetings. In formal organizations, bylaws might specify the rules for conducting meetings or specify that they have adopted a parliamentary authority such as Robert's Rules of Order, which was first published in 1876 and since has been published in various revised editions. The object of using parliamentary procedure is to assist the assembly in accomplishing—in the best possible manner—the work for which it was designed. Under no circumstances should concern for parliamentary correctness be permitted to impose undue artificiality on a business meeting. A full discussion of parliamentary procedure is beyond the scope of this document and the reader is encouraged to seek other sources for questions about parliamentary procedure. Rulesonline.com contains a full copy of the fourth edition of Robert's Rules of Order Revised (n.d.), which is available at http://www.rulesonline.com.

Atmosphere and Attitude

As a leader and manager, it is important to determine what type work atmosphere and attitude you want to convey in your practice and relationships with others. Using a parable inspired by the positive attitudes of workers in the Pike Place Fish Market in Seattle, Washington, Lundin, Paul, and Christensen (2000) offer ways to boost morale in the workplace and improve results. The basic tenets of their philosophy are as follows (Camilli, 2003):

1. Choose your attitude. Each day you have an opportunity to choose your own attitude. Who do you want to be while you do your work?
2. Play. Having fun is energizing. No matter where you work, you can still have moments of play and create more energy! Happy people treat others well.
3. Make their day. Engage with your customers; create energy and goodwill. Who are your customers and how can you make their day?
4. Be present. Be focused on both your customers and your coworkers. Take moments to be attentive.

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