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Fixing St. Luke’s Online Reputation: An Inside Look

What do you do when your internal surveys show your patients are thrilled with their care….but your external online reputation is terrible?

No one knows this better than today’s guest, Cindy Graham, Director of Digital Strategy at St. Luke’s Health System in Boise, Idaho. Cindy has worked in healthcare for almost 25 years and has been in her current role for almost a decade, which gives her a unique position to be able to share the changes that have happened during that time and the areas that she and her team are focusing on now, going into the new year.

The discussion begins with one of those areas – reviews and online reputation management. Cindy gives insights on how she turned an overall poor rating into an overwhelmingly positive one over the last year while boosting the number of reviews by nearly 20 times!

They also discuss the delicate balance of budgeting with the need for additional healthcare space and constructing the hospital system’s image and reputation in the community both in need of important funding. Jenny and Cindy end by talking about continuing education, mentorship, and other ways that you can help your organization now as you continue along your career path.

Connect with Cindy online:

Connect with Jenny online:

Read the show’s transcript:

Jenny: [00:00:00] Hi, I’m Jenny Bristow and I’m the CEO and founder of Hedy & Hopp, a healthcare marketing agency based in the Midwest. We started the We Are, Marketing Happy podcast because of our passion for improving patients’ access to care. And understanding the innovations and shifts in the healthcare industry are key to making that happen.

Please follow, share, and let us know what topics you’d like for us to cover next. Enjoy!

Hey friends! Welcome to today’s episode of We Are, Marketing Happy, a healthcare marketing podcast. I am so excited to have Cindy Graham with us today. She is the director of Digital Strategy at St. Luke’s Health System in Boise, Idaho. 

Cindy, you have been at St. Luke’s for 12 years, but you’ve been in this particular role for seven to eight years.So I think it’s a really cool opportunity when somebody’s been in a role for so long to kind of step back and kind of take the view of what you tell your younger self, or what would you [00:01:00] tell somebody who’s entering healthcare marketing for the first time. So I’m really excited to dig into a couple of different topics with you today.

Cindy: Welcome. Thanks for having me. I’m happy to be here. 

Jenny: So one of the things that, I really wanna talk about is, I know that less than a decade ago, you had mentioned in a prior conversation that your organization had only one brave soul managing the entire website, and you had really no digital to speak of.

And I will say through our experience and all the systems we work with, that was such a common place for organizations to be. But you have stepped in and now you manage the digital team and there are other groups within the organization you collaborate with to make sure that you’re really providing the best and easiest access to patient care.

But let’s talk about some of your group’s key wins in particular – Reviews. So reviews are an area that [00:02:00] providers can be really afraid of. Honestly, providers in general are always worried that all of the reviews will be negative, and there can be a lot of fear around purposely trying to get more reviews.

But you had mentioned that 18 months ago your organization received about 250 Google reviews a quarter. Now you’re receiving 5,000. So talk to me about this initiative. Why did you take this on?

Cindy: Yeah, it was really good timing actually, because everything we had been working on with respect to our website and patient access had redirected towards covid response support.

So our regular old digital roadmap for all the things that we had planned to do for the organization was kind of put on pause. And we were very dedicated to the covid response but then also it kind of slowed the rest of that stuff down to give us an opportunity to look at what other things we had we just hadn’t been able to get to.

And one [00:03:00] of those things was proactive management of our online reputation. And when we really looked into what our current online reputation was, we were stunned with how bad it was because we know that we provide excellent patient care and we receive great feedbacks through our cap surveys and all of that kind of feedback that we collect but we don’t share publicly. 

So we started with a bit of discovery, not only with kind of what our reputation was out there in the online wilderness, but also kind of what our internal leaders and physicians thought about us pursuing proactive online reputation management. And we found two things. The first was that our online reputation was pretty poor.

We know that when people are motivated to post on their own right, when we’re not asking them to do so, they just are motivated to post on their own. They’re typically motivated by an extreme experience. It’s awesome when that extreme experience is really [00:04:00] good and they’re posting something glowing about your clinics, your providers, or you.

But sometimes they’re motivated by something that really disappointed them or frustrated them. We were seeing significant percentage, I think 35 to 40% of the reviews that were being posted about our physicians, our clinics, and our hospitals were, were negative and challenging. And then the other thing that, that we discovered as we were asking questions internally.

Was a lot of hesitation to ask for more reviews because people were like, why do we want people to tell us more things, more bad things about us? Right. Especially some of the providers that, that had been a little pummeled, right? They felt really, really reluctant and really demoralized, I would say, because, you know, they go into work every day with patient’s best interests in mind, doing their best with schedules and during a [00:05:00] really stressful time during a pandemic, we’re trying to certainly care for people with covid, but then there are people with a lot of other things too, who had limited access and stressful situations. And so they really felt like this would be something that would demoralize them further.

And so I knew that we had the opportunity to shine a light on the great work that they were doing, and I felt like this would be a good way to do it, but I had to convince. So what we, ended up recommending was a six week pilot, right? Our health system is the largest in Idaho. I know that there are many larger health systems across the country, but we have eight hospitals, about 250 ambulatory care clinics, and then other lab imaging surgery centers.

So it, it comes out to about 300 plus locations. All of those have their own Google business listings and all kind of stuff. I really wanted to make sure that, that we proved that this could work. So we invited five [00:06:00] ambulatory clinics to participate in a six week pilot, and I included the providers that were the most scared, which I’m pretty excited to report worked out pretty well 

But it was a risk, right? You know, they were nervous. And I said, just take this leap of faith with me and we’ll see what happens. And then we’ll adjust and decide after six weeks. So we started small and we texted patients after every appointment as long as we only sent one text every 90 days.

That was our rule. If they came in next week, we wouldn’t text you again. We don’t wanna pumble anybody. 80% of the time we asked for a comment about the provider. 20% of the time we asked for a comment about the clinic, and we received all of that feedback. Then we’d also ask somebody if they wanted to post to Google.

And sometimes they say yes, and sometimes they say no, and that’s okay. But we would get all of feedback. And what we found in that pilot period was that 98% of what [00:07:00] we received was five star positive, positive, positive. And it was awesome because what it proved to those providers and to the organization was that the excellent patient experience that we strive for every day and that we’re committed to deliver is being seen and recognized by our patients and their families. All we’ve gotta do is ask them to let us know how, how it went. So over the proceeding or the following, six to eight months, we rolled out the program to each of our additional service lines. So we have about 11, you know, everything from primary care and children’s to cardiology, oncology, orthopedics, all the specialties.

And we’ve been fully rolled out now for about a year, and our reputation score has increased dramatically. We went from kind of, I would call it poor and sad, [00:08:00] and we didn’t change anything about our patient care. All we did was ask people to tell us about their experience. And so now it’s a better reflection of our actual patient experience and our reputation.

Scores across the board have gone through the roof. So we were getting about for all of our locations and all of our employed physicians, which totals about 17 to 1800 entities in total, we were getting about 200 Google reviews a quarter that were 35 to 40% negative.

Today we get around 5,000 Google reviews a quarter that are 98% positive. And that being able to share that reporting back with physician leadership groups that they can then share with their own colleagues and sharing it with our executive leaders and our clinic managers. I am so proud [00:09:00] because we didn’t really do anything but reflect back how the patients truly feel about the work that they’re doing, which has been really important after such a tough period.


Jenny: so wonderful, and I love your approach about including the people that are most afraid of the initiative in the trial rollout because it really helped make sure that you got organization wide buy-in immediately, but it was a risk, and that’s something that I think people early on in their careers likely would be afraid of.

So that’s definitely a great piece of advice. One thing that struck me during a former conversation that we had is you have a pretty good process for deciding as a system, really for responding to or not responding to reviews. How do you decide when you engage with someone or what resources you provide to them?

Cindy: Yeah, so we set up a foundational rule that, well, and this is how he initially started, let me say, a foundational rule [00:10:00] that we were gonna respond to every single review. And for the most part, that is what we do. We thank everyone, whether it’s a positive or negative review, we try to do so within 24 hours.

Sometimes it’s, it’s closer to 48, but, but we wanna make sure that we are responsive and anybody who gives us feedback understands and believes that we’re listening and that we care about their feedback because it’s true. And we do. And especially when those comments are negative, or they express some disappointment or frustration.

We want them to know that that matters to us and that we’re going to ensure that there’s visibility to that feedback internally. Sometimes that comes through me and I will share it with clinic managers, but other times when the feedback is tougher, let’s say, we do have a process with our patient relations department where we escalate for [00:11:00] for follow up.

 And I think that that has been extremely successful as well for a couple reasons. First of all, we wanna make sure that those patients and families that have concerns immediately have a pathway for follow up. So, so they can make sure that the organization understands what happened and can learn and be better next time.

Or sometimes there’s just needs to be more communicative or provide an explanation on why certain decisions are made or why things happened in the way that they did, and that gives the organization a chance to connect with that patient and family and have that conversation outside of a public space.

Right? We, we don’t, we don’t want to have lengthy patient care conversations on Google. Not only would that be a HIPAA violation, but that wouldn’t be a great customer service experience either. So we route people into that process. But in terms of responding or when not to respond, I think we’ve learned some pretty good lessons.[00:12:00] 

This country has had a politically charged climate for a while. I don’t know that that will change anytime soon and, and sometimes people will use Google reviews as a place to complain about things that aren’t really that specific to patient care experience. I mean, they might have touched a patient care episode.

I’ll just use a simple, easy example. Someone complaining about having to wear a mask in our facility, you know, for safety reasons. Around during the Covid pandemic, we had a lot of Google reviews posting us about the fact that they disagreed with having to wear a mask. The reality is that it’s a safety issue for our patients, our providers, our staff, and we need to protect our patients in a safe care environment.

But some people would just want to argue with us there. And it was almost posting something to debate us into a debate about philosophy that [00:13:00] we were never going to change their mind and so we look carefully for things that just seem to be trying to pick a fight when they’re more general and they’re not specific to patient patient care episodes and encounters and we don’t respond to those.

One other thing that I think is important to mention though is, is in the same vein, sometimes people will post things that give you an opportunity to reinforce your organizational values. So you’re not talking necessarily about an individual patient encounter, but you are talking about what’s important to you as an organization and, and standing up for what’s right.

I’ll give you another example. So we flew pride flags proudly throughout our health system during Pride Month, and we had a Google Review posted about how upset somebody was that we flew a pride flag, and that just gave us [00:14:00] the opportunity to respond and reinforce our organizational values, which is everybody’s welcome here, and we care for everybody.

We’re a welcoming and safe space for everybody in this community. It gave us the opportunity to reinforce that, not just for the person that commented, but for everyone else that reads that comment. I think it’s important that when you have those opportunities to reinforce your organizational values so the community understands who you are, that that’s a good opportunity to do that.

Jenny: That’s a beautiful way to look at it. Let’s talk a little bit about budgeting, because one of my favorite things about healthcare is the wonderful people that work within healthcare, but one of the most difficult things is that marketing budgets have to be considered alongside clinical and operational and many other very, very important budgets.

So as you are creating your priorities for the year and as you’re thinking about what you want to do to [00:15:00] really improve patient’s access to care, and provide a better digital experience, what do you do to try to ensure the success of your projects actually being approved during the budgeting process, and then making sure that they’re supported really for the long term, and it’s not something that you allocate money to for a year, and then it died on the vine the following year? 

Cindy: You know, wish I knew the, the magical answer that, that anyone in healthcare wouldn’t have to face this issue. I do think I have some perspective and advice, but I will be honest in saying that this is still something that I struggle with in the healthcare industry all the time. And that is exactly what you said, right?

We are an important and critical function of our health systems to connect the community, patients and families with the products and services, really services more than anything that they need to maintain and proactively stay healthy, right? But we have to compete [00:16:00] with the dollars that are necessary for delivery, excellent, exceptional patient care and outcomes, and those are things.

You know, our population is growing like crazy and we have to build additional hospital space and we have to build additional primary care clinics, and those things are very significant capital investments. It’s a little hard to compete with those types of investment because you know that we need the capacity to care for those patients.

But that also the function that we offer is critical, connecting those patients and offering them access and information about those services. So the way that I tackle it here, and what I’m still working towards at St. Luke’s is ensuring that our leadership has an understanding of the impact of each of those connection points and kind of the extent in the volume of them, [00:17:00] right?

So, you know, when you have 10 million visits to your website in a year, for example. They need to understand the impact and the value of those connection points so they understand the importance of continuing to invest in them and that our world changes so quickly and evolves so quickly as well, that we need to be able to be nimble, right?

So whatever you guys can do out there to educate your leadership. Every time somebody invites you to present anywhere, say yes and like it doesn’t matter if you don’t think you have anything new to say, go there and remind them about the importance of all these things. Talk to them about what you’re doing.

Talk about what you’re seeing in the community and what patients are asking for. Talk about what trends are happening out in other industries that that could influence healthcare, the evolution of your digital experience, but it has to be top [00:18:00] of mind for them always as a critical piece of your patient engagement and community engagement infrastructure, I would say.

But what that really boils down to from a budget perspective is that it has to be kind of an ongoing budget that’s dedicated to helping you evolve over time. You will always struggle if it’s project-based, right? You don’t wanna have to go ask, and now I wanna do this, and now I wanna do that, and now I wanna do this.

Like, it has to be something that the entire organization understands, needs constant feeding and investment. And it’s critical as the front door to your organization. So whatever you can do to. For that, for that ongoing committed and dedicated budget. And then also whatever you can do to continue to get in front of as many leaders as you can, whether they’re your executive leaders, whether they’re patient care leaders, even [00:19:00] nursing leaders.

I really think that as much as they understand about the work that you do, the more you’ll be considered as a critical part of that infrastructure and the easier it will be for you to get that funding, not as a competitor to the things. The organization needs to build buildings and to expand access, but as a critical piece of being able to do that successfully.

Jenny: That’s a great perspective and one that we hear often is that relationship building within your organization is so important. 

Final question is, let’s talk about resources. So if you were to give advice to someone just entering the healthcare marketing space, what resources would you point them to for continuing education and to kind of understand the trends and what is happening?

If they are in a situation, say that they can give a presentation to their organization’s leadership team, or really just even a stay up to date themselves, where should they be looking? 

Cindy: Well, you know, I will tell you that this may be not the answer that you were expecting, but I’ll tell you it is what came to.

So [00:20:00] my career is about 25 years old and I have been at St. Luke’s for 12 years, but I’ve been working for a bit longer than that. And earlier on, especially in my healthcare role, I was really looking outward for inspiration on what to do next. I have to tell you that these days I am looking inward within our organization more for that inspiration.

I’ll tell you why. I think that’s really important for younger people who are earlier in their careers. What I have found is that I would go out and I would get these really amazing ideas about trends and opportunities, and then they would be incredibly difficult to advance or implement just for practical reasons.

Everybody else would think that they were awesome and exciting and definitely something we’d be interested. But, but getting them prioritized and getting them executed practically [00:21:00] sometimes was challenging. Like the fact that, you know, we had the opportunity during Covid to launch that online reputation management work.

It wasn’t a new idea right The timing was right. I don’t know if we would’ve gotten to it yet if Covid hadn’t happened. But I would say that what I have found to be most valuable in my career in learning and helping me support St.Luke’s in achieving its objectives is putting myself out there within the organization and helping connect the dots where they might not, you would think they’re connected, but maybe they’re not. I’ll give you an example. One of the things that I feel has been most helpful is building relationships.

You said a lot of people mention this, but with senior nursing leaders, usually in a healthcare marketing role, I feel like you hear more from executive leaders or [00:22:00] physician leaders or physicians or clinic managers that want something. I didn’t have any earlier on in my healthcare career any natural connections with senior nursing.

But I will tell you that I think that say they’re the best people to know within an organization to really understand what is working well in our patient care engagements. What is not working well? What are some of our opportunities and how someone in a marketing or digital role can help support patient experience.

So one of my closest colleagues here at St. Luke’s has become our director of patient care experience. And we talk all the time about the types of things that they’re seeing, the content that we can deliver, the things that we can say, the way that we, ways that we can help educate the patients and the community to help ease their experience and improve their experience.

And what I found is that we don’t always have to look outside for ways to really dramatically change our organizations and help [00:23:00] our organizations, the opportunities are there, and they’re glaring often right in your face. And sometimes they just need someone with a marketing mindset or an experienced mindset to help activate those things.

So if you’re in healthcare and you don’t know any nursing leaders find a way to meet some. And I also think, I’ve always struggled with the sort of quote unquote mentorship relationship. If you just ask someone for a mentor and then you sit down for coffee every once in a while and that can be great and it’s awesome.

And I have some people that I do that with, but I have learned the most when I dive into a project with someone that scares me a little bit. Right? I’ve done that a couple of times with some nursing leaders in a healthcare organization. There are lots of things that need to get done that are not really anyone’s job to do.

And I volunteered sometimes, sometimes with a little [00:24:00] bit of hesitation, but I volunteered sometimes to take on things that would certainly impact my work and impact patient care. But if I hadn’t taken them up, nobody else really would’ve done them because they’re nobody’s job. And so I kind of decided to bring together some people that I thought could help get it done.

And in one, in one particular instance, those leaders were senior nursing and we worked together for 18 months on a way to improve our information governance on patient care materials, right? Like how we’re organizing them, how we’re delivering them, how we’re templatizing them, all those sorts of things.

It was nobody’s exact job, but it was something that we knew would help improve our patient care experience, and I learned so much from them during that period, even though I had already worked at St. Luke’s for eight or nine years.And then of course you have these relationships throughout the organization that you can tap into as you go on for more of that mentorship, more of those ideas and more of a finger on the pulse of where you can help and [00:25:00] where you can improve.

So I don’t have any great outside resources to share. I mean, not that they aren’t there. I still go to conferences. I still read marketing articles and all of those things, but where I find the inspiration that is most practical and easy to implement at St. Luke’s is from within. 

Jenny: Cindy, it has been an absolute joy having you on today’s episode. I will link to your LinkedIn bio in the show note. So if anybody’s interested in reaching out directly, they can connect and chat more in depth about these topics. But thank you so much for being on. It’s been a joy. 

Cindy: Thank you for having me.



About the Author

Jenny Bristow is the CEO and Founder of Hedy & Hopp. Prior to starting Hedy & Hopp, Jenny launched, grew and sold a digital agency in Seattle and worked at Amazon. She was named one of St. Louis Business Journal’s 30 under 30, won a Stevie Award for Female Entrepreneur of the Year in 2018 and speaks regularly at healthcare marketing industry events.

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