NMPP and Harlem Hospital are responsible for developing a marketing plan for the new Birthing Suite/Center at Harlem Hospital that will serve as a guide to locate, motivate, listen to, support and enroll low-risk pregnant women enter our care system. We must communicate the qualitative birthing experiences that will take place at the Birthing Center that would motivate Harlem and South Bronx-based customers to utilize this new service.

Ten years ago many hospitals, clinics and social service agencies believed that marketing was useless. These executives believed that good health care does not need to be sold. Today, this is a false notion where the leadership of every social institution understands the importance of marketing for the continued survival of the institution. To achieve the business, clinical and marketing objectives of the Birthing Center, we have decided to be in the business of social change. Our objective is to change the behaviors of various types of pregnant women to select our service offering.

Social marketing is the business of creating, building and maintaining exchanges. For example, I give you 89 cents and you give me a bar of sweet-smelling soap, or I walk two hours to get to the doctor’s office, wait there three more hours, and worry that my house and children are being neglected, and the doctor gives my baby an immunization which protects her from measles. The ultimate goal of a social marketing campaign is to influence behavior. Either we want to change our customer’s behavior (walk into our Birthing Center and adopt new women’s health and well-baby care behaviors) or keep it the same in the face of other pressures.

Social marketers have a unique mindset when they go about their work. That mindset is best described as a customer-centered mindset. We must begin to answer the following questions. To whom are we planning to market? Where do these customers live and what are the characteristics that define them as a customer segment? What are their current positive and negative perceptions about service quality at Harlem Hospital? What messages would motivate a particular segment to utilize the Birthing Center?

Will these perceptions, needs and wants be different in the future when our marketing strategy is implemented? How satisfied are our customers with Harlem Hospital’s current service mix? Why don’t high-risk and low-risk pregnant women utilize Harlem Hospital’s birthing services more often? How can Harlem Hospital change the nature of their services and treatment processes to influence the behaviors of our target audience segments?

Marketing is the business of offering benefits people want; reducing barriers people face, and using persuasion not just information. We are in the business of creating a better birthing experience for targeted women and their families and therefore we have to modify what we offer to our customers (CHANGE) in order to get the people we’re trying to serve to change and utilize our service.

Strategic Social Marketing Planning Process (SSMPP)

1. Birthing Center Mission Statement & Business Definition:

In three paragraphs, what is the mission and unique business definition of the Birthing Center? How does this mission relate to the mission of Harlem Hospital and NMPP? What unique birthing experience are we selling to Harlem and South Bronx women that differentiate our business from the competition? What are the unique value propositions that will motivate women of childbearing age to utilize our service? What are the differences in service offerings between a Birthing Center/Suite and a regular OB/GYN ward? The mission and business definition should be brief, feasible, motivating and distinctive.

2. Analysis of External Environment-Marketing Research:

The team must develop an up-to-date picture of the various forces that can influence whether we achieve our marketing objectives. The plan must sum up the status of our target customers now and possibly in the future. Reviewing available statistics and organizing a few focus groups can tell us more about our potential customers as well as how well the hospital is serving its current patient base.


*Demographic and socio-economic data on women of childbearing age
in Harlem and the South Bronx-examining 2000 Census data
*# of immigrant women living in our target area who need services
*Health status of teenagers who decided to have a child
*Status of women in our target area who are over 35 who decide to have a child
*Class and race analysis of differences in perinatal health
*Perinatal needs of substance abusing women
*Low birth rate and infant mortality data for Harlem & South Bronx
*Health access roadblocks for various target customer groups
*Review data on late/no prenatal care by race of mother
*Examine birth rate data sets by class and ethnic groups in target areas

3. Internal Audit of Harlem Hospital’s System of Care:

Marketing is not only concerned about what is happening externally to our customers but it must critically examine how we function as a system of care in meeting our customers’ needs. Completing this audit will help the planning team identify actions, policies and structures that produce results.
Also, we can begin to make the tough decisions to abandon strategies, policies, programs and interventions that have failed to motivate our customers to utilize Harlem Hospital for pregnancy services:

*examine current appointment system at labor & delivery suite
*examine how intake staff interacts with patients at front door of system
*talk to patients about the quality of clinic care received on L&D suite
*examine discharge system and aftercare interventions for pregnant women
*examine current marketing efforts to motivate women to use existing service
*examine physical environment on 4th floor to see if it is patient friendly
*Why has the number of births at Harlem Hospital declined over the last ten years?
*What are some of the strengths about Harlem Hospital’s service system?

4. Marketing/Customer Definitions:

NMPP has researched and defined four distinct customer segments that the marketing plan will reach. What will be the unique value propositions offered to each segment? They are as follows:

1. African-American Working Class/Medicaid Segment
2. South Harlem/South Bronx (SoHa) West African Population
3. Strivers Row Segment of Urban Settlers or Pioneers of Various Ethnicities
4. Growing Latina (Mama) Segment: Mexicans, Dominicans and Puerto Ricans

Our review of statistics and focus group results will help us define the nuances of the above market segments or decide on some new ones that are not mentioned above.

5. Competitive Analysis:

No marketing plan would be complete without an assessment of Harlem Hospital’s competition. We need to examine the service offerings of St. Luke’s Hospital Center and the larger Continuum Health Partners network the hospital is apart of. We need to closely examine the growth of this competitor’s outpatient clinic expansion in Harlem, which is their main strategy to capture market share (women of childbearing age and pregnant women) from Harlem Hospital. The Presbyterian Hospital System Allen Pavilion midwifery practice marketing efforts to convince patients to travel from Harlem to Washington Heights to deliver their babies must be studied. Why are Harlem-based pregnant women traveling to Washington Heights or Bellevue Hospital in lower Manhattan to receive prenatal and pregnancy services instead of Harlem Hospital? What are Mount Sinai Hospital’s and Cornell’s plans for Harlem when it comes to serving pregnant and parenting women? This analysis should communicate in a grid format the differences between Harlem Hospital and its competitors on:

*front door contact with patients during intake and triage
*time it takes to obtain an appointment for pregnancy testing and ongoing treatment
*quality, levels and intensity of care by midwives, nurses and obstetricians
*status of home-like nature of each facility’s birthing rooms
*quality and extent of pre-pregnancy counseling, childbirth classes and prenatal care
*review how family members are integrated into the treatment process
*quality of discharge plans and follow-up post-natal and well baby visits
*status of midwife clinical and business practice development at each site

6. Set Quantitative and Qualitative Marketing Objectives by Quarter & Segment

7. Develop Marketing Strategies & Messages for Each Customer Segment

8. Set Marketing Tactics, Timeframes and Team Members

e.g., direct mail, print & electronic media work, flyer distribution work, poster work, beauty
parlor activities, door-to-door outreach, public speaking engagements, health fair
organizing, website development, blast fax activity, radio talk show circuit, mobilize
maternal and child health organizations to steer potential patients, complete Pathmark
and other neighborhood supermarket package stuffing work, develop brochure for
upscale market segment, develop unique church and teen marketing strategies,
coordinate e-mail blast work, use mapping software to target flyer distribution sites,
organize grand opening ceremony, saturate West African and Dominican civic
institutions with Birthing Center marketing materials in their language, etc.

9. Implement Strategies and Tactics and Evaluate Results-Begin Process Again

10. Target Population: Marketing Demographics

The target population for this assignment will include women in Harlem Hospital’s primary and secondary service areas. Zip codes: 10027, 10030, 10031, 10037 and 10039 define the primary service area.

These zip codes comprise what we call Central Harlem. Central Harlem’s main ethnic groups are poor and working class African Americans and West African women plus a burgeoning cohort of women of various ethnicities who are defined by their middle class and upper class economic status, home ownership rates and lifestyle needs (Clintonian Moms/Strivers/Pioneers). Harlem Hospital has captured the African-American poor and working class sectors in the service area and must do a better job convincing more of the West African and Clintonian Moms to do business with our service structure.

Zip codes: 10025, 10026, 10029, 10032, 10033, 10034, 10035, 10040 comprise the communities of East Harlem and Washington Heights. Zip codes 10452, 10453 and 10456 comprise the community called Morrisania in the South Bronx. The above zip codes and communities define Harlem Hospital’s secondary service area. These communities have large numbers of Puerto Rican, Mexican, West African and Dominican women of childbearing age. Harlem Hospital has not captured a sizable share of this market.

Live Births in Primary & Secondary Service Areas 2002 Vital Statistics NYCDOH:

Central Harlem/CH: 1,934
East Harlem/EH: 2,042
Washington Heights/WH: 4,313
Morrisania/M: 3,410

Age Range Women in Primary Women in Secondary Total
Service Area Service Area

15-24 13,901 45,204 59,105
24-44 33,259 125,976 159,235
Total Women of Childbearing Age 47,160 171,189 218,340

Live Births by Hospital & Service Area 2002
Market Share

Harlem Hospital Center/CH-EH-M 1,014
St. Luke’s Hospital/CH-EH-WH-M 3,907
Columbia Presbyterian Medical Center/Allen Pavilion/WH-CH-citywide 6,430
Bellevue Hospital Center-Lower Manhattan/CH-citywide 2,100
Metropolitan Hospital Center/EH-CH 1,908
Mount Sinai Hospital/EH-CH-citywide 4,621
Bronx Lebanon Hospital Center-M-and other area of the Bronx 2,638

Situational Analysis

Our CHIP placed the strategic alliance between NMPP and Harlem Hospital in the turnaround quadrant. As a separate entity, NMPP is the market leader among the other 15 Perinatal Networks in New York State. To achieve our mission, our new competitors and collaborators are hospitals. NMPP has led a campaign over the last 14 years that reduced infant mortality from 27.7 deaths per 1,000 live births in 1990 to 6.2 deaths in 2002.

We achieved this objective by designing the war plan for other social service agencies, clinics and hospitals to follow and saturated the Harlem community with over seven perinatal case management programs that located high-risk pregnant women and encouraged them to enter prenatal care early while establishing for them a medical home. We simply have to focus more of our resources on meeting the needs of the West African pregnant woman, addressing the Perinatal needs of women over 35 years of age and increase our work to address the needs of women with perinatal mood disorders.
Harlem Hospital, as a separate entity four months ago received a score of 98 on their JCAHO review. During the month of April 2004, Mayor Bloomberg awarded Harlem Hospital with a capital grant of 225 million dollars to build a new hospital over the next five years. Harlem Hospital also has one of the busiest emergency rooms in the nation. On September 7, 2003, NMPP and Harlem Hospital opened our Birthing Suites project on the fourth floor of the hospital. It took about five years to raise two million dollars and build the facility. Currently, this facility has no equal in New York City in terms of the size (800 square feet each) of the five birthing rooms and the equipment and ambiance. This advantage won’t last forever!

However, Harlem Hospital operates each year with a sizable deficit. The number of deliveries declined from over 4,000 a year in 1992 to 1,104 deliveries in 2002. The hospital also has a reputation for poor quality care delivered to the residents of Central Harlem. This reality is part perception and part reality. Finally, Harlem Hospital has not responded to the new market realities and competitors who have cut into their market share by developing and implementing a professional marketing plan to recapture market share.

To reduce the infant mortality rate below six deaths per one thousand live births over the next three years, NMPP and Harlem Hospital developed a strategic alliance to transform some of our weaknesses into strengthens.

St. Luke’s Hospital Center is our main competitor in the industry. They have built about seven outpatient clinics along the 125th street corridor and throughout Central Harlem in an attempt to attract women of childbearing age into these clinics. Once the staff determines that a woman is pregnant, she is immediately referred to their birthing suite for triage. St. Luke’s does not carry out much advertising. They use their clinic infrastructure to capture market share.

However, their birthing suites are located on 57th Street several miles from Central Harlem. While Harlem-based pregnant women have been known to travel to distant facilities to get the best quality service, we must convince these women to utilize Harlem Hospital to meet their need for quality care and respect.

The Columbia Presbyterian Hospital Center/Allen Pavilion has about 30 midwives and since 1955, they have provided birthing services to the women of Northern Manhattan. Research has revealed to us that large numbers of Central Harlem-based women have traveled north to their facility in Washington Heights for prenatal care as well as delivered at the Allen Pavilion. Our task, if we choose to accept it, is to cut off the corridor north to this facility by better understanding and meeting the needs of Harlem-based pregnant women at Harlem Hospital. Recently, Presbyterian administrators decided to only allow obstetricians to deliver babies at their facility taking away the competitive advantage of midwife deliveries. We plan to take advantage of this new policy change once we roll out our market program.

Morris Heights Birthing Center is the only free- standing birthing center in New York City. This fact provides them a competitive advantage versus hospital-based birthing suites. Due to the fact that our target market moves to obtain prenatal care in one borough and then deliver their child in another, Morris Heights is a strong competitor that we must keep our eyes on! Morris Heights has a business relationship with Bronx Lebanon Hospital. While
we don’t see this facility as a major market threat, we plan to
watch their behavior because together they can make a
serious push to capture market share in Harlem although they are both based in the South Bronx. Harlem Hospital has a sizable number of West African women obtaining prenatal care and delivering their children at Harlem Hospital who come from the Morrisania section of the Bronx. We plan to expand our share along this corridor in the near future.

To conclude, we are now positioned to take advantage of the opportunities in the external environment by utilizing the combined resources of NMPP and Harlem Hospital to reduce infant mortality a few more percentage points. To achieve our objectives, we also must be mindful of our internal organizational weaknesses and transform them into strengths over the next three years or we will go out of business.

We are very concerned about the rapid economic development that is taking place in Central Harlem that has displaced the historic poor and working class base in Harlem. Examining 2000 census
data reveals 10% of our Medicaid population moved from Central Harlem from 1990 to 2000. While this is a major concern, we strongly believe that the economic development has also played a role in neighborhood stabilization which has decreased the infant mortality rate in Harlem because a new patient population has moved in with better birth outcomes.

Intense competition in the NYC healthcare market has closed several facilities and forced others to consolidate within larger hospital networks or systems. The fog that sometimes defines our industry’s market landscape is getting clearer. We now have a clear picture of the competitors left standing, their weaknesses, strengths and their marketing objectives. It is now time to make our move. It is time to take the lead!