How does a hospital website branding have positive effects of patients visiting and hospital recruitment?

Introduction

In 1978, Herbert A. Simon won the Nobel Prize in Economic Sciences, the same prize that was won by Daniel Kahneman in 2002. Simon applied psychological ideas to economic theorizing to define behavioral economics. His ideas percolated through the economic community, so that Kahneman, whose research advanced Simon’s broad perspective, could be the psychologist who won the Nobel Prize in economics (1). Behavioral economics, such as Nudge behavior change, is a relatively new field with approaches that supplement conventional approaches to improving health behaviors, [which rely on education or standard economic theory (2)]. Indeed, Nudge’s inflection of behavioral economics towards a policy is expressed by US President Obama: “A growing body of evidence is accumulating to shows that behavioral science insights research findings about how people make decisions and act on them. Behavioral science insights can support workers to find better jobs, by improving the effectiveness and efficiency of Government” (3). Nudge is used in healthcare science to modify her behavior by changing choice architecture (4) and a good case of behavioral science.

Similarly, social marketing is commonly used as an intervention strategy in global health (5). Social marketing is a technique used to analyze, plan, execute, and evaluate programs aimed to influence the behavior of target audiences, so as to improve their personal welfare or that of society (6). Social marketing provided adequate information to determine if the program met at least one of the Social Marketing Benchmark Criteria (7). In sum, decision-making processes due to exposure to information are the key to good strategy.

In the context of medical institutions, websites are utilized for practical purposes such as to educate patients and provide information (8-10). The advertising benefits of websites can also be used to secure new patients and job applicants, to contribute to the profitability of the institution. The penetration of the smartphone established the website as the most useful tool for information retrieval. Smartphones (both iPhone and Android devices) have been rapidly adopted in Japan since 2011, leading to a change in information gathering behavior. The publishing world uses content management systems (CMS) to manage content development, and to review and facilitate concurrent publication in paper and electronic formats. Therefore, adapted rather than conventional website branding is demanded by modern smartphone users for extensive dispatch of information. We aim to show how behavior modification of a person (that is, a new patient or job applicant) can take place, using regularly updating hospital website management as vertically communicated information (which is one of the social marketing techniques).

Methods

Study design

We increased the number of pages of a website by regular website updates in a certain hospital, which is located in Hyogo prefecture, from November 2015. This study forecasted the monthly website log, number of new patients, and job applicants. Website statistics Google Analytics (https://www.google.co.jp/intl/ja/analytics/) collected, stored, and maintained site usage data for the period of November 2014 to October 2016, inclusive. We defined November 2014 to October 2015 as pre-intervention period, and November 2015 to October 2016 as intervention period.

The website code allows information to be collected by Google Analytics, which is then separated by community (Hokkaido, Tokyo, and other prefectures in Japan) and stored under specific profiles. In brief, Google Analytics was used to gather website indicator data on the number of page views, sessions, website visitors, local website visitors, bounce rate, new session rate, and visiting time. We defined “local” to mean that the website visitor came from the same prefecture as the hospital.

Prior to the intervention, the website displayed doctor profiles, treatment philosophy, and practice information. The website was updated every Monday, Wednesday, and Friday from November 2015. The 19 departments updated their information more than once a month. The updated contents consisted of symptoms of illness, illness mechanisms, lifestyle advice, diagnosis processes, the education program of each department, and the welfare of employees. Each update consisted of more than 1,000 characters, and included more than one photograph of people to provide a warm and personable perspective.

All data were anonymous and aggregated, and analyses were performed at group level; thus, individuals could not be identified. No studies of patient records were undertaken. Therefore, an ethics approval was not required as per clinical guidelines and national laws and regulations.

Definition of website conversion

We recorded and communicated achievement or non-achievement of website conversion as a basis for evaluation. Conversion is defined as a local website user visiting a designated web page. In this study, website users visited the hospital for guidance or job opportunities.

Statistical analyses

Continuous variables are expressed as means ± standard deviations (SDs), and categorical data are expressed as sums and percentages. We compared the website log with the entry route of job applicants before and after the intervention. Inter-group comparisons were performed using unpaired Welch’s t-tests for continuous variables and Fisher’s exact tests for categorical variables. All statistical tests that had differences with a P value of <0.05 were considered statistically significant. Statistical analyses were performed using the R software ver. 3.2.3 (http://www.r-project.org).

Results

Hospital management information and Google Analytics characteristics

Table 1 provides monthly logs of hospital management information, new patients, or job applicants, and the Google Analytics data. In the pre-intervention period, Google Analytics characteristics did not change significantly in every month. In contrast, each parameter increased on a monthly basis during the intervention period.

Influence of regularly updated medical content on new patients and job applicants

This intervention led to a change in the behavior of new patients or job applicants. Website visitors were classified according to achievement or non-achievement of conversion, which refers to local website visitors that visited a designated web page. This definition follows because a new patient could possibly visit the hospital after accessing hospital website information. Similarly, a potential job applicant could apply after accessing information about job opportunities. To demonstrate the achievement of conversion, Tables 2,3 shows the website log during the intervention period, indicating increased website visitors, sessions, and bounce rates, and decreased page views; the website is structured so that requested information is immediately available. Similarly, achievement of conversion for job applicants is shown through increased page views and a decreased bounce rate. The monthly number of new patients from November 2015 to October 2016 is shown in Figure 1, indicating an increase in the average monthly number of new patients of 97 during pre-intervention to 121 during the intervention—an increase of 1.25 times (Figure 2).

Figure 1 The monthly number of new patients from November 2015 to October 2016.

Figure 2 The average monthly number of new patients of during pre-intervention and intervention.

Table 4 summarizes the entry route of job applicants from November 2014 to October 2016. Job applications via the website had a significantly higher success rate compared to other systems. Table 5 shows a job application rate of 10.9% for successful job applicants through the hospital homepage during pre-intervention period, while the rate during the intervention period was 27.8%. Website-based applications increased significantly during the intervention period. These results indicate that updates to the number of pages of a website lead to a change in the behavior of new patients and job applicants.

Associations between human behavior and website indicator

We used qualitative indicators such as visit duration, page views per session, and visit duration per page as a means of demonstrating the specific website log indicators that would lead the next-generation behavior modification. Tables 6,7 indicate that website visitors and visit duration per page increased during the intervention period, while the page views per session decreased.

Figure 3 showed the schema in this study. We demonstrated medical staff increased pages of website by regularly website update of medical contents. To make use of website intervention, the number of page views was increased. The new patients and job applicants were significantly increased due to the website intervention. These meant the continuous website update of medical contents increased new patients and job applicants.

Figure 3 The schema in this study.

Discussion

The information found on a website can be seen at any time of day from anywhere; enabling a person to find and select desired information requires strategies to direct them towards that information. The purpose of this study was to show how the behavior of a person (new patient or job applicant) could be changed through a website branding strategy of regular updates. In this study, it was found that regular website updates led to an increase in the number of new patients and job applicants. Regular updates to the number of pages of the hospital website, as an aggressive means of dispatching information, leads to a change in human behavior.

A recent study showed that selected website factors—which were warm and personable and consisted of answers to visitor’s key questions—lead prospective patients to make appointments with practices, while other website factors caused them to reject practices (11). The website was updated more than 19 times in a month by every department in this study. The updates were made to benefit patients and job applicants, and consisted of information about illness, the hospital education program, and welfare. Furthermore, the contents of each update consisted of a regular volume (more than 1,000 characters), and provided a warm and personable perspective, through the inclusion of photographs of the people. We assume that these contents satisfied website visitors’ needs and concerns.

Mobile and tablet internet usage exceeded global desktop usage for the first time in November 2016 (12). The website creator must ensure that the website is designed appropriately for mobile access. This includes paying attention to screen size, ensuring that the site is easy to navigate with a keypad, and recognizing that most searches performed will be simple (13). When consumers visit the website, information must be easily accessible and understandable. In this study, the content design was conscious of CMS, and content was designed to accommodate increased sessions and increased visits from smartphone users. Furthermore, website log indicators such as visit duration per page increased, while page views per session decreased, following the intervention. Above all, we thought that visit duration per page was the specific website log indicator to lead next-generation behavior modification. If the website is structured so that requested information is immediately available, the number of page views per session would decrease and the information search time would be shortened. Visitors would then carefully read a page that satisfies their interest, because the website contents have a high attraction for visitors’ interest. As a result, the visit duration per page is the specific website log indicator to lead next-generation behavior modification.

The key limitation of this study is that we utilized a single website. For a hospital in a different location, the number of page views, website visitors, new patients, and job applicant trends may differ. Google Analytics does not acquire complete data; it has a few minor errors, which do not affect the main results. Further, the survey period was delimited by a fixed interval; future work should therefore include an examination of the long-term trends of changes in the number of new patients and job applicants. We assumed these confounders, such as clinic relocation, types of treatments covered, treatment dates and times, and changes in the number and availability of medical staff. One of the strengths of this research is that there were no structural changes, such as hospital relocation or changes to the number of departments.

Conclusions

In general, the social marketer’s challenge is to harness the consumers’ collective wisdom and interest about the product. Most social marketing programs directly target behavior change of a specific consumer of interest, using a range of communications channels to do so (14). In this study, we used the multi-directional communication model with the website as a social marketing method (13). In the multi-directional communication model, information is communicated vertically to consumers who actively seek information. The reach or impression of viral communication method, such as social networking service’s, is more difficult to measure. Even more challenging is assessing the impact that this communication has on actual behavior. While website page views are the best-accepted measure of affinity of website visitors, we speculate that the specific website indicator to use was visit duration per page. In this study, the anonymity of data prevented individual follow-up of website visits. However, we obtained results that indicated a change in the number of website logs and in the actual human behavior.

This study indicates that novel website branding (i.e., by regularly updating the website as an aggressive approach to information dispatch) contributed to an increase in new patients and job applicants. This vertical communication approach could influence established novel human behavior change positively, by increasing reach and effectiveness, and establishing consumers as partners.

Acknowledgments

Funding: None.

Footnote

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jhmhp.2019.07.02). The authors have no conflicts of interest to declare.

Ethical Statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All data were anonymous and aggregated, and analyses were performed at group level; thus, individuals could not be identified. No studies of patient records were performed. Therefore, an ethics approval was not required as per clinical guidelines and national laws and regulations.

Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0/.

References

1. Leahey TH, Herbert A. Simon: Nobel Prize in Economic Sciences, 1978. Am Psychol 2003;58:753-5. [Crossref] [PubMed]
2. Volpp KG, Asch DA. Make the Healthy Choice the Easy Choice: Using Behavioral Economics to Advance a Culture of Health. QJM 2017;110:271-5. [PubMed]
3. Obama B. Executive Order -- Using Behavioral Science Insights to Better Serve the American People. 2015. Available online: https://obamawhitehouse.archives.gov/the-press-office/2015/09/15/executive-order-using-behavioral-science-insights-better-serve-american
4. Patel MS, Volpp KG, Asch DA. Nudge Units to Improve the Delivery of Health Care. N Engl J Med 2018;378:214-6. [Crossref] [PubMed]
5. Firestone R, Rowe CJ, Modi SN, et al. The effectiveness of social marketing in global health: a systematic review. Health Policy Plan 2017;32:110-24. [Crossref] [PubMed]
6. Carins JE, Rundle-Thiele SR. Eating for the better: a social marketing review (2000-2012). Public Health Nutr 2014;17:1628-39. [Crossref] [PubMed]
7. Centre TNSM. Social Marketing Benchmark Criteria. 2012. Available online: http://www.thensmc.com/sites/default/files/benchmark-criteria-090910.pdf
8. Young VL, Rajapandian V, Eley CV, et al. Monitoring Web Site Usage of e-Bug: A Hygiene and Antibiotic Awareness Resource for Children. JMIR Res Protoc 2015;4:e131 [Crossref] [PubMed]
9. Forczek E, Makra P, Lanyi CS, et al. The Internet as a new tool in the rehabilitation process of patients--education in focus. Int J Environ Res Public Health 2015;12:2373-91. [Crossref] [PubMed]
10. Brochmann N, Zwisler AD, Kjerholt M, et al. A new internet-based tool for reporting and analysing patient-reported outcomes and the feasibility of repeated data collection from patients with myeloproliferative neoplasms. Qual Life Res 2016;25:835-46. [Crossref] [PubMed]
11. Wallin WS. Does your web site draw new patients? Am J Orthod Dentofacial Orthop 2009;136:746-51. [Crossref] [PubMed]
12. Stats SCG. Desktop vs Mobile vs Tablet vs Console Market Share Worldwide 2016. 2016. Available online: http://gs.statcounter.com/platform-market-share/desktop-mobile-tablet-console/worldwide/2016. Accessed 17 February 2017.
13. Thackeray R, Neiger BL. A multidirectional communication model: implications for social marketing practice. Health Promot Pract 2009;10:171-5. [Crossref] [PubMed]
14. Thackeray R, Neiger BL, Hanson CL, et al. Enhancing promotional strategies within social marketing programs: use of Web 2.0 social media. Health Promot Pract 2008;9:338-43. [Crossref] [PubMed]