andy howell emba 1 major project – final...

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ANDY HOWELL

EMBA 1

MAJOR PROJECT – FINAL REPORT

A study into the marketing techniques of dental practitioners in the urban areas of Greater Durban,

Kwazulu-Natal, serving the Living Standards Measurement (LSM) 6-8, patient base.

November 2000

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EMBA1 – Andy Howell – Research Project

Page ii

Acknowledgements

The following research project could not have been conducted without :

The time and effort of the patients and dentists, who responded to the questionnaires

The help of Dr Olivier from the Health Professions Council on the New Stipulated Guidelines for advertising dental practices

The assistance from staff of the South African Dental Association on previous research activities and for providing insights into the context and idiosyncrasies of the current South African Dental profession

The assistance of Professor Tom Ryan, Director, Graduate School of Business, UCT, in the compilation of the final draft

The administrative team from our company, Marketing Support Services, for the questionnaire postage, data collation and accompanying administrative duties

The never flagging support of my wife, children and parents – Thank you.

To all, - my sincere thanks.

Administrator

The 2 year confidentiality embargo on this Research Report has expired

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I N D E X

Page Number

Executive Summary.. 1 Question Formulation.. 4

Literature Review of Marketing Theories.. 6

Synthesised Marketing Theory.. 7

Legislative Restrictions.. 8

Current Marketing Activities and Profile of Dental Practitioners.. 8

Current selection criteria of Patients.. 10

Comparison of Current Marketing Activity to Synthesised Marketing Theory.. 11

Comparison of Current Marketing Activity to Patients needs and wants.. 12

Comparison of Synthesised Marketing Theory to Legislative Requirements.. 13

Recommendations.. 13

Action Learning Summary.. 17

Supporting Data.. 19 Literature Reviews.. 20

Health Profession Council – Legislative Limitations.. 38

Dental Questionnaire.. 42

Patient Questionnaire.. 48

Patient Findings.. 56

Dentists Findings.. 58

Example of Data Analysis – Dentists.. 59

Example of Patient Analysis – Patients.. 60

References.. 60

Appendix.. 61

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Page 1

Executive Summary

This executive summary serves to provide an overview of this research

project.

It is compiled to provide you, the reader, with:

an understanding of the greater context in which the dental

practitioner operates

an insight into the reasons for the research topic and the formulation

of the research question

a summary into the background and current legislative limitations

a synopsis of the researched marketing literature

an overview into the research methodology

an understanding of the conclusions drawn from the research results

and finally, a synthesis of the research project including:

- the author’s recommendations for marketing opportunities, and

- an action learning reflection on the research project.

It is envisaged that the executive summary is read in conjunction with

the support material. Bracketed notations, showing the page number on

which the relevant detailed data can be found, are reflected in this

summary. This will enable the reader to easily refer to further detail on

any specific issue, should it be required.

----------------

The dental profession has come under increasing financial pressure in recent times.

As a result of technological advancements in toothpaste and preventative medicine,

combined with consumer education on effective dental hygiene, the demand for

regular dental services requiring fillings and ‘general repair’, has declined. The pain

derived from conditions associated with severe tooth decay - which previously served

as a catalyst for patients to seek immediate professional dentistry - has therefore

also declined. The net effect, is a reduction in the frequency of patient consultations

with dentists.

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Medical Aid rates (as stipulated by the newly formed governing body, the Board of

Healthcare Funders) have increased at a rate that many dentists’ claim, is below the

rate of their rising costs. As a result, some dental practitioners have increased their

rates to above the allowable medical aid tariff rates, requesting patients to bear the

extra costs. Others, fearing loss of clientele, have resigned themselves to lower

margins.

This phenomenon is not isolated to the dental profession. In general, patients have

now to bear the burden of greater medical expenses, which demand a greater share

of their disposable income. With every visit to a dental practitioner now potentially

requiring a subsidy from the patient, patients are now both reticent to adhere to a

regular ‘dental check-up’ regime, and are more likely to expect higher service levels

and value for money.

As a legacy of the apartheid era, ex-government paid dental therapists, are now

eroding the professional dentists’ lower-income level patient base.

These dental therapists, were employed by government, and were trained in basic

dentistry skills, to equip them to provide the basic dental services needed in the rural

areas.

Two unintended consequences have arisen.

Firstly, the dental therapists, having had significant hands-on, unsupervised

experience in the rural areas, approached the government with a proposal to

privatise, and to be given the permission to become ‘registered dental service

providers’. This would mean that they forfeited their government salary packages but

could charge their patients for each consultation. Given the immediate cost savings

from a pruned salary bill, and embracing the philosophy of privatisation, government

approved. This approval meant that patients could now use the services of dental

therapists and have medical aid re-imbursement. This led to declines in the patient

base of many smaller town-based ‘fully-qualified professional dental practices’, and

to those of urban dentists serving the lower-income market.

Secondly, more recently, (during the compilation of this paper), issues of medical aid

scams and below par dentistry by the dental therapists, are being frequently

reported. This has given raise to concerns amongst medical aid companies due to

the financial losses experienced both from fraud and from repeated dentistry repair.

Concern is also being voiced from the qualified dental fraternity as patients are

beginning to perceive an erosion of dentistry standards overall (patients see little

explicit distinction between therapists and professionally qualified dentists). An

additional concern is that dental therapists, due often to their rural or informal

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location, are perceived to be able to practice outside of the conventions defined by

the Health Professions Council.

In addition, the depreciation of the S.A. currency against many of the ‘hard

currencies’ (in particular the US$ and UK Sterling), and high interest rates, have

impacted on the purchase of the required dental equipment and technology. Dentists

face significant repayment and maintenance costs, to provide their patients with a

modern dental practice.

These combined factors have resulted in an increasing profit squeeze, in dental

practices. Dentists that had built a ‘secure’ practice based on previous patient

demand levels and the somewhat protective legislation, have now to re-focus, and to

actively develop differentiated products which will attract profitable patients.

Once the new services, specialised equipment and the enhanced skills capacity of

the dental team are in place, dentists are still faced with severe limitations in the

promotion of these services. Their marketing activities are limited by legislation

enforced by the Health Professions Council. This has led to a situation where :

developing a patient base is difficult for both a new dental practitioner, or a

established dentist wanting to attract clients to their new services

an established practice enjoys legislative protection from aggressive competitive

marketing campaigns - hence artificially raising the barriers of entry into the

market

patients are not given the opportunity to be informed of new services, or given

sufficient available information to compare costs /benefits

patients have to actively search for a dental practitioner and make enquiries from

acquaintances as to the quality, price, etc of their service. (This activity re-

enforced the reliance on ‘word of mouth referrals’ as the preferred selection

criteria for many patients)

The replacement of the Medical and Dental Council in 1995, with the Health

Professions Council, saw no significant reduction on the marketing limitations

imposed on dental service providers. Rather, these limitations were essentially made

more explicit and updated to include issues such as the use of logos, computer

images, and electronic signage limitations. (See Appendix for both the Old Guidelines – as defined by the Medical and Dental Council,

and the New Guidelines – as defined by the Health Professions Council)

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Some business networking of dental practitioners (registered with the South African

Dental Council) has begun, with the formation of a profit oriented training body

named OralNet. Their strategy is in the formative stages and marketing plans are still

to be formulated.

(Their MD, Dawie Schlebush, showed interest in this research paper, with colleagues

suggesting the findings may be presented at the KZN Chapter)

With this swing toward a more market-forces driven environment and the financial

imperatives forcing a revision of the dental value creating process, the following

questions arise:

‘What marketing effort, if any, are dental practitioners, who service the LSM 6-8 patient base, currently undertaking?’

‘Do they address LSM 6-8 patient needs /wants?’

‘Are they in sync with current espoused marketing theories?’

‘What marketing activities can be undertaken, which will comply with the Health Professions Council requirements?’

‘Are there any local conditions, which require a revised, more localised marketing theory?’

NB: The selection of LSM 6 –8 patients /dentists was selected for this research, as it

was believed that they would have the disposable income to make use of private

dental practitioners. In addition, the author of this paper had to operate within both

financial and logistical constraints, making the selection of this dentist / patient-type,

the most expedient.

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This paper endeavours to:

uncover the current key marketing practices undertaken by dental practitioners

serving LSM 6-8 patients, within the Greater Durban area and to compare them

with:

1. a synthesised theory of ‘best professional services marketing practice’ as

espoused by leading marketeers,

2. the findings on current patient needs and selection preferences.

highlight emergent tendencies and trends

provide an overview of legislatively allowable marketing practices

if necessary, devise a localised ‘theory of best marketing practice’ which will best

suit local conditions and be cognisant of the prevailing limitations

provide a study, with both quantitative and qualitative aspects, which will

conclude with recommendations for future marketing action by practicing dental

practitioners serving LSM 6-8 patients, in Greater Durban, Kwazulu-Natal.

In order to achieve these objectives, there were four key areas on which data was to

be obtained. (A summary of this data is reflected in the following pages)

The marketing theories as espoused by leading marketeers

The current legislative restrictions of marketing practice

The current marketing activities by local dentists

The current preferences and selection criteria of the patients

Thereafter the dentist’s marketing practice was compared with:

The developed synthesised marketing theory

The patient’s needs and perceptions

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The marketing theories as espoused by leading marketeers

A study of publications written by leading marketeers was undertaken. These

included:

How to Sell a Service – Malcolm HB Macdonald & John Leppard

Marketing Management – Philip Kotler

Managing the Professional Services Firm – David Maister

In the first publication, How to Sell a Service, the authors highlight the need to

actively sell the service. As a result they concentrate on the techniques and

competencies required for this process of selling. They investigate issues such as

communication techniques, general selling aids and marketing the benefits, in fairly

significant detail. Whilst the author provides insights into the selling techniques, he

fails in providing knowledge vis-a-vis research techniques and consumer behaviour. (See details of the literature review on pages 20-25)

In the second publication, Marketing Management, Kotler focuses on the aspect of

researching and uncovering customer needs and wants. Issues such as defining

customer value, defining the target market and researching the potential life-time

earnings of a customer, are discussed. He purports the building of customer

satisfaction through having a competitive edge, service uniqueness and effective

marketing strategies.

The author’s work is comprehensive and detailed and provides the reader with a

thorough understanding of the core underlying concepts of marketing, focusing

strongly on the aspect of research. The publication does allude to aspects of physical

evidence likely to create favourable impressions, however does not provide detailed

tangible, practical examples of why consumers buy specifically a professional

service. (See details of the literature review on pages 26 - 30)

In the last publication studied for this research project, Managing The Professional

Services Firm, Maister focuses on why clients buy a professional service – as distinct

from other services. He explores the psychology of buying, proposing that clients buy

with both emotion and logic, that they feel exposed and insecure, and are looking for

someone who they can trust. He explores the tried and tested methods of client

attraction including aspects of marketing literature / client liaison. (See details of the literature review on pages 31 - 35)

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The three publications, which include aspects of research, the psychology of buying

and selling techniques, provide the material for the synthesised marketing theory.

SYNTHESISED CAUSAL LOOP DIAGRAM OFMARKETING THEORIES

EXTERNAL &INTERNAL

RESEARCH REALLYUNDERSTANDING HOWTHE CLIENT BUYS AND

WHAT THEY FEEL &WANT

PROFESSIONAL SERVICESFIRM DEVELOPMENT

APPROPRIATE SERVICES

CLIENTSATISFACTION

REFERRALS

NEWBUSINESS

LISTENING TOCLIENTS

COMMENTS

UNDERSTANDING PROBLEMSASSOCIATED WITH SERVICES

MARKETING

STRONGCOMMUNICATION

CONTENT

GENERAL SELLING AIDS

MARKETING THEBENEFITS

TARGET MARKETCLASSIFICATION

BENEFITIDENTIFICATION

CUSTOMER'SPOSITIVE

EXPERIENCE

CUSTOMERRELATIONSHIP

BUILDING

DEVELOPMARKETING

STRATEGIES

SERVICE UNIQUENESS

SUSTAINING THEEDGE

CLIENTPATRONAGE..

UNDERSTANDING THE MARKETDYNAMICS

UNCOVER REALDECISION

MAKER

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This Synthesised Marketing Theory (see Causal Loop Diagram on the previous

page) indicates the need to:

Research the market

Uncover the real ‘influencers’ and decision-makers

Develop marketing strategies

Provide services in the manner that supports and reinforces the patients

psychology of buying

Undertake a client relationship building program to ensure top-of-mind awareness

Develop new or improved services to sustain competitive advantage (See details of the literature review on pages 36 - 37)

The current legislative restrictions of marketing practice The marketing limitations imposed on the dental practitioners, severely restricts any

explicit marketing strategies. Over the years these restrictions have forced patients to

rely almost entirely on recommendations given by friends, family or colleagues, for

their selection of a dentist. The Health Professions Council has continued to adopt

the strict historic controls, initially introduced by the Medical and Dental Council, and

has merely provided further clarity of the allowable legislative tolerances for

advertising/ promotional material.

To some extent, some dental practitioners have been marginally breaking the

Council’s new guidelines and have introduced some element of differentiation in their

promotional material. Explicit marketing campaigns remain, as far as the research

has uncovered, non-existent. (See details of the legislative review and examples of advertisements on pages 38-41)

The current marketing activities of local dentists serving LSM 6-8 patients Research was undertaken of dental practitioners providing a dental service to LSM 6

– 8 category. To begin the study, it seemed prudent to have ‘informal’ discussions,

with a small number of dentists (3), to elicit the current trends and to gain knowledge

of the context in which the industry found itself. Thereafter, the methodology

employed was to obtain information from dentists by way of both postal and personal

interview-type questionnaires.

26 Questionnaire responses were obtained.

The salient findings were.

Dental practitioners were, by business life cycle measures, fairly established –

the mean of the practice age was 7.8 years, and in their current location, 5.57

years

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Majority of dentists (80% ) indicated that they have marketing plans

- whilst this is what most dentist’s indicated on the questionnaire, probing

questions during the one-to-one interviews revealed that the definition of

‘marketing plan’ varied significantly between dentists. In some cases, very

loosely defined target markets (i.e. all patients in the Durban North area)

and lack of a coherent marketing plan, was evident, even though the

respondents suggested that they had a marketing plan. Further probing

created defensive posturing, and hence further questioning was

inappropriate. This lack of clarity on the definition, and the absence of

details/evidence to support the dentists claims of having a marketing plan,

is thus is a weakness of this research. In may be possible, that the line of

questioning was of a confidential nature and hence details were not

forthcoming, or, the ‘confession’ of having no marketing plan seemed to

be an inappropriate response – and hence not selected.

Only 11 % indicated they had a three year marketing strategy

48 % said they reviewed their marketing plans ‘ whenever it seemed appropriate’

90 % said they had defined their target market

- as previously mentioned, the level of definition was open to interpretation

The majority (71%) said their services were not significantly different to other

local dental practitioners

73 % had adjusted their prices to suit the medical aid rates - the remainder were

evenly split between adjusting their pricing to suit their competition, or their

customers

Most (52%) posted check-up reminders to their patients

Over 80% did not post newsletters to their clients

100 % (with the except of one incorrectly completed questionnaire) said that

‘word of mouth’ was a significant aspect in attracting new clients, yet 80 % said

they had no marketing plans which would serve to enhance this phenomenon

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Costs – in particular, the decreased usage of their services due to decreasing

medical aid benefits and hence increasing patient subsidisation – was seen as

the most pervasive threat

There was no distinctive trend in the dentist’s perception of their greatest

strength, however, most (80%) selected their team’s people skills, price and

location as being their most likely strengths, as perceived by their patients.

When asked what their patients would rank as the aspect which created the

highest impression, dentists ranked ‘ the dentist is warm and friendly, and,

‘makes you feel at ease’ as number one

7 % had advertised in the press, but none provided details of their objectives or

indicated the responses that they had obtained. (See further details of on pages 42 - 47)

The current preferences and selection criteria of the LSM 6 - 8 patients Research was conducted by way of distributing questionnaires and one-to-one

interviews, to 400 local LSM 6-8 patients.

117 questionnaire responses were obtained.

Salient findings were:

Just over half (53 %) of the respondents indicated that their partner’s used a

different dentist

Over 60 % of mothers went to the same dentist as their children

When asked to indicate the dominant reasons why they remained loyal to a

dentist, respondents claimed ‘ they feel familiar and trust the dentist’ as the

dominant reason, followed by ‘ the dentist makes me feel relaxed’.

22% said that they only went to the dentist ‘when in pain’

The mean period of time that respondents have been with their current dentist is

3,1 years

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When asked how they would find a dentist in a new city, respondents reflected

that they are five times more likely to ask work or sports club colleagues for their

recommendation, that any other mechanism.

Over 86 % said their final choice of dentist would be the dentist most highly

recommended by others

(See details of the questionnaire and data analysis on pages 48 – 55)

Comparison of marketing activity with the Synthesised Espoused Marketing Theories

Explicit promotional activity is almost non-existent in this profession, however, the

fact that these businesses ‘trade’ successfully, suggests that some forms of

promotion and marketing activity, however subtle, intuitive or unstructured, must

exist.

Nevertheless, the research did not uncover substantial detail as to the current

marketing activity of the targeted dental practitioners. This could mean that the

information was of such a nature, that even a brief indication, would be considered

inappropriate, or, that marketing plans are in fact not coherently articulated and

perhaps remain an intuitive response to the market. For the purposes of this study,

and as a result of my perceptions in interviews, I have chosen the latter.

In my view the synthesised espoused marketing theories, represent a coherent and

comprehensive theory by which to develop a marketing strategy for a dental

practitioner’s enterprise. The research indicates, most practitioners have a marketing

plan. (I have already indicated the problems surrounding the definition thereof)

Nevertheless in my belief, albeit perhaps subjective, this is an area on which dental

practitioners could increase their focus and attention. Clearly defining the target

market and practicing allocentrism (putting yourself in your patient’s shoes), would be

a useful exercise. In particular, Maister’s influence on the theory with regards to the

psychology of buying, would help define and tailor the services with more precision..

The theory espouses an aspect of active selling. Dental practitioners may argue that

the legislation does not allow such activity, however, I believe the principles of the

synthesised theory, still hold true. There are moments were one can ‘sell’ benefits

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(i.e. “Can we polish you teeth for you Mrs Patient? “You will have the benefit of

brighter and healthier teeth?”) and use selling aids (before and after pictures of

cosmetic surgery), in a dental practice.

The reinforcing loop of client satisfaction, and repeat usage is particularly relevant.

The aspect of listening to clients needs, and developing new/improved services

accordingly, is also very applicable.

Lastly, given the 100% response by dental practitioners that word of mouth is a

significant aspect of developing new business, customer contact between dental

consultations, is vital. It serves to enhance top-of-mind awareness, and could

influence their propensity to refer the dentist to friends or colleagues.

I believe that the synthesised marketing theory would thus remain as originally

described, and not reflect any changes as a result of the dentist’s marketing

activities.

Comparison of marketing activities with patient needs and perceptions

The marketing activity of a dental practitioner remains heavily focused on the less

explicit attributes of delivering an impressive service. The research – as previously

mentioned - failed to find the distinctive characteristics of actual marketing plans (if

indeed they do exist) and concluded that much of the marketing plan was implicit in

the manner in which the dental practitioner conducted their business.

- The key finding was that 73% of dentists indicated that they had adjusted

their prices to suit medical aid rates, yet patients did not indicate price as the ultimate

selection criteria – although it was a factor. This suggests that perhaps dentists could

adjust their prices upwards, without losing their current patient base.

- The patients indicated a strong reliance on the recommendations of friends,

family and colleagues when selecting a dental practitioner. They also indicated an

awareness of the attention to physical evidence, as clues to suggest a preferred

dentist.

- Supposedly insignificant issues such as ease of parking, the receptionists

efficiency, magazines being current, overall ambience of the waiting room, dress

code of the dentist and their assistants, the ability to enjoy speedy payment

processes combined with cash discounts, all combine to form a favourable

impression for patients.

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More significant attributes such as the ability of the dentist to provide a warm and

relaxing atmosphere, and to discuss the procedures whilst he/she works, rate highly

on patients’ list of key requirements.

Interestingly, patients have indicated that they would not mind receiving a newsletter

(or some form of written contact). In this regard the current marketing activities, which

seem devoid of a structured customer relationship building program, fail to exploit

this opportunity to keep contact. This is particularly important given that most patients

only see the dentist once a year, or when they are in pain!

The research fails to give clues as to the marketing plans devised to address such

user trends such as the influence of the children on the dentist selection, or the fact

that mothers were most likely to bring their children. The fact that the LSM 6-8

patients all use a car to get to the practice also suggests the need for ease of secure

parking, and perhaps a secure passage from the car park to the reception.

Both the dentists and the patient’s concur that a warm, friendly dentist rates highly as

a significant attribute. (See further details on pages 56 - 59)

Comparison of synthesised marketing theory with legislative requirements

The legislative requirements do restrict some of the promotional aspect that the

authors, in the literature, have suggested. However, the synthesised marketing

theory includes the focus on other areas such as price, products, place, physical

evidence, etc. Hence, I believe that the legislation is merely a market condition that

must be investigated, reviewed, and taken into account when creating a marketing

plan. It is thus not a factor that would materially impact on the synthesised marketing

theory.

RECOMMENDATIONSFinally, given the known current marketing activity and customer preferences, and,

after reviewing the synthesised marketing theory and legislative limitations, what

recommendations should be made?

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Kotler (1997) proposes the four areas of focus to stimulate thought on generating

new clients.

- New uses – finding an alternative use for the existing product.

In the dentists case, this may be quite difficult. The equipment and skills are

essentially used for dental healthcare. However, the dentist’s core

competency of people skills, fine motor co-ordination and dexterity, and

medical knowledge, combined with an existing patient base and office

infrastructure, could be used to develop an allied service.

- New users for the existing product – new patients

In the light of the limitations to explicitly ‘self-promote’ a dental practice, the

dental practitioner must find ways to enhance this ‘word of mouth’ promotional

phenomenon.

My recommendation is based on the following factors from the research

results.

53% of respondents indicated that their partner’s had an alternative

dental arrangement,

most respondents dentist selection was strongly influenced by the

recommendations of friends family and colleagues,

newsletters were indicated as acceptable by respondents

such promotional leaflets to a current patient base are an legislatively

approved activity, (and from previous experience, have proved to increase

the level of the recipients awareness on the senders activities)

These suggest that :

there is significant opportunity to attract the partners of patients from the

existing patient base

prospective patients are likely to trust the recommendations of their

partners,

current patients are more likely to be recommending a product/service

that is top-of-mind – and that they are satisfied with.

With this in mind, dentists should investigate using tools such as a

newsletters, courtesy calls, or similar, to assist in building client relationships.

They thereby provide a regular tangible vehicle to display professionalism and

patient care.

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It is likely that this focused approach will have a positive impression on those

potential patients within the current patient’s intimate circle.

In addition, this approach is an allowable patient liaison medium provided :

- it is used as a medium to convey dental educational issues

- the editorial is not overtly canvassing for customers,

- it does not provide misleading material

- it’s primary motive is not to self-promote the professional.

- It is distributed to the existing patient base

- Increased usage of the existing product This aspect could best be akin to the marketing phenomenon of cross-selling

and up-selling. An example of cross-selling would be where the patient, when

having a check-up is offered an additional allied product (such as a dental

polish or additional fluoride treatment), and an example of up-selling is where

a superior product is recommended. (A longer lasting, more prestigious filling

material, a suggestion of cosmetic dentistry)

The newsletter can also be used to stress the importance of the regular

dental check-up thereby serving to retain the existing patient usage.

- New products The development of new products, seems an unlikely opportunity, however,

the dental practitioner must bear in mind that they are not only in the dental

repair business, but in the beauty and wellness business as well. Without

intervention, a toothless person would have to make significant changes to

their eating habits, their speech would be adversely affected, and their

outward appearance would change considerably. The ‘entrepreneurial radar’

for new products and services should seek to sweep in all which is applicable

to these wider market definitions.

Maister (1997), reflects on the occasion that his dentist called him at home on the

evening after some dental work, and asked how he was feeling. He reflects on how

that left a positive impression and increased his loyalty significantly.

The point to note, is the attention to detail. Dentistry is a personal business. Small

personal details really count. Plan for them in the daily schedule.

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Richard Mulvey in his book ‘ The Will to Win’, purports that for professionals to

succeed and provide clients with a positive experience, they must manage all the

micro stages of that experience (Sometimes called the ‘Moments of Truth’). From the

initial call for an appointment, to the courtesy call after the surgery, each micro stage

must provide a positive experience.

Kaplan and Norton in the publication, The Balanced Scorecard suggest that

management should embrace a management measurement system that will ensure

the reflection of four key perspectives : financial, customer, internal business, and

innovation & learning. They propose if we fail to measure a balance of business

perspectives, we are likely to excel at one area, to the detriment of others. In a dental

profession, which is likely to be managed by a sole proprietor, a balanced approach,

is sound advice.

Lastly, whilst perhaps a little beyond the scope of this study, authors Bradenburger

and Nalebuff suggest that a business (and indeed a dental practice) should have a

conscious plan to maximise opportunities with all players in the ‘Value Net’. These

players consist of Customers (Patients), Competitors, Complementors, and

Suppliers.

This suggests that there are many instances were competitors (other local dentists)

may, in fact, be complementary. I.e. they may refer patients to you when they are

unable to provide a dental service, or they may assist you with second opinions or

advice.

Suppliers may provide you with piggy-back marketing opportunities, and patients with

the suggestions that will improve your services.

Whilst the ‘Value Net’ may explicitly suggest the investigation of using these four

players, in addition, the authors also discuss the influence of government. In this

regard, the marketing efforts of dental practitioners are severely limited by

government legislation. It could be argued that the principles of the Health

Professions Council were designed to protect the public from unscrupulous operators

who would have influence in their time of need. This may be quite relevant for life-

threatening diseases, but may not be quite as relevant in the case of cosmetic

dentistry.

If this is the case the authors suggest proactive plans for dialogue with the governing

bodies to influence their legislation.

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ACTION LEARNING SUMMARY

This research project underwent various stages of development and implementation

prior to this compilation.

Stage One: - The Immersion

In understanding the context in which the dental practitioner conducts their

profession, significant time was spent in dialogue with the role players. On reflection,

the time spent in this stage proved to provide a vital foundation and necessary for the

selection of appropriate literature to review, questionnaire compilation, and the one-

to-one interviews.

Should I repeat a similar exercise, I probably would spend even more time on this

aspect.

Stage Two – The Literature and Legislation Reviews

These took longer than was originally planned. The information available is immense

and time is needed to select that which is pertinent and to obtain information from the

relevant government bodies.

Stage Three – Questionnaire design and distribution

The selection of the appropriate questions required more time (and I am sure more

my level of skill and experience) than was anticipated. Notwithstanding this input, the

questions relating to the marketing plan and corresponding details, were insufficient

to elicit the necessary information and proved to be an aspect that perhaps

weakened this research report (Even in the one-to-one interviews, this information

remained illusive). On the positive side, the questionnaire to patients received an

above average response and the information requested (and more) was provided.

The letter using the appeal of ‘a graduate needing help’ seemed therefore to be

successful.

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Stage Four – Questionnaire Receipt and data analysis

On reflection we could have allowed greater time for the responses from dentists.

(Patient response time was acceptable) The analysis, which is probably somewhat

rudimentary when compared with a quantitative study, proved to be undertaken,

within the time, budget and completeness required. Interesting data (and perhaps

lack of it in the case of the dentist’s marketing activities) soon emerged. This was

probably the most enjoyable part of the exercise, and the completion of this

milestone, gave a sense of accomplishment. (I love it when a plan comes together!)

Stage Five – The drafting and the written paper

After the elation of stage four, which provided a sense of ‘nearing the finish line’,

drafting the paper proved more difficult, time consuming and mildly depressing, than

expected. My own mental model somehow failed to notify me that it always takes

longer than you think. The effort required for the correct articulation, and many

subsequent re-writes, was significant.

In conclusion, the research project did show benefits to both the dental practitioner,

and myself. The lack of elicited information on marketing activities, may in fact be

indicative of the lack of focus on this aspect of the dentist’s practice. If that is the

case, to those involved, the questionnaire may have served as a prompt to increase

their efforts in this direction. It was interesting to note the accentuation of service

issues rather than price, from the patients. This indicates some elasticity in price,

must also provide dentist’s with the courage to adjust prices where required.

For myself, it provided knowledge on both the industry and patients, and gave a

deeper insight into the business of investigative research. It may, in the future,

provide the opportunity to undertake further studies in this area, who knows…?

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SUPPORTING DATA

Including

LITERATURE REVIEWS SYNTHESISED MARKETING THEORY

QUESTIONNAIRE METHODOLOGY DENTIST AND PATIENT QUESTIONNAIRES,

DATA ANALYSIS APPENDICES

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MARKETING THEORY - LITERATURE RESEARCH

In order to uncover current marketing thought as espoused by leading authors, I

undertook the readings of three leading marketing publications.

The methodology used to distil the authors key learning points from these

publications, was as follows:

Whilst reading the publication, to informally record the key learnings and theories

of application

To then cluster these findings into groups of essentially the same concepts and

topics and to suitably label each cluster

By making use of a digraph, to uncover the concepts which were the key drivers

of the overall theory

Draft a causal loop diagram, indicating the salient learning points and their

systemic relationships

Briefly outline the book, making use of the SCQARE methodology, endeavouring

to provide context and clarity to the author’s writings.

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HOW TO SELL A SERVICE –Malcolm McDonald with John Leppard

Orders consistent with marketingobejectives & strategy

Not just have the best service- but sell this best service

Problems associatedwith selleing

Large elementof trust

The salesman becomespart of the product/service

There is a productelement and a service

element

Know who is the decisionmaking unit

Decisions based on a both feelings & logic

New Buy

Starightre-buy

Modifiedre-buy

Informationofficer

Consultant

Salesman

Negotiator

Root client concern:Fear of making a

mistake

TerritoryPlan

Right spread of focuson current and potetial

Classifycustomers

Descibes the benefits ofyour service in your

clients terms

Letter, call,visit

ABC - Attention,Benefits, Close

Customersbuy a

benefit

StandardBenefits

CompanyBenefits

DifferentialBenefits

CustomerAppeal

Features

Advantages

Proof

Keep itsimple

Closing thesale

HOW TO SELL A SERVICE - Unclustered Key points

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Orders consistent with marketingobjectives & strategy

Not just have the best service -but sell this best service

PROBLEMS ASSOCIATED WITHSERVICES MARKETING

Large elementof trust

The salesman becomes partof the product/service

There is a product elementand a service elementKnow who is the decision making

unit

Decisions based on a both feelings & logic

New BuyStraightre-buy

Modifiedre-buy

Informationofficer

Consultant

Salesman

Negotiator

Root client concern: Fearof making a mistake

Territory Plan

Right spread of focus oncurrent and potetial

Classify customers -area, high value etc

Descibe the benefits of yourservice in your clients

terms

Letter, call,visit

ABC - Attention,Benefits, Close

Customersbuy a benefit

StandardBenefits

CompanyBenefits

DifferentialBenefits

CustomerAppeal

Features

Advantages Proof - to bere-assured

Keep itsimple

Closing thesale

RESEARCH

COMMUNICATIONCONTENT

GENERALSELLING AIDS

MARKETINGTHE BENEFITS

PSYCHOLOGY OF BUYING

HOW TO SELL A SERVICE - Clustered key points

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HOW TO SELL A SERVICE - Digraph

RESEARCH COMMUNICATIONCONTENT

GENERALSELLING AIDS

PROBLEMS ASSOCIATEDWITH SERVICES MARKETING

MARKETING THEBENEFITS PSYCHOLOGY

OF BUYING

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HOW TO SELL A SERVICE - Causal Loop Diagram

PSYCHOLOGY OF BUYING

PROBLEMS ASSOCIATEDWITH SERVICES MARKETING

COMMUNICATIONCONTENT

RESEARCH



CLIENT CLASSIFICATION


CUSTOMEREXPERIENCE

CUSTOMERSATISFACTION

CUSTOMER REPEATUSAGE

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HOW TO SELL A SERVICE – SCQARE ANALYSIS

Situation - The authors have primarily focused their writings as a useable tool to

assist with the selling of a service. They have recognised the growing worldwide

trend in which a growing percentage of the working population is now involved with

the supply of a service.

Concern – ‘If you don’t sell you don’t survive’ is the authors note in the opening

paragraphs of their publication. What counts today, in their view, is not only having

the best service, but, in addition, selling this best service !

Question – How do you sell a service ? The operative word in this publication is the

word sell.Answer – The authors outline a number of active selling techniques, which are

typically used in both product and services selling. They introduce the problems,

which differentiate services selling, to that of products, and include learnings from

sales representative call planning to closing the sale.

Rationale – the rationale behind their theory of active selling, is not supported by any

statistically valid data. Neither are there case studies showing quantitative or

qualitative study. Rather, the publication is the authors’ view on successful service

selling techniques. The strength of their commentary coming from the qualifications

of the authors themselves (One with a doctorate in marketing, and the other

experienced in training such issues)

Their learning points are frequently supported by the underlying rationale e.g. don’t

talk too much in a sales presentation – over half the buyers in our sample said sales

personnel talk too much.

Evaluation – In the context of my study, it would seem that that the aspect of ‘one-

to-one’ selling would not be appropriate, to a dental practitioner. Having said this

however, many of the principles (e.g. to actively sell the service : to promote benefits,

as perceived by the client, not features ; the realisation that once you have made the

initial sale, the real job of on-going customer relationship begins) are extremely valid,

and are of significant value.

On the other hand, the publication provides little emphasis on research and on an

explanation of how to pinpoint customers. Demographics, client profile definition,

marketing strategy, branding, market positioning, etc – all essentially marketing

issues at a normative /strategic level, have not been addressed. This is a significant

shortfall.

As these issues are a topic of magnitude, I suspect that they may have been

deliberately excluded from the scope of this publication.

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MARKETING MANAGEMENT – P Kotler

What is Marketing - CoreConcepts

Needs, WantsDemands

DefiningCustomer

Value

Convenience, Status,Personal Image,

Building Customersatisfaction

CustomerValue

Attracting andretaining

customersDefine and

measure theretention rate

Identify thecauses ofattrition

Determine the cost toaddress the defection rate

RelationshipMarketing -

The Key

Suspects, prospects, first-timebuy, repeat buys, clients,

advocates

Basic, Reactive,Accountable,

Proactive, Partnership

Frequency marketingprograms / club

marketing programsWinning clientsthrough Market

Oriented StrategicPlanning

Ananlysing ConsumerMarkets and Buying

Behaviours

Identifying market segments andtarget markets

Research -Mystery

Shoppers

Hybrid Service - partproduct/part service

Seves apersonal

need

Practice is privatelyowned and profit

focused

Look for signs of quality - waiting room,secretarial efficiency, office condition

Credence factors vitalto mkt strategy

Quality control - training,standardisation, monitoring

customer satisfactionIntangibility

Inseparability

Variability

Perishability

Price

Place

Promotion

Product

Packaging

People

PhsyicalEvidence

Process

Requires internal andinteractive marketing

High touch& high tech

Tasks - increasecompetitive

differentiation,service quality,

productivity

Exceedexpectedservice

ReliabilityResponsiveness

Assurance

Empathy

Tangibles

ServiceQuality

Post-salesservices

Post-sales contact, newletters,reminders, personal greetings, top of

mind awareness

MARKETING MANAGEMENT - P.Kotler -Unstuctured Key Concepts

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What is Marketing - CoreConcepts

Needs, WantsDemands

DefiningCustomer

Value

Convenience, Status,Personal Image,

BUILDING CUSTOMERSATISFACTION

CustomerValue

Attracting andretaining

customers

Define andmeasure theretention rate

Identify the causes of attrition

Determine the cost toaddress the defection rate

RelationshipMarketing -

The Key

Suspects, prospects, first-timebuy, repeat buys, clients,

advocates Basic, Reactive,Accountable,

Proactive, Partnership

Frequency marketingprograms / club

marketing programs

Winning clientsthrough Market

Oriented StrategicPlanning

Ananlysing ConsumerMarkets and Buying

Behaviours

Identifying market segmentsand target markets

Research -Mystery

Shoppers

Hybrid Service - partproduct/part service

Seves apersonal

need

Practice is privatelyowned and profit

focusedLook for signs of quality - waiting room,secretarial efficiency, office condition

Credence factors vitalto mkt strategy

Quality control - training,standardisation, monitoring

customer satisfaction

Intangibility Inseparability

Variability Perishability

Price

Place

Promotion

Product

People

PhsyicalEvidence

Process

Requires internal andinteractive marketing

High touch& high tech

Tasks - increasecompetitive

differentiation,service quality,

productivity

Exceedexpectedservice

ReliabilityResponsiveness

AssuranceEmpathyTangibles

ServiceQuality

Post-sales contact, newletters,reminders, personal greetings, top of

mind awareness

Measure theretention rate

Heavy reliance onword of mouth

referrals

RESEARCH

SERVICE UNQIUENESS

Geographical, financial, social andpersonal

WHY THEY BUY YOUR SERVICE

SUSTAINING THE COMPETITIVENESS EDGE

DEVELOP MARKETINGSTRATEGIES

MARKETING MANAGEMENT - P.Kotler- Clustered Key Concepts

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WHY THEY BUY

MARKETING STRATEGIES

SERVICE UNIQUENESS

BUILDING CUSTOMERSATISFACTION

SUSTAINING THE COMPETITIVEEDGE

MARKET ING MANAGEMENT -P.Kotler

DIGRAPH

RESEARCH

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MARKETING MANAGEMENT – P. Kotler – SCQARE ANALYSIS

Situation – The author describes the situation in which services are becoming an

ever-increasing part of the economy. The book attempts to assist marketers by

providing an inclusive, systemic view of the services marketing process.

Concern – The concerns raised in this publication exist at two levels. The first, being

the fundamental marketing principles, which the author argues, exist in all

businesses. The second, being principles which apply to the services industry alone,

due to their specific peculiarities.

Question – The author attempts to answer the question :

“How does one market a professional services concern. How does it differ from other

industries, and what must marketers pay specific attention to?

Answer – the author describes a comprehensive array of concepts from basic

marketing principles to principles relating to specific industries. The principles are

grounded in scientific thinking, in which the author espouses the need for companies

to build their marketing plans on sound scientific research as opposed to ‘Marketing

MARKETING MANAGEMENT - P KotlerCAUSAL LOOP DIAGRAM

RESEARCH

MARKETINGSTRATEGIES

WHY THEYBUY

SERVICEUNIQUENESS

BUILDING CUSTOMERSTAISFACTION

SUSTAINING THEEDGE

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Myths’. He encourages healthy skepticism toward managers who “know how their

market works”, preferring to undertake research, thereby forcing a revisit of these

basic assumptions.

Rationale – the author offers both case studies and scientific studies to substantiate

many of his claims. In addition, the authors’ credentials, and being well known as a

world-leading marketing expert further strengthen the theory.

Evaluation – this publication is an in-depth study of marketing concepts and

principles. My study has not attempted to undertake an exhaustive analysis of this

comprehensive publication, but rather an analysis of the key concepts impacting on

the professional services industry, such as dental practitioners.

From this focused perspective, the publication emphasises the need for a clear,

coherent marketing plan as the fountainhead of all activities. He stresses the need to

accurately define the target market, research their core needs and to provide

customers with services that exceed their expected service value.

The publication does not provide a ‘to-do’ list, nor provide in-depth details on selling

techniques. Rather, it provides a normative / strategic view of the marketing concepts

and purports a lucid, scientific approach to the discipline of services marketing.

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MANAGING THE PROFESSIONAL SERVICES FIRM David Maister

MANAGING THE PROFESSIONAL SERVICE FIRM -Unclustered Key Concepts

D. Maister

PracticeLife Cycle

Balance : Profitability, ClientService, Employee

Development & MarketShare

Management ofProfit Drivers

PerformanceEfficiency Listening to

clients Quality work does notmean quality service

Structuredmarket

intelligenceHow the client

buys

Partemotion,part logic Marketing thrust to

existing clientsThe purchasing process:

a clients perspective

professionals rarely hiredsolely for the technical

capabilities

Buyers take personal risk,feel insecure, skeptical,

concerned, and exposed

The professional mustbe someone the client

can trustClients rely on clues andimpressions, often created by

small actions.

Preparationprior to meeting

key

Personalisedattention

Provide aneducating

experience

Clients want a conversation,not a lecture.

Dont solveunacknowledged

problems

Don't try closing techniques on me,rather progress with the

relationship

Rehears therespones to the

difficult questions

Treat objections/problemsseriously

Both technical skill and adesire to be helpful

How's yourassest - yourunique skills

Motivation /Rewards/ Building

Human Capital

Create aBalancedScorecard

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MANAGING THE PROFESSIONAL SERVICE FIRM -Clustered Key Concepts

D. Maister

PracticeLife Cycle

Balance : Profitability, ClientService, Employee

Development & MarketShare

Management ofProfit Drivers

PerformanceEfficiency

Listening toclients

Quality work does notmean quality service -

focus on service delivery

Structuredmarket

intelligence

HOW THE CLIENT BUYS ANDWHAT THEY FEEL & WANT

Partemotion,part logic

Marketing thrust toexisting clients

professionals are rarely hiredsolely for the technical

capabilities

Buyers take personal risk,feel insecure, skeptical,

concerned, and exposedThe professional mustbe someone the client

can trust Clients rely on clues andimpressions, often created by

small actions.

Preparationprior to meeting

key

Personalisedattention

Provide aneducating

experience

Clients want a conversation,not a lecture.

Dont solveunacknowledged

problems

Don't try closing techniques on me,rather progress with the

relationship

Rehears therespones to the

difficult questions

Treat objections/problemsseriously

Both technical skill and adesire to be helped

How's yourassest - yourunique skills

Motivation /Rewards/ Building

Human Capital

Create aBalancedScorecardINTERNAL RESEARCH

EXTERNAL RESEARCH

PROFESSIONAL SERVICES FIRMDEVELOPMENT

For the professional tobe on time - or a finitewaiting period given

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MANAGING THE PROFESSIONALSERVICES FIRM - D. Maister

DIGRAPH

INTERNALRESEARCH EXTERNAL

RESEARCH

HOW THE CLIENT BUYSAND WHAT THEY FEEL &

WANT


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Situation – The author describes the situation in which the professional services firm

conducts business. Clients are no longer held in awe of the professional’s technical

skills and are searching for both skills and the ability to communicate effectively.

Concern – To exist in the evolving services market, professionals are looking for

ways in which to be competitive in the market and to retain and attract new clients.

Question – “How do we manage a professional services firm so as to be both

profitable and to sustain our long term competitive advantage?”

Answer – The author bases his marketing theory essentially around understanding

the customer and providing services to suit. The author focuses initially on the aspect

of research – both internal and external. Internal – assessing the positioning of the

firm in their life cycle, analysing the various profit drivers, looking at the professional’s

MANAGING THE PROFESSIONALSERVICES FIRM - D. Maister

INTERNALRESEARCH

EXTERNALRESEARCH

HOW THE CLIENT BUYSAND WHAT THEY FEEL &

WANT


CAUSAL LOOP DIAGRAM


CLIENTSATISFACTION

REFERRALS

NEWBUSINESS

LISTENING TOCLIENTS

COMMENTS

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efficiency, etc. He then assesses the external environment. In particular, he

investigates how clients buy professional services, as this will directly indicate the

key aspects of the value proposition delivery, which the professional service firm

must concentrate on, to provide client satisfaction. This author focuses on ‘How

clients buy” rather than on “How to sell”.

He also looks at building new skills to ensure the growth of the ‘asset base’. He

purports that to manage an effective professional services firm, the professional must

pay attention to both the income statement and the balance sheet. Short-term

income should not be gained at the expense of assets. The professional needs the

courage to adhere to their strategy of, for example, providing quality service, even in

the face of temptation from short-term cash flows derived from a volume of low

quality work.

Rationale – the rationale the author embraces has intuitive appeal. He argues, if one

really knows what the client wants, and how they buy (both physically and

psychologically), the professional will be able to develop and deliver services, which

will create customer satisfaction.

He also argues that, just as the assets in a factory environment (machinery), the

professional’s ‘asset of skills’, is also depreciating. These professional assets need to

be continually replaced / upgraded in order to sustain a competitive advantage and to

the provide services to match evolving client needs.

Evaluation – The publication provides a clear focus on the customer, expanding at

some length on the psychology of buying. The rationale of this focus is sound and

logical, and substantiated in many cases by case studies.

It provides a much needed look at the psychology of buying, the need to prepare and

follow up on the small things, the need to devise a comprehensive strategy – and

challenges professionals to ‘stick with it’.

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SYNTHESIS OF MARKETING THEORIES.

SYNTHESISED CAUSAL LOOP DIAGRAM OFMARKETING THEORIES

EXTERNAL &INTERNAL

RESEARCH REALLYUNDERSTANDING HOWTHE CLIENT BUYS AND

WHAT THEY FEEL &WANT



CLIENTSATISFACTION

REFERRALS

NEWBUSINESS

LISTENING TOCLIENTS

COMMENTS

UNDERSTANDING PROBLEMSASSOCIATED WITH SERVICES

MARKETING

STRONGCOMMUNICATION

CONTENT



TARGET MARKETCLASSIFICATION


CUSTOMER'SPOSITIVE

EXPERIENCE

CUSTOMERRELATIONSHIP

BUILDING

DEVELOPMARKETING

STRATEGIES

SERVICE UNIQUENESS

SUSTAINING THEEDGE

CLIENTPATRONAGE..

UNDERSTANDING THE MARKETDYNAMICS

UNCOVER REALDECISION

MAKER

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Kotler highlights the need for professionals to effectively research their markets. He

stresses the need for a focus on the people delivering the service, the credence

factors (physical clues of professionalism), and efficient process (productivity).

Maister accentuates the role the psychology of buying a service has to play in

devising and in the delivery of exceptional service. He also explores the issue of

ensuring that short term cash flows do not detract from the long term strategy. In

addition, he encourages the development of ‘human assets’ (skills and experience) in

order to secure evolving customer needs.

McDonald emphasises the skill required to sell these services. Selling benefits rather

than features, and ensuring on-going client relationship management long after the

sale.

Together these three authors combine to produce a comprehensive and coherent

‘Best professional services marketing theory’ for the dental practitioners of

Greater Durban, KZN, - albeit excluding the limitations that the Health Profession

Council may impose.

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HEALTH PROFESSIONS COUNCIL

The following are the salient limitations as highlighted after :

undertaking both discussion with the client liaison of the Health Professions

Council (Dr. F Olivier)

studying the distributed legislation (20 March 2000)

Essentially, the council seeks to protect the public/patient from misleading

promotional, advertising or ‘improper’ competitive activities.

What is not allowed? It prohibits publications improperly drawing attention to:

The titles

Professional attainments

Personal qualities

Superior knowledge

Quality of service

The practice itself

Best prices offered

They should not include any:

Canvassing or touting for business

Logo’s showing anatomical reference

Signage that deviates from Council specification

Importantly, issues such as:

The motive

The way the material is presented

Whether the material is designed to attract patients and to refer themselves

directly to that health care professional

would be considered when ruling on the promotional appropriateness.

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What is allowed?

Practitioners may:

make information about the practice known in any medium (By this it is meant,

the name, whereabouts, contact details, specialisation details, payment terms,

and consulting hours). There is no limit on how frequently, or which medium

these may appear. (Includes the Internet)

use direct mailing (pamphlets, leaflets) methods to post boxes, street addresses

etc. They are allowed to be displayed in dentists’ room, libraries, museums and

other local information centers. (Bulk distribution to passing motorists or at

shopping malls is prohibited and the use of photographs are not allowed on these

leaflets)

Communicate with their existing patients with bone fide information on their

practice, health care information, and changes in tariffs.

Is there a revision to the preceding Synthesised Marketing Theory? These limitations essentially restrict all ‘explicit’ promotional material (Written or

verbal) to those members of the public that are not yet patients of the dental

practitioner.

This means that the marketing strategy could include creative ideas to provide

potential patients with ‘implicit’ information that could attract their patronage. In

particular, the marketing opportunities around legitimate contact with existing

patients, should be considered.

It could be argued that this is unethical, as it may be seen to flout the principles of the

Health Professions Council. Others may argue that as long as the level of

professionalism, and adherence to a ‘code of truthfulness’, is upheld, the public

benefits by becoming better informed as to the latest dental technologies – and

linked opportunities - available to the patient.

Do these limitations effect the synthesised marketing theory for dental practitioners?

The synthesised marketing theory does not explicitly advocate a particular medium of

promotion. It merely suggests the systemic development and implementation of

marketing strategy. As a result, the above limitations, whilst having an impact on the

ultimate marketing plans, do not alter the theoretical underpinnings in any way, and

hence the theory remains unchanged.

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ANALYSIS OF SAMPLE ADVERTISEMENTS

In Local Regional Press The following adverts were found in the Regional Press of the Highway Mail and

Berea News. (16 June 2000, 21 July 2000, 17th November 2000, 10th Nov 2000)

As can be seen, not all of the adverts comply with the Health Professions Council’s

stipulated requirements.

For example, some adverts include :

- anatomical diagrams (teeth)

- editorial that intends to promote the a distinctive feature of a practice (“gentle

dental care”)

- computer graphics of dental equipment (toothbrushes, dental equipment)

An advert displaying “Tooth Whitening” with no reference to a particular dental

practitioner appears in amongst the dentist’s adverts.

Whilst this may not be contravening any legislation (of which I am aware), it does

serve to detract from the professionalism of the dental practitioners who are

advertising alongside.

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A leaflet (see below), distributed in post boxes, also contravene the legislation by

specifying price as a distinctive competency (Affordable dentistry – rates negotiable –

discounts for pensioners) and hence serves to attract price sensitive patients.

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The next step in the process, was to elicit information from dental practitioners, with regards to their current marketing techniques, their successes/failures, and the way they attract and retain patients.

Methodology This was undertaken by way of a questionnaire, which was sent to 40 dental

practitioners in the Greater Durban area.

The questionnaire, consisted of three major parts - the initiation, body and conclusion

– and was grouped by topic. It was printed on plain white paper and was posted with

a self-addressed & stamped envelope, together with a covering letter. In the case of

one-to-one interviews, I used the questionnaire as the prompt and physically

completed it myself.

The questionnaires were marked for record keeping purposes and to determine if any

significant trends appeared in the varying areas. Dentists were selected by area. In

addition, personal one-one interviews were conducted.

At the time of completing this paper, 26 questionnaire responses had been obtained.

Of these, 7 were postal responses, 8 were delivered and collected from the dentist’s

practice, and the balance were personal interviews.

Whilst this is a small sample size, and may not represent a statistically valid size from

which to make reference about the marketing practice of dentists of Greater Durban,

it nevertheless represents a sizeable sample for useful qualitative input.

The responses were recorded on a spread-sheet and emergent trends analysed.

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DETAILS OF QUESTIONNAIRE

Dear Dentist

Thank you for taking the time to complete this questionnaire.

I cannot offer any prizes but please be assured that you are making one aspirant

university graduate very happy – and grateful !!

The questionnaire is essentially to assist me with a thesis currently been undertaken

as part of my degree. Through this questionnaire, I hope to learn more about the

current marketing activities, that dentists are using to retain and attract patients. At

the same time, another questionnaire is being sent to patients in order to get

feedback on the ‘psychology of buying a dental service’.

I then will attempt to reconcile the two so as to obtain an indication of their

congruency.

I have also obtained the current legislation from the Health Profession Council with

regards to marketing limitations. With these limitations in mind, I will attempt to

construct a marketing theory, which would be appropriate for SA conditions.

Your details are kept absolutely confidential.

Please complete the questionnaire, enclose it in the self-addressed envelope, and

post it at your local post office. (If you don’t mind going the extra mile – you could

alternatively fax it to me on 7022174)

Many thanks !

Andy Howell

MBA Student (University of Cape Town)

Cell: 0828814828

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DENTIST’S – QUESTIONNAIRE

How long has your practice been in existence?…………………………..

How long has the practice been in the current

premises (or immediate area)?………………………………………………..

Did you .. ? (Please tick appropriate box)

- start the practice

- take over an existing practice

- join an existing practice

Does your practice have ..? (Please tick appropriate correct answer)

- an annual marketing plan Yes / No

- a three-year marketing strategy Yes / No

If so, please give brief details (target market, practice promotion plans)

……………………………………………………………………………….

………………………………………………………………………………

How frequently are these marketing plans reviewed? (Please tick appropriate box)

- every year

- every six months

- whenever it seems appropriate

Does your practice have a formal mechanism by which

to measure the success of the marketing strategy? Yes /No

How frequently is the strategy measured…? (Please tick appropriate box)

- every year

- every six months

- every month

- whenever it seems appropriate

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Have you clearly identified your target markets? Yes / No

Could these target markets be described as niche markets? Yes / No

Do you believe your services are significantly different

to that of other dental practices in your immediate area? Yes / No

If so, please specify………………………………………….

Of the following three scenarios, which one would most likely represent

your pricing policy? (Please tick appropriate box)

- You adjusted the price of your services, to match that of the

competitors, aiming for a similar target market?

- You adjusted the price of your services, to suit the

medical aid rates?

- You adjusted the price of your services to suit

the prices your patients are willing to pay?

Which one of the following post-appointment arrangements, are you most likely to

use?

- make an appointment for the next check-up, as the patient

is leaving the last appointment

- phone patients with a reminder when a check-up is due

- post reminders when a check-up is due

- Other (Please specify)

Do you send a newsletter to your patients?

If so,

- for how many years have you done this?……………………

- who in your organisation actually compiles

it, and is responsible for it’s distribution?………………………

Do you have a specific plan to network with fellow local dentists? Yes / No

If so, please specify…………………………………….

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Do you send out a ‘newsletter’ to fellow dentists? Yes / No

Is “word of mouth” referrals by your existing clients a significant

aspect of attracting new clients? Yes / No

If so, do you have any marketing plan to enhance this phenomenon? Yes / No

If so, please specify…………………………………………………….

What do you believe to be the greatest threat to your practice

in the next three years?

…………………………………………………………………………………

………………………………………………………………………………….

What do you perceive your practice’s greatest strength is?

- you and your team’s people skills

- your technical ability

- your location

- your price

- your reputation

What do you think your patient’s are most likely to quotes as your strengths?

- you and your team’s people skills

- your technical ability

- your location

- your price

- your reputation

Have you ever conducted a survey of your patient base?

If so, what was the survey’s objective?……………………………………

Have you done any advertising in the press?

If so, what was your objective?……………………………………………..

If so, what was the response?………………………………………………

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In the patient questionnaire, patients have been asked, what characteristics of a

practice, are most likely to create a positive impression.

What do you think the ranked top five of this list will be?

(Please select five and rank them from 1 to 5

1= the aspect that would cause the biggest impression

5 = the aspect that is important, but would cause a lesser impression)

I can get an appointment within a week

Parking is easily accessible

The receptionist is warm and friendly

The receptionist is polite and efficient

The reception area is clean, orderly and quiet

The reception area is warmly decorated with background music playing

The reception area is geared to provide entertainment for children

The dentist is polite, efficient, and is obviously prepared

The dentist is warm, friendly and makes you feel at ease

The dentist is dressed in the appropriate dress code

The dentist is always on time

The dentist remains quiet and methodical whilst attending to you

The dentist discusses the process with you whilst he works

Dentist’s Room is state-of-the-art, clean and organised

Dentist’s Room is airy, warm and relaxing

The dentist was the best price

The dentist who sends a reminder for your next check-up in the post

The dentist (or assistant) who personally phones you with the reminder

Many thanks for completing the questionnaire.

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The last step in the process was to obtain information from consumers on the way they find and choose their dental practitioners, why they continue to make use of their dentist, and their view on the marketing of dental practices.

Methodology This was undertaken by way of a questionnaire, which was sent to 400 households in

the Greater Durban area.

The questionnaire, consisted of three major parts - the initiation, body and conclusion

– and was grouped by topic. The initial questionnaire was sent to a control group of

ten, were any errors and ambiguous questions were rectified. It was printed on plain

white paper (80gram) and was posted with a self-addressed & stamped envelope,

together with a covering letter.

The questionnaires were marked for record keeping purposes and to determine if any

significant trends appeared in the varying areas. Households were selected both by

area and by soliciting the assistance of family, friends, business acquaintances,

shopkeepers and others.(admittedly, the households had both a post-box and

reasonable access to the author of this paper - the pedestrian pamphlet distribution

manager !) In addition, personal one-one interviews were conducted in both an

administration office and shopping mall environments.

Questionnaires were also left in the dental waiting rooms, for completion by the

patients whilst waiting for their consultation.

At the time of completing this paper, 117 questionnaire responses had been

obtained. This represents a 29.25 % response rate. (48 were postal responses –a

12% postal response which is significantly higher than the average as experienced

by the Durban-based branch of Research International - and the balance were

personal interviews or business acquaintance responses)

Whilst this is a small sample size, and may not represent a statistically valid size from

which to make reference about the population of Greater Durban, it nevertheless

represents a sizeable sample for useful qualitative input.

The responses were recorded on a spread-sheet and emergent trends analysed.

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DETAILS OF QUESTIONNAIRE

Dear Recipient

Thank you for taking the time to complete this questionnaire.

I cannot offer any prizes but please be assured that you are making one aspirant

university graduate very happy – and grateful !!

The questionnaire is essentially to assist me with a thesis currently been undertaken

as part of my degree. I hope to learn more about the process patients use to find the

available dentists, why they choose a particular dentist, and why they remain loyal /

or choose to look elsewhere. I also want to obtain feedback as to your thoughts on

the dental practitioners’ marketing techniques.

You have been asked to complete this questionnaire as you live in the selected area

of study, and because you lived in a fairly accessible street (for my door-to-door

walkabout delivery). Your details are kept absolutely confidential, you will not be

subject to any subsequent promotional calls, junk mail, etc. Your comments are also

not forwarded to any dentists. The trends that I uncover, may however, be used to

assist dentists provide an improved service.

Please complete the questionnaire, enclose it in the self-addressed envelope, and

post it at your local post office. (If you don’t mind going the extra mile – you could

alternatively fax it to me on 7022174)

Many thanks !

Andy Howell

MBA Student (University of Cape Town)

Cell: 0828814828

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PATIENT - QUESTIONNAIRE

Please would you place a tick alongside the answer, which you think is most

applicable. (e.g Yes / No)

Do you, or your family, use a dentist? Yes / No

If not, please indicate why not…………………………………. (If not, please pass on this questionnaire to a friend.)

Are you on a medical aid that pays either all, or part of the

dentist’s bill? Yes / No

Are you male or female Female / Male

Do you have any children? Yes / No

If so, what are your children’s ages

Child One:………

Child Two:………

Child Three:…….

Do your children use the same dentist as you? Yes / No

If not, do they

- use your partner’s dentist Yes / No

- use their own dentist Yes / No

- other (please specify)……………………………

Do your children influence your choice of dentist? Yes / No

Are you the guardian that is most likely to take your children

to the dentist? Yes / No

If not, please indicate who would take them:………….

Does your partner use the same dentist as you? Yes / No

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Are any members of your family extremely nervous

about the dentist visit? Yes / No

If so, have you any idea why this may be the case?…………………………………..

Do you go to a dentist in your immediate area?

(approximately a 15km radius from home) Yes / No

If no, approx. how far away are they: ……………….

Would you – for yourself - use your current dentist for :

- Usual frequent check-ups Yes / No

- Occasional fillings and minor dental work Yes / No

- Major dental work such as crowns, braces,

or cosmetic dentistry Yes / No

Would you – for your children - use your current dentist for :

- Usual frequent check-ups Yes / No

- Occasional fillings and minor dental work Yes / No

- Major dental work such as crowns, braces,

or cosmetic dentistry Yes / No

Please would you place a tick alongside the answer, which you think is most applicable.

On average, what is the frequency that you see a dentist ?

- Once every three years

- Once every two years

- Once a year

- Twice a year

- Only when you are in pain !

During your dental visits over the past three years, have your dentistry needs been

mostly: (Please select only one)

Routine check-ups with little need for fillings etc

A few fillings and perhaps an X-ray

Significant dental work such as wisdom tooth removal, crowns, etc

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How many years have you been going to your current dentist?………………..

How do you get to the dentist?

Car

Taxi

Public Transport

Family/ colleagues give you a lift

Walk

Other

Suppose you had just moved to a new town or city in South Africa. How would go

about finding a new dentist for you /and your family? (please select only those that

you are most likely use)

From the newspaper adverts

From the directory of dentists listed with the SA Dental Council

By asking the mothers at your children’s school

By asking colleagues at work /sports club

By asking at the chemist

By looking in the phone book for a dentist in you area

By asking your previous dentist if they could recommend anyone

Other (please specify)

Once you had heard of a few dentists, how would you choose the one to go to?

(please select one – your most important - attribute only)

The dentist who was :

- most highly recommended

- closest to where you lived

- closest to where you work

- the most cost effective

- was, in your view, the most qualified to

provide the dentistry skills that you require

- Other (Please specify)………………………………….

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Please rank in order of importance the following attributes e.g. 1 = the most important, 2 = quite important, 3 = important,

4 = not very important, 5 = the least important

- The dentist must charge medical aid rates

- The dentist must be in my immediate area (+- 15km)

- The dentist must have a pleasing ‘bedside manner’

- The dentist must be known as “technically” one of the best

- The dentist must be on time and not keep me waiting

Please look at the following groups of two sentences, compare the two and tick the box next to the attributes that you are most likely to prefer.

The reception area is clean, business-like and organised

The reception area is warm, ‘lounge-like’ and relaxing

------------

The reading material, is light up-to-date magazines

The reading material is good quality books (coffee-table type)

-------------

The receptionist is warm and friendly

The receptionist is polite and efficient

-----------

The reception area is clean, orderly and quiet

The reception area is warmly decorated with background music playing

-----------

The dentist is polite, courteous, and is obviously prepared

The dentist is warm, friendly and makes you feel at ease

------------

The dentist remains quiet and methodical whilst attending to you

The dentist discusses the process with you whilst he works

------------

Dentist’s Room is state-of-the-art, clean and organised

Dentist’s Room is airy, warm and relaxing

-------------

The dentist who sends a reminder for your next check-up in the post

The dentist (or assistant) who personally phones you with the reminder

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If you have frequently been using the same dentist, please indicate only threedominant reasons, why you think this may be the case.

- the dentist has a pleasant personality

- the practice is close to home and has easy parking

- the prices are the most reasonable in town

- the dentist makes me feel relaxed

- the dentist is extremely skilful at his dentistry

- the dentist rooms are nice

- the dentist is always on time

- you feel familiar and trust the dentist

- you are happy with the overall service

Would the fact that the magazines in the reception area were older than six months..

- create a negative impression

- create a positive impression

- not create any impression at all

Have you seen the advertising of a dentist’s practice recently ? Yes / No

If so, where did you see them ?

- In the press (i.e. main paper like Daily News)

- In a regional paper (i.e. Highway Mail, Northglen News..)

- In a magazine

- Other (please specify)

What are the impressions that you have about these adverts?

(Please select the two that are most likely to reflect your feelings)

- If a dentist was truly excellent, they would not have to advertise

- It’s good to see the adverts because you can learn what is available

- It in many ways cheapens the dentistry industry

- It serves as reminder for me to see my own dentist

- I believe dentists that advertise give the impression of not

being trustworthy

- It gives the impression of a ‘special offer’ and that has a negative

connotation for me

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Would the fact that the dentist has ‘small talk’ with their dental assistant whilst he/she

is working on you, on matters not concerning you and your dental issues..

- Irritate you – you think it is rude

- Calm and relax you

- Not really give you any impressions

Would you object to receiving a newsletter, which includes the latest

dental developments and perhaps some relevant information

on your dentist’s activities ? Yes / No

On a scale of one to five, where : 1 = very likely and 5 = very unlikely

Please read the following sentences and mark your response. (Please circle your selected number)

After reading a dentist’s advert….. How likely are you to call the dentist for an

appointment,? 1 2 3 4 5

How likely are you to call and check costs,

and compare them against your current dentist 1 2 3 4 5

If you were brand new to the city, how likely are you

to use the advert as a basis to choose a dentist? 1 2 3 4 5

How likely are you to cut out the advert and keep

it until you needed it 1 2 3 4 5

Many thanks for taking the time to complete this questionnaire – it is very much appreciated.

Please enclose it in the pre-addressed envelope and post off at your nearest post office.

How likely are you to post this ?

Today This is the correct answer !!! – Many thanks..!

Tomorrow

The day after

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Once the completed questionnaires had been received, the results were then

collated on a spreadsheet (see appendix).

The significant patient findings were as follows:

55 % of the respondents were female

75 % of the respondents had children

Just over half the respondents said that their partner used a different dentist

Over 60 % of mothers went to the same dentist as their children

Over 58% of the respondents said that they had a partner or child who was

“extremely nervous” of going to the dentist. They quoted ‘pain’ as the leading

cause, followed by the ‘fear of injections’

90% of respondents went to the dentist by car

52% of respondents said that they went to the dentist once a year

22% said that they only went to the dentist ‘when in pain’

50 % said that their dentistry needs, over the past three years, had been confined

to check-ups, fillings and x-rays

The mean period of time that respondents have been with their current dentist is

three years

When asked how they would find a dentist in a new city, respondents reflected

that they are five times more likely to ask work or sports club colleagues for their

recommendation, that any other mechanism.

Over 86 % said their final choice of dentist would be the dentist most highly

recommended by others

When asked to rank selected attributes of a dentist, respondents quoted

‘technical expertise’ as the highest selected attribute, followed by a pleasing

‘bedside manner’. In the one-to-one interviews, when asked how they determine

whether their dentist was technically competent, all but one respondents said it

was because they ‘had heard that the dentist was good’

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Respondents show a distinct preference for the reading material in the reception

area, to be up-to date magazines. 72 % said that magazines older than six

months, would create a negative impression.

61 % said that they would prefer a dentist who was warm and friendly and made

them feel at ease

86 % said that would want the dentist to discuss the process whilst he was

working on them

When asked to indicate three dominant reasons why they remained loyal to a

dentist, respondents claimed ‘ they feel familiar and trust the dentist’ as the

dominant reason, followed by ‘ the dentist makes me feel relaxed’.

Only 20 % of respondents had seen an advertisement of a dental practitioner and

that most had seen them in a regional newspaper

When asked for two impressions of the advert the respondents replied

- “ it is good to see the adverts so that they can learn what is available’ and

- “ it serves as reminder to see their own dentist

47 % said that non-work related discussion between dentist and dental assistant,

was irritating and rude. 30 % said it was relaxing. The remainder had no

comment.

89 % said they had no objection to receiving a brochure

The response to adverts was poor, with only 13 % saying that they may use the

advert to select a new dentist.

Additional Findings: In one-to-one interviews, furthers details of patient preference was uncovered. There

was a preference for:

- the dentist to be dressed in the traditional all-white uniform (usually a safari

suit or similar)

- for payment to be made immediately after the consultation – especially as a

discount was the usual practice for this cash payment

- a clean, warm, and organised reception. It created a favourable impression.

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The significant findings on marketing effort by dentists were:

Dental practitioners were, by business life cycle measures, fairly established –

the mean of the practice age was 7.8 years, and in their current location, 5.57

years

Majority of dentists (80% ) indicated that they have marketing plans

- whilst this is what most dentist’s indicated of the questionnaire, probing

questions during the one-to-one interviews revealed that the definition of

“marketing plan’ varied significantly between dentists. In some cases, very

loosely defined target markets (i.e. all patients in the Durban North area)

and lack of a coherent marketing plan, was evident, even though the

respondents suggested that they had a marketing plan. Further probing

created defensive posturing, and hence further questioning was

inappropriate. This lack of clarity on the definition, and the absence of

details/evidence to support the dentists claims of having a marketing plan,

is thus is a weakness of this research. In may be possible, that the line of

questioning was of a confidential nature and hence details were not

forthcoming, or, the ‘confession’ of having no marketing plan seemed to

be an inappropriate response – and hence not selected.

Only 11 % indicated they had a three year marketing strategy

48 % said they reviewed their marketing plans ‘ whenever it seemed appropriate’

90 % said they had defined their target market

- as previously mentioned, the level of definition was open to interpretation

The majority (71%) said their services were not significantly different to other

local dental practitioners

73 % had adjusted their prices to suit the medical aid rates - the remainder were

evenly split between adjusting their pricing to suit their competition, or their

customers

Most (52%) posted check-up reminders to their patients

Over 80% did not post newsletters to their clients

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100 % (with the except of one incorrectly completed questionnaire) said that

‘word of mouth’ was a significant aspect in attracting new clients, yet 80 % said

they had no marketing plans which would serve to enhance this phenomenon

Costs – in particular, the decreased usage of their services due to decreasing

medical aid benefits and hence increasing patient subsidisation – was seen as

the most pervasive threat

There was no distinctive trend in the dentist’s perception of their greatest

strength, however, most (80%) selected their team’s people skills, price and

location as being their most likely strengths, as perceived by their patients.

When asked what patients would rank as the aspect which created the highest

impression, dentists ranked ‘ the dentist is warm and friendly, and, ‘makes you

feel at ease’ as number one

7 % had advertised in the press, but none provided details of their objectives or

indicated the responses that they obtained.

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REFERENCES

Malcolm HB Macdonald (1996) ‘How to Sell a Service’ (William Heinemann Ltd)

Philip Kotler (1997) ‘Marketing Management’ ( Simon and Schuster Company)

David Maister (1993) ‘Managing the Professional Services Firm’ (The Free Press)

Adam Brandenburger & Barry Nalebuff (1996) ‘Co-opetition’ (Doubleday)

Richard Mulvey (2000) ‘The Will to Win’ (Perception)

Kaplan & Norton (1999) ‘The Balanced Scorecard’ (Sage Publications Ltd)

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APPENDIX

andy howell emba 1 major project – final...

Documents