If a brand stands for anything, it stands for consistency. It says, "This identity has integrity because wherever you encounter it, whenever you encounter it, however you encounter it, it reliably will deliver the same benefits, the same experience, the same value." That is the power of a brand, whether it's for a tangible product or an intangible service. And that's why most health care brands are so vulnerable.

Apply the test of consistency to everything you know about hospitals and physicians. How consistent are they from department to department, floor to floor, unit to unit, practice to practice? A long tradition of inconsistency lies at the heart of many of the quality and cost problems that bedevil health care today. Inconsistency makes a product suspect, and no strong brand can be built on the shaky foundation of a flawed product. To build a strong brand, you first have to build a strong product. Absent strength in the product, a brand is a hollow claim, a kind of lie.

Standards of Behavior Form a Brand

When an industry's product is tangible, consistency is more straightforward. An automobile is an obvious example. A tangible product becomes the physical embodiment of the brand. It's not nearly that simple in a service industry in which the experience becomes the embodiment of the brand. In defining experience, it's important to recognize that it's all about interactions. People obviously interact with tangible things and draw an experience from that interaction. But in a service industry, the interactions that matter most are those between people. Because human interaction is so fundamental to a service brand, managing interactions against standards becomes essential.

Saying that a brand must stand for consistency raises a question: "Consistency of what?" Key to building a powerful service brand is an insistence on adherence to standards of behavior that matter: Washing your hands. Double-checking a surgical site. Applying a checklist. Making eye contact. Addressing people in a respectful way. Helping with directions. Listening attentively. Providing feedback that demonstrates you've listened.

Identifying meaningful standards gives the brand "anchors of consistency." To deliver extraordinary service, these anchors are conveyed to employees who then are empowered to invent enhancements within the boundaries of the standards.

Outcomes, timeliness, accuracy, throughput and cleanliness all can be measured. Measurement translates to the kind of performance that government and commercial payers have begun to aggregate, report and reward. Regardless of arguments about the appropriateness of the performance data being reported, the market will default to this information because it is what's available. The power of health care brands eventually will be strengthened or diminished as credible performance data gain visibility and understanding.

More than a Logo

There seems to be a view that throwing money at designing a logo and plastering it all over billboards, buildings and ad campaigns somehow breathes differentiation and value into services that are otherwise remarkable only in their inconsistency. One of the primary reasons health care executives have been so quick to invest in branding is that, compared with delivering true value, pumping dollars into a new identity is easy. In relatively short order, you can have a new logo to put on golf shirts, stationery and signage; perhaps a slogan, too. This gives the appearance of change but, too often, appearance is all it delivers. The hard work remains undone.

New "system brand names" have proliferated. They've often been crafted by some of the same ad agencies and branding firms that transformed banking into a thousand vanilla permutations. Of course, a lot of brand names are generated by computer. Take a chunk of meaning from this word, combine it with a hunk of meaning from that word, roll them together and what do you get? Too often a nonword that stands for nothing. Slap that name across several hospitals that are studies in inconsistency and what do you get? Something worse than nothing. You get a brand that is likely to represent all the disappointment and danger that inconsistency engenders.

There are instances when the institutional brand is so weak or damaged that a new name is definitely in order. But putting a new name on a bad product (or bad products) only generates a brand identity for a poor reputation. When health care organizations merge, often the first question is, "How are we going to brand our new system?"; the first question ought to be, "What are we going to do together to create a difference worth branding?"

The Brand Disconnect

There's invariably a gap between what consumers think of a health system brand and what the executives of the health system think. The executives get comfortable working for XYZ Health System. It's on their business cards and stationery, after all. It's on the outside of the corporate offices and on the outside of their hospitals, and it runs through their advertising.

But what does the market research say? Time and time again, consumers say they couldn't care less about the system brand. What they relate to is the institutional brand: the name of the hospital or the clinic. In Akron, Ohio, locals generally don't talk about going to Summa Health (the system brand) for care. They talk about going to "City." (Akron City Hospital is Summa's flagship.) In Milwaukee, St. Luke's Medical Center, not Aurora Health Care, is the destination for care. In Chicago, it's Lutheran General Hospital, not Advocate Health Care.

When meaningful system brands have been built, it's the result of infusing an existing institutional brand into the new system brand. Sentara Health successfully applied this approach. Much of the lasting power in the Sentara brand resulted from its early association with the system's well-respected flagship hospital, Norfolk General. Eventually, Norfolk General's strength got rolled across the other hospitals in the system as well as its health plan and its 350-plus employed physicians.

Poor Marketing

Even health care organizations with powerful brands can be ham-handed in managing them. Mayo and Cleveland Clinic are two of the most powerful brands in American health care. The reason they enjoy this leadership position is that they've spent 100 years consistently improving on a set of standards that clearly shape the behavior of their staff and the experience of their patients.

But Mayo Clinic still struggles to position the network of rural hospitals and physicians it has branded as the Mayo Health System. A visit to the Mayo Health System website provides a stark contrast to the image conveyed on Mayo Clinic's main website. The Mayo Health System comes across like a redheaded stepchild with hospitals and physicians that just aren't quite the same as those associated with the infamous "three shields" that brand the Mayo Clinic's website.

Perhaps Mayo leaders believe that differences in typeface and logo are enough to signal distinctions between Mayo Clinic and Mayo Health System. But both the clinic and the health system are branded "Mayo." For consumers, the question becomes, "Is the care delivered by the Mayo Health System in Eau Claire on the same plane as that delivered by the Mayo Clinic in Rochester, Jacksonville or Scottsdale?" It's a puzzle that an organization so active in the health care reform debate seemingly has been impotent in driving its own model of care consistently into a health system it owns and controls.

Cleveland Clinic brands the community hospitals it owns with the same square logo it uses for its main campus on Euclid Avenue but, like Mayo, has not extended its unique model of care into those hospitals. On the main campuses of both organizations, physician compensation is designed to generate behavior consistent with what the brand represents. It is a straight salary system that discourages overutilization and facilitates "groupness" over individualism. But both organizations default to productivity-based physician compensation for the "community physicians" they employ outside their main campuses. This is inconsistent with the unified standards and culture represented on the main campuses of Mayo and Cleveland Clinic and, as such, undermines the integrity of each organization's brand.

Taking Charge of the Brand

There is a joke often repeated in Cleveland regarding community physicians who enter the employ of the Cleveland Clinic and soon get their white lab coat with the clinic's name and square logo embroidered on it. The line goes like this: "Yesterday I was just a community doctor. Today, I'm a world-class doctor." Like many jokes, this one masks some fundamental questions including: "What does it mean to be a Cleveland Clinic doctor? What does it mean to be a Cleveland Clinic hospital? What should it mean?"

Recent research conducted with health care organizations nationwide reached a troubling conclusion. No one is in charge of the patient experience in most of those organizations, which is another way of saying no one is in charge of their brand. Given that some of America's most respected health care organizations have estimated that the monetary value of their brand exceeds the value of their tangible assets, that's a lot of value to have no one overseeing.

Some health care CEOs quickly will assert that the marketing department is responsible for their brand. Such an assertion only underscores the problem. A brand is not a slogan, a logo or an ad campaign. It is a manifestation of everything that consistently makes you different in a way that is meaningful and valuable. Nothing more. Nothing less.

Dan Beckham is the president of The Beckham Company, a strategic consulting firm based in Bluffton, S.C. He is also a regular contributor to H&HN Weekly.

The opinions expressed by authors do not necessarily reflect the policy of Health Forum Inc. or the American Hospital Association.