Gaston Memorial Hospital billed itself as "In Love with Life." But the people who most often saw and heard that advertising slogan seemed to think a life worth loving featured plenty of couch surfing, snacking, chug-a-lugging soda and harder stuff, smoking or chewing, taking drugs and having unprotected sex. Out of 100 North Carolina counties, according to a 2013 study by the University of Wisconsin Population Health Institute, Gaston County ranked 81st in overall health as measured by premature deaths and days of sickness. It stood 61st in tobacco use, obesity, substance abuse, sexually transmitted diseases and teen births.

"To put it bluntly," declared Randall Kelley, who took over as CEO of the 435-bed nonprofit community hospital in January 2012, "we have a health care crisis in Gaston County. And to solve it, we're going to have to transition to an entirely new structure of delivering health care."

It was Wednesday, April 3, 2013. Kelley stood at a podium surrounded by banners bearing an unfamiliar name for the hospital and a new tagline to replace "In Love with Life." He was there to announce the kickoff of a $2.5 million marketing campaign headlined by a rebranding of 47-year-old Gaston Memorial as CaroMont Regional Medical Center. Market research had shown the original name had accumulated negative associations, Kelley explained. "[It] no longer reflects who we are."

Henceforth, promised Kelley, the 4,000 employees of CaroMont Health System's flagship facility, seven affiliated companies and 33 physicians' offices would work more closely with local businesses and schools to heighten awareness of healthy lifestyles. Restaurants, for example, would offer nutritious menus, and fitness centers would develop special workout programs that would bear the new catch phrase the hospital had adopted as its brand signature. Flanking Kelley were hospital staffers wearing blue T-shirts emblazoned with that brash new slogan: "Cheat Death."

A Bold Rallying Cry

One by one, the assembled hospital employees filed forward to sign an oath that began, "I do solemnly swear to do my part in providing each resident of Gaston County with every opportunity to cheat death so they may live a healthier, better and longer life."

"Cheat death?" Community reaction was immediate.

It was not, on the whole, good.

"We, along with almost all of the physicians and nurses at the hospital, were deeply offended by the ‘Cheat Death' slogan," complained two prominent staff doctors in a scathing op-ed in the Gaston Gazette. They called the new branding tagline "ill-advised and insensitive." Social media sizzled with outraged commentary. One member of the hospital board admitted that many Gastonians were "embarrassed," the staff felt "cheapened" and some local pastors were calling the signature phrase "blasphemous."

Kelley was taken aback. "Our intent was never to offend or incite," he pled in a press release. "Our objective is to start a health revolution through an audacious goal and a bold rallying cry."

Indeed, he noted, "whether you like the tagline or not, for more than five days we have received more commentary and discussion than any other campaign in the hospital's history." Added a hospital spokeswoman, "There is no doubt this campaign is polarizing. Love it or hate it, people are talking about health care, and that's precisely what we intended to happen."

But not all ink is good ink, Kelley had to concede. On Sunday, April 7, he bowed to the furor and agreed to kill the "Cheat Death" tagline while a replacement "that will unite us" was devised.

It was too late to save his own occupational skin. A week later he was fired.

Realistic Expectations

The "Cheat Death" campaign was the brainchild of Immortology, an agency in Chapel Hill, N.C., that "specializes in cre­at­ing hard to ignore and impos­si­ble to for­get" brands. Immortology began by reviewing some 400 taglines used by hospitals across the country, according to principal Bill Harper. There was a blah sameness to them, he suggested to a reporter for the Charlotte Business Journal. "That's exactly why nobody has ever made such a ruckus. We've done something that did get attention."

Charlotte-area advertising and marketing peers awarded Immortology full marks for that. But as Elaine and Melia Lyerly, partners in a Belmont, N.C., agency whose clients have ranged from the American Red Cross to Physicians for Peace, wrote in the Gaston Gazette after CaroMont's change of heart, the slogan was "too edgy for its industry … . Associating it even loosely with a hospital showed a lack of sensitivity toward those who had lost a loved one and a blindness toward mortality. A hospital is a stark reminder that, in the end, no one cheats death."

It's on that level that CaroMont's campaign arguably failed the principles and best practices checklist compiled in 2010 by the AHA's Society for Healthcare Strategy & Market Development. To guide organizations in developing new marketing communications strategies, SHSMD advised, "Only when you are able to answer ‘yes' to each question [on the checklist] is the campaign ready to be launched."

The first question: "Does the product or service being promoted add genuine value for the patient?"

Here Kelley and Harper would voice a loud affirmative. "This is a lot bigger than a branding campaign," the former maintained. "This is a wellness movement." Agreed the latter, "We needed a way to get the issue of health care and the seriousness of the situation on the lips of every man, woman and child in the county."

It's on the second question in the SHSMD best practices checklist that the tagline could be said to have fallen short: "Does the communication set realistic expectations? Does it avoid embellishment?"

Not only did many people in the community find the colloquial phrase "Cheat Death" jarring and in poor taste, but also its implication was offensive when voiced by a hospital, where many are saved, but, sadly, many die.

Cheating on Cancer

Of course, no one contended that Immortology's slogan meant CaroMont was literally promising its patients immortality. Truth was not an issue in the campaign. Unfortunately, the same can't be said for many of the ads placed in major media by leading hospital cancer centers, according to a recent study published in the Annals of Internal Medicine.

Of 409 print and television advertisements for clinical services sponsored by 102 U.S. cancer centers in 2012, researchers at the University of Pittsburgh found that more than a quarter touted the benefits of a particular therapy but only 2 percent mentioned any associated risks. The cost of treatment was listed in a mere 5 percent of the ads. None said whether insurance coverage was available.

Most of the ads — 85 percent — were designed to tug at readers' or viewers' emotions. Six in 10 played on hope of survival. Four in 10 described patients as engaging in a "fight" or a "battle." Three in 10 appealed to fear. Almost half the ads featured patient testimonials — but none mentioned the results a typical patient could expect, and only rarely (15 percent) were there any cautionary disclaimers.

Truthfulness is the touchstone of marketing communications in health care, SHSMD emphasizes. That means — according to the checklist — not implying that outcomes are routine when they're uncommon or specific to a single patient. It means not creating a fictitious "average" patient without disclosing that the experience described is a composite. It means not implying that a successful outcome is guaranteed (unless it can be, which is hardly likely).

Truthfulness also means not massaging statistics to boost reported survival rates — by turning away patients with poor prognoses, for example, or using esoteric qualifications — as some cancer centers have been accused of doing. "If data are being used (success rates, outcomes and other statistical evidence), are they presented with great care and accuracy, and is all pertinent information, including the source of the data disclosed?" the SHSMD checklist challenges. "Are the data current?"

In the "spirit of disclosure of all material information," SHSMD counsels, "procedures that may require additional screenings or may cause the patient to incur additional costs should be described fully." Citing only the low initial price for a procedure that is likely to lead to escalating expenses is unethical. Screenings that automatically will trigger referral require a warning to that effect up front. Only 18 percent of the cancer center ads were for screening modalities and only 13 percent for supportive services; fully 88 percent were aimed at drawing patients into treatment.

Testimonials by patients, families or health care providers should, of course, reflect their "genuine opinions, beliefs, treatments or experiences," the SHSMD guidelines assert. If the endorsers were paid or compensated, that should be revealed. Those presented as experts should possess the relevant expertise.

Where all too many cancer center ads flunked that checklist was in their tone and their content. "The use of tactics that induce fear or promote the use of excessive or unnecessary healthcare services is unethical," the SHSMD advisory declares flatly. Moreover, ethical health care marketing materials have to "disclose risks associated with procedures that may affect the person's decision to participate."

Death Comes to the CEO

Before unveiling any new marketing initiative, SHSMD recommends that hospitals and health systems run it through a formal review process. Representatives from marketing, legal, risk management and senior leadership teams should vet the content. When data are cited or claims like "first," "most," "only or "best" are made, a substantiating fact sheet should be compiled. Clinical and physician leaders should be involved from the outset, too, especially when service lines are being promoted.

That's where CaroMont fell down, according to critics.

"Had Mr. Kelley consulted the board or the medical staff or taken the time to really get to know our patients and our community," physicians Frederic Levy and Steven Yates objected in their angry critique, "he would have known that the ‘Cheat Death' tagline does not reflect who we are and the values we hold."

In the end, it was that — a failure to communicate before communicating, a management style that could be blamed for a marketing stumble — that condemned CaroMont's CEO to corporate capital punishment.

David Ollier Weber is a principal of The Kila Springs Group in Placerville, Calif., and a regular contributor to H&HN Daily.