ࡱ> 03-./y bjbj .z{{'f f 8 mmm$5m^mmmՆ%%%mv%m%%znp\u}`0}pssnnsmm%mmmmmG"mmmmmmmsmmmmmmmmmf :  University of Central Florida College of Health and Public Affairs M.S. H.S.A. Program Course Title: Service Management in Health Care Course Number: HSA 6128 Semester: Spring 2013 Time & Place: Thursday, 6:00 8:50 PM CL1, Room 301 Professor: Dr. Myron Fottler HPA 2, Room 209 A Phone: (407) 823-5531 (O) (407) 971-0618 (H) Fax: (407) 823-6138 E-Mail: Myron. HYPERLINK "mailto:fottler@ucf.edu" fottler@ucf.edu Graduate Assistant: Alicia Beardsley Office Hours: Thursday 2 5:30 p.m. or by Appointment E-Mail: UCFLicia@knights.ucf.edu Office Hours: Wednesdays & Thursdays 2 - 5 p.m. Course Materials: Fottler, Myron D., Ford, Robert C., & Heaton, Cherrill P. Achieving Service Excellence; Strategies for Healthcare, 2nd ed. Chicago, IL: Health Administration Press, 2010. Thomas, Richard K. Marketing Health Services, 2nd ed. Chicago, IL: Health Administration Press, 2010. Course Website: http://myronfottlerucf.wordpress.com/ Course Description: This course will provide a broad perspective on the conceptualization and development of marketing and customer service in health care organizations. The focus is on the links between theory and practical applications. Representative state-of-the-art methods from the best customer service organizations (inside and outside of healthcare) will be reviewed. By the end of the course, students will be familiar with a variety of approaches to marketing and enhancing customer service and should have a framework and specific skills for enhancing it in their own organizations. Course Objectives: Upon completion of this course, students will be able to: Discuss the significance, importance, and benefits of healthcare marketing and customer service in the healthcare industry. Explain and implement various approaches to marketing health services in the healthcare industry. Explain and implement various approaches to enhancing customer service in the healthcare industry. Domain/Competency/Indicators DOMAINCOMPETENCYINDICATORUnderstanding of the Healthcare Environment: The understanding of the healthcare system and the environment in which healthcare managers and providers function.Healthcare Systems and Organizations Demonstrate knowledge of the healthcare system and the environment in which it operatesAssess the interrelations among access, quality, accountability, and communityPublic Health and Health Outcomes Develop outcome measures for planning and policy DOMAINCOMPETENCYINDICATORBusiness Skills and Knowledge: The ability to apply business principles, including systems thinking, to the healthcare environment.General ManagementAnalyze and evaluate information to support a decision or recommendationConduct needs analysis, identify and prioritize requirementsDemonstrate critical thinking and analysisIdentify alternate processes and potential solutionsPerformance management and employment satisfaction measurement and improvement systemsExamine and implement selection, recruitment, and retention techniquesOrganizational Dynamics and GovernanceAbility to analyze and apply organizational systems theory and structureAbility to analyze and apply governance theory and structureAssess organizational culture and its impact on effectivenessStrategic Planning and MarketingDefine and construct strategic planning principles and processesInformation ManagementExplain the role and function of information technology in operationsInterpret and analyze data necessary for decision making Quality ImprovementUnderstand and apply quality management principlesFamiliarity with and ability to apply data collection, measurement, and analysis tools and techniques DOMAINCOMPETENCYINDICATORCommunication and Relationship Management: The ability to communicate clearly and concisely with internal and external stakeholders, establishes and maintains relationships, and facilitates constructive interactions with individuals and groups. Communication SkillsDemonstrate effective written, oral communication, and presentation skillsProvide and receive constructive feedbackListen and respond effectively to the ideas and thoughts of othersRelationship ManagementBuild collaborative relationshipsDemonstrate effective interpersonal relationsPractice and value shared decision making DOMAINCOMPETENCYINDICATORLeadership: The ability to inspire individual and organizational excellence, create a shared vision and effectively manage change to attain the organizations strategic ends and successful performance.Leadership Skills and BehaviorEngage in critical thinking and decision makingUtilize relevant data to critically analyze organizational issuesProvide visionary leadership identifying future possibilities for the organizationOrganizational Climate and CultureCreate an organizational climate that encourages teamworkSupport innovation and creativityCommunicating VisionPromote systems thinking in operationsIdentify opportunities for growth and development of the organizationManaging ChangeAnticipate and plan strategies for overcoming obstaclesAnticipate the need for resources to carry out initiativesDOMAINCOMPETENCYINDICATORProfessionalism: The ability to align personal and organizational conduct with ethical and professional standards that include a responsibility to the patient and community, a service orientation, and a commitment to lifelong learning and improvement. Personal and Professional AccountabilityUphold and act upon ethical and professional standards and principlesProfessional Development and Lifelong LearningEnhance knowledge, skills, and abilities in healthcare administration through hands on experienceValue and act on feedback that is provided about ones own strengths and weaknessesContributions to the Community and ProfessionParticipate in community projectsSupport collegial relationships with peers through networking, information sharing, and mentoring Grading: Activity Relative Weight Mid-term Exam (Individual) 40% Group Project 30% Group Presentation 15% Group Debate 15% 100% Peer Evaluations +/- 5% of final grade Requirements: All students will self-select into ten groups of 2 students. These groups will prepare in advance and present to the class all three assignments as noted in the outline. The first is to prepare and present a group project as outlined below. The second assignment is to make a presentation to the class on the dates noted. The third is to prepare for and present one side of a debate on the topics at the end of this syllabus. All dates for team presentations and debates are noted on the course schedule. Midterm: All mid-term questions will be drawn from material covered by this syllabus, including all assigned text chapters and case studies. Each student group will be asked to prepare two essay questions from which the mid-term questions will be drawn. In addition, the mid-term exam will draw upon the "Class Discussion Questions" as well as the debate issues attached to the syllabus. The mid-term examination will be completed by individual students and is not a group project. The nature of the questions in the midterm exam are complex and involve extensive discussion s that go beyond regurgitating what is found in the text. On average, a well done response to these essay questions will entail 3 to 7 pages. Obviously, superficial answers to the questions even if valid will earn less credit than comprehensive and detailed responses. Make sure to include appropriate references in the text as well as the reference section when answering questions. The required referencing format is the American Psychological Association (APA). Group Project: Each student-group will choose one of the following three projects: a consultation project or a benchmark evaluation project or a mini-marketing plan. All three will be done in a health care organization. The consultation project is an evaluation of some aspect of customer service in one health care organization. Students will contact an appropriate executive in a health-care facility, identify a customer-service problem or issue facing this facility, gather and analyze relevant data, and write a comprehensive report including recommendations. The benchmark evaluation will involve students comparing customer service standards in a healthcare organization with benchmark industry standards (Joint Commission, etc.). The mini-marketing plan will provide students with an opportunity to develop a marketing plan for a healthcare organization or a subunit of a healthcare organization (See Chapter 15 Marketing Health Services for more detail on the mini-marketing plan. See also the following two items on our course website: Additional Readings- Chapter 2, Conducting a Marketing Audit of Your Practice, and Chapter 6, Developing a Marketing Plan for Your Practice). The goal for all of the above projects is for the student group to act as external consultants to the organization and to provide relevant specific recommendations to help them solve whatever problems are identified. All reports should outline the procedures used to gather the information as well as the group's specific recommendations and rationale for each. In other words, as external consultants, the goal should be constructive suggestions for improvement in the organization's customer service or marketing system. Group Presentation: Dates for group presentations and debates are shown on the course schedule section of this syllabus. The group presentations will involve preparing a summary of the book chapters assigned to a given group for a particular class session (see course schedule). Student groups assigned to prepare the class for a given day will be responsible for presenting those chapters assigned. The group should meet prior to class to prepare the presentation for that day. Then they should prepare a written analysis summarizing and synthesizing these readings. Groups are not expected to present everything in a given book chapter - only the most interesting and relevant information should be presented. In addition, at least two current journal, newspaper, or magazine articles on that topic or topics should be discussed. The goal is insight, inspiration, and reaction to reading, not a mere recital of the readings. The presentation itself should not exceed 45 minutes; however, questions and discussion may continue for another 30 minutes. Use of PowerPoint as well as handouts for the class is expected. Each student group should be prepared to explain the key themes, issues, and implications of each of their assigned readings or cases. They should then lead a class discussion raising the questions and issues as noted above. Summaries of both the readings and two current articles should be handed out to the class and turned into the professor. The goal is to enhance class involvement with the topic, this can be achieved by asking questions of the class, asking members of the class to do something, or inviting in an outside speaker who will involve class members in the subject matter. Evaluation of the group presentations will be done both by the instructor and the other students in the class. The instructor will base his grade on the summaries of both of the readings and the two current articles, the power points used in the presentation, as well as the quality and clarity of the arguments presented to the class. The students in the class will do a peer evaluation based on a 10 point scale. The mean of the student evaluation score will be averaged with the instructors grade to compute the final grade for each group presentation. There are two criteria: the presentation and the content, and the scale ranges from 1 (poor) to 10 (superior). The mean score for each team based on peer evaluation will then be calculated and translated to a 0-100 percent scale. That score will then be averaged with the instructors score to calculate the final score. Every member of the group will receive the same grade for this assignment. Guidelines for Presentations: 1. Follow instructions 2. Outline presentation in bullets 3. Don't read to class -explain 4. Bring in outside examples and outside information. Search the various media for at least two items related to material in the text to discuss and share with the class 5. Don't try to cover everything. Make shorter presentations by hitting only the highlights, what you believe is important. 6. Use clear visuals with large print (not many words on one sheet) 7. Integrate material 8. Interact with class 9. Emphasize managerial implications Debate: The topics of the group debates are shown on page 16. The actual debate will involve two groups (an affirmative and a negative group). Each team will use three students during the actual debate: a first affirmative, a second affirmative, and a rebuttal. All group members should be involved in the debate, as both debaters and researchers to prepare the debate points or to prepare the team paper which will be passed out to the class. We only require a 1-2 page summary in outline form of the points to be made on each groups side of the debate. Evaluation of the debate presentations will be done both by the instructor and the other students in the class. The instructor will base his grade on the 1-2 page handout, as well as the quality and clarity of the arguments presented to the class. The students in the class will do a peer evaluation based on a 5 point scale. The mean of the student evaluation score will be averaged with the instructors grade to compute the final grade for each group debate. There are seven criteria and the scale ranges from 1 (poor) to 5 (superior). The mean score for each team based on peer evaluation will then be calculated and translated to a 0-100 percent scale. Every member of the group will receive the same grade for this assignment. Peer Evaluations: Team members will evaluate one another at the end of the course and this input will also influence your final grade. These evaluations will be particularly important for students "on the border" between one grade and another. Evaluation forms for Debates, Presentations, and Group Members can be found on the class website. General Policies: Attendance at all class meetings is expected. The assumption is that any individual enrolled in a graduate program is a responsible adult and will be treated as such. However, more than two absences throughout the semester will affect the overall grade in class participation. Assignments/Exams are expected precisely when they are due. Late assignments will not be accepted. A grade of ZERO will be given to any assignments not submitted on the due date. However, even late assignments must be completed since the failure to submit any assignment will constitute unsatisfactory performance in the course. All papers submitted must comply with the following guidelines, unless otherwise specified: Typed, using 12 point font (Times New Roman, Arial, Courier New) Double spaced with 1 margins Use an APA format for citations and references. Make sure you give proper credit to the sources you are using. Plagiarism will NOT be tolerated. Page numbers in the top right corner of all pages except title page Have a cover sheet with the individuals or group members names, title of paper, and date submitted Have a list of references at the end of each assignment as well as in text citations Paragraph form is expected where each paragraph has one and only one complete though. 3-4 page paragraphs are not acceptable. Be error free make sure you do a spell-check/grammar-check before submitting! Requirements: Read the assigned materials BEFORE each class meeting Participate in class discussion of assigned materials and class activities Complete assignments on the assigned date Submit final project Academic Honesty: By enrollment at the University of Central Florida, you are bound by The Golden Rule rules of conduct. Cheating is a violation of the student academic behavior standards. The common forms of cheating include: Unauthorized assistance; communication to another through written, visual or other means. The presentation of material that has not been studied/learned but obtained through someone elses efforts and utilized as part of an examination, course assignment, or project constitutes a violation. The unauthorized possession or use of an examination or course related material may also constitute cheating. Plagiarism whereby anothers work is deliberately used or appropriated without any indication of the source, thereby attempting to convey the impression that such work is the students own. Any student failing to properly credit ideas or materials taken from another is plagiarism. Any student who knowingly helps another violate academic behavior standards is also in violation of the standards. Special Needs: The University of Central Florida is committed to providing reasonable accommodations for all persons with disabilities. This syllabus is available is alternate formats upon request. Students with disabilities must contact the professor at the beginning of the semester to discuss the needed accommodations. No accommodations will be provided until the student has met with the professor to request accommodations. Students who need accommodations must be registered with the Student Disability Services, Student Resource Center, Room 132, Phone (407)-823-2371, TTY/TDD only Phone (407)-823-2116, before requesting accommodations from the professor. This syllabus is subject to change at the Instructors discretion. COURSE SCHEDULE DateTopicBehavioral ObjectiveAssignmentJan. 10 Intro to course Review of syllabus and course expectations "Healthcare and the New Consumerism" Consumer Behavior The Customer as Guest "Understanding the New Consumerism" (Handout) Student will be familiar with the course content, course expectations, and assignments. Student will share service experiences. Student will meet and interact with other students and form groups. Student will be able to list the best benchmark customer service organizations. Student will be familiar with the reasons for the growing importance of customer service. Student will be familiar with the three fundamental concepts of customer service. Student will be able to discuss guestology in healthcare facilities. Student will be able to identify how healthcare consumers are similar to or different from other consumers Ice Breakers Fill out note card with contact information. Fottler, et.al., Chapters 1 and 2 (Fottler) Jan. 17 What is Marketing? History of Healthcare marketing Future Challenges in Healthcare Marketing Students will be able to define healthcare marketing, marketing strategy, internal marketing and external marketing. Students will be able to explain to essential activities of marketing. Students will be able to explain the core goals of marketing including gaining market share, marketing new products, and differentiating services. Students will be able to explain the evolution of marketing in healthcare. Students will be able to provide rationale for healthcare marketing. Student will be able to discuss the four Ps of marketing and how to create a marketing-oriented organization. Students will be able to discuss trends affecting the future of healthcare marketing. Thomas, Chapters 1,6 and 17 (Group 1) Discussion of Class Discussion Questions 1, and 2 in small groups Jan. 24Meeting Customer Expectations Through Planning Market Planning The Service Profit Chain Article: How Super is your market?Students will be able to define and differentiate three key drivers of patient satisfaction. Students will be able to describe the managers role, as well as the role of others in planning for customer satisfaction. Students will be able to explain the evolution of marketing in healthcare Students will be able to discuss trends affecting the future of healthcare marketing. Students will be able to describe the attributes of an internal audit of customer service. Students will be able to identify and discuss the evolving societal and healthcare context. Students will be able to identify the process for implementing and evaluating a marketing plan. Students will be able to discuss the service-profit chain. Fottler, et al., Chapter 3 (Group 2) Thomas, Chapters 2 and 15 (Group 2) JL Heskett, et al . Putting the Service-Profit Chain to Work, Harvard Business Review March-April 1994, 164-07. (Group 2) Jan. 31Basic Marketing Concepts Health Care Markets Students will be able to explain and give examples of several service differentiation strategies. Students will be able to explain several communication strategies. Students will be able to identify the 4 Ps in marketing. Students will be able to identify stages of healthcare marketing. Students will be able to define and discuss the changing nature of healthcare markets.Thomas, Chapters 3,4, and 5 (Group 3) Debate # 1 Group 10 (Affirmative) VS. Group 9 (Negative) Discussion of Cases 15.2 and 5.1 in small groups Feb. 7Health Care Products and Services Retail Medicine Techniques for promotion, advertising, and sales Article: Putting Drug Adds back in the bottle Students will be able to define healthcare products and services. Students will be able to identify various techniques for promotions, advertising, and sale of healthcare products. Students will be able to identify newer and more effective marketing techniques. Students will be able to discuss implications of the retail revolution in healthcare Thomas, Chapters 7, 10 and 11 (Group 4) Donna Malvey & Myron D. Fottler The Retail Revolution in Health Care, Healthcare Management Review Vol 31(3), July-Sep. 2006 pp.168-178. (Group 4) Debate # 2 Group 8 (Affirmative) VS. Group 7 (Negative)Feb. 14"Creating a Healing Environment" Service Utilization Students will be able to discuss what healthcare can learn from hospitality. Students will be able to discuss and illustrate a comprehensive model of environmental elements that impact the patient and their responses to that environment. Students will be able to discuss the factors which predict demand for health services.Fottler, et.al., Chapter 4 (Group 5) Thomas, Chapter 8 (Group 5) Debate # 3 Group 4 (Affirmative) Vs. Group 3 (Negative) Project Topic DueFeb. 21 "Developing a Culture of Customer Service" Marketing Strategies Students will be able to explain the importance of culture to customer service. Students will be able to discuss how culture can be communicated and reinforced. Students will be able to develop a strategic marketing plan for a healthcare organization. Students will be able to discuss and give examples of branding in healthcare. Fottler, et.al., Chapter 5 (Group 6) Thomas, Chapter 9 (Group 6) Discussion of Case 12.1 and Class Discussion Questions 7 and 8 in small groups Mid-Term Exam Distributed Feb. 28  Mar. 7Staffing for Customer Service Training for Customer Service NO CLASSStudents will be able to explain how to recruit and hire clinically competent staff who enhance customer service. Students will be able to explain how selecting for personal qualities beyond clinical competence can enhance patient satisfaction. Students will be able to the process of training for customer satisfaction. Students will be able to discuss five training principles for customer service.Guest Speaker: Kenneth Peach, FACHE- Executive Director of Health Council of East Central Florida Fottler, et.al., Chapters 6 and 7 (Group 7) Discussion of Case 12.2 and Class Discussion Question 9 in small groups SPRING BREAK Mar. 14 Motivation and Empowerment "Involving the Patient and Family in Co-production" Students will be able to identify a variety of individual and team based methods of positive reinforcement. Students will be able to identify areas where teams may be most appropriate. Students will understand and be able to use various employee empowerment strategies. Students will be able to discuss how to use the patients and their families as quasi-employees. Students will be able to determine where patient or family participation makes sense.Fottler, et.al., Chapters 8 and 9 Article: HSAs are A-Ok (Group 8) Debate # 4 Group 6 (Affirmative) VS. Group 5 (Negative) MIDTERM EXAM DUE Mar. 24 "Communicating for Healthcare" "Delivering the Service" Students will be able to define and discuss the role of information in customer service. Students will be able to explain how advanced information systems can be used to enhance customer service. Students will be able to define and discuss how the system can and does impact customer service. Students will be able to explain how measuring service outcomes can be used to improve customer service. Students will be able to discuss the role and significance of marketing segmentation.Fottler, et.al., Chapters 10 and 11 (Group 9) Discussion of Case 9.1 and Class Discussion Question 12 in small groups Debate # 5 Group 2 (Affirmative) VS. Group 1 (Negative) Mar. 28  Article:"Waiting for Service" and Doctors learn to say Im sorry "Fixing Service Problems" Students will understand and be able to discuss how waiting can effect patient satisfaction. Students will be able to identify and describe methods of managing patient waits. Students will be able to discuss the importance of fixing customer service problems. Students will be able to describe how and why service problems happen. Students will be able to discuss how to recover from service problems.Fottler, et.al., Chapters 12 and 14 (Group 10) Discussion of Case 10.1 and Class Discussion Questions 13 and 14 in small groups Apr. 4Measuring the Quality of the Patient Experience Marketing Research Marketing Data Article: How did you find our Jell-o Students will be able to discuss how to measure the important things. Students will be able to discuss the advantages and disadvantages of various methods of measuring service quality. Students will be able to discuss the value and use of marketing research. Students will be able to discuss the steps in the marketing research process. Students will be able to identify and access various sources of data for healthcare marketing.Fottler, et.al., Chapter 13 Thomas, Chapters 14 and 16 (Fottler) Discussion of Case 10.2 Apr. 11  Apr. 18 Serving Perfectly Evaluating the Marketing Process Final Project Presentations Groups 1-5Students will be able to discuss how to evaluate the effectiveness of an organizations marketing strategy. Students will be able to discuss and implement a plan for maximizing customer service. Students will be able to discuss the process for evaluating the entire marketing process. Students will present highlights of their final project to their peers using no more than 20 minutes to present. Students will critique classmates on their presentations. Fottler, et al., Chapter 15 Thomas, Chapter 13 (Fottler) Class Discussion Questions 15 and 16 in small groups No readings just make sure you attend! Apr. 25 Final Project Presentations Groups 6-10 Students will present highlights of their final project to their peers using no more than 20 minutes to present. Students will critique classmates on their presentations. No readings just make sure you attend! DEBATE QUESTIONS Health care marketing creates unnecessary consumer needs and drives up the cost of health care. Retail medicine provided to the masses outside of a traditional healthcare setting by retailers such as Wal-Mart benefits the general public. Advertising by pharmaceutical companies is beneficial to both the organization and the general public. Customer service in health care provided through automated telephone systems and the internet is as acceptable as customer service provided through telephone and personal contact with human beings. The Patient Protection and Affordable Care Act passed by Congress in 2010 will enhance the clinical and service quality of care available to Americans. CLASS DISCUSSION QUESTIONS At a recent hospital planning meeting, the marketing director reports on consumer interest in a woman's health center. Hearing strong interest, the planning committee endorses the concept. A group of clinicians is charged with developing the program. Upon introduction, market response does not meet expectations. A senior physician was heard to complain, "What went wrong? We did a survey." Explain possible reasons for the program's failure. What environmental factors would you suggest account for: (a) the rapid growth of Nordic Track, a premium priced home fitness equipment company that formerly sold only through direct mail and has now opened retail stores in shopping malls and (b) the success of after-hours clinics and urgent care facilities in many urban areas? The major on-line computer sources such as America Online and major healthcare providers now provide health news, medical and health forums, etc. where users can access medical libraries, exchange messages, and discuss health problems. In what ways might the growing use of these services by consumers affect future strategies for (a) family practitioners and (b) HMOs? Do you believe this is true: Expansion and widespread use of medical savings accounts will enhance service quality in health care. If so, why. If not, why not? Explain the relative emphasis that would be placed on advertising or personal selling in each of the following situations: (1) the manufacturer of an infusion pump therapy kit for use in hospitals; (2) a hospital offering a nutrition workshop for seniors; and (3) an academic medical center offering a helicopter service for trauma cases within a 200 mile radius of the facility. Using Figure 4-1 as your reference, consider how well a particular healthcare organization with which you are familiar manages various environmental factors. Which ones can or cannot be managed by management? Which ones seemed to have been managed well and which ones have not? What suggestions to you have for the latter? What is good service? Pick two service organizations in the same field (i.e., hotels, restaurants, healthcare) you have patronized recently or can visit conveniently. Compare them in terms of service quality and value received. What were the key drivers of your assessment? Identify a healthcare organization with a strong, clearly defined service culture. How does the organization create and sustain that culture? What staffing, training, incentives, compensation, and communication techniques are used to create and define the culture? By contrast, identify and discuss a healthcare organization with a weak, muddled, or unfocused culture. The next time you visit a service provider, take particular notice of your servers. Although you did not see the training they received, do they seem to be conforming to some training and doing the job as it was designed to be done? If not, where are they going wrong and why? Identify a service organization that seems to have succeeded in motivating its frontline employees to give outstanding customer service. How do they do it? Alternatively, have members of your group worked for organizations which have not sufficiently motivated them? What are these organizations doing or not doing to cause demotivated employees? To what extent are patients in healthcare facilities allowed to co-produce the services they receive? Give specific examples. Discuss the extent to which you are required/invited to co-produce your own education. How do you feel about it? Think about a service job you have had. What communication devices, channels, and sources did you have access to and use? Did these provide adequate and timely information that you needed and wanted to do your job? What strategies could have been used to improve the information flow? (March 25) Evaluate waiting-line situations (movies, bank, hotel, athletic events, fast food, etc.) in which you have found yourself over the past month. Evaluate how well the lines are being managed. What line management strategies might have been used to improve these situations? Identify a service failure you or another group member has experienced. Describe how the organization attempted to recover from this failure. Evaluate the recovery strategy based on your reading on this topic. Imagine you are a mystery shopper for a large, multi-specialty, multi-unit, medical group practice whose identity has been concealed from the group members. You call a primary care physician practice to make an appointment for a routine physical exam. Write up a list of the activities in which you engage as well as your evaluation criteria beginning with making the appointments by phone. For example, what would your standard number of telephone rings be? If you dont know and understand your customers, you will not be able to satisfy them. How can database mining help you to know and understand your customers? What steps would you suggest for a healthcare organization that is just beginning to try to know their customers?      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