Increased competition and shrinking reimbursement are two sides of
a vice squeezing healthcare and senior care professionals pressured
to fill beds their buildings. The temptation is greater than ever
to say the one statement that will close the deal and influence the
consumer to choose your facility. Where is the line between good sales
skills and unethical behavior?
There is no simple answer to apply to the myriad of complex situations
faced daily by healthcare professionals and others working with
referral sources, prospective consumers and their families. Codes
of Ethics provide general guidelines, which act as a reminder of
the goals and purposes of elder care providers, but practical advice
about handling common situations is lacking. As buyers as well as
sellers of goods and services, we are all influenced, knowingly
or unknowingly, by various psychological factors that affect our
purchasing decisions. Understanding influence and how it can be
used effectively and ethically can direct our decisions when interacting
According to Webster, influence is the "power of persons or
things to affect others, seen only in its effects". Indeed,
healthcare professionals are in the business of exercising power
over individuals and families to affect the decision to utilize
a particular facility, product or service. There is nothing inherently
sinister about exercising power to influence decisions provided
that the influencing is done fairly and without deception. Influence
can simply be a matter of putting your best foot forward, presenting
your community and services to a consumer in a way that will influence
that person to select your facility above the competition.
In his book, Influence: The Psychology of Persuasion, Robert
Cialdini identifies seven rules of influence, all of which can be
applied effectively and ethically. Understanding the principles
of contrast; reciprocity; scarcity; authority; consensus; commitment/consistency;
and friendship/liking can assist senior care professionals engage
in intelligent sales skills. While the concepts discussed can apply
in any sales setting, the examples presented focus on the relationship
between the senior care professional presenting the senior living
community and the prospective consumer and his or her family.
Contrast: Changing Perception Based on Immediate Prior Experience
First impressions can only be made once. The first impression can
be used to influence the person's overall perception of the community
and set the stage for the buying decision. Whether your facility
is an assisted living or skilled nursing community, begin by showing
every prospective client the most expensive and most attractive
room. After seeing the best first, other rooms will not compare
well and, if the person can afford it, will want the best the community
has to offer. If the person cannot afford the number one unit or
room, then the other, less expensive rooms will appear to be a bargain
by contrast yet the person will know that he or she is part of a
Reciprocity: Obligating Behavior by Giving Back the Same Type
By behaving towards a prospective consumer in a particular way,
we can influence her to reflect our behavior and mirror it back
to us. For example, remember that the overwhelming number of healthcare
and senior care decision-makers is women. When showing a facility
to a woman, begin the tour by giving the person a flower. The flower
is a gift, a Thank You for taking the time to visit the facility.
A gift generally creates a sense of obligation in the recipient.
The person's desire to give back to you may take the form of the
person's complete attention, favorable comments made later to third
parties, or enrollment of the family member. Understand that you
are creating a sense of obligation and use it wisely. If the person
gives you her undivided attention, make sure what you are saying
is worth listening to, otherwise you will have wasted an opportunity.
The flower itself endures while the memory of the visit is fresh
in the person's mind. It will also foster conversation from third
parties and will give the person an opportunity to talk about your
facility. "Where did you get that lovely flower?" "At
a beautiful assisted living facility I went to visit with my daughter".
Scarcity: Motivation by the Possibility of Losing a Benefit
People are more motivated by what they might lose than by what
they might gain. For some sectors of the healthcare industry, scarcity
exists and need hardly be pointed out to consumers. Facilities with
high occupancy rates are a real issue for elderly males and those
with Alzheimer's and related dementias. What can be done for those
facilities that are struggling with low occupancy rates?
While a facility may be almost empty, certain steps can be taken
to make the building seem more full. Many senior living communities
have small commercial spaces such as community rooms or halls that
can be rented out to community groups for a variety of reasons such
as personal fitness classes, seminars, or social functions. Having
more people in and around the facility doing things that are fun
gives the impression that census is better than it may be.
Take a look at the physical presentation of your facility. Is everyone
parking in the lot behind the building because it is closer to the
entrance leaving the front lot disserted? Have people park in front
of the building to give the impression that parking is limited because
the facility is full.
As long as the actual census is not misrepresented, there is nothing
wrong with rearranging the window dressing to make the facility
look fuller than it really is. If people think the facility only
has a few spaces available, they will not want to be left out.
Authority: Encourage the Response to Comply with Authority Figures
Anyone who has ever seen a doctor understands the response that
the figure in the white coat evokes - compliance with what the doctor
says. Other authority figures create the same Pavlovian response.
Experts usually do know more about a particular subject than laypersons
do so we rely on their expertise in making our decisions. A wise
exercise of influence is to emphasize the ways in which your facility
and staff are authority figures.
The message to send to the community at large is that independent
authority figures recognize your facility as outstanding. Promote
and communicate affiliations with organizations and agencies such
as AHCA, ASHA, ALFA, CARF and JCAHO by listing them on your letterhead,
brochures, newsletters and other documentation. When a new affiliation
is entered into or accreditation achieved, announce it in your newsletter
and in a press release.
To communicate the professionalism of your staff, make sure that
people display their degrees, diplomas, certificates and other credentials
on their office walls or areas visible to residents or prospective
consumers. As authority figures, healthcare professionals can influence
consumers by encouraging reliance on their advice.
Consensus: Decisions Influenced by the Decisions of Others
Consumers base decisions on what other consumers are doing. If
one restaurant is hot and trendy, then everyone wants to eat there.
The same principle applies in healthcare. When tied together with
the idea of scarcity, consumers can be influenced to select your
facility over the competition simply because everyone else is making
the same choice.
Even if census is a problem, the message can be conveyed to prospective
consumers that your facility is the hot place to be. For example,
plan facility tours during, immediately before and after well-attended
events. People get caught up in the excitement of preparing for
a party or the exhaustion of cleaning up after an event. The fun
of a party is infectious. Prospective consumers will want to join
in because everyone else is having fun.
If your facility has gotten strong results from customer and consumer
satisfaction surveys promote that information in newsletters and
letters to prospective consumers. People will assume, "If that
person is happy then I will be too."
Commitment/Consistency: Create Barriers to Change
No one likes to be viewed as flighty or contradictory. Once a statement
or a decision is made, people will act in accordance with that behavior.
This principle can be used very effectively with the concept of
For example, Dr. Jones loves referring patients to your facility.
With Dr. Jones' permission, he is featured on the front page of
your newsletter indicating that he frequently refers patients to
your community because of the high quality of care people receive.
This newsletter should be sent to doctors, hospitals, case managers
and other referral sources communicating the importance of this
relationship and the positive endorsement from Dr. Jones. Make sure
Dr. Jones gets copies of the newsletter with his smiling face on
the front page so that he can distribute it to his patients.
By linking your facility with Dr. Jones, your staff will work hard
to keep Dr. Jones happy and Dr. Jones will continue to be a referral
source for your facility. This marriage will be a barrier to both
sides to change their commitment to a good relationship.
Friendship/Liking: Saying Yes to Ourselves
People are more favorably inclined to say "Yes" to someone
who is similar in terms of age, sex, and social group. It is like
saying, "Yes" to ourselves. Fostering ways to identify
with the consumer can influence the decision to come to a facility
where that person or family member will feel at home.
If possible, select the person to give the facility tour to match
the characteristics of the person who is coming to look at the facility.
Choose someone from your staff who is the same age, sex, and social
group as your prospect. The consumer will feel more relaxed and
more open to receive the information about your facility.
Everyone who gives facility tours should be trained in the basic
interactive skills of listening and finding ways to identify with
the prospect. Ask questions that may unearth similarities such as
where the person is from, where they went to school, if they have
children, what hobbies they enjoy. Careful listening will give you
the connection you need to influence the person to see herself in
Influencing decision making in creative, caring ways can improve
sales skills and promote the image of your facility. There is no
room or need for unethical behavior in applying these principles
when interacting with the community. Utilize your power wisely.
Code of Ethics:
College of Healthcare Executives
for Health Care Ethics
Information and Management Systems Society
Marketing Association: Code of Ethics
American Journal of Ethics and Medicine
American Journal of Law and Medicine
Journal of the American Medical Association
Journal of Health Politics, Policy and Law
Kennedy Institute of Ethics Journal
New England Journal of Medicine
Influence: The Psychology of Persuasion, Robert B. Cialdini,
Ph.D., William Morrow and Company, 1984, 1993.
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