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How to Grow and Prosper, Part 2: Strengthening the Roots and Expanding the Branches

How to Grow and Prosper, Part 2: Strengthening the Roots and Expanding the Branches
Markus Hilbert, AuD
March 7, 2011
This article is sponsored by Ear Works Inc..

There are five general action plans we can navigate in order to grow and prosper a practice. In the first article of this series, Grow and Prosper in Uncertain Times these action plans were discussed in detail and focused mainly on internal systems (Hilbert, 2010). As you become more skilled in balancing mark-ups with discounts, creating meaningful relationships with patients, and staying the course with a long-term vision through changing economic climates, you can reap the benefits of a prosperous practice. To grow and prosper is a conscious decision and requires the ability to adapt and change. The focus of this article is two-fold: how to adapt to define and reach your patients, and how to get connected with them.

How do we get connected as it relates to our practice? Think of your practice in a botanical sense, with roots, branches, a food source, and a hospitable climate. The fundamental principle in plant growth is strengthening the roots- the plant cannot grow and thrive without a sufficient foundation. As the root system is fortified, the branches expand and grow to new lengths. If the roots are malnourished or weak due to poor soil, the plant withers and is restrained. It only makes sense to begin discussing our roots before we expand the branches.

Roots: Work Flow

In order for any business to be effective, it must be solidly grounded and run like a well-oiled and finely tuned machine. In-house efficiencies must be assumed. We assume that processes and protocols are in place, that standards of administrative, clinical, and managerial practice are established and enforced, and that marketing standards allow you to be different from the rest of your competition while allowing you to make adjustments fairly quickly. If in house efficiencies are absent, there is more work, clutter and disorganization; more time and resources are wasted on fixing mistakes than operating efficiently.

Internal efficiencies are one part of the root system that will help to ground your business. There are three core work flows that, when combined, yield a successful practice: clinical work flow, administrative work flow and management work flow. Examples of clinical work flow would be how your patients are welcomed at your practice; what kind of professional they see for testing, counseling, orientation, etc.; what kind of testing is done - both subjective and objective; how patients experience testing and counseling from the initial testing through the recommendations, fitting, and tune-ups. How is the whole process experienced by the patient? You must firmly establish your goals and what you want your brand to convey in the relationship with your patients. This relationship must be strong and consistent, and it has to create a memorable experience in the clinical work flow.

Administrative work flow is keeping up with the day-to-day paperwork and unforeseen circumstances that may create hiccups on the business-side of your practice. For example, you do not want to misplace files, have orders come in late or incomplete, have devices that are not able to be fit because software is missing or incompatible, or have IT problems that impact how you conduct business internally and externally. This work flow includes how phones are answered, how questions are handled, and how accessible your staff is. A good administrative work flow is one that stays ahead of the curve, rather than with it.

Management work flow relates to the decisions that are made at the top. These must be seamless and in line with the way practice is carried out in the clinic. There can be no disconnect to the actual workers in the trenches. Many practices have great marketing ideas and execute them without fully informing the staff of the ramifications. Management needs to understand all the details of a plan to execute it successfully. This includes having an accurate understanding of the numbers. The astute manager will critically analyze, "Who am I seeing? What kinds of demographics are coming in? How can I fine-tune my marketing to meet that demographic?" Business development has to be redefined on a regular basis. Management work flow is geared towards growing the business and reaching the right clients. Some of the best and biggest clinics sometimes plan and market great promotions, only to be disconnected to those executing them at ground level, with too much information or to much complexity to integrate seamlessly into the day to day flow.

Patient experience is created by the efficiency of these three work flows. The internal systems have to be solid to create a sense of reliability and trust. The patient experience should be one of no clutter, total organization, and a relaxed clinical experience. But some part of that experience has to be different than the next clinic five blocks over. That experience has to be unique and set you apart so as to generate word-of-mouth marketing. There is no stress. There is no hassle. Work flows are quick and efficient, and this fuels confidence for the patient and creates a positive end-user experience. Tools are available to help manage work flows. Ear Works 4 practice management software, for example, does all of this by creating automated work flows encompassing those three elements. Additionally, it creates marketing tools through loyalty points clubs, mailers, data mining, event planning and more that allow you to effectively strengthen the roots of your practice. Internal systems should not be costs, but profit centers. They are going to help you grow your practice. The key of any good system is not just storing data on your patients, but actively and easily using the information to do more.

Malcolm Gladwell (2000) wrote a book titled The Tipping Point: How Little Things Can Make a Big Difference. In this book, Gladwell (2000) categorizes people into three distinct groups. First, there are Connecters. These are individuals who have ties in many different realms and act as conduits between them, helping to engender connections, relationships, and cross-fertilization that might not have otherwise occurred. These are really important people who influence others to come to you. Next are Mavens. Mavens are people who have a strong compulsion to help other consumers by assisting them in the decision-making process. Lastly are Salesmen. These are people whose unusual charisma allows them to be extremely persuasive in steering others' buying decisions and behaviors. All these influencers, these "tipping point clients," are going to grow your practice. But they will only be active for you if you can give them the experience that they expect, which is something above and beyond what the normal hearing clinic, hearing test, and hearing aid fitting would entail. Unique and good customer service creates good word of mouth. No matter how much you advertise, word-of-mouth is ultimately your best referral source even for the average Joe.

Once you have identified and streamlined the internal efficiencies, begin to focus on what can be done on the outside. This does constitute being socially aware. Michael Bloch, on his Web site, supports this idea with data. According to Bloch (2010), over 66 percent of Americans consider a company's business practices when deciding what to buy. Ninety-two percent state that they have a more positive image of a company that supports a cause that they also care about. Eighty-seven percent are likely to switch from one brand to another if quality and pricing is the same but the other brand is associated with a better cause. Thirty percent have recommended a product or a company after hearing about a company's commitment to social issues. This means that even if a patient comes into your practice for a standard hearing test and they don't require a hearing aid, they would have a greater likelihood to recommend you if you demonstrate some kind of social commitment. And lastly, 22 percent have used the Internet or other technologies to engage in grass-roots activism. In summary, people are more likely to purchase or recommend you if they feel you are giving back to the community. Consider the legacy that you are building and how you communicate that to both current and potential patients.

Roots: Get Connected

To connect with patients, we might think of testimonials as a good medium to communicate confidence and success. Actual clients can provide positive statements about their experiences, which directly relate to their satisfaction with good internal systems and work flows. Generally, these people don't care how much you know; they want to know how much you care. A corporate organization is more likely to focus on numbers and results, whereas a smaller organization, such as a private practice, can build those results better with a more personal approach and are generally more flexible and responsive to market trends and changes as there is not a large superstructure to manage. Testimonials are valuable tools, and a great way to spread word-of-mouth advertising and evaluate what things actually worked to make those patients very satisfied and impressed with your services. Remember that testimonials have to be honest and cannot be contrived, overstated or otherwise untrustworthy.

While testimonials work to spread word-of-mouth, you want to convert that into referrals. Not only do you want to make people happy, but you have to make sure that they spread their happiness. This kind of currency and satisfaction is a spiral that can spin upward or downward. If people are not wowed or do not experience good service, they may not give a testimony in the first place. And if they do, it may not be a testimonial that would drive the next person to come in. A referral program helps to negate that possibility by providing discounts or free services. This is only one example of how to convert testimonials into new referrals. Often referrals are "bought" by a benefit - a free coffee or some other kickback. True references are offered, not elicited, and are rarely bought.

Expanding the Branches: Being Seen

You must be seen in order to grow. Now that the root system is in place, it is time to start expanding the branches and reaching out. Working on "being seen" can be either an active or passive endeavor. Active marketing would be an ongoing effort. This includes physical marketing such as mailers and newsletters. These are things that you would do when business is slow, so that you do not take time away from patients. Phone calls can also be considered active marketing. Passive marketing is a social type of marketing, where you wait and let people come to you. The hearing health industry has traditionally been active. We plan an event, host an open house, or have a lunch and learn. We go out to physicians and do area screenings. These actions take time and resources. Leads, referral sources, and event planning are all done in a place where the consumer is already seeking information. You are physically going out to your customer base.

Another way to go to where the people are and do some general marketing is through the Internet. This is another root strengthener that is all in one place and can help grow your business. Seth Godin's 2003 book, Purple Cow: Transform Your Business by Being Remarkable, describes driving through the countryside and seeing several cows in a field, which is kind of exciting if you are a city person. But after a while they all get kind of boring until you see a purple cow, which is really cool until you see several purple cows, and then they, too, become mundane. The point Godin makes is that you constantly have to evolve your business, especially online where people will find you any time of the day or night. The Internet is your open office and online presence beyond your physical location. You need to stand out. Why would a potential patient visit your site or engage you online instead of one of your competitors?

Marketing online can be done while you are working in the clinic, but you may also need to consider having it done for you professionally. There are many external Web development companies that will build your Web site. You have to have the ability to list yourself in various clinic finders, whether that is through the local yellow pages or through professional registries such as AAA or ASHA. Maximize the strategies to grow your business with minimum effort.

The Internet is widely used by people of all ages. Think of how many times a day you may use a search engine and what you use it for. It is likely that you first go to the Internet to find a phone number before you would look in a newspaper or phone book. How often do you find directions on a paper map? Most likely, you are in the majority of people who use geographic modifiers under search engines to calculate directions. Gone are the days when e-mail was the only reason for logging on to the computer. This type of trend should get our attention as an industry that while the world is using the Internet to find things from restaurants to ancient history, they should also be able to find you.

Consider this: if you are found online, is the lead any good? This means that if someone does find your practice, are they interested enough to follow-up offline and actually visit your location, make a phone call, or better yet, make a purchase? If you have a strong online presence that communicates the uniqueness and the experience you present to the community, those leads will allow you to grow and prosper.

Paul Dybala cites statistics indicating that Internet usage is increasing swiftly in the over-50 age demographic (Dybala, 2008). Health information is a high priority for Internet users. Dr. Dybala adds that 90 percent of people online in the U.S. are primarily using e mail and search engines; eighty-one percent are researching products and 75 percent have searched for health information on at least one topic. A recent report by the Pew Research Center corroborated these numbers, indicating that 80% of users online look for health information (Pew Research Centers, 2011).

Large numbers of hearing-aid related searches are done, and a large majority of people are looking at local searches. When you claim a local listing on major sites such as Google or Yahoo, the action part of the marketing is done for you. The client is now doing the work by searching. The actual cost of maintaining the account on Web sites is minimal in contrast to the outcome of maximized "visibility" to potential customers.

It is not news that we are in the midst of an aging population. The 65-plus population is exploding starting next year. What is the best way to market to this group? Based on statistics (Dybala, 2008) using online resources is ultimately the best way. It is faulty thinking if you believe that the older population who could benefit from your services is not online.

An online return-on-investment (ROI) is higher than newspapers or television. It is also much cheaper per impression. Your cost is much lower while you have a captive audience searching for your product. The steps to increase your ROI are to first, do a search engine optimization. Then subscribe to services like Google AdWords that make your site come up on related searches, and lastly, make yourself searchable on Google Places local business search. While I do not endorse Google per se, these are the three steps that I would highly recommend every clinic do in order to ensure better local searches.

What is search engine optimization? The ranking is made by having reciprocal links where other Web sites link to your page and vice versa. Use social networking sites like Facebook and Twitter. Use an online agency to get you set up. There are a lot of companies that do search engine optimization, and they can be hired for a reasonable fee which will, in turn, increase your business and get your ROI fairly quickly. All these steps make it easier for the client to find and contact you.

Consider how to engage your online audience, or prospective clients. Clinical and professional connections can be made at LinkedIn using the Ear Works LinkedIn open pro-community, ZipAud and so forth. Other useful resources are Hearing Loss Nation, Hearing Journal Now,, and even the online yellow pages. There are many resources already established in engaging you as a clinic and your potential end-users online. Getting involved and getting noticed using these avenues will make a difference in your bottom line.

Branching Out: Web Site Considerations

You, as a clinic, are not an island. However, Web sites are essentially islands at this point. You want visitors to come to your island, and then when they are there you can show them how connected you are through social causes, promotional initiatives and various other programs. These programs are more passive than active and are easier to execute at lower costs online. You will want to get your Web site mapped with a local search. Even if you've done all the ad links and search engine optimization strategies, it does not necessarily mean that once a consumer finds you that they'll choose you. Once you have been found, you need to sell yourself, not the hearing aids. You are selling an experience, a professional experience above all others. Stretch your branches.

Your Web site needs to make an impression. You do not want people to come to your site and browse away quickly. You want them to stay, investigate, interact, be entertained, and re-visit frequently. People are not necessarily online because they question whether you are licensed or whether you have a location. What they care about is that their experience will be better and unique in some way. When it comes to content, be short and concise instead of verbose. If you are unsure how to display or convey your content, you can check out published literature and books that will teach you how to communicate effectively on the Internet.

You want to be active on the Internet. You want to contribute. You want to write into your newspaper on hearing related issues. You want to be in touch with your media. And you want to have a strong brand, not just a vanilla Web site. Whether you have a vendor build a Web site for you or you use an out-of-the-box solution, you want it to stand out like the purple cow. Include your logo and your Web site on your letterhead, business cards and pamphlets in order to have a strong presence and brand across all media.

Your advertisements need to be well-chosen and based on the demographics to which you cater. When you use paper marketing, use it wisely. Include referral incentives for existing customers, or hand out current lists of promotions. Engage the social impact component. Build on your existing patient pool as your "community". Choose a non-profit charity or another cause you believe in that is a grass-roots effort, and work with that group. Tell your patients you are working cooperatively and promoting that chosen charity. Engage in media relations. Media relations are an important tool to getting your message out. Many clinics have been able to post messages on radio stations or community events calendars as service announcements and not as advertisements. You can get a lot of free advertisements through strong media relations.

The real issue, however, is not what we do to market our clinics, but how we do it. Old school thinking is posting an ad or doing some kind of "active" marketing initiative that uses the bullet-spray approach - eventually you'll hit a target! Most of the people seeing your ad could not care less about your very exciting differences from your competition. New school thinking encourages finding your very specific market niche, and targeting them specifically with lower-key promotional activity that they would be interested in. Where are your potential new patients looking for information on hearing loss and your clinical services? Go there, don't try to reach everyone!

What's In It For the Consumer?

Steady focus should be placed on how the consumer or patient can benefit from what you offer. Whether it is through a phone call or a visit to a Web site, what are you communicating to the public? Sometimes in order to differentiate ourselves, we need a niche. We may have to say "no" to certain market segments and "yes" to others to really grow. Perhaps you only want to deal with corporate clients or adults; maybe you have expertise in tinnitus or noise-induced hearing loss. Whatever it may be, market that to the consumer and make sure they understand the value they will receive. Create a message that will last for the long-term. Rather than submitting to reactionary planning when sales are low or funds are tight, plan ahead for the entire year with smart marketing across all media. When developing your message to consumers, rally your team for input and steer away from pushing it down from management.

Once that message has been created and you have your three internal work flows running like a finely tuned machine, you can then take that message out to the media. It should be reiterated that the number one place to spend your money is online. Your time and resources spent online will be more effective and get a much higher ROI. Remember that people who are perusing the Internet are, in fact, actively searching. They have to have an idea of where they want to navigate, which is different than sending an ad or shouting that you have a promo. When the patient is ready they will seek online (or their caregivers will), which is where you should be.

Think of clients as individuals who are your marketing team, support you financially, grow your business and generate buzz for you. Stakeholders in the practice are not shareholders. Stakeholders are your patients; they are your influencers. They are the ones who are paying your bills and growing your business. If they not out there generating a buzz, then your ROI for each of those resources is lost. We need to first give the customer exactly what they want and then some, and then view them as marketers. In a busy practice, there are thousands of ambassadors who talk to hundreds of other people in the same demographic with the same challenges and break-downs with hearing. There should never be an instance when your patient would not tell a friend about you. We are solution providers to these people and need to make ourselves accessible on all levels. Although influencers are important, each and every patient is your word of mouth agent.

Access is not being open longer hours or on weekends, or going off-site to see people. If your experience is good enough people will come to you. Access means that you can converse with people about hearing loss and remediation in a timely manner, and if needed integrate other online tools from other end-users. Answer questions for patients when you are not in the office through your Web site. Add a link where they can e-mail, fill out a form, or ask a question. Create opportunities for them to download pamphlets or hearing aid product brochures. Make yours a one-stop shop for all the links and information they may need, even when you are not there. This is true access.

Market to the consumer in a way that is a conversation, not a lecture. Traditional marketing lectures say, "Here's who we are. Here's what we do. If you come in the next 10 minutes, we'll give you something even better." That kind of pressurized communication is not what your Baby Boomer wants. What they want is a conversation. That conversation begins the first time they hear about you, the first time they call you, right through to the 20th follow-up visit they make years down the road. That conversation shows them not how much you know, but how much you care. That really is what we are after.


Challenge yourself to actively pursue a new angle on marketing. Reassess your internal realities. Look at online systems for communicating those realities. Spend more time and resources online then you would in regular traditional marketing environments, because your ROI will be higher and your costs will be lower. Your effort level will be much, much less and you will get more out of it.


Bloch, M. (2010). Cause marketing and social conscience in online business. Taming the, Article. Direct URL: Retrieved February 10, 2011 from

Dybala, P. (2008, August 18). Ten million reasons to think about the Internet, marketing and your website. AudiologyOnline, Article 2092. Direct URL: Retrieved February 2, 2011, from the Articles Archive on

Gladwell, M. (2000). The tipping point: How little things can make a big difference. Boston: Little, Brown and Company.

Godin, S. (2003). Purple cow: Transform your business by being remarkable. New York: Penguin Group.

Hilbert, M. (2010, July 26). Grow and prosper in uncertain times. AudiologyOnline, Article 2340. Direct URL: Retrieved February 2, 2011, from the Articles Archive on

Pew Research Center's Internet & American Life Project. (2011, February 1). Health topics. Retrieved February 3, 2011 from

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Markus Hilbert, AuD

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Related Courses

Strengthening the Roots and Expanding the Branches - How to Grow and Prosper, Part 2
Presented by Markus Hilbert, AuD
Recorded Webinar
Course: #177571 Hour
No CEUs/Hours Offered
Strengthening the roots and expanding the branches, taking the next step to growth and prosperity in the hearing aid dispensing industry is a course designed to establish clear assumptions and expectations about standards of practice and how to use current marketing trends to kick start this industry. We are reliant on tried and true methods that worked 20 years ago but are slow to adopt approaches that are well established and proven. In fact, many of the "new" marketing methods are simply reincarnations of the oldest marketing tool in the book: word of mouth. This course will explore what it means to strengthen roots while expanding the branches and redefining how we market in the second decade of the 21st century.

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