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Industry Trends from Geonetric's 2016 Healthcare Digital Marketing Survey

The results are in! Learn key findings from our recent survey of healthcare digital marketers and go into 2017 with the data you need to make important decisions.

You'll learn:

  • How budgets and teams are shifting
  • Which tactics and techniques are producing results
  • How the most effective healthcare marketers plan and track activities
  • The biggest barriers to success (and how to address them)
  • And more...

Interested in learning more? Watch the on-demand webinar or download the slide deck.

Video Transcript

Ben: Good afternoon and welcome to Geonetric's November webinar. This is the November webinar, and we are gonna be talking about our 2016 healthcare digital marketing survey. So over the course of the next hour here, we'll be talking about budgets and teams, strategies and tactics and the biggest barriers to success that healthcare organizations experience, and hopefully get a little bit of insight into how to address them.

Now those of you that have followed Geonetric for a while know that we have done these surveys periodically over the years. We don't do it as a standard yearly thing but we do it every couple of years to get a fairly up-to-date view of what's going on in our space. It's been, I guess, about two and a half years since we've done this. We thought it was time to get a new read of what's going on in the market, and as always some really fascinating insights into what's going on in our space and how are things changing and moving over the next year or two.

Just to get an idea of what we've done in terms of the data collection and analysis, this was an online survey. We really reached out in a great number of different ways to reach people like you to include in the surveys data collection. Certainly, through social media, through emailing lists, through influence or outreach. And this year, a very exciting new way is, we partnered up with eHealthcare Strategy and Trends. So we work very closely with EHS and T on the development of the survey itself. And they've been a great partner in helping us get both the survey and the results and learnings from that survey are out into the market.

If you are someone who has an interest in what we're talking about today, you should probably be a subscriber to them, and there will be more information coming out through their publication. We've got some articles and things coming up here after the first of the year with them that we'll continue to share some of the insights from the survey. We did also use a nationally known research organization, Vernon Research, to do a lot of the heavy lifting in terms of data cuts and data analysis. We sort of read into that analysis and did our own interpretation after that.

So, just to understand a little bit about what we've done in terms of the survey and the survey audience as well, as the way that we cut the data. For today, we're not gonna be looking at organization size a lot. There's a few places I'll probably refer to some insights we've had based on different sizes of organization. But mostly we'll be talking about some other ways that I'll talk about in a moment, but I did wanna give you a sense of the respondent base.

We had 215 respondents, 104...I'm sorry, 46 of those were vendors, the remaining 169, 170, something like that, 171, were healthcare organizations. And so we do, in the book, break a number of things out by science, which I don't have enough time to look at all of the data, cut all the different ways within our hour here together, but we've got good representation from across the healthcare system in all its different forms.

We've more or less banged to different groups of respondent types together as large, medium, and small. I will say that we did a little bit of manual moving within that. There's multi hospital systems that really didn't qualify as large, the way that we were thinking about it. We also had some oddball's road community hospitals with 2,000 beds and things like that, that we moved up into some different categories. So there's a little bit of manual manipulation in there. But those, from a sizing perspective, were how we bridged those categories.

Also, we did something different this year with vendors and consultants. And so, in the past, we've really only gotten insights from people from healthcare organizations directly. This year, we had a different set of questions that we asked vendors and consultants, many of which were designed to map up to insights that we were specifically getting from people who worked in the hospital. And so, a couple of my favorite insights that you'll see today come from the intersection of the vendor, consult agency perspective of the world, and the perspective from people inside the hospital or healthcare organization.

The way that we are gonna talk a little bit more in terms of our split today is what we call leaders and laggards. So we don't just want the survey to be a generic benchmark of stuff going on within our space. We really also wanna look at this information and get a sense of what organizations at the leading edge are doing differently from everybody else, and it gives us a couple of different insights. In some ways, it helps us to understand how are they doing things differently that we might want to adopt to help us get to that leading position.

Also, we just see different behaviors amongst leaders, the kind of average group, and the laggards. I think it's a lot of interesting insights in looking at how those groups are approaching these problems in similar ways and sometimes in very different ways. This year we broke these groups out by asking a handful of different questions, "Are you ahead or behind in the number of different areas?" We asked questions of all kinds and got a nice distribution. So the average group is anywhere where that subtraction ended up with minus one to one.

And then if they did better than one, they were in the leader category. If they did worse than one, they were in the laggard category. And the insights that we got tend to suggest that what we did here, I think, worked pretty well in terms of breaking out that distribution. Let's look a little bit at that question, the question that we use for that particular segmentation. Because the question itself, I think, provides some interesting insights here as well. When we asked, "Were you ahead or behind the curve?" the area where organizations are furthest ahead is in social media.

Social media is the one that more organizations than anything else said, "Yep, we feel like we are doing better than the curve overall." The area that anchors the bottom end of this, in pretty much every case, was website features and functionalities, and we'll talk more about that in a moment. Now, because this is the way that we define the categories. obviously, we're gonna have many, many more aheads than behinds amongst the leaders, many, many more behinds than aheads amongst the laggards. That's just by definition.

So, as we look at this, that's what where this goes. However, I think it is interesting to see the organizations in the leader category had very few items where they felt like they were behind. It wasn't universally true, there were some behinds in there, but they were very few. And you'll see amongst the laggards there are very few areas where they feel like they're ahead of the curve. So, again, evidence that we feel like the splitting that we did really captured the essence of these groups pretty well.

Now, amongst the leaders, the areas where they felt like they are doing most strongly are website design, website content, social media, content marketing, then we start to see some dropping off. And again, anchored at the bottom there with website features and functionality, where they still feel like they're ahead of the curve, but it's far and away the area where we have more negative connections than in anywhere else in the set of areas that we explore here.

Now, the average group we start to see more balance. You can see, again, they're still feeling pretty good about themselves from a social media perspective, but much less so in some of the areas where the leaders excel, website design and content. Really all the content things we see a pretty significant dip here, content marketing, SEO, things like that, we see them really dialing back. And again, the thing where they are most negative is website features and functionality, although it's still a somewhat balanced presentation between those who feel like they're ahead and those who feel like they're behind.

In the laggards, again, very few bright spots amongst this cohort, social media being the only one where we saw any real number saying that they were ahead of the curve. And here again, website content, content marketing, areas where they particularly feel like they're struggling and a universal feeling that from a website feature functionality perspective that they're behind the curve.

So since the website feature and functionality component of things was such a major dissatisfier, we thought we'd sort of dive into marketing technology first. And I know a few of you, at least, have taken some of our previous surveys. And you remember that we had these huge multi-page questions where we were asking, "Do you have this feature function kind of content?" Whatever, really a laundry list of those things, and we really pared it down.

It was one of the things that we got feedback was just an...it's kind of an onerous part of the survey itself. And frankly we looked at it and said to ourselves, "The organizations that have a physician directory are gonna have a physician director." There's not a lot of organizations where that's really sort of on their to-do list, but they just haven't gotten around to yet. Similar with jobs, similar with a lot of the things that we've been looking at over time.

So we really tried to pared this down and look at the pieces where we felt like leading organizations would be...that other organizations, but not or at least the things where we are seeing early adoption happening kind of advanced or more cutting edge sites features and functionality. Now there were two items that we put on this list that really do have pretty high adoption levels.

Patient portal is doing very, very well, and then responsive design as well, very much at the high end of that. And really, as you see the yellow...the golden bar there being the planned implementation over the next year or simply for 2017. We're going to get pretty close to 100% in both of those categories here over the course of the next year.

Other areas that are getting big bumps up here, the number one adoption area is physician ratings and reviews, right, the stars and ratings. So University of Utah did this four, five years ago now. Over the last year we started to see some movement amongst some other organizations. Almost 45% of respondents indicated that this was on their to-do list for 2017.

So we expect that, to see a huge step up here over the next year. It's been a powerful tool and it makes a lot of sense that it's happening here over the next 12 months. Appointment scheduling, CRM integration, and personalization are other areas that are seeing some pretty significant steps up overall. As we break out the different groups to kind of see how their behavior is different, you'll see that amongst the leaders, first off, they've got a more aggressive set of plans for things they want to implement in the coming year, although the substance of those isn't in many cases all that different.

So they're already largely there in terms of responsive design, they're really kind of there from a patient portal perspective, lots of adoption of physician ratings and reviews, CRM integration, scheduling online appointments, personalization, AB testing, some things like that. Probably the place where they distinguish themselves in terms of new investment more than any others is in some of the marking technologies that are a little further down.

Still relatively small levels of market penetration on these, but to the extent that people are doing them they're really happening here amongst the leaders. Things like AB testing, wait times, geo-targeting, things like that, if they're happening, they're probably happening in this group and not the other two. As we look at laggards, it's in many ways a question of catching up on some of those things that have already been adopted among the leaders.

So this is the cohort that was furthest behind in terms of responsive design, but they're planning to completely catch up here in the next year. So by the end of 2017, just about everyone will have responsive design. It will genuinely be the norm and not the exception. They'll be few and far between where you do not have responsive design. Patient portal, they're playing some catch up as well, as well as a appointment scheduling. And again, they are adopting physician rating and reviews in large numbers as well.

So one final way that we wanted to look at this data, and this is comparing the feature adoption, too important. And this is important that it was a question that we asked to vendors and consultants and agencies. I'll probably just refer to them as agencies from here on out. So when we got the agency partner perspective and mapped it to the current adoption of some of these capabilities and the planned adoption of these capabilities, we found some interesting items here.

So there are some areas where these things are very well-aligned. Responsive design, very, very high importance, very, very high level of adoption. And through the course of the next year, we'll see that get very close to 1000%. Similarly for patient portal. Those are things that make sense. We also had some areas where there's some catching up to that importance line that we expected.

So appointment scheduling or physician rating and reviews, fairly high priority. And while the adoption today is modest, huge adoption planned for the next 12 months where we'll be getting pretty close to matching the level of stated importance with the adoption levels that we're seeing in these areas. And there's a couple other where things are way behind and they're not gonna catch up in the next 12 months.

We're probably looking at several years before we start to see the levels of adoption and usage that sort of correlate to the importance that we're hearing from agencies. Personalization is probably the most extreme. It was the number one item from an importance perspective. Very little adoption today. While there is gonna be a significant uptake relative to the adoption levels we have today, it still puts it at a far cry from sort of the stated importance we see here.

CRM integration is a similar question as is pricing transparency initiatives and geo-targeting. And so you can look at that gap in a couple of ways. You can say agencies are working with many, many Healthcare partners, and they've seen these things work. However, because the levels of adoption of these things is so low, I take a little bit more cynical approach. That gap is really the sales pitches that you'll be hearing over the course of the next year. That gap represents a sales pitch.

And to be to be fair, things like systems integration for CRM with your web operations, personalization, pricing transparency, these are not simple plug and play solutions. These are very expensive and complicated to implement correctly and effectively. So there's a lot of business that goes along with those. Those are areas that we're going to see a lot of agencies pushing very aggressively in the next 12 months.

And we also asked about redesigns and platform changes as well. And so we've created a matrix here and I hope it's not too hard to follow. Across the top we're asking about platform changes. So, "Are you planning to change your content management system?" And for both of these, the scale is basically the same. "No, we have no plans to have to change or redesign. No, we're not changing because we just changed within the last 12 months. We have a change in progress now. We have a change in the planning stages, so change will happen kind of next year, sort of thing."

And so across the top from the columns those are a platform change, content management, system change. The rows down the left side, those are a redesign with, again, the same scale. So as we look at what's going on here we've had approximately 20% of sites redesigned within the last 12 months. We've got another quarter in redesign now, we've got another quarter that are planning a redesign. And this is a bit of a shift from what we've seen in the past.

Really we saw almost all organizations in the past at some phase of the, "We just did it. We're doing it now. We're planning to do it," kind of cycle. And so we had it about a third, a third, a third. And so we've been saying for a while that we were on more or less a three-year redesign cycle as a result of that. And this year we're seeing it somewhere different. We've got 30% that are nowhere in that cycle right now, and we have 25% redesign now, 25% redesigning for the future. So we may be seeing a cycle now where we're really more of a four-year kind of redesign cycle.

It's slowing down a little bit post responsive design kind of flurry of activity here, and that organizations may be on a little slower pace to be replacing the designs of their site. On the content management system side, we saw 14%, 15% change in the last 15 months. A smaller group of about 7% in process of changing now, another 14%, 15% changing the next year. So we're seeing that on something more like a six to seven-year cycle for content management system changes. So they're holding on to those CMSs for maybe two redesign cycles before they're starting to re-evaluate.

We also asked about CRM, Customer Relationship Management Systems. And some results here that were a little different than what we expected based on other things, other reads of our market that we've seen, we found in the low 40% range overall had a CRM in place today. That was a little bit lower than we expected. We have seen numbers that are a little closer to 50%. But that's offset by the fact that we've got almost 30% that are in the process of implementing a CRM in the next 12 months here.

And so huge adoption. If that level of adoption is real and maps out to the healthcare market overall, I think we're gonna be seeing some pretty significant delays in terms of some of those vendors not being able to implement enough folks quickly enough. That would be a huge uptake in this technology here over the next 12 months. Now, CRMs don't change as often, and again that's this is a technology that for most organizations is still newer. We still see many, many organizations that don't have this in place yet.

So the numbers that we see around planning to swap out CRMs are a little bit lower here, with about 12%, 13% overall looking to change here in the next 12 months and another sort of similar size group that completed a change in the last 12 months. So again, probably a more of like a six-year cycle of re-evaluating these things. And these systems can be a little bit painful to swap out particularly if you've done extensive integration to other systems out there.

All right, the next area that we explored is goals, the goals organizations have, how they're doing their strategy, how they're doing planning, what metrics are important to them as they move forward. So, one of the ways that we looked at this was, it was really kind of a proxy for how sophisticated is your digital marketing. And what we see is the organizations that are really doing this well have spent a lot of time and effort integrating their online and offline marketing into one single cohesive strategy.

And so here is the first place where we started to see some interesting and unexpected shifts between the groups, something different than we'd expect to see. So the gray on the right side of things is essentially, "We always do online and offline planning together. We have an integrated strategy." The pink and darker blue over on the left, those are, "We hardly ever or never actually do those plannings together, that we don't really do those things together at all."

And so, not surprising to us, the laggards are doing less of this than the other two cohort groups. But the big surprise to us was that the average group has a significantly larger audience that is in fact doing these things together. They also have more organizations that are in that kind of sometimes range than the leader groups. But significantly more average organizations are doing that integrated planning than the leader organizations.

And so, again, I think this is one of a number of things that we will look at that kind of lead us to think that the average group is getting aggressive and is really trying to play catch up. And when they do that they're gonna catch up with, first off, a better strategy plan, as well as a lot of other better strategy approach, as well as some other systemic advantages which may put leaders in more of a defensive position and playing catch up in a couple years.

We looked at what metrics organizations consistently track, and on the whole these track pretty close together. They're not wild differences. For several of these, we saw the leaders 10 to 12 percentage points higher in terms of their usage of metrics like engagement and reach. And that's true all the way until we get to ROI. And the ROI number, again, not so wildly different between the three. Only notable because the leaders are actually lower in their tracking of ROI than the other two cohorts rather than 10 to 12 points higher.

Now, what we find is that it's not because they don't care about that metric, but presumably because it's just hard to get those numbers in a credible way or a defensible way. And the thing that leads us to that is this chart right here. So, one of the questions that we've always gotten some good insight on in the past has been, "What is the biggest barrier to you being more successful with your digital marketing? What's the number one thing holding you back?"

And over the years that has always been lack of budget, lack of time, lack of staffing, essentially. And over and over again, we've gotten those numbers. This year, by breaking this out amongst the cohorts, we get some interesting detail that tells a much more nuanced story. So, yes, organizations feel like lack of budget, lack of time are the things holding them back, but then you look at the spikes from individual groups and you start to see some things that are a bit different.

So the gold line is our average group, and that average group, as we'll see in a minute, invests their dollars differently than the other two...than the leaders certainly. They're spending more of every dollar on staff to a pretty wide margin than the leader organizations are. And they're doing that in an environment where sort of overall they don't have more staff. And in part that they're slightly smaller organizations, but because of that they have a greater perception of a lack of time because they're not investing in outside expertise as aggressively.

They're trying to do more things internally, although they don't have huge staffs necessarily to support that. And so it makes sense that that staffing, that time component is going to be a bigger deal to them. As we track along here, from left to right, we see that our laggards, the gray line, have a particular challenge in having adequate skills and training. And this, again, that group is spending less on external resources. They don't have as big a budgets overall, they'd have less staffing overall.

But that staff is being asked to do much, much more. So you end up with a lot of generalists there. You end up...anecdotally, you end up with a lot of people who have come from elsewhere in...typically the marketing organization, sometimes the IT organization, where they are not necessarily digital specialists walking into those jobs. So they're being asked to do a lot and they often don't have the skills or the ability to get trained on those skills that they need to be fully effective.

And also with small teams and generalists so rather than specialists, we find those generalists have a harder and harder time now executing as effectively as specialists who are trying to do some of those same projects, and we'll talk about that a little bit more as we get in some other data in a few minutes. The leaders have a different set of priorities all together, and so they feel very, very strongly about the importance of ROI.

The fact that they can't demonstrate good ROI, they see as a big issue, as well as just other analytics and reporting questions. This is a fairly major factor. So reflecting back to that last one, we don't have greater actual measurement of ROI. We have less measurement of ROI amongst the leaders because it's hard. However, the leaders do see it as very important. So it's not for lack of desire that they aren't measuring some of these factors as they go forward.

We also map these barriers to progress from healthcare organizations perspective with essentially similar, essentially identical question that we asked the agency. So we asked the agencies, "Hey, what's the biggest thing holding your clients back in this mold?" And so interestingly, and you see the kind of purplish blue line there, those are the hospital responses. And as we saw a moment ago, lack of budget, lack of time, far away, the biggest vote getters on that side of things.

But we asked agencies the same question, they have a different perspective. They look at it and say, "No, no, you're not telling the story that you need in order to earn or to get the budget and the staff that you want. You don't have an effective strategy. You don't have effective internal buy-in, and to a lesser extent you're not able to demonstrate ROI. In the absence of those things, you're not getting the budget and staff that you might want."

But your problem isn't the budget and staff, the problem is you don't have a strategy. You don't have internal buy-in and you can't demonstrate ROI from these efforts. So this is maybe my favorite aha moment from digging through the data, was mapping these two things together and seeing in years. We look at the same organizations from an entire internal perspective, an extra perspective just how different the interpretation is of some of the challenges that they're facing.

All right. It's a great segue into budgets, you know, budgets and staff are the top two. We're going to talk a bit more about budgets and staffing here across the board. So we'll start with just average total investment. And here, the TMR [SP] is the non-staff investment. Basically, what you're spending on software, on external services and consulting, those sorts of things. The gold bar is what these organizations are spending on staff and only staff.

So when we add all of these things together, we get a pattern, which is a bit surprising again. So maybe not surprisingly the laggards are spending less than everyone else. But as I think I mentioned a little bit, the leaders also happen to be somewhat larger organizations. Average tends to be somewhat larger than laggards. It's not quite as cleanly mapped or not nearly as cleanly mapped as the size breakout that we did. But there's some correlation between the leadership and the size to be sure.

So we would expect perhaps to have laggards spending less than average, spending less than leaders, but what we actually have is leaders spending somewhere between what the laggards spend and what the average spends. The average groups are investing aggressively. They're spending more money and, in fact, a dollar for a dollar, they're spending more on staff than, relatively speaking, they're spending on tools and external resources as well.

When we break that out on a per bed basis, because really it's most useful to be able to size this to different organizations, we see a slightly even more exaggerated story here. Again, the leaders are larger organizations, so when we break this down on a per bed basis. The leaders actually spend less per bed than either the laggards or the average group. They're also spending the greatest portion of each dollar on external resources relative to what we see from the other two groups.

And again, here, that light blue, purplish line is the without staff. The gray line is the total, inclusive of both staff and non-staff investments. Because the average group is spending almost 50% more than leaders overall, and, again, a greater portion of every dollar is going to staff resources rather than external tools and resources out there relative to size.

Now, we looked at also overall marketing budgets, those are the columns, and digital marketing budgets, those are the rows. So the overall marketing budgets, we see about 55% remaining the same. Some increasing about 22%, some decreasing about 11%. And obviously, there were a number of I don't knows that we didn't incorporate into the matrix here, but a little more than half staying the same with more increasing than decreasing.

Digital budgets, very different story. Almost that same percentage, 54% of digital budgets will be increasing next year, about 30% remain the same, and almost none decreasing at this stage of the game. And digging into those in more detail, those are all organizations that had huge staffing components in there. So just from looking at some of the data around them, it appears that the ones that are planning a decrease, those are organizations that have oversized teams to do an in-house implementation where there's no expectation that they're going to be able to support that entire team after the new site goes live.

And so, that's a little bit of an unusual kind of confluence of circumstances there, and it represents, again, a very small percentage of the overall picture here as we go forward. Now, agencies for their part are even more gung-ho about their clients' budgets. Three quarters feeling like those budgets are increasing here in 2017 of what they've had in 2016. All right, let's talk about the team and staffing a little bit. So we asked quite a bit about structure, and the reality is that we've seen more and more movement towards a centralized structure in which digital and the rest of the marketing team is very much connected through the organization.

So 55% indicated they're in a centralized team, 14% said they're a team of one, which is often not necessarily a part of the overall marketing team, but I guess in its own way it becomes centralized, and then we have a couple of different models for decentralized and hybrid and sort of standalone teams that are represented as well. But really, the largest component going into centralized teams that are marketing and digital for the entire organization.

And we look at digital marketing team size, we see that leaders have a larger overall team than average laggards. And again,leaders are somewhat larger organizations, so this is not really unexpected. When we look at the breakout of team sizes overall, the mean across everybody is 3.62 people. But it's important to realize that while the mean is 3.62, the median, the 50% point, is at two FTEs. So while on average people have 3.62, half of organizations have two FTEs or less, and in fact a third of organizations have essentially one FTE or less.

So we have a lot of small organizations and a smaller number are very, very large teams that skew those averages a little bit as we look at those numbers. And we also do a bed sizing factor for staff. When we start to ask for staff members per bed, the number gets very, very small and kind of hard to wrap your head around so we flip it on its head and we say, "How many beds per staff member?" So a lower number here represents a higher staffing level relative to their size.

So laggards, we have two, one staff member... I'm sorry. Laggards, we have 209 beds per staff member. Average, we have 282 beds per staff member. Leaders, we have 372 beds per staff member. So, again, this is a little more linear just, again, mapping size and those team sizes together. But laggards have more staffing relative to their size than average, which has more staffing relative to their size than leaders.

When we ask about hiring in the coming year, about a little more than a third are planning to add FTEs, add staffing to their digital marketing organizations during 2017. And in terms of where that's being added, we sort of broke it out by functional areas. So a couple of things going on this particular chart. The line is what functions organizations perform and how. So 88% perform in social media in-house, 33% do CRM administration in-house. That's what that line is telling us.

One of the things we wanted to look at was when organizations say they're doing things in-house, when do they have at least one dedicated staff person and when are they using more generalists who are covering a lot of different functional areas at the same time? And again, this is because, as many of these areas have become more and more specialized like SEOs, of you're not watching and tracking week to week, things are changing all the time. It's hard to keep up unless it's really the thing you do on a day-to-day basis.

Likewise, analytics, content management, content marketing, CRM, these are areas that are very deep, require a fair amount of specialization, and really we see specialists in these areas being much, much more effective than generalists in these areas. And so we really wanted to look and see where do organizations have dedicated staff in some of these areas, and that's what this chart is telling us.

So the teal bar at the bottom is organizations that have an FTE but aren't planning to hire any further. The gold is organizations that have an FTE currently and are planning to add additional FTEs in that functional area in the coming year. And the gray are organizations that don't have a dedicated FTE today but are planning on adding an FTE to that area in the next 12 months.

So, in general, most of these line up in terms of what portion are actually using, having FTE relative to doing these things in-house. It's pretty consistent. Web development being the outlier as those folks tend much more often to be deep functional experts, and not really multi-functional, sort of cross-functional folks in the same way, that a web generalist or web master function might be.

Areas where we're seeing bigger hiring in the coming year are those areas to the left where organizations are more likely to be doing some of these in-house, so social media, content marketing, web writing, analytics. Those are growing important areas. More interest in doing at least part of that in-house, bigger hiring overall in those areas. The one outlier to that is CRM administration, and we've generally seen very low levels of in-house dedicated staff, which, I think, has really hurt adoption of CRM, and the value that organizations get for that.

While the total numbers are still small, we are seeing big plans to hire for that function in the coming year. We also looked at what things organizations are purchasing externally, where are they outsourcing some of these capabilities. And again, maybe not surprising, leaders, they have a larger non-staff budget component. They're outsourcing more than everyone else across a wide range of areas. In some areas, they're pretty close areas like digital advertising. While there's a lot of this across the board, they are outsourcing more than the other cohorts.

The other areas where we really see them outpacing the average and laggard groups here are in some of the more cutting edge areas, in areas where, I think, in some cases, if organizations aren't outsourcing, they may not be doing it at all. Social media being an exception of that, most organizations are doing that at some level and are doing that in-house. But things like usability testing or compliance work things like that, those are functions where I suspect the outsource component is pretty close to the number of organizations actually trying to perform those functions at all.

At this stage, it's mostly outsourced, and again the leaders are doing some of those things much, much more aggressively than the other cohorts that they compare to. All right, our final section here is digital marketing. So, first up, which content marketing tactics do you use? And so, video has been such a hot item out there this last year. All indications are it's going to continue to be very, very popular here going forward. Everybody's doing lots of video articles on the website, email marketing, and then we get into in person events, photos, blogs, things like that.

We start to see a drop off along the way. Again, not surprising, leaders are just doing more of all these things than everyone else is, with two exceptions or three exceptions. The big exceptions are in-person events where they're not necessarily outpacing folks, and also some of the print stuff, and then we'll see why here in just a moment. Because we asked not just what things are you doing from a content marketing perspective, but which of those things do you really find to be effective. And so the way that we ask the question, really no one was going to put something as effective that we're not doing today.

We didn't ask kind of the, "Which do you think would be most valuable"? It really was, "Which of these things are effective?" So we expected there to be this gap all along the way. It doesn't really mean that people are investing inappropriately. It just means that not all their investments are yielding as much as they would like them to. Some of the areas that get the biggest gaps here, though, are articles on the website, photos or illustrations. And then videos and email marketing is a significantly smaller gap, but we're seeing some gaps in there as well. Microsites and infographics as well, I guess, are a little on the higher side there in terms of that gap.

So we are seeing some things that lots of organizations are doing that many fewer organizations are seeing as much value to, but we see a lot of things being probably done appropriately today. When we look at the different groupings and which things they found most effective, this is really why we saw some of these things being done in different numbers. The in-person events, we see leaders find them much less valuable than everyone else. Likewise, the print magazine, you see them finding that much less useful than the other cohorts.

So, the digital things, the things where they are doing more of them, they tend to see more value in those things. And so, some of that may be that they're executing some of those pieces more effectively. Some of this just may be philosophical that they do not perceive the print and in-person events as being as valuable, and so they're not doing may be quite as much of those things or it encourages them. They just see this greater value in some of the digital tools that they have available to them and they're getting behind those tools more aggressively as a result.

We also looked a bit at the types of paid digital advertising that organizations are using, and no surprise, display ads, social media ads, social media promoted posts are really at the top of that list. Overall, looking down the list, investment on the core things that the majority of organizations are doing, pretty similar across the board, a little less amongst the laggards than the other two groups. But the average and leaders, in a pretty similar position.

Where we really start to see the leaders getting more aggressive is in, I think, it's probably safe to think of them as some of the emerging opportunities for paid advertising, so video ads, audio ads, native advertising platforms, in app mobile ads, and this does not assume that they have an app. This means that they're putting ads through a platform that when people are using other people's apps, those ads are popping up there. Those are platforms that are not as well understood, not as utilized as often. And really, if someone's using them today, they're probably in that leader group in most cases.

And then finally, "Which methods do you use for targeting your digital advertising? So what targeting tools are you using out there or approaches anyway?" Audience targeting is very, very common as is demographics, geo-targeting, as well. From there, we tend to just see greater usage of targeting technologies by leaders in areas like behavioral targeting, remarketing and retargeting and contextual targeting, where they're putting related content on a page or something along those lines. When you're reading something about this subject, we're gonna put related stuff on the page about a similar subject.

All right, so I have a couple of final thoughts in a moment here. But before we get into those, I wanted to remind you we do have an e-book coming out here shortly. There's a lot more information. There's just not enough time in an hour for us to cover all of the different things that we asked about and all of the different ways that we cut that information. So there's quite a bit more information in that e-book.

So, visit geonetric.com/marketingsurvey. So, geonetric.com/marketingsurvey and you can sign up for that report. We may also have a question in the post within our survey. So having gone through all this, again, we didn't want this just to be a data dump, but we really wanna look at this and say, "What is going on that makes the organizations that are more successful be more successful?" And there's some areas that we're pretty clear, they told us that, but there are also areas where, I think, the story is probably buried in some history and some other things that are going on.

And that we're seeing some shifts that the current behavior doesn't necessarily represent where organizations are so much as where they're trying to get. So there does seem to be some connection between how successful organizations are at doing these things in scale. It is harder for small organizations to be leaders, although there are small organizations that are leaders. It is somewhat easier for larger organizations to get to that point. And again, it's because they get some of those efficiencies of scale.

That they're getting staff overall while still spending less staff relative to the size of the organization. Likewise, for dollars they're investing in expertise and things like that. So scale certainly helps here quite a bit. But, again, there are big organizations that are flailing. There are smaller organizations that are succeeding. So there is sort of an ability to execute question here. There's some indication that for some of these organizations it comes down to having been serious about this for a longer period of time.

More staff, better staff, more resources over a longer period of time, so that some of these things are just implemented and out there in a way for some of these organizations that they're not out there, for organizations that are frankly playing catch up today. However, what we saw amongst that average group appears to be a real effort to actually catch up. That they are investing more aggressively, certainly much more aggressively relative to their size, that they're getting better planning, that they're doing some other things very well really because they don't want to be average.

They would like very much to be in that leader position. And if they're able to execute on some of these pieces and get some other things done, they're gonna end up catching up to those leaders at a point where they have a more robust budget behind them. They have a better planning process in place. They have some other systemic advantages, which could very well lead some of today's leaders scrambling if they don't really continue to push to remain ahead of the curve here as we go forward.

So, with that, we've got a couple of questions. If you still have a question you've not typed in, please do enter that into the Q&A box, and we'll get to as many of them as we can here in the time that we have remaining. So there's a question, "Are there specific areas where organizations appear to be overstaffed or are over-investing?" I think that's a little bit hard to say overall. I think we certainly see different patterns. So, you know, the laggard organizations don't...clearly under invest, I think, across the board.

They're trying to do too much stuff internally with far too little staff and they don't have the dollars to be able to reach out in as aggressive a way to expertise outside the organization. They can't really outsource very much either. And so they're between a rock and a hard place from that perspective because they just have a hard time executing in general. I think, when we get to the average and leader organizations, those organizations are both investing aggressively, they're investing with different strategies.

And it's difficult to see at this stage which one's gonna be more effective, but certainly the leaders are doing more outsourcing of capabilities. The laggards are doing more things in-house, again, with sort of staffs that are larger relative to their size but not as large in absolute terms because the organizations tend to be a little bit smaller. So those are, I think, the areas... At this point I see very few organizations where adding dollars or staff would not continue to make them effective.

But eventually you reach a point of diminishing returns, to be totally honest, relative to the size and sophistication of the organizations we represent. Healthcare spend is very, very little on marketing in general, and that is true of digital marketing as well. So, really across the board, even the big spenders in the great scheme of things compared to retail or a lot of other industries out there, we're running on a shoestring budget. So I think it's hard to justify the idea that people are overstaffing or over-investing in any way shape or form.
All right. The next question here, "How do we get a copy of the results?" Well, that's pretty easy. If you go to geonetric.com/marketingsurvey you can fill it out there, and I should have checked this before we jumped in. I'm fairly certain that we have a question in the post, webinar survey as well, that we can just say, "Yes, please send that to me." If not, I think there's a comment box and just type in there. Please send it to me. One way or another, we'll make sure it gets to you in that case.

All right. The next one here, "Do you feel that leaders are truly leaders or simply feel ahead in less competitive markets? Might that lead them to be complacent?" This was an interesting discussion point that we hashed around as we were trying to figure out how we really wanted to cut this data because this is self-reported. We could have gone out and reviewed and evaluated all of these different sites and tried to determine who we thought were leaders and laggards.

And there are a couple of things that led us to still believe that the leaders are doing a pretty fair job of self-reporting. We weren't asking about intranets or things that people couldn't see. So I think most organizations do spend a fair amount of time looking at direct competitors, looking at other sort of national organizations that tend to be in the spotlight for a lot of reasons, but certainly for some of their marketing is one of those, and so I think they may look at those.

I think they have pretty fair perception of where they are from those perspectives. Also, just as we looked at what things they had in place today, what things are we planning and investing in, some of those sorts of things, it does tend to support their narrative that they are today ahead of the curve relative to some of those other organizations. We really saw lots of organizations saying, "We're really ahead," but really didn't see meaningful differences in terms of who was doing what or what kinds of capabilities they had or some of those features.

I think we might have gone back to the drawing board and rethought the way that we were going to analyze some of this information. Good question, though. We spent a fair amount of time sort of hashing on that question as well and we feel pretty comfortable with the splits the we've got. "How did you categorize leaders, average, and laggards?" Okay, so we talked about that a little bit at the beginning. It was self-reported data and that we asked questions in a number of areas.

So instead of just saying, "Are you ahead or behind?" as a generic question, which we did once in the past, and again it did seem to play out pretty well in some of the detail questions, we actually asked in a number of different category areas. So, content marketing and web design and web content and website features and functionality and a couple of other areas. And we just took the number of times they said, "I'm ahead," and we subtracted the number of places they said they're behind. And, of course, there was sort of a...you could indicate not ahead or behind.

And so we just sort of summed up those things up, and the ones that had many more aheads than behinds are the leaders, the ones that were the other way around were laggards, and the ones were netted out pretty close to zero we put them in the average category. And again, we had a nice bell curve, which doesn't necessarily mean anything, but the statistician in me feels comfortable when you slice things a certain way and you get a nice pretty bell curve out of it. It's somehow very validating.

That is the last question that we had submitted here. So I'm going to go ahead and wrap things up. But on our way out the door here, I want to remind you that in December we have another webinar, a few of our favorite things. And this is lots of ideas, examples of what other healthcare organizations are doing to really...that were really fun and exciting here in 2016 as you are doing you're planning and thinking about the things you want to try and do in 2017.

These are one of our favorite webinars to put on. We usually do in December or January, and I think it's always a great opportunity to go just get a look at some individual pieces of different websites that really shine, to sort of feed the idea machine that you're thinking about how do you up your game as you go into the New Year. So I encourage you to go out to geonetric.com/webinars. Have a look. Go ahead and sign up for that one in December and we hope very much to see you then.