FEATIREARTBLr

Challenges and Opportunities

for Personal Selling
By Thomas L Powers and Michael K Bowers
ersonal selling pro- ly has not used or under-
grams are develop- stood mai'keting. Not surpris-
ing into key ele-
ments of the pro-
motional mix for
H ealth care organizations are beginning to
use sales forees in iinich the same way as ingly, manv health care orga-
nizations use terms other
traditional far-profit organizations have used sell- than "sales" to describe their
many hospitals (Bowers and ing programs in tfie past. Hozoe~oer, nuinerous acti\'il:ies in tiiis area. Terms
Powers 1991, Sumrall and such as "detailing" or "physi-
Eyiiboglu 1989). in the past, challenges to the iiiiplenieiitntion of selling in the cian liaison" are used in place
thougli marketing in the health eare industry luroe i/et to be overcome. The of the more direct term
health care industry was well authors report viewpoints expressed by adminis- "sales." Though other words
accepted (Cooper and Kehoe are used tor positioning pur-
1978, Lovelock and Weinberg trators in a national survey of health care organi- poses, they refer to sales
1978), general advertising zations. activities, and we treat them
was the major focus of mar- as such in our discussion.
keting activities (Franklin 1985, Mack and Bruns 1988). The adcJption of personal selling represents a greater
J^ecently, marketing efforts ha\'e begun to encompass organizational commitment to marketing than does
personal selling to health care institutions' \"aiious ad\'ertising. Implementing a sales program requires
publics (Gelineau aad Cameron 1987) to supplement structural cliange fora hospital—changes in accounting
advertising and publicity (Brown 1985; Williams 1985). pnxx'dures, compensation policies, and performance
Previous research has examined the extent to which re\ iew techniques. By comparison, ad\'ertising is typi-
sales policies and philosophies have been adopted in cally created and performed by an outside agency. I'he
health care, but has not addressed the problems encoun- relationship with the agenc\' is a temporary one and eas-
tered by administrators while implementing sales pro- ily canceled. Ad\'ertising expenses likewise may be seen
grams, how these problems might be addressed, or what as a variable cost that is easily terminated. 1 liring new
benefits administrators expeet from sales efforts. salespec^ple and the addition of other sales programs
We report observations on the challenges and t)pportu- involves an additional fixed cost to the organization that
nities of selling in health care from a national sample of cannot be easily eliminated.
health care administrators—-mos!: of whom are directly The nature and scope of organizational change that
involved with the development and implementation ol sales programs represent to hospital administrators
sales programs. In our previous research (Bovvers and make the adoption of personal selling a difficult addition
Powers 1991), we examined the level of selling orientation to the marketing effort. Unfortunately, relatively little is
of health care organizations and described how it \'aried known about personal selling in the health care indus-
across different types of organizations. As part of that try. Sumrall and Hyuboglu (1989) reported that large
research stream, we subsequently explored the problems hospitals anci hospitals with high levels of competitive
and opportunities that administrators are finding in intensity (as measLired by the number of competitors)
implementing personal selling activities in their organiza- have implemented more sales policies than smaller hos-
tions. Tlieir opinions and statements about the obstacles pitals ox those with less competition. In our prexioLis
in the organizational adoption of sales programs as well study (Bovvers and Powers 1991), we found no relation-
as possible solutions to those problems are reported here. ship between the sales orientation of hospitals and their
size or number of competitc»rs. Rather, we found sales
orientation to be a function of profit status, geographic
Background range, type of organization, and location of the sales pro-
gram in the organization. We concluded that liospitals in
The term "sales" represents perhaps lhe sharpest general are struggling to adopt sales programs, though
edge of the marketing efft)rt. This point is particularly there Is great \'ariation in the le\'el of this effort by indi-
significant for the health care industry, which historical- organizations.

26
 Reluctance to accept marketing and selling activities naire, to compare the mean scores for the first mailing
is not unique to health care. Personal selling has often with the mean scores for the second mailing. No signifi-
been misunderstood by even traditional profit-making cant differences were found (t=.24, p=.81). This compari-
organizations, as well as society in general. Immediately son suggests that nonresponse bias is not a factor in the
after the Industrial Revolution, as in the health care survey results (Churchill 1987).
industry today, personal selling was usually not a for- A profile of the hospitals responding to the survey
mal organizational activity. Firms eventually found it was compared with that of the national membership of
necessary to create a separate sales function (MacBain the American Hospital Association (1990) as a means of
1905). The economic events of the 1920s caused selling to nonresponse analysis. The Academy does not keep a
be seen as a primary moving force in the economy and it profile of members. Twenty-nine percent of the respon-
was highly regarded {Dawson 1970; Tosdal 1957). The dents to the survey said they were with for-profit insti-
perception of selling activities declined sharply during tutions. Nineteen percent of the AHA member institu-
the Great Depression, however, and salespeople were tions are for-profit organizations. Forty-six percent of
even blamed as part of its cause (Tosdal 1957). Today, a AHA member institutions are hospitals with fewer than
wide disparity remains in the perception of the value of 100 beds. Only 17"o of the respojidents were with orga-
selling activities and, not surprisingly, it extends to the nizations that small. Thirty-two percent of the respon-
health care field. dents said they were with organizations having 500 beds
or more. Only 6% of
TABLEI member organiza-
Research Method Problems and Obstacles Seen by tions have 500 beds or
more. Number of beds
To obtain administrators' Administrators in Developing Selling and profit status are the
opinions, we sent question- Programs* only available points of
naires to institutions through- comparison between the
out the United States that were respondents to our study
drawn from the membership Number Percent and another industry
of the Academy for Health Lack of resources/sales support 96 50.2 group. The comparison is
Services Marketing. Question- inadequate, but suggests
naires and cover letters con- Inadequate backing from that the type of organiza-
taining the endorsement of the administration or physicians 70 36.7 tions responding to our
Academy were sent to market- Administration's misunderstanding survey may be more like-
ing professionals within the of what a sales program is 64 33.4 ly to adopt sales pro-
organizations on the mailing grams than the industry
list. Those individuals were Lack of a coordinated strategy at large.
asked to route the question- or plan 37 19.4 What is being sold in
naire to the person most ^Percentages do not sum to 100 because respondents health care can be a point
knowledgeable about personal could provide more than one answer. The table should of confusion. To a degree
selling efforts in the institu- be read as: Of the 191 respondents answering the ques- this confusion is due to
tion. A total of 1,203 member tion, 96, or 50.2^, said that a lack of resources was a widespread disagree-
institutions representing vari- big problem in developing an effective selling program.
ment as to what consti-
ous types of health care deliv- tutes a "product" in
ery systems received questionnaires. These institutions
were the ones that remained on the Academy member- health care {Bowers and Taylor 1990). For the purposes
ship list after market research firms, advertising agen- of our study, the products being sold included cardiolo-
cies, and other consulting organizations had been gy {heart services), oncology, psychiatric services, treat-
removed. The 1,203 institutions represent as closely as ment of digestive diseases, women's health care, lip-
possible a census of health care provider membership in totripsy, treatment of diabetes, and rehabilitative ser-
the Academy. vices. The average number of product lines sold by a
sales representative was three. About 26','<) of the respon-
In the case of one organization having multiple mem- dents said they represented only one product. At the
berships, one member was chosen to receive the ques- other extreme, about 23"/) said they represented seven
tionnaire. When a title was given, the member with a products or more. These products were presented to
clearly marketing function or senior position was cho- physicians on staff, physicians external to the hospital's
sen. If titles were not available, the first member listed staff, benefit managers, and other health care profession-
was chosen to receive the questionnaire. The mailing list als including social workers, therapists, and psycholo-
was checked for duplication by ourselves and two grad- gists.
uate students; none was found. The initial mailing yield-
ed 186 responses, A second mailing produced another 93 Research Questions
usable questionnaires for a total of 279, a response rate Because of the rapid rate of development of selling in
of 22.4'K>. health care organizations, the following questions were
The relatively low response rate suggested an asked of administrators:
appraisal of nonresponse bias, which was done in the
form of a wa\'e-to-wave comparison. We performed a t- • What are the biggest problems and obstacles in
test, using a standardized scale included in the question- developing an effective selling program for your hospital?

27
 • What are the most important priorities tor increas-
ing selling effectiveness in your hospital?
• What are the primary benefits you believe you arc
getting out of personal selling activities?
• What do you believe will be the significant issues or
changes in personal selling within the health care indus-
try over the next five years?
These questions sought to capture the essence of the
problems and opporfuiiifies that administrators are cur-
rently facing in implementing selling programs. To orga-
nize the results for each
question, commonalities of TABLE2
responses were identified
and then individual Priorities for Increasing Selling
responses were categorized Effectiveness
by major common area. We
identiBcd the major com-
mon areas, a graduate assis-
tant classified the individual
responses, and we cross- Improve some aspect of
validated the classification. sales management
This process resulted in the
categories of response in Sell the sales program to
administration and staff
Tables 1 through 4, A series
of cross-tabulations with Improve the competitive
chi-square analysis was per- position of the organization 68
formed to determine
whether the responses differed on the basis of the orga-
nizations' status as a for-profit or not-for-profit institu-
tion.
Description of the Respondents
The respondents' titles reflected an increasing role of
marketing, but not necessarily selling, in the health care
industry. The most popular title for the respondents was
marketing director/manager (45.5'''o). Approximately
]H% of the respondents held titles pertaining to physi-
cian relations. The balance of the respondents rept)rted
nonspecific job titles (such as executive director) or did
not report their title.
Seventy-six, or 27%, of the respondents were associat-
ed with for-profit organizations. One himdred and
eighty-five, or 66%, of the respondents wore associated
with not-for-profif organizations. Approximately 70% of
the not-for-profit organizations were reported to be indi-
vidual hospitals or members of health care systems. The
largest category specifically mentioned by the respon-
dents in for-profit organizations was psychiatric care
facilities (23.5"4), followed by group practices (20.5"o),
Results
Our results suggest that though selling activities are
taking place in the health care industry, sales has a long
way to go before it becomes a fully integrated manage-
ment tool in a health care setting. Sales programs are
being implemented in health care organizations, but
remain a difficult challenge to implement and manage.
Administrators responding to our study consistently
reflected on the need for selling in the new health care
market environment; however, they expressed both
28
administrative iind philosophical concerns about putting
it into place.
Problems and Obstacles in Developing
Effective Selling Programs
Administrators indicated that the major source of dif-
ficulties they encountered was internal. More than 50"o
of the administrators surveyed mentioned a lack of
resources and sales support. As seen in Table I there
was also a ver\' strong indication of inadequate backing
h"oni physicians and administrators in the respondents'
orgiini/ations, which was
reflected in the statements
^ that there was a misunder-
standing as to what exactly
a sales program actually is.
Another common rospt)nse
was that a coordinated
Number Percent strategy or plan for the sell-
ing effort was lacking.
administrators
85 50.0 indicated that their organi-
zations recognized the need
77 45.3 for a sales function, but had
not yet developed a clear
focus for sales with specific
40.0 ^ ^ standards, protocols, train-
ing, and evaluations based
on clearly defined expectations.
The largest number of comments related to the prob-
lem of inadequate support for the selling activity by
senior managers and also the fundamental misunder-
standing by managers as to ivhat selling actually is sup-
posed to accomplish. As one administrator put it,
"Although senior administi'ation endorses the program,
their lack of understanding regarding the sales process
and its complexity causes them to ha\'e unrealistic
expectations regarding the results."
We found a consistent pattern of administrators sfat-
ing thaf they could not get upper le\"el managers to
accept the concept of sales in a hospital setting and to
understand its importance. This misunderstanding of
the role of sales also carried over intc) upper-level ad-
ministrators' unwillingness to recriiit top salespeople
and to compensate them adequately. Respondents
reported a lack of understanding of the need to attract
quality people who can sell health care services. A tvpi-
cal comment was that it is important "for hospitals to
realize sales is a discipline and you c.-\n not just take
someone off the floor and put them t>uf on the street."
A common complaint from the respondents was the
attitude held by others that selling is "someone else's
job." Respondents said that there was resistance to the
"sales concept" by administrators and that there were
very negative feelings toward sales—as one administra-
tor put it, "the used car salesman myth," One adminis-
trator mentioned that the background of the individuals
who were opposed to sales was a major cause of this
attitude. Their background included social work and
education, but e\'en some MBAs were not oriented to
selling.
In addition to lack of backing by senior managers,
several respondents reported inadequate suppt)rt and
 understanding of the sales function by physicians and A large number of factors mentioned involved
other hospital staff members. A typical comment was: improving sales management practices. They included
"The medical personnel have little concern for the corpo- improved and additional sales training, centralizing
rate world. They feel the outside world is at their dispos- sales efforts, developing better promotional materials,
al." Also, medical staff members in many cases reported- improved organization and planning of sales calls, and
ly believed that "since their services should be automat- feedback to sales on its performance. Respondents felt
ically demanded by the market, they viewed marketing that changes to these elements would improve sales and
as expensive and unnecessary." after-sale service. They stated that it was important for
A common remark was that the clinical staff and con- their people to better know what and how to sell.
sumers resisted the idea of "sales" in health care. As a Another major issue was seen to be obtaining the
result, a significant amount of time was being spent in right people to perform the sales function. Respondents
internal education about the indicated that more
role of the sales staff. One TAfH.E3 ^_^__ ^ emphasis should be
administrator stated that "the
health care industry must M^jor Benefits Organization Is Receiv- placed on hiring experi-
enced salespeople from
study sales and understand its ing From the Personal Selling Program other service industries
evolution in business and and teaching them health
industry." Concern was Number Percent care selling applications,
expressed also that the respon- as opposed to hiring clin-
dents' health care organiza- Increased utilization icians and teaching them
tions do not have a structure of the facility 57 35.2 sales techniques. This
that includes a clear focus approach was described
shared uniformly among all Better relations with the
as instrumental to
marketing team members. The medical stafCreferring
physicians 51 31.5 increasing a customer
structural problems included service orientation and
inadequate reporting and fol- Financial benefits 43 26.5 improving the quality of
low-up systems. services.
The actual implementation Increased market share 35 21.6
Rellecting the prob-
of selling activities, above and Increased visibility of the lems mentioned in the
beyond the problems of organization in the market 28 17.3 preceding section was
administrati\'e support, was a administrators' concern
major concern of respondents. Higher levels of marketing
sophistication in the about the role of sales
They reporfed many problems organization 23 within the organization.
with organizing, goal setting, 14.2
They indicated that sell-
and getting systems in place to Organization is more ing's effectiveness could
provide programs, products, ^ ^customer
^ ^ ^ ^ ^oriented
^^^^^^ 20 12.3
be greatly improved if
and services promised to cus- ^^^^^^^^^^^^^ the balance of the institu-
tomers. They also mentioned problems in coordinating tion were first sold on selling. Other areas of their health
efforts of salespeople and prioritizing sales over admin- care organizations were seen as important not only in
istrative activities. understanding the role of the sales function, but also in
Other difficulties reported were in sales training, supporting it through their own customer contact func-
properly defining sales territories, and creating enthusi- tions. Getting total commitment by all involved
asm among service delivery people. A frequently men- providers so that they work and deliver as a team was
tioned problem was an inadequate amount of time to seen as vital to becoming more responsive to consumers'
accomplish all of the required selling tasks, which was needs. The issue of accessibility among referring physi-
compounded by the fact that salespeople often have cians was mentioned as part of the improved levels of
other duties in addition to those involved in selling. effectiveness sought, along with the importance of bond-
Time constraints also affected areas thaf are relatively ing future customers.
routine, such as obtaining accurate research data for var-
ious specialties in the respondents' markets. Benefits Obtained From Selling Activities
The answers to our first two research questions were
Priorities for Increasing Selling Effectiveness quite uniform. In many cases 50% or more of the admin-
The most common approach mentioned that would istrators surveyed shared the same opinion. However,
increase the selling effecti\'eness of health care institu- we definitely did not find such agreement about the ben-
tions was to improve some facef of sales management efits of using personal selling. The most common
such as hiring or training. As seen in Table 2, it was response (Table 3) was that there is a major benefit in
mentioned by one half of the managers surveyed. The terms of increasing the utilization of the facility.
second most common response was to sell the impor- Respondents indicated that personal selling resulted in
tance of a sales program internally to physicians and increased utilization of hospital services, including ancil-
staff. The third most commonly rnentioned approach lary services such as pharmacy and laboratory, and
was related to execution—namely, to improve the com-
petitive position of the organization, primarily to make it resulted in incremental admissions and revenues. They
be perceived as more accessible. cited increased referrals to hospital programs due to
building relationships with referral sources and increas-

29
 ing awareness/visibility ot hospital programs. other hospitals have not caught on as to what selling is,
Selling was beiieved to have <i direct impact on and we are cleaning up."
improved market share and financial retLU'n, as well as Closely related to the prediction of a greater organiza-
increased visibility for the institution in the marketplace. tional emphasis on selling was the belief that there
U was thought that selling helped to "break" established would be a greater understanding of the selling fmic-
practice patterns of physicians and hospitals. Higher le\ - tion. Again, this would be a part of an organized
els of marketing sophistication in the organization were approach to market planning and product representa-
also seen to be a benefit of selling that resumed in the tion supported by piiysicians and institutional adminis-
organization being more cuslomer and market oriented. trators. As one administrator said, "The next fi\'e years
This market orientation was viewed in the context of may see an end to the fear of the 's' [sales] word."
"identifying relationship needs and providing benefits Another administrator, lamenting the current state of
to match these needs" and affairs, noted that "it is truly
"enhancing long-term trusi: ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ ^ _ , frustrating when a hospital
relationship with referring wants sales but does not
physicians that "will give Significant Issues or Changes Over the iOO'>i> imderstand or sup-
strength to the broad cus- Next Five Years? port the components ol
tomer base which is already sales-—they are only inter-
established." Number Percent ested in the results."
kespfindents expected
Significant Issues and Greater organizational changes in the ox'erall deliv-
emphasis on personal ery of health care, including
Changes Over the Next Five selling programs 96 64.4
Years opportunities for cost effi-
Administrators belie\'e a Better understanding of cient, quality-sensiti\'e
large number of issues and personal selling on the health care organizations to
future changes would affect part of administration 44 29.5 attract managed care con-
personal selling in health tracts and corporate con-
Changes in the delivery of
care o\ er the next five health care 42 28.2 tracts. As part ot this trend,
\ ears. As seen in Table 4, they belie\'ed that the sales
the\' were uniform in Improvement in the effort within the industry
expecting a greater organi- performance of sales would become increasingly
management activities 27 18.1 formalized and sophisticat-
zational emphasis on per-
sonal selling in the future. Increased levels of
ed, catching up with the
Almost one third of the ^^^__________^^^^^
competitive intensity 20 13.4 methods used in other ser-
sample indicated that the ^^^••••••••••^^^^^ """""^^ \'ice and product industries.
problem of selling not being accepted by senior adminis- Respondents reported that in the future the selling ot
trators within their organizations would be at least par- health care services would be done in a packaged format
tially overcome in the future. They also expected an whereby services such as outpatient surgery facilities,
increased level of change and competitiveness in the full ser\'ice laboratories, and radiology departments
health care market in the future which, in combination would enable doctors within the seller organization to
with an increased acceptance of sales in the organiza- poo] iheir resources and "sell" to a much larger popula-
tion, would result in a significantly improved level ot tion. Concern was expressed that the growth of selling in
sales management activities. health care might cause increased scrutiny of the "ethi-
Administrators believed strongly that increased cal" nature of sales in health care, and that questions
emphasis would be placed on selling in tlie future might be raised about sales incentives used for motiva-
through various means. They predicted that one method tional purposes.
would be to require more hospital employees outside Not surprisingly, in view of the increased emphasis
the selling function to document how they contribute ajid understanding of selling, respondents predicted that
revenues to the organization. This approach would in the actual performance of the selling function would
effect place responsibility—and accountability—for sales impre)\'e in fhe future. Sex'era! respcMicients expected a
on all hospital employees. It was observed that, increas- de\'e]opment of product line areas that would be han-
ingly, hospitals would expend money in sales and mar- dled by a "sales team." They said that sales representa-
keting against a defined objective and as part of a cohe- ti\-es would be better assigned to accounts, they wtiuld
sive overall strategy. become more professional, and ongoing training would
Another prediction was that the selling einphasis become the norm rather than the exception.
would be extended to general acute care hospitals, Other respondents said that various forms of direct
which do not now use selling as much as psychiatric or sales and telemarketing would be one of the biggest
rehabilitation centers. Respondents believed that in both breakouts from the way selling is currently performed.
types of institutions the level of CEO responsibility for Perhaps most important was the expectaticin stated hy
"selling" would increase and salespeople would be per- many respondents that adequate budgets would be
cei\'ed as an investment as opposed to an expense. Some de\ eloped to support the selling function in the future.
administrators indicated that this trend could hurt their The increase in resources put into the sales effort was
organization's present competitive position. As one put seen as a result of greater levels of competition in the
it, "We are doing a very good selling job right now— health care industry. Respondeiits believed that this

30
level of competition would occur to such an extent that
the level of competitive effort today would appear slight
by comparison.
Chi-square analysis revealed no significant differ-
ences in the responses across all questions between
administrators of for-profit and not-for-profit institu-
tions. Though there is a significant difference in the sales
orientation oi the differenf fypcs of organizations
(Bovvers and Powers 1991), administrators appear to rec-
ognize similar problems and priorities in adopting sales
programs.
Limitations and Implications
for Future Research
Our findings have several implications for future
research. Perhaps foremost is the clarification and identi-
fication of the reasons for selling's somewhat limited
acceptance in the health care industry. We can speculate
as to why sales is not being accepted and implemented
at a high rate in many health care organizations. First,
lack of institutional endorsement clearly hampers its use.
Second, the implementation of sales activities is perhaps
not being handled well by the individuals responsible
for it, which would limit the credibility of sales pro-
grams.
Another reason may be that sales activities have yet to
demonstrate their bottom-line value. As with other mar-
keting activities in health care organizations, this value
is difficulf fo prove because of the somewhat indirect
linkhetween market stimuli and a corresponding sales
response for health care services, in contrast to other
goods and services. If the value of sales activities can in
fact be documented in the future, we suspect that their
acceptance will increase at a rapid rate. Sfill another rea-
son is that sales activities are not the answer for all pro-
grams or areas. If sales activities were to he used where
they do not apply, the result would be undesirable and
would limit the acceptance of selling in other parfs of the
organization. Finally, there is the problem of a sales
function trying to sell an ill-conceived product or pro-
gram. As in traditional organizations that have used per-
sonal selling for decades, a bad product tends to result in
sales being blamed—though sales simply cannot market
an ill-conceived good or service.
Several areas involving personal selling activities in
the health care industry warrant further investigation.
As an example, a typology describing the various kinds
of sales jobs in health care would be useful. Such typolo-
gies have been developed in other areas, such as ind.us-
frial selling (JVloncrief 1986). If such a typology were
available, problem specification in future research could
be more specific. Several traditional areas of sales man-
agement research can be applied to health care. For
example, the ethical nature of selling in health care could
be examined, particularly as if relates to the acceptance
of selling by the industry. Perhaps most significant for
the advancement of selling in the health care industry
would be identification of the link between the sales
effort and bottom-line performance. That issue requires
extensive examination.
A notable limitation of our research is the size and
nature of fhe sample. Respondents fo the survey fend to
be associated with hospitals that are larger than most. In
comparison with national figures, the number of for-
profit organizations is proportionally greater among the
respondents. In addition, all respondents are members
of the Academy for Health Services Marketing, which
implies that they are more willing and capable of adopt-
ing sales programs than the industry at large. Even so,
the respondents bemoan how little has been accom-
plished and how great the struggle is to implement per-
sonal selling activities. Assimilation of sales programs
and sales cultures is evidently a difficult task for health
care organizations. To date, research on personal selling
in health care (including ours) has consisted of descrip-
tive studies. Theory-driven research is notably absent.
The answer to why sales programs arc so difficult for
health care organizations to accept may be found in
future research, perhaps studies based on the organiza-
tional change literature (Hannon and Freeman 1977,
1984).
Summary and Conclusions
The results of our research indicate that as a whole
the health care industry has not made significant strides
in adopting personal selling as an integrated manage-
ment tool. Respondents reported a certain frustration
associated with managing a sales program in their insti-
tutions. Too much is expected from too little. The
respondents were convinced, however, that personal
selling will grow in importance and effectiveness. They
believe personal selling will become a vital part of their
organizations' promotional mix.
We found a high level of belief among administrators
surveyed that personal selling is needed in fhe health
care field and that it will be increasingly used and
accepted in the future. However, they expressed great
concern abouf the use and effectiveness of selling it its
current form in health care. Mnch of fhe concern is relat-
ed to properly integrating the philosophical acceptance
of persona] selling into a health care setting. Because the
health care industry does not have a tradition of person-
al selling it is not surprising that the industry is current-
ly at a relatively early stage of accepting and implenient-
ing selling activities. Most health care organizations dif-
fer dramatically from traditional for-profit businesses
that are normally thonght of in conjunction with selling
activities. The common perception of the purpose of sell-
ing is to increase sales volume and market share.
Solicitation of patients is still viewed as a taboo activity
for many members of fhe health care community. In the
future, as competition for patients increases, they may
be compelled to adjust their thinking fo accommodate
personal selling activities.
Two key areas of improvement for facilitating the
acceptance of personal selling programs emerged from
the survey responses. First, personal selling and sales
management activities mnst be performed more profes-
sionally. Particularly notable is the need for the sales
program to be demonstrably accountable for developing
patient volume. If a sales administrator can prove the
MraalafHeaitieaKHIbrketag 31
 value of the program, gaining acceptance of the medical
staff and senior administrators is expected to become
easier. The need for more professional sales and sales
management activities suggests also that training should
be a high priority for sales administrators.
The second key area for impro\-ement is the educa-
tion of the medical staff and senior administrators on the
About the Authors
nature and role of the sales effort. Personal selling Thomas L. Towers is an Associate Pr<ifessor of
should be presented as a means of satisfying customer Marketing Department of Marketing, Graduate
(physician and patient) needs and improving patient School of Management, University of Alabama at
care. Effort should be expended to invoK'e other mem- Birmingham, Birmingham, Ala.
bers of administration and physicians in the sales effort.
Only when personal selling receives a full measure of Michael R. Bowers is an Associate Professor of
support throughout the organization will it reach its full Marketing, Department of Marketing, Graduate
potential. School of Management, University of Alabama at
Personal selling, though relatively new to the health Birmingham, Birmingham, Ala.
care industry, will undoubtedly become a major compo-
nent of the marketing effort of many organizations in the
future. Our study has ideiitified problems and opportu-
nities that are being encountered at the current early
stage of this development. We hope that our findings
will help in further developing effecti\'e and profession-
al selling programs in the future.

References
American Hosptta! Association (1990), Hospifnl Statistics 'I990-1991
Edillon. Chicago: American Hospital! Association.
Bowers, Michael R. and Thomas L. Powers (1991), "I'ersonal Selling
in Health Caro Organizatkms: A Status Report/' jaurmil of Hcnllh
Can- Marketing, 11 (September), 19-27.
and jack A. Taylor (1990), "Product Line Management in
Hospitals: An Exploratory Study of Managing Change,"
Hospifnl and Health Services Administratinu^35 (Fall), 365-75.
Brown, Stephen VV. (1985), "Minding the Store as Competition
Intensifies," jowim! of Health Caw Marketing, 5 (Summer), 65-7.
Churchiil, Gilbert A., Jr. (1987), Marketing; Rfseardi, 4th ed.
Hinsdale, iL: The Dryden J'ress, 514-15,
Cooper, P,D. and W.J- Kehoe (1978), "Health Care Marketing: An
Idea Whose Time lias Come," in Educators' ConfaTiice
Proceeding!;, Series 43, Subhash C. Jain, ed. Chicago: American
Marketing Association, 369-72-
Dawson, [.eslie M. (1970), "Toward a New Concept of Sales
Management," joiirmi of Marketing;, 34 (April), 33-8,
Franklin, Danie! P. (1985), "The Seven Most Common Mistakes
Made by I \ea\th Care Marketers and How to Avoid Them," in
Building Marketing Effectiveness in Heiilthairc, D. Terry Paul, ed.
Chicago: Academy for Health Services Marketing.
Gelineau, Stephen D. and Christine M. Cameron (1987), "Hospital
Sales Programs: A State of the Art Assessment," paper present-
ed at Seventh Annual Symposium of Academy for Health
Services Marketing, San Diegt), CA (March 3).
Hannon, Michael T. and John H. Freeman (1977), "The Population
Fcology of Ofganizations," American jourmil of Socioloi^i^. 82, 929-
64. "
and (19S4), "StructLir.iE Inertia and
Organizational Change," American Socioh'^ical Review. 49, 149-
64.
Lovelock, Christopher H. and Charles B. Weinberg (1978), "Public
and Nonprofit Marketing Comes of Age," in Review of
Mnrketing. Chicago: American Marketing Association, 413-52.
MacBdin, A. L. (1905), Sdling. New York: The System Company. 9-
38.
Mack, Ken E. and Steven K. Bruns (1988), "Healthcare Sales: Why It
Should Be Everyone's Business," in Marketing: Evayhodi/'s
Business, Peter Sanchez, ed. Chicago; Academy for Health
Services Marketing,
Moncrief, William C, (1986), "Selling Activity and Sales Position
Taxonomies for industrial Salesforces," loiirrmi of Marketing
Research, 23 (August), 261 -70.
Sumrall, Delia A. and Nermin iiyuboglu (1989), "Policies for
Hospital Sales Programs: Investigatiiig Differences in
Implementation," lournal of Health Care Marketing, 9 (December),
41-7.
Tosdal, Harry R. (1957), Selling in Our Economy. Homewood, IL:
Richard D. Irwin Inc., 88-9.
Williams, Richard C. (1985), "Sales: Executing the Plan," in iiuilding
Effectiveness in Healthcare, D. Terry Paul, ed. Chicago: Academy
for Health Services Marketing, 10-12.

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