In 2004, Metro Imaging celebrated its 10th anniversary. With five full-service imaging centers in the greater St. Louis area, the company had experienced rapid expansion and growth in those 10 years, due primarily to its emphasis on service to patients and referring physicians.
But 2004 proved to be the apex, and over the following years business began to decline. Metro Imaging became increasingly less able to influence physicians to refer their patients as more and more referring physicians were acquiring their own imaging equipment. And Metro Imaging, solely owned by local radiologists, would not give financial incentives for referrals and had no hospital leverage.
Hope that legislators or insurers would come to the rescue led to disappointment. Something had to change. In 2007, a book landed on my desk. Since I was packing for a beach vacation in Mexico, I threw it in my bag for airplane reading.
The book was Blue Ocean Strategy, by W. Chan Kim and Renée Mauborgne.1 The authors described two kinds of market space: red oceans, where industry boundaries are defined and the competitive rules of the game are known, and blue oceans, where there is untapped market space and the rules of the game are waiting to be set. They defined red ocean strategy as competing in existing market space and exploiting existing demand and blue ocean strategy as working in uncontested market space and creating new demand.
Metro Imaging was indeed mired in a red ocean of imaging providers, all competing for the same referring physicians. But what could we do differently? Where was Metro Imaging's blue ocean?
As I sat on the beach, gazing out at Puerto Vallarta's ocean, it came to me. It was time to let go of the red ocean strategy of marketing to referring physicians and try the blue ocean strategy of marketing directly to patients. The patients who came to Metro Imaging for their exams had a common concern: They all wanted to know, with more or less urgency, what their MR or CT scan or mammogram would show. They begged our technologists to give them results and told us it could take weeks to get results from their referring physicians.
Metro Imaging's blue ocean strategy would be to give patients their results—all of them—at the time of service. We would become the patient's agent, as opposed to the referring physician's agent.
There were logistical problems with this strategy, as well as risks. Except for screening mammograms, patients required an order from a referring physician before they could come to Metro Imaging for an exam, and the referring physician often had to get approval from the patient's insurer. If our strategy was to succeed, we had to help patients understand that they could choose their imaging provider and ask to go to Metro Imaging, as opposed to automatically going where their referring physician sent them. And we had to do this delicately (at least at first), so as not to alienate those same referring physicians.
I set to work with my management team to put together a basic framework for this new strategy for presentation to the radiologists who practiced at our offices and then to our owners. It was important that our radiologists buy into this plan since it would significantly change the way in which they practiced. It was also important that our ownership group approve.
Both groups approved, with a mixture of enthusiasm and apprehension. We engaged an advertising agency to help with marketing. We branded the new service OnSite Results (OSR) and gave it the tagline, The Choice is Yours. The Results are Now.
Patients would be given an OnSite Results card (Figure 1) on arrival at our office. They would check “yes” or “no” on the card, signifying whether they wanted to receive the “preliminary results” of their exam. The card stated that results provided would be only preliminary and that the full report would go to the patient's physician and questions should be directed to him or her. It also made clear that the preliminary results did not rule out the need for further evaluation or treatment.
