Barriers to Advanced Practice

Doctor and patients discussing health records

Workshop Two introduced two primary stakeholders in healthcare: physicians and patients. This workshop expands the list of stakeholders to include payers, the public, and the political presence, as discussed in Healthcare Marketing: A Case Study Approach, Chapters 7-9.

The passage of the Patient Protection and Affordable Care Act (ACA) in 2010 set in motion several fundamental changes in healthcare, including greater integration of public health into the delivery of medical services – in the form of population health management – and a drive toward greater transparency and a resultant emphasis on consumer choice based on cost and quality. To address this shift, the broad term “public” is further analyzed to include the role of public health and the influence of policy and advocacy groups.

Healthcare marketing supports many aspects of health services organization strategy and operations. As such, marketing efforts must consider the perspectives of many diverse stakeholders, groups that can have divergent or even conflicting goals.

Upon successful completion of the course material, you will be able to:

  • Describe the interactions and impacts of multiple stakeholder groups that influence healthcare.


  • Textbook: Healthcare Marketing: A Case Study Approach

Background Information

Almost no management decision in healthcare can be made in isolation. Federal, state, and local regulations must be followed. Internal constituencies must be aligned. External influencers considered. The views and values of the communities served will often determine the success of a service line or location. Considerations such as brand loyalty, identification with a community, and the very personal nature of seeking healthcare services drive the selection of a healthcare provider. Some factors may have nothing to do with the quality or availability of services; communities have opposed building of a new hospital because of the increased traffic volume it would generate. The ability to market an institution is further defined by the fact that healthcare delivery is a profession; the classic consumer goods approach of “new and improved” is not likely to impress a target audience.


  1. Review the rubric to make sure you understand the criteria for earning your grade.
  2. Read Chapter 9 in Healthcare Marketing: A Case Study Approach, including the” Case Study: Remembering Caribou Clinics”at the start of the chapter. Review Chapter Questions 1 and 2 and Chapter Exercise 1 at the end of the chapter.
  3. Your instructor will assign each student to act as a leading member of one of the six following stakeholder designations, each with the indicated characteristics:
    1. Caribou Medical Clinical Foundation Marketing Staff:
      As described in the case study. Part of the reason for establishing a planned giving program is that the Caribou Foundation CEO wants to expand operations into adjacent cities and counties. This might entail the submitting of certificate of need applications to construct new facilities.
    2. Caribou Medical Clinical Foundation Medical Staff:
      Dr. Metzger and colleagues, as described in the case study.
    3. State Medical Society:
      The broader physician community, a powerful lobbying presence in the state. Under its new president, Dr. François Égalité, the Society has begun emphasizing medicine as a profession and discouraging what it sees as self-promoting advertisements.
    4. IndemniCare:
      A health insurance company (payer). IndemniCare is currently in contract negotiations with Caribou. The insurer wants to reduce reimbursement and is looking for any evidence that the clinic is wasting money.
    5. Caribou Cares Coalition:
      A patient advocacy group. The Coalition is an independent, nonprofit watchdog group formed to monitor Caribou Foundations operations with an eye toward responsible financial operations.
    6. State Senator Will C. Greenfields and staff:
      Senator Greenfields is chair of the powerful Senate Committee on Health and Hospitals. He is also an adamant environmentalist who vehemently opposes new construction in his district, the intended location of the new clinics.
  4. The Caribou CEO is scheduled to announce the planned giving program in a speech she will give at the Caribou Caravan Gala, an annual black-tie event, in two weeks. Using a SWOT (strengths, weaknesses, opportunities, threats) analysis framework, develop a five-slide presentation depicting your plan to influence the CEO’s decision.

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