One Size Does Not Fit All: Think Segmentation

Marketing gurus call it "segmentation" — the process by which products and services are designed and targeted to meet the specific needs of a particular group of customers. In the past few decades, marketing professionals have moved beyond a strategy of "market aggregation," which treats a marketplace as homogeneous, to a highly targeted approach that recognizes and focuses on heterogeneous needs. This technique has paid dividends for the world's leading marketing organizations.
Similarly, health care organizations need to move beyond a "one size fits all" approach, and strive to customize services for individual needs. Segmentation can help.
There are many ways to segment customers, the obvious being demographic dimensions such as gender, age, race, etc. Although these dimensions are important, they usually provide little understanding about how and why consumers go about shopping for, selecting, using, and evaluating health care services. A more useful construct is to look at "psychographic" dimensions — people's priorities, attitudes, and values.
As an example of one framework, the PATH Institute has developed a model for understanding, measuring, and predicting consumer health care attitudes and behavior. Their studies show that 90 percent of adults across the US can be classified into one of nine groups, each with a distinct and predictable pattern of health care use, health risks and status, trust in medical professionals, level of satisfaction, and compliance.
The nine PATH "Valuegraphic" Profiles of health care consumers are:
  • Clinic Cynic — generally distrustful of the medical profession
  • Avoider — refrains from using health care services until very sick or injured
  • Generic — tends to balance a concern for cost with a concern for quality
  • Family Centered — puts family health above all other matters
  • Traditionalists — willing to pay more for quality and tends to use the same providers
  • Loyalist — characterized by moderation in health care opinions and behaviors
  • Ready User — actively seeks and uses health care services of all kinds
  • Independently Healthy — very actively involved in their own health
  • Naturalist — has a propensity to use non-traditional or alternative health care methods
Focusing on the different needs of distinct segments such as these can optimize the effective use of resources. A "one size fits all" concept may seem efficient, but in the end, it produces a high level of waste and may miss the mark with a high percentage of patients. Here's how:
Diagram 1 depicts three patients, each with a different service level requirement. In a limited resource environment, a single high-level product/service (represented in the diagram by the yellow box) designed to meet the needs of all of these patients is likely to produce waste. Patients B and C would have been completely satisfied at a lower level of service.
Graph_Diagram 1.gif 
Conversely, Diagram 2 depicts a bare-bones product/service designed to meet the needs of some, but not all, patients. While this service meets the needs of Patient C, it will necessitate the expenditure of extra effort to meet the needs of Patients A and B.




A more efficient and effective strategy would be to minimize waste by first understanding patient needs and then customizing services to meet those needs, thus more closely aligning services with the specific needs of specific segments. This approach is illustrated in Diagram 3, in which three hypothetical products or services are targeted to meet the needs of the three different patients.





Donald Berwick, MD, the Institute for Healthcare Improvement's (IHI) former President and CEO, often captures this philosophy with the phrase, "Every Patient Is the Only Patient." Dr. Berwick further articulates this vision in his 2001 IHI National Forum plenary speech, "Every Single One":
"I visited Paul O'Neill when he was CEO of Alcoa. O'Neill was soon to be named Secretary of the Treasury, but, on that occasion, he was meeting with me and a few of my colleagues from IHI to help us understand about the initiative that he started in Pittsburgh to drive surgical infections and medication errors to zero in the Pittsburgh area. But, O'Neill didn't start by talking to us about perfection in health care. He was too excited about the meeting he had just come from. It was with the principals and superintendent of the schools in Pittsburgh. He challenged them to pursue perfection in education. 'Why shouldn't every kid in Pittsburgh read?' he asked. 'I told them that they ought to make a promise, that every single ten-year-old child in Pittsburgh will read by age ten, one at a time. One at a time,' he repeated."
"Every single one. That's the secret. That's the exact nature of pursuing perfection — in hip surgery or in children reading in Pittsburgh, in tackling incurable disease in Carabayllo or in pursuing perfection in American health care. The secret is promising, without compromise, what we will do for each and every person who comes into our care, one at a time."


The maxim, "You can't be all things to all people," may be true. But segmentation thinking helps us give it our best shot.
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