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Personal selling in health and medicine:
using sales agents to engage audiences
James K. Elrod
1
and John L. Fortenberry Jr.
1,2*
Abstract
Background: Personal selling—the use of sales agents to personally deliver messages to target audiences—is often
not the first conveyance pathway that comes to mind when thinking about marketing communications in the
health services industry. This is not surprising given that sales force roles are not as public and prominent as other
promotional avenues, such as advertising and public relations. Further, the titles held by those in sales-oriented
roles in the health services industry are usually more discreet, carrying designations such as community liaison,
business development officer, and the like. Regardless of title, sales roles involve personally interacting with desired
audiences to compel some sort of action, adding a vital form of communication that bolsters engagement
opportunities.
Discussion: Personal selling plays a critical role in the promotion of health services organizations. Perhaps most
obviously, it is distinguished from its counterparts in the marketing communications mix by its use of people to
deliver messages to desired audiences. Associated titles, duties, and expectations vary widely between and among
those healthcare entities which make use of personal selling, as there is no pat formula for deployment within
health services environments. To shed light on personal selling, this article presents an associated overview through
the lens of Willis-Knighton Health System, sharing practical insights and experiences which can assist peer
healthcare establishments in understanding, shaping, and honing sales roles within their own facilities.
Conclusions: Taking advantage of the utility afforded by direct, personal interactions with audiences, personal
selling provides a helpful communications resource that better enables healthcare providers to connect proficiently
with target markets. It supplements other forms of marketing communication, operating synergistically to help
healthcare institutions achieve their conveyance goals. Prudent deployment of this unique marketing
communications method affords health and medical institutions with a capable conveyance asset that can provide
great assistance in achieving communicative ambitions.
Keywords: Personal selling, Marketing communications, Promotion, Hospitals, Healthcare
Background
Meaningful audience engagements are essential for
health and medical organizations, compelling patronage
which fosters institutional growth and prosperity [1–5].
Success on this front yields the obvious benefits of via-
bility and vitality for given health services organizations,
but it also delivers benefits that extend beyond the walls
of these institutions, encouraging audiences to attend to
their healthcare wants and needs, ultimately affording a
healthier populace [2,6,7]. The mutual benefits gained
by communicating well should remain at the forefront
of thought for healthcare providers, prompting them to
pursue marketing communications excellence as
voraciously as they do healthcare delivery excellence.
When one thinks about marketing communications in
the healthcare industry, very often images of billboard
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data made available in this article, unless otherwise stated in a credit line to the data.
* Correspondence: john.fortenberry@lsus.edu
1
Willis-Knighton Health System, 2600 Greenwood Road, Shreveport, LA
71103, USA
2
LSU Shreveport, 1 University Place, Shreveport, LA 71115, USA
Elrod and Fortenberry BMC Health Services Research 2020, 20(Suppl 1):819
https://doi.org/10.1186/s12913-020-05600-z
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
advertisements, television commercials, direct mail par-
cels, and similar conveyances come to mind. This per-
spective is not surprising given the prominence and
persistence of these promotional avenues, especially
when driven intensively by health and medical establish-
ments in an effort to reach target audiences. But less ob-
vious communication pathways also exist, with one of
these being personal selling which involves the use of
sales agents to personally deliver messages to target au-
diences [2,8]. The notion of the sales representative
often evokes images of occupations far removed from
the health services environment, but sales roles indeed
exist in health services establishments and they are very
important [2,5,9–11].
Pat formulas for effecting personal selling in health
services organizations do not exist, as institutions and
their deployment needs vary, leading to variations in ti-
tles, roles, and missions. Still, it often is helpful to ob-
serve the personal selling efforts of peer healthcare
facilities when possible, as doing so can provide inform-
ative details, permitting opportunities for reflection and
refinement. Gaining such insights, however, is somewhat
rare, given the competitive nature of the health services
industry, but some healthcare establishments are willing
to share accounts of their personal selling insights and
experiences, with this particular article forwarding those
of Willis-Knighton Health System, bolstering the experi-
ential profiles available in the literature and supplying
operational guidance for health and medical providers.
Definition and overview
Personal selling is a key communicative component of
the broad discipline of marketing, formally defined as
“a management process that involves the assessment
of customer wants and needs, and the performance of
all activities associated with the development, pricing,
provision, and promotion of product solutions that
satisfy those wants and needs”[2], p. 288. Promotion,
as evidenced in this definition, is a core feature of
marketing, earning inclusion as one of the Ps in the
classic expression known as the four Ps of marketing
(i.e., Product, Price, Place, Promotion). The promotion
aspect of marketing essentially entails any and all ele-
ments associated with engaging audiences, with the
core pathways for engagement being depicted in a de-
scriptive model known as the marketing communica-
tions (or promotions) mix [1,2].
The marketing communications mix, as traditionally
depicted, contains five principal avenues of communica-
tion; namely, advertising (i.e., the paid use of mass media
to deliver messages), personal selling (i.e., the use of
sales agents to personally deliver messages), sales pro-
motion (i.e., the use of incentives, such as contests and
free giveaways, to encourage patronage), public relations
(i.e., the use of publicity and other unpaid promotional
methods to deliver messages), and direct marketing (i.e.,
the delivery of messages via mail, the Internet, and simi-
lar routes directly to consumers) [2,8]. Healthcare pro-
viders examine each of these communicative avenues,
selecting one or more believed to be most capable of
reaching target audiences, with the ultimate goal being
to encourage patronage or compel some other desired
action [2,12].
Personal selling is used in the health services industry
in situations where communicative challenges require
establishing a personal, interactive dialogue with sought
audiences [1,2,8–11]. Personal selling through its com-
municative vehicle, the sales agent, is capable of sending
messages, receiving responses from recipients, reacting
to those responses, and continuing an established dia-
logue with one or more parties involved in the particular
engagement [2,13,14]. This, of course, gives personal
selling a dramatic capability over advertising, perhaps
the most utilized component of health services market-
ing communication, as message dissemination through
mass media channels is unidirectional and nonpersonal
(i.e., not delivered in-person). Even with direct market-
ing, which notably includes telemarketing, social media,
and other interactive avenues [2,13], personal selling
has an advantage in that it incorporates face-to-face, real
world, in-person communications, which, for some mis-
sions, are imperative [8,10,13,14].
Personal selling is deployed in many different ways
across the health services industry, with implementation
characteristics being dependent on the missions called
for by given healthcare providers. Roles are often titled
discreetly to reduce the overly commercial tone of de-
scriptors such as sales representative or sales agent, opt-
ing instead for titles that are softer, such as community
liaison, business development officer, and so on. Regard-
less of title, such roles involve personally interacting
with desired audiences to compel some sort of action,
adding a vital form of communication that bolsters op-
portunities to engage audiences [2,8–10,13,14].
Nursing homes, for example, are dependent on refer-
rals from families, hospitals, social services agencies, and
other establishments in their given markets. In pursuing
these referrals, personal selling often is used, with repre-
sentatives calling on sources, seeking to encourage asso-
ciated patronage. Without personal, direct contact,
referrals would dwindle and the livelihoods of given
nursing homes would be in jeopardy. Personal selling
agents working on behalf of more diversified healthcare
entities, like major hospitals, often have broader
outreach-related roles. They, for example, might be
called upon to engage referral sources, attend commu-
nity events as representatives of their given healthcare
establishments, provide informative presentations about
Elrod and Fortenberry BMC Health Services Research 2020, 20(Suppl 1):819 Page 2 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
the health services of their institutions at civic clubs and
other venues, meet with politicians and other dignitaries
to discuss community health matters, and so on. Those
engaged in personal selling play critical roles which posi-
tively contribute to the overall communications strat-
egies of healthcare providers [2,8–10].
Institutional background, deployment history,
and context within marketing communications
Established in 1924, Willis-Knighton Health System pos-
sesses a rich history of successfully communicating with
audiences. Communications excellence, in fact, has been
and continues to be viewed as a strategic priority, com-
pelling extensive use, experimentation, and innovation.
Based in Shreveport, Louisiana and situated in the heart
of an area known as the Ark-La-Tex where the states of
Arkansas, Louisiana, and Texas converge, Willis-
Knighton Health System holds market leadership in its
served region where it delivers comprehensive health
and wellness services through multiple hospitals, numer-
ous general and specialty medical clinics, an all-inclusive
retirement community, and more. The achievement of
market leadership can be credited, in part, to communi-
cations prowess, permitting the institution to effectively
engage customer groups, yielding significant interest and
attention, ultimately leading to all-important patronage
and customer loyalty.
Today, Willis-Knighton Health System leverages the
power of the full marketing communications mix,
deploying all of its components, including personal sell-
ing, with this particular element having an intriguing in-
stitutional history. Customer care and attention roles,
community outreach initiatives, business development
directives, and similar sales-oriented pursuits have al-
ways been a requirement of the establishment. Prior to
the 1970s, it was not uncommon for key executives to
hold simultaneous duties as sales agents of the establish-
ment. During this era, the institution played a relatively
small role in the delivery of health services in the greater
Shreveport-Bossier City marketplace which was domi-
nated by larger, better resourced competitors. Resource
scarcity demanded economization at every turn, which
often translated into employees holding a range of re-
sponsibilities well beyond what would constitute usual
and customary duties associated with their official titles
[15]. As the institution developed and resources in-
creased, however, specialization became possible, per-
mitting the hiring of personnel dedicated to sales roles.
Formalization of personal selling roles became particu-
larly robust in the 1970s when Willis-Knighton Health
System embarked on an aggressive growth campaign, de-
siring an expanded geographic footprint. To achieve this
bold vision, the institution pursued a range of growth-
fueling innovations, including adoption of the hub-and-
spoke model [16,17], establishing centers of excellence
[18], expanding physical space via the practice of adap-
tive reuse [19,20], and more. Knowing that these new
initiatives would count for very little without attracting
increasing numbers of patients, Willis-Knighton Health
System carefully assessed its communications efforts,
seeking to shore up capabilities to ensure that it could
meet its growth ambitions. Personal selling roles, notably
including those involving community outreach, business
development, and related missions were slated, with
these continuing to evolve as the institution’s fortunes
increased.
Today, personal selling remains a valuable component of
Willis-Knighton Health System’s marketing communica-
tions strategy. It primarily is used as a strategic communica-
tions enhancement, complementing other components of
the marketing communications mix, with it being deployed
for missions that are difficult or impossible for nonpersonal
methods of communication (e.g., advertising) to fulfill.
Willis-Knighton Health System’s business development of-
ficers, for example, are charged with engaging community
influencers. These notably include leaders of churches, edu-
cational institutions, military establishments, health insur-
ance companies, and other organizations with populations
which might benefit from Willis-Knighton Health System’s
services. Further, as designated community liaisons, the in-
stitution’s business development officers are highly involved
in community organizations, such as Rotary, Kiwanis, the
Chamber of Commerce, and related establishments.
Through these interactions, agents are able to learn about
the needs of institutions and individuals in Willis-Knighton
Health System’s served markets, share opportunities for the
provision of assistance, nurture existing patronage and
build new patronage, and foster general goodwill.
Business development officers are highly
knowledgeable of Willis-Knighton Health System’s his-
tory, service array, community initiatives, and related
programs, permitting them to speak with authority to
others as they make rounds in the community, building
valuable connections. Sometimes human delivery and as-
sociated interactions between parties are required to ef-
fectively disseminate communications, address inquiries,
and secure desired actions, with personal selling being
the operative avenue for such missions. The highly-
distinguishing human touch characteristic afforded by
personal selling has compelled Willis-Knighton Health
System to make use of this particular communicative
pathway as a means of pursuing challenging communi-
cations goals and objectives.
Strengths
Willis-Knighton Health System’s personal selling experi-
ences suggest a number of strengths, with these compel-
ling its historic and continued use. Chief attributes of
Elrod and Fortenberry BMC Health Services Research 2020, 20(Suppl 1):819 Page 3 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
personal selling prompting its use are described as
follows.
Engagement flexibility
Personal selling permits two-way, interactive dialogues
between sales agents and their audiences, giving a vital
human touch to associated engagement opportunities [2,
13,14,21,22]. This stands in sharp contrast to the vast
majority of marketing communications which are unidir-
ectional, conveying information but not permitting re-
ceipt of responses via the disseminating channel, and
nonpersonal, relying on delivery methods which do not
involve in-person interactions [2,8,13,23,24]. Adver-
tisements encouraging patients to visit particular med-
ical centers, direct mail pieces compelling patient
patronage, and press releases carried in newspapers
which announce new medical services at hospitals serve
vital purposes, but without the ability to receive replies
and respond in-person and in real-time, communica-
tions potential remains limited. While those exposed to
various nonpersonal forms of promotion certainly can
telephone given healthcare facilities for more informa-
tion or pursue other pathways to address lingering ques-
tions, the ability to inquire immediately with a sales
agent represents perhaps the most ideal form of engage-
ment possible.
Potential to build relationships
The in-person, interactive aspect of personal selling
gives this particular communications pathway a charac-
teristically human nature, permitting the establishment
of productive relationships between sales personnel and
target audiences [2,13,14,21,22]. Just as personal rela-
tionships are advanced through direct, human interac-
tions, so too are professional relationships, including
those between the agents of healthcare establishments
and their clients, whether those clients happen to be pa-
tients, peer institutions, or other publics. Personal inter-
actions between sales agents and their target audiences
over time engender trust which sets the stage for mutu-
ally beneficial exchange to occur.
Potential to bolster market intelligence
Courtesy of their exposure to audiences, those engaged
in personal selling endeavors on behalf of healthcare in-
stitutions are ideally situated to collect market
intelligence [2,13,14,21,22]. Through interactions with
current and prospective patients, peer healthcare institu-
tions, community organizations, politicians, and other
publics, as well as exposure to the sights and scenes of
marketplaces, individuals holding sales-oriented roles are
positioned to acquire vast amounts of information.
These insights often shed light on sources of satisfaction
and dissatisfaction, opportunities for improvement,
desired healthcare services, emerging competitive
threats, and related facets that can help healthcare insti-
tutions elevate their service competencies, fend off com-
petitors, and better address their constituents. Such
perspectives also have the potential to shed light on
findings from existing marketing research efforts, such
as patient satisfaction surveys, focus groups, customer
advisory panels, and other investigative avenues, bolster-
ing institutional intelligence, permitting improved strat-
egies and tactics.
Limitations
The strengths motivating selection of personal selling as
an engagement pathway are moderated by a series of
limitations which must be factored into associated evalu-
ations. Notable limitations are described as follows.
High cost
Personal selling is a costly endeavor. People, serving ef-
fectively as the medium of communication, are expen-
sive, requiring the usual resources of salaries, benefits,
supervision, training, and so on [2,13,14,21,22]. As-
suming the given individuals are skilled and deployed in
a proper manner, however, health and medical institu-
tions should expect an acceptable return on investment.
Further, very often those involved in personal selling
roles on behalf of healthcare institutions hold additional
duties and responsibilities, widening opportunities to re-
coup and capitalize on expenses associated with fielding
sales forces. Even if individuals are completely dedicated
to sales-oriented roles, multitasking often is possible,
affording opportunities for sales agents to engage in an-
cillary activities related to their given duties. Other
forms of marketing communication by contrast offer
limited dimensionality as quite typically, they can only
serve as conveyance mechanisms, with associated costs
resting only on that particular role.
Limited reach
A defined weakness of personal selling is that of limited
reach. The number of clients that an individual sales
agent can contact and address quite obviously is limited,
simply due to the finite capacity of the given representa-
tive [2,13,14,21,22]. By contrast, a single promotion,
such as a billboard advertisement, can reach thousands
quickly and easily, depending on placement characteris-
tics [2,8,23,24]. Reach limitations, however, should not
be viewed in an entirely negative fashion. Sales roles
ideally should be used to supplement other forms of
marketing communication, with each being deployed in
a manner to play on its given strengths. Those forms
capable of delivering conveyances to large audiences ul-
timately support sales agents in the field who deliver
communications more strategically toward defined
Elrod and Fortenberry BMC Health Services Research 2020, 20(Suppl 1):819 Page 4 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
targets that require additional communicative support. It
is simply a matter of using the components of the mar-
keting communications mix in an appropriate manner,
affording opportunities to derive the most from each
pathway and collectively achieve communications goals.
Potential for inconsistency
Unlike other forms of marketing communication where
promotional materials can be reviewed and approved be-
fore deployment, offering reasonable assurances that the
messages will be transmitted exactly as intended, per-
sonal selling offers no such guarantees [2,13,14,21,22].
This, of course, is due to the inevitable differences be-
tween and among individuals serving in sales roles.
People vary in their competencies, dedication, persever-
ance, and commitment, among many other qualities,
with this ultimately influencing personal selling out-
comes. The best method for reducing the potential for
inconsistency among those in sales-oriented roles is to
recruit effectively to ensure that candidates possess ex-
cellent qualities for engaging audiences. Attention also
must be directed toward the provision of excellent train-
ing and proper supervision, ensuring that those in sales
roles possess the skills and guidance required for suc-
cess. Of course, anyone can face hardships, personally or
professionally, impacting their performance, so regard-
less of steps taken to ensure consistency, the potential
for variation is ever present. The human factor in per-
sonal selling in this particular case represents a weak-
ness, but this very factor also delivers the avenue’s chief
strengths.
Operational reflections
For administering any component of the marketing
communications mix, Willis-Knighton Health System
advises establishing a baseline foundation of resources,
including (1) top leadership support and commitment,
(2) financial resources sufficient for funding communica-
tions activities, (3) competent personnel charged with
effecting given initiatives, and (4) formal processes per-
mitting effective planning, implementation, and evalu-
ation of initiatives. Adequate resources set the stage for
productive audience engagement endeavors, minimizing
chances of resource-depleting and reputation-damaging
mistakes which, in the realm of marketing communica-
tions, often are very public, given the open circulation of
such conveyances. These resources also ensure compe-
tencies in using given marketing communications mix
components, with proper deployment being essential for
realizing desired outcomes.
As for personal selling, specifically, beyond the advi-
sories presented elsewhere in this article, operationally
Willis-Knighton Health System recommends that
healthcare providers reflect on their given workforces,
identifying all individuals involved in audience engage-
ment pursuits, ensuring that their contributions and in-
sights are factored into the greater marketing
communications plans of given entities. Failures to do so
represent missed opportunities to make use of valuable
marketplace intelligence acquired by sales agents, cour-
tesy of immersion in their respective communities. Ex-
clusion of such also diminishes abilities to integrate
personal selling with other components of the marketing
communications mix. Imagine, for example, the pro-
found loss of intelligence that would occur if Willis-
Knighton Health System neglected to tap into the wealth
of insights collected by its business development officers.
Indeed, marketing communications campaigns must link
each and every communicative element together to
present a consistent story to audiences, something which
affords integrated marketing communications. Since
sales agents sometimes are overlooked and omitted from
greater marketing communications planning activities,
healthcare establishments would do well to take positive
steps to ensure their inclusion, permitting these individ-
uals to make the highest contributions possible to ad-
vance the conveyance initiatives of their employers.
Conclusions
Taking advantage of the utility afforded by direct, per-
sonal interactions with audiences, personal selling pro-
vides a helpful communications resource that better
enables healthcare providers to connect proficiently with
target markets. It supplements other forms of marketing
communication, operating synergistically to help health-
care institutions achieve their conveyance goals. Care
must be taken to deploy personal selling properly, capit-
alizing on its strengths while minimizing or avoiding its
limitations. Healthcare institutions also must ensure that
they accurately identify all individuals under their em-
ploy who are engaged in personal selling initiatives, seek-
ing their full engagement in marketing communications
planning. Prudent deployment of this unique marketing
communications method affords health and medical in-
stitutions with a capable conveyance asset that can pro-
vide great assistance in achieving communicative
ambitions.
Acknowledgments
A special note of thanks is extended to Brad Perry and the greater Willis-
Knighton Health System family for their helpful assistance throughout the
development and publication of this article.
About this supplement
This article has been published as part of BMC Health Services Research
Volume 20 Supplement 1, 2020: Marketing communications in health and
medicine: perspectives from Willis-Knighton Health System. The full contents
of the supplement are available online at http://bmchealthservres.biomed-
central.com/articles/supplements/volume-20-supplement-1.
Elrod and Fortenberry BMC Health Services Research 2020, 20(Suppl 1):819 Page 5 of 6
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
Authors’contributions
The authors jointly developed the submitted manuscript, with each
performing critical roles from early conceptualization through to the
production of the full manuscript. The manuscript resulted from a
collaborative effort. Both authors read and approved the final manuscript.
Authors’information
JKE is President and Chief Executive Officer of Shreveport, Louisiana-based
Willis-Knighton Health System, the region’s largest provider of healthcare ser-
vices. With over 55 years of service at the helm of the institution, JKE is
America’s longest-tenured hospital administrator. A fellow in the American
College of Healthcare Executives and honoree as a Louisiana Legend by
Friends of Louisiana Public Broadcasting, he holds a bachelor’s degree in
business administration from Baylor University, a master’s degree in hospital
administration from Washington University School of Medicine, and an hon-
orary doctorate of science and humane letters from Northwestern State Uni-
versity of Louisiana. He is the author of Breadcrumbs to Cheesecake, a book
which chronicles the history of Willis-Knighton Health System.
JLF Jr. is Chair of the James K. Elrod Department of Health Administration,
James K. Elrod Professor of Health Administration, and Professor of Marketing
in the College of Business at LSU Shreveport where he teaches a variety of
courses in both health administration and marketing. He holds a BBA in
marketing from the University of Mississippi; an MBA from Mississippi
College; a PhD in public administration and public policy, with
concentrations in health administration, human resource management, and
organization theory, from Auburn University; and a PhD in business
administration, with a major in marketing, from the University of Manchester
in the United Kingdom. He is the author of six books, including Health Care
Marketing: Tools and Techniques, 3rd Edition, published by Jones and Bartlett
Learning. JLF Jr. also serves as Vice President of Marketing Strategy and
Planning at Willis-Knighton Health System.
Funding
Article processing charges were funded by Willis-Knighton Health System.
Availability of data and materials
Not applicable.
Ethics approval and consent to participate
Not applicable.
Consent for publication
Not applicable.
Competing interests
JKE and JLF Jr. are both employed with Willis-Knighton Health System.
Published: 15 September 2020
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