9B14C043

AUB MEDICAL CENTER: ACHIEVING 2020 VISION (B)

Hounaida El Jurdi and Nadine Yehya in wrote this case solely to provide material for class discussion. The authors do not intend to
illustrate either effective or ineffective handling of a managerial situation. The authors may have disguised certain names and other
identifying information to protect confidentiality.

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Copyright © 2014, Richard Ivey School of Business Foundation Version: 2014-09-10

On February 25, 2014, Dean Sayegh and Dr. Tahir of the American University of Beirut Medical Center
(AUBMC) were discussing the annual report submitted to the board of trustees at the end of 2013 and
their plans for the coming year. The colourful posters on the white wall caught Sayegh’s attention. The
posters described AUBMC’s six core values — respect, integrity, teamwork and collaboration,
accountability, stewardship and diversity — which served as the guiding principles for AUBMC’s
behaviours, interactions and decisions.

Already more than three years had passed since Sayegh and Tahir joined AUBMC. So much effort had
been put into introducing new policies that were meant to reinforce the core values. Many initiatives had
been undertaken to revamp AUBMC and its image. It was a lot of hard work and the results of their
efforts were beginning to show. New career ladders had been created for nursing. The Patient Affairs
Office had been established in September 2010 to attend to the needs of patients and obtain patient
feedback. Seventy new faculty members had been recruited mainly from North America and Europe to do
research, teach and practice medicine at AUBMC. All of the new recruits brought unique and specialized
skills including research, clinical and medical education and training expertise. In October 2011, the
Multiple Sclerosis (MS) Center and Abu-Haidar Neuroscience Institute had opened as unique additions to
AUBMC’s existing centres of excellence. Growth was also evident in the two newly erected buildings
and additions to the hospital.

Sayegh had known from the start that the physical expansion was going to be the costliest part of his
vision. He had thus divided the expansion into three phases to secure and facilitate funding for each
phase. But if AUBMC was to continue growing as planned, it would have to find ways to face the new
challenges that had emerged. The political and economic situation was deteriorating. Lebanon had been
the subject of various terrorist attacks in recent years, which had resulted in many countries, namely Gulf
Arab nations, issuing warnings to their citizens against travel to Lebanon. Furthermore, the real GDP
growth rate had decreased from seven per cent in 2010 to 1.5 per cent in 2013.1 Would AUBMC be able
to pursue its growth strategy in the face of these new challenges? How would it secure funding? How
would it combat the mushrooming of medical centres and increased competition? In the face of the

1
“Lebanon Facts and Figures 2013,” Bank Audi, 2013,
http://research.banqueaudi.com/documents/EconomicReports/lebanon_facts_figures.pdf, accessed January 8, 2014.
Page 2 9B14C043

turbulence and chaos in the country and the region, would it be able to shield the internal culture from
fragmentation and discord?

AUBMC: 2020 VISION

Sayegh had known from the start that his biggest challenges in introducing change in an organization
entrenched in internal disputes and a lack of teamwork were going to be cultural, mainly related to
employee attitudes and behaviours. He had therefore taken the precautions necessary to minimize these
challenges and overcome the negative corporate culture that was dominant prior to his arrival. He had
negotiated a memorandum of understanding (MOU) with the board of trustees and included special
conditions in his contract relating to his governance. In the MOU, it was agreed that Sayegh would
evaluate the management team, and decide who was competent enough to stay or otherwise leave, in
addition to what the dismissal packages would contain.

Soon after Sayegh had officially taken over the management of the Medical Center, he had made several
changes to the management team. He had recruited Dr. Adnan Tahir as the director and chief medical
officer and promoted Dr. Dania Baba from the human resources director to the chief operating officer of
the hospital. Sayegh, Tahir and Baba worked on crystallizing the elements of the vision that Sayegh had
presented to the search committee in January 2009 (see Case A). Sayegh aimed for AUBMC to be the
leading academic medical centre in Lebanon and the region through the delivery of excellence in patient-
centered care, outstanding education and innovative research:

The history of AUBMC has put a great responsibility upon us. The responsibility of an institution
that has contributed to building an excellent reputation for healthcare in Lebanon and an
institution which has been strongly linked with the fields of medicine and healthcare delivery in
the country and the region. Let’s look forward to the 21st century with further improvement and
continued leadership.2

The vision became known as the 2020 vision, given that the timespan needed to implement the plan was
10 years starting from 2010. The play on words, which borrowed meaning from ophthalmology and
produced a pun, was intentional to stress the vision.

The Six Main Paths

The 2020 vision aimed to fulfill AUBMC’s mission of continuous improvement and innovation and
consisted of six main paths.

Path One: Expansion and Renovation: To pursue renovation and physical expansion to grow the Center
from a 350-bed medical centre to a 600-bed medical complex. The new complex would consist of a new
pediatric hospital, a new adult hospital and two new administrative and academic buildings, in addition to
the renovation of the Diana Tamari Sabbagh building, the headquarters of the medical school.3 The new
facilities would be equipped with the most up-to-date technology and equipment.

2
“AUBMC Reveals Ambitious 2020 Vision for Expansion and Continued Regional Leadership,” AUB Office of
Communications, April 29, 2011, www.aub.edu.lb/news/Pages/aubmc-2020.aspx, accessed July 15, 2013.
3
Ibid.
Page 3 9B14C043

Path Two: Aggressive Recruitment: To recruit top-calibre, highly specialized faculty members, since the
best working teams provided the best service. Recruiting the best talent in their fields would apply not
only to medical and academic staff but also to the wider AUBMC family.

Path Three: Relentless Focus on Understanding Patients and their Changing Needs: To lead the way in
patient satisfaction and further emphasize patients’ changing needs and the delivery of the highest
standards of patient-centered care, quality and safety. This included redefining service excellence and
constantly updating and changing systems so that patients were at the centre of everything staff did.

Path Four: Innovation through the Creation of Centres of Excellence: To become the hub for clinical
practice and research and lead innovation through the establishment of clinical and research centres of
excellence and specialized medical services to meet the medical needs of patients locally and regionally.

Path Five: Establishment of Strategic Partnerships and Collaborations Locally, Regionally and
Internationally: The establishment of strategic local and international partnerships (academic, clinical and
research-based) to access more patients, provide more training opportunities and improve the quality of
healthcare in Lebanon.

Path Six: Commitment to the Academic and Research Mission of the Faculty of Medicine and AUBMC:
The commitment to academic research and the education mission of the Faculty of Medicine through
outstanding education and innovative research.

For such an ambitious vision of development, the institution would have to rely on fundraising of around
$400 to $500 million for the physical structures, and another $100 million for hiring, network-building,
investments in new research capabilities and so forth. Thus, it was decided that the work on expanding the
physical structure was to be implemented in three stages.

FIVE-YEAR PLAN

Soon after the formulation of the vision in 2010, Tahir worked on translating the 2020 vision into a
tangible and actionable plan that supported and served as a guide for the 2020 vision. The five-year plan
and 10-year plan were devised. The five-year plan had defined action steps and was related to five goals:

1. To provide patient-centered care: Patient-centered care was no longer a slogan; it became the number-
one goal. For the successful provision of patient-centered care, five essential elements were needed
— work efficiency, waste reduction, work effectiveness, use of evidence-based medicine, and
timeliness of care.
2. To ensure patient care quality and safety: Quality and safety goals were clearly defined by taking the
view of patients instead of that of the AUBMC administration. Good-quality care was based on
clearly defined metrics, and evaluation and monitoring systems were created to evaluate their
progress.
3. To guarantee service excellence to patients, physicians and employees: Given the complexity of the
healthcare delivery process, coordination and collaboration across disciplines was the only way to
achieve service excellence and deliver the highest-quality care to patients.
4. To ensure operational efficiency: The amount of waste created at AUBMC was between 10 and 20
per cent, which was considered substantial compared to U.S. healthcare standards. This high level of
waste was partly due to the negligence of some employees who were not truly held accountable for
the institution and its assets.
Page 4 9B14C043

5. To maintain the financial performance to support the mission: Financial performance as a goal was
aligned with the 2020 vision. It became a goal with the change from a cost-reduction orientation to a
vision of expanding revenue.

The five-year plan was communicated to all AUBMC staff and faculty to express the new direction of the
institution. In order to ensure staff commitment to the vision and goals, Tahir developed a set of core
values that everyone was expected to adhere to. The core values served as the guiding principles for
behaviours, interactions and decision making at the institution. According to Tahir, “The core values are
extremely important; they define the institution, its leadership, what is expected of us and what the patient
expects of us. How we are dealing with each other, with the patient, is important” (see Exhibit 2).

SIX CORE VALUES

1. Respect: To consider worthy of high regard

2. Integrity: Adherence to moral and ethical principles
3. Teamwork and collaboration: Putting the needs of the whole over their own personal gain
4. Accountability: Acknowledgement and assumption of responsibility for actions and decisions
5. Stewardship: The careful and responsible management of something entrusted to one’s care
6. Diversity: To better understand, represent and serve their community

Integrity and respect were the most important values, since they influenced the other core values,
especially accountability and stewardship, and hence were stated first. With regards to integrity, it was a
value that touched on moral and ethical principles deployed at AUBMC. The intention was to highlight
that the administration wanted its staff to apply at work the best principles and ethical behaviours they
used in their personal lives. “Many employees felt offended by this value because to them it implied
mistrust; however, the emphasis was really on getting staff to cherish the institution and its assets with the
same values which they applied at home because it affects stewardship,” said Tahir. This issue was
particularly important because the first problem Tahir had noticed was the reflection of the dominant
chaos in the country in staff attitudes and behaviours. It was not uncommon for doctors and nurses not to
answer their pagers, or for patient appointments to be cancelled without reason, or for a cashier or nurse
to be rude to patients. Another problem he had noticed was that there was little care for the institution and
its assets, as was reflected in the waste level: “There was a predominant attitude that since AUBMC is a
not-for-profit institution, then it should not be making money,” said Tahir. There was also the impression
that if AUBMC incurred losses, then those losses would be subsidized. Very few were acting responsibly
and taking ownership of the institution and its assets. For example, it often happened that expensive
equipment was ordered and bought, yet such equipment was later left in cartons, unopened and never
used. Such incidents affected the institution’s financial performance, which in turn influenced its ability to
cater to patients with limited financial means.

There was also a general attitude of carelessness. There were no clear expectations for job performance,
for no one had taken the time before to set performance standards and clear expectations. “It is very hard
to hold people accountable if the administration has failed to set clear expectations,” said Tahir.

Thus, it was very important to announce that there was a change in direction, and the core values served
as a message that bad behaviours were no longer tolerated. The goals and core values were communicated
personally by Tahir to the department heads and staff through ad hoc meetings, assemblies and town hall
meetings. Over a period of 12 months, 15 assemblies were held for all 2,200 employees. Pocket cards
were also distributed to all employees, and posters were plastered on the walls of AUBMC’s hallways as
Page 5 9B14C043

a reminder to staff of their responsibilities and as a promise to patients about the quality of the service
they sought.

With regard to teamwork and collaboration, Baba had observed that operations before the 2020 vision
resembled fragmented pieces of patchwork where each department worked as a separate and independent
unit with no logical flow of operations. In order to enhance teamwork and collaboration between
employees and departmental units, a joint effort was made with the HR department to develop training
opportunities, workshops and employee team-building events. Multiple job-specific training efforts were
also launched in supply chain and project management for middle- and high-level employees in various
departments. The HR Department further created an anonymous HR forum where employees could
submit their concerns, complaints and suggestions.

To ensure proper implementation of the core values, Tahir translated the values into policies that
governed the institution and its staff. The policies aimed at transforming the values into actionable,
tangible behaviours that would effectively change the way people viewed AUBMC. Furthermore, at the
time of joining the institution, AUBMC staff were required to sign a code of conduct document that
highlighted the importance of adhering to the core values.

In order to motivate staff to embrace the core values and strengthen their commitment to the institution,
Tahir knew that the institution had to demonstrate its commitment to and appreciation of its employees.
For this purpose, a variety of initiatives were launched, one of which was the “Award and Reward”
program, in which monetary and non-monetary rewards were distributed to outstanding employees.
Award ceremonies were also held with recognition for those who had served at AUBMC for more than
10, 15 and 20 years and the honoured employees were given a salary increase ranging from four per cent
to 12 per cent. In order to motivate employees to embrace the five goals and the core values, performance
appraisal software was created based on a balanced scorecard strategy that showed the performance and
improvement of each employee, linked with each employee’s performance goals as well as AUBMC
goals. “AUBMC is evolving; it is changing and improving on many fronts. We are trying to proactively
get everyone on board,” said Roudaina, the HR manager.

NURSING AND CAREER LADDERS

The perceived quality of healthcare services provided at any healthcare provider largely depends on the
interaction between patients and front-liners, namely nurses. The nursing profession, one of the most
important disciplines in healthcare, had been neglected for a long time at AUBMC. Under the new
administration, the nursing department had a huge transition. Taher and Baba, in collaboration with the
HR Department, conducted 25 focus groups with 500 nurses and nurse managers and gave them the
chance to voice their concerns. The number-one concern was the grading system at AUBMC. Nurses
entered at grade eight and were supposed to transition to grade nine within a year, but could never go
beyond grade 11 because grade 13 was a management grade and grade 12 was denied to them.
Unfortunately, some nurses had been forgotten at grade eight for several years. “How are nurses supposed
to deliver care in an institution that does not listen to them?” said Taher. A taskforce, which included
members from HR, nursing and the administration, was created to find ways to enhance job satisfaction
for nurses. A new career ladder was developed and written by the nurses, and included clear career maps
and job motivators. The taskforce also worked on increasing salary levels. Some nurses were also
promoted to managerial positions in the newly opened departments. While investigating the problems, it
was obvious that there was a shortage of nurses. Thus, a staffing plan was created and job fairs were held
Page 6 9B14C043

in seven different leading Lebanese universities. Two open houses were held that attracted 300 candidates
from different areas in Lebanon and resulted in the recruitment of 150 nurses.

PATIENT AFFAIRS OFFICE

In line with AUBMC’s goal to provide patient-centered care, several initiatives were launched to address
patient complaints and enhance healthcare service quality. These initiatives culminated in the
establishment of the Patient Affairs Office in September 2010. Dr. Maher Soubra, a pediatric surgeon and
the director of clinical services at AUBMC, was appointed as the director of the Patient Affairs Office.
Soubra wanted to focus on enhancing and maintaining long term relations with patients. “If the staff did
everything right but did not satisfy their patient, then it is as if they did nothing,” he said.

The patient affairs taskforce conducted a complete assessment of the patient experience, starting with the
very moment a prospective patient picked up the phone to make an appointment. A variety of tools were
used to evaluate patients’ experiences, including quarterly patient surveys, interviews with patients and
their families, consultations with heads of services and hospital units, and the heads’ own personal
assessments. The results were staggering. Findings revealed that patient complaints covered a range of
issues including long wait times in private clinics, cancelled appointments, unfriendly telephone
operators, rude staff, long nursing response times, inadequate waiting areas and lack of parking spaces.
The admissions and discharge processes were not streamlined either. “In each case,” Soubra explained,
“we investigated, asked questions, and made our own observations to determine the problems and identify
possible solutions.”4

The Patient Affairs Office made many improvements, such as the expansion of the waiting area at the
laboratories, the introduction of a fast-track emergency room for minor emergencies, the provision of
valet parking services, the streamlining of admission and discharge processes, and implementing a new
phone system at the call centre. The new system allowed schedulers to handle calls more quickly and
efficiently, and provided statistics on how many phone calls were answered, how many were dropped and
the time callers were kept on hold,. The scripts that the receptionists followed when answering the phone
were also changed. Moreover, a plan for the renovation of the lobby, which was showing severe signs of
wear and tear, was put in place. Dress codes were created for 247 front-liners, designed by the famous
designer Reem Acra and executed according to strict standards. The Food Service Department was
revamped; new utensils were bought and new processes, rules and regulations were set.

The Patient Affairs Office was created with five major services. First, and in line with the institution’s
commitment to provide high-quality care, four “patient advocates” were made available to proactively
manage all patients’ problems. The patient advocates visited patient rooms daily and assessed the patient
experience by following a script that covered the quality of medical care, hospital services, cleanliness
and staff attitude, among other issues. Their main role was to spot problems, make investigations and
come up with solutions. Other services provided by the Patient Affairs Office were the “Patient
Satisfaction Survey,” “Complaint Management,” “Foreign Patients Assistance Program” and “Patient
Education Program.”5

4
“The Problem Solvers,” AUB MainGate, Spring 2010, p. 20, www.aub.edu.lb/maingate/Documents/Spring-2010.pdf,
accessed December 10, 2013.
5
“Patient Affairs Office,” American University of Beirut Medical Center,
www.aubmc.org/patientcare/adm_ser/Pages/pao.aspx, accessed December 10, 2013.
Page 7 9B14C043

“The bottom line,” said Soubra, “is that we want our patients to feel that not only are they receiving the
best medical care, but also that they are treated well and respected throughout their clinical experience,
which starts when they call to make the appointment and ends after they leave.”6

OUTREACH PROGRAMS

AUBMC’s management sought to widen its reach in Lebanon and the region by collaborating with
different types of public and private hospitals, especially those in remote areas like Sidon, Tripoli and
Shebaa, to enhance the quality of services provided by these entities to the public. These collaborations
and resulting projects addressed issues relating to infant and mother mortality, intensive-care units for
children, and breast cancer. This was done through capacity-building by establishing strategic
partnerships to offer high-quality services similar to those partnerships made by Johns Hopkins and
Harvard. The goals of the strategic partnerships were for AUBMC to become the institution of choice for
partnerships, improve training opportunities, facilitate access to more patients, assist with capacity-
building and improve the quality of healthcare in Lebanon and the region, in addition to fostering clinical
exchange and collaboration. Through these partnerships, AUBMC would create a partners network in
Lebanon and the region, in which it would manage satellite healthcare institutions.7 As of 2014, AUBMC
had eight local partnerships, including those with Clemenceau Medical Center and Rafik Hariri
University Hospital, while regional partnerships included those with the United Nations Relief and Works
Agency and Medical City Teaching Hospital - Iraq. To better coordinate such projects, Sayegh
established an External Medical Affairs Program responsible for managing the outreach programs and
providing assistance to clients.8 AUBMC also collaborated with the Ministry of Health in Lebanon, and
the latter played a significant role in refining and advancing the government’s provision of healthcare
facilities and capabilities.

Beginning in January 2014, and in light of the humanitarian crisis in Syrian refugee camps in Lebanon,
AUBMC sent a mobile clinic staffed by doctors and nurses to the Bekaa region twice a week to provide
urgent medical care to this vulnerable population. All medical examinations and medications were
provided free of charge. This initiative emphasized the role of service to the community as a component
of the institutional mission of AUB.9 Peter Dorman, the president of AUB, said, “Through both calm and
turbulent times, we have cared for millions of patients, and AUBMC in particular was the face of healing
and humanity for communities here in Beirut, during the difficult years of civil strife. The dedication and
resilience of our talented medical staff have been amply proven.”

CENTRES OF EXCELLENCE

Prior to 2009, AUBMC had two established clinical centres of excellence — the Children’s Cancer
Center of Lebanon, which was affiliated with St. Jude Children’s Research Hospital, and the state-of-the-
art Naef K. Basile Cancer Institute, which was dedicated to the treatment of and research on cancer in
adults. In 2011, two new centres were established — the Abu-Haidar Neuroscience Institute and the

6
AUB MainGate, op. cit.
7
“Dean Dr. SAYEGH: In 2020 AUBMC Will Look Very Different from what it is Today,” Human & Health, October 2010, no.
13,
8
“Q&A,” AUB MainGate, Spring 2010, p. 18, http://staff.aub.edu.lb/~webmgate/Spring-2010.pdf, accessed August 10, 2013.
9
“Syrian Refugee Relief Crisis Evokes Community-wide Response at AUB,” AUB, February 14, 2014,
www.aub.edu.lb/news/2014/Pages/aubmc-syrian.aspx, accessed February 22, 2014.
Page 8 9B14C043

AUBMC Multiple Sclerosis Center. Plans were underway to establish a heart and vascular centre of
excellence in 2015.10

Other specialized clinical programs and services were created such as the AUBMC Special Kids Clinic,
the Calcium Metabolism and Osteoporosis Program-Bone Density Unit, the Executive Health and Travel
Medicine Program, the Center for Skull Base Surgery, the Children’s Heart Center (supported by the
Brave Heart Fund), the Comprehensive Adult and Pediatric Epilepsy Program, the International Patients’
Services, the Hamdan Voice Unit, the Inborn Errors of Metabolism Program, the Mikati Foundation
Hepatopancreaticobiliary and Liver Transplantation Unit, the Mamdouha El-Sayyed Bobst Breast Unit,
the Wound Care Center, the Pulmonary Rehabilitation Program and the Women’s Health Center.

One of the goals of AUBMC and the Faculty of Medicine was to create a regional research centre to
address research needs and improve research standards. Five basic and translational research centres of
excellence were being established in cancer biology, cardiovascular sciences, genetics, immunology and
therapeutic stem cells in order to raise basic clinical research at AUB to international standards.

EXCELLENCE IN EDUCATION

The curriculum of the Faculty of Medicine had a “problem-based learning” focus, similar to curricula
adopted in the United States and Europe, to reflect the changing needs of the healthcare profession as a
result of the adoption of the IMPACT Curriculum. In 2010, AUBMC established the Office of Continuing
Medical Education in partnership with the Cleveland Clinical Foundation Center for Continuing
Education, which organized trainings and courses on different clinical and healthcare subjects, in order to
advance research and education at AUBMC and the Faculty of Medicine. With this partnership, AUBMC
would be able to certify medical education activities in Lebanon and the region.11 In 2010, AUBMC
founded the Clinical and Professional Development Center, which promoted the ongoing development of
nurses by providing education, mentorship and accredited certification through the American Nurses
Credentialing Center. In addition, the External Medical Affairs Office was created in 2009 for AUBMC
to become the leading academic medical centre in the region.

FINANCING THE 2020 VISION

With the implementation of Sayegh’s vision, which emphasized expansion and aggressive recruitment of
talent from the United States and Europe, costs increased unimaginably. Prior to 2009, AUBMC had been
running a deficit of $7,000,000 per year for the previous 10 years, which made Walid Uthman, the chief
financial officer, put all his efforts into reducing this loss. The first step was to decrease the “receivables
balance,” which had a direct effect on operational costs. In a span of two years, Uthman and his team
managed to lower the debt through admitting more privately funded patients and fewer patients with
public insurance, such as those funded through the National Social Security Fund (NSSF), who had a
different (lower) fee structure (see Exhibit 3). This helped in strengthening the payer mix. The second
step was strengthening the relationship with medical insurance companies. The load increased, which
directly decreased the deficit. Price arrangements with insurance companies were also reviewed and new
packages were introduced.

10
“AUBMC 2020 Vision,” American University of Beirut Medical Center Website, p. 2,
http://staff.aub.edu.lb/~webhrdmc/downloads/nursingopenhouse/AUBMC2020vision.pdf, accessed September 18, 2013.
11
“Inside the Gate- Views From Campus: HSON,” AUB MainGate, Summer 2011,
http://viewer.zmags.com/publication/f118f7eb#/f118f7eb/22, accessed February 3, 2014.
Page 9 9B14C043

Uthman and his team developed a 10-year projection. Although AUBMC had payments in the millions of
dollars, Uthman knew that when the new building opened and the hospital bed capacity doubled, it would
be able to cap its expenses. The biggest fear was how to control costs in light of the unstable political and
security situation in Lebanon. Sayegh, on the other hand, was more optimistic and revealed that AUB
planned to invest around half a billion dollars in this plan, in which most of the funding would come from
philanthropy efforts. Indeed, in February 2014, the largest single donation to date, $32 million, was
donated by Jamal Daniel and The Levant Foundation toward the expansion of AUBMC.12 According to
Sayegh, as long as AUBMC successfully attracted patients from Lebanon and the region, sustainability
was not a problem.

MARKETING THE GROWTH

Prior to 2009, all marketing and communication activities were handled by the AUB Office of
Communication. However, with the plans and vision he had outlined for AUBMC, Sayegh deemed it
better for AUBMC to have its own marketing department and dedicated communication team. For that
purpose, the Department of Strategic Planning and Communication (DSPC) was created in August 2010
under the directorship of Rana Alley. Sayegh, Alley and the administrative team worked on defining the
communication and marketing plan of the Medical Center.

The Center’s name had changed from AUH to AUBMC in 1974, yet it was still widely referred to as
AUH, even by hospital doctors and staff. Before the 2020 vision could be communicated to the general
public, it was necessary first for the public to realize that AUBMC was no longer a hospital, but had
developed into a medical centre and was becoming a medical complex, with multiple unique inpatient and
outpatient services. A rebranding effort was therefore in order.

The department developed internal and external marketing plans to rebrand AUBMC and its services. The
objectives of these plans were to rebrand AUBMC internally, while externally they focused on regaining
public confidence and establishing brand recognition, loyalty and leadership. Both plans were
implemented almost in parallel, especially because they addressed common goals.

The main aim of the external plan was to position AUBMC as the undisputed leader in healthcare in the
Middle East and North Africa region, through providing the best patient-centered care and using the most
advanced technology, unique services and high-calibre faculty, as shown through accreditations,
professional staff and international reach. The plan consisted of three phases. The main aim of the first
phase was to create awareness of the “new” AUBMC name change, new leadership and direction, and the
new promise slogan. The second phase was designed to progressively implement and establish the new
revamped brand identity, recognize AUBMC’s superiority in medical services and, finally, promote its
competitive differentiators. The goal of the third phase was to promote the new and unique services and
skills, support the brand affinity among the target audience and make AUBMC the audience’s “top-of-
mind” brand for healthcare.

Phase 1: Rebranding AUBMC (April 2010–May 2011)

The first task of the DSPC was to embark on the rebranding of AUBMC and communicate the name
change and new direction with the 2020 vision. M&C Saatchi was hired to help with that task. The

12
“Jamal Daniel and The Levant Foundation Commit to the Largest Gift in AUB’s History,” AUB, February 5, 2014,
www.aub.edu.lb/news/2014/Pages/jd-acc.aspx, accessed February 22, 2014.
Page 10 9B14C043

strategy was formulated by AUBMC and the role of M&C Saatchi was to assist in the implementation.
The objective of the campaign was to maximize reach, yet AUBMC had a limited budget, hence it was
important to keep the message simple. The first message therefore was “AUH is AUBMC — Where Our
Lives Are Dedicated to Yours,” and was communicated in English. “The slogan was torture to come up
with. One of the trickiest matters of local culture is that the Lebanese are very skeptical and cynical,” said
Alley. The ads were the result of multiple revisions, since people interpreted the messages differently than
how AUBMC intended (see Exhibit 4).

Several delivery mechanisms were used to propagate the message, starting with the website, billboards,
TV ads, TV interviews, press conferences, events, press releases, feature articles, radio ads, public lecture
series and the provision of hardcopy publications to other stakeholders, government entities, NGOs and
professional associations and bodies. Over the span of a month, 600 billboard ads were posted in Beirut
and the greater Beirut area and 400 were posted in the North and South of the country, in Arabic and
English. Magazine and newspaper advertising were also used. Unfortunately, due to budgetary and time
constraints, the marketing department was not able to conduct a market research exercise to assess the
success of Phase 1 prior to starting Phase 2.

Phase 2: Brand Recognition (June 2011–December 2012) (see Exhibit 4)

One of the objectives of Phase 2 was to portray AUBMC as a patient-friendly institution that was still
continuously improving, despite being one of the most established medical hubs in Lebanon. The main
focus in the campaign was on competitive differentiators, experience, quality faculty, technology and
innovation, quality care, accreditations and patient-centered care. A variety of media were used including
billboards, print ads, interviews and in-flight magazines, in both Arabic and English. Billboards were
posted in high-traffic areas of Beirut, and a seven-second TV commercial was broadcast 40 times a week.
The TV ad was broadcasted on major TV stations during April 2012 and the first week of May, around
the news and primetime. The target audience for this phase was the public in general and local and
regional AUBMC patients who were educated and middle- or upper-class, with private insurance.

One of the trickiest parts for Alley was discovering the sources of information people used. For example,
the Internet and social media were the main sources of healthcare-related information to people in the
United States. However, in Lebanon institutions did not invest much in social media, but focused more on
newspapers, magazines and societal journals. Although social media was picking up in Lebanon, the
DSPC, at the time in January 2012, did not have a social media platform despite social media being a less
expensive means of communication than other forms of media.

Alley faced further challenges. Television stations in Lebanon could be aggressive and sneaky and have
political agendas. It was difficult for AUBMC to get on the news of some of the most popular and leading
TV networks due to the religious and political affiliations of such networks. That was a source of
frustration because AUBMC made many medical breakthroughs and some TV stations did not even show
up for press releases. Even footage of press releases issued by the Medical Center were often edited. The
only way the Center could prevent editing was by paying for the press releases to be published as they
were, which could be very costly. For example, a quarter of a page in a newspaper cost a couple thousand
dollars. Moreover, there was a tendency to misrepresent information in the local media. There was an
incident once where an AUBMC doctor developed a cure for a specific type of leukemia in the lab that
was still not patient-tested, but which still constituted a medical breakthrough. One of the newspapers
reported that a doctor at AUBMC had developed a cure for leukemia and AUBMC was obliged to publish
a correction in order to not give false hope.
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Lebanese TV stations did not always respect privacy. A bone marrow transplant from a non-relative
donor was performed at AUBMC in 2011, which was the first of its kind in Lebanon. The procedure was
only possible because the surgeon had contacts with the National Board in the United States, which was
able to secure the donor. A leading TV station wanted an exclusive story and AUBMC was also interested
in the exposure it would get from that TV station, so it held off the news for a few weeks. AUBMC got
permission from the patient and the physician for filming and interviewing, but the TV station did not
abide by the appointment time. Its staff arrived early and started filming in the waiting room without
obtaining permission from patients.

Phase 3: Brand Loyalty (November 2012 to Present)

Phase 3 focused on marketing the unique services available at AUBMC. Sayegh wanted to make sure that
the private clinics, which were a major part of the Medical Center, were not sidelined in the external
communication. The DSPC focused on five different unique services and centres of excellence, such as
the Multiple Sclerosis Center (see Exhibit 4).

The messages were created in both Arabic and English at the same time. It took several months to
successfully translate them. The ads were tested internally through different focus groups. Some messages
worked well in English but not in Arabic, and vice versa. Also, in order to target regional audiences,
formal Arabic was used instead of the Lebanese dialect, even though using local dialect would have
produced some really strong messages.

One challenge AUBMC faced in developing the campaign was that in Lebanon it was not common to
market healthcare, and local advertising agencies had no experience in this field. Given the uniqueness of
the healthcare industry and the required positioning of AUBMC, the approach to take had to differ from
regular advertising approaches. The development of the campaign took between six and eight months to
complete. Another challenge was that some staff members failed to see the benefits of the campaign and
felt that the money spent on the campaign could have been used to finance needed equipment.

Not assessing the success of a phase before proceeding to the next phase was a major drawback. AUBMC
was able to conduct a few assessments through faculty and staff, yet it did not check if the public’s
perceptions of AUBMC had changed.

MOVING FORWARD

Sayegh retired to his office later that afternoon, feeling pleased with all the progress made so far. Many of
the goals AUBMC had set had been achieved or were underway. The biggest challenge was to complete
the planned physical expansion. Would it be able to complete it before 2020? Sayegh was confident that it
would be able to secure funding, for AUB had very dedicated alumni, and businesspeople with links to
AUB or the region had always pledged their support in the past. But given the turmoil in the region,
would AUBMC be able to secure all the funding needed within the timeframe set initially? Would it be
able to continue its growth strategy in the face of Lebanon’s deteriorating economic and political
conditions? How would it maintain leadership in healthcare with the mushrooming of medical centres and
increased competition? With the turbulence and chaos in the country and region, would it be able to shield
the internal culture from fragmentation and chaos? Would it be able to attract and retain faculty in these
turbulent times?
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EXHIBIT 1: NEW AUBMC ORGANIZATIONAL CHART

Source: Human Resources Department, American University of Beirut Medical Center.

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EXHIBIT 2: CORE VALUES POSTER

Source: “AUBMC 2020 Vision,” American University of Beirut Medical Center website.

EXHIBIT 3: CATEGORIZATION OF AUBMC PATIENTS

Groups 2009 2010 2011

Number % Number % Number %
Private: Third Party Payers 16,791 66 17,757 66 18,998 60
National Social Security
Fund/Ministry of Health 6,157 24 6,731 25 9,917 32
Health Insurance Plan of AUB 2,352 9 2,419 9 2,502 8

Total Inpatient Admission 25,300 100 26,907 100 31,417 100

Source: AUBMC.
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EXHIBIT 4: SAMPLE ADS IN ENGLISH

Source: Department of Strategic Planning and Communication, AUBMC.