Centre of excellence launch: the first hundred patients

A Centre of Excellence is approved on a spreadsheet that assumes demand. The capital case for a new oncology or neurosciences or joint-replacement programme has a volume ramp in it, and the ramp starts in month one, because a ramp that starts in month nine does not clear the hurdle rate. Then the doctors arrive, the equipment is commissioned, the inauguration happens, and the growth function is asked why the OPD is empty.

It is empty because a specialty with no brand has no demand of its own. The hospital may be known. The new programme is not. Nobody in the city searches for your liver programme, because until last month it did not exist, and the surgeons you hired have a reputation in the city they came from, not this one. The demand has to be manufactured, and the first hundred patients are the hardest hundred you will ever acquire — they cost the most, they come from the strangest places, and they are the only evidence you will have when the executive committee asks whether the ramp is real.

This is the playbook I have run, in different forms, for several such launches. It is a sequence, not a list, and the sequence is most of the point.

Start with the patients you already have

The cheapest first hundred are not in the market. They are in your own records. A group with several units and a decade of history has thousands of patients with the condition the new programme treats, who were seen for something else, or were referred out because the capability did not exist, or were told to come back in six months and never did.

Before any external spend, run the query. Patients tagged with the relevant diagnoses, or on the relevant drugs, or who had the relevant investigation, in the last two or three years, across every unit. Then get the medical director to agree a clinically appropriate outreach — a review invitation, a call from a clinical coordinator, a letter from the treating physician — and route the responses into the new programme’s OPD. The consent and tone here need a clinician’s sign-off, and I would not send a word of it without one. But the volume is real, the cost is near zero, and the patients already trust the building.

The internal referral is the second source. Every physician, every emergency department and every other specialty in the group sees candidates for the new programme weekly and has been sending them elsewhere out of habit. A CRM prompt at the point of consult, a one-page summary of what the programme does and who to call, and the new consultants doing rounds of the other units’ OPDs will move more patients in the first quarter than any campaign. I have watched programmes miss this entirely and spend the first six months buying from strangers what they could have had from the building next door.

The first quarter: build the surface before the traffic

Paid demand in month one is wasted, because there is nothing for it to land on. A programme that exists as a paragraph on the hospital page and a couple of doctor profiles with no photographs will convert almost nothing, however much you spend to send people there. The first quarter is about making the programme findable and credible when someone does look.

The programme page and the condition pages. Not a brochure. A set of pages built around the questions people actually search for at the moment of diagnosis — what the condition is, what the treatment options are, what the recovery looks like, what it costs in broad terms, who the doctors are. Written with the clinicians, reviewed by them, in the languages your catchment speaks.
The doctor entities. Every consultant with a complete profile: qualifications, procedures, years, the previous institution named where he is willing, a photograph that looks like him. Their names are the first thing anyone will search when a referrer or a relative mentions them, and if the search returns the old hospital, you have handed the enquiry to someone else.
Listings. The map listing, the aggregator profiles, the review platforms — all reconciled so that the programme, the doctors and the unit appear together, with the same phone number and the same hours. This is dull and it is where most launches leak.
The enquiry path. A number and a form that go to a person who knows the programme exists. I have seen a beautifully launched centre whose contact-centre script had not been updated, so callers asking for it were told there was no such department.

None of this generates demand. It stops you wasting the demand you are about to buy.

Doctor content is the brand, for now

A programme has no brand. The doctors have one, in fragments. In the first two quarters the only credible thing you can put in front of the market is the clinician explaining the condition, the decision and the options, in his own words and, ideally, in the regional language as well as English.

Short video, one question per piece, recorded in a batch, cut into the formats each channel wants. Written explainers under the doctor’s name. A regular slot with the local press, who are always short of a specialist to quote. The purpose is not reach. It is that when the patient, or the referring physician, or the relative doing the family’s research, searches the doctor’s name or the condition, something of yours appears that sounds like a person who knows what he is doing.

The trap is production values. A programme head who insists on a studio and a script will produce four videos in a quarter. A coordinator with a phone and a list of questions will produce forty, and forty is what the search engine and the feed reward.

The second-opinion offer

The most effective demand instrument I have used for a new programme is also the least glamorous: a structured second opinion. A patient who already has a diagnosis and a treatment plan from somewhere else can send the reports, get a consultant’s written view within a defined time, and decide what to do. Low commitment, high intent, and it plays to the one advantage a new programme has — new consultants with time in their diaries and a reason to be generous with it.

The mechanics matter. Reports come in through a form and a messaging thread, not an email address nobody checks. A coordinator confirms receipt the same day. The consultant reviews within the promised window. The opinion goes back in writing, and the follow-up call asks whether the patient would like to be seen. The conversion from second opinion to treatment will not be high and should not be forced. The value is that every one of these is a patient with the condition, at the decision point, now in your CRM with a named consultant attached.

Price it low or free for the first two quarters. The finance team will ask why you are giving away consultant time, and the answer is that the alternative use of that time, in month two of a programme, is sitting in an empty OPD.

Referral outreach, done as a campaign

For most tertiary specialties, the majority of volume is referred, and a new programme has no referrers. Building them is a sales campaign with a target list, a sequence and a system, and it should be run by the growth function with the consultants as the product.

The list comes from the data you already have — physicians in the catchment who have sent anything to the group, sorted by the relevance of what they send — plus the obvious names in the Tier 2 towns within three hours’ drive. The sequence is a visit from the consultant, followed by a piece of collateral that answers the referrer’s questions rather than the patient’s, followed by a referral line that acknowledges within the hour and a report that comes back within the day. The system is the CRM, with every doctor on the list as an account and every referred patient linked to it.

The programme heads will want to do this themselves, informally, over dinner. Some of it should be. But a programme whose referral book lives in one surgeon’s phone has not built a referral book; it has built a dependency, and the group will discover the difference the day he resigns.

Paid media, and when to turn it on

By the start of the second quarter the surface exists, the doctor content is accumulating, the second-opinion path works and the referral outreach is running. Now paid media has something to do, and it does two things well.

It buys search intent for the condition and procedure terms where you now have pages that answer the query and a phone number that gets answered. And it buys the doctor’s name in the geography where he was previously known, which is often a different city, and where his old patients are still searching for him.

What it does badly, for a new programme, is awareness. A display campaign for a specialty nobody knows to look for, from a centre nobody has heard of, spends the budget on people who are not ill. Keep the paid work close to intent for the first two quarters and let the rest of the programme create the awareness that display cannot.

The budget conversation with the CFO is easier if you frame the paid line as the last instrument switched on, not the first. It shows you spent the cheap money before the expensive money, and it gives you a clean before-and-after in the enquiry data.

The metrics that show it is working before the volume does

The executive committee will look at admissions and OPD count, and for two quarters those will look like failure. You need leading indicators that are honest, and you need to have agreed them before launch so that they are not dismissed as excuses afterwards.

Branded search for the doctors and the programme. If nobody is searching the names, nothing else is working. It moves first.
Enquiry mix. The share of the unit’s enquiries that are for the new programme, week by week. It should climb steadily; a spike and a drop means a campaign, not a brand.
Second-opinion requests and the time to respond to them.
Active referrers — doctors who have sent at least one patient — and the count of internal referrals from other units and departments.
Enquiry-to-consult conversion for the programme, against the unit average. If it is far below, the path is broken and more traffic will not help.
Consult-to-procedure, which is the clinicians’ number, and which tells you whether the demand arriving is the demand the programme was built for.

Put these on one page, alongside the volume ramp from the capital case, and take that page to every review. When the leading indicators move and the volume has not yet, you have a programme that is working and a ramp that was drawn too steep — which is a different conversation from a programme that has failed, and you want to be having the right one.

What I would do differently

I have launched programmes where the inauguration happened before the pages existed, where the consultants’ old profiles outranked the new ones for a year, and where the paid campaign started in the first week because someone senior wanted to see activity. All of it cost money and none of it produced patients.

The one I would most change is the ramp itself. I now argue, before the capital case is approved, for a volume curve that assumes two quarters of near-nothing and that names the leading indicators the programme will be judged on until then. It is a harder case to get approved. It is a far easier programme to run.

The order of operations

Before launch: query your own records, agree the outreach with the medical director, and brief every other department on what the programme does and who to call.
Month one: pages, doctor entities, listings and the enquiry path. No paid spend.
Month one onward: doctor content in volume, in two languages, on a schedule.
Month two: the second-opinion offer, with a coordinator and a turnaround promise.
Month two: the referral target list, the consultant visits, the referral line and the CRM accounts.
Month four: paid search on condition and doctor terms, in the geographies where the doctors are known.
Throughout: the leading-indicator page, reviewed weekly with the programme head and monthly with the executive committee.

The hundredth patient is not a milestone. It is the first point at which the programme has a brand of its own, and the first day the growth function can stop manufacturing demand by hand.

Until then, nobody is coming for the specialty. They are coming because you went and got them.

Questions people ask

Why is a new Centre of Excellence OPD empty after launch?

Because a specialty with no brand has no demand of its own. The hospital may be known; the new programme is not. Nobody searches for your liver programme, because until last month it did not exist, and the surgeons you hired have a reputation in the city they came from, not this one. The capital case assumed a ramp from month one. The demand has to be manufactured, and the first hundred patients are the hardest hundred you will ever acquire.

Where do a new hospital programme first patients actually come from?

Your own records, before the market. A group with several units and a decade of history has thousands of patients with the relevant diagnoses, drugs or investigations who were seen for something else, referred out or told to come back and never did. Run the query, agree a clinically appropriate outreach with the medical director, and route responses into the new OPD. Then internal referral from every physician and emergency department in the group. Both are near-zero cost.

How long does it take a Centre of Excellence to build real demand?

Assume two quarters of near-nothing on admissions and OPD count. Month one builds the surface: pages, doctor entities, listings, enquiry path. Doctor content starts immediately and accumulates. The second-opinion offer and referral outreach begin in month two. Paid search switches on around month four. The hundredth patient is the first point at which the programme has a brand of its own and the growth function can stop manufacturing demand by hand.

When should paid media start for a new specialty programme?

Not in month one. Paid demand then is wasted because there is nothing for it to land on — a paragraph on the hospital page and two profiles without photographs convert almost nothing. Turn paid search on at the start of the second quarter, close to intent: condition and procedure terms where you now have pages that answer the query, and the doctor’s name in the geography where he was previously known. Display awareness for an unknown specialty spends money on people who are not ill.

What is a structured second-opinion offer and why does it work for a new programme?

A patient who already has a diagnosis and treatment plan elsewhere sends reports through a form and messaging thread, a coordinator confirms receipt the same day, the consultant reviews within a promised window, and a written opinion goes back with a follow-up call. Low commitment, high intent, and it uses the one advantage a new programme has: consultants with time in their diaries. Every request is a patient with the condition, at the decision point, now in your CRM.

How should referral outreach for a new programme be run?

As a sales campaign with a target list, a sequence and a system, run by the growth function with the consultants as the product. The list comes from physicians who have already sent anything to the group, plus the obvious names in Tier 2 towns within three hours’ drive. The sequence is a consultant visit, referrer-focused collateral, a referral line that acknowledges within the hour and a report back within the day. The system is the CRM, with every doctor as an account.

Which leading indicators show a new programme is working before the volume does?

Branded search for the doctors and the programme, which moves first. The new programme’s share of the unit’s enquiries, week by week, climbing steadily rather than spiking. Second-opinion requests and response time. Active referrers who have sent at least one patient, and internal referrals from other departments. Enquiry-to-consult conversion against the unit average. And consult-to-procedure, the clinicians’ number. Agree these before launch so they are not dismissed as excuses afterwards.

What has to exist before a hospital spends on demand for a new programme?

The programme and condition pages built around the questions people search at diagnosis, written with and reviewed by the clinicians, in the catchment’s languages. A complete profile for every consultant, with a photograph that looks like him. Map listings, aggregator profiles and review platforms reconciled so the programme, the doctors and the unit appear together with one phone number. And an enquiry path that reaches a person who knows the programme exists, including an updated contact-centre script.

What does the medical director need to sign off on when contacting existing patients?

The outreach itself: who is contacted, on what clinical basis, in what tone and through which channel — a review invitation, a coordinator call or a letter from the treating physician. I would not send a word of it without a clinician’s sign-off. Consent and clinical appropriateness are theirs to judge; the query, the routing and the CRM are the growth function’s. Done this way, the medical director becomes the programme’s first ally rather than its objector.

Why should doctor content for a new programme be low-production?

Because volume is what search and the feed reward. A programme head who insists on a studio and a script produces four videos in a quarter; a coordinator with a phone and a list of questions produces forty. The purpose is not reach. It is that when a patient, a referring physician or a relative doing the family’s research searches the doctor’s name or the condition, something of yours appears that sounds like a person who knows what he is doing.

What does it cost to build demand for a new Centre of Excellence?

Less than the capital case usually assumes, if the sequence is right. The first two sources — your own records and internal referral — are near free. Pages, profiles, listings and content are staff time. The second-opinion offer costs consultant hours that would otherwise sit in an empty OPD. Paid search is the last instrument switched on, which lets you show the CFO you spent the cheap money before the expensive money and gives a clean before-and-after in the enquiry data.

What goes wrong most often in a Centre of Excellence launch?

The inauguration happens before the pages exist. The consultants’ old profiles outrank the new ones for a year, handing enquiries to their previous hospital. The paid campaign starts in week one because someone senior wants to see activity. The contact-centre script is not updated, so callers are told there is no such department. And the referral book lives in one surgeon’s phone, which is a dependency, not an asset, as the group discovers the day he resigns.

How should the volume ramp in a Centre of Excellence capital case be set?

Argue, before approval, for a curve that assumes two quarters of near-nothing and names the leading indicators the programme will be judged on until then. It is a harder case to get approved and a far easier programme to run. When the leading indicators move and the volume has not yet, you have a working programme and a ramp that was drawn too steep — a different conversation from a failed programme, and the one you want to be having.

Can a single hospital run this playbook without a group behind it?

Most of it, yes. The internal-records query is smaller but still the cheapest source. Internal referral from other departments still applies. The surface, the doctor content, the second-opinion offer and the referral campaign into nearby Tier 2 towns work at one unit. What a single hospital lacks is other units’ OPDs for the new consultants to visit and a group brand to borrow, so referral outreach and doctor content carry more of the load.