Brand Leadership Magazine  ·  Case 01 – Diaverum

From Gambro
to Diaverum

Interview with Christina Sterner, (former) Director of Communications, Diaverum

The moment Investor's representative signed the agreement making Bridgepoint the owner of Gambro's more than 140 dialysis clinics, work began on building a new brand under the name Diaverum. Christina Sterner explains how it all unfolded.

Everything was the same — and everything was new

Everything was the same, yet everything was also new. The brand challenge in this situation was obvious — how could all the goodwill and trust built up around the Gambro name, the foundation of a business worth three billion kronor a year, be transferred to the new brand?

What was once Gambro Health Care is a piece of Swedish industrial history. The company was founded in 1964 in Lund by Holger Crafoord and Professor Nils Alwall. Professor Alwall was one of the first in the world to successfully construct an artificial kidney. The company was named Gambro — an abbreviation of Gamla Brogatans Sjukvårdsaffär Aktiebolag. In 1967, mass production of disposable artificial kidneys and dialysis machines began. The company quickly achieved a world-leading position and the Gambro name became synonymous with cutting-edge technology in dialysis. During the 1990s, the company also built up a network of dialysis clinics around the world, where patients with chronic kidney problems today have their blood cleaned on average every three days. It was this business that Investor sold on to Bridgepoint — and which became Diaverum.

– The internal need for information about what Diaverum would stand for and what the strategy going forward looked like was naturally very great after the sale, explains Christina Sterner, Director of Communications and a member of Diaverum's management team. The fact that the information was in demand is a great advantage, but also a significant challenge. It wasn't just the name that was new — our business strategy and the foundation of our corporate culture were also new. To meet the internal need while also securing a longer-term perspective, we had to work both short-term and long-term on embedding our business and brand strategy in the new company, she explains.

Service strategy and soft values

To establish Diaverum as a competitive private healthcare provider, management decided early on to focus one hundred percent on kidney care and on creating a superior patient experience. Public healthcare systems around the world are facing a period of significant change due to dramatic increases in healthcare costs. Expenditure has grown far faster than historical GDP growth, and costs will increase further in the future due to an ageing population, rising demand for high-quality care, and a sharp increase in lifestyle-related conditions such as cardiovascular disease and diabetes. These trends place additional strain on public finances.

– In most markets there are strong reasons to seek out more cost-effective models for publicly funded healthcare, says Christina Sterner. This is also where Diaverum can take a position as an international, focused care provider with expertise in kidney care. Our approach to the question is holistic, meaning we do not only offer patients dialysis, but also preventive care and lifestyle-related services such as holiday dialysis.

Work on developing the Diaverum brand literally started from scratch. Since the name was entirely new, the brand equity was non-existent. There was no built-up awareness and no associations connected to the name, the logotype or the visual identity. In addition, the established service strategy required the creation of a different type of values and behaviours. Having come from Gambro — a brand deeply rooted in technology — Diaverum now needed to focus on delivering soft values, without losing the fundamental expertise and the life-critical quality of the dialysis treatment itself. Work on developing a brand strategy began immediately within the management team. A vision, mission, values, a distinctive personality and a brand promise were shaped over several working weeks. The new strategy was based partly on the existing knowledge and experience of management and the new owner, but also on the results of extensive studies of trends, competitors and patient needs around the world.

– Bridgepoint is one of Europe's leading private equity firms, with a portfolio of companies that together generate revenues of 5.6 billion euros and employ over 55,000 people. A strong focus has been placed on investments in health and healthcare, so there is a solid knowledge base about our market here — knowledge that is of course enormously valuable in a strategic process like this, says Christina Sterner. Among others, Alan Milburn, former Secretary of State for Health in Tony Blair's government, is attached to Bridgepoint as an advisor and is also a member of Diaverum's board.

Growing competition

In the US, private healthcare providers account for over 70 percent of the market, and the international companies in the sector are growing through acquisitions of these, but also by opening their own clinics. The major players are American companies DaVita and Baxter, and Germany's Fresenius. Diaverum is the leading independent player on the European market. As the industry consolidates, competition will intensify further and the differences between the leading players will become more pronounced.

– A cornerstone of the new strategy, and what sets Diaverum apart from competitors, is that we focus exclusively on kidney care. Our competitors often have other operations, which makes them less distinctive in the market, says Christina Sterner. Another strength is that we are completely independent, which means we can, for example, choose to purchase the dialysis technology and medication we consider to be best for the patient.

Implementation in 17 countries

Once the new strategy had been anchored in the board, the extensive work of implementation began. Since the organisation is spread across several continents and encompasses a total of 14 different languages, the starting point for the implementation was that it would be carried out with a high degree of involvement from the employees themselves. The programme was therefore developed using the train-the-trainer method, with local ambassadors given the responsibility of organising and carrying out the work.

Before the programme was rolled out, the quality of the working material was tested in three pilot exercises in different parts of the company. The management team went first. In a three-hour session, they worked through the exercise material, asked questions and suggested changes to the content. The exercise material, based on what is known as dialogue technique, encouraged participants to work in smaller groups to reason through, for example, the company's strategy, competitors, history, future, and — based on the values, desired behaviours and brand promises — to resolve situations that might arise in everyday working life. All of this with the aim of gaining deep insight into which factors matter for building Diaverum into a strong brand and creating a strong shared culture.

– When the management team is involved in the development work in this way, it creates both engagement and confidence about how the programme will work when it is rolled out in all countries. It is in this situation that the management team truly becomes ambassadors. They are in fact involved in developing the material and therefore feel a strong sense of ownership and gain a detailed knowledge of the content that makes it easier for them, in the next step, to explain what the programme aims to achieve and what internal work it is designed to do, says Christina Sterner. Furthermore, the management team's commitment signals to all employees that this matters.

The implementation programme

Many companies that develop a brand strategy settle for producing a so-called Brand Book and then distributing it at a kick-off event in the belief that the rest will take care of itself — an approach that rarely works. An implementation process requires significant attention and resources, both in the form of people who drive it forward and in the form of communication across various channels. To give Diaverum's implementation programme a high internal profile and to ensure that internal communication with all employees was as effective as possible, the programme was given its own name: The Touch Programme. Under the motto We have the touch that makes the difference, the new brand strategy was communicated internally. The concept of The Touch was intended to highlight the soft values on which the strategy was based.

The further development work then proceeded through two additional pilot exercises — one in which Diaverum's 30 most senior managers participated in a corresponding three-hour exercise to the one the management team had taken part in. The difference between this pilot and the first was that the working material was now finalised. The purpose was to continue anchoring the programme and to get the local managers engaged and comfortable with the content. After completing the exercise, all participants filled in an evaluation as input for further refinement of the material, and also to obtain confirmation that managers were prepared to stand behind and support the rollout.

"When the management team is involved in the development work, it creates both engagement and confidence about how the programme will work when it is rolled out across all countries."

— Christina Sterner, Director of Communications, Diaverum

– It was a little nerve-wracking to ask everyone for an evaluation, but it was the only way to ensure we would get maximum value from our investment, says Christina Sterner. I daren't even think about the cost of making an investment like this without bringing the managers along with you. That's why we chose to put a lot of resources into this phase, she adds. Because the evaluation showed in black and white what participants thought, we were able — after the high scores the programme and its content received in our test pilots — to continue investing in our rollout with great confidence. I think many companies skip this phase to save money in the short term, but I am certain it pays back many times over in the long run, says Christina Sterner.

Culture shapes the service experience

Since the actual delivery of a service occurs between people, brand building is very much a question of culture. The internal culture governs the organisation's behaviour, both among employees themselves and in their contact with customers. To achieve as broad a buy-in as possible, it is important that management as a whole is engaged in the issue, but it is also important that those ultimately responsible for HR and brand work together over the long term.

HR is responsible for the necessary processes that govern the development and competence of managers and employees, as well as the structure for performance reviews and reward principles. The communications department, in turn, is responsible for systems and processes for conveying messages internally and externally. Combined with the overarching support of management, alignment between these functions is decisive for how effective strategy implementation becomes. The most successful companies manage to bridge any differences between the HR department, communications department and management — often by finding a common language and consistently using the overarching business and brand objectives as a steering mechanism.

A local pilot test

The third pilot was conducted in a local market. Nurses, clinic managers and other staff from four different clinics gathered for a morning at a hotel in central Birmingham to carry out exercises equivalent to those that management and the top 30 had completed earlier. This was the final test to see whether the material would also work out in the clinics.

– When we started discussing which method to use to roll out The Touch Programme, we were often asked whether we thought the nurses and clinic staff would really be interested in discussing strategic issues. My experience is that it is very easy to underestimate the interest that exists throughout an organisation for the long-term questions. Most employees genuinely want to know what the company they work for stands for and what the long-term goals look like — not least in parts of the company that are far from head office. Furthermore, a strategy needs to be broken down into something concrete that leads to action, which is really the core of The Touch Programme. We wanted all employees to have a dialogue with their colleagues and translate the strategic content into actions that meant something to them in their everyday work. It is at the clinic that patients encounter Diaverum. That is where the brand strategy needs to be translated into a customer experience that makes patients want to stay with us and speak well of us. It really is as simple as that, says Christina Sterner.

The train-the-trainer method

Following the positive evaluations from all three pilots, planning for the train-the-trainer training began. There are different ways of approaching the question of internal trainers — should selection be based on formal position or on voluntary commitment? The advantage of choosing managers is that they can automatically, through their position, give the issue priority in their organisation. The disadvantage may be that a manager does not personally have time to prioritise the task and therefore does not carry out the work with the focus that good implementation requires. The other route — choosing people who voluntarily come forward — ensures commitment but may not carry the weight needed for the programme to achieve its intended impact. In that case it is important that the locally responsible manager clearly demonstrates their support for the work.

Diaverum chose a mix of formal leaders and voluntary trainers, primarily because different markets had different conditions for succeeding with their implementation. For example, Argentina chose a voluntary solution because the size of the country would have made it impossible for a manager to travel between the clinics themselves, while Hungary — a significantly smaller market with fewer clinics — had the country manager personally conduct and lead all exercises.

One month before the launch of The Touch Programme, 40 employees gathered in Munich to undergo training that would qualify them as trainers. As support for their training, each received a Brand Ambassador Kit containing all the working material in their local language, an exercise manual, and a Q&A with a compilation of answers to questions that participants might be expected to raise during the exercises. They also received a DVD in which CEO Dag Andersson presented the programme's business purpose, explained why it was important for everyone to participate, and described how the programme fitted into the company's long-term development plans.

Growing through acquisition

Diaverum grows both by opening its own clinics and through the acquisition of existing ones. These clinics are often owned by private-practice nephrologists who run their own clinic with a local patient base. When acquired clinics are integrated into Diaverum's operations, the brand strategy forms the basis, among other things, of a 100-day programme that the new clinics commit to completing in order for the integration to take place as quickly and smoothly as possible. Within the framework of The Touch Programme, staff learn what Diaverum stands for, which values are to permeate the company, and which promises are associated with the service delivery.

Based on four experience drivers — Products/Services, Communication, Behaviour and Physical Environments — the business is developed in a way that is intended to strengthen the brand experience and ensure that the experience is consistent regardless of which clinic you visit.

"We have organised virtually all of our brand development around products and services, our physical environments, our behaviour, and of course our communication."

— Christina Sterner

– Our four experience drivers have been the cornerstones of brand delivery from the very beginning and have also been the basis for a number of internal development projects. We have organised virtually all of our brand development around products and services, our physical environments, our behaviour and of course our communication. We have even organised our annual management conferences around our experience drivers, says Christina Sterner. For developing the brand experience from the inside, this has been tremendously useful. Moreover, we have not always needed to talk about "brand building", which can sometimes complicate the process since it is a conceptual world that marketing managers and communications professionals are primarily used to working with.

The Diaverum Experience Board

To create broad buy-in for the brand strategy development process, a Diaverum Experience Board was established early on, with the aim of initiating, steering and evaluating long-term initiatives. The group's primary responsibility is to ensure that Diaverum's brand equity is managed and developed optimally. The group consists of a mix of nephrologists with business responsibility for some of the largest countries, communications professionals, HR and business developers. Leadership responsibility is shared between Christina Sterner and the Head of HR, Snježana Spajić, both of whom sit on Diaverum's management team. The work of the Diaverum Experience Board is also organised around the brand's four experience drivers, ensuring that all initiated brand projects and activities genuinely contribute to strengthening Diaverum's brand experience for patients and other target groups. The group meets four times a year.

– Over the two years that the Diaverum Experience Board has existed, we have gone through all the experience drivers and touch points in a very thorough way. Under Products and Services, the group has, among other things, developed a brand hierarchy and a naming strategy, but has also contributed to evaluating and proposing new services that drive the brand experience. Under Physical Environments, we have initiated, discussed and evaluated proposals from our architects aimed at giving our clinics an expression that sets us apart from our competitors, but also conveys and reinforces the experience we want Diaverum to be known for. We have also decided on an interior design guideline. The clinics and the physical space are an important experience driver for us because our patients spend so much time in our clinics. A treatment takes approximately three to four hours and the patient needs to be treated on average every three days. The environment at the clinics therefore naturally becomes extremely important for the experience, underlines Christina Sterner. Under the Behaviour experience driver we develop and steer our culture project called The Touch, which I described earlier. Under Marketing Communication we of course discuss and steer everything related to the company's internal and external communication. Issues that the Diaverum Experience Board has decided on have included the development of a communications platform and a communications strategy, a communications concept and a CSR strategy, a web strategy, and the development of a graphic design concept and a social media policy. Issues that the Diaverum Experience Board does not have the mandate to decide on are decided by the management team, with the Diaverum Experience Board's evaluation and recommendation as the basis for the decision, explains Christina Sterner. The Board is also responsible for brand measurements and employee satisfaction surveys.

Implementation — Phase 1

When the first wave of implementation activities had been rolled out in all countries via local trainers, the ideas, comments and concrete development proposals that had emerged at the local meetings were compiled into a Brand Management Report. In the first phase, over 6,000 people in 17 countries had completed a dialogue exercise based on Diaverum's business and brand strategy. At every single clinic in these countries, the questions of vision, mission, values, competitors and brand promise had been discussed based on the day-to-day reality of the local operation and the collective experience as the basis for discussion. Since many conclusions and collective opinions from these discussions had been written directly onto the dialogue material, the material could, after the exercise was completed, be analysed and compiled in the form of a report.

– Much of what we learned during the first phase of implementation we naturally brought with us into the next phase, says Christina Sterner. Since we work according to well-defined annual cycles, the next natural starting point was the annual management conference. At the same time as we now had motivated employees at the clinics, we had also awakened an engagement and a hunger for more. It was therefore important that the senior managers now recognised that expectations within the organisation for a next phase were very high. The responsibility for managing and steering this engagement naturally rested with our managers, explains Christina Sterner.

To ensure that the insight among the company's 200 most senior managers was as clear as possible, the annual meeting was organised around the content of the Management Report and the brand strategy's four experience drivers. Using the content of the report as a foundation, managers were engaged in smaller groups to carry out workshops aimed both at developing activity plans for the next phase of implementation, and at gaining greater insight into the role they as managers had in the brand work. The entire conference was framed with a film showing how employees at clinics around the world had worked with the implementation material. The purpose of the film was to increase awareness of how great the engagement was throughout the organisation, but also to build pride in Diaverum and strengthen the sense of team among the management group.

Implementation — Phase 2

One of the fundamental outcomes of the management conference was the decision to place additional internal focus on the patient. Based on that decision, the next phase of the implementation work was developed. The core message of Phase 2 was formulated personally by CEO Dag Andersson. The statement "Our patients are patients but should be treated as customers" became both a motto that further concretised what The Touch means, and reinforced understanding of how the healthcare business is evolving — and that patients will have increasing choices in the future as privatisation grows.

Based on the decision to further increase focus on patients, development work began to make Diaverum even more service-oriented by getting all employees to treat patients as customers. In line with these ideas, Phase 2 of the implementation work was developed, with the cornerstone being the introduction of so-called Touch Meetings at the clinics. The purpose of these meetings was to discuss, in a structured format, how Diaverum could become even more customer-oriented.

– Obviously we could not simply communicate that the local clinics were now to hold four Touch Meetings a year. Through the Diaverum Experience Board, work was initiated that resulted in a support organisation led by our HR department. We established a group of people who were given the title of Touch Navigators, with the task of initiating and developing the local Touch Meetings. Here too we worked according to the train-the-trainer method, says Christina Sterner. The advantage in this phase of the implementation work was that a basic understanding of our strategy and brand work now existed among most employees. In this way, the new meeting structure was placed in a context that everyone understood and had accepted. Furthermore, it has turned out that these meetings — which we hold approximately four times a year at each clinic — are also seen as a team-building activity. Culture-building in themselves, in other words. The idea is also that the regular meetings should contribute to a self-learning organisation, and that wisdom created in one forum should also spread to other clinics around the world. Our task in the Diaverum Experience Board is to ensure that there are processes and systems that facilitate and stimulate this. Of course, senior management and all employees at the head offices in Lund and Munich also hold Touch Meetings, concludes Christina Sterner.

About the Company

Diaverum is one of the world's leading providers of kidney care and the largest independent service provider in Europe. Diaverum's experience in kidney care stretches back 20 years, to when the first dialysis clinic in what is today Diaverum opened. Since then, Diaverum has remained at the forefront of the kidney care market. The business today spans 270 clinics in 19 countries, where 7,400 employees serve a patient base of more than 23,000 people.