Don’t Miss The Train!
Part Three of a Three Part Series
How The Three Rails will Simplify your path as a Market-Driven healthcare professional.
If you’ve been following along, you’ve seen us lay the groundwork for this message in two earlier posts—one exploring what it really means for a hospital or health system to be market-driven, and another unpacking the three rails that guide sustainable strategy.
This post is where those two threads come together for you and your career.
We’ll start with a quick history of how market-driven philosophies emerged in healthcare, then look at where the industry is headed today and why The Three Rails are the framework you can use to navigate this transformation with clarity, credibility, and confidence.
HISTORY LESSON. MYSTERY LESSON.
Institutionally-Driven.
Inward looking; prioritizes tradition, politics, and internal stakeholders.
Tactically-Driven.
Quick fixes; chasing campaigns, fads, or volume without strategic grounding.
We’ve moved through these two eras already—first, the institution-driven model, where hospitals looked inward and relied on tradition and politics, and then the tactical-driven phase, marked by quick fixes and short-term campaigns. But those approaches can’t carry us forward.
Market-Driven
Outward looking; grounded in consumer insight, responsive to patient and community needs, aligned with financial sustainability, community understanding, and public good.
Hospitals and health systems of the future will be Market-Driven. They will be outward-looking, insight-grounded, and aligned with both financial sustainability, strategic evolution, and community good. The Market-Driven philosophy has been on a long and necessary journey to reach today’s inflection point—understanding that journey will help you understand why the shift is happening and to have confidence in adopting the Market-Driven way of thinking.
1. Early Roots (1960s–1980s)
1960s–70s: Hospitals were primarily institutionally-driven—funded and organized around charity, religion, or local government mandates. The philosophy was “build it and they will come.” Patients were seen more as recipients of care than as consumers with choices.
1980s: With the rise of managed care and DRGs (Diagnosis-Related Groups in Medicare, 1983), hospitals began competing more directly for revenue. Marketing departments emerged, but the philosophy was still largely promotional and focused on advertising services rather than responding to consumer needs.
2. The Emergence of Market-Driven Thinking (1990s–2000s)
Competition Intensifies: As health systems consolidated and for-profit players expanded into the market, hospitals realized they had to compete for patients the way retailers or airlines did.
Patient as Consumer: This era brought the first wave of “patient satisfaction” measures (e.g., Press Ganey surveys) and branding campaigns designed to differentiate hospitals.
Influence of Corporate Strategy: Many leaders adopted tools from the corporate world to inform service line strategies, market segmentation, and consumer research, marking the start of a shift toward truly market-driven thinking.
3. The Acceleration (2010s)
Affordable Care Act (2010): Introduced reimbursement penalties tied to readmissions and quality measures, directly linking patient experience and outcomes to financial performance.
Consumerism Boom: Patients gained more out-of-pocket exposure through high-deductible health plans, making them more price-sensitive and selective.
Digital Transformation: The rise of search, online reviews, and social media empowered consumers to shop for care. Hospitals had to respond with transparency, digital front doors, and better experience design.
4. Why It’s Gaining Steam Today (early 2020s)
This decade, several forces have converged to make market-driven philosophies not just optional, but existential:
Financial Strain: Thinning margins, declining reimbursement, and rising labor costs mean hospitals can no longer afford institutionally-driven inefficiencies. They must align offerings with what the market (patients, employers, payers) values.
Consumer Expectations: Today’s healthcare consumer compares their hospital experience to Amazon, Apple, or Marriott. They expect convenience, transparency, and personalization.
Retail & Tech Entrants: Non-traditional competitors like CVS, Walmart Health, Amazon, and One Medical are reshaping consumer expectations and siphoning off profitable service lines.
Public Health & Community Impact: COVID-19 highlighted that health systems aren’t just clinical institutions; they are anchors of economic and community well-being. A market-driven hospital recognizes its role in both financial sustainability and broader community outcomes.
Growing Workforce Shortages: Health systems are under unsustainable pressure to address growing talent gaps as staff and provider burnout is at a record high and competition for trained professionals continues to outpace supply. Market-driven systems are laser-focused on new ways to attract, engage, and retain the people who make care delivery possible in their institutions.
Leadership Buy-In: Perhaps most importantly, boards and senior leadership teams are beginning to embrace this philosophy. CEOs are increasingly hiring marketing executives who understand how to lead a market-driven transformation, while CFOs and operations leaders are acknowledging the need to make space for, and invest in, consumer-focused strategies. What once felt like “soft” marketing work is now being recognized as a core driver of organizational survival and growth.
5. The Philosophical Shift Sets-in (2024 / 2025)
2024–2025: Visible Proof Points: The past two years have given boards and executives a front-row seat to what happens when hospitals fail to evolve, and what’s possible when they do. Leaders are watching peers in other markets invest in consumer-centered strategy and seeing tangible returns: stronger payer negotiations, higher-value service line growth, and measurable community trust.
This has accelerated belief at the top: boards are leaning into the market-driven philosophy, CEOs are recruiting marketing executives who can lead this transformation, and CFOs and COOs are carving out resources to make it real. What was once theory is now visible practice, and the industry is taking notice.
THINGS ARE GETTING REAL
This is not a fad, rather this is the legitimate evolution in business, strategic, and economic thinking that hospitals leaders across America are committing to. And it is reshaping the marketing leader’s role and sphere of influence inside health systems, as they move beyond the brand and demand architects to be orchestrators who link critical systems and functions for better access and care experiences.
The Three Rails were born in one very real context
While working with a hospital in the Southeast, where its CEO asked for help rebuilding their marketing function to be truly market-driven. As a way to teach and operationalize this shift, LIFT coined the “The Three Rails”, a framework born out of necessity, not theory, and a framework that we now use in almost every marketing or research conversation we have. It is the best way to guide leaders and teams through a disciplined, consumer-centric transformation.
And for you, as a marketing professional, this is your opportunity to rise. By championing the three rails of healthcare marketing, you can elevate your business acumen, strengthen your stature inside the organization, and step into the role your hospital desperately needs right now: not just promoter, but strategist, educator, and community builder.
Here’s where the three rails come in. They’re the operating system for being Market-Driven.
Rail One: The Financial Imperative
This is the rail you know best—because this is where the math lives.
Rail Two: The Strategic Imperative
Rail Two elevates you from campaign executor to organizational strategist.
Rail Three: The Economic Imperative
Rail Three provides you the tool to shape a healthier, more empowered community.
In order to maximize your career and your work as a Market-Driven professional, these three rails are your best friend. Success comes when your marketing team considers all three imperatives not in isolation, but in harmony.
Your role is to keep your hospital balanced on all three rails at once. Being Market-Driven shows leadership that marketing is not a cost center, but a driver of financial health, strategic advantage, and community relevance.
TWO PHILOSOPHIES CONVERGE
Market-Driven is about orientation: you look outward, not inward. Market-driven ensures you’re listening to the right signals.
The Three Rails are about structure: holding every effort accountable across financial, strategic, and economic outcomes. The three rails ensure you’re measuring the right results.
Together, they create a cohesive framework for you as a marketer.
OPPORTUNITY CALLING
When you bring these two together, you stop being seen as “the department of promotion” and start being seen as “the driver of organizational truth.” You become a force multiplier and a respected member of the larger leadership organization.
Ground strategy in real market insight.
Push conversations beyond institutional politics to drive strategic alignment.
Create enterprise-wide transparency that demonstrates marketing’s leadership in driving overall performance.
Advocate for a balanced view of success—financial, strategic, and community.
This isn’t about producing more ads. It’s about leading your hospital into the only future that makes sense: one where being Market-Driven is inseparable from running on the three rails that support the philosophy perfectly.
WHAT TODAY?
The model is here. The rails are set. The philosophy is mature. And this is your moment.
This philosophy of being market-driven, and the framework of running on The Three Rails—is not a fad. It is the natural progression of Engel’s biopsychosocial truth and the Balints’ relational insights. It’s here, and it’s not going away.
The pandemic may have accelerated awareness, but it did not create the foundation. That bedrock has been waiting for decades. What’s different now is the reality of adoption.
As a marketer, this is your continuing education. This is your chance to elevate your business acumen, your influence, and your impact. Hospitals can no longer just sell services. No, hospitals and health systems must connect, engage, educate, and empower. And you are the professional who can make that happen.
The market has been waiting. The time is now.
The future belongs to those who step forward to become fully Market-Driven and who navigate the change firmly on the three rails. This evolution is deeply grounded in a tradition that has always pointed us here. Let’s keep moving forward, together.
David McDonald, Co-founder & CEO
As CEO of LIFT and a trained anthropologist, David brings a deep passion for human understanding to every facet of leadership. Blending empathy with innovation and data, he drives empathic, people-centered solutions that elevate the healthcare marketing profession and successful client outcomes.
Camille Strickland, SVP Health at BVK
At BVK, Camille uses her background in strategy for health organizations and firms to help internal and client teams shift from ‘business as usual’ to more innovative, technology-driven, and human-centered ways of delivering health services and products.
This post concludes our three-part professional development series on becoming a Market-Driven healthcare leader. If you’re ready to deepen the journey, we invite you to connect with us at LIFT—whether for conversation, collaboration, or to bring this framework to life inside your organization.