Join us in Boston for the best tactical B2B marketing conference on the planet. Get your ticket by August 31 to save $$$

“You are cordially invited to attend our annual reunion to be held in the Royal York Hotel in downtown Toronto. The gala event will include dinner, entertainment, camaraderie, and an examination of your hernia repair.”

-- From an invitation to Shouldice Hospital's annual hernia patient reunion

Each year, a tight-knit group of patients from Shouldice Hospital in Thornhill, Ontario, Canada, get together

They have dinner, entertainment, dancing. Maybe do some hula. It's a fun night. All of the party-goers have two things in common: all have had hernia surgeries, and all are patients of Shouldice.

Shouldice is not your ordinary hospital. It encourages patients to meet one another and build relationships. Its approach to hospitalization: it should be an experience—a happy and memorable one, not a frightening and forgettable one.

It all began in 1947 when several patients of Dr. Edward Earle Shouldice suggested he host a get-together for himself and his patients. They said it would renew friendships and help them stay in touch with the hospital.

Shouldice loved the idea; he saw it as the perfect opportunity to launch his idea for annual checkups and building research data.

The first party in 1948 drew 100 patients. Since then the hospital has sponsored annual reunions, with attendance topping 1,500 in the late 1980s. The reunion has since been pared back to just under 1,000. A committee of former patients helps the hospital plan the parties.

Shouldice Hospital looks more like a posh country club than a medical facility. It has 20 acres of landscaped grounds, a solarium and a putting green. From the outside, there's no indication that 7,500 hernia operations are performed each year. (That's more than 30 procedures every day.)

The hospital reports a 99 percent success rate with hernia repairs since 1945. They know because they have painstakingly followed up with every patient—270,000 in all. The hospital contacts 130,000 patients every year by:

  • Inviting them to the hospital for checkups.
  • Hosting the annual reunion of Shouldice alumni, examination included.
  • Setting up traveling clinics in small towns around Ontario for those that can't travel to the hospital.
  • Mailing or emailing every single patient a follow-up survey.

As Dr. Shouldice envisioned it, the hospital has created a continuous research project that enables it to understand its success rate. It also provides an opportunity to market the success rate.

But hospital officials say it's more than surgical success that lands new patients. Daryl Urquhart, the hospital's marketing director, says Shouldice focuses on creating patient communities. Getting to know other people leads to memorable experiences, he says. Its community creation strategy:

  • Hospital stays are 3-4 days. Instead of hectic in-and-out outpatient surgery, patients are encouraged to meet other patients. What results is a type of “empathetic therapy:” an instant support group that compares notes, discusses concerns and alleviates anxieties about common conditions.
  • Each room has two beds so that each patient has a “buddy” during his stay.
  • Phones and television sets are located only in communal areas; none are in patient rooms. This small detail helps keep patients out of their beds, walking around and meeting others.
  • Patients eat in a common dining room with tables of six.
  • The hospital has billiards, shuffleboard, a common area to play cards, solarium and putting green.

During its 55-year history, Shouldice has often been the talk of Canada's medical establishment. In 2001, a study by Concordia University in Montreal found that of new patients:

  • 49% were referrals from former patients
  • 34% were referrals by healthcare professionals (physicians, chiropractors, dentists, etc.)
  • 13% were referrals from acquaintances who had heard of Shouldice
  • 3% were from news articles
  • 1% were from Internet searches

Almost half of all patients heard about Shouldice from former patients. Urquhart calls these patients “the apostles.”

“It's our job to make sure every patient who walks out the door is an apostle, and not a terrorist,” he says. A terrorist is “an unhappy customer who makes it his business to destroy your business.”

What's the reason for the hospital's high rate of patient evangelism?

“We focus on not just the surgery, but the entire experience,” Urquhart says. Much of the experience is due to the community building among patients and the lifetime follow-up.

Why Community?

Organizations that create customer communities tend to create communities of evangelists. For companies, customer communities:

  • Build loyalty
  • Provide valuable feedback
  • Contribute to increased sales
  • Reduce costs

A 2001 McKinsey-Jupiter Media Metrix study showed that customers of web community features generate two-thirds of sales despite accounting for only one-third of a site's visitors.

Customers who contribute product reviews or post messages visit community web sites nine times more often than sites without communities, remain twice as loyal, and buy almost twice as often. Even customers who read but don't contribute to community interaction are more frequent visitors and buyers.

People join communities to share and celebrate their similarities: To meet others like themselves; to be part of something bigger than themselves.

Communities create evangelists and build word of mouth because members share information, help one another solve problems and meet others who can help them with their lives.

For some companies like Cisco and Dell, online communities on their respective web sites lower support costs as customers help one another solve hardware and software problems.

Companies such as Harley-Davidson and Saturn demonstrate the power of loyalty via online and offline communities: 600,000 members of the Harley Owners Groups (or HOGS) meet in 1,200 clubs located in 100 countries around the world to ride their bikes, exchange information and welcome new members to the “club.” Harley actively supports the groups with information and ideas and relies on them as a direct source of feedback.

Saturn welcomes thousands of customers each summer to Tennessee for a picnic, tours of its manufacturing plant and a challenge to find their car among the thousands of Saturns at the end of the day. For many, the annual picnic is a pilgrimage. Saturn enjoys high levels of long-term loyalty.

How can your company create a vibrant customer community that increases loyalty?

  1. Host customer events. Follow the Saturn model for hosting an annual customer picnic, or local/regional customer appreciation events, where guests are served breakfast and hear from a well-known speaker. Apple Computer hosts an annual Mecca for its tens of thousands of feverish evangelists: Macworld.
  2. Create owners groups. If you manufacture products, create and support owners groups, like Harley-Davidson does with the Harley Owners Groups (HOGs).
  3. Create an online customer support group. Think of the groups created by Dell Computer, Microsoft, eBay or Cisco. Customers in these groups support one another with troubleshooting problems and issues.
  4. Create an email discussion group. They're easy and free using Yahoo! Groups and Both services allow you to moderate discussions. If you're strapped for resources, ask several of your customer evangelists to act as volunteer moderators.
  5. Ensure that your email newsletters feature your customer community. The Friends of Krispy Kreme email newsletter is consistently warm and friendly in its approach and doesn't overload customers with promotions and pitches.
  6. Support fan web sites. If you are lucky enough to have one, email the webmaster and ask her how you can support her work. Keep your lawyers locked in a cage.

Your customer community is like a family: Embrace the good with the bad and ugly. A Big Brother mentality about controlling what customers say in your communities only results in mistrust. Embrace criticism. Apologize. Let people vent. Tell them you promise to improve.

If you have an irrational customer in your community, use the Socratic approach to deal with him or her: Ask the group if it's their experience as well. A vigilante will be neutralized if you have strong supporters.

Underneath the umbrella of your organization's goodwill, customers in communities make themselves known as your evangelists.

Sign up for free to read the full article. Enter your email address to keep reading ...


Ben McConnell and Jackie Huba are the authors of Creating Customer Evangelists: How Loyal Customers Become a Volunteer Sales Force.