Most agencies own the click and nobody owns the front desk. How we structure clinic work in three horizons, the research behind each one, and one year of results.
Healthcare marketing agencies stall because they own the ad and the click report while the result depends on what happens after the click: who answers the phone, how the administrator talks about price, and whether anyone calls back an unanswered enquiry. Pushers structures clinic work in three horizons. Short wins in the first month test offers and audit the booking funnel on a small budget, so the clinic sees a checked result early. Mid wins over 3 to 6 months bring the clinic's own team into strategy sessions, fix shared targets such as cost per acquired patient, and connect marketing to the front desk and revenue. Long wins build a roadmap of two years or more with budgets, a sales function and a product line. The design draws on Kotter's short-term wins, McKinsey's three horizons of growth and the cross-functional experiments described in Hacking Growth.
When we set up Pushers as a separate marketing agency in 2022, I had already spent years on the client side of the table. I had hired contractors who arrived with the same pitch: we’ll run your marketing, your social media, your performance traffic. They charged a lot and guaranteed nothing. Many of them met their obligations. They set up the campaigns, produced the creatives, presented the strategies. None of them moved the numbers.
The weak point was the operating model. In a clinic, the outcome of an ad depends on what happens after the click: who picks up the phone, how the administrator answers a question about price, whether anyone calls back the patient who asked about braces three weeks ago. Agencies rarely own that part, and agency contracts rarely ask them to.
So we rebuilt how we work with clinics around that gap. This is the model, the research behind each stage, and what it produced over one year with a multi-specialty clinic.
Agencies tend to work at one of two ends. At one end sits short-term tactical work: launch campaigns, report clicks and leads. At the other sits the long-term strategy deck that describes where the clinic should be in three years. Operating efficiency lives between the two. It comes from tactical work done every week, at a high tempo, together with the clinic’s own staff, against numbers both sides agreed on in advance. That middle layer is where Pushers specialises.
The middle layer matters in healthcare because clinics sell very differently from one another. A large multi-specialty clinic usually has, at best, a call centre or front-desk administrators processing enquiries. There is no sales department in the commercial sense. Specialised clinics and larger groups more often have proper sales management: a process for presenting treatment, signing contracts with patients and following them through every stage. And plenty of high-status clinics still leave patient management to the doctors, who book their own appointments.
A campaign that ignores this structure fails at the front desk, and the data shows how often. BSM Consulting and Allergan have run a telephone mystery-shopping programme for US aesthetic and dermatology practices since 2009, covering more than 1,500 practices and more than 11,000 completed surveys. More than 32% of the shoppers said they would not have booked with the practice they called, and another 23% were undecided. Only about a quarter of staff asked for the caller’s name, and statements about the clinician’s credentials came up in fewer than 28% of calls (Practical Dermatology, 2025).
Response speed is the other leak. In an audit of 2,241 US companies published in Harvard Business Review, 37% responded to a web enquiry within an hour, and 23% never responded at all. A related study of 1.25 million leads found that firms contacting a lead within an hour were nearly seven times as likely to qualify it as firms that tried even an hour later, and more than 60 times as likely as those that waited 24 hours or longer (Oldroyd, McElheran and Elkington, HBR, 2011). For a clinic, that is the Instagram direct message that sits unanswered overnight.
None of this shows up in an agency’s click report. All of it shows up in the clinic’s revenue.
We structure every engagement as a roadmap toward long-term goals, built from a series of short wins. Two management frameworks shaped the design.
The first is John Kotter’s eight-step model for leading change. One of its steps is generating short-term wins, because people keep committing to a change only when they see results from it (Kotter Inc.). In Leading Change, Kotter describes a good short-term win as visible, unambiguous and clearly related to the change effort. A clinic owner who has been burned by two agencies needs exactly that kind of evidence before trusting a third.
The second is McKinsey’s three horizons of growth, which argues that a company has to manage its core business, emerging opportunities and future options at the same time, rather than one after another (McKinsey, Enduring Ideas). We apply the same logic to a clinic’s marketing and sales, on a shorter clock.
| Stage | Horizon | Who takes part | Main output | Judged by |
|---|---|---|---|---|
| Short wins | Month 1 | Pushers team, clinic owner | Tested offers, funnel audit, preliminary strategy | Cost per lead on tested offers, list of funnel gaps |
| Mid wins | 3 to 6 months | Operations lead or chief physician, head of sales or front desk, in-house marketing | Quarterly tactical strategy, agreed target metrics, organic channels | Cost per lead, cost per acquired patient, sales-qualified leads |
| Long wins | 2+ years | Clinic C-level | Roadmap with budgets, tools and product line | Market share, brand awareness, payback |
Every new client starts with a short express analysis. We study the clinic’s current services, who its patients are and where they come from, and collect whatever primary and secondary data exists on patients and acquisition sources.
In parallel we look at the market: local search queries, Google Maps data, competitors’ ads in the Meta Ad Library, and tools such as Semrush to see who ranks for what. We also run a 360-degree audit of how the clinic presents itself across every channel.
Then come the fast levers:
The volume of creatives is deliberate. Nielsen’s 2017 analysis of nearly 500 consumer-goods campaigns found that creative is still the largest driver of the sales an ad produces, even as the share driven by media has grown from 15% to 36% over 11 years (Nielsen, 2017). Testing many messages cheaply tells you more in four weeks than months of refining audience settings.
The goal of month one is a preliminary strategy that the next two stages can build on, plus results the clinic can see and check. That is Kotter’s test applied to marketing: a tested offer with a known cost per lead is visible and unambiguous, and a promise of “brand growth” in month one is neither.
At this stage we run strategy sessions with the clinic’s team, and attendance is required. We need the clinic’s operations director or its head (often the chief physician), the person responsible for sales or patient enquiries, and whatever marketing team the clinic already has. In these sessions we explain why we tested the hypotheses we did and walk the team through the method we use in our Growth Lab, so that attracting new patients and bringing back past ones becomes work the clinic’s staff and our team run together.
This is also where we fix the targets. Together with the clinic we agree on the financial and numerical indicators that define our work: cost per lead, cost per acquired patient, or the number of sales-qualified leads. Those numbers are how the clinic and we decide whether we did a good job.
The toolkit widens here as well. Paid performance keeps running, and we add organic growth: visibility on social media with its own channel strategy, presence on maps, listings on medical aggregators and other platforms.
Most importantly, this is the stage where we step into the clinic’s revenue. We show how marketing results should feed into the clinic’s financial results, and we start working across the whole loop of marketing, sales and operations, including how the patient is handled after the first contact.
The approach follows the logic of Hacking Growth by Sean Ellis and Morgan Brown: growth comes from cross-functional teams running continuous, high-tempo experiments against one shared metric (Ellis and Brown, 2017). In a clinic, the cross-functional team is the marketer, the administrator and the doctor. The daily work of that team produces the operating efficiency; the long-term plan alone does not.
The quarterly tactical strategy agreed at the mid-wins stage turns into a long-term view of how the clinic should operate. From this point, the clinic’s C-level executives take part in developing or implementing the strategy.
We build a roadmap for the clinic’s development with a horizon of at least two years and define the resources it needs: budgets and the tools that have to be created. By then the clinic should have a sales function in place, a diversified product line with its own product marketing, and clear mechanisms for scaling ad traffic.
Long wins show up as market share, brand awareness and target metrics reached over the medium and long term. For younger clinics and healthcare startups, the long-wins stage is also how the business gets to payback.
Research on advertising effectiveness supports running both clocks at once. Les Binet and Peter Field’s analysis of the IPA effectiveness databank, The Long and the Short of It, is the usual source of the guideline that, on average, about 60% of spend on long-term brand building and 40% on short-term activation works best. In our model, short wins fund and justify the long-term work.
We have worked with this clinic for one year inside the framework above: fast launches first, then a medium-term strategy covering 3 to 6 months, with operational work done by both sides.
The results:
Performance traffic brought in new patients. The bigger change came from positioning. By packaging services around what patients in this segment and region were asking for and not getting, we repositioned the clinic from “multi-specialty, for everyone” to a clinic focused on women’s health and age-related changes for women over 40.
The segment choice has a logic beyond one market: women in the United States make approximately 80% of the health care decisions for their families (Matoff-Stepp et al., 2014).
Next, we plan to diversify the clinic’s service portfolio, move into scaling, and work on the long-term strategy.
Cost per acquired patient is marketing spend divided by the number of people who became patients (booked, attended and paid), counted from the clinic’s own scheduling and billing records rather than from the ad platform.
These follow directly from the model above. An agency that cannot answer them will deliver campaigns without a link to your revenue.
Because most agencies are paid for campaigns and reports while the revenue depends on intake: call handling, response speed and follow-up. If nobody in the engagement owns that part, more leads can arrive while bookings stay flat.
A short audit of services, patients and acquisition sources, a market scan, mystery shopping of the booking path, and a small test of offers and creatives. The output is a list of funnel gaps and a known cost per lead on tested offers.
Agree on one before the work starts: cost per lead, cost per acquired patient, or the number of sales-qualified leads. Cost per acquired patient is the closest to revenue, because it counts people who became patients.
The operations director or chief physician, the person responsible for patient enquiries or sales, and any in-house marketing staff. Without them the agency can run ads but cannot change what happens after the click.
Most paid channel tests do not end with a decision. They end when the budget runs out, the attribution model changes, or everyone quietly stops looking at the dashboard.
The two models solve different problems: how to tell which one your company needs, and what each costs in time and control.
Six named AI workflows, from KYC intake to monthly close support, each with the metric it moves, the data it touches and the human checkpoint that stays in place.
