Building smart brands through online and artificial intelligence tools: A quantitative analysis about the best hospitals in Spain

ABSTRACT


FROM HOSPITAL COMMUNICATION TO SMART BRANDING Hospital's Brand
Hospitals promote their brands in an integrated way and provide stakeholders with meaningful content that is consistent with the organization's roots (Lithopoulos et al., 2021;Rindell & Santos, 2021).However, to efficiently implement a holistic authentic brand, the first step consists of defining the hospital's brand architecture: identity, values, culture, mission and vision (Medina et al., 2020).Identity refers to the hospital's purposes and beliefs and involves the use of symbols and behaviors (Singla & Sharma, 2021).Corporate values describe in a more tangible way how the company develops its internal and external projects (Sander et al., 2021).These values are directly related to the hospital's culture, which refers to how employees behave to become a unique organization (Li & Zhao, 2021).Finally, the mission defines the organization's objectives in the midterm, meanwhile the vision refers to the long-term goals (Hart & Phau, 2022).Once hospitals have clearly depicted their brand architecture, they ensure that it is consistent with ethical principles and legal frameworks (Basha et al., 2022).Finally, they design and execute corporate communication initiatives to promote their brand architecture and influence their stakeholders' perceptions: employees, patients, media companies (Reitsamer et al., 2021).
When promoting their brand architecture, some hospitals resort to their employees and implement personal branding campaigns (Rahman et al., 2021).Even if these campaigns are determined by several elements-employees' self-development, relationships with peers, ethics (Basha et al., 2022)-, they clearly contribute to improve doctors' and nurses' reputation, as well as the hospital's brand.Thanks to these campaigns, doctors enhance their scientific credibility, social reputation and public image (Zhang et al., 2021), which helps them to improve their relationships with patients (Ren et al., 2021), as well as media companies and public health authorities (Etheredge & Fabian, 2022).Concerning nurses, they also benefit from these campaigns.Thanks to these campaigns, nurses promote the sense of unity among them (Godsey et al., 2020), understand patients' new needs in terms of information and emotional support (Zhang et al., 2021), and reinforce patients' loyalty towards the hospital (Wu et al., 2019).Finally, personal branding campaigns also bring benefits to hospitals since these organizations improve their relationships with patients and reinforce their scientific credibility (Tan et al., 2020).
Besides personal branding campaigns, hospitals resort to other corporate communication initiatives to promote their brands (Khosravizadeh et al., 2021).First, they conduct research about stakeholders, competitors, trends and legal issues affecting the hospital's brand to take better decisions concerning strategy and creativity (Odoom et al., 2019).Second, they implement corporate communication actions based on traditional media -events, media relations-as well as new platforms-websites, social media- (Govers, 2020).And third, they develop corporate social responsibility plans addressed to different targets, such as employees, public authorities, or patients' associations (Lithopoulos et al., 2021;Zhao et al., 2021).Thanks to these initiatives, hospitals positively influence their stakeholders' perceptions and promote their brand (Xifra, 2020;Wang et al., 2020).

Branding Hospitals Through Smart Technologies
Multidimensional health care, including the use of websites and patient portals, has been shown to be very successful; that is why many hospitals resort to these platforms for medical reasons, but also for branding purposes (Farsi, 2021).Thanks to corporate websites, hospitals enhance their relationships with patients, implement health education campaigns and reinforce their social legitimacy (Barredo et al., 2021).In other words, corporate websites help hospitals to revitalize their brands and become more dynamic organizations (Shieh et al., 2020).On the other hand, patient portals have become a common tool for patients who want to strengthen their empowerment and interact with doctors in a more efficient way (Parsons et al., 2020).Thanks to these portals, hospitals provide patients with meaningful content about diseases, treatments and internal procedures (Tong et al., 2021).Both websites and patient portals contribute to reinforce hospitals' scientific credibility (Jenkins et al., 2020;McKeown et al., 2021).
Besides corporate websites and patient portals, many hospitals manage social media platforms to promote their brands and build better relationships with stakeholders (Shieh et al., 2020).When using social media, hospital follow a corporate communication approach focused on satisfying their stakeholders' information and emotional needs (Medina et al., 2021).Thanks to social media platforms, hospitals reinforce their emotional, social and professional relationships with stakeholders (Wu et al., 2019), which helps the last ones to become an active part of the hospital's collective branding processes (Yantian et al., 2022).On the other hand, many hospitals integrate their social media platforms with mobile applications (Confente & Kucharska, 2021).Thanks to these applications, hospitals launch learning initiatives addressed to doctors and nurses (Chamberlain et al., 2021), reinforce patients' skills in health literacy (Crossley et al., 2020) and implement health education campaigns (Mackert et al., 2020).
Promoting the hospital's brand cannot be considered an intangible asset, but something that gives rise to practical behaviors and changes within the organization (Odoom et al., 2019).One of these practical changes refers to the integration of artificial intelligence into medical protocols.This technology allows hospitals to become more innovative organizations (Lv & Qiao, 2020) and improve their patients' medical outcomes (Shilo et al., 2020).However, this technology is also useful for branding purposes.On the one hand, thanks to artificial intelligence, hospitals analyze large amounts of data in a cost-effective manner and understand their stakeholders' perceptions in a clearer way (Tsai et al., 2021).And on the other hand, artificial intelligencebased tools allow hospitals to implement more visual, creative campaigns that reinforce the organization's brand (Butow & Hoque, 2020).In other words, thanks to artificial intelligence, hospitals can lead a medical and communication revolution, and become more dynamic brands (Bian & Haque, 2020).

Impact of Smart Branding on Hospital's Stakeholders
Smart technologies help hospitals to lead a branding revolution that focuses on integrating technology into different organizational processes and establishing new relationships with stakeholders (Medina et al., 2021).Thanks to this branding revolution, doctors and nurses change their mentalities and start working differently (Farsi, 2021).Both use social media platforms and mobile apps to optimize their time and provide patients with a better content (Parker et al., 2021).Besides, they grow from a professional perspective since they assume new responsibilities: training patients in online health education, monitoring patients through mobile apps, publishing medical content on social media (Marca-Frances et al., 2020).In other words, doctors and nurses become experts in satisfying their patients' needs from a medical, emotional and social perspective (Reza et al., 2022), which helps them to reinforce their professional credibility and their social legitimacy (Mackert et al., 2020).
Besides doctors and nurses, the branding revolution positively influences on patients.Thanks to nurses' and doctors' new mentalities and behaviors, patients can actively participate in collective making-decision processes concerning their health (Mackert et al., 2020).Patients become active players in the healthcare system, they reinforce their empowerment (Valizadeh & Ghasemi, 2020) and they contribute to make hospitals more human organizations (Nichols et al., 2021).Besides, they build a more efficient organization by requiring new services such as electronic medical records (Tseng et al., 2020), new legal frameworks that protect their rights (Komorowski et al., 2020) as well as new organizational processes that prioritize their medical and emotional needs (Schmit et al., 2020).In other words, thanks to the smart branding revolution, patients become opinion leaders who determine the hospital's reputation (Bol et al., 2020).
Finally, media companies also benefit from this smart branding revolution since hospitals produce and share with them a more professional content about treatments, diseases and health education (Mheidly & Fares, 2020).When developing this content, some hospitals resort to different disciplines, such as sociology, anthropology or philosophy (Kreps, 2020).This way, they produce a high-quality content that subsequently media companies can use for different purposes, such as health education campaigns (Rudd, 2022).On the other hand, thanks to social media and mobile apps, hospital's employees can interact with media companies in an easier way and become opinion leaders (Medina et al., 2021).Finally, hospitals can also use both applications to train journalists in healthcare and this way fight misinformation, which reinforces hospitals' and media companies' scientific credibility (Mheidly & Fares, 2020).

METHODOLOGY
The smart branding revolution have led hospitals to integrate social media, mobile apps, artificial intelligence and other technological platforms into their corporate communication initiatives.In order to analyze how these organizations use these platforms to make their brands more dynamic, we conducted a quantitative analysis based on the world's best hospitals 2023, a ranking elaborated by Newsweek and Statista.
Both organizations analyze every year 2,300 hospitals from 28 countries considering four indicators: (1) 80.000 online surveys to medical experts from 28 countries, (2) patients' opinions about hospitals, (3) hospitals' quality metrics, and (4) PROM questionnaires concerning patients' quality of life.
To calculate each hospital's score and position in the ranking, the following weights are considered: online surveys to medical experts (54.00%), patients' opinions (14.50%), hospitals' quality metrics (29.00%) and PROM questionnaires (2.50%).Finally, results are confirmed by a global board of medical experts from France, Germany, Israel, Switzerland, and the United States (Newsweek, 2023).Thanks to this ranking, we identified the 100 best hospitals in Spain (Appendix A).We evaluated how each organization managed smart technologies to establish a more dynamic relationship with their stakeholders: (1) patients and society, (2) media companies, (3) public authorities, suppliers, and shareholders, and (4) employees.
Several reasons led us to consider these stakeholders: patients are true opinion leaders who influence on the hospital's brand (Driever et al., 2020); media companies can determine hospital's scientific credibility (Etheredge & Fabian, 2022); public authorities play a key role in hospitals' medical and education projects (Parker et al., 2021); and employees represent the hospital's brand and are an essential part of these organizations' reputation processes (Medina et al., 2020).We conducted a quantitative analysis from 20 th July to 16 th August 2023 to understand how the 100 best hospitals in Spain managed smart technologies to improve their relationships with stakeholders and build a more reputed brand.To do that, we defined 34 brand indicators that we grouped in four main categories according to platforms and stakeholders: (1) homepage (patients, society), (2) online newsroom (media companies), (3) about us (public authorities, suppliers, and shareholders), and (4) Department of artificial intelligence (employees) (Table 1).
We only considered official websites.We resorted to the binary system to analyze each indicator.Finally, to ensure that results were valid, we implemented the following methodology: the first author analyzed the first 50 hospitals, the second author focused on the last 50 hospitals, and the third author reviewed results concerning the 100 hospitals.

RESULTS
Most Spanish hospitals resort to different smart branding initiatives to improve their relationships with stakeholders and build a reputed brand.However, some of them can still improve in this area: use of platforms, quality content, integration of channels, etc.In order to justify this sentence, we present our results grouped in four main categories: (1) homepage, (2) newsroom, (3) about us section, and (4) artificial intelligence department.

Newsroom
Our data proved that 85.54% of hospitals managed online newsrooms.However, most of them only fulfilled one indicator: digital press archives (92.96%).The other ones were barely respected: B-roll videos (50.70), interactive corporate reports (50.70),online translation services (8.45%), news alerts (7.04%), interactive infographics (4.23%), podcasts (0.00%), online interviews with doctors (0.00%), online press conferences (0.00%), and mobile app or platform for journalists (0.00%).On the other hand, 83.00% of hospitals respected between two and four criteria out of 11 applicable, and the best one in this category was Clinica Universidad de Navarra (Table 2).

About Us
Most Spanish hospitals showcased an about us section: 90.36%.However, most of them did not comply with many indicators: interactive corporate documents (62.66%), videos (29.33%), suppliers platform (9.33%), interactive infographics (6.67%), and shareholders platform (0.00%).In fact, on average hospitals fulfilled 2.08 indicators out of six applicable.The only hospitals respecting four criteria were: Hospital Universitari Vall d'Hebron, Clinica Universidad de Navarra, Hospital Universitario la Zarzuela, and Hospital Vithas Valencia 9 de Octubre.

Artificial Intelligence Department
According to our quantitative analysis, Hospital de la Santa Creu i Sant Pau was the only one having an artificial intelligence department: functional unit of digital health (unidad funcional de salud digital).This department tried to integrate artificial intelligence into different medical protocols, trained its employees in this area, carried out research projects, and collaborated with external technological companies such as Capgemini, Cisco, Exheus, Intel, Microsoft, or Vodafone.However, they had not implemented any project with universities or research centers.On the other hand, 45 hospitals did not have an artificial intelligence department, but they developed research projects about this area in collaboration with external organizations (Table 3).Besides, 29 hospitals had not implemented this department, but they developed research projects in-house about artificial intelligence, without collaborating with any external company.Finally, 25 hospitals did not mention anything about artificial intelligence in their corporate communication platforms.

DISCUSSION
Patients are true opinion leaders who can determine other stakeholders' perceptions about the hospital and its services (Caron et al., 2020).That is why, when these organizations develop online tools (websites, social media, etc.), they must include patients at an early stage and consider their information needs (Zegers et al., 2021).This way they can help patients improve their skills in health literacy (Luo et al., 2020) and establish better relationships with them (Rahman et al., 2021).However, our results demonstrated that 43.37% of hospitals only respected four-six criteria out of 11 applicable to the homepage.In fact, only 12.05% of hospitals proposed video consultations with doctors, and none of them had a symptom checker.These results prove that Spanish hospitals must do an effort to develop more useful homepages and this way establish better relationships with patients.Analyzing patients' needs in terms of information and emotional support, integrating different platforms, and developing a useful content is essential to make hospitals' homepages more relevant.Some hospitals integrate different technological tools into their organizational processes to enhance patients' medical outcomes (Shi et al., 2020), but also to improve their relationships with other stakeholders, such as media companies (Minou et al., 2020).On the other hand, hospitals should train their employees in corporate communication skills so that they can efficiently represent the brand when they interact with media companies (Medina et al., 2021).But after analyzing Spanish hospitals' online newsrooms, we proved that most of them did not consider media companies as a main target: that is why no hospital proposed podcasts, mobile apps for journalists, online interviews with doctors or online press conferences.These facts show that Spanish hospitals need to revisit their media relations strategies and become more flexible organizations able to provide journalists with meaningful content, in several formats and a regular basis.
Public health authorities play a key role in health education (Tseng et al., 2020).These organizations collaborate with hospitals to develop a credible content (Caron et al., 2020) that is consistent with patients' new requirements in terms of formats and languages (Berg et al., 2021).However, based on our results concerning the About us section, we can state that most Spanish hospitals remained conservative when interacting with public authorities, that is why they focus on corporate documents (62.66%), and not on interactive infographics (6.67%) or corporate videos (29.33%).Spanish hospitals need to become more dynamic organizations and provide public authorities, as well as shareholders and suppliers, with meaningful content that represents the organization's brand architecture.
Hospitals' employees need to be trained in artificial intelligence: protocols, advantages, risks, ethical principles (Rickert, 2020).They represent the hospital, but also the medical profession, that is why they need to become experts in artificial intelligence (Abuhammad et al., 2020).Thanks to this expertise, hospital's employees reinforce their personal brand and improve their relationships with patients (Reza et al., 2022).Even if these concepts are valid from a theoretical perspective, our analysis about Spanish hospitals' artificial intelligence department demonstrated that most of these organizations are not following this logic.In fact, only one hospital out of 100 had implemented an artificial intelligence department: Hospital de la Santa Creu i Sant Pau.Nevertheless, 46 hospitals that had not set up this department were very active in this area and developed different projects in collaboration with external companies such as GE Healthcare, Microsoft or Philips.These collaborations represent an interesting opportunity for hospitals to reinforce their expertise in artificial intelligence, but also to develop co-branding initiatives that reinforce their reputation.This paper aimed to analyze how the Spain's best hospitals managed online and artificial intelligence tools to enhance their relationships with stakeholders and reinforce their brand reputation.Our research showed that, even if most of them had implemented different initiatives (websites, social media platforms, mobile apps, etc.), they still need to improve in this area: quality of content, integration of platforms, analysis of stakeholder's information needs, etc.Despite these interesting facts, we must highlight some limitations affecting this paper.First, we could not contact each hospital's communication department, which avoid us to better know their budgets, annual communication plans, and artificial intelligence projects.Second, we could not find any other paper analyzing similar facts in Spain, that is why we could not compare our results and hone our conclusions.And third, we did not consider the Spanish legal framework affecting hospitals, which highly determines how these organizations communicate with their stakeholders.Lastly, researchers interested in this area could focus their papers on how to integrate artificial intelligence into the hospital's branding initiatives, how to use mobile apps to make organizational processes more dynamic, and how to train doctors and nurses in branding skills.

CONCLUSIONS
Hospitals manage different corporate communication initiatives (media relations, events, etc.) to promote their brands and improve their relationships with stakeholders.However, stakeholders' new needs in terms of information and emotional support have led many hospitals to revisit their corporate communication strategies.In this framework, some hospitals have implemented smart branding initiatives based on online and artificial intelligence tools to make their communication initiatives more dynamic.This paper aimed to analyze how the Spain's best hospitals managed smart branding initiatives to enhance their relationships with stakeholders and reinforce their brand reputation.After analyzing this area from a qualitative and quantitative perspective, we can highlight three last ideas.First, most Spanish hospitals focused their smart branding initiatives on patients (4.98 indicators out of 11) rather than media companies (3.14/11) or public authorities (3.14/6); however, they did not provide patients with enough applications and platforms.This fact proved that Spanish hospitals need to implement integrated communication strategies that consider all stakeholders' information and emotional needs, and that contribute to integrate those stakeholders into the hospital's collective branding processes.Second, the fact that 99.00% of hospitals did not have an artificial intelligence department demonstrated that these organizations need too much time to adapt to their stakeholders' new medical needs, which can represent a problem from a public health and a reputation perspective.These organizations need to increase their investments in technology and use artificial intelligence as an added value that reinforces their employees' brand as well as the organization's reputation.And third, only 6 hospitals complied with at least 50% of all indicators considered, which proved that these organizations need to make their branding communication strategies much more professional: defining the hospital's brand architecture, developing annual communication strategies, and implementing evaluation systems would help hospitals to build more reputed brands.

Table 1 .
Brand indicators

Table 2 .
Best hospitals: Online newsroom

Table 4 ,
the two best hospitals in Spain in this area were Clinica Universidad de Navarra and Hospital Universitari Vall d'Hebron.

Table 3 (
Continued).Hospitals & external partners Hospital de Sant Joan de Déu & Hospital de Sant Joan de Déu Barcelona-Pediatrics used the same website

Table 4 .
Best hospitals in Spain Hospital Universitario la Zarzuela, Hospital de Sant Joan de Déu, & Hospital de Sant Joan de Déu Barcelona-Pediatrics 17 Note.*Hospital de Sant Joan de Déu & Hospital de Sant Joan de Déu Barcelona-Pediatrics used the same website