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How to Operate an On-site Hospital Fitness Center

Black, Stephen A. M.Ed., PT, ATC/L, NSCA-CPT

ACSM's Health & Fitness Journal: March-April 2007 - Volume 11 - Issue 2 - p 24-27
doi: 10.1249/01.FIT.0000262476.28573.6f

Learning Objective The readers will gain valuable insight into the integration and operation of a medical fitness center.

The integration of fitness facilities either on campus or within satellite ambulatory centers are gaining in popularity. This article offers valuable insight into the integration and operation of a medical fitness center.

Stephen A. Black, M.Ed., PT, ATC/L, NSCA-CPT, has 30 years of experience in the medical fitness industry. He is a frequent author, researcher, and presenter at industry meetings and workshops. He has traveled extensively to assist individuals and organizations in the development and integration of medical services into the fitness and health promotions industries. For further information, visit his Web site at

The integrated medicine model that hospitals embrace for their fitness centers combines traditional fitness/medicine with a psychological approach, such as counseling, pastoral care, and stress reduction; a therapeutic approach, such as massage and acupuncture; and an integrated approach, including fitness and mind/body activities. The patients' health and well-being are recognized as something far beyond medical procedures and medications.

Hospitals, experiencing a decline in net revenue due to changes in state and federal regulations and reimbursement strategies, have looked outside their traditional model at a relatively new pyridine, which is the hospital-allied, medically integrated fitness industry. They are attempting to capitalize on what more than 15,000 health/fitness centers across the country already know-fitness/wellness is a prosperous industry. According to the annual report published by the Medical Fitness Association (MFA), there are an estimated 875 hospital-associated fitness centers currently in the United States and Canada. They have seen an average annual growth of 12% since 1985. MFA predictions estimate over 1,150 centers by 2010 (Medical Fitness Association; Benchmarks for Success 2006). If this trend is to continue, and there is no reason to doubt it will, hospitals will need to be schooled in the appropriate management of said facilities to fulfill their fiduciary responsibilities to the board of directors and establish, as well as maintain, their credible image in the community.

The future, however, is bright. Hospitals have the opportunity to provide a direct link to the health care system using an integrated continuum of care model (Figure) that incorporates a retail business plan. Managing risk factors, providing early detection, rehabilitation, postrehabilitation, and overall lifestyle management should be the mission and priority of any hospital-based center. The demographics are skewed toward success. Changes in demographics of the U.S. population have far-reaching implications. The number of youngsters (aged 5 to 17 years) will reach 53 million in the next decade. This, according the Sporting Goods Manufacturers Association, is a key group for growth of several industry segments, including fitness. According to the International Health and Racquet Sports Association, baby boomers aged 35 to 54 years now account for 12.4 million members within the health club industry. Baby boomers prioritize health and quality of life in their daily lives. This is why they are spending an estimated $35 billion annually on integrative health care. Americans aged 50 to 79 years are well aware (63%) that exercise is the best thing that they can do for their health. Most (89%) believe that a person their age should exercise at least three times a week, preferably for 20 to 30 minutes each time.



Figure. Ca

Figure. Ca

The antithesis is the economic burden of obesity in youths aged 6 to 17 years. The estimated cost of this burden in 1999 was $127 million, up from $35 million in 1979 (American Academy of Pediatrics, May 2002). This is the market that hospitals stand to dominate should they embrace a well care strategy, which uses "out-of-the-box" strategies and credentialed individuals, and avoids many of the pitfalls of the commercial health club industry, which often focuses on profits versus quality care. Hospitals should focus on cleanliness, appropriate equipment, qualified staff, and exquisite programming to meet the demands of a diverse, aging, and diseased population. There is no substitute for clinical-based, peer-reviewed literature tempered with wisdom and insight into the integrated medical model. New scientific knowledge based on epidemiological observational studies, cohort studies, controlled randomized trials, and basic research has led to an unprecedented focus on physical activity and exercise.

The operation of a hospital-allied medically integrated facility requires a plethora of knowledge, principles, skills, and techniques. It is beyond the scope of this article to explore all that is required to effectively and efficiently operate a facility. Thus, the focus will be on those areas that the author feels urgent in the prioritization of operational responsibilities. It is up to the reader to interpret, digest, and incorporate the concepts presented and use creative license in further development of hospital-allied medically integrated utopia.

The industry is young, too young in fact for arguably any entity to stand out as the leader in evidence-based randomized clinical trial methodology of hospital-allied medically integrated operations. There are, however, many qualified, degreed, experienced individuals available for hire for commensurate wage and loyalty.

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Know Your Clientele and Cater to Their Needs

As Hippocrates said, "listen to your patients, they are telling you the cure." Listen to your members, and they will tell you what they want. The rest is easy, just deliver.

When working with adults, engage them in the learning process. At first, this may seem fairly straightforward. But if you really want to convey knowledge and have them walk away with skills they can use, you need to be aware of some adult learning basics. Adults are different, and the "say and spray" method is extremely ineffective. Saying the most information in as short a time as possible is not the best approach. Unfortunately, the drenching doesn't penetrate, and the small percentage of information they do remember is likely to evaporate quickly. When designing a training class, teaching the use of equipment, or conducting classes, start at the end and work backward: what specific action does the patron need to be able to take away when the training is finished. Try not to overwhelm, but rather identify some core tasks or behaviors that are most important. If the participants master these tasks, they will learn enough of the basics and be confident about experimenting.

The staff should reflect the membership accordingly. Having staff of various ages will allow the members to feel comfortable and at ease in the facility. The dress code also should reflect the image and mission of the facility without offending anyone. Staff training and certification also should reflect the overall philosophy and clientele of the facility. Hospitals are steeped in tradition and conservatism. In many cases, the clinical setting needs to be perpetuated but understated. Therefore, the level of expertise of the staff will need to reflect the expectations of the members and the medical community.

Additional considerations:

  • Provide greater space between equipment and strategically place rest stations for members.
  • Provide adequate signs with large letters for directions and instructions.
  • Provide extra space, seating, privacy coverings in locker rooms and wet areas.
  • Invest in staff's continuing education.

You get what you pay for: clinical staff is expensive, so budgets should take into account the level of education, experience, and expertise necessary to work in a hospital-allied medically integrated facility. A good staff is hard to find and even more difficult to keep. Look to the organizations grounded in clinical evidence-based scientific research to meet your staffing requirements. Maintaining high standards will lend credibility within the medical community and provide extraordinary service to the members.

Quality leads to growth and profitability. The essence of quality can be distilled into four cornerstone principles: improvement, customer focus, employee involvement, and commitment to measurement and evaluation.

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Hospitals tend to use outside agencies to market their product. No one knows your product better than you do. There is no proven rule of thumb on how much capital should be spent or allocated to marketing and public relations. Large mailings usually end up in the trash, and if done by an outside agency, may deliver the wrong message and could offend your target market. Newspaper ads appropriately placed can be effective, but don't overdo it. Obtain the editorial calendar from local publications and strategically place ads that will highlight the facility's services and compliment the main feature of the publication.

Here are some guidelines that should help determine where to spend marketing dollars. Try to conserve energy and be creative.

  • Marketing material basics. Buy good-quality letterhead and business cards. All employees should have business cards and feel free to dispense them liberally. Facility staff are marketing extenders, and their enthusiasm and expertise will pay dividends. Incentivize the staff with commissions on membership. Be sure not to pay commissions until the member has stayed at least a year. Staff and member loyalty is a critical success factor.
  • Paid advertising. Don't spend money on paid ads early in the game. They are usually expensive and sometimes not effective.
  • Speak, speak, speak. Speak for free to audiences who are part of the target market (i.e., rotary clubs, chambers of commerce, and trade associations). Look to the local/state medical associations because they typically allow presentations that are pertinent to their association. The hospital most likely has a variety of special interest groups that always welcome guest speakers, such as the local chapters of American Heart, American Cancer, Arthritis Foundation, Diabetes, and others.
  • Write, write, write. Write how-to or advice articles for weekly or daily newspapers, local business magazines, trade publications, and electronic newsletters. Be sure to maintain the copyright so you can offer the same articles to other publications.
  • Teach classes. The local adult education program might need assistance and the facility staff is a valuable resource.
  • Do media interviews. Call local reporters who write for publications read by your target audience. Invite them to call on the facility when they need background, commentary, or story ideas about your industry.
  • Start a newsletter. Publish an email newsletter, and pack it with helpful information and special offers. This is much cheaper than a paper-and-ink newsletter because you don't have to pay for printing or postage. Link the newsletter to the facility's Web site.
  • Create a Web site. This is mandatory in today's operations and marketing arena. If money is available, spend it on the development and maintenance of a premiere Web site.
  • Build strategic alliances. Introduce the facility to other businesses that don't compete but sell products or services to the same target audience. Offer to promote them if they promote you. Make sure they are people you can trust.
  • Do pro bono work. Offer free services to an influential nonprofit group. It will provide a chance to get in front of their board members who may be in a position to bolster membership or provide influential introductions.


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Customer Service

You never get a second chance to make a first impression! With all the billions being spent on customer service and training, one would think that service would be great everywhere. Wrong. Service is still lousy-in fact, it seems to be getting worse. Here are several suggestions to ponder when evaluating customer service in your facility:

  1. Establish written principles for the members. Policies and procedures are great, but most are written in terms of the facility, not the customer. Develop customer principles to guide the employees and the business.
  2. What examples does upper management set? The ones who are inaccessible to customers and employees alike are poor role models for the rank and file. Be more concerned with helping others rather than helping yourself. Evaluate how much day-to-day contact does upper management have with the customer.
  3. Complaints are opportunities in disguise. Handling an angry customer in a hostile environment is an art. Take every opportunity to hone this skill, and teach all employees how to appropriately diffuse a hostile situation.
  4. Responsibility-takers are so rare that they often receive awards. Reward employees who follow through and provide extraordinary customer service and complaint handling.
  5. Companies are overly concerned with customer satisfaction rather than loyalty. Satisfaction is the lowest form of loyalty because satisfied customers will shop anywhere. Loyal customers will fight before they switch and will get others to do business with you by referral. Does your facility measure satisfaction or loyalty?
  6. What is the facility's training budget? Look at General Electric, Microsoft, and Franklin Covey for guidance in employee training. They are the leaders in employee training and accountability.
  7. The facility concentrates on competitive issues rather than competitive advantages. Capitalize on your competitive advantages and make them grow.
  8. Don't fail to realize that anyone who talks to a customer is really in sales and service. Do the people who interact with the customers execute and deliver the mission and customer service principles of the company?
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Be Mindful of the Technology Pitfalls

Technology is great and facilitates operations, customer service, marketing, and data mining. It also is mandatory for data collection and outcomes analysis. However, technology wrongfully used to replace customer service can breed complacency among the staff. How many facilities have you visited only to find the staff huddled around a computer screen rather than on the floor servicing the members?

If the facility is too technological, there will be greater issues with service and inoperable equipment. There is nothing more frustrating to members than equipment that does not work. Treadmills with televisions, sound systems, and management stations may confuse and frustrate the typical member of a hospital-affiliated facility. Remember, these people have never set foot in a fitness facility, and everything is new. They must be educated to use the technology in a logical systematic fashion, with reinforcement on a regular basis. Be patient, speak slowly, and use terminology easily understood by all. Technology is wonderful if used appropriately. Choose the technology wisely; educate the staff and members on the how and why it is beneficial to them.

Hospital-allied, medically integrated fitness centers continue to be an emerging market and a financial contributor to the hospital's bottom line. With appropriate and insightful operations, these facilities provide a vital service to the community and have the potential to positively impact the delivery of health care.


Integrated Care; Rehabilitation; Marketing; Customer Service; Integration

© 2007 American College of Sports Medicine