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STRATEGIES FOR CREATING VALUE IN THE PATIENT EXPERIENCE

FIRST EDITION

BARBARA ROSS WOOLDRIDGE AND KERRI M. CAMP

HEALTHCARE MARKETING

Bassim Hamadeh, CEO and PublisherBob Farrell, Senior Field Acquisitions EditorGem Rabanera, Project EditorChritian Berk, Associate Production EditorMiguel Macias, Senior Graphic DesignerTrey Soto, Licensing CoordinatorChris Snipes, Interior DesignerNatalie Piccotti, Senior Marketing ManagerKassie Graves, Vice President of EditorialJamie Giganti, Director of Academic Publishing

Copyright © 2019 by Cognella, Inc. All rights reserved. No part of this publication may be reprinted, reproduced, transmitted, or utilized in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying, microfilming, and recording, or in any information retrieval system without the written permission of Cognella, Inc. For inquiries regarding permissions, translations, foreign rights, audio rights, and any other forms of reproduction, please contact the Cognella Licensing Department at [email protected].

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Cover image copyright © 2017 by iStockphoto LP / TethysImagingLLC.

Printed in the United States of America.

ISBN: 978-1-5165-1426-7 (pbk) / 978-1-5165-1427-4 (br)

iii

TABLE OF CONTENTSAcknowledgments �� iXPreface�� Xi

CHAPTER 1: THE 7PS OF HEALTHCARE ORGANIZATIONS

Learning Objectives�� 2 introduction �� 3 Notes from Practice�� 4 7Ps for Creating Value �� 5

1� Product �� 5 2� Price �� 63� Place �� 64� Promotion �� 75� Physical Evidence (Packaging) �� 7 6� Process �� 87� People �� 8

Target Markets�� 9 Value Proposition �� 10Reading Selection �� 11

Marketing for Doctors and Staff �� 11Reflections on the Reading Selection�� 19Application and Synthesis �� 20Questions for Discussion �� 21Summary of Main Points �� 21Comprehension Assessment �� 21Conclusion �� 22References �� 22image Credits�� 23

CHAPTER 2: THE HEALTHCARE PARADIGM SHIFT

Learning Objectives�� 24 introduction �� 25

iV | HEALTHCARE MARKETiNG: STRATEGiES FOR CREATiNG VALUE iN THE PATiENT EXPERiENCE

Notes from Practice�� 26 Patient Experiences and Reimbursement �� 27

Survey of Patients’ Experiences �� 27Hospital Value-Based Purchasing Program �� 29

Technology in Healthcare �� 29Reading Selection �� 30

Fiscal Year (FY) 2016 Results for the CMS Hospital Value-Based Purchasing Program �� 30

Reflections on the Reading Selection�� 36 Application and Synthesis �� 37Questions for Discussion �� 37 Summary of Main Points �� 37Comprehension Assessment �� 38Conclusion �� 38References �� 38image Credits�� 39

CHAPTER 3: UNDERSTANDING THE COMPETITIVE ENVIRONMENT

Learning Objectives�� 40introduction �� 41Notes from Practice�� 42Concierge Medicine—Case Study �� 43

Concierge Medicine—A Services Perspective .................. 43introduction �� 43Scenario One �� 44Scenario Two �� 45Scenario Three �� 46Discussion Outline/Question Set �� 47

The Changing Healthcare Market �� 48Medical Tourism �� 49Telemedicine �� 50Digital Health Tools �� 51Reading Selections�� 52

A Revolution in Healthcare: Medicine Meets the Marketplace �� 52 “Alternative” Healthcare: Access as a Revenue Source in a Consumer-Driven Market �� 57

TABLE OF CONTENTS | V

Medical Tourism: A New Venue of Healthcare �� 62Facilitators ............................................... 71

Reflections on the Reading Selections �� 80Application and Synthesis �� 81Questions for Discussion �� 81Summary of Main Points �� 82Comprehension Assessment �� 82 Conclusion �� 83References �� 83image Credits�� 84

CHAPTER 4: STRATEGIC HEALTHCARE MARKETING

Learning Objectives�� 86introduction �� 87Notes from Practice�� 88Reading Selection �� 90

Developing and Enacting Strategic Marketing Plans �� 90Reflections on the Reading Selection�� 143Application and Synthesis �� 145Questions for Discussion �� 145Summary of Main Points �� 146Comprehension Assessment �� 146Conclusion �� 146References �� 147image Credits�� 148

CHAPTER 5: CREATING VALUE BY LISTENING

Learning Objectives�� 150introduction �� 151Notes from Practice�� 152

References �� 155Service Encounters as a Moment of Truth �� 156Listening�� 156Word of Mouth (WOM)�� 157

Vi | HEALTHCARE MARKETiNG: STRATEGiES FOR CREATiNG VALUE iN THE PATiENT EXPERiENCE

Reading Selections�� 1583 Organizations Using the Power of Patients in Healthcare Marketing �� 158Storytelling as a Strategic initiative �� 161

Reflections on the Reading Selections �� 171Application and Synthesis �� 171Questions for Discussion �� 171Summary of Main Points �� 172Comprehension Assessment �� 172Conclusion �� 172References �� 173image Credits�� 173

CHAPTER 6: HOW CAREGIVERS CREATE VALUE


Hospital’s Service Excellence Program Aims to “Wow” Guests �� 176

Teamwork �� 179Reading Selection �� 181

Teamwork and Performance �� 181Reflections on the Reading Selection�� 190Application and Synthesis �� 190Questions for Discussion �� 191 Summary of Main Points �� 191Comprehension Assessment �� 191Conclusion �� 192References �� 192image Credits�� 192

CHAPTER 7: BEING PATIENT-CENTERED—A KEY FOR SUCCESS


TABLE OF CONTENTS | Vii

Patient-Centered Care�� 197Patient Satisfaction �� 198The Patient Experience �� 198Reading Selections�� 200

The Truth About Patience Experience: What We Can Learn From Other industries, and How Three Ps Can improve Health Outcomes, Strengthen Brands, and Delight Customers �� 200

inspiring innovation: Patient Report of Hourly Rounding �� 212Reflections on the Reading Selections �� 216Application and Synthesis �� 217Questions for Discussion �� 217Summary of Main Points �� 217Comprehension Assessment �� 218Conclusion �� 218References �� 218image Credits�� 219

CHAPTER 8: ETHICS AND HEALTHCARE MARKETING

Learning Objectives�� 220introduction �� 221Notes from Practice�� 222Ethical Decisions—Case Study�� 224

Workplace Ethical Conflict �� 224 Medical Ethics�� 227

Code of Medical Ethics �� 227AMA Principles of Medical Ethics �� 228

Medical Marketing �� 230Reading Selections�� 231

Marketing to Patients: A Legal and Ethical Perspective �� 231The Organizational Costs of Ethical Conflicts �� 238

Reflections on the Reading Selections �� 255Application and Synthesis �� 256Questions for Discussion �� 256Summary of Main Points �� 256Comprehension Assessment �� 256

Viii | HEALTHCARE MARKETiNG: STRATEGiES FOR CREATiNG VALUE iN THE PATiENT EXPERiENCE

Conclusion �� 257References �� 257image Credits�� 257Author Bios �� 259

ACKNOWLEDGMENTS | iX

ACKNOWLEDGMENTS

A number of individuals contributed to this book. We would like to thank Carroll Rogé, Paula E. Anthony, Felix Liu, John Rathnam, John Frank Harper, East Texas Medical Center, Patrick Simonson, and Beth Israel Deaconess Medical Center Ethics program for their contributions to the notes from practice. We would also like to thank Kerrie Anne Ambort-Clark and Brandy Meadows for their contributions of case studies. We also would like to thank our editors at Cognella, Gem Rabanera and Bob Farrell, for having faith in this project.

Each of us would like to add a personal note:

(From Barbara Woolridge) I would like to thank my wonderful husband Stan Wooldridge and my sweet son Ford for allowing me the time without guilt to work on this project. I want to add it was a pleasure to work with such a wonderful co-author as Kerri Camp.

(From Kerri Camp) First of all, I want to thank my loving and supportive husband Danny Camp for his continual encouragement. I also want to thank my students for challenging me to write a textbook that meets their desire to learn more about mar-keting as it relates to the healthcare field. Finally, I would like to thank my co-author Barbara Ross Wooldridge for partnering with me on this project.

PREFACE | Xi

PREFACE

Healthcare is a dynamic and changing industry. It is no longer enough to be a “good” clinician. Those involved in healthcare face the dual challenges of being strong in both healthcare expertise and management. The Affordable Healthcare Act has moved patient satisfaction to the forefront of healthcare. Irrespective of any forthcoming changes to healthcare legislation, the horse is out of the barn, and patient satisfaction will not go away—nor will the measurement of patient satisfaction.

The rapidly changing environment creates new challenges that must be solved. Kate Walsh, president and CEO of Boston Medical Center, stated at the sixth annual Becker’s Hospital Review, “The biggest [surprise] is just how hard it is to move our patient satisfaction scores. Our other one is just how slow the rate of change actually is, despite how breathless we all feel.” Hence, this book was developed to provide insight on how healthcare combined with marketing principles can help healthcare providers not only survive in this volatile environment but thrive.

This text provides the foundation of marketing and its role in healthcare in a unique and focused manner. Highlights of this book include insights from the practice of healthcare professionals on the front line of this changing world, focused readings on key topics, and background on marketing insights deeply connected to the world of healthcare.

CHAPTER1

THE 7Ps OF HEALTHCARE ORGANIZATIONS

LEARNING OBJECTIVES

In this chapter, you will learn about the following:

• The 7Ps of the marketing mix • Target markets• Value proposition• Perceptions about branding • The marketing mindset• Importance of building trusting

and lasting relationships with patients

The last three learning objectives will be discussed in the reading selection “Marketing for Doctors and Staff” (Stevens, 2015).

3

INTRODUCTION

The purpose of marketing is to identify the wants and needs of consumers and then to develop the appropriate marketing mix that will communicate that value for con-sumers. The American Marketing Association (AMA, July 2013) offers the following definition: “Marketing is the activity, set of institutions, and processes for creating, communicating, delivering, and exchanging offerings that have value for customers, clients, partners, and society at large.”

Although many marketers use the 4Ps of the marketing mix—Product, Price, Place, and Promotion—healthcare delivery, due to its services nature, encompasses several other aspects. For this reason, the 7Ps of Creating Value provided in figure 1.2 are more appropriate for healthcare organizations. All of the seven components of the marketing mix are controllable variables for the healthcare organization. The market-ing mix is also a means for healthcare organizations to differentiate themselves from other competitors in the healthcare environment. The competitive landscape will be discussed in greater detail in chapter 3.

4 | HEALTHCARE MARKETiNG: STRATEGiES FOR CREATiNG VALUE iN THE PATiENT EXPERiENCE

NOTES FROM PRACTICE

Carroll Rogé never planned to pursue a career in healthcare marketing. “I liked to write, so I gravi-tated toward journalism and technical writing in college,” he remembers. “My first job out of school was as a writer at an engineering firm, where I worked with their ad agency. I learned quickly that marketing was creative and fun for me.”

From there, Rogé moved on to direct the advertis-ing program for a chain of sporting goods stores. “I enjoyed that, but I really missed having a connection with people and telling their stories,” Rogé says.

Rogé ultimately accepted a position in marketing for the ETMC Regional Healthcare System, based in Tyler, Texas. “It was very fulfilling to tell the stories of life-saving care that make a profound difference in the lives of patients and their families.”

Enjoying being able to write again, Rogé became ETMC’s corporate director of marketing and pursued his MBA at night. In this role, he directed the promotion and outreach for the healthcare system operating in 40 counties of northeast Texas.

Currently, he serves as vice president of marketing and planning for the organi-zation. He also spearheads its customer service program.

Rogé sums up his thoughts best, “I’m thankful to go home most days feeling good about the people I’ve touched. I wasn’t cut out to be caregiver, but I enjoy support-ing our amazing healthcare team and helping fulfill our mission of care. Unlike any other type of marketing, working in healthcare is incredibly rewarding. I’m glad I found where I was supposed to be.”

Figure 1�1 Carroll Rogé

THE 7PS OF HEALTHCARE ORGANizATiONS | 5

7Ps FOR CREATING VALUE

The 7Ps of Creating Value model (figure 1.2) identifies the seven areas healthcare organizations should examine when determining whether the products and services offered provide value to their patients. The specific areas that should be explored within each of the 7Ps are discussed below.

1. PRODUCT

Product includes the goods, services, or ideas that are offered by the organization to consumers. Typically in healthcare today, a product refers to the medical procedure delivered by the provider or facility or the medical equipment or pharmaceuticals sold to the consumers for their personal use. Hospital patients are surveyed as part of the Affordable Care Act with the standardized Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey that is administered by third-party vendors. Because the entire patient experience encompasses many dif-ferent areas of the hospital—including registration, emergency department, surgery staff, floor nurses, phlebotomy personnel, hospitalists, surgeons, and primary care

Figure 1�2 7Ps of Creating Value


providers, to name a few—the patient’s evaluation of the services received may be difficult for healthcare administrators to effectively assess and manage.

2. PRICE

Price refers to the amount consumers are willing to pay for their medical procedure, medical equipment, or pharmaceuticals. Within healthcare, the concept of price is even more complex due to the many types of reimbursement. For example, patients may have commercial insurance (Blue Cross Blue Shield, United, Aetna, etc.), Medicare, Medicaid, Veterans Administration, workers’ compensation, or private pay (uninsured). Medical procedures may be bundled with anesthesiology, radiology, laboratory services, or other hospital services, or procedures may be billed separately to the consumer.

This issue becomes even more difficult to understand when providers factor in the value-based modifier that is now tied to reimbursements. This will be discussed in greater depth in chapters 5 and 6. One aspect providers should control is the transparency of pricing. If a patient has scheduled an outpatient surgical procedure with a surgeon, the surgeon’s staff should preauthorize the procedure with the patient’s insurance, determine the portion of the deductible the patient has or has not met, and estimate the out-of-pocket expenses the patient can expect to pay from that provider. The patient should also be notified to expect other charges from the hospital and hospital providers. All of these communications should be documented in writing and signed by the patient prior to the scheduled surgical procedure. Obviously, in the event of emergency procedures, this may not be possible. However, with planned procedures, the expectation by consumers is that providers should be able to closely estimate what the patient should expect to pay so that necessary arrangements for payment can be made and the patient has the appropriate knowledge to determine if the elective procedure should be scheduled.

3. PLACE

Place is also referred to as distribution, or how the product is delivered to the consumer. The physical location of the facility, hours of operation, type of facility (hospital, clinic, urgent care center, rehabilitation center, nursing home, etc.), and newer healthcare delivery models such as medical websites, smartphones, and house calls all factor into the consumer’s assessment of place.


The competitive landscape has certainly changed the place component for traditional healthcare delivery. Chapter 3 will discuss the complex issues involved with the evolv-ing competitive landscape in healthcare.

4. PROMOTION

Promotion involves any communication with consumers about the product offered. The prevalence of social media today increases the importance of Word of Mouth (WOM) communications by consumers. Online reviews such as Yelp, Healthgrades, RateMDs, Vitals, and ZocDoc and social media platforms such as Facebook, Twitter, and Instagram offer consumers immediate access to customer opinions about health-care providers and healthcare organizations. Positive WOM works as a referral for consumers who place more importance on feedback from family and friends than from organized marketing activities by organizations. Social media usage with nega-tive WOM requires organizations to continually monitor customer feedback to help improve service recovery (converting dissatisfied customers to satisfied customers).

Marketing promotions include advertising (television, radio, billboards, print media, social media), public relations and publicity (sponsorship of events, news stories), professional selling (typically used with sales of medical equipment and pharmaceuticals), and sales promotion (contests, coupons, loyalty programs, other incentives—although sales promotion is not used as often in healthcare organizations, it is often used in specialty practices such as dermatology and cosmetic procedures).

5. PHYSICAL EVIDENCE (PACKAGING)

Physical Evidence includes the packaging of healthcare products (equipment and pharmaceuticals) and the servicescape (ambience and physical environment) in which the healthcare service is delivered. It includes all of the physical evidence—buildings, logos, uniforms, equipment, etc. Imagine in your mind the aesthetic differences among the following hospital types: private hospital, concierge hospital, children’s hospital, county hospital, and a VA hospital. Each hospital will look and feel very different to the consumer. For example, many hospitals differentiate their obstetrics departments by offering patients private rooms, in-room labor and delivery, aesthetically pleasing room décor, and comfortable newborn clothing.


6. PROCESS

Process is how the healthcare service is delivered to the patient. This includes every-thing the patient must do to receive the needed healthcare, from the first telephone call to set up an appointment to the final hospital discharge and post-operative care instructions.

The University of Texas MD Anderson Cancer Center in Houston, Texas, is an example of a hospital that differentiates itself from competitors through its processes. Patients and their families are met at the hospital with valet parking and individual pagers that notify patients when it is time for their appointment (radiology, laboratory, physician visit). Patients are also provided a free mobile application for patients, caregivers, and visitors that makes it easy to access information about scheduled appointments, messages, test results, medications, and other medical records. The patient-friendly processes complement the state-of-the-art medical care that is provided, but often-times, the process is more memorable to patients and determines whether a hospital experience is favorable or unfavorable for the patients and/or their families.

7. PEOPLE

Healthcare is a service delivered by people for people. Patients evalu-ate healthcare not only based on the quality and outcome of medical treatments, but also on how they perceive they were treated and the quality of interaction delivered by their healthcare provider. The qual-ity of the service delivery will depend upon the skills, training, experience, and attitude of the person providing the service, which can vary signifi-cantly from one provider to the next. The very nature of healthcare service delivery means that the consumer is

Figure 1�3 Physician Circle of Struggle


also involved throughout the service experience, and each person’s perception of the service that was delivered may vary from patient to patient and caregiver to caregiver.

Today more than ever, healthcare providers are managing the stress of high patient-to-provider ratios, controlling the high costs of healthcare services, focusing on quality patient outcomes, and managing the “business side” of healthcare. Administrators should strive to engage all of the employees within the healthcare organization who impact the patient’s perception of the quality so that the patient always receives a positive and memorable experience. This will be discussed in greater detail in chap-ters 6 and 7.

TARGET MARKETS

The target market for any organi-zation is the group of consumers most likely to use the organization’s services or those consumers the organization desires to attract. Market segmentation is the pro-cess of dividing up the market into homogenous groups of consumers so that the marketing mix can be customized to meet the wants and needs of that particular market segment. There are many ways to segment markets, but the most com-mon for healthcare are:

• Demographic—age, gender, race, ethnicity, income• Geographic—where they live: state, region, country• Psychographic—how they live: their attitudes, interests, and opinions• Behavioral—how they will use your product or services (i.e., Botox injections for

cosmetics, migraines, or hyperhidrosis)

Figure 1�4 Market Segmentation


VALUE PROPOSITION

One of the most important aspects of creating value for patients is the determina-tion of the value proposition. A value proposition is a statement by the organization that provides a rationale for why consumers should purchase products (or services) from that organization and how its specific products better meet their wants and needs than other competitors with similar product offerings. Chapter 5 focuses on how healthcare organizations can create more value in the patient experience.


REFERENCE

Gallo, C. July 21, 2012. “7 Sure-Fire Ways Apple Store Converts Browsers into Buyers.” Forbes. http://www.forbes.com/sites/carminegallo/2012/07/25/7-sure-fire-ways-apple-store-converts-browsers-into-buyers/ (accessed July 12, 2015).

REFLECTIONS ON THE READING SELECTION

We offer the following editorial commentary on the reading selection.

1. On p. 13, most likely the author meant to state “customers” rather than “patients” because it would not be appropriate to use “patients” when referring to Tiffany’s. The relevant point is that branding can help your organization differentiate from competitors with something as simple as unique packaging.

2. In the section on branding, the discussion about market, expertise, passion, dif-ferentiation, and testimonials can also be helpful in determining your value proposition. Always try to look through the eyes of your patients and prospec-tive patients to “see what they see” regarding your organization.

3. With regard to Developing a Mindset for Marketing, the author refers to “doc-tors,” but this mindset also applies to all healthcare providers. By their innate desire to help others and their previous medical training and experience, healthcare providers have previously only focused on delivering quality care to their patients. The very idea of the “business” of healthcare runs counter to how healthcare providers want to think of healthcare delivery. We never suggest that quality care should be compromised for the sake of a business decision, but healthcare administrators must learn to manage the organization effectively and efficiently to maximize the capabilities and long-term financial stability of the organization. We understand that this business mindset is a paradigm shift that can be difficult for healthcare providers to embrace.

4. In the second-to-last paragraph of Developing a Mindset for Marketing, the reading selection author states “a bit later in this chapter.” This reading selec-tion is only an excerpt and does not contain the entire chapter.


5. In the 7 Laws of Relationship in Marketing, we suggest a phrase that is similar to the “out of sight” and “out of mind” concepts is “top of mind awareness.” If a patient needs an urgent care center, you want them to immediately think of your urgent care center, and not your competitors. The same is true for specialists, including orthopedists, pulmonologists, and gastroenterologists, and ancillary services such as home health agencies. When patients or family members are faced with finding new healthcare providers, oftentimes top of mind awareness is a determining factor in the selection process. This is also the case with refer-ring providers. When patients ask for referrals from either the healthcare provider or support staff, those providers and/or organizations that come to mind are then recommended to the patient. If your healthcare organization relies on referrals from healthcare providers, you should also include business-to-business marketing efforts in your marketing plan to increase the top of mind awareness for your organization rather than using only business-to-consumer marketing efforts.

6. We agree testimonials are an effective means to share your patients’ stories to help build trust and reinforce your brand. However, due to HIPAA requirements, always obtain written permission by your patients to use their testimonials. To protect their privacy, avoid using protected health information (PHI), and we recommend only using the patient’s first name. We also recommend if you have a legal department in your organization that it be contacted to review any patient testimonial prior to public release.

7. In The Law of Community section, the reading selection author mentions Marketing Acceleration© discussion. This reading selection is only an excerpt and does not contain the entire chapter.

APPLICATION AND SYNTHESIS

“I realized that as a doctor you’re just a guest in your patient’s life… I shifted from asking the question ‘Am I being a good host?’ to the magic question ‘Am I being a good guest?’… I strive to be a good guest in people’s lives.” —Kaveh Safavi, MD, JD, managing director for Accenture’s Global Health Practice (Accenture.com, 2016)


QUESTIONS FOR DISCUSSION

1. What did the term “marketing” mean to you before you read this chapter? Did your perception change after reading the chapter? If yes, how?

2. What is the role of marketing in your healthcare organization?

3. For your organization, answer the following questions:

a. Who is your target market?

b. What is your value proposition?

c. Which P of the 7Ps is the most critical for your target market?

4. In the 7Ps for Creating Value model, what is the greatest challenge to implement for your healthcare organization? Why do you think it is difficult?

5. How do you shift the paradigm in your organization from being a good host to being a good guest as Dr. Kaveh Safavi suggests?

SUMMARY OF MAIN POINTS

After reading this chapter, you should be able to:

√ Distinguish among the 7Ps of the marketing mix (p. 5–9) √ Identify the target market and determine the various ways to segment markets (p. 9)

√ Create a value proposition (p. 10) √ Understand how branding impacts patient acquisition (p. 11–16) √ Identify the 7 Laws of Relationship in Marketing (p. 17–18)

COMPREHENSION ASSESSMENT

1. Why is the 7Ps model more appropriate for healthcare organizations than the traditional 4Ps?

2. Why is it important for organizations to identify their target market?


3. What are the differences between demographic, geographic, psychographic, and behavioral market segmentation?

4. Why should organizations create a value proposition?

5. Explain why branding is important for healthcare organizations.

6. Discuss the importance of relationships in healthcare marketing.

CONCLUSION

This chapter provided you with an overview of marketing—specifically, marketing in health-care organizations. You learned about target marketing and market segmentation so that your marketing efforts can be directed more appropriately and efficiently. You should also have a bet-ter understanding of how patients may view your organization through the lens of a marketing mindset. You understand how you can better position your organization through a well-defined value proposition. Finally, we discussed the importance of branding and how relationships can enhance the overall perception patients develop about you and your organization.

Now that you better understand the principles of marketing, the next chapter will focus on the changing healthcare paradigm shift and what these changes mean to you and your healthcare organization.

REFERENCES

American Marketing Association (2015). Retrieved from https://www.ama.org/AboutAMA/Pages/Definition-of-Marketing.aspx.

Accenture (2016). Perspectives: Getting your money’s worth in the health industry. Retrieved from https://www.accenture.com/us-en/insight-perspectives- health-q-and-a-kaveh-safavi.


IMAGE CREDITS

• Fig. 1.0: Copyright © Depositphotos/Wavebreakmedia. • Fig. 1.3: Copyright © Depositphotos/Wavebreakmedia. • Fig. 1.4: Copyright © Depositphotos/dizanna.

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