When we audit a new Google Ads account, we find the same problems over and over: campaigns crammed with hundreds of loosely related keywords, ad groups where the ads do not match the keywords triggering them, landing pages that have nothing to do with the search query, and conversion tracking that was set up once and never verified. The result is Quality Scores of 3, 4, 5 out of 10 — which means Google charges you more per click than your competitors and shows your ads less often. We have managed Google Ads accounts across medical tourism, real estate, and e-commerce, achieving consistent 10/10 Quality Scores. This is the structure that makes it possible.
Why Most Accounts Are Structured Wrong
The most common structural mistake we see is accounts built around what the business sells rather than how searchers think. A medical tourism clinic, for example, might have a single campaign called "Services" with one ad group containing keywords like "hair transplant Istanbul," "dental implants Turkey," and "rhinoplasty cost abroad" — all served by the same two ads.
The problem: those three searches represent completely different intent, different decision stages, and different conversion paths. A single ad cannot be simultaneously relevant to all of them. When relevance drops, Quality Score drops. When Quality Score drops, cost-per-click rises and impression share falls.
Structure should follow search intent, not your internal org chart. The hierarchy below enforces that discipline at every level.
The Correct Account Hierarchy
Google Ads has five structural levels. Each level has a specific job, and conflating them is where most accounts go wrong.
Billing, time zone, currency. One account per business.
Do not run multiple businesses in one account — data and audiences bleed across campaigns.
Budget, bidding strategy, network, location targeting.
Separate campaigns by product category, match type, or objective. Each campaign needs its own budget so you can control spend at the right granularity.
A tightly themed cluster of keywords that all share the same ad.
This is where most accounts collapse. Each ad group should contain keywords so similar that a single ad can be genuinely relevant to every one of them.
The Responsive Search Ad (RSA) served to the searcher.
Headlines and descriptions must directly reflect the keywords in the ad group. The closer the match, the higher the expected CTR, the higher the Quality Score.
The page the ad sends traffic to.
This is the most neglected level. A campaign-specific landing page that mirrors the ad copy and keyword intent will always outperform a generic homepage.
Campaign Types in 2025: When to Use Each
Google has added campaign types over the years, and the right choice depends on your objective and how much control you want to retain.
| Campaign Type | Best For | Control Level |
|---|---|---|
| Search | High-intent keyword targeting, lead generation, direct response | High |
| Performance Max | Broad reach across all Google channels when you have strong conversion data | Low |
| Display | Remarketing, brand awareness, visual products | Medium |
| Shopping | E-commerce product listing ads | Medium |
| Video (YouTube) | Brand awareness, product demos, top-of-funnel | Medium |
Our default recommendation for new accounts is to start with Search campaigns — they give you the most control and produce the most interpretable data. Performance Max only earns budget once you have at least 50 conversions per month in the account, because Smart Bidding needs that data to optimise effectively.
Match types in 2025 behave very differently from how they worked even two years ago.
Keyword Match Types in 2025: What Has Changed
Match types are the most misunderstood lever in Google Ads — and Google has quietly changed how they behave. Here is the current reality:
- Broad MatchNow powered by Smart Bidding and audience signals. In the right account with conversion data, broad match can find queries you would never have thought to target. In a new account with no conversion history, it will spend your budget on irrelevant searches. Use with caution and only once you have conversion volume.
- Phrase MatchHas expanded significantly. It no longer requires the exact phrase in the query — it matches searches that include the meaning of your keyword. "dental implants Istanbul" might now match "tooth implant surgery Turkey." Treat it as a mid-funnel targeting tool.
- Exact MatchThe most precise — but Google now allows close variants (plurals, misspellings, reorderings, and some synonyms) even in exact match. Use it for your highest-value, highest-converting keywords where you need maximum control over spend.
Our standard structure for new Search campaigns: launch with phrase and exact match only. Once conversion data accumulates and Smart Bidding has a signal to work with, test broad match in a separate campaign with its own budget cap.
Ad Group Structure: Tightly Themed vs SKAGs
Single Keyword Ad Groups (SKAGs) — one keyword per ad group — were the dominant structure recommendation for years. In 2025, they are largely obsolete. Google's RSA format means you cannot specify which headline shows for which exact query anyway, and the machine learning that powers ad serving performs better with slightly more data per ad group.
Our current recommendation: tightly themed ad groups with 5–15 keywords that share the same core intent. All keywords in an ad group should plausibly trigger the same ad without that ad feeling irrelevant to any of them.
- "hair transplant"
- "hair loss treatment"
- "beard transplant"
- "FUE surgery cost"
- "hair clinic Istanbul price"
- "hair transplant Istanbul"
- "hair transplant Turkey"
- "Istanbul hair transplant cost"
- "FUE hair transplant Istanbul"
Negative Keywords: The Most Underused Tool in Google Ads
If we had to name the single biggest difference between an account wasting 40% of its budget and one running efficiently, it would be negative keywords. Most accounts have almost none. Every account we take over has a Search Terms report full of irrelevant queries that have been eating budget for months.
- →Build a negative keyword list before launching any campaign — start with obvious irrelevant terms (competitor brand names if not targeting them, informational queries like 'what is', 'how does', 'meaning of').
- →Review the Search Terms report every week for the first month and every two weeks thereafter. Anything irrelevant gets added as a negative.
- →Use campaign-level negatives for brand-safety exclusions and account-level negatives for universal exclusions.
- →Negative keyword lists can be shared across campaigns — build a master list and apply it everywhere.
- →Watch for conflicts: a negative keyword that accidentally blocks your target keyword will kill impressions silently.
Bidding Strategies: Manual CPC vs Smart Bidding
Smart Bidding (Target CPA, Target ROAS, Maximise Conversions) is powerful — but only when it has data to learn from. The machine learning model needs a minimum of 30–50 conversions per month per campaign to perform reliably. Below that threshold, Smart Bidding often over-bids on poor-intent queries and under-bids on your best ones.
Our bidding progression:
- 1
Launch (0–30 conversions)
Manual CPC with Enhanced CPC. Full control. Learn which keywords actually convert before handing control to automation.
- 2
Growth (30–100 conversions/month)
Maximise Conversions with a target CPA guardrail. Smart Bidding has enough data to improve, but you are setting a ceiling on cost.
- 3
Scale (100+ conversions/month)
Target CPA or Target ROAS. Let Smart Bidding optimise fully — it will outperform manual bidding at this data volume.
Conversion Tracking: The Non-Negotiable Foundation
We will not run Google Ads for a client without verified conversion tracking in place. Full stop. Without it, you are optimising blind — bidding strategies have nothing to optimise toward, and you cannot prove what is working.
- ✓Implement conversion tracking via Google Tag Manager, not directly in the page code — it is easier to manage and update.
- ✓Track the actions that actually indicate value: form submissions, phone calls (use Google forwarding numbers), WhatsApp clicks, and purchase completions.
- ✓Verify every conversion action in the Conversion Summary — confirm that conversions are being recorded before spending any real budget.
- ✓Set the correct conversion value where possible. Even rough estimates (average deal value) allow Smart Bidding to optimise toward revenue, not just volume.
- ✓Import Google Analytics 4 goals as secondary conversions — useful for micro-conversions and audience building, but never use them as your primary bidding signal.
How This Structure Achieves 10/10 Quality Scores
Quality Score is Google's 1–10 rating of the relevance and expected performance of your keyword, ad, and landing page combination. A score of 10 means Google considers your ad the most relevant possible result for that search — and rewards you with lower CPCs and higher ad positions.
The three components of Quality Score are Expected CTR, Ad Relevance, and Landing Page Experience. The account structure described above optimises all three simultaneously:
Tightly themed ad groups mean your ads can include the exact keyword in headlines and descriptions, driving higher click-through rates.
When your keyword, ad copy, and offer are all about the same specific thing, Google rates your ad as highly relevant to the search.
Dedicated landing pages that mirror the ad copy and keyword intent — not generic homepages — tell Google the post-click experience matches the pre-click promise.
The practical impact of a 10/10 Quality Score versus a 5/10 is not trivial. Google uses Quality Score to calculate Ad Rank — the formula that determines both your ad position and what you actually pay per click. A higher Quality Score can mean paying 50% less per click than a competitor with the same bid, while appearing in a higher position. That is a structural cost advantage that compounds as the account matures.
Building this structure correctly from day one is far easier than fixing it later. Restructuring a messy account typically requires pausing campaigns, rebuilding ad groups from scratch, and losing the conversion history that Smart Bidding relies on. Get the architecture right upfront and the account will perform better in month one and continue improving for as long as you run it.