The Changing Image of Healthcare
As the healthcare field becomes more complex and competitive, hospitals are searching for ways to stand out in the crowd

"The dignity of a physician requires that he should look healthy, and as plump as nature intended him to be; for the common crowd consider those who are not of this excellent bodily condition to be unable to take care of themselves."

—Hippocrates

If one were to extend the above dictum to include the image and financial condition of entire healthcare facilities, Lexington's hospitals could be characterized as pleasingly plump. In what everybody sees as a hectic and confusing marketplace, local medical centers are almost uniform in their robust yet measured growth: a litany of grants and new services at UK Hospital, a new heart center at Central Baptist, the re-entry of obstetrics into Saint Joseph's menu of services with its acquisition of Jewish Hospital, Samaritan's planned office park expansion.

Doctors and eight hospitals in Fayette County provided $930 million in services in 1997. In a recent Lexington Herald-Leader article, University of Louisville economist Paul Coomes estimated that out-of-town patients accounted for over $550 million of that. Even while the grappling continues over HMOs and managed care delivery, hospitals continue to roll out new and more all-encompassing programs, trying to carve more than a niche for themselves in becoming the public's one stop for total healthcare.

In the course of this phenomenal growth, and in recognition of the need to serve a large geographic region, marketing intensity and innovation have reached a new level. Business Week notes that healthcare provider advertising expenditures have gone from $235 million in 1990 to almost $800 million in 1996, and are expected to approach $1.6 billion by 2000.

"Ten years ago we had no marketing at all," says UK Hospital's CEO Frank Butler. "You'd see an annual report in the paper, but that's it."

Area healthcare marketing didn't really start in a formal sense until the 1980s, with Humana leading the way. As the choices for consumers have become more numerous and more muddled at once, hospitals have garnered communications professionals to get the word out. However, most area institutions don't follow the national trend in greater budgets.

"Our marketing allocations have been flat to marginally increased," says Samaritan CEO Frank Beirne. "We view marketing as part of what we do. It's a cost and service center like the balance of the organization. The best marketing is a satisfied patient."

Donna Slone, public affairs director for Appalachian Regional Healthcare, based in Lexington, sounds a similar note. "While we must respond to the marketing challenges presented by for-profit entities moving into our service area, we continue to be frugal in spending marketing dollars," she says.

Central Baptist's Rob Ramey offers, "We look for creative ways to get the message out and increase awareness. It doesn't always involve spending a lot of money or making a billboard."

And the same holds true at the area's biggest hospital, the University of Kentucky Chandler Medical Center. "The marketing budget grew quickly initially, but it's been fairly stable the last few years," says Butler. "We're under pressure to keep costs down, so it's grown at the same rate as the general University budget, two to three percent a year. It all depends on how you define marketing."

It certainly does. You don't need a billboard when a new facility will do. And area hospitals are growing buildings, services and expertise at an unprecedented rate.

Miles of milestones

UK Medical Center needs a sophisticated calculator to keep track of all the private and public grant money coming in for research. At a December meeting alone, the medical center accounted for nearly $8 million in grants and other allocations submitted before the UK Board of Trustees. With operating revenues growing to almost a quarter billion dollars, and growth and innovation occurring in so many different areas of the medical center and Colleges, the institution is the primary engine in the University's drive toward Top 10 research status. The medical center's various projects range from new research into children's cancer to continuing and groundbreaking efforts to solve the puzzle of Alzheimer's disease.

Central Baptist Hospital is currently the fastest-growing hospital in Kentucky and among the top 30 fastest-growing healthcare facilities in the United States, a recent national survey concluded. The hospital ranked 28th in the survey, one position ahead of the only other Kentucky hospital mentioned, Jewish Hospital of Louisville.

Central Baptist Chief Financial Officer Bobbie Prather credits much of the hospital's success to its dedicated cardiovascular, obstetrics, oncology and medical/surgical programs.

Central Baptist's newest facility, currently changing the skyline on the east side of Nicholasville Road, is scheduled to by early 2000. It will house a comprehensive Heart Institute, with all services for cardiac care in one area. A learning center will have connections to the operating rooms upstairs, providing a modern cineplex version of the old-time surgical theatre.

Saint Joseph's vice president of network development Patricia Mason says the health sector's overall growth is an indication of the success of the organizations, and of their ability to adapt to change. "Over half of our business is now outpatient-based. We've had to shift toward quicker in-and-out services.

"Saint Joseph is seeing 100,000 square feet of new construction: the Keeneland Health Education Center, a cardio-thoracic unit, five operating suites, a 27-bay recovery area and an MRI facility. Specialists want to be close to the site of their work. Right now our office space is 96 percent occupied and we're still seeing demand."

The office plaza plays a key role in Samaritan's marketing efforts as well. "From our standpoint, it's less about marketing the medical office building directly than about what it does for the establishment as a whole," says Beirne. "It's a lightning rod as far as community awareness of the facility – it's put us back on the map. This building is the first of several more new buildings to be constructed toward downtown, a full one and a half blocks. It will be an extended campus."

Adapting to consumer needs

The sense of campus is just the kind of feeling healthcare providers are after. Buffeted by the increase in outpatient services, home healthcare, a chaotic health insurance scene and the constant parade of new technologies, hospitals are moving far from the intimidating fortresses of yesteryear, where even the lighting seemed sickly.

"We've taken a really hard look at the flow of the process for the patient," explains Samaritan's Michelle Bowe. "We try to make it as convenient and hassle-free as possible. We've even used mystery shopping in order to answer questions like how did the nurse interact, how was registration, did the doctor explain things thoroughly? It enables us to put ourselves to the test."

The biggest change in Saint Joseph's campus is the addition of Saint Joseph East off of Richmond Road, a facility formerly run by Humana and then Jewish Hospital of Louisville. Besides bringing Saint Joseph back into obstetrics after a 20-year absence, the new addition allows them to serve the fastest-growing zip code in the state.

"Our women's cancer facility, Gill Heart Institute and Center for Advanced Surgery are being designed around what patients' expectations are," says UK's Frank Butler. "For instance, when my wife had treatment recently, she had to go to seven different locations to get services. Now we're bringing it to the patient. That's a design model you'll see replicated programmatically as well as architecturally."

At Central Baptist, an affiliated program called Health Dimensions, operated since 1996 in partnership with Saint Joseph, is bringing seminars, current information and literature, and screenings to a statewide audience -- by opening up shop at Fayette Mall in Lexington.

"We always had a health resource center at the hospital," says Rob Ramey, "but we realized we were severely limiting access. We looked at what other communities had done, approached Saint Joseph and the mall, and it was seen as an opportunity. It's intended to help patients through the whole process."

"We've been pleased with Health Dimensions," adds Saint Joseph's Mason. "Close to 700 people a month are coming in. It really meets a need."

More than advertising

Today, healthcare institutions and the professionals who staff them are still getting used to the intrusion of both Wall Street and Madison Avenue into their formerly private neighborhoods. But the more competitive it gets, the more phone calls the marketing departments receive from their practitioner colleagues, as all parties seek to boost business and develop innovative approaches, whether they're delivering the care or the message.

"I did a little pushback at the beginning," says UK's Butler. "We're the University, why do we need to market?' I thought. Some people still feel uncomfortable. In 10 years, everybody will have forgotten why they disliked it."

A recent Time article asks, "Has it really come to this? An institution of Duke's caliber forced to sell itself like toothpaste?" Saint Joseph's Patricia Mason offers more restrained words.

"We've seen a change in the attitude of physicians toward marketing. Because we are such an information society, it's taken on more of a role of making sure we're offering what the public needs. We're dealing with people at the most vulnerable point of their lives. There has to be a level of dignity and integrity about the process. I won't ever advocate trying to develop demand for something. We have a responsibility, as part of the public trust, to determine what types of programs people really need. That's at the core of what we try to do."

Marketing = Education

A study conducted last year by the University of Toledo showed that consumers tend to trust marketing by hospitals more than by individual physicians. They also appreciate the value of information-laden public-service type messages, as opposed to slick commercials.

At Central Baptist, Project Fit provides playground equipment matched with an educational course specially designed to help kids exercise. STUFFY the giant doll opens up to show kids about anatomy and organs. The Germ Box employs a special light to show them all the germs on their hands, sending them screaming toward the bathroom.

UK educates not only through its outreach programs, but through its esteemed medical school, ranked among the top 20 in the country for seven straight years.

At Samaritan, arthritis and mammography seminars have proven successful. A simple fat-gram booklet they give out has been requested by school systems to help educate students about nutrition.

Preaching healthy lifestyles in Coronary Valley

Kentucky's general population continues to rank near last in the country in overall health. Heart problems are Kentucky's No. 1 health crisis, followed closely by stroke and diabetes.

"People are demanding about what is available," says UK's Butler. "Part of the response to that phenomenon is that they had better understand who we are and what we do. You have to get the word out about what you do.

"If we market something, we'll be doggone sure we're prepared to deliver. Generally, you only get to market something once, and if you don't deliver, all the marketing in the world won't help you. So it's fair to say that everybody is involved in marketing."

Statistics source: Morgan Quitno's Health Care State Rankings 1996; Atlas of Kentucky

Adam Bruns is a staff writer for The Lane Report.

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