Strategic Health Care Marketing
April 2001
by James Folger

Isn't It Time to Review Planetree -As a Marketing Strategy?
Few Have Capitalized on Considerable Benefits

As the CEO or chief marketer and strategic planner for a hospital or health system, how often have you raised the question, "What can we do to differ-entiate ourselves from the competition?" A companion question might be, "How can we do a better job of meeting the needs of our patients?" The Planetree model of patient-focused care may provide a potential solution to these questions, and at the very least, a strategic alternative that should be evaluated by senior staff and board members.

A blinding flash of the obvious
Planetree is essentially what a consumer would want a hospital to be. Indeed, it was originally conceived by a consumer of health care services - Argentine-born Angelica Thieriot. Thieriot went through the unfriendly and frightening experience of hospitalization that has become too common in U.S. hospitals. The lack of caring and sterile surroundings that she saw in the United States were a stark contrast to the environment she experienced in Argentina. This led her to seek an alternative that emphasized human caring and the impor-tance of a total approach to healing. She successfully lobbied the chief of medicine at Pacific Presbyterian Medical Center (now California Pacific Medical Center), in San Francisco, to establish the first model "Planetree" unit in 1985, named after the tree (also known as a sycamore) where Hippocrates taught the first medical students in ancient Greece.

In Planetree units, patients can wear their own pajamas and robes, review their medical records with a doctor or nurse, and assume responsibility for taking their medications on schedule. Family members are welcome around the clock and can cook meals in a nearby kitchen, stay overnight, and become "care partners" if they wish, taking part in routine nursing tasks. Live music, poetry readings, storytelling, pre-surgery massages are all staples of this consumer-focused approach.

The architecture is also altered to be more patient-friendly. In 1995, Consumer Reports described the environment on the eighth floor of New York City's Beth Israel Medical Center as follows: "Flowered balloon drapes adorn the bedroom windows and oak ward-robes hold personal items. A ceramic nameplate is out-side each door. Gone are the metal crash carts and harsh fluorescent lighting in the hall, replaced by deli-cate ceiling arches, textured wallpaper, and indirect lighting. Soft music and sweet baking aromas waft through. Gone too is the standard fortress-like nurses' station. Instead, an accessible area of desks curves along one wall; comfortable chairs invite patients to sit alongside."

Planetree meets reality
Unfortunately, the widespread implementation of Planetree programs fell victim to the harsh realities of deteriorating hospital bottom lines and resistance to change by medical staff and administration. In the first years of its existence, Planetree failed to grow much beyond the five model programs established in San Francisco, San Jose, and Delano, CA, New York City, and The Dalles, OR. Planetree did attract interest but converted only 15 facilities to its program from 1985 to 1998.

A few bold leaders have continued to trumpet the value of Planetree as "the right thing to do." Among them are Mark Scott, CEO of Mid-Columbia Medical Center in The Dalles.

Scott deplored the way patients were treated in many hospitals and vowed to change that -restoring patients' dignity and respect and embracing the family as part of the healing process. He has given "hundreds of speeches and hosted 900 visits over the last seven years" to The Dalles. Although he does not have a lot of hard data to support Planetree, he does say that the programÕs visibility has allowed him to attract "a gem of a medical staff, and has allowed the hospital to purchase the best in technology and information systems."

Others, like Longmont (CO) United Hospital, signed on with Planetree because it was consistent with exist-ing practices. As Gail Sundberg-Douse, education manager at Longmont, states, "Planetree was not about changing what we were doing, but taking a resource and expanding what we were already doing."

In truth, the lack of concrete operational efficiencies and/or market and revenue gains from Planetree has been the greatest factor in inhibiting its acceptance. Further, the very fervor of the movement's leaders in insisting that Planetree should be adopted for altruistic reasons has detracted from a greater focus on tracking and demonstrating results.

The one study, which was initiated by the University of Washington and tracked 760 patients from 1986 to 1990, was not completed until 1996 and not accepted for publication until October 1997. The study concluded that patients were more satisfied in the Planetree model versus the hospital control group, but there were no significant differences in length of stay, charges, or outpatient visits after hospital discharge. There were some guarded positive comments in the last paragraph of the published document, stating, "Such units have the potential for improving the quality of care and making the hospital more attractive in to-day's competitive environment."

Griffin as champion and market leader
Griffin Hospital, in Derby, CT, was a convert to Planetree in 1992 and opened a new facility in 1994 that was guided by the design philosophy embodied in the patient-friendly approach. Griffin believed in the value of the concept and was unflinching in its com-mitment. This led to the acquisition of Planetree in 1998 from its owners in San Francisco, who were operating on a minimal budget and were unable to fol-low up on facilities that showed interest. Griffin has experienced great success by "providing personalized, humanistic care in a healing environment." In February 1999, Inc. magazine described Griffin's "Intensive Care" program and the reformation of the industry that Griffin was encouraging "by asking its customers what they wanted and then giving it to them - giving it all to them."

Pat Charmel, Griffin's CEO, states that his organization is unwilling to compromise when it comes to patient care. For Griffin, the results have been dramatic. In a highly competitive market, surrounded by seven other facilities, Griffin has achieved financial and market success. Before 1994, market share had been declining. The addition of Planetree helped to stabilize that situation, and market share has increased 1 share point per year since 1998. In contrast with an average 3 percent growth rate for the region's hospitals, Griffingrew 7 percent in discharges in 2000 and 30 percent in outpatient business over the past two years.

As reported by Catherine Lackner in the July 2000 issue of Strategic Health Care Marketing, "The gospel of Griffin is spreading throughout the land." While that may be a slight exaggeration, the interest levels should increase based on Griffin's success. In a recent issue, Fortune magazine recognized Griffin in its annual "100 Best Companies to Work for" list for the second year in a row, putting it in such heady company as Southwest Airlines, Nordstrom, and Wal-Mart.

Exposing the light under the bushel
At last count there were 23 hospitals/systems affiliated with Planetree. In interviewing these organizations, this article's author asked, "How has Planetree been used as a marketing strategy?" The predominant response is that it has not been used as a marketing strategy, that it was adopted to improve customer service. Most organizations that were contacted had done little, if any, advertising of the concept to the public.

Jim Mullins, vice president of outpatient services at Northside Hospital in Atlanta, says that his organization has downplayed the public relations aspects of Planetree, and that Northside became an affiliate to improve customer service. At the same time, he remarks that "the nursing staff gets it," and that Planetree has helped with recruitment.

Sally Lienemann, operations director in critical care at Alegent Health in Omaha, NE, echoes Mullins' comments and cites a reduction in nursing turnover and lost productivity. If it costs $20,000 to recruit and train a nurse, then these reductions in turnover could be substantial. It has been reported that nursing turnover in the United States has increased from 12 percent in 1996 to 15 percent in 1998. If a hospital employs 100 nurses, reducing the turnover from 15 percent to 10 percent could mean operational savings of $100,000 per year.

Along with increases in patient satisfaction, the most notable benefits of Planetree have been from an internal marketing standpoint. As Mitzi Jobes, director of human environment at Phoenix-based Banner Health Arizona, describes it, "While we have not looked at market share data, our employee turnover has decreased, and employee satisfaction has increased from 70 percent to 75 percent to 80 percent over the last three years." The result of a merger between the Samaritan and Lutheran systems in 1999, Banner Health is looking to a systemwide commitment to Planetree.

Looking to the future
As Planetree's new executive director (as of May 2000), Susan Frampton is optimistic about the future potential of Planetree. She understands that the healing ministry and enormous patient care commitment embodied in Planetree may tend to blur other focal points related to market share gain. But as she herself has stated, the situation at Griffin was similar to "David fighting Goliath." There may be a particular opportunity for the more nimble, smaller community hospitals to use Planetree to position themselves for success against the bigger tertiary players. Griffin's share gains of 1 per-cent per year should not be taken lightly. If a hospital has $100 million in revenues, 10 percent incremental margin, and 25 percent share of market, 1 share point would mean $400,000 per year flowing to the bottom line!

The lack of a significant body of statistical evidence to prove Planetree's value should not deter the marketer/planner from exploring the approach as a marketing strategy. The small investment and expenses involved with Planetree will most probably be offset by enhanced employee satisfaction and concomitant reduction in the cost of employee turnover. The upside then becomes the opportunity to differentiate your hospital from the competitors and capture a larger share of the market.

Based in Cedaredge, CO, James Folger is a partner with the TEAM Consulting Group.

© 2001 Health Care Communications. Reprinted by permission from Strategic Health Care Marketing, April 2001. For additional information, go to www.strategichealthcare.com.