Sharp Coronado Hospital makes dramatic financial turnaround using 'patient-centric' care model

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Sharp Coronado Hospital in Coronado, California is doing pretty well these days, but that wasn't always the case. In the mid-1990s it had lost a lot of market share and was struggling mightily. It was only after adopting a patient-centric model of care that the tide started to turn, and now the hospital is almost a rarity: a smaller, community-oriented facility with a robust bottom line.

The turnaround began when the hospital looked at five geographically isolated community facilities that were doing well financially, trying to identify which practices were common to each one. Sharp Coronado noticed a few themes pop up -- practices that placed both the patient and the staff experience at the fore, amenities such as massage and acupuncture, and even simple things, like baking fresh cookies.

Then, in 2001, Sharp Coronado partnered with a Connecticut-based nonprofit called Planetree, which helps provider organizations transition to a patient-centered care model. 

"We started making money right around 2011," said Susan Stone, MD, the hospital's senior vice president and CEO. "We went from negative $14 million, to right now having plus- $32 million."

It's a pretty dramatic turnaround. And it's a testament to how the healthcare culture has shifted in the U.S. Consumerism has taken root, and the message is clear: If organizations don't do what it takes to make the patient experience as good as possible, the patient will simply bring their business somewhere else.

"Patient-centered care is good medicine, but it's also good business, because people talk," said Christopher Walker, chief nursing and operations officer at Sharp Coronado. "Our customers are really receiving a product that has service excellence. When you start to look at things from the patient's perspective, you start to deliver what they really want.

"It's tough for small hospitals to stay viable in this day and age, but that's what delivering exceptional service does to your business."

It was really the patient experience recommendations from Planetree that spurred the most innovation on that front. Founded in the San Francisco area in the 1970s by a patient who had endured an adverse experience in a hospital, the nonprofit helps a variety of provider organizations -- hospitals, physician offices, long-term care centers -- look at things from a family and patient perspective. Much of its work is centered around organizational culture change.

For one, it acts as an advocate of patient rights, pressing Capitol Hill to take action on things like patient access to information, and allowing families to be present during clinical interactions. Planetree also works with provider organizations to enact practices such as shared medical records, shared treatment planning goals, and making sure the physical environment fosters an atmosphere of healing.

Perhaps most importantly from Sharp Coronado's perspective, though, is Planetree's certification program. The nonprofit has developed a set of standards for excellence in person-centered care, and if a provider organization can meet those standards -- and prove to Planetree that the standards are being met -- they're awarded gold certification. Testimonials from patients and staff are usually what puts a provider over the top in this regard.

The broader Sharp health system had already been looking at ways to make their facilities more patient-centered, but the Coronado campus used Planetree's gold certification criteria as a benchmark and pulled ahead of the rest of the system in terms of financial performance.

"Their outcomes were better than the outcomes across the rest of the system," said Susan Frampton, MD, president of Planetree. "This convinced the system that this is something worth pursuing as well."

Planetree works with 800 different clinical sites across 25 countries, about a quarter of which are located in the U.S. About 90 sites in five different countries have achieved gold certification. Sharp Coronado is one of them. Planetree sent a team to the hospital's campus and asked patients: Were you informed that you could have input into your treatment plan? Were you informed that you could have a loved one stay at your bedside 24 hours a day? The answers came up aces.

"These are the kinds of practices that organizations have to put into place, and demonstrate that they're doing them, and that they're having an impact on patients," said Frampton.

And the Coronado community has been talking, about changes both large and small. The fresh-baked cookies in particular have generated some buzz.

"We have volunteers here who bake cookies, and that was a simple thing to implement on some level, but it changes your relationship with the community," said Stone. "People would go out for walks and time them so they could drop by when the cookies are fresh."

"Some of the simplest things are the most elegant," said Walker. "Cookie baking is the original aroma therapy. It brings you back home. It hits something that's nostalgic and doesn't feel like a hospital. It brings that feeling back, not just for visitors but for the staff and the patients themselves."

Other patient-centered initiatives include aromatherapy in a spa-like format, which has been touted as a means of reducing pain without utilizing opioids or other pain management medicines; and an online emergency room reservation option for patients experiencing non-urgent symptoms.

This kind of success has not only revitalized the hospital, but has opened the floodgate to even more monetary success.

"Success breeds success," said Stone. "Our community has stood alongside us … and it's allowed is to be successful at philanthropic endeavors to help us stay relevant. We were the first hospital in the California and SoCal region to have a da Vinci robot to help surgeons in the application of prosthetics. We also recently had some physicians say, 'We would love to come there, we just want to have a da Vinci robot,' and we were able to have that happen through philanthropic means.

"So the changes that we've made help us attract the best," she said. "People want to be part of a successful endeavor."

While Walker sees this as a model that can be replicated at other community hospitals, he said it can also be scaled up and enhanced to fit the needs of large hospitals and systems. It's about thinking differently, he said -- which is what innovation is all about.

"Challenging ourselves to think differently is usually the hardest thing in healthcare, because there are so many other variables," he said. "It's not like manufacturing, where it's an assembly line. It takes a little more."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com