What's in a name? Everything and nothing, if the current strategy of the nation's largest hospital chain is taken at face value.
Officials at the company formerly known as Columbia/HCA Healthcare Corp. were eager to unveil their new name and corporate identity after announcing a tentative $745 million partial fraud settlement with the federal government several weeks ago.
The winner of the name game was, not surprisingly, HCA-The Healthcare Co., an echo of happier days when the current chief executive officer's late father was still involved in the hospital company he founded. Those were the days before it had been tainted by criminal and civil investigations into its billing practices, parts of which remain unresolved today.
"HCA is a part of me," says Thomas Frist Jr., M.D., the company's chairman and CEO and one of its three founders. "I wouldn't put that out there on the line if I didn't think we had reached a certain milestone as far as the repositioning is concerned."
While the name change holds profound meaning for the Frist family and longtime employees, it should be invisible to patients at the company's hospitals.
"I personally believe you could have kept Columbia/HCA and it wouldn't have affected our business at all," says Victor Campbell, a senior vice president at the new HCA and an employee of the company for nearly 30 years. "This is really for employees."
The head of the consulting firm that fine-tuned the company's new image says the Nashville chain had made its final decision on the name about a month before reaching a settlement with the government. But the company held off on the announcement so as not to risk negative press coverage that might link a new name with the fraud settlement.
"It was our recommendation that they wait until the partial settlement was announced," says Michael Watras, president and CEO of Straightline International, the New York-based consulting firm HCA hired about 18 months ago to help it rebuild its image. "Common sense would dictate that if they came out with a new name before they announced a settlement, the press would be using it in a negative connotation."
Back to the future. Barbara Kahn, a professor of marketing at the University of Pennsylvania's Wharton School of Business, says there are two components to a brand strategy: building a general awareness of a brand and building positive associations. Some companies pump money into turning a negative association into a positive one, but a negative association can be hard to cleanse, she says.
"Sometimes what you try to do is change the association in a positive way," she says. "It sounds like there were such potentially strong negative associations with the investigation that their instincts told them they just couldn't get rid of them."
For anyone who expected the company to make a completely fresh start, though, the choice was probably something of an anticlimax, although Frist says he has since received letters from industry leaders praising the return to HCA.
HCA is certainly not the first hospital company to change a name to erase a checkered past. That's how Santa Barbara, Calif.-based Tenet Healthcare Corp. was born. National Medical Enterprises, which was trying to get beyond a criminal investigation into its psychiatric hospitals, morphed into Tenet in 1995 when it acquired Dallas-based American Medical International.
But in HCA's case, as Frist has repeatedly pointed out, the theme is "back to the future," with an emphasis on the moral dimensions of the company he and his father, Thomas Frist Sr., M.D., founded with Kentucky Fried Chicken entrepreneur and Nashville businessman Jack Massey in 1968.
"Today we are taking a step back to that heritage," Frist told shareholders at the company's annual meeting in Nashville May 25 as he unveiled the name and simple blue logo.
Notably absent is the infamous diamond-shaped "C" that accompanied the old Columbia/HCA logo when the original HCA merged with Columbia Healthcare Corp. in 1994.
"They knew they had a problem," Watras says. "It's quite common for companies going through what Columbia/HCA was going through to take a look at themselves."
That problem revealed itself in the course of interviews Straightline conducted with about 250 people, inside and outside the company. Employees, shareholders, analysts, journalists, hospital CEOs and former patients were polled in hour-long interviews on their thoughts about Columbia/HCA and its hospitals.
"We had a very negative reaction to `Columbia,' " Watras says. "There were some patients who told us they would actually go to other facilities because they wouldn't go to a Columbia facility. They just told us it had to do with the government inquiry and that the hospitals weren't as good as they could have been. I think people were just confused."
Employees also had a negative association with the Columbia name, sometimes remarking that it was a tough company to work for, he says.
"I felt sorry for many of them who had been there for many years, who simply wanted to get on with what they did every day," Watras says.
Corporate baggage. Much of the negative attitude stemmed from the government probe that first hit the newsstands in 1997 and policies that date back to the tenure of Columbia founder and former CEO Richard Scott and President David Vandewater, both of whom resigned shortly after the investigation became public. At the time, the two companies had been merged for only about three years.
Also unpopular was the company's history under Scott's tenure of national-branding everything that came in its path, down to the adhesive bandages at the company's hospitals, which Watras says were imprinted with the Columbia "C."
Watras maintains that his firm began the HCA project with no bias in favor of the HCA name. In fact, he says, he initially would have recommended a totally new name for the company. But the firm's research uncovered lingering positive associations with the old HCA name.
Watras says this project marks the first time in his 20 years in the business that a company actually chose to go back to a previous name rather than start fresh.
"But again, it was probably the first time in my 20 years of working on projects like this where so many people supported the fact that HCA was a great name," he adds.
Though the fondness for the old HCA may have come as a surprise to Watras, it apparently did not surprise Frist.
When asked on the day of the unveiling whether there was ever any doubt that HCA would be part of the new corporate name, Frist smiled and responded, "In whose mind?"
According to Watras, Straightline proposed six final names, one of which was HCA. None of the other potential names was tested in interviews before being brought to the company, although respondents were asked their opinions of both "Columbia" and "HCA." Some of the other finalists, three of which Straightline registered in HCA's name for possible future use, were taken from Greek and Latin words with medical and health associations, yet another emerging trend in the healthcare industry. Frist declines to disclose the names because HCA may use them in future acquisitions or spinoffs, he says.
Straightline also toyed with the possibility of adding a graphic symbol, such as a mother holding a child or a family silhouette, to the logo. The graphics were ultimately abandoned because they "interfered with the integrity of the name and the healthcare company," Watras says.
To go along with its new image and emphasis on the values fostered by HCA's founders, the company recently distributed to employees an oversized magazine-style publication called "Who is HCA?" designed by Straightline and filled with grainy black and white photographs of HCA employees from around the country, quotations about what their jobs mean to them and a mission statement.
The final page is dedicated to a photograph of the late Frist Sr. and a short history of how he founded the company by opening Parkview Hospital in Nashville. As the story goes, he and several other physicians could not find room at local hospitals for their patients, so they opened their own hospital, which grew to become the giant of for-profit hospital chains.
Nowhere in the publication is there mention of the company's recent acquisitions, future growth strategy or its commitment to return profits to its shareholders.
Branding backfire. At the heart of the company's compassionate image strategy is the idea that the people, not the equipment, bricks and mortar, or the corporate identity, make a company strong. This focus on the individual naturally leads to a lack of corporate identity at the community level. And it so happens that forcing hospitals far and wide to add "Columbia" to their signs backfired on the company several years ago, causing resentment within communities that saw their hospitals being gobbled up by an out-of-town corporation.
"We were told over and over again by CEOs of local hospitals that they wanted to operate in the local communities as local hospitals," Watras says. "They didn't want to be forced into this giant conglomerate."
Continuing a 2-year-old course, HCA hospitals will not be asked to change their names or incorporate HCA into their logos, officials say.
Watras says it was clear throughout his firm's involvement that HCA management shies away from the concept of branding.
"We used to make our presentations and never use the word branding during our meetings," he says.
This lack of name identity, however, is in itself a more subtle form of branding.
Where Columbia was known for its nationwide advertising campaign and bullying marketing techniques, the new HCA has been trying to foster a community-centered identity at the opposite end of the spectrum.
Jeffrey Simless, vice president of business development at what is now called Doctors Hospital in Augusta, Ga., says his hospital has suffered several identity crises caused by its Columbia/HCA lineage and has finally come full circle, in what can be seen as a microcosm of the evolution of its parent company.
Opened in 1973 by a group of physicians, the hospital was originally known as Doctors Hospital. Several years later, the doctors sold it to a company called American Medicorp, which was soon taken over by Humana. In the early 1980s, Humana decided to brand its hospitals, and the hospital was renamed Humana Hospital-Augusta. In 1992, Humana decided to spin off its hospitals into a company called Galen Health Care, which meant the "Humana" had to go. It then became Augusta Regional Medical Center.
"That was during the push when everyone wanted to be `Regional' this, `Regional' that," Simless says. " `Medical center' sounded bigger and better than the word `hospital' did."
That name soon caused confusion among vendors and patients because there already was a psychiatric hospital called Georgia Regional Hospital in Augusta.
Enter Columbia, which merged with Galen in late 1993. On the heels of that deal came the merger with HCA, which led to yet another name change, this time to COLUMBIA Augusta Medical Center.
In the years after Columbia/HCA was thrust into the unflattering glare of public opinion as the federal government launched its criminal and civil investigations into its billing practices, the company backed away from its branding campaign.
Getting rid of national branding was one of Frist's early proposals when he stepped in to take the reins from then-CEO Scott, who tendered his resignation amid the blossoming scandal in 1997.
But for this Georgia hospital, geography intervened. As it turns out, the hospital happened to be less than a mile from Columbia County. So as hundreds of hospitals around the country began ditching the Columbia name, it simply lowercased the letters and added a hyphen to arrive at Columbia-Augusta Medical Center.
"About the summer of 1999, we realized that people just weren't getting the name right," a frustrated Simless says. "Either they would add a `Regional' or leave off the `Columbia.' "
In the latest chapter, the hospital--like its corporate parent--is going back to its roots.
As of late 1999, it has returned to the original name, Doctors Hospital.
And the slogan, fitting for an HCA hospital, is: "We had it right the first time."
Thomas Scully, president and CEO of the Federation of American Health Systems, views the corporate name change as a matter of family pride for the Frists.
"I think one of the reasons Dr. Frist got back in the middle of the problems a couple years ago was to restore the family honor to what was a good Nashville company," Scully says. "Five years from now, nobody will know what Columbia is; it will fade with time."