Doug Shaw is beaming like a proud parent, showing off the biggest prize of his 28-year career at Louisville's Jewish Hospital: the AbioCor mechanical replacement heart.
It's not a particularly impressive trophy, at least at first glimpse. A seemingly simple mix of titanium and clear plastic about the size of a grapefruit, the yo-yo shaped contraption is mounted inside a glass case on a cabinet in Shaw's first-floor office.
But this modest-looking mechanical heart--an exact replica of the first device of its kind, which has been whirring away inside the chest of a Kentucky man since July 2--represents a potential ticket to the big time for Shaw and others at Jewish who believe it will help vault the hospital into an elite class of healthcare providers.
For status-conscious Jewish, two internationally acclaimed hand transplants since 1999 apparently were just a public-relations appetizer before a lavish main course.
"We want to be in the same league with the Johns Hopkinses and the Mayos," declares Shaw, who joined Jewish as a vice president in 1974 before becoming president in 1994. "That's been our plan for years."
Indeed, hospital officials--recognizing the impact of the historic procedure--spent millions to gain the inside track for the first implant, upstaging four nationally recognized institutions that are generally perceived to have more status and clout in America's healthcare community.
If Shaw and other executives have their way, a combination of groundbreaking clinical techniques and lots of media acclaim will transform Jewish into the "Mayo of the South," a facility synonymous with world-renowned institutions like Johns Hopkins, Massachusetts General or the Cleveland Clinic.
"We want to be the best in everything," says Linda McGinity Jackson, the hospital's chief spokeswoman since 1987 and vice president for public relations since 1992. "We have very, very high goals."
While Jewish is showered with almost universally positive media attention, some critics question the sky-high aspirations of a 442-bed, not-for-profit hospital that committed at least $8.2 million, excluding salaries for hospital staff and researchers, in the race to perform the AbioCor heart implant.
Local critics and competitors question those costs.
"Do I see us dedicating those kinds of resources to get national attention?" asks Michael Fleming, spokesman for Norton Healthcare, the principal competition to Jewish Hospital on the downtown Louisville Medical Center, which also includes 272-bed University of Louisville Hospital. "I would say, `No.' "
"We have a lot of priorities, a lot of programs that require a lot of attention," he says. "Of course, we're open to opportunities that bring us that kind of exposure. We have to be responsible with our dollars. I guess it all depends on what your priorities are. Our responsibility is balancing the marketing objectives and what you can offer to the community."
Officials at Jewish Hospital dismiss the criticism. They maintain that the publicity is simply a logical outgrowth of the hospital's longtime push for clinical excellence.
"Marketing and public relations follows the work we're doing," Shaw says. "It's not the other way around, like the way you'd introduce a new cereal. This is an organization known for education, teaching and research that has brought the outside world to us, in terms of our image and our branding."
Jewish Hospital's painstaking struggle to reach the big time began about two decades ago, when the hospital created a strategy to carve out certain areas of excellence as a way of distinguishing its highly specialized care. Since then, it has earned acclaim, at least on a regional basis, for its work in cardiac care and transplantation, including the first-ever hand transplant in the U.S. two years ago. A second successful hand transplant was performed in February.
The hospital's long-range plan is now producing results in both overall quality and reputation, says Hank Wagner, the president and chief executive officer of Jewish Hospital HealthCare Services, Jewish Hospital's parent company, which has built a powerful regional network of 40 healthcare facilities in two states.
"Many hospitals get seduced into being all things to all people," says Wagner, who served as Jewish's CEO for 14 years until 1994, when Shaw took over. "It took 25 years to get to July 2 (and the heart implant). There were no shortcuts."
Twenty-five years ago, Wagner says, Jewish "wouldn't have been in the top 500 hospitals in the United States. I'd say Jewish is now one of the top 50."
Still, Jewish Hospital has yet to be ranked among the nation's best hospitals in the annual rankings by U.S. News and World Report.
Jewish, acutely aware of that limitation in its national standing, spared little expense to ensure that its doctors performed the first procedure with the AbioCor mechanical heart, which now sells for $75,000. It spent at least $8.2 million on the project, not including sharing the costs with the University of Louisville of tens of thousands of dollars in salaries for as many as 80 people involved in the project. Officials could not provide even an estimate of the costs of the operation and follow-up care.
"They were doing what it took, moneywise, to do the operation," says Robert Jarvik, M.D., who developed the first artificial heart in the early 1980s and now is highly critical of the public-health benefits of the AbioCor device, which has so far cost about $60 million to develop (See related story, p. 32).
Indeed, as a result of its no-holds-barred commitment, Jewish edged out competitors UCLA Medical Center in Los Angeles, the Texas Heart Institute in Houston, Hahnemann University Hospital in Philadelphia, and Boston's Massachusetts General Hospital, which teamed with Brigham and Women's Hospital on the project. Because of its commitment of cash and resources, only Jewish was in a position to perform the procedure in early July.
O.H. Frazier, M.D., chief of cardiopulmonary transplantation at the Texas Heart Institute, was prepared to perform the first operation until Tropical Storm Allison swept across the state in June, flooding the hospital's facilities and washing away the hogs about to be used in experiments that were required to be done before the first human implant. Yet Frazier expresses no regrets at losing out in the transplant sweepstakes.
"This isn't a competitive thing," Frazier says. "The main thing is not to foul up. I certainly wasn't going to try to be first just for the sake of being first. The motivating factor is having the proper patient. If chance had been otherwise . . . if we hadn't had the flood, and if we had a suitable patient, well . . . ."
Even as they attempt to burnish their reputation and take advantage of the publicity, officials at Jewish somewhat paradoxically maintained a news blackout for nearly two months on any personal information about heart-implant recipient Robert Tools, who was described only as a diabetic in his mid-50s until the 59-year-old Kentuckian was unveiled in a dramatic appearance by videotape on Aug. 22.
That subdued approach was vastly different than the media circus in the early to mid-1980s, when Jarvik-7 mechanical hearts were implanted in three patients at a Louisville hospital then owned by Humana. The company, which left the hospital business in 1993, had been willing to pay for 100 artificial-heart transplants after the 1982 transplant of retired Seattle dentist Barney Clark, who died 112 days after his operation at the University of Utah Medical Center in Salt Lake City.
During one procedure in the mid-1980s at Humana Hospital-Audubon, now Norton Audubon, more than 200 members of media from around the world descended on the quiet southern city, camping out at the Louisville Convention Center for daily briefings to chart the progress of a retired federal worker named William Schroeder, who lived for 620 days.
"This kind of thing buys a lot of (free) advertising, but it's important to handle it right," says Barry Bingham, the former owner-publisher of the local Louisville Courier-Journal. "I was in the newspaper business back then (during the Jarvik procedures). (Hospital officials) set up a newsroom as big as a football field. They made a circus out of it."
Seeking publicity for publicity's sake, Frazier says, "can backfire."
Regardless of institutional benefit, he says, every hospital involved in the clinical trial must work together and pursue the same goal: perfecting a device that will help thousands of patients dying prematurely of heart disease. Frazier believes Jewish is doing just that.
"The goal of the hospital in Louisville is not just to get publicity," Frazier says. "But it doesn't necessarily hurt in this case."
The war room
So far, the mechanical-heart implant has been an unqualified success for Jewish Hospital. The patient has lived 10 weeks--longer already than doctors gave him when he entered the hospital too weak to lift his head. Before the procedure, he was given an 80% chance of living 30 days.
To handle the scores of daily calls from the media in the days and weeks after the implant, Jackson and her staff of eight established a "war room," or command center, in a large conference room around the corner from the executive offices on the top floor of the gleaming Heart and Lung Center, a 15-story facility where about 2,000 open-heart procedures are performed each year.
By early August, the operation had generated thousands of stories in newspapers, including front-page headlines in the New York Times, the Wall Street Journal and USA Today. An estimated 4,555-plus airings on television news programs have reached an audience of more than 735 million viewers around the world, Jackson estimates.
"Suddenly, Louisville is on the healthcare map--big time," says Henry "Sonny" Altman, board chairman of JHHS, which served about 300,000 patients last year. "There's a window in which you've got to capitalize on this kind of thing. And the window is now open."
Jackson describes the operation as "one of the biggest things that's happened in medicine over the past 20 years."
International publicity is nothing new to Jewish, given the experience with the hand transplant in January 1999. Coverage of that procedure and a second transplant earlier this year, according to brochures produced by Jewish's perennially busy public-relations staff, reached 352 million people and amounted to an "advertising value" of $46 million.
The comparable "advertising value" of the AbioCor procedure: About $100 million, Jackson says.
All this publicity--and the hospital's concerted effort to highlight its "firsts"--has raised the stakes in a highly competitive metropolitan market that includes Jewish, 213-bed Caritas Medical Center, 407-bed Baptist Hospital East and Norton Hospital, a 687-bed facility so closely connected to its competitor in the downtown medical center it shares a system of indoor walkways.
Jewish and Norton are locked in an increasingly bitter legal dispute over Jewish's plan to build a $67 million ambulatory-care center that would directly compete with both Norton and Baptist in the suburb of St. Matthews, about 20 miles from downtown Louisville.
That struggle for market share bubbled over into angry words during a hearing in early August, when JHHS' Wagner called Norton a "failing organization" and publicly stated that his competitor has lost an estimated $120 million in the past four years. Two weeks later, a judge ruled in favor of Jewish, which hopes to open the facility next year. Norton has not yet decided whether to appeal the decision.
While Jewish may tout itself as one of the top hospitals in the country, it's battling in its own hometown for the right to call itself the best in Louisville.
Norton, for instance, is going head-to-head against Jewish in an effort to lure cardiac patients by billing itself as the "region's top heart program" as rated by HealthGrades, an Internet-based consumer health-information service that publishes hospital ratings in several clinical specialties. Baptist, too, is angling to take advantage of its own sterling reputation in the surrounding area--it was named the city's best hospital by Louisville Magazine and tied with Jewish as the best in the state in a ranking conducted by Kentucky Monthly magazine.
Spreading the wealth
Jewish's well-honed reputation is also helping strengthen the regional foundation of its parent, which now has about 7,400 employees and more than 1,500 patient beds in Kentucky and southern Indiana. JHHS, which boasts annual revenue in excess of $500 million, owns Jewish Hospital; the Frazier Institute, a 95-bed rehabilitation hospital; and 76-bed Jewish Hospital Shelbyville, about 27 miles from its headquarters.
Asked about Jewish Hospital's determined drive to reach the elite among the nation's hospitals, Rebecca Brown, director of marketing and public relations at Baptist East, says, "I know that's been a goal of theirs for a long time. It's no secret. Every hospital has a different goal. Our goal is to meet the community's healthcare needs. Every hospital has a niche. Some are still searching for theirs."
For now, at least, Jewish has pretty much cornered the Louisville market on national and international attention with the AbioCor implant.
"Now is the time for them to push their brand, their quality," says Bridget Meaney, editor of COR Healthcare Market Strategist, a national monthly newsletter that covers marketing and promotion. "It's the greatest time for them. They've done some incredibly innovative care. Who knows how long (the good publicity will last). It can drop off quickly."
Whether by design or not, Jewish has tantalized the media by withholding information about the patient. It wasn't until after 50 days of anonymity, on Aug. 21, that Tools was introduced to a throng of media during a videoconference that again made Jewish a national media darling.
The press conference was covered by every major network, including CNN, which provided a live broadcast of the 9 minutes, 22 seconds that a gaunt Tools spent answering seven questions from the media. The next day, his picture was prominently displayed on the front page of the New York Times.
Jackson shrugs off any suggestion that information was withheld to help maintain media interest, but the hospital's public relations staff remained in full gear, distributing e-mail updates on the patient's condition and periodic press releases. Tool's appearance was the fourth full-blown press conference since the first announcement of the procedure.
"We weren't trying to tease people," Jackson says. "We decided from the start we'd handle this as a clinical procedure, with the patient coming first. There was never any discussion about how we could get the most media out of it. We were trying to protect the patient."
Jackson heads a marketing machine that spends about $2 million per year. It includes a nine-person public-relations department, which works closely with the hospital's interrelated marketing and advertising machinery.
Despite the public relations effort, not every report on Jewish Hospital or the AbioCor implant has been glowing. Some critics wonder whether the hugely expensive operation--and the torrent of publicity that followed--will ever translate to anything more than a transitory and immeasurable public-relations benefit. The key question, some ask, is whether it will ever increase earnings and draw more patients.
"There is not going to be a mad rush to Jewish because of this procedure," says Shaw. "But the hospital will benefit. And society will benefit."
Jewish hasn't needed the extra push of positive publicity, posting operating profits of about $65 million in the past four years. Norton, which accounts for about 46% of all the admissions in Jefferson County, has lost about $123 million on patient-care operations--a statistic officials were forced to confirm after Wagner's dramatic revelation. Norton, which bought four Columbia/HCA Healthcare Corp. facilities in 1998, has an occupancy rate of about 65%. Jewish's occupancy rate is about 74%, and Baptist's is tops at 92%.
Brown, the spokeswoman at Baptist East, disputes whether high-tech, high-profile procedures such as the AbioCor implant will ever bring in more patients and bigger revenue. "They add to your reputation, but as far as a hospital seeing a change (in patient revenue), I don't think so."