For several weeks, motorists eastbound on state Route 78 have been able to see both Tri-City Medical Center and a new billboard from Sharp HealthCare declaring the medical provider’s presence “from Vista to Chula Vista.” Westbound travelers see a similar message, this one documenting Sharp’s reach from “Oceanside to Otay Mesa” just before they reach Interstate 5.
That’s more than 100,000 vehicles per day, according to Caltrans estimates, receiving the message of Sharp’s presence in coastal North County. This messaging appeared as the county’s largest medical provider pursues a 30-year lease of Tri-City’s assets and liabilities, a deal that would cause the facility to begin operating as “Sharp Tri-City Medical Center.” But some might wonder if those billboards signal that Sharp is now running the Oceanside hospital.
Given that Tri-City’s governing board approved the deal in December after a half-dozen community meetings, including widespread media coverage, it would be easy to make such a logical connection, even though neither billboard mentions Tri-City in any way.
A message announcing that Sharp’s reach spans the entire county, situated directly across the freeway, less than 300 feet from Tri-City’s main entrance, certainly seems to imply who is now in charge, even if it does not say so explicitly.
And that would be a bit premature, given that this deal, one that would transfer 100% of Tri-City’s assets and liabilities to Sharp, requires voter approval. Though leadership on both sides is excited to start updating signage, nothing is finished until the vote in June.
Dr. Gene Ma, Tri-City’s chief executive officer and a long-time emergency department physician at the Oceanside hospital before stepping up to the leadership job, said that he remains at the helm.
“Day-to-day operations have not changed overall,” Ma said. “All management decisions are made by the Tri-City management team and the board.
“Can they (Sharp) make suggestions? Yes. But we make the decisions.”
In a statement attributed to Scott Evans, Sharp’s chief strategy officer, the company said, “we understand that the vote of the health care district residents will determine our final course and are hopeful that the residents will support our affiliation.” Billboards, the statement adds, are not intended to indicate any current change at Tri-City but rather to begin making residents aware of Sharp’s general presence.
“Sharp HealthCare has made the decision to continue expanding our brand and services into North County,” Evans said. “We have affiliated physicians, real estate ventures, clinics and ambulatory surgery centers already operating in North County, and our advertising is designed to raise consumer awareness of these services as the largest provider of health care services from North County to South County.”
Tri-City’s board acknowledged the public awareness push during a special meeting last week. A marketing executive stated that the branding effort is Sharp “telling their story,” which “has to do with the fact that we know voters need to know more about Sharp.”
It looks like the affiliation agreement has a strong chance of voter approval. Tri-City’s board received polling results last week that indicated 70% of survey participants said they would vote yes. The measure would need a simple majority — 50% plus one vote —to pass.
While Sharp once had a visible presence in coastal North County through its Sharp Mission Park medical group, it sold that asset to Scripps Health in 2008.
But that does not mean that Sharp has no doctor network up north. While Sharp Rees-Stealy Medical Group bears its logo on about 16 large outpatient centers from Otay Mesa as far north as Rancho Bernardo and Del Mar, about 1,000 independent physicians across the county are also affiliated with Sharp Community Medical Group (SCMG). Billed as the largest independent practice association in the region, SCMG is generally a silent partner, providing back-end support in joint contracting with health insurance companies and providing business resources, even though affiliated doctors generally don’t advertise themselves as Sharp practitioners.
While Tri-City is not currently listed among SCMG’s affiliated hospitals, that is expected to change if voters approve the lease, a move that would make it more seamless for community medical group members to send referrals to the Oceanside medical center.
Recently, Sharp opened a new outpatient surgery center in Carlsbad and has another office building on Laurel Tree Lane in Carlsbad where it intends to provide medical services in the future. Sharp said Friday that its Carlsbad investments were acquired before affiliation discussions with Tri-City began and are a part of a long-running push to expand north.
Sharp has long marketed itself under the moniker “The Sharp Experience,” an initiative developed by previous Chief Executive Officer Mike Murphy. The phrase is used to inculcate a sense of hospitality among Sharp’s staff, and it appears to work as the organization’s hospitals have generally done well on the satisfaction scores that all patients receive after being discharge. As it states on its website, this program is not just about following the right medical protocols but also about the requirement that patients be treated as people. This process is quite specific. For example, a “Five Must-Haves” list instructs all employees to “greet others with a smile and use their name if possible; take people where they are going, avoid pointing; use key words at key times; foster an attitude of gratitude, send thank-you notes; and round for relationships to better connect.”
While full marination in the Sharp Experience would seem to be de rigueur if voters approve the affiliation and Sharp begins running Tri-City, Ma said that there is already an attempt to learn from the program. Last year, he said, Tri-City leased the services of a Sharp employee with deep Sharp Experience expertise.
“We are using her as a consultant because we don’t want to reinvent the wheel, and Sharp is well known for being best-in-class in patient experience,” Ma said. “We know that this is not just a tagline for Sharp; it’s a culture.”
Thus far, Ma said, this experiential consultant has advised that Tri-City’s executives be more strategic in their rounding, an industry term used to describe managers visiting hospital units and checking in with individual patients. Dropping in is seen as a main way for leadership to make sure that the overall patient experience is being delivered day in and day out. An analysis of the hospital’s data, he said, argued for making these assignments easier to fit into busy schedules and also a focus on the handful of departments where recent patient surveys show that improvement is needed.
Tri-City, like many hospitals, especially those not embedded in a larger system, has struggled financially in recent years, requiring extreme economy, and even closure of departments such as labor and delivery, due to very low patient volume.
Part of this cultural work, Ma said, is showing employees that the standard is not expediency.
An example, he said, is a recent visit on rounds where a patient said he could not wait to go home and get some sleep. Attempts to rest in the hospital, the patient reported, had been defeated by a second patient in a double-occupancy room refusing to turn the sound down when playing smartphone videos all night long, despite requests from nurses.
“I went out to the charge nurse and said, ‘I understand he’s being discharged potentially in a few hours, but please change his room,” Ma said.
While that order made no sense at all in terms of efficiency, that was not the point.
“The staff needs to see that we are okay going out of our way, even if it’s costly, even if it may not seem to make sense … we need to show them that, when they are here, they are family,” Ma said.
Though he said he does not want to publicize details until he has seen a multi-month trend, Ma said that recent patient satisfaction scores are already showing significant improvement. And work is also underway, he added, to create a new obstetrics and gynecology practice nearby that would help greatly in reopening Tri-City’s labor and delivery department, though that decision is not yet final.