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Harborview clinic closures: Can officials be serious?

Guest Opinion: Top services for the public are at risk. And health care providers are deeply discouraged.
Harborview Medical Center

Harborview Medical Center rutlo (Matthew Rutledge)/Flickr

There is still no clear word on whether the shocking plans for shutting down and moving Harborview’s primary care clinics — women’s, pediatrics, internal medicine and family medicine — will actually take place. The Dec. 22 announcement by the UW and subsequent attempts at “clarification” could not have been more bungled. Though it would take time to restore trust levels, damage can be mitigated by a prompt and emphatic halt to the clinic closure plans.

The decision was first disclosed to the chairs of the respective UW Medical School departments on Dec. 10 by Johnese Spisso, UW vice president for medical affairs, and Eileen Whalen, executive director of Harborview. The message was unambiguous: The primary care clinics were to be moved off the Harborview site beginning in July 2014.

The department chairs transmitted the news to their faculty members based at Harborview, which quickly spread through the hospital. But it was not until December 18 that Deborah Gussin, associate administrator for ambulatory services, met with the staffs of the affected clinics to “clarify” the situation. A story in the Seattle Times on Dec. 22 announced closure of the primary care clinics along with the reasons given by the UW for the action.

The university and Harborview say the moves, far from being real closures, could serve people better, in their own neighborhoods. But shutting down and moving the clinics would eliminate the huge advantages of central services like interpreters and, importantly, the ability for providers to deal with patients' range of needs, especially when their cases are complicated by chronic conditions. And there's reason to fear that isolated clinics might become easier targets for budget cutting.

But officials undertook a course alteration on Dec. 24 with a message to Harborview staff from the administration saying: “It appears that there may be some misinformation regarding the Primary Clinics at Harborview and we wanted to take this opportunity to clarify this issue. There is no immediate plan for Harborview Medical Center to discontinue providing services to our primary care patients. We understand the possibility for misunderstanding and confusion whenever a process of change is discussed and apologize for introducing any element of concern. We want to assure our patients they are welcome at Harborview and it is our honor to serve.”

The unctuous message did nothing to allay the concerns of the staff. Morale is at a low ebb; people are seeking jobs elsewhere.

Here are some of the missteps that took place during the plan’s rollout:

1. Higher echelon planning: Characteristic of today’s corporate America, the shots were all called by administrators far removed from areas where patients are seen. Physicians who work in the clinics, some of whom are national experts in community medicine, were not involved.

2. Absent accountability: An important change in policy should be announced and explained by the top executives who made the decision. Instead a mid-level administrator, capable as she might be, was trotted out to face the flak. Curiously, the person who speaks with the most authority, medical school Dean Paul Ramsey, has made no statement to his faculty members at Harborview.

3. No contingency plans: The Times story noted that “possible new locations for the primary-care clinics have not been identified,” and quoted Ms. Gussin as saying “the medical center has embarked on a strategic planning process to explore how care can best be provided in the new world of health care.” Whenever I hear someone attach the term “strategic” to “planning,” or wax on about “the new world of health care,” I turn off the sound.

4. Where is the Harborview Board of Trustees on this matter? Harborview is a public hospital with a specified mission to care for the underserved.

5. Ditto for the King County Executive and members of the County Council. They own the property.

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Posted Fri, Jan 10, 9:39 a.m. Inappropriate

"Where is the King County Executive on this matter?"

It's important to bear in mind that Dow Constantine doesn't actually run King County government. He has delegated that responsibility to former Republican and Boeing executive Fred Jarret, the creator of King County's Lean initiative, which is aimed at running King County like a Toyota factory. In the county's own words...

"Lean thinking and Lean tools enable us to create more public value with the resources we have. By listening to our employees [well, at least listening to them in theory and/or after the fact], eliminating waste, and constantly experimenting to find better ways to work, we can deliver better results for the people we serve. We can also free up resources for other uses. That’s better value. That restores the public’s confidence in their government. That makes democracy work."

Presumably the Harborview staff got the Gemba-gram on this.

Mud Baby

Posted Fri, Jan 10, 9:43 a.m. Inappropriate

I have been dithering about finding a new doctor because of the bureaucratic minutiae I am subjected to when I call to get an appt. Then there is the officious reminder call that makes me feel as if I would be lucky to have an IQ of 50.

It seems the bureaucrats are running amok everywhere at U Medicine. In addition to Shakespeare's call to 'kill all the lawyers,' I would include those bureaucrats as well. They are completely out of touch and screwing up a once great medical delivery capability.


Posted Fri, Jan 10, 11:49 a.m. Inappropriate

Abe, thank your lucky stars that Harborview hasn't been taken over by the Catholics...YET.

You mention corporate decision-making--and in this case, the growing hegemony of Catholic hospitals, and the very widespread ownership of medical practices by non-physicians, the long-forbidden "corporate practice of medicine" is upon us.

The excellence of Harborview, and it's vital importance to the community in so many ways, isn't well-recognized or appreciated in the community.

It's unfortunate and ironic that the assumption of administrative responsibilities by the University of Washington has proven to be a backward step, diluting Harborview's ability to continue charting its own course in service to the community.

The Board of Trustees, as is far more common than not in this age of management ascendancy, has failed to do its job as timely overseer and guarantor of accountability.


Posted Sun, Jan 12, 8:15 p.m. Inappropriate

Can officials be serious about even considering closing primary care clinics? Where would these people go? Especially the folks for whom Harborview provides a whole range of services and who would be in serious trouble if they were expected to learn new processes. And Dr. Bergman is absolutely right on about continuity of care and access to a variety of specialists all within a few blocks' radius. To destroy a working system....what utter madness to even contemplate such a move. Right on, Dr. Berman!!!!!

Posted Sun, Jan 12, 8:35 p.m. Inappropriate

"First, the affiliation with the UW provides that all staff physicians are members of the faculty, which in turn assures a reasonably high standard of care."

I'm sure the good doctor believes this, he's one of them, but I expect a reasonably high standard of care at all hospitals. But hell that's just me, maybe others think differently.

My experience with UW Medical staff was that they weren't any better then the local Drs. and nurses here in my hometown. They have more specialists handy to consult but for regular stuff it's a stretch to assume that just because a doctor is a faculty member that he/she has a great bedside manner, listens to the patient, or has more knowledge. Lot's of us have had professors that lack that human spark in the class room and to no surprise it carried over out of class.


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