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.
6. Why announce a cutback in a large primary care site for poor families right now? Even before the Affordable Care Act came into effect, primary care practitioners were being swamped. Our area’s community clinics that are comfortable seeing Harborview patients are already at capacity. With thousands of individuals newly covered by Medicaid, who knows what will happen?
Harborview is the best public hospital in the country for two reasons. 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. Second, the hospital serves both the poor and the rich, which explains the excellent support provided by the state Legislature and the general public.
Those of us who work at Harborview feel privileged to be there. We were attracted to the institution because of its special mission. Crippling that mission blurs the distinction between us and the other large medical centers in the region. The uniqueness of the institution must be retained.