When healthcare's margin takes away from its mission
The ongoing headlines about the staffing challenges and waits in the emergency room are just part of the picture related to St. Michael Medical Center. I was honored to be the director of rehabilitation at Harrison Medical Center for 15 of my 20 years at Harrison. The recent front-page story on the upcoming closure of the Silverdale outpatient rehabilitation clinic suddenly made it personal.
Watching the deconstruction of our community hospital has felt like death from a thousand cuts. I am proud to have been a 20-year hospital leader at Harrison throughout the 1990s and 2000s. Under the senior leadership of experienced and long-term community members, Harrison became a highly respected medical center and an employer of choice with exceptional caregivers with decades of experience from all over the world choosing to work at Harrison and be part of something that we could all feel proud to share with the community. Coupling this proud hospital with one of the most beautiful locations on the planet allowed me to maintain a long list of prospective employees wanting a place at Harrison. As leaders we were encouraged to celebrate our teams, treat them with respect, and trust in their judgement and clinical skills to provide exceptional medical care. They rewarded us by creating a culture of caring and respect that, every day, carried over to our patients and our community.
When the corporatization of healthcare finally made it impossible to remain an independent hospital, Harrison joined other community hospitals to become part of a corporate system. When I learned that the Franciscans, now a subsidiary of Catholic-owned CommonSpirit organization, was to be the new owner of Harrison, I knew it was time to look for other options and left an organization from which I fully prepared to retire. Over the ensuing years, I watched the Franciscans begin to disassemble what was a great hospital, fire or transfer quality leaders, and consolidate physician ownership to the extent that they have a monopoly over many critical specialties in KItsap County. They finished their takeover by changing the name to St. Michael Medical Center and it became just another star in the Catholic corporate constellation. The driving mission of this corporation is to generate profit. We even joked at the time that their mission statement was "No Margin, No Mission." This has driven the Franciscans to make St. Michael one of the most expensive hospitals in the state, with the highest charges and to strip out essential services that don't contribute to that margin.
Today we have a hospital system in crisis. The Franciscans are not alone in financially struggling to make the necessary profit to continue their expansion. However, the difference today is that Harrison was beholden to the community to do the right thing for Kitsap. That meant creating services and programs that didn't necessarily contribute greatly to revenue but were essential services nevertheless. Outpatient rehabilitation is the latest cut and will cease to exist with the exception of a small clinic in Port Orchard. The comprehensive rehab clinic in Silverdale provided state-of-the-art aquatic therapy for people with mobility limitations. It provided interdisciplinary therapy services to patients with complex medical conditions including strokes, spinal cord injuries, neurological conditions, and traumatic brain injuries. Combining Physical Therapy, Occupational Therapy, and Speech Pathology Services, patients were able to work on their recovery from trauma and illness. With the closure of this service, a critical safety net for our community is lost and therapists with decades of professional skills and training will be cast off as unnecessary cogs in the corporate machine that is the Franciscans. Under this umbrella, every service is weighted on the scale of profitability to the corporation. It doesn't matter that patients will need to travel to Gig Harbor or Tacoma for essential services. These are less expensive to operate due to the corporate efficiencies of consolidation. That it adversely impacts the hundreds of patients receiving care there is irrelevant.
At St. Michael Medical Center there are hundreds and hundreds of caregivers who give everything they have every day to support this community, despite the corporate oversight of their hospital. I respect them for everything they do and know many of them have stayed in this system despite its leadership in Chicago and the Vatican, who apparently know nothing of, and care even less, for the needs in our community. Now there are staff shortages, driven by a broad recognition that this is no longer the employer of choice for healthcare in Kitsap. There is now a beautiful and expensive shiny hospital on the hill in Silverdale that can't be optimized because prospective employees see what this corporation is doing to healthcare in Kitsap and across the country. I long for the days when maximizing profits was secondary to meeting our community's needs. I look back affectionately at what Harrison used to be. I look ahead with trepidation at what the system will look like in the future as I need to use its services.
Redge Campbell is the former director of rehabilitation at Harrison Medical Center and a retired health care executive. He lives in Bremerton.
This article originally appeared on Kitsap Sun: Healthcare profit margin now more important that patients in Kitsap
