These are some of the most challenging times in our country’s history for both health care and the economy. As Greater Seattle’s largest nonprofit provider, we believe it is Swedish’s responsibility to lead the region through these difficult times and serve the community no matter what the circumstances. Today, I am very proud to announce that Swedish is leading the way in partnership with Providence Health & Services. Both of our boards recently approved an innovative plan to join forces and form a new integrated health system to serve Western Washington.

There are still many details to be worked out, and the affiliation is pending regulatory review. But when finalized, our new system will dramatically improve health care for the region and serve as a local solution to the nation’s health-care crisis.

What makes our affiliation so innovative is that it is not a merger or acquisition. Rather, it is a unique structure that will allow us to work together to coordinate care for the region while respecting our individual identities and heritage.

In other words, Swedish will still be Swedish. We are keeping our name and will not become a Catholic organization. Likewise, Providence will still be Providence. They will keep their name and maintain their Catholic identity.

What will change, however, is that we will closely collaborate to coordinate care seamlessly for patients from Centralia to Seattle to Everett by:

• Harnessing the power of electronic health records to better serve patients and improve clinical outcomes
• Using our collective data to drive rapid quality and safety improvements
• Sharing resources to assure underserved communities have access to the continuum of care, including subspecialized care and innovative research
• Working together to implement best practices and gain operating efficiencies so that we can reduce costs and make health care more affordable for government payers, commercial insurers and employers.

A partner with a shared mission

Welcome to Swedish’s new blog. Thank you for taking a moment to check it out. We’re excited to have a forum where our physicians and clinical staff can interact with the community and share their expertise and perspectives on health issues.

On this blog, you’ll get a chance to meet different members of the team at Swedish, from our health educators and nurses to our primary-care physicians and specialists. They’ll share tips on how to keep you and your family safe and healthy, and they’ll tell you about promising new breakthroughs in medicine, including innovative treatment options and diagnostic tools being used here at Swedish.

We also plan to use this blog to report on Swedish’s work in the community. As a nonprofit, we’re passionate about strengthening the health-care safety net and improving the health of our region. We’re looking forward to using this blog as a way to highlight our community health initiatives and tell you about some of the nonprofit agencies we’re partnering with to reach underserved populations.

But we don’t want this blog to be just a one way conversation. We encourage questions, comments and ideas for blog topics. The more interactive, the better. With your input, we hope to make this blog a valuable resource that will inspire and motivate people to take charge of their health and do their part to create a healthier community.

With this being the first installment of our blog, I thought it appropriate to include a few thoughts on patient safety in this initial post.

Whenever I talk to people about Swedish, they are often surprised to learn we’re a nonprofit organization. Many people, even those who’ve lived here all their lives, just assume Swedish is a for-profit healthcare system. But the truth is Swedish was founded as a nonprofit institution 101 years ago, and we have remained true to those roots ever since.

The Puget Sound region is fortunate that most of the hospitals in our local area are either private nonprofits like Swedish, state or county hospitals like Harborview or public- district hospitals like Evergreen. The for-profits have not yet made significant inroads into our local community.

That’s not the case in other parts of the country. Of the 5,000 hospitals in the United States, about 18 percent, or 889 hospitals, are for-profit. And that number is growing. Most of these investor-owned hospitals are located in the South and Rocky Mountain region. Here in Washington, only six of the state’s 95 hospitals are for-profit.

The issue of nonprofit vs. for-profit is one I am very passionate about. I’m a big proponent for nonprofit health care and believe it plays a vital role in the fabric of society. That’s why I decided to focus this issue of Perspectives on what nonprofit health-care providers do for the community. I also wanted to use this as an opportunity to talk specifically about Swedish’s nonprofit mission and share some of the innovative new ways we are working to address the community’s health needs.

For-Profit vs. Nonprofit

What’s the difference between for-profit and nonprofit hospitals? One of the main differences is that for-profits are accountable to shareholders. Nonprofits are accountable to the community.

As a nonprofit, Swedish is not governed by investors. Our Board of Trustees is made up of volunteers from the community who work to make sure we’re: 1) meeting the health-care needs of the region; 2) delivering high-quality health care; and 3) managing our resources responsibly. Our board members take their role of preserving Swedish as a community asset very seriously and are focused on ensuring that Swedish is available as a resource for those in need for many years to come. In other words, they see to it that Swedish serves the interest of the public, not that of private investors. And it is worth noting that many members of our Board have made their own significant philanthropic investment in Swedish and thus our community’s health.

Nonprofit hospitals are tax-exempt organizations. We maintain this status by providing a number of services that benefit the community – charity care for the uninsured being one of the most vital. Tax-exempt hospitals in Washington state fill this critical need by providing a combined total of nearly $280 million in charity care per year. Washington hospitals also provide an additional $514 million in other services that benefit the community, including Medicaid subsidies, health-education programs, health-screening programs, support groups, medical education and clinical research.

Not being a public-district or government-owned hospital, Swedish does not raise revenue through tax levies. Instead we rely on the generous support of our community to help us invest in the health of our region. That support helps us to actively do our part to meet community needs and continuously look for ways to do even more.

In 2010, Swedish provided $112 million in services for the community, including:

• $25 million in charity care
• $67 million in Medicaid subsides
• $20 million in health education, screenings, clinical research and other community benefits

Innovative Ways Swedish Is Serving the Community

Health care is one of the most pressing and talked about issues of our time. Not a day goes by when the topic isn’t in the news. The cost and quality of health care, access to it, the overall health of the American population, etc., are all subjects of endless debate and political rancor.

My team and I started this series, Perspectives, to help make sense of the rhetoric and share our point of view on what it all means for our local community. We’ve explored the topic from different angles, from why electronic health records matter to the importance of end-of-life planning. Each letter has generated thoughtful questions and comments from many of you. I’ve appreciated and enjoyed the dialogue, and I encourage you to keep sharing your thoughts and opinions as the series continues.

Elevating the dialogue

Another way we’ve tried to elevate the conversation is by bringing leading thinkers in health care to the Seattle area. Through a partnership with Seattle Arts & Lectures (SAL), we’ve had the privilege of hosting some brilliant writers on the subject, including author and New Yorker contributor Atul Gawande, M.D., and Washington Post and NPR correspondent T.R. Reid. Both are gifted communicators who challenged us to think in new and different ways about health care. Thank you to everyone who was able to join us for these lectures. We hope you got as much out of it as we did.

We are bringing two more authors to the community this year in conjunction with SAL. Siddhartha Mukherjee, M.D., will present at Town Hall on Jan. 12. His new book “The Emperor of all Maladies: A Biography of Cancer,” was named as one of the 10 best books of the year by the New York Times. Then on March 2, we have the great honor of hosting Tracy Kidder, author of several books including Mountains Beyond Mountains, the story of Paul Farmer’s work in Haiti and other forgotten parts of the globe.

The lecture series is one way we chose to commemorate Swedish’s 100th anniversary. Rather than throwing parties to celebrate our centennial, we felt we could have more of an impact by creating opportunities for meaningful dialogue around the very complex and nuanced topic of health care.

Our 100th anniversary symposium: how to fix health care through innovation

The capstone of our centennial year was a national symposium on how to fix health care through innovation. The two-day event was held in October and drew 41 distinguished speakers from around the globe, including chairman and CEO of General Electric, Jeffrey Immelt, as well as thought leaders from Mayo Clinic, Johns Hopkins and Dartmouth to name a few. More than 500 people from the community attended the event, including business and community leaders, health-care providers, health advocates and educators. 

We concluded the symposium with 12 specific action items that individual communities could implement to improve health care at the local level. A few of those action items are summarized below and were part of an opinion piece I wrote for the Seattle Times this fall. I thought I’d share those findings with you in this letter as well.

Here are some of the main ideas that emerged from the symposium:

In this quarterly series of letters, Perspectives, we’ve examined several issues and trends that impact the future of health care. But one of the great untold stories we have yet to discuss is the difference philanthropy makes.

While there is endless debate over the government’s role in health care, one thing you don’t hear much about is the role of philanthropy. Yet behind the scenes, private individuals throughout the country are doing their part to strengthen the health-care safety net by making charitable donations to community hospitals and health-related causes. It’s a spirit of generosity that is quietly transforming – and helping to save – nonprofit health care in the United States.

Philanthropy critical to nonprofit mission of hospitals

There was a time when hospitals considered philanthropy “nice to have.” But today, charitable gifts are critical to the mission of every nonprofit health institution. Even as hospitals work to reduce expenses and operate as efficiently as possible, the funding they receive from Medicare and private insurance companies still doesn’t come close to covering the true cost of meeting the health-care needs of local populations.

The generosity of private individuals and foundations makes it possible for nonprofit hospitals to serve the uninsured and indigent populations. It also supports vital health programs and services, and helps fund needed facilities and equipment upgrades. Just as important, philanthropy also goes towards innovations in health care, ranging from new treatments and techniques to new models of delivering care. (In fact, some of the greatest medical advances of the last century have been funded through philanthropy.)

Still, hospitals throughout the country have felt the impact of the economic downturn on their fundraising initiatives. According to the National Association of Healthcare Philanthropy, about 85 percent of hospital respondents said they were negatively affected by the recession and about half failed to reach their fundraising projections in 2009. 

Swedish experiencing unprecedented support

Welcome to the latest installment of Perspectives. Since we started this series 18 months ago, we’ve examined a number of issues that impact the future of health care. But one topic we have not yet addressed is the severe shortage of physicians in this country.

About 60 million Americans are affected by the shortage in that they live in one of 3,000 U.S. communities designated as medically underserved, meaning there are not enough doctors to meet the needs of the local population. Our state has a higher rate of physicians than most, but even still, there are 147 communities right here in Washington that carry the medically underserved designation.

The physician shortage dates back, largely, to the mid-1990s when experts predicted the country was headed for a surplus of physicians. As a result, medical schools froze enrollment and began graduating fewer and fewer doctors.

The shortage has been exacerbated by aging baby boomers, who require more medical attention as they grow older. And now that health-care reform has passed and 30 million more Americans will have access to health insurance, the demand for doctors will continue to outpace the supply – by a large margin.

Addressing the shortage

The goal of this series, “Perspectives in Health Care,” is to provide a point of view on various aspects of the future health care. Because end-of-life planning has become such a lightening-rod issue, I thought it would be worthwhile to make it the focus of this letter.

At some point in the health-care debate, the issue of end-of-life planning became associated with “death panels” and the idea that a group of bureaucrats will decide who lives and who doesn’t. That’s a shame because that’s not what end-of-life planning is about. In fact, it’s the opposite of that.

End-of-life planning is about you taking control and making your own decisions about how you want to live out the last few years, months and days of your life. It’s about understanding your options in advance; consulting with family and physicians (even pastors and attorneys); and making your end-of-life wishes known via advance directives and living wills.

In my view, it’s one of the most important things you can do for yourself and your loved ones, especially if you’re seriously ill or nearing the final stages of a chronic condition. It allows you and your clinical team to plan a course of care that will help you have the best possible quality of life given your medical condition, so that you and your loved ones can make the most of your time together.

Providing the best possible quality of life in the final days