Birth of a Practice Plan
Children’s surgical nurse and physicians
Physicians present the greatest challenge to CEO Treuman Katz. In the mid-1980s, close to 800 physicians are approved to practice at Children's: community physicians who have private practices, house-based physicians who are salaried by Children's and University of Washington School of Medicine faculty members.
Each group has distinct professional and economic interests that come together in the Medical Executive Committee — a group that represents all the physicians practicing at Children's. This committee advises the Board of Trustees, but does not report to it, the medical director or the CEO.
In 1980 more than half of the medical specialists at Children's are full time, either as part of the full-time house-based medical staff or as university faculty; however, 70% of the surgeons practicing at Children's are from the community.
Unlike the University of Washington Medical Center, Children's remains an open-staff hospital with community physicians having full privileges based on their qualifications. Leadership of the clinical departments remains with the department chiefs at Children's.
Medical Director John Neff and the dean of the University of Washington School of Medicine, David Dale, work together to develop the basic principles of a practice plan — a corporate structure — under which all physicians practicing at Children's Orthopedic will be integrated under the joint leadership of Children's CEO and the UW School of Medicine dean.
Physicians are to be paid by the hospital with the hospital and university splitting the revenue evenly — an unprecedented agreement.
In March 1990, Children's University Medical Group (CUMG) becomes the final practice plan structure that makes all physicians truly part of Children's Orthopedic, not just transients passing through it.
First and Only Service
First liver transplant at Children’s
On May 8, 1990, Drs. James Perkins and Robert Sawin perform the first pediatric liver transplant in the Northwest on a three-year-old Olympia, Washington, boy. Since that first surgery, Children's continues to be the only pediatric liver transplantation provider in a six-state area.
Taking the Address Out of Children's
Since the 1960s, Seattle's share of the county population steadily declines as population growth in the surrounding suburbs increases.
To meet the demand for pediatric specialty services, Children's expands its reach farther and farther outside of Seattle, so that families can access care without leaving their communities.
Nurses work with patients at Children’s regional outpatient clinics
By the 1990s, Children's is no longer defined by a single building at one location. It now encompasses satellite clinics and services and partnerships with many other institutions, including a neonatal intensive care unit at Providence Hospital in Everett; inpatient beds at Bellevue's Overlake Hospital; outpatient clinics in Everett and Bellevue; and once-a-month clinics in smaller towns such as Mount Vernon, Port Angeles and Aberdeen.
Re-engineering to Save Costs
Motto from a slide presentation about Children’s re-engineering effort
By 1993, managed care and rate caps on procedures create financial deficits that force Children's to streamline treatments and cut costs, particularly for inpatient care.
In 1995, consultants analyze the hospital and recommend that it downsize from 200 beds to 65... or risk closure!
Hospital leaders embark on a program of "re-engineering" to cut expenses, a plan that includes departmental reorganizations.
Chief Operating Officer Andy Man organizes committees in all departments to identify cost savings and find more efficient ways to complete everyday tasks.
In one example, a committee of physicians, nurses and administrators finds that the hospital orders more than 800 different types of sutures to accommodate the individual preferences of surgeons. The committee comes up with 100 models that serve just as well — and saves the hospital precious resources.
The process of re-engineering lasts several years and produces some $18 million in savings, without compromising Children's inpatient beds.
A Deadly Bacterium
Skilled lab technician at Children’s
Between January 3 and January 19, 1993, adults and children start showing up at emergency rooms in Western Washington complaining of severe stomach cramps and bloody diarrhea.
Ultimately, 50 children are sent to Children's, where physicians and lab technicians work tirelessly on the Dialysis Unit to treat some of the patients for kidney failure.
In the lab, pathologist Dr. Kathy Patterson quickly and accurately identifies the bacterium E. coli 0157:H7 as the culprit, a critical step in treating patients who are in danger of death.
Within five days of being notified, state and county health investigators trace the cause of the outbreak to local Jack in the Box fast-food restaurants where tainted meat from California had been cooked at temperatures too low to kill E. coli.
State officials document a total of 477 E. coli cases and new sanitation rules quickly follow, but not fast enough to save the lives of three children under the age of six, or to spare some survivors permanent kidney damage.
However, it could have been much worse without Children's Hospital's fast medical detective work, collaboration with the Seattle and King County public health departments and the treatment of scores of victims at the hospital's Dialysis Unit.