Envisioning a new day for St. Luke's Hospital

Posted on March 6, 2009
 Once upon a time, leaders from all over San Francisco, including representatives from the academic, health, business, labor, and political realms, gathered around a table… and they talked and they listened to each other. After some months, they came to common agreement and shared a plan of how to transform the world…or at least one small corner of it. This may sound like a fairy tale, but it’s not. This is the story of how St. Luke’s Hospital, which has been serving the community south of Market Street for the past 138 years, was saved to make sure that it will continue to offer unmatched care to patients regardless of their ability to pay.

In 2007, California Pacific Medical Center (CPMC), which runs St. Luke’s, announced plans to turn the hospital into an outpatient hub, abandoning it as an acute care institution within a few years. As part of its plans, CPMC also said that it would build a 555-bed hospital on the site of the Cathedral Hill Hotel at Geary Street and Van Ness Avenue at a cost of $1.7 billion.

The plan would have left the neighborhood with only one full-service hospital, San Francisco General. Realistically, people suffering common acute illnesses would be sent to one of the dozen hospitals on the other side of the city, a daunting journey for the elderly and infirm.  “The need in the south of Market area is intense,” said the Rt. Rev. Marc Handley Andrus, bishop of the Diocese of California. “That’s where our most vulnerable populations are. If St. Luke’s disappeared, there would be a healthcare crisis.”

The potential loss of the hospital put factions from every corner of the community into uproar. “St. Luke’s has a very strong identity inside its host community and is deeply connected, not only to individual patients that use its services, but to community stakeholders,” said Paul Kumar, panel member and vice president of the United Health Workers (SEIU), which represents service, maintenance, and technical employees at St. Luke’s Hospital. “It is known in that community as an extraordinary place of healing and there is a deep loyalty and devotion by residents of the area. It’s a special place.”

The Blue Ribbon solution

In response, the Blue Ribbon Panel, an independent and non-partisan committee, was formed to generate creative and usable strategies for ensuring that the hospital would be allowed to continue its long history of community service. “We knew that it would be unsuccessful if the process belonged either to the city or to the labor unions,” said Andrus, who vice chaired the committee.  “We invited a broad group to be involved in the intense, several month process. We wanted to create a neutral space with the shared goal of finding a solution that would serve the healthcare needs of south of Market in an affordable way.”

The 31-member group was notable for its breadth of participants. “It’s pretty astounding to be able to pull together this group of diverse leaders in the business community, labor and healthcare leaders, and a whole community forum as well,” said Dr. Stephen Lockhart, panel member, Vice President, Chief Administrative Officer St. Luke’s Campus, and Associate Vice President Medical Affairs California Pacific Medical Center. “We really were able to bring a focus to what is the best delivery system for healthcare in the south of Market area.”

An Episcopal history

Since the Episcopal Church has been deeply involved in the life of St. Luke’s Hospital from its inception, the involvement of the Diocese of California was a natural choice. St. Luke’s Hospital was founded in 1871 by Thomas Brotherton, a physician and Episcopal priest, using a $5 gold piece donated by a parishioner inspired by his dream of founding the first Episcopal hospital in California.

The hospital became one of four campuses of CPMC in 2007 and an affiliate of Sutter Health, a leading not-for-profit network of community-based healthcare providers since 2001. The hospital primarily cares for residents from South of Market neighborhoods. “With a disproportionately indigent, uninsured and underinsured population that it serves, it has been difficult for St. Luke’s to serve its mission and survive its financial challenges,” said Kumar.

From the beginning, the hospital dedicated itself to serving those in need. “St. Luke’s doors are open wide for the reception of all colors, nationalities, and creeds. Its benefits, refused to none, will be limited only by its means,” said the hospital’s founding mission statement, a sentiment that is echoed in the hospital’s current mission statement as well.

Further, the work of the Blue Ribbon Panel allowed the Episcopal Church to bring its strongest gifts to the table. “The Episcopal Church has a long history of being the convener of public discourse and of work that is comprehensive in the Anglican sense,” said Andrus. “We seek to discern if a container can be created where multiple points of view can be heard. It is often identified with our church and it is an important role for a Christian body to play in an increasingly fragmented world.”

New model yields new results

In total, the Blue Ribbon Panel met seven times between March 2008 and June 2008. In that short period of time, the group managed to achieve the unimaginable task of building accord about how to save St. Luke’s. Besides hearing from its own members, the Panel also got input from a Community Outreach Task Force, which carried out interviews and held a series of town hall meetings to gather opinions from groups and individuals representing a diverse range of backgrounds and experiences.

“The process brought people together and got them to agree that there is a need for a continuation of a level of medical care on an inpatient and outpatient basis that would answer the needs of the community,” said panel member Dr. Ed Chow, Chinese Community Health Plan and SF Health Commissioner. “The Blue Ribbon Panel was called together to see what consensus could be created about the best way to respond to these needs.”

At least in part, the group’s leadership prompted the positive atmosphere and open communication. Andrus, for example, used his experience in community organizing, urban planning, and leading groups to help the panel do its work efficiently and well, said the Rev. John Golenski, an Episcopal priest and executive director of the George Mark Children’s House in San Leandro, California, who mediated the panel. “He invites people to move out of polarized dialogs,” added Golenski. “When he sees people entrenching in opposite corners, he’ll ask them to think of a third and fourth way to think about the problem. It gets them off the dime and out of this locked conflict.”

At the end of the process, the group created a multifaceted set of recommendations, which were adopted by CPMC’s board in September 2008. After considering the future, the group realized that emergency care, obstetrics, and geriatric services will be critically important going into the future, said Lockhart. As part of the new plan, the St. Luke’s campus will be fully integrated into the broad mission, strategies, and operations of the CPMC system. Further, CPMC will build a new community hospital on St. Luke’s site (at a cost of between $120 to $200 million) to replace the old buildings that cannot withstand an earthquake. The new hospital will maintain critical services at St. Luke’s, including an emergency room, an intensive care unit, urgent care, medical/surgical services and a new senior health services.

Broader implications

The results of the Blue Ribbon Panel process were gratifying, but the far-reaching implications of the work of the panel continue to unfold. “This process has transformed some of the relationships between the involved groups,” said Lockhart. “We were forced to all talk to each other and work toward a common goal and that’s never a bad thing.”

Further, those changes have inspired others to consider the possibilities that open and collaborative communications offer. “When the recommendations of the panel were brought forward to the health commission of San Francisco, I saw something there that I had never seen before: labor leaders standing before the commission and supporting a plan brought forth from CPMC,” said Golenski. “The health commissioners were equally amazed. A year ago, they were in the same forum calling each other terrible names.”

Today, Andrus and Golenski are talking to city leaders about starting an informal dialog about the broader health needs of the city that would recreate some of these same opportunities for open communications, said Golenski. “The Blue Ribbon process gave people an image of what’s possible,” he added. “Building peace is one of the great works of the Christian church and the bishop is carrying that out in a way that really works.”

In the Diocese of California, meanwhile, Andrus hopes that Episcopal Charities, which supports nonprofit agencies in the San Francisco Bay Area, will adopt some of these lessons as it moves forward in forming Action Networks around healthcare and education. “I hope we can move some of the energy and the experience of the Blue Ribbon Panel into that work,” he said. t