Speaker 0: This is Laura Dierda with the Becker's Healthcare podcast. I'm thrilled today to be joined by Summer Klavanowalli, chief executive officer at Harborview Medical Center, part of UW Medicine. Summer, it's a pleasure to have you on the podcast today.

Speaker 1: Thank you for inviting me.

Speaker 0: Now I'm really excited for our discussion because I know there's been so much happening in health care, and particularly, Harborview Medical Center has been doing some really unique things as of late. And so I'm looking forward to hearing more about them. But before we dive in, can you tell us a little bit more about Harborview Medical Center? What makes it unique?

Speaker 1: So Harborview Medical Center is part of the UW Medicine System, which is part of the University of Washington here in Seattle, Washington. We are about a 500 bed hospital, that well, Harborview is about a 500 bed hospital, and we are a pretty complex combination of a very large safety net. At the same time, we also are a very quaternary level, facility, and we are the only level 1 adult and pediatric trauma center in a four state radius. So we have a pretty unique combination of a mission that is focused on those that are the most in need, those are the that are the most marginalized, very heavily focused on access and equity and care. While at the same time, we are equipped and, very much focused on providing the highest level of care for those that are the most, critically ill.

In addition to that, we are also one of the largest, behavioral health inpatient providers in the state of Washington, and we have the only, psychiatric emergency, department. We have a a division within our emergency department that is for psychiatrically ill individuals that is staffed 247 by psychiatrists. So we're pretty, diverse, hospital.

Speaker 0: No. That's great to hear, you know, and definitely a very, very needed resource for the community. So looking back on the last 12 months or so, what accomplishment are you most proud of?

Speaker 1: Yeah. So, you know, I would have to say we have done a lot of amazing things coming out of this, you know, out of the last several years with, pandemic and then with financial, you know, kind of disastrous financial results. And we've done a lot of really, you know, great improvements in our our quality and safety and patient experience, all the things that everybody needed to, get back to. But I would say that my my biggest achievement over the last year or even 18 months really was the financial stability of the organization. One of the things that Harborview was unique in is that even though we are a county hospital so we're owned by the, by King County, which is a large county in the state of Washington, in Seattle.

We are operated by the University of Washington or UW Medicine, and we were unique in that up until or up until January 1 this year, we are the only county hospital that I've been able to find that did not have, county support for dollars for operations or maintenance or infrastructure. We only had money from taxpayers that would come about every 20 years for some type of a large, like, building expansion or something like that. But on a on a day to day, year to year level, we did not have operational support. So we were in a position where we were as even as a large safety net, we were competing with all the other, health systems in the area from a strictly patient revenue perspective alone. So that that has made that has put us into a pretty complex position over many, many years and put us at a very big disadvantage, particularly after the financial, complications that happened in in health care after the pandemic.

So over the last, year, we were able to work with our state legislative, partners and then eventually with our King County Council members to, pass a councilmanic, tax that is the first time that a county hospital will receive operational maintenance and infrastructure support. So that tax will go into place, January 1 this coming year. And although it doesn't necessarily fix our you know, it's not a magic pill for all of our financial problems, it is a huge precedent that for the first time in all of its, all of its many years, Harborview has a source of income that is consistent and that is based outside of, revenue dollars or federal pull down dollars or things like that. So many, many different, leaders tried it, and, we were able to in the past, and we were able to pull it through over the last year in, you know, in in partnership with, our government relation official our government relation director, our elected official partners, and in particular, our, labor union partners who helped us, SEIU 1199. So really thrilled.

Speaker 0: Well, that's amazing to hear. Congratulations. And, you know, what a a great and unique accomplishment setting yourself up for success next year. I know as you mentioned, you know, others have tried it and not been able to achieve, achieve it. So, you know, what do you think gave you the edge?

Was it just the strong partnership you you have with, your elected officials, labor union in in in your team, or were there other things too that really contributed to your ability, to actually make this come to fruition?

Speaker 1: Yeah. I think it was a magic combination of a very strong government relations director who did a an incredible amount of work to to educate the elected officials both at the state level and at the county level along with myself and chief administrative officer really getting out there and and getting to a point where we were able to show the burning platform of, you know, here's the financial status of Harborview. Here is how we are different because of the mission that we are here to provide, and and here is how it is really hard to compete in a in a competitive health system environment when you are committed to doing over 60 to 70 percent, of your work in a federal governmental, you know, whether it's federal or state money, or state payers. Right? So Medicare, Medicaid as opposed to commercial.

So, you know, kinda setting that platform. And then I think probably more than anything, it was really strong partnerships with elected officials, but then in particular with our labor unions. That's a very strong message, particularly in the state of Washington, to have management and labor standing together to say this is absolutely what we need for this facility to continue to deliver on its mission. And we did that. And that was quite a message to everyone that we were absolutely aligned.

Speaker 0: That's amazing to hear. I know that alignment, doesn't exist in very many places when you think about the labor and management. So, really cool to to see that type of relationship, especially coming to something so important as in this. Now from your perspective, looking into 2025, what are some of the big organizational goals that you're focused on?

Speaker 1: Yeah. Achieving the ability to receive tax money was part of a, multifaceted financial turnaround plan. So other pieces of that financial turnaround plan are really focusing on, you know, operational efficiencies, revenue growth, and philanthropy. The revenue growth is highly focused on capital expansion. And so we are in the midst of, moving into a a period of time where we were we are going to be putting out a RFP to, expand a into a brand new tower to basically, to build a brand new tower.

And so 2025 is going to be filled with a lot of planning with architects, designers, frontline staff, physicians, really to kinda start looking at what what this new tower will look like, how it will help, us achieve our mission, how we design it and build it in a way that is very, patient facing, patient focused, and then provider and staff experience focused. We have a current campus that is very, very old. It is not, we do not have enough space for our patients. We still have many, many patients boarding, you know, not only in double triple rooms, but in hallways and conference rooms, etcetera, here at Harborview. So we are incredibly excited to design this, and really are are looking to, dig in in 2025 to kick that off.

Speaker 0: I love that. I I think it's, you know, really such, an important way, as you mentioned, to show growth, provide the expanded access to care, and really make sure patients are able to, receive the treatment that they need in a timely fashion. So, it seems like a huge project and something that, will be really beneficial as well. So lots of opportunity, it sounds like, ahead, but I'm also wondering what are some of the headwinds that you're anticipating for the next year or 2?

Speaker 1: Yeah. So, you know, headwinds are going to be continued financial, you know, struggles as we figure out how to, increase our capacity, our space while we're waiting for that tower to go up to get creative in order to continue to enhance our revenue to, you know, be able to not only move ourselves into the black, but also, start to to, have enough cash to have a little bit of, have a little bit of money to reinvest in people and in our people and our programs. But most I I would say the biggest headwind we are facing is our incredible worry about, new administration at the federal level and what that will mean for Medicaid in particular in the state of Washington. We are a huge Medicaid expansion state, and we are also very dependent on our directed payment systems from our, from our federally directed payment programs. And so any changes to that type of funding those types of funding sources that would limit access and limit ability to, get reimbursed for those for that Medicaid population, which is one of our, you know, really our the core of our mission is incredibly, concerning and and and would be quite devastating for a facility like Harborview.

Speaker 0: Absolutely. I can imagine just the uncertainty of exactly what will happen and and how, you know, the the next few years unfold. Certainly, it's unnerving, especially given, how reliant folks are on, you know, the Medicaid and being able to provide care to that population is so critical. Yeah. When you're working with your team through this and and knowing, you know, the possibilities that could occur over the next few years in Medicaid, is there anything that you're doing to try to just protect yourself against the the that potential?

Or

Speaker 1: or Right. Right.

Speaker 0: Navigating some of those waters, I guess.

Speaker 1: Yeah. I think I mean, first of all, we're just trying to understand, you know, and anticipate what could be coming. Right? Just trying to follow really closely with our with our federal government relations, individuals back in DC and just trying to understand, the lay of the land as it as it will evolve. But I think, you know, from our perspective right now, we're really trying to that that is why it's so important for us to, figure out additional sources of revenue that it's not just, those those Medicaid federal dollars.

We're also you know, the tax was so important. However, I also think it's really a time for for us in health care in large safety nets like Harborview to really think about what the how we can how we can partner a little bit differently with our states around, how we manage our Medicaid populations and how we can think differently about, partnerships with managed Medicaid plans, trying to have a much more population health focus even though, you know, patients that are on Medicaid plans can be can have a lot of complications that make it difficult for population health to be successful. But I think that we have to start to get much more creative in the space of, of how we deliver health care to those that are the most in need. And because there is a a real world in which we will continue to be squeezed and limited in in money that will be given, in order to deliver these types of services. So we have to think differently just like we are, you know, at the at the federal level with Medicare with making care primary and and things like that.

Those types of pilots need to move to what can you learn about managing the most complicated of our individuals, the most sick, the most, socially and behaviorally complex, and how we better our how we're better stewards of the resources we are given.

Speaker 0: That makes a lot of sense. Thank you so much for digging a bit deeper there with me. Now before we wrap up, I wanted to, talk for just a moment on leadership. How are you evolving as a leader, especially given some of the opportunities ahead, but but also clear challenges?

Speaker 1: Yeah. Boy, have I learned you know, I I came into the CEO position in December of 2020 after after being at Harborview for a very long time in a in a very, you know, various operations roles. I I would say I'm evolving very quickly in well, I don't know 4 years as quickly, so that was probably way too much credit for me. But I am evolving in my ability to better understand how I'm going to have to navigate this facility and set it up for the future. I think when I first came into this position, I was very much focused on a, you know, worldwide pandemic, keeping patients safe, you know, kind of in the moment type crisis management where the last couple years I've had to pivot more to a traditional CEO role, and really start to think about, you know, this is a complex institution that has not had a good way to ensure its viability into the future.

And so a lot of what I'm doing as a leader is thinking about, okay. When I'm gone, what is the legacy I wanna I wanna leave here? Here? What do what do I want the leader, the person sitting in this seat 20 years from now to say about the time I spent as CEO? And I want them to be able to say, well, that that particular CEO set us up for, for the future.

She ensured we had, you know, sufficient buildings built and sufficient space built to to accommodate growth, both organic and strategic, up, you know, well into the 20 forties, 20 fifties, not just, you know, what we need right now. She looked at creative ways to ensure we had revenue coming in for Harborview. You know, just really look at how I set up the future of this place. Harborview has been such an iconic institution in the state of Washington for for so long, and things were so precarious, during COVID that I really set my mind to my job as a CEO or as a CEO during this time frame is to ensure Harborview is here, you know, 20, 30, 40, 50, 60, 70 years from now and being able to deliver the same exact mission we deliver right now.

Speaker 0: That's amazing to hear. Summer, thank you so much for joining us on the podcast today. This has been such a fun and inspiring conversation, and I look forward to connecting with you again soon.

Speaker 1: Thank you so much, Lauren. I really enjoyed myself. Thanks for having me.