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One of the keys to revitalizing Northwest Hospital was to establish a better relationship with the medical staff.

Northwest had always had physicians on its board of trustees — the by-laws require at least three, including the chief of staff, who is elected for a three-year term. However, this familiarity seemed to breed something more akin to contempt than to understanding, and the medical staffs relationships with the board and with management had deteriorated badly.

The board recognized the problem in the early 1970s. In January 1974, Allan Davis told a joint meeting of the professional relations and new concepts committee what he planned to do to improve the situation: attend sectional medical staff committee meeting, circulate in the building during the morning hours when doctors make their rounds, survey patients by telephone, and personally go to physicians' offices to observe the flow of patients between their offices and the hospital.

Changes in attitude take a long time, though; one year certainly would not be enough. "When Jim Hart came," recalled Ms. Hageman, "I can remember saying to him, 'You're going to find this medical staff very difficult.' He told me later that when I said that, in his mind he was thinking, 'So what? They all are.' But [later] he said, 'They really are!' "

The board and administration have worked hard to build a solid relationship with the medical staff making trust a first priority. They've worked hard to find out what the physicians' needs are and to get to know them personally. Physicians know that their ideas will get a hearing and that the hospital will be as responsive as possible. They are invited to be part of the strategic planning process and participate in setting priorities for the hospital.

Physicians also know that their patients will be well cared for at Northwest. "Instead of being a modest, average — or less-than-average — little community hospital, it's become a superior community hospital," said Mr. Hart.

It has never, however, lost its warmth. "One of the comments that we always get when patients are discharged and discharge surveys come back," commented Roger Jones, "is that they all love the warmth and the commitment and the concern of the nursing they've been given at Northwest Hospital."

Today the hospital's relationship with its medical staff is among the best in the country. "As I go out to seminars involving representatives from hospitals all over the country, I find that we are unique in the degree of trust we have with each other," said Mr. Jones.

Northwest has worked hard to solidify its relationship with the community as well. From the beginning the board has tried to enlist its neighbors' support for its plans. In the 1970s, the board, administrators, and architect George Hazen held community meetings regarding the Planned Unit Development. By the time the tower was being planned, in the late 1970s, the federal government required a Certificate of Need for any expenditure of more than $100,000. To obtain the Certificate of Need, the hospital's plans had to be approved by the King County Health Planning Council, the area-wide Health Services Agency, the Washington State Hospital Commission, and the Department of Social and Health Services. The hospital's neighbors would have their say in this process as well.

While immediate neighbors and the hospital have not always agreed, they have been generally harmonious. And there's no doubt that the hospital has been an important part of the community at large, offering outreach programs such as the MED-INFO telephone line, Lifeline service and blood-pressure screenings for seniors, the annual Christmas party for hearing-impaired children, the Totem Guild's Alumni Baby Club, and a host of educational opportunities covering topics ranging from "Heart Healthy Eating" to childbirth to living with cancer.

One relationship that seemed not to change over the years was the relationship with Northgate. Twenty years after Northwest and Northgate contended for Hill-Burton funds, they were talking about merging again, this time in connection with the Certificate of Need the hospital had filed for the tower and at the insistence of the Puget Sound Hospital Planning Council, which wanted Northgate, Waldo General, and Northwest to see how they could combine forces to prevent duplicated services and provide more efficient medical care.

The three hospitals met on several occasions to explore joint planning and service options, but there were some difficulties with going beyond that. Northgate was a for-profit hospital; Waldo was an osteopathic teaching hospital and would lose its teaching status if its chiefs of service were not osteopathic physicians. Furthermore, there was no competition for patients between Waldo and Northwest.

However, there was competition between Northgate and Northwest, and the two hospitals often found themselves at odds with each other. Northwest protested Northgate's emergency department expansion and did not endorse (although it also did not actively op-pose) its plan to develop an intensive care unit. Northgate opposed Northwest's Certificate of Need for the tower building.

In 1977, Northwest made an attempt to buy Northgate, going so far as to visit the parent company, National Medical Enterprises, in Los Angeles to discuss the matter. According to Northwest's Certificate of Need application, "Our attempts to buy the institution were rebuffed, simply because of the highly profitable nature of the institution, even though the occupancy is very low."

Northgate did finally succumb to competitive pressure. By the mid-1980s, Northwest was the premier hospital in the North End. In 1984, Northwest bought the Northgate facility. It is now used for day surgery, diagnostic imaging services and physicians' offices.

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