Health Clinic Trying to Heal Sore Spot--Its Public Image

On the wall of the county’s new Long Beach Comprehensive Health Center, someone had put up a county-produced poster of health employees shouting: “We believe in being the best!”

Down the hall, employees listened to a presentation from a Nordstrom department store wardrobe consultant about how to dress nicely for work.

In a nearby office, Administrator Ed Lee boasted about the center’s goal of getting a patient in to see the doctor and out the door in one hour.

With competition for low-income patients increasing between health maintenance organizations and the county’s facilities, the health department is trying to change its dowdy, inefficient, and, some would say, dehumanizing image.

The Patient Services Improvement Program, begun in 1985 by Department of Health Services Director Robert Gates, is intended to cut waiting times in health facilities, clean up aging and unattractive medical buildings and waiting rooms, and teach county employees to treat patients with more respect.

“This helps us be defensive in keeping the patients we have, and I also wanted to do it because I think it’s the right thing to do,” Gates said. “It started out just as an idea I had, but it has gone far beyond that now.”

Wants to Set Example

Lee wants the Long Beach center to be a sparkling example of the new strategy.

“We’re doing our darndest to show people that we not only provide quality medical care, but that we’re going to treat them right,” Lee said. “And that means with dignity and courtesy.”

Opened in May, the $15-million, palm-bordered building at 14th Street and Chestnut Avenue replaced the old Long Beach General Hospital across town on Willow Street, whose land county officials wanted for a proposed business park. The hospital’s closure set off a furor among community groups that wanted it to stay open, but that criticism has recently diminished.

The new center, along with other county facilities, has begun offering seminars to all employees on everything from adopting a good bedside manner to communicating better with co-workers.

On a recent day, Phyllis Sussman, a representative from Nordstrom, coached a packed room of 35 women, including nurses, doctors, technicians and secretaries, on how to dress for the public.

“You all want to deal with people on an eyeball-to-eyeball level, so when you dress, you are trying to draw people to your face,” Sussman told the audience as she demonstrated tying scarfs to go with suits.

Floretta Taylor, assistant administrator of the Long Beach facility, said that sessions such as that one already are paying off.

“I’ve worked with this group of people for 11 years, and I can’t remember a time when they have gotten behind something like they have this improvement program,” Taylor said.

One big issue the training classes will focus on is patient privacy, which she said “has always been a real problem in public clinics.”

Taylor told a story of a clinic she is familiar with, not in Long Beach, where women can get obstetrical care as well as abortions. Typically, she said, the receptionist at the clinic waits until several women have gathered in the waiting room, and then announces: “OK, ladies, abortions line up on the left, obstetrics on the right.”

“It’s that kind of callousness that hurts public health facilities, and we are well aware of it,” she said.

Lee said patients are already noticing the changes.

A recent survey of their clientele showed that 92% were pleased with their care and the way they were served, he said. The facility had an 8% growth in its patient load over last year, when it was housed temporarily at the El Cerrito Health Services Center across the street, he said.

Lauraine Barber, chairwoman of the Long Beach Health Advisory Council, said her organization, which led the fight against the new facility and against the closure of the hospital, has accepted the change and is encouraged by the medical programs the center offers.

“In fact, we have really been trying to get out the word about their services, because a lot of the public doesn’t know about it yet, they’re so new,” Barber said.

“They have a night clinic you can walk right into, and they have a staff of pediatricians that could handle even more children, so we’re encouraging people to take their children in,” she said.

This year the center expects to serve 45,000 Long Beach-area residents, about one-quarter of whom will come from outside the city limits, he said. The patient mix so far reflects Long Beach’s rich cultural diversity, with about 42% Anglo, 23% Latino, 21% black and 10% Asian, he said.

Shorter Patient Waits

One of his top priorities has been to cut down the long waiting periods--sometimes several hours--that county patients have traditionally been expected to endure.

“All of us have had to stand in line waiting for our own doctors, and by the time we see our physician we’re really up-tight,” Lee said. “So we’ve made a lot of effort to eliminate the waiting time here at the county.”

Toni Yaffe, coordinator of the Patient Services Improvement Program countywide, said a long overdue but simple change in the appointment system has cut waiting times by as much as 40% at some facilities, and by an average of 9% countywide.

Until last year, Yaffe said, patients were told to arrive at county health clinics in waves--the first at 8 a.m., the second at noon--to wait in line for a doctor. Now patients can sign up for a regular appointment.

“It was a very inefficient way of getting them through,” Yaffe said. “But you know how people say, ‘We’ve always done it that way?’ Well, we’d always done it that way.”

Yaffe said that such outmoded practices have driven Medi-Cal and Medicare patients away to HMOs, which are happy to take them on.

Irving Cohen, assistant director of administration and finance for the health department, said the HMOs are signing up more and more Medi-Cal patients, whose enrollment helps pay for fixed costs like utility bills.

Cohen said that according to the state Department of Health Services, HMOs served 115,000 Medi-Cal patients in 1979. By last year that number had swelled to 215,000.

“It shows they are getting more of these (traditional county) patients to sign up for HMOs,” Cohen said. “That’s competition.”

Marion Currie, a county nurse for 20 years, said the situation today is a far cry from the past, when Long Beach General Hospital was the only place poor people could go.

“Everybody feels like this new push is badly needed, because we know that medical care is all competitive now,” Currie said.

Currie, who was named Nurse of the Year by the county this year, said many employees were at first sad to leave the old hospital. But now, she said, the campaign to keep patients happy is spilling over to the staff.

“The mood here is very upbeat. The staff loves the new building because it was built just to our needs and we don’t have to make do and improvise like we did across the street at El Cerrito.”

New Location Criticized

Lee said that when the center was proposed by the county, one of the most bitter controversies was over its location, which critics said was far from the poor population that Long Beach General Hospital had served.

But, he said, the poor are finding their way to the center without much difficulty.

About 50% come by car, 26% by bus and 16% walk, he said.

Because so many patients come by bus, especially the elderly, the county is negotiating with the City of Long Beach to move the bus line closer to the health center.

Right now, Lee said, the bus stops a block away instead of right in front of the building.

“That’s not too bad, but you have to remember that the people who come here aren’t feeling too well,” he said. “We’d like to make it as easy for them as possible.”

That attitude, Yaffe said, is one that the county hopes will be embraced by all its health employees.

“We’re all so used to providing really good medical care, but we kind of let the patient’s other needs slide,” she said. “Now it’s time to give the patients what they want.”