The Observation Deck

Lynn Farris wrote:...What I see from the comments is that the Clinic did a good job of negotiating contracts with the city and the City didn't do so good.

I think if you look at other contracts we negotiated with other entities, we most likely should have hired someone else to do our negotiating.

...

Lynn

I was thinking about this the other day, Maybe the city did the best they could?

Let's be honest. The Cleveland Clinic is the city's largest employer, our only hospital and carries a lot of clout on everything from the schools, to Mainstreet, from Office on Aging to Pre-Natal Care. In short I have to think many of these conversations are pretty one sided.

Bill

What would you have thought about the person that held out for another $.10 a square foot and lost the deal? We all know what happens to the mayor and council that runs the hospital out of town.

I know this is just the big hippie in me, wanting everyone to get along. But I wold love to know what the Hospital actually spends in this town every year. Rent, taxes, civic involvement, school programs, scholarships, etc. or what percentage of what they take in.

It would seem to me that the Clinic has a 30 year contract. So that said shouldn't we be doing everything we can to make them want to stay and build and be part of the community. Or should we stand 50 yards away and through rocks at the windows?



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Jim,

I think you are exactly right. We were afraid to lose.

The person who negotiated the contract didn't want to be the one holding out for the extra .10 or .50 or $5.00 and lose the Clinic. They didn't want to lose the hospital or the employees. But the first time it was negotiated was many years ago and we didn't have the Clinic, we ran it independently I believe.

Only if you are willing to walk away and say we can find someone else who can do better, or just as well, if you don't want it, will we win.

It is a calculated risk, sometimes you lose. We were risk adverse, we wanted it or needed it too badly. We certainly didn't seem to play hard ball or even semi hard ball. Could we have negotiated a better deal? Most likely. Could we have lost? Possibly.

The West End Contract, which I am very, very familiar with was the same. The city got a bad deal because we wanted it too badly, we didn't think another developer would ever want to come to Lakewood if we didn't agree with it. Mayor George has proven that wrong by negotiating a much fairer contract for the city with Ryser.

I think it has to do with the "We're not worthy syndrome."

The point I was making was the contract negotiation really has nothing nefarious to do with the Clinic not wanting to be located in Lakewood.

Lynn Farris wrote:...I think it has to do with the "We're not worthy syndrome."

Lynn

Lakewood's single biggest problem - Low Self Esteem.

It would be interesting to see where this really took over the psyche of the city. I remember back to when many different groups would use the terms "Last Chance for Lakewood," "No one else will ever be interested if we do not...," "Lakewood would be better if we just had..." All of this point out decencies in the city, the businesses and the residents.

What kills me is that it becomes a self fulfilling prophecy. But it is so easy to change, costs nothing, has an immediate positive impact on the city and the property values. If someone needs proof, look no farther than Tremont.

"Well they have art walks...," "They have restaurants...," "They have this or that." Tremont has changed very little outside of the PR of the residents, that has bled over to the community. Because it is now "cool" new businesses are attracted, residents flood in the prophecy is fulfilled. The Warehouse District another example. It was single residents that got that going decades before it became "cool" and the developers got involved turning it from cool to clean and "developed."

One might also wonder why this drive to low self esteem was ever started. The easiest reason to see, is to drive down property values.

We are planning on a series of articles that disprove all of the "reasons" for bailing. The next time someone says the taxes, see if it is not one of those people that asked us to raise the taxes for schools for decades. Then ask how old their kids are. But it leaves the age old reason why "old style Lakewoodites" want to leave, and even that is a misconception. We have people that moved to Westlake, Bay Village, Cleveland Heights, Shaker Heights and New York that lived here moved out, and moved back! We have examples of people from outside the city moving here because they couldn't believe what they found when they toured the city. Intelligent, engaged, residents in a walkable city that is safe with parks, lakes and more. A perfect city to LIVE in.

So here we are, poor Lakewoodites, nothing to be happy about. Stuck in the most livable area in the USA, in the best suburb in the region. Sounds like people from outside(who did these studies) see Lakewood a little differently than Lakewoodites do, and that is very sad. I mean in a country going to hell in a hand basket, stuck in the most livable area in the best city sounds like a great foundation to build on.

But what do I know, I just see the numbers, talk to the people, walk the streets, and enjoy this city more and more each day.



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On a side-note about the Clinic decisions (not to take away from the civic pride comments!) but the one that really made a difference in my family life (and many others in Lakewood, I would think) was the decision to take out our pediatrician's office (Dr. Muniak) and move her out to Avon! I was willing to bet that many of her patients were local kids who, like us, loved the easy access to her office and quick response when an urgent appointment was needed. She was the very best of a more urban-based medical practice. I am nearly 40 and she was my second pediatrician when I was a wee lad so I was excited to find that she was still in local practice when we moved back up here with our daughter. We want to continue with her but taking a 1/2 hour to drive with a sick child makes us now think about finding a new physician. She wasn't happy (not publicly, I would assume) and neither were her staff. I can't see what the Clinic was thinking when they made this move. While I don't see all of Mr. Call's points, I do have to wonder why Avon needed a new pediatrician and we needed to lose one.

Good friends of ours knows a councilperson personally so they brought it up with him and he said his hands were tied in this move. I guess it is decisions like this that make me question whether or not the Clinic the best steward of Lakewood Hospital. Anyway, good topic either way. Always good to chat about that.

...but there are practical things that we, as a community, should bear in mind while we discuss the Clinic's role in Lakewood.

The first thing to keep in mind is that this ship has long since sailed and debating who should be blamed for a contract that could have been better is not be the most efficient use of our time and resources. Clearly, hindsight is 20/20 and guessing the negotiator's strategy and reasoning at the time is a spotty game at best.

I tend to believe that in most circumstances people make the best decisions that the can with the information that they have in from of them at the time. Would it not be better to look forward and say: "Here is our situation and here are our goals... how do we make them happen TODAY?."

Another thing to keep in mind is that the Clinic is a regional operation and they will do their business planning accordingly. I find it HIGHLY unlikely that someone in the marketing department at the Clinic has put a bulls-eye on Lakewood. Instead, they will look at their entire product & services mix as well as their entire patient flows and create marketing strategies that will generate the greatest return on their investments.

That means promoting the places where investments were made as well as advertising in places that have a lower response. I would tend to agree that there is little chance that they would place their advertising dollar on E 50 for LH as the return on that advertising dollar would be far less than they could get by placing the same ad on W 117.

Lastly, I take GREAT exception to the stereotypes that the originator of this article has presented. I wont take my rant to the degree that I could as far as that is concerned other than to say - you should be ashamed of yourself.

Peace,
~Charyn

Mr. Florian

Your comment illustrates my point.

Why should you have to go to Avon to see a pediatrician?

Why should I have to go to Crocker Road to see a specialist?

The Clinic ill serves this community. Perhaps kill was too strong a word.
A better term might have been use, drain, wast away, weaken, deplete, impoverish, undermine or diminish.

Mr. Call.

The possibility exists that without the Clinic, LH may already have been closed. In the era of PPOs, etc, stand-alone hospitals are virtually extinct. Look at the number of hospitals that have closed in Cleveland in recent years. And all the ones that have survived are now part of the Clinic or UH systems.
Why should you have to go to Crocker Road to see a specialist? For the same reason you'll go there to buy a book. Because you have to
The question of Lakewood's inferiority complex aside, you just can't ignore the fact that everything is moving further out. You'll see your specialists or buy your books in Westlake because, at the end of the day, you really have no alternative, do you?

I think it is sad that we have such a feeling of "well, I guess we have to do it because there is no alternative." It is kind of a rip off that the most densely populated city between NYC and Chicago has to leave the city to get some basic things like specialist medicine or something as simple as buying a book. We aren't some bedroom community. We have two huge main thoroughfares that are emptying out yearly. Why? So people can drive to a place like Crocker Park that strives to imitate what we already have... a city block of storefronts all within walking distance of one another. They have to park farther from the very stores they won't support in Lakewood for the reason of what? Parking, oddly enough.

I think, at least in terms of medicine, we are at risk of becoming irrelevant as a city, stuck between two distinct types of medicine with nothing of our own. In Cleveland there a lot of Family Medicine offices throughout that cater to a population that may lack in both funds and insurance. They tie into Metro (the last Public hospital in the area) and provide a good spectrum of services. In the outer ring suburbs you get the specialists in droves, providing services that fit their population that has both money and insurance for a wide variety of services that many can't access. This is where the real money is and yes, the Clinic can make economic decisions but they do so at the expense of the communities around them. This isn't the first decision that the Clinic has done at the expense of the communities they find themselves in. It isn't just the more working class or at risk neighborhoods, too. My mother who lives in Westlake complains that many Clinic doctors are forced to make referrals to the main East Side hospital to bring business there vs. using services more accessible on this side of town. Deconness Hospital provided some of the low cost services that supported the more at risk neighborhoods around it. It provided a pressure release for the similar sorts of services up the street at Metro but when it was bought out by the Clinic it became an office building only, reducing options for most of Clevelanders in need of services but lacking the resources to pay for them.

Where does that leave Lakewood? I am not predicting gloom and doom but I see the Clinic thinking, as others on here have pointed out, regionally instead of locally. This is fine as a business model but terrible when medicine really isn't a regional business. It is local, it is neighborhoods and it is sad when decisions are made not even at a county level (as I now have to leave the county to get the same medical for my daughter as I have gotten for the last 6 years since we moved up here). Sure I can switch providers but I don't want to do that. Doctors aren't like restaurants or big box stores where you can just drive around the corner and find a new one. There is a level of trust and understanding that gets built up over time and can be difficult to replace.

What is more frustrating is that our own City Council doesn't really seem to be able to do anything about it, even though some (at least one of them) have expressed concerns over this as well. I assume it is for fear that making too many waves will make the Clinic decide that being a resident of Lakewood's hospital isn't such a good idea. It is a kind of big money blackmail that makes my stomach turn.

Is this strictly a self-esteem issue? To Ms. Roberts it seems to be. Just "accept the way it is" seems to be that mantra and many accept that to be true around here. To Mr. Call it is more conspiratorial where there are meetings behind closed doors maybe where their goal is to purposely upset the balance in Lakewood. I don't think it is to that level. I think it is worse. I think it is a disconnect between decisions being made at the corporate level and the communities that these decisions effect. I doubt that a single call from the Clinic was made to a soul in Lakewood when they decided to move our pediatrician. They certainly didn't ask her or her staff as they were just as surprised as we were. They certainly didn't ask our council people as they were just as dumbfounded by this decision.

We went to the Ombudsman at the Clinic and we were simply told, in so many words, that is the way the cookie crumbles. So what do we do? Sit back and pay the gas prices to drive out of county to get the kind of services we should expect in a town built on the idea that you shouldn't have to drive everywhere? Where do we go when corporate interests outweigh a neighborhood or customer interest?

Sorry to ramble, it is just upsetting and concerning to me. Thanks for reading this far!

Mr. Florian.

Two comments on your insightful post.
First, a philosophical one. Is "that's just the way it is?" defeatist thinking or just realism? The move to outer suburbs didn't start yesterday, and it's certainly not limited to NEO. Entities like the Clinic have the billions to continue the exodus. The Davids may be spunky and have sentimental support, but the Goliaths hold the cards, especially in something as necessary as health care. Right or wrong? I can 't say, but truly that IS the way it is.
Second I had a conversation a few days ago with a Clinic system employee who works in a suburban hospital (not LH) operated by the Clinic. I asked a similar version of your musing that the "good stuff" goes downtown. "Are the satellite hospitals just farm teams for the main Clinic?" Her response was a surprisingly frank and unequivocal, "of course."
So there you have it. To some degree at least, Mr. Call is right. Over its tenure, LH will continue to evolve (or devolve) from the full-service community hospital it traditionally was. But I still contend we have the civic power to exert at least some power in this situation.

I would call "just the way it is" defeatism vs. realism. Realism is acknowledging that the sun rises and sets. Defeatism is saying we only have light for half a day and must huddle up in the dark and do nothing! We have fire and later electrical lights because of the need to change our perceptions of what is not changeable. It is cliche to mention it but "just the way it is" would have us still owning slaves or still paying taxes to the Queen.

I do agree that we can't necessarily stop what the Clinic is doing. That in itself isn't in our control, apparently. But maybe we have to be more directly involved in the development of such services in Lakewood. Are these decisions being made because there truly is no revenue coming from local in-city doctor's offices? Maybe I won't get my pediatrician back to Lakewood because that is outside of our control but couldn't the city say "we need more of this type of service" to get an answer as to how that would work? Or put some strings on their rental of the hospital that at least asks to be involved with decisions involving the types of services coming in or leaving the city? Maybe they won't have a true say in the final decision but at least the city officials would have a better understanding of these decisions when citizens call with concerns.

I have no doubt that the Clinic sees the other non-main hospitals as "farm teams" to a degree. This is fine if 99% of the services are just as good as the main house. I realize if I have a serious condition requiring special needs I would end up at the main campus. But for this shouldn't mean that more "routine" medical needs be left short shrift. I hope that isn't what your friend meant!

But to your first point, just shrugging and moving on will only hasten Lakewood's dive into urban decay. Maybe we can't be what we all want to be but I think we have to find out how to keep at least a decent amount of basic services in the city or we will become just another West Side Cleveland Neighborhood vs. a unique city in its own right.

Actually, Phil, Lakewood is a bedroom community in the sense that the daily commuter outflow to jobs outside of Lakewood, is second to Cleveland Heights, among suburbs, in the region. (The PD reported this last year.)

Also, that hospital-oriented medical practice supposes a regional business model seems to follow from years of consolidation, economies of scale, and, whether we like it or not, bottom line considerations which do not find a place for what could be called, 'humanitarian' factors.

imo

Phil I understand that you are upset that your pediatrician left Lakewood, but please don't think there aren't any pediatricians left in Lakewood. Of all my friends I only know two who leave Lakewood to see a pediatrician. There are plenty of fabulous pediatricians still in the city. I am very picky about my doctors because I have children with special needs and I have to say that Lakewood has some great pediatricians associated with the hospital. I do get aggravated that for specialists I have to go downtown, but it makes sense. There are not a lot of specialists and its realistic to keep them in a central location. Its a pain but I am grateful that we have such good health care in this area. Sometimes its easy to lose sight of the fact that here in Cleveland we have two big hospitals that both give extraordinary care. A lot of large towns don't have the care. When we were in Arizona I was shocked by how awful medical care is out there. I would have loved to drive 40 minutes to see a specialist but their hospitals didn't have them. They suggested a mental hospital for my son to get him the care he needed! So my point is we may not always agree with what the Clinic does for Lakewood, but we should be grateful that we have a wonderful local hospital and the opportunity to see specialists here in our town and also nearby.

Danielle, I completely agree that there are other pediatricians in town. My wife's midwife gave us some recommendations on some of them and we are considering them. I guess what upset me was that my pediatrician provided a brisk service to a lot of local (meaning Lakewood) residents and the decision to move her had nothing to do with her, her customers or the city she works in. We have a thriving medical community in Lakewood. My dental care is all Lakewood (even specialists) and all of our prenatal care is done in Lakewood. I agree that what we have now is good, if not great many of the times. But I have to be concerned when decisions aren't made that make sense at a customer level and simply saying "oh well" doesn't make it sit well, I guess. I could see a situation where some doctor needs to move out because their practice has declined but when a practice is thriving and meets the needs of many consumers in the neighborhood it just smacks of... well, apparently the inevitable from much of what I read on this thread. Thanks for the good words, though.