At the turn of the twentieth century Seattle's medical community was largely dominated by hospitals run by religious orders and small, infirmary-type hospitals. When Dr. Nils A. Johanson arrived from Denver in 1907, a new type of hospital was developing. These would be established by doctors and emphasize new methods of treatment and care. Johanson and a group of fellow Swedish Americans established one of these new hospitals, Swedish Hospital in 1908. Over the next three decades he would lead the hospital's expansion by hiring specialists, establishing a nursing school and the Tumor Institute (now called the Swedish Cancer Institute), and utilizing the latest treatment advances. Swedish Hospital, now called Swedish Medical Center, has grown from a 24-bed hospital in a converted apartment building to a multi-site complex with more than 1,000 beds and multiple specialty programs in King and Snohomish counties.
A New Kind of Hospital
Seattle was still a somewhat isolated city in 1907 when Dr. Nils A. Johanson (1872-1946) arrived from Denver, where he had recently earned his medical degree at the University of Denver. As a recent graduate, Johanson was well-versed in the latest surgical and treatment techniques. He soon found that these new techniques had not been introduced in Seattle's hospitals. The existing hospitals, including Seattle General and Providence, which were run by Protestant and Catholic religious orders respectively, and a handful of smaller, doctor-run hospitals, relied on older models of general-practice medicine.
Johanson received his medical training just as specialization was becoming more common. His training had also emphasized sterility in the operating room. Recent scientific discoveries had explained germs and their role in infections, but antibiotics had not yet been developed, making surgery a very risky endeavor.
Johanson, a Swedish immigrant, recruited a group of fellow Swedish Americans to invest in a non-profit hospital to be built on the new developments in medicine. On June 13, 1908, Johanson, Andrew Chilberg, Peter A. Hallberg, John A. Soderberg, John Kalberg, Godfrey Chealander, Nels J. Nyquist, Emil Lovegren, Israel Nelson, Gustav Axel Edelsvard, and H. E. Turner signed the incorporations papers for Swedish Hospital. This hospital's incorporation papers stipulated that only Swedish Americans could be trustees, a requirement that would remain in place until 1967. The charter also stipulated that the facility would be operated as a non-profit entity, with all revenues reinvested in the hospital.
The trustees represented a cross section of area occupations. Nelson practiced law; Lovegren managed the Preston Mill Company; Edelsvard was an architect. There was also a restaurateur, Hallberg, and a banker, Chilberg. Katharine Johanson Nordstrom noted in her biography of her father, Dr. Johanson, that this diversity served the hospital well because of the diverse knowledge the trustees brought to the hospital's management.
Raising funds for a hospital building took two years. The Swedish American community, including members of the Swedish Club and several churches, gave generously. According to Nordstrom,
"The Swedes living in the Pacific Northwest were grateful for the opportunities they had found in America ... . They wanted to do something concrete to express their appreciation, and the hospital gave them this opportunity" (Nordstrom, 26).
Fundraising took a variety of forms. The hospital solicited $20 or higher donations that could be redeemed for 60 percent of their value in hospital services, up to $100. The Swedish Building at the Alaska-Yukon-Pacific Exposition, a world's fair held on the University of Washington campus in 1909, was built and managed by hospital supporters as a fundraiser for the hospital. Unfortunately, it did not turn a profit.
By June 1910 they had sufficient funds to sign a lease on an apartment house on Belmont Avenue in Seattle's Capitol Hill neighborhood. The hospital adapted the apartments into hospital wards, laboratory space, and operating rooms. Just a month later, on July 21, 1910, the first baby was delivered -- Clara Peterson. In a 1973 interview, Clara remembered how she often heard the story of Dr. Johanson taking her mother to the Capitol Hill hospital in his Stutz roadster from their home in Queen Anne. The rutted dirt roads between the two hills slowed their progress, but they made it in time for her birth. She was the first of thousands who have since been born at Swedish Hospital.
Very soon after opening the 24-bed hospital on Belmont, it became clear that the building would be inadequate. In August 1912 the Trustees voted to issue $100,000 in bonds to finance a new, bigger building.
From Tragedy to Opportunity
At the same time Swedish Hospital was planned and opened, another Seattle doctor, Edmund M. Rininger (1870-1912), had purchased very large home from Charles J. Smith at 803 Summit and was renovating it. His Summit Hospital was near completion when, on his return from visiting a patient in Kent on July 25, 1912, Dr. Rininger's car collided with an Puget Sound Electric Railway train at Riverton, south of Seattle, and he was killed.
Dr. Rininger's death left his soon-to-be-opened hospital without a doctor. His widow, Eleanor Rininger (1869-1960), hoped to find a buyer for the hospital and the Swedish Hospital Board of Trustees seized the opportunity. They voted to purchase the 40-bed hospital and its furnishings, including china conveniently monogrammed with the initials "SH." In addition to the board issuing bonds for the hospital's purchase, the Swedish Club held a bazaar to benefit the hospital and raised $5,000 in one week.
A dedication ceremony marked the March 16, 1913, opening of the new hospital building. Mayor George Cotterill (1860-1958) spoke at the dedication, as did Washington governor Ernest Lister (1870-1919) and Dr. Johanson. The new hospital featured an X-ray machine and a medical library, which Eleanor Rininger donated to the new hospital for a Rininger Memorial Library.
Nurses and Their Training
The nurses who staffed the hospital lived in an adjacent house. Swedish had operated a nursing school since 1910, as did several area hospitals. Legislation passed in the Washington Legislature in 1909 required that nurses complete a course of study and be certified by a licensing board. This led to a proliferation of nursing schools run by hospitals.
Due to evolving methods of nurse training, in 1946 Swedish combined its nursing school with the University of Washington School of Nursing. Nursing students did their course work at the university and their clinical work at Swedish, receiving their Bachelor of Science degrees from the university. In the 1980s, an increase in nurses with Associate Degrees led Swedish to sign an affiliation agreement with Seattle Pacific University to assist those nurses in gaining their Bachelor of Science degrees. Swedish provided classroom space at the hospital and paid the nurses' tuition. Swedish has continued to support nursing through additional affiliations and by providing tuition reimbursement programs for nursing assistants who would like to complete their Bachelor degrees and become registered nurses.
Swedish Hospital's nursing school grew steadily, from a first class of four to 89 graduates in 1927. The program consisted of a three-year course of instruction and was affiliated with Children's Orthopedic Hospital (later renamed Seattle Children's Hospital), where nursing students studied and worked with children for two months.
Applicants to the nursing school had to be female, between the ages of 18 and 35, and graduates of high school or its equivalent. Upon their acceptance, students had to outfit themselves with four gingham dresses, 12 aprons, six collars, and two pairs of "high black leather shoes with low military heels, rubber capped" (Sixteenth Report, 58).
The nursing school combined with the University of Washington School of Nursing in 1946. Nursing students did their course work at the university and their clinical work at Swedish. In the 1980s Swedish signed an affiliation agreement with Seattle Pacific University and provided space for classes at the hospital. Swedish has continued to support nursing through additional affiliations and by providing tuition reimbursement programs for nursing assistants who would like to complete their bachelor degrees and become registered nurses.
The nurses lived next to the hospital in a series of residences until about 1960. At first they lived in a series of houses on the block with the hospital, then, in 1946, the hospital built Eklind Hall, a residence for the nurses.
The Tumor Institute
The new hospital on Summit Avenue quickly filled with patients. In 1916, with the completion of the Peterson Addition, the hospital grew to 130 beds. This was followed with an expansion in 1929 that added 70 beds in the Roseleaf Wing. The hospital could also care for 70 babies in its nursery.
In 1928 Dr. Johanson attended an international cancer conference in London where he learned about new methods of treating cancer with X-ray radiation. Johanson also visited the Karolinska Institute and the Radiumhemmet in Stockholm, Sweden. Both of these hospitals conducted research into radiation therapy and treated cancer patients. Johanson established the Tumor Institute at Swedish (now known as the Swedish Cancer Institute) in 1932, based on this model of integrated research and treatment.
Seattle architect Carl F. Gould designed the Tumor Institute building to accommodate a 16-foot-long X-ray tube with a 30-inch-wide bulb. It also held 75 beds for patients undergoing cancer treatment. Dr. Charles B. Ward, who had recently studied cancer treatments in Europe, and Dr. D. H. Nickson, a Swedish Hospital pathologist, led the institute. It was the first treatment center west of the Mississippi River to do high-energy radiation therapy for cancer.
Decades later, in 1988, Swedish's Executive Director Allan Lobb would identify the opening of the Tumor Institute as one of the keys to Swedish's success. A newspaper article quoted his assessment that "the development of the Tumor Institute was a forerunner of the modern hospital enterprise," and he traced the hospital's later achievements to its establishment (Paulson). The Tumor Institute was the first of several times that Swedish would adapt new techniques and bring in new specialists to its facilities. This, in turn, attracted more such ventures and staff that wanted to be part of those endeavors.
Recruiting and Training
Dr. Johanson often looked outside the hospital for promising doctors who would advance the care of its patients. In 1913 he asked Europe-trained Dr. Carl Leede, a specialist in the new field of internal medicine, who Dr. Rininger had brought to Seattle, to stay on and work for Swedish. Later he hired doctors who had trained at the Mayo Clinic in Rochester, Minnesota, and brought Dr. Simeon Cantril and Dr. Franz Bushke, prominent specialists in radiation therapy, to the Tumor Institute. Johanson also hired Dr. William B. Hutchinson (1909-1997), who would later found the Fred Hutchinson Cancer Research Center.
In the same vein, Swedish has long been an active supporter of medical training. In addition to the nursing school, the hospital has hosted internships and residencies for newly minted doctors since 1921. According to Dr. John Wright, former Vice President for Medical Staff Affairs at Swedish, having interns and residents creates an open, innovative working environment for doctors because those students ask questions and bring in new ideas from their recent coursework. When state licensing requirements changed to include a requirement for continuing education hours for doctors, Swedish developed a program that is open to all area doctors.
In 1937, the hospital expanded again with the addition of the 36-bed Northeast Wing built at the corner of Summit Avenue and Marion Street. The new wing also housed a swimming pool, a classroom, vocational education rooms, and physical therapy rooms. These new orthopedic medicine facilities served patients between the ages of 14 and 20 who could not go to Children's Orthopedic Hospital, which only took patients up to the age of 14.
The architectural firm Smith, Carol, Johanson designed the Northeast Wing. The firm's Johanson partner was Perry Johanson (1910-1981), Dr. Johanson's nephew. When Perry joined with Floyd Naramore (1879-1970), William Bain, Sr. (1896-1985), Clifton Brady (1894-1963) to form Naramore, Bain, Brady, Johanson (known today as NBBJ) in 1943, Swedish hired the firm to design Eklind Hall, the nurses' residence adjacent to the hospital. NBBJ's relationship with the hospital has continued over decades of expansion, including the most recent Swedish project, the Swedish/Ballard medical office building scheduled to open in the fall of 2010.
Dr. Johanson's Legacy
Dr. Johanson died in 1946. Working at the hospital until nearly the end of his life, he saw it grow into a cornerstone of Seattle's medical establishment. His daughter, Katharine Johanson Nordstrom, wrote that Johanson's practice of seeking out and hiring expert doctors, instituting the latest medical techniques, and emphasizing continuing education for doctors and nurses formed a firm foundation for the hospital's continued success.
The 1940s saw another burst of hospital development. In 1941, a project The Seattle Times described as "one of the largest private building projects in Seattle since 1929," when the Great Depression hampered development, added four new floors, 11 surgeries, six delivery rooms, a new business office, and an entire floor of rooms for asthma patients ("Hundreds Inspect $400,000 Swedish Hospital Addition"). In its article the Times pointed out repeatedly that the new space was fully air conditioned -- a novel amenity in 1941.
A new nurses' home, opened in 1946, was named Eklind Hall in honor of Swedish Hospital's longtime employee Herina Eklind (1892-1968). Eklind had started at the hospital as a nurse in 1924 and served as the hospital's superintendent for nine years, retiring in 1955. The residence featured a library, a chapel, a recreation room, sitting rooms one newspaper reporter called "beau" parlors, classrooms, and a roof garden.
Eklind Hall was built on land formerly owned by James (1856-1947) and Mary (1861-1939) Lowman, a Seattle businessman and his wife. A walnut tree originally planted at the Lowmans' East Coast home in 1881 now grew in the middle of the planned building's courtyard. The architect designed the courtyard around it and bricklayers left an opening in a wall to accommodate one of the tree's branches. When the tree had to be felled some years later, Swedish Executive Director Dr. Alan Lobb, an accomplished artist in addition to his work as a surgeon and hospital administrator, used the wood to make a number of objects, including gavels for the Board of Trustees.
A Busy Decade: the 1950s
In 1956 the six-story Johanson Wing expanded the hospital's capacity to 380 beds and then to 396 beds in 1958 when the second phase of the project was completed. The project added the hospital's first parking garage and changed the entrance to Columbia Street. A $198,000 grant from the Ford Foundation as part of a program for non-profit hospitals "to help them extend and improve the services they were providing their communities" enabled the hospital to purchase an emergency generator, a new passenger elevator, and a new central supply service in 1957 (Bigelow, 11).
Also in 1956, Swedish Hospital surgeon Dr. William B. Hutchinson founded the Pacific Northwest Research Foundation. Independently incorporated but housed at Swedish, the research foundation provided a place for practicing physicians to carry out their own research. Over the next several decades doctors associated with it would develop a heart and lung machine for use in heart surgeries, the Scribner shunt for kidney dialysis treatments, and cancer and diabetes treatments. In 2004, the research foundation, then known as the Pacific Northwest Research Institute, changed its mission to focus solely on diabetes research and became the Pacific Northwest Diabetes Research Institute.
Collaborations and Medical Advances
The Fred Hutchinson Cancer Research Center started as part of the Pacific Northwest Research Foundation in 1965 (it later separated and became independent). It too, was housed on the Swedish campus, though not officially part of Swedish Hospital. The Hutchinson center made extensive use of Swedish Hospital facilities. Patients receiving treatment there were cared for at the hospital and Hutchinson doctors used equipment at the Tumor Institute. For several decades Swedish cared for Hutchinson patients until the center became part of the University of Washington medical system, after which patients received care at University Hospital.
In 1960, Dr. Charles Scribner, a researcher at the University of Washington, developed the Scribner shunt. This device revolutionized kidney failure treatment by providing a reusable port for attaching a dialysis machine to a patient. Prior to its development patients had to undergo surgery to access their arteries, making it impractical for longterm treatment.
At the time, University Hospital, just a year old, did not have space for a dialysis unit. Dr. Scribner approached the King County Medical Society and the Seattle Area Hospital Council to find a space for a treatment center. Swedish Hospital had space in Eklind Hall that was available and grants from the Hartford Foundation and the United States Public Health Service funded the three-bed Seattle Artificial Kidney Center, the first outpatient dialysis treatment center in the world.
Opened in 1962, the kidney center (now named Northwest Kidney Centers) could only serve nine patients at first; that soon increased to 12. A seven-member, anonymous Admissions and Policies Committee, popularly known as the "life and death committee," decided who would receive the life-saving care until funding from the state of Washington, private insurance, and community support made it possible to treat all referred patients after 1971. The kidney center, always an independently operating organization, now (2010) has its own facilities serving communities across the Northwest.
Refining Technique, Expanding Facilities
In 1960, Swedish Hospital began a new phase of expansion fueled by federal funding made available thought the Hospital Survey and Construction Act, more popularly known as the Hill-Burton Act. First passed in 1946, but regularly renewed, the Hill-Burton Act funded property purchases and construction of new buildings to stimulate hospital development. Swedish Hospital received $1.6 million in 1960 and then $55,000 in 1963. Swedish also purchased adjoining lots and received property adjacent to the hospital from Dr. O. A. Nelson.
The construction of a new surgical pavilion in 1963 brought "state-of-the-art infection control" to Swedish (Williams, 12). The new operating rooms utilized higher air pressure to keep airborne germs out of the surgeries. To further reduce the chance of infection, all patients, staff, and equipment came in one door and left through another.
In 1967 four new floors were added to the Johanson Wing, increasing the hospital's capacity by 88 beds and doubling the intensive care unit for heart patients. The hospital built the addition to meet a predicted increase in need due to the establishment of the federal Medicare program.
That same year the Board of Trustees voted to change the hospital's charter to allow those without Swedish ancestry to serve on the Board of Trustees. The next year the first two non-Swedish trustees, Dr. Quin B. Marsh and Dr. Edward B. Speir join the board.
The Harold H. Heath Tower opened at the corner of Broadway and Boylston Avenue, next door to the hospital, in 1968. Harold Heath, owner of Heath Tecna, donated $1.5 million toward the construction of the 10-story building. The opening of the Heath Tower marked a shift in the relationship between the hospital and the doctors who treated their patients there. For its whole history doctors who admitted patients to Swedish had their offices elsewhere. The Heath Tower had some hospital facilities, but it was primarily a space for doctors' offices. Although the doctors were not employed by the hospital, having an office next door made it more likely they would admit their patients to Swedish. The facility connected the doctors more closely to the hospital.
Through the 1970s, expansion continued. On November 1, 1975, the hospital dedicated the Lawrence M. Arnold Pavilion. Named for a Seattle banker who donated $1 million for its construction, the seven-story building designed by NBBJ added more doctors' offices and new space for the Tumor Institute. It also housed the first self-contained outpatient surgery unit in the region.
The Southwest Addition opened in 1976. Designed by NBBJ, it rose nine stories and included 150 beds, the John Loor Locke Coronary Care Center, diagnostic and treatment facilities, the 200-seat Paul F. Glaser Auditorium, and a new 150-bed obstetrics department that replaced those of Seattle General and Doctors hospitals. The maternity ward featured two rooms that could accommodate fathers who wanted to stay with the mother during labor and delivery.
Merger and Further Affiliation
In the 1940s and 1950s the Seattle area had seen tremendous grown, increasing in population from 368,302 to 557,057. But in the 1960s and 1970s, an abrupt slowdown took place. By 1970 the city's population had dropped to 530,831, and hospitals in central King County suffered from low occupancy rates.
In 1968, Swedish, Seattle General Hospital, and Doctors Hospital began work on a merger. Swedish Hospital would be at the helm of the new organization. It would take 12 years to work out the details and finalize the merger.
In the Certificate of Need filed by the three hospitals with the Washington State Hospital Commission seeking permission for the merger and related construction, the hospitals argued that the merger would reduce the number of acute care beds in the central region of King County and eliminate two emergency rooms. Both of these actions fulfilled recommendations made by the King County Hospital Development Steering Committee in 1973.
The merger was approved in 1977 and the three hospitals officially merged operations on May 14, 1978. The Swedish Hospital Board of Trustees gained three members from each of the other hospitals' boards. Construction was already underway on yet another pavilion at Cherry Street and Minor Avenue to replace 148 of the closed hospitals' beds. This raised Swedish's total number of beds to 600 and made it the biggest hospital in Washington, which it remains today.
During the 1970s, Doctors and Seattle General had struggled financially, when Swedish had not. Partly this was due to their reliance on a general practice model in which family practitioners rather than specialists predominated among the staff. This trend had begun in the 1900s and became more pronounced in the latter half of the century. Also, those two hospitals had not emphasized the development of a wide array of services that would encourage doctors to admit their patients to the hospital, such as the Tumor Institute and the outpatient surgery unit.
The 1970s also marked a change in how doctors received their training. Before this, all doctors spent the year following medical school in a series of internships, giving them a wide breadth of experience before going into their residency program for their chosen specialty. In the new system, most doctors began their residency programs immediately after medical school. In order to offer residents more depth of experience, Swedish affiliated with University Hospital. Doctors Hospital had a well-established family residency program, which Swedish adopted after the 1980 merger.
Expanding Facilities, Expanding Care to the Uninsured
In 1982 Swedish completed a Certificate of Need to add 32 beds, 27 for patients getting leukemia and aplastic anemia treatment, five for other patients. Researchers at Fred Hutchinson Cancer Research Center had developed a bone-marrow transplant method. Swedish argued that its bed increase would not adversely impact other hospitals because the patients would come from around the country and the world for the cancer treatment.
During the course of the approval process, Swedish was criticized for its relatively low amount of care for the poor. The Seattle Post-Intelligencer described an exchange between members of the King County Health Planning Council and hospital officials as a "blistering attack from council members concerned about the level of subsidized care offered by the First Hill medical complex." Council members used words like "inexcusable" and "deplorable" (Maier). Swedish countered that it did not turn patients away and that its patients tended to be referred by their doctors and had insurance. Also, Swedish had not received as much of the Hill-Burton Act funds as had other area hospitals, thereby reducing their legal obligation for free care. In the end, the hospital agreed to triple its free care and the expansion was approved.
Adapting to New Realities
The 1970s and 1980s saw a tremendous physical expansion of Swedish Hospital. In addition to the projects described above, the Elmer J. Nordstrom Medical Tower, a 16-floor medical office building located at Madison Street and Summit Avenue, opened in 1985 and named in honor of one of Swedish Hospital's longtime Trustees and the son-in-law of Dr. Johanson. The hospital opened a multi-story parking garage that covered the entire block bordered by Cherry and James streets and Minor and Boren avenues. Swedish covered several blocks and had even had parts of two streets vacated so the buildings could be closer together.
In 1983 the federal government made changes to how Medicare paid for patient care. Whereas before Medicare paid for care through a fee-for-service model, reimbursing doctors and hospitals for whatever treatments or testing they decided needed to be done for a particular condition, the new system, known as the prospective payment system, only reimbursed a pre-established amount for each disease or ailment. Of particular concern for Swedish, and other hospitals, were limitations on how many nights of hospital care would be covered. It became essential that hospital and medical staff cooperate to ensure that patients received the care they needed after discharge.
In addition to concerns relating to patient care, these changes, and others set in motion by a general trend toward managed care, made it more important for hospitals to reduce overhead costs and to attract more patients. Swedish had long offered myriad services in addition to inpatient care. The various clinics and institutes associated with the hospital helped it remain viable in the coming decades when other area hospitals struggled financially.
Ballard and Providence Join the Fold
A 1986 article in The Seattle Times traced the transformation of First Hill -- by then often referred to as "Pill Hill" -- from a neighborhood filled with large homes, such as the Smith home that Swedish first occupied on Summit Avenue, to a "community of expanding institutions" (Nelson). Swedish shared the the hill with Seattle University, Harborview Hospital, Virginia Mason Hospital, O'Dea High School, Providence Hospital, the Washington State Convention Center, and Central Seattle Community College. Hemmed in by these other institutions, the hospital looked beyond First Hill for space to increase its facilities to encourage more doctors to send their patients to Swedish.
In 1992 Swedish purchased Ballard Community Hospital. Founded 1928 in Seattle Ballard neighborhood, Ballard Community Hospital was struggling financially because the aging population of Ballard led to an increased proportion of Medicare patients, with their relatively lower payments. Buying the Ballard hospital enabled Swedish to increase its patient beds while reducing overhead costs. Ballard Community Hospital also contributed a long-established visiting nurse program, the CareUnit program for addiction treatment, an on-site MRI, and a sleep disorders clinic. The merger was completed on July 1, 1992.
A group of Ballard campus employees created the Sven and Ole characters that were featured in merger-related information sent to employees. Sven, a Swedish-named character, represented Swedish Hospital and Ole, a Norwegian-named character, represented Ballard Community Hospital because of Ballard's historically Scandinavian population. The group also issued Finns, the "Official Viking Currency," for use at Sven and Ole's Viking Heirloom Auction where employees could buy "treasures."
Beginning in 2000 with the purchase of Providence Medical Center, which became the Swedish/Cherry Hill campus, Swedish started to expand further by opening clinics and developing facilities in eastern King County and in Snohomish County.
Swedish Hospital Today
In 2010, Swedish Medical Center includes the Cherry Hill campus, the Ballard campus, the recently added Stevens Hospital in Edmonds campus (to be known as Swedish/Edmonds), a freestanding emergency room in Issaquah, and primary care clinics in multiple King County communities, in addition to the buildings on the original campus. More than 200,000 babies have been born at Swedish Medical Center since the first was born in 1910.
The hospital that started in an apartment building with 24 beds now serves more than 40,000 patients per year in more than a thousand beds, not including emergency room visits, which numbered some 100,000 in 2008. Dr. Johanson and his fellow Swedish Americans laid a solid foundation for a hospital that has served Seattle for a century.