Caroline S. MacColl (1923-2007), a nurse with a master's degree in public health education from Columbia University, became involved with Group Health Cooperative in 1969 when she married Group Health's first pediatrician, Dr. William A. "Sandy" MacColl (d. 1989). She helped to lead Group Health's Women's Caucus when it formed in 1973, was elected to the Board of Trustees in 1977, and served for 18 years, from 1977 to 1985, and again from 1988 to 1977. She served as chair of the Board of Trustees for two terms, 1982 and 1983. Karen Lynn Maher conducted this oral history interview of Caroline MacColl on January 30, 2002, at MacColl's retirement community in Seattle, Washington.
Interview with Caroline MacColl
Maher: How did you become involved with Group Health?
MacColl: I married Sandy MacColl, (Dr. William A. MacColl), one of the founding physicians of Group Health. We were married in 1969.
I can’t remember how my first encounter (with Group Health governance) happened, but in the early 1970s I met Lyle Mercer who was chairperson of a membership committee. I don’t remember the exact name of the committee, but I served on it for a couple of years and found it interesting. I was busy raising my last child, a twelve-year old daughter, and working. I didn’t find the committee fun enough to continue so I resigned. That is how I got to know the membership side of Group Health. Being part of a health care cooperative was a brand new experience for me.
Maher: Where were you working at the time?
MacColl: I was working for the University of Washington. The School of Public Health had received a HUD (Housing and Urban Development) grant and contract to develop health services in the community. I helped develop clinics.
Maher: So your background was in health care?
MacColl: Oh yes. I had my Master’s Degree in Public Health from Columbia University and worked for the Allegheny County Health Department in Pittsburgh for some years. I also worked with the New York City Health Department for several years.
Maher: What brought you to Seattle?
MacColl: Sandy MacColl. Unknowingly, we both had taken the same trip to Europe. When we received a list of the people who had been on the trip, I didn’t recognize any names; neither had Sandy, but he recognized my address. I lived across the street from the college his sisters had attended. He looked me up.
Maher: What has been your most significant experience at Group Health?
MacColl: Developing the GHC policy manual in the late 1970s with the help of Beth Anderson (a former staff member). The job took us eighteen months to complete. Until then, there had been no such thing as a policy manual. If someone wanted to know whether policy had been established during a Board of Trustees discussion, the secretary for the Board had to search a typewritten list of Board decisions. Well, Group Health was growing and was getting more and more sophisticated and needed a better system for recording and circulating policies so people (Cooperative staff) would know what they were supposed to do. We also recognized the need for more staff to the Board. The Board of Trustees Office was established.
Maher: How and when did you begin serving on the Board of Trustees?
MacColl: I’m trying to remember and this is where my memory is at fault. (Caroline MacColl was first elected to the Board in 1977.) James Evans, who was President of the Board in 1976, recruited me because there was a lot of stirring in the membership for change. He felt that we needed to do a bit of research and come up with some recommendations. Again, Beth Anderson and I worked together to recommend bylaw changes to the membership and policy changes to the Board. I wish I could remember the name of that project because it was a fascinating project and it did the whole Cooperative a lot of good.
(In July of 1977, Mrs. MacColl authored a discussion paper for the Task Force on Governance. The paper was titled, Consumer Participation . . . Why and How. Subsequently, she chaired the Task Force and prepared two reports to the Board: Part I on January 5, 1978 and Part II on June 1, 1978.)
Maher: Why does consumer involvement matter at Group Health?
MacColl: Consumer involvement is still a way of holding the Board of Trustees accountable. I think it is important for a board to have a body to which it must report and whose interests have to be met. For me it is an accountability issue. I also think that, believe it or not, consumers -- even those with no training whatsoever in medicine, nursing or any of the allied professions—sometimes have very bright ideas about how things should be done or what should be done. To my sorrow, too many of our enrollees have never become members even though there is no barrier to membership nowadays. I also think that having the medical center councils is another form of accountability for the individual clinics, a way for management to learn about what matters to the consumers who receive their care at Group Health clinics.
Maher: Do you have any continued involvement with Group Health or do you attend the Former Officers Group?
MacColl: I do attend meetings of the Former Officers Group.
Maher: Do you find those meetings helpful and interesting?
MacColl: The meetings are nice and I appreciate the updates. I served on the Board for eighteen years with a short break in the middle. I had to go off the Board in 1985 due to the limitation of terms policy. However, I continued to chair the Quality Committee for a year. I felt so disassociated from everything because I only served on a committee. I didn’t like having no direct influence on the Board.
Maher: That must have felt unfamiliar and strange. (Pause)
Maher: When you reflect on receiving health care as a consumer of Group Health, what has been your most significant experience as a patient?
MacColl: During the 1990s, I had a lot of hospitalizations. The most significant experience was with Patricia Dawson, a surgeon. I was admitted into the hospital through the emergency room. My bowel was blocked and I was vomiting a lot. I had never met Dr. Dawson; she was assigned as my surgeon and did the surgery to release the bowel. However, I had four more episodes of partially blocked bowel that summer and she treated me each time. These episodes needed medical treatment—rather than surgery—and she was just wonderful. I would wake up in the morning about seven o’clock and she’d be sitting on the windowsill waiting for me to wake up. She didn’t rush in and wake me up or send the nurse in to wake me up. She didn’t practice that way. She talked to me about how I was and answered all my questions.
Then one weekend, the surgeon on duty for the weekend was an arrogant, rather fresh young man who had come to us from Virginia Mason Medical Center. He looked me over and ordered x-rays and a bunch of tests. I told him I didn’t want the tests because Dr. Dawson had not ordered them and there had been no change in my condition since she had last seen me. I was afraid he was going to put enormous pressure on me. I wasn’t feeling all that sharp, but I spoke to very nice head nurse and asked her if she could get in touch with Dr. Dawson and tell her what was going on. The nurse managed to do that and Dr. Dawson talked to the young man. He never showed up again and all of his tests and x-rays were canceled; they were unnecessary.
To me, that was a very significant experience because it is very hard for a doctor to challenge another doctor. Dr. Dawson did it. I certainly felt very well cared for.
Maher: Cheryl Scott and her management team are in the process of unveiling a new purpose statement for the Cooperative, the essence of which is “to transform health care.” How is the Cooperative transforming health care?
MacColl: I think the Cooperative has resources that are not characteristic of other managed care organizations. We have the MacColl Institute for Healthcare Innovation (named after Dr. Sandy MacColl) which can do research that would help us figure out how and what to transform. One of the things that need transforming -- both on the part of patients as well as on the part of some of our physicians—is acceptance that there comes a point in life where the medical care one receives should stop perpetuating the expectation of being fixed or cured. The focus should shift to helping patients manage the medical problem. I recently realized that one thing that makes me so dissatisfied with the non-functioning parts of my body is that they cannot be fixed.
My back can hurt like the devil and I have help managing my back pain. I have trouble walking because of arthritis and I have help managing my pain with physical therapy exercises. But it’s a real shift in expectations, and it gave me a jolt to realize that my current medical problems are not going to get fixed. My heart is pumping properly because I take a pill every morning. My blood pressure isn’t high because I take a pill every morning. But, that’s symptomatic treatment, not curative treatment. Our doctors need to be able to help patients change their expectations as they age. A lot of people getting older are very, very frustrated and they think they’re receiving bad medical care because they’re not being cured. They don’t cooperate with the medical approach given to them. They need help understanding the shift I’m talking about and realizing that they are receiving everything science and medicine can offer nowadays. Maybe then they’ll see the value in following their treatment plan.
Maher: Yes, that’s a valuable approach—acceptance of what is happening with our bodies.
MacColl: I think the other thing that I’d like to say about transforming health care is that until I came to Seattle, I was treated in various parts of the country and always by fee-for-service medicine. My first husband was also a physician and I got “Cadillac” treatment as a physician’s wife. But I have never received as consistently good care as I get at Group Health. It took me a while to find a doctor with whom I could feel confident; I went through six doctors the first two years I was here before I found one that I settled with for years thereafter. I think it’s much easier to choose a doctor nowadays because information is given to patients about doctors, and patients are encouraged to try out a doctor. It’s okay to try out somebody else if the first doctor is not a good match. That was not an emphasis in 1969 when I came to Seattle. Group Health has been transforming itself over the 32 years I’ve been here. That’s one of the remarkable things about the Cooperative. We have a remarkable medical staff. They (the physicians) didn’t always like change, but they learned to be a part of change.
Maher: What was your most significant contribution to the Cooperative?
MacColl: One of the things that I have been worried about is the Board’s decision to change the way it is involved in reviewing the qualifications of new physicians and certifying all physicians. There used to be a trustee on the review committees and in the end, the Board as a whole approved the privileges of all physicians. Not only did I find that the doctors weren’t all that good about their files, I reminded them when paperwork needed to be signed and so on. I found that the recent change in procedure made a distance between Board members and the medical staff. One of my sorrows is that I was unsuccessful in convincing the Board that the change was unsatisfactory, so the Board (as a whole body) doesn’t certify the physicians anymore.
(The Board of Trustees delegates responsibility for granting medical staff privileges to trustees who serve on the Board Oversight Committee of Credentialing and Privileging.)
Maher: Why should a young family consider joining Group Health?
MacColl: I think it’s essential for a young family to join Group Health. You can’t anticipate what kinds of disasters or illnesses may happen to every member of the family, particularly to young children. The family medicine model in which the whole family is taken care of by one physician works very well for many families. If a physician finds some weird symptoms in a child, it is a helpful to know the medical history of the whole family to help determine the appropriate treatment. Also, Group Health is so good about getting immunizations done and reminding parents that the immunizations are due. The care that’s given particularly to the young children I think is quite remarkable. Group Health’s commitment to the family practice model and its Family Practice Residency program is definitely a benefit for the family.
Maher: Do you find that Group Health’s focus on family medicine and the care of young families is a different approach than in a fee-for-service environment?
MacColl: No, I think there are family practitioners in fee-for-service. The trouble is that family practice physicians don’t get paid as much as surgeons or orthopedists so it isn’t as attractive from a financial point of view. People don’t always realize that finances are sometimes a strong motivation for people who choose to become doctors. Those who pick family medicine are very devoted, dedicated, and well trained.
Maher: What is Group Health’s greatest strength?
MacColl: I think its greatest strength is the integrity of its people and I mean the doctors, the administrators, the managers, and all its employees. As an organization, its integrity is quite remarkable. I don’t know how else to say it.
Maher: Do you have a story that might exemplify the integrity?
MacColl: No. I worked as a volunteer for the Cooperative and I’m sure there were people who were not entirely ethical, but I never saw one.
Maher: How has Group Health changed the Seattle community and why do you think that change was important?
MacColl: I’m not sure Group Health has changed the Seattle community. It gave up one of its two hospitals and that grieves me a good deal. I still hear the term “group death.” Out of 175 residents here at Bayview Manor (a retirement community in Seattle), about 44 residents are Group Health members. The rest of the people are scattered throughout the different systems.
Maher: How do you describe Group Health to other people?
MacColl: I describe it to other people as an integrated system with the family practitioner or the family doctor combined as an internist. The family doctor organizes medical care, including arranging any specialty care needed. Physicians do a remarkably good job. They’re very cooperative with patients, a marked change for me. When I was growing up and in my earlier adult years the physicians I contacted were patriarchal, even though they might give me very good care. They told me what to do and expected me to do it. They didn’t give me options. They were god-like figures that knew the answer and it was impossible to argue with them. Well, it wasn’t as bad as that when I first came to Group Health, but there was a patriarchal relationship and options were not given.
One of the things I worked on after I was elected to the Board of Trustees was encouraging doctors to become consultants to their patients, to give them options when options were available and to help them come to the best decision about their medical treatment. My favorite question to pose to a doctor has always been, “Which option would you recommend to your spouse?” I think my encouragement permeated family practitioners, general internists, and primary care physicians. Also, some of the highly trained specialists were affected. I would expect it to be a difficult change for them because of the way they are trained, but they’re getting better. I’ve seen a lot of them (specialists) in the last ten years.
Maher: When I say “Group Health,” what immediately comes to mind?
MacColl: St. Luke’s Hospital at the old campus on Capitol Hill. Visually, that’s what comes to mind, not the new building.
Maher: What do you think are the emerging trends in health care to which Group Health should be paying attention?
MacColl: I don’t think I can answer that question. I’m too distant now. I don’t read the literature anymore and I don’t have the routine contact with people working at Group Health. I do think what I said earlier is part of the answer—for people to understand the change in the mode of care from “cure” to “manage” as our bodies age. One of the things I didn’t say earlier is that it is important to recognize that we are all going to die and we shouldn’t be foolish about expecting to manage our way out of death.
Maher: In your mind, what is the single greatest challenge Group Health faces in the next five years?
MacColl: Financial survival. The cost of medicine and pharmaceuticals and all the things that go into medical care keeps going up and up and up. Those are costs we can’t control. We can manage them. We can become as efficient as possible. We can use generic drugs. But, whatever we do, we still face a challenge.
Maher: How do you think Group Health’s past—its roots—prepared the organization to meet current and future challenges?
MacColl: From the beginning, Group Health and its Board of Trustees stood for change. The founding idea of Group Health was a big change. I think Group Health has accepted the necessity of change from the time it was organized. The Board and the medical staff got into a big fight in the early 1950s because they didn’t have the same vision for change; they had to work that one out. There have been ups and downs in the history of Group Health. All parties did not always accept some necessary changes. Time and time again, they had to work it out. Group Health must continue to see the need for change and take action.
Maher: What is your greatest hope for Group Health?
MacColl: That it continues, as it has in the past, to improve and become more and more quality oriented.
Maher: What has been the Cooperative’s most significant contribution to you personally?
MacColl: Saving my life, several times. I’ve had brain surgery for an aneurysm. That was a life-saving event. If the aneurysm had burst, it would have killed me. The aneurysm may have outlived me but I felt that I could not drive if I had that little bomb up there in my head, so I went ahead and had the aneurysm tied off. Also, Dr. Dawson’s surgery certainly saved my life, but that particular surgery could have been done by a lot of different surgeons. What was so special about her was the way she handled me as a patient, the way she related to me as a human being.
Maher: If you were going to use one word to describe your overall experience with Group Health, what would it be?
MacColl: Marvelous! The word describes my experience both as a Board member and as a patient.
Maher: I’ve gone through all the questions I have for you but want to give you an opportunity to say whatever else you want to about your experience at Group Health. Is there anything else you’d like to share?
MacColl: I don’t know if it continues to be true, but when I left the Board it seemed to me that the distance between the Board and the medical staff and the Board and the membership was increasing. A contributing factor might be geographical since the Cooperative now has a statewide presence. Trustees used to be assigned to visit specific medical center councils at least twice a year and communicate regularly. I don’t know how to close that gap, but I feel it is a gap that needs to be closed or at least lessened.
I thank Group Health. My experience there was a growing and learning experience for me in many ways and I appreciate the opportunity I had to serve. And, I certainly appreciated my health care experience.
Maher: How do you feel about being a part of this oral history project?
MacColl: I was astounded that I was selected and I was pleased. Then I felt very hesitant because as I told you, my recent memory is not very good, which was evident in some of my answers when I couldn’t remember the names. Then I thought, “Well, I’ll try it.”
Maher: I’m very glad you did.
MacColl: Thank you.