California’s SB 1953 law requires that all hospitals in the state review their buildings and facilities for compliance with current seismic standards. Findings of this review were to be reported by 12/31/01, and were to include plans for compliance if warranted.

Sutter Health, a major hospital group that operates California Pacific Medical Center (CPMC) in San Francisco, has decided to integrate a major consolidation of three of its San Francisco hospitals with its plans to comply with SB 1953. The 3 hospitals, which were formerly operated independently, are the following: Presbyterian in Pacific Heights, Children’s/Marshal Hale in Laurel Heights and Davies Medical Center (DMC) in the Duboce/Castro area.

In anticipation of the effects of the consolidation on the Davies Medical Center and its surrounding areas, the neighborhood associations nearest Davies-- Duboce Triangle Neighborhood Association (DTNA) and Buena Vista Neighborhood Association (BVNA)-- formed the Davies Citizens Advisory Committee (DCAC) to work with CPMC to represent the local community around Davies Medical Center.

DCAC co-sponsored several community meetings with CPMC representatives during 2001, wherein residents expressed their reactions and offered their suggestions with regard to CPMC plans for DMC. In November 2001, DCAC commissioned a research survey among households within the coverage areas of the neighborhood associations in order to obtain a quantitative read of residents’ opinions on CPMC plans. The questionnaire for the survey explored various ideas generated from the community meetings.

The objectives of this research were:

1. To measure and quantify neighbors’ reactions to CPMC’s current plans for Davies Medical Center.
2. To identify perceived benefits and disadvantages of these plans.
3. To identify the elements of the plans that elicit the strongest positive and negative reactions from neighbors.
4. To elicit neighborhood input and suggestions for resolution of any areas of concern.

DCAC will share all findings from this study:

• With CPMC, with the expectation that this neighborhood input will be utilized as a key component of CPMC’s planning process.
• With nearby residents through the neighborhood associations
• With appropriate city and state officials in public forums when CPMC seeks permit approvals for its proposed changes.

A self-administered, paper survey questionnaire was delivered to about 4300 households within the coverage areas of the neighborhood associations. Specifically, the surveys were distributed to all households within a several-block radius of Davies Medical Center as well as all paid members of DTNA, BVNA and members of Castro Area Planning+Action (CAPA), another local citizens’ group.

Before it was finalized, a copy of the questionnaire was provided to CPMC for its review, to ascertain that it was factually correct and up-to-date with CPMC’s current plans. DCAC retained "editorial control" over the questionnaire and the entire survey process.

A cover page on the letterhead of the respective neighborhood associations accompanied the survey. Respondents were asked to put a stamp and mail back completed questionnaires to DTNA.

About 3 weeks after surveys were distributed, the neighborhood associations gave reminders (via e-mail and personal contact) to their members and others in the area, reminding them to complete and mail back the questionnaires.

A total of 338 completed questionnaires were received, representing an 8% response rate. This is a respectable response rate given that:

• The sample is essentially a community general population sample and includes people of varying levels of interest or involvement with the topic, as opposed to most mail surveys that are usually sent only to customers, organization members, etc. who would tend to have more involvement with the topic.
• No monetary incentive or gift was offered to motivate participation.
• The survey was lengthy (6 pages).
• Return postage was required.

Of the 338 completed questionnaires, 39% came from households that are not affiliated with any neighborhood association and 61% from households that are members of DTNA, BVNA or CAPA.

Questionnaires were distributed in early January 2002; all those received by February 15 were tabulated. Completed questionnaires were hand-tabulated and analyzed.

1. The sample size of 338 has a statistical error range of plus or minus 5% at the 95% confidence level.
2. Columns of percentages which add to more than 100% are the result of rounding or multiple responses. Small differences from 100% (99% or 101%) are the result of rounding, while large differences typically are the result of multiple responses, and these are noted in the table.
3. The questionnaire utilized a 5 point anchored scale, to provide the respondents with a wider choice of options to reflect their opinions. The analysis looks at nets of the top 2 and bottom 2 scales {e.g. Very/somewhat favorable (net) and Very/somewhat unfavorable (net)} to look at general trends, and then examines the top or bottom scale (e.g., Very favorable, Very unfavorable) as these indicate the depth and intensity of respondents’ feelings/opinions over a certain issue.

This survey of neighborhood reactions to CPMC’s plans for Davies Medical Center identifies two issues of major concern to the neighborhood:

• Eliminating the Davies Emergency Room by 2012 and putting an Urgent Care Center in its place
• Increased car traffic and stronger pressure on street parking spaces that are anticipated as a result of the higher activity loads envisioned for the hospital when it is converted to a primarily "continuum of care" facility.

The neighborhood is not satisfied with replacing the ER with an Urgent Care Center. There is a strong desire and strongly-felt need to have an ER right in the neighborhood for personal assurance as well as for disaster preparedness.

With regard to the second major concern--increased car traffic and pressure on street parking spaces--the survey indicates that respondents are somewhat more in favor of mass transit solutions compared to simply increasing parking facilities. Respondents feel that more widespread use of mass transit can be encouraged if CPMC would

• Subsidize hospital employees’ commute expenses and
• Provide shuttle services to and from mass transit hubs (BART and Muni Metro stations) for hospital employees and visitors alike.

Solutions like providing parking for hospital staff, neighbors and local businesses, while endorsed by the majority, are not supported as unanimously as the mass transit solutions are. In fact, the sample is split on the question of building additional parking facilities at the Davies campus, with 41% in favor and 50% opposed to this idea.

The concern with increased traffic is such that when asked to rate community-based benefits/services that might be requested of CPMC to help off-set the impact of their plans, the traffic-related measures are the most popular: funding for pedestrian safety and traffic calming measures around the hospital, and funding to re-design a more user-friendly stop for the N-Judah line obtained the most favorable ratings.

In addition, respondents are very positive to the idea of aligning mass transit stops with hospital entrances in order to make what is currently a long, difficult, uphill walk (especially for the sick and elderly) shorter and less strenuous. As this would significantly improve physical access to the hospital, it may also encourage use of mass transit among hospital users who currently find this walk daunting. The other ideas to improve physical access to the hospital are also well-received, suggesting that current access may be considered problematic. These ideas include improving signage to make it easier to get around the hospital, installing transit monitors inside Davies buildings that provide information on the next train/bus and creating more visible public entrances to the hospital from all four streets bordering the campus.

Respondents are also generally in favor of the ideas to improve the current design of DMC, especially retaining open spaces for public viewing of cityscapes. In addition, a number of respondents wrote comments on their questionnaires regarding the importance of keeping and maintaining the existing trees and landscaping in the Davies campus.

Respondents’ overall opinions on the aesthetic and architectural appeal of the current Davies buildings and grounds are mixed: 42% consider them appealing, 35% find them unappealing and 24% are neutral. The rather lukewarm levels of "Very appealing" ratings (13%) suggest that changes to the current design are unlikely to be met with fervent resistance, assuming that the changes will be appropriate and neither too drastic nor extreme.

Finally and importantly, the survey reveals the presence of a very high level of goodwill for Davies Medical Center among respondents: 79% feel positive about having DMC in their neighborhood, including 54% saying they feel "Very positive". This suggests that respondents’ opposition to some specific CPMC plans as communicated in this survey are given in good faith toward a well-regarded neighbor, rather than being merely a knee-jerk reaction to change. As CPMC goes forward on its project, it can leverage this goodwill to work out issues and solutions identified by this survey, so that the changes at Davies can become a win-win for both CPMC and the neighborhood. Goodwill is an intangible business asset, but a very valuable one nonetheless; it is simply a good business decision for CPMC to protect and retain this level of goodwill among its neighbors who are also its customers, as it moves forward to modify and fine-tune its plans.

The majority of respondents are unfavorable toward two of the specific changes planned for Davies:

• The plan to replace the Emergency Room with an Urgent Care Center by the year 2012 generates very strong objection, with 63% of respondents critical of this plan. Note the particularly high level of "very unfavorable" ratings (37%), suggesting that this plan will be a major source of contention in the community.

• The plan to eventually convert Davies from a full service hospital to a primarily "continuum of care" facility ("facility utilization") is resisted by 54% of respondents.

The plan to improve physical access to Davies is favored by the majority of respondents (68%); this suggests that current access may be considered problematic.

Table 1: Overall opinion of specific changes planned for Davies (Q3, Q8 & Q10)

Respondent objection to phasing out the ER is intense, with about 75% expressing concern over three specific disadvantages of this plan.

The Urgent Care Center is not considered to be an adequate substitute for an Emergency Room in the neighborhood, not only because the UCC’s operating hours would be limited, but because respondents want an ER in their immediate neighborhood for personal assurance as well as for disaster preparedness. Again, note the high levels of "Very concerned" ratings that these statements generate, suggesting the intensity of feeling around this issue.

Relative to the other 3 items, the loss of the ER to care for homeless and substance abusers is less of a concern.

Table 2: Ratings of perceived disadvantages of plans to replace ER with UCC (Q7)

The strong opposition to phasing out the Emergency Room may be driven by the relatively high usage of the Davies Emergency Room services among respondent households: 41% of respondents belong to a household that had used the ER in the past 2 years. (See Table 14.) However, worth noting is that 75% are concerned about losing the ER, indicating that it is not only the recent users of the Davies ER who are concerned about losing this facility.

B. Plan to Phase out ER and Replace with UCC, continued

The primary perceived benefit of the plan to phase out the ER and replace it with the UCC, important to 58% of respondents, is that it may reduce the number of homeless people/substance abusers in the neighborhood.

Only 34% consider the reduction of ambulance traffic/noise an important benefit, compared to 41% who consider it unimportant.

Note that respondents had a considerable problem responding to 2 statements ("Don’t really need an ER at Davies" and "UCC is a satisfactory replacement for the ER"), and rightly so, as the statements were considered by respondents to be incompatible with the Importance scale used. Respondent difficulty is evidenced by the lower than usual base sizes for these statements, suggesting that a number of respondents were unable to provide an answer. However, respondent sentiment is expressed in the many comments written on the survey sheets that clearly stated objections to replacing the ER. Examples of verbatim comments:

For this reason, responses to these statements will not be analyzed. Fortunately, the response to these issues is unequivocally captured in the "disadvantages" section discussed earlier (Table 2).

Table 3: Ratings of perceived benefits of plans to replace ER with UCC (Q6)

It has been noted in Table 1 that 24% of respondents are favorable to the "facility utilization" plan to eventually convert Davies from a full-service hospital to a primarily "continuum of care" facility.

The primary benefit of this plan is the expectation that it would result in better patient care, considered important by 74% of respondents.

Benefits of secondary importance are those related to increases in efficiency for hospital operations and increases in property values, considered important by about half of respondents (46% and 44% respectively).

The least compelling benefits are those associated with improved business opportunities for the neighborhood (i.e. new businesses in the neighborhood, new customers for neighborhood businesses); these are considered unimportant by about half of respondents (48% and 44% respectively).

Table 4: Ratings of perceived benefits of facility utilization (Q1)

C. Plan to Use Davies as a "Continuum of Care" Facility ("Facility Utilization"), continued

It has been noted in Table 1 that 54% of respondents are unfavorable to this plan. Respondents’ primary concern is that increased hospital activity levels generated by this plan would result in increased traffic (of concern to 84% of respondents) and more difficult street parking (83% concerned). The high "Very concerned" ratings (64% and 68% respectively) indicate the level of intensity felt around these issues. In addition, about three-quarters of respondents are concerned that increased activity loads would change neighborhood character (77%) and make the neighborhood less safe (72%).

Other concerns are that conversion to a primarily "continuum of care" facility

would:

• Shift the burden of acute care to public hospitals (73%)
• Eliminate important hospital services at Davies (66%)

Relative to the other items, there is somewhat less of a concern that the proposed changes in facility utilization would result in increased rents in the area (52%).

Table 5: Ratings of perceived disadvantages of facility utilization (Q2)

Respondents respond favorably to the 5 suggestions offered to address potential traffic and parking issues.

Two specific solutions obtain almost unanimous endorsement: the hospital would subsidize employees’ mass transit expenses to encourage use of mass transit (93% favorable), and the provision of shuttle services to and from mass transit hubs (90% favorable).

Suggestions to provide parking for various groups (hospital employees, local businesses, neighbors) are also positively rated by about three-quarters of the sample, but are not as enthusiastically met as the mass transit solutions, as suggested by the lower "Very favorable" ratings of the parking vs. mass transit suggestions.

Table 6: Ratings of solutions to potential traffic and parking issues (Q4)

D. Potential Traffic and Parking Issues, continued

Despite the very strong concern about the potential negative impact on the availability of street parking, the respondents are divided on the suggestion of building additional parking facilities as a solution (41% in favor, 50% opposed). This is consistent with the more favorable ratings given to mass transit solutions relative to parking solutions noted earlier, suggesting that the respondents believe that use of mass transit is a better solution than having more people driving into the neighborhood.

Table 7: Are you in favor or opposed to having additional parking facilities built? (Q5)

As noted earlier in Table 1, the plan to improve physical access to Davies is favored by the majority (68%) of respondents.

While the majority of respondents responded positively to all 4 specific suggestions, 2 proposals generated the heaviest endorsements: improving signage inside and outside the buildings (78%) and aligning mass transit stops to hospital entries (76%).

Table 8: Ratings of plans to improve physical access to Davies (Q9)

Respondents’ opinions on the overall aesthetic and architectural appeal of the current Davies buildings and grounds are mixed: 42% consider them appealing, 34% find them unappealing and 24% are neutral. In addition, the rather lukewarm levels of "Very appealing" ratings (13%) suggest that changes to the current design are unlikely to be met with fervent resistance, assuming that the changes will be appropriate and be neither too drastic nor extreme.

Table 9: Overall appeal of current Davies buildings and grounds (Q11)

F. Davies Building Design and Improvements, continued

Response to the five specific design improvements suggested for the current Davies buildings and grounds is generally positive.

Retaining open space for public viewing of cityscapes elicits the most positive response (76% favorable), followed by provision of a convenient and pleasant community room (67%).

The majority is also favorable to the two specifically "architectural" suggestions: to include public art appropriate to the site (59%) and to open up the building facades for a more welcoming, less "fortress-like" appearance (56%).

Worth noting is that while almost half of respondents are favorable to including retail space for neighborhood services in the buildings (44%) and to encouraging use of Duboce Park by hospital patients and visitors (45%), one out of four respondents oppose these suggestions.

Table 10: Ratings of proposed improvements for Davies building (Q12)

Finally, in the "Other specify" row, a number of respondents wrote comments that underscored the importance of keeping and adding trees in the hospital campus.

Respondents were asked to rate a number of community-based neighborhood benefits and services that may be requested from CPMC to help offset the impact of their plans for Davies.

Given respondents’ strong concern about traffic issues that increased hospital activity levels would generate, it is not surprising that the 2 traffic-related items elicit the strongest support, especially in terms of "Very favorable" ratings:

• Funding for pedestrian safety and traffic-calming measures around the hospital (53% Very favorable)
• Funding to redesign a more user-friendly Muni stop for the N-Judah line (42% Very favorable)

In addition, also favorably rated are grant programs for

• Friends of Duboce Park for park improvements (45% Very favorable)
• Specific community-based programs at the Harvey Milk Center (42% Very favorable)
• A child-care facility at Davies for employees and neighbors (39% Very favorable)

Table 11: Ratings of community-based benefits/services to request from CPMC (Q13)

Half (52%) of respondents are not in favor of the construction of an additional building on the Noe Street side of the Davies campus; 30% are neutral and 18% are favorable.

Table 12: Opinion on additional building on Noe St. side of campus (Q14)

	Opinion on additional building on Noe side of campus
Base: Total Answering	(323)
	%
Very/somewhat favorable (net)	18
Very favorable	6
Somewhat favorable	12
Neutral	30
Somewhat unfavorable	23
Very unfavorable	29
Very/somewhat unfavorable (net)	52

Respondents have tremendous goodwill for DMC, with 79% feeling positive (including 54% feeling "Very positive") about the hospital’s presence in their neighborhood. This suggests that respondents’ opposition to some specific CPMC plans as communicated in this survey are given in good faith toward a well-regarded neighbor, rather than a knee-jerk reaction to change. In addition, as CPMC goes forward on this project, it can leverage this goodwill to work out issues and solutions identified by this survey.

Table 13: Overall attitude towards DMC (Q16)

	Overall feeling about having Davies in neighborhood
Base: Total Answering	(329)
	%
Very/somewhat positive (net)	79
Very positive	54
Somewhat positive	25
Neutral	14
Somewhat negative	6
Very negative	1
Very/somewhat negative (net)	7

I. Attitude Toward DMC and Use of Davies Services, continued

Sixty-five percent (65%) of respondent households have used a medical service at Davies in the past 2 years, indicating that two-thirds of the sample belongs to CPMC’s customer base.

Emergency Room services and doctor’s office visits were the most frequently-used services, utilized by 41% and 38% of respondent households respectively.

Table 14: Davies services used by any household member in past 2 years (Q15)

10. Membership in Neighborhood Organizations

DUBOCE TRIANGLE NEIGHBORHOOD ASSOCIATION

BUENA VISTA NEIGHBORHOOD ASSOCIATION

For more information about the survey, DCAC or the sponsoring neighborhood organizations, contact:

www.DTNA.org