Vashon voters have approved the formation of a hospital district and sent a clear message that they want access to health care services on the island. This is a huge step forward for island-based medical care. The community is on the right track, and now the hard work begins.

The task we have before us is to change the health care delivery environment in which we have lived for the past 10 years. The change will take time, it will occur in stages and it will be full of challenges. What will this process of change look like as we go forward? Let me provide a brief overview of the process.

Your elected hospital district commissioners will be seated, elect officers and organize themselves into topical areas of focus or concern. A superintendent will be hired to assist with management, administration and with regulatory compliance duties. A schedule for public hearings and work sessions will be developed.

One initial task of the board will be to survey the existing facilities on the island and in the area. The job of stabilizing basic clinical primary care and associated services, with staffing and hours suitable for island needs, is an obvious and immediate priority for the community.

Another issue is the status of the current Neighborcare Health clinic at Sunrise Ridge. The clinic is in serious financial jeopardy. Finding a way to keep the doors open, the lights on and our local healthcare providers employed will be a substantial task. Discussions with Neighborcare will begin shortly and are critical to the maintenance of current services.

Talks and negotiations with other medical provider groups concerning longer range relationships will need to occur in the early part of 2020. Important elements of these discussions include the range of services; hours of operation; staffing models; and operating systems, to name a few. A budget — likely a tentative one at first — must be developed based on these initial discussions. That budget requires analysis of roughly calculated anticipated revenues from services provided, the property tax levy, anticipated expenses for contracting with medical service providers and the costs of operating the district and facility.

The gap in time between the startup of district activity and the time revenue (from taxes or services) is received must be addressed. Even presuming the district commissioners submit a timely budget for state approval in 2020, there will be no tax revenue received to fund the district until 2021. This is not an insurmountable problem; it is one that will draw on continuing discussions with the current clinic operator and with county and state officials who have assisted the island on health care matters in the past.

As things move forward, budgets will be revised and new ones will be developed to address services and priorities for the next several years. Discussions among current island health-related districts and entities (such as Vashon Island Fire & Rescue) should take place, and coordination which can result in greater efficiencies will be explored. A plan for dealing with the obsolete clinic structure on Sunrise Ridge must be developed.

Throughout this process, the public will have both a window to the PHD operations and an important role in the discussions. The best public input will be that which comes from an educated and thoughtful consideration of the issues. Attendance on meetings will be the best means of keeping apprised of the conversations taking place and the basis for the decisions being made. This is a great thing for the community. It’s an exercise in community building and caring.

Philosopher William James wrote “It is our attitude at the beginning of a difficult task which more than anything else will affect its successful outcome.” This is a tough time to create a new health care delivery system. Let’s approach this task with energy, a spirit of compromise and respect for competing points of view and values. Please support your commissioners and together we will create a health care system of which we can all be proud.

It has been my absolute privilege to work with members of the Vashon-Maury Health Collaborative over the past several years and to have met so many members of the island community who have offered so much to our understanding and to the process of finding our way forward in this complicated landscape.

We have a lot of work to do. Let’s get started.

John Jenkel is a retired attorney, a member of the Vashon-Maury Health Collaborative and a former member of the Board of Directors for Neighborcare Health.