The Georgia Hospital Association held its Center for Rural Health (CRH) Annual Meeting in St. Simons Island August 22-24, 2018. Rural hospitals from across the state convened on the island to discuss success stories, learn about key regulations, and share the latest issues facing their rural health communities. Key takeaways on these timely topics include:

Turnaround in an ailing Rural Hospital

Conference attendees heard from Dr. Michael Williams, former CEO of Hill Country Memorial Hospital in rural Fredericksburg, Texas. Dr. Williams is credited with helping turn a struggling hospital with poor quality performance into a top performing, award-winning healthcare provider. The turnaround required radical changes in leadership, focus, and values. Dr. Williams discussed:

• Teaming up with business outside the healthcare industry that are top performers in quality and customer service and implementing those company’s strengths in the hospital setting. For example, Hill County hired an executive from Toyota to help put safety and quality first. The hospital also consulted the Ritz Carlton to learn to deliver excellent patient service and experience.
• Hiring an executive team that was business minded, regardless of whether they had healthcare backgrounds. He needed a team that was ready for change, and could see his vision, which meant that stagnant leadership that had been around for a while had to go. According to Dr. Williams, “we’d rather be failing forward than standing still.”
• Starting a leadership training program to invest in and develop talent from within the organization and using team based rewards rather than rewarding individual success.
• Setting values and not losing heart. Changing culture is tough, and staying true to values is key to successful change.

Tips for Telling Your Story

Ms. Kay Temple, a writer for the Rural Health Information Hub, discussed the importance of being able to “tell your story” to patients and the community at large. Successful communication will:

• Tell people something important that they do not already know. To find that “something” talk with providers and community (e.g., school nurses, librarians), who often know what knowledge individuals are seeking.
• Be simple. Patients believe good care is care they understand.
• Resonate with the audience. Tell a story about someone that looks like your patients.
• Use resources that are free and available. Hospitals often have staff members who would play a role in the hospital’s messaging, may be great writers, or have a knack for video editing, photography, etc. Engaging staff strengths is a great way to empower your staff and obtain low cost assistance in creating messaging. The community at large may also offer resources—e.g., team up with local high school writing programs, or partner with the local newspaper.

Large Capital Investments in Rural Hospitals

Top executives from Morgan Memorial Hospital and Cook Medical Center (a campus of Tift Regional Medical Center) shared their insights having gone through (and still going through) the massive undertaking of large capital investments (in this case, building new hospitals). Their insights included:

• Finding funding may require several avenues, including finding a strategic partner, fundraising (e.g., land donations, community fundraising) in addition to other financing options.
• The community must understand the value proposition—that it matters to have a community hospital.
• Tough decisions must be made during the process to keep the hospital running, and financial decisions, even when not favored in the community, may need to be made to keep the hospital functioning. For example, Cook Medical Center closed its emergency department and Morgan Memorial closed its nursing home, despite possible community opposition.

Aligning Physician and Hospital Incentives through Quality

In order to get physicians to participate in hospital incentives, hospitals must understand how physicians view quality. This was the message delivered by Dr. Mac Knight of the Coker Group. Some of the tips offered by Dr. Knight to get physicians on board included:

• Outcomes matter more to physicians than patient experience or satisfaction.
• Talk to physicians in terms of mortality, % of patients that leave without being seen (“LWBS”) rather than Yelp reviews, hospital market share, or patient satisfaction.
• When using comparison data, make sure to consult variations in the physician’s practice (because the physician may fall back on “my patients are sicker” when viewing comparison data).
• Physician leadership can drive quality—so find physician leaders that are putting quality first.

Achieving a Culture of Zero Violence

Every hospital, whether rural or not, has a risk of experiencing violence, generally in the emergency department, although not always. Conference attendees learned various ways to reduce risk and anxiety, and in turn, violence:

• Healthcare is a community, and each floor is a neighborhood. Each neighborhood has different risks and issues that should be assessed and addressed for security issues. The emergency department for example, would have different issues than the labor and delivery unit, although both have security and violence risks.
• Establishing trust is important—the security staff should regularly interact with patients and staff, and even use k-9s to establish trust and prevent violent situations.
• Prevent crime through design using well-lit areas, low bushes, etc.
• Training staff in scenario-based training is imperative. As oft quoted, “people do not rise to the level of expectations, they fall to the level of training.”
• Know pre-incident indicators for employees—including paranoia, co-worker fear, police encounters, obtaining weapons. Human resources department plays an important role in prevention and seeing pre-incident indicators.