Coulee Medical Center: Scott Graham, Chief Executive Officer

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As hospitals expand and make large investments in new facilities, the expectations for care also expand. In rural eastern Washington State, a 25-bed critical-access hospital has recently moved into a new facility and is creating a culture that fully supports its growing vision.

Coulee Medical Center (CMC) plans to be “a regional medical center that is the best place for care and the best place to work locally,” said Chief Executive Officer Scott Graham.

The hospital serves five counties, covering about a 50-mile radius. CMC moved into its new facility in early 2011 and has all-new equipment in its emergency room, two OR suites, a labor and delivery unit, and observation rooms. The 66,000-square-foot facility also houses an outpatient medical clinic. With a larger facility, the hospital invested in new CT machines, mammography, telemetry and anesthesia machines.

“We replaced our equipment from top to bottom,” Graham said. “We knew this investment was going to have to last us a while, so we tried to ensure we have equipment that will last us five to 10 years.”

Going paperless

In preparation for the transition to a new facility, CMC began an initiative to go paperless in the next several years. All paper documents were scanned prior to the move and now live on a server rather than in large files.

In recognition of its efforts, CMC achieved Stage 6 designation from the HIMSS Analytics EMR Adoption Model, putting it one step away from becoming a fully paperless hospital. CMC is one of only six critical-access hospitals in the country to have reached that level.

“We have a commitment from leadership and medical staff to be as advanced as possible in electronic health records and becoming streamlined,” Graham said.

Driven by mission and values

Graham said all executives, physicians and staff are engaged and invested in the health of the organization. Part of this is through an emphasis on the hospital’s values–integrity, compassion, respect, competence, professionalism and financial viability. The goals are manifested throughout the hospital and are all a part of meeting the vision of becoming the best place for care and to work.

“Integrity is at the top, and we strive to meet that not just in traditional terms of keeping the books clean, but also in avoiding the over-promising and under-delivering syndrome,” Graham said. “We do everything we can to follow through on what we say. We also work together to operationalize and communicate change. We aren’t afraid to make tough decisions. Sometimes this goes over well and sometimes it doesn’t.”

Graham also emphasized respect as a key value for working at CMC. Respect applies in communication at all levels of the organization, and disrespect is not tolerated.

“I think the emphasis on respect has had positive effects,” he said. “We have seen improved recruitment and retention for nurses and physicians.”

Professionalism is another key aspect to the success of the organization. To Graham, this means putting the patients’ needs first, and putting the organization’s needs ahead of individual needs. Since becoming CEO in March 2010, Graham, along with the hospital board, also implemented a dress code.

“We behave ourselves in a way that distinguishes who works in this organization,” he said. “A dress code is part of that. When you dress professionally, you act professionally.”

Another aspect to improving the environment has been the move to becoming a tobacco-free facility in the fall of 2010. Graham said the response from the community has been overwhelmingly positive.

Focus on finances and the future

As with any healthcare organization, financial viability is also a huge concern for CMC. Graham said the organization is doing well financially. With many federal employees in the region, the hospital enjoys a favorable payer mix compared with other community hospitals. But Graham has been implementing changes to become more proactive with finances.

“When I first started, the way the hospital determined viability was looking at a balance sheet at the end of the month,” he said. “We are developing a dashboard that will have key metrics available every day for each manager and executive in the organization. There will be a finger on the pulse of the health of the organization rather than a retrospective look at balance sheets.”

The dashboard will include measures such as employees per occupied beds, average daily census and productivity. It will be electronically pushed to leadership on a daily, weekly, monthly and quarterly basis.

CMC is undergoing cultural changes and shifts not just physically from the move to a new facility, but also in its strategic vision, becoming more streamlined and electronic. Graham looks forward to the future and the effects of these current initiatives. The executive team is only a couple years old and committed to doing everything it can to become the best place for care and work.

-by Patricia Chaney

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