Melissa Memorial Hospital: John J. Ayoub, FACHE, Administrator/CEO

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Melissa Memorial Hospital is a 15-bed critical-access hospital in Holyoke, Colo. MMH has 100 employees, 78 of whom are full-time. The hospital also maintains a rural health clinic and an ambulance medical services organization.

In February 2008, MMH moved into a new, 48,500 sq.-ft. facility on-schedule and $1 million below budget. This facility localized both their clinic and hospital under one roof. Since that time, the size of the organization has grown by roughly 50 percent.

“It just allows us to provide the care that we know we can in a healing environment that is conducive to the best outcomes of our patient,” John J. Ayoub, FACHE, administrator/CEO, said.

MMH’s growth is evident in its statistics. In 2007, the hospital had revenue of $5.7 million. By 2010, that had multiplied to over $10 million gross revenue. During that time, MMH has increased both recruitment of personnel and retention of providers. In 2007, the hospital had one full-time doctor and two part-time nurse practitioners; it now has three full-time doctors, two part-time doctors, and two full-time nurse practitioners.

A unified staff

Ayoub is effusive in his praise for both the hospital’s staff and board of directors. Because the hospital is a political subdivision of the state of Colorado, they are supported through a mill levy in their district. Their board of directors is thus comprised of five elected members.

Ayoub said these individuals are attuned to the needs of the community. Most of MMH’s staff is from the local region, so they have their personal lives invested in the hospital because they’re often treating friends and family members.

Furthermore, most of the medical staff has been with the hospital for several years, thus it is built around a core of unified, caring, and involved professionals. For example, Dr. Dennis Jelden, chief of staff, has been in the community for 13 years.  Ayoub describes Jelden as a “work horse that ties the place together.”

“We now have a cohesive medical staff that really brings the culture of caring and culture of healing that we want,” he added. “I tend to think that I am professionally blessed with a phenomenal team. The people and employees are really invested in the organization’s success.”

The new facility also gives employees a sense of pride that is only bolstered by the tremendous support they receive from the community. For example, the Melissa Memorial Hospital Foundation had pledged $600,000 toward the new building. From a town of 2500 people and a service area of fewer than 10,000, the foundation was able to bring in $750,000.

This all came to a hospital that grew out of a tiny brick building.

“I am continually amazed at the support that we get from the community,” Ayoub said.

Owning the vision

Beyond MMH’s core set of values, Ayoub has sought to instill within his employees a sense of ownership.

“I meet with every single employee on their first day of orientation,” he said. “I emphasize with them that we are here for people. This is a very real responsibility.”

He also cultivates a team mentality. He strives to create for his employees a vision that ties each individual into MMH’s success.

“Taking care of people is an awesome responsibility,” he said. “And it’s something we strive to do to the best of our ability every day.”

A field of challenges

Ayoub is constantly encouraging his team to grow in their professional lives, especially with healthcare reform looming on the horizon.

“What does that mean for those of us within a small rural organization?” he asked. “How will the efforts on a federal and then a state level impact us as an organization and a community?”

Being a small organization, MMH is faced with many financial challenges, not to mention the reality that it can’t be all things to all people.

“Sometimes that is disappointing for some folks,” Ayoub said. “For example, we can’t do dialysis because it’s not an overwhelming need.”

Other avenues, however, provide a great deal of service for the community at great  personal expense to the hospital. For example, MMH’s ambulance service loses a great deal of money every year. In spite of this, Ayoub said the board has decided it is an important service that the community needs.

Modern advancements don’t always come easily to the hospital either. For instance, MMH’s rural health clinic just went live with EMRs in August of 2010.

“As with any new tool, it takes a while to become as efficient and proficient as possible,” Ayoub said. “So we took a dip in the patients we could see while we worked it out.”

Now, the clinic is gaining the benefits it hoped to see from EMRs, including less redundancy and more accuracy. The organization is now looking at EMRs for the hospital, even though they know there will be learning curves that come with the implementation.

“One of the things we need to make sure that we don’t do is to get overextended,” Ayoub said. “We want to make sure that when we start a project, we make it a major focus.”

Aware of the patients

Ayoub is devoted to ensuring that MMH gives their patients every tool they need to take care of themselves. If they don’t have those resources, then he sees it as the hospital’s duty to link the patient up with home care, a nursing home, a loved one, or a neighbor who can see that they get adequate care. To this end, MMH is a proud member of the AHRQ’s Project RED (Re-Engineered Discharge).

“We’re here to serve our community,” Ayoub said. “It doesn’t do us any good to care for the patient in our hospital and then discharge them and not care what happens to them.”

MMH’s board of directors was one of the first boards in Colorado to adopt a Never Event policy, a standard which defines six categorical events that should never happen in a hospital.

Even though there is a great deal of talk at the federal level with regards to tying payments into these events, many exceptions would be made for critical-access hospitals like MMH. The MMH board rejects these loopholes as a default excuse.

“Our board said that these are events that should never take place in any high-quality healthcare organization,” Ayoub said. “We decided to hold ourselves to this standard whether Medicare holds us to it or not.”

Therefore, if a patient experiences a negative outcome that should not have happened, as categorized by Never Event, they are not charged by MMH for their care.

“I’m proud to be associated with an organization that will say this is the right thing to do, whether somebody’s looking or not, whether somebody’s going to base your payments on it or not,” Ayoub said. “We’re here to do the best thing for our community, and we’re going to hold ourselves accountable to that regardless.”

-by Pete Fernbaugh

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