Tuba City Regional Health Care Corporation: Joseph Engelken, CEO

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Tuba City Regional Health Care Corporation (TCRHCC) is situated in Tuba City, Ariz., and serves the western part of the Navajo and Hopi Reservations.

The hospital is a 75-bed acute-care regional medical center with burgeoning centers of excellence in trauma, diabetes, and cardiovascular services. Tuba City has new advanced-medical technology you rarely find in Indian country.

Tuba City is dedicated to providing the best care possible to the Native American communities it supports. The health system furthered that mission in 2002 when it shifted decision-making from the U.S. government to a local board comprised of community members.

The hospital was previously under control of the Indian Health Service, a division of the U.S Department of Health and Human Services. The change to self-governance has allowed Tuba City to create new jobs, establish a 501(c)(3) branch for fundraising and pursue more community-based opportunities for funding rather than only receiving available federal dollars.

“Our hospital board has an entrepreneurial spirit,” said Joseph Engelken, chief executive officer. “Our medical staff is very involved; all our physicians are employed. We are becoming an integrated community engine.”

By integrated, Engelken is referring to the 12 primary and specialty community clinics Tuba City runs in addition to the main hospital campus. Self-governance has benefitted the healthcare corporation as it has completed many new projects.

Adding and expanding

In 2010, Tuba City opened a 34,000 square-foot ambulatory medical facility on campus and an outpatient primary-care center on campus. Expanding community services, Tuba City also opened the Sacred Peaks Health Center, a primary-care facility in Flagstaff to serve more Native-American beneficiaries in Arizona.

Engelken said quality is always a focus at Tuba City, and the hospital has increasingly added services in the past couple of years. In 2010 and early in 2011, the hospital began offering 24-hour MRI and CT-scan services, 24/7 pharmacy, a regional mail-order pharmacy, along with electronic medical records. Future plans include continued growth of the trauma system and cardiovascular services.

Tuba City is also looking into opportunities to serve the northern region of its service area, to provide long-term care on campus, and to offer smaller independent living/health-service facilities in the eight chapters it serves.

Becoming a community engine

Tuba City’s desire to become a larger facility and to provide more services and support to the community was part of the organization’s impetus for pursuing self-governance. With healthcare inequality being a major issue throughout the United States healthcare system, Tuba City felt self-determination allowed it to close the gap in healthcare disparities among Native Americans compared with other citizens. In addition to focusing on quality care, Tuba City is dedicated to growing the community and ensuring the hospital is a community-driven engine.

The entire Tuba City Corporation serves about 6,000 square miles, and the hospital receives about 410,000 patient visits annually. It has a referral or beneficiary base of about 75,000 individuals.

“Our board believes in community-based planning and care,” Engelken said.

This mission can be seen through the hospital’s addition of 450 employees in the past six years. On a Navajo reservation, this number is huge in terms of economic development and sustainable community life. Engelken said Navajo nations typically have about a 40-percent unemployment rate. Seventy-three percent of the workforce at Tuba City is Native American.

“Through self-governance, we are helping grow a business that was traditionally done only by the Indian Health Service,” Engelken said. “Our workforce is adjusting to the change and becoming more entrepreneurial. We are moving increasingly toward a Navajo, Hopi, and other Native-American tribe executive team driving the health system.”

For CEO succession planning, the board this year started an innovative Associate Executive Officer (AEO) mentorship program so a Navajo or Native-American CEO is ready to tale the helm of this expanding healthcare system when Engelken’s tenure concludes in four years.

The change in leadership hasn’t come without challenges. Although it’s been nine years since the change, within healthcare, transitions can take time, especially with the federal adjustments in reimbursements and delivery modalities. Engelken said most of the physicians have worked both within the Indian Health Service as well as the private sector.

“Change is always complex and tough,” he said. “But it is more rewarding to overcome those daily challenges.”

Tuba City continues to work through those daily challenges with continued focus on quality care for the patients they serve. Quality improvement is key to reducing costs and building consumer trust.

Remembering the goal

Engelken said the goal of Tuba City is to become a regional medical center of excellence, but it must still be anchored in community-based care, “so we don’t get too full of ourselves.”

“Our mandate as a tribal health organization is to serve primarily Native-American beneficiaries,” he said. “Consumer expectations for care are always increasing, and we are working hard to ensure we maintain the trust of our patients. As we work toward becoming a center of excellence, our clinics are a vital vehicle to keeping us grounded in the communities we serve.”

-by Patricia Chaney

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