Just because a hospital is located in a rural service area doesn’t mean it isn’t progressive and steadily evolving with the times. Davis County Hospital, a 25-bed critical-access county facility in the primarily rural southeast corner of Iowa, is a prime example.
With approximately 13,000 people in its service area and annual revenues in the $24 to $26-million range, Davis County Hospital is the only critical-access hospital in Davis County.
In June 2010, Davis County Hospital completed a large-scale renovation project that introduced a new patient-care area for inpatients and a brand-new ER. Key to the renovation was enhanced patient privacy and employee and patient safety, along with several significant upgrades in hospital technology and focused attention on implementing the best contemporary infection-prevention practices.
The renovation also brought MRI services in-house, rendering the MRI mobile unit, so common in rural healthcare, obsolete for Davis County Hospital’s area. Additionally, the hospital opened a sleep lab to study an alarming number of patients in its area who suffer from sleep apnea and have the potential to develop cardiac disease or diabetes as a result.
Working with Communications Engineering Company (CEC), Davis County Hospital integrated a new nurse-call system and brought all of its other low-voltage technology onto one platform under CEC.
Thanks to these measures, Davis County Hospital is a stand-out organization in the American rural healthcare scene. But Deborah Herzberg, chief executive officer, said this doesn’t exempt Davis County Hospital from the present and future worries that plague rural facilities and that threaten their very existence.
The perils of being underappreciated
As CEO since January 2006, Herzberg has sought to build a senior team that is dedicated to the core values of integrity, honesty, commitment, persistence, and community.
“Rural healthcare, I don’t believe, is appreciated enough,” she said. “I’m really concerned right now about how our federal government is going to address these issues, and what’s that’s going to mean for the patients that we serve, because we know that the patients we serve in rural America, especially in our area, if they can’t get it done here at their local hospital or there’s not a local healthcare option for them, they just don’t get it done.”
Herzberg said that many patients in Davis County Hospital’s area do not focus on wellness or managing disease processes. The population is heavily elderly, and oftentimes, worse complications develop because of this neglect. She is worried that politicians won’t take into account the nurturing and educational relationship that rural hospitals have with their patients when it comes time for a Congressional vote on the critical-access hospital program.
“I think there are a lot of things on the horizon that are going to be very important to us as rural Americans,” she stated.
Networking with like minds
Part of the solution to this legislative intrigue, Herzberg said, is to network with fellow rural critical-access hospitals. Davis County Hospital is already a part of the Mercy Des Moines Central Iowa Network that consists of 16 other hospitals.
Herzberg said Davis County Hospital is required to be a member of a network according to the Critical-Access Hospitals Conditions of Participation, but the benefits go deeper. A network brings a group of like-minded facilities together and enables them to share best practices and benchmark quality scorecards and provide needed support for each other.
“The networking that I’m able to do with other critical-access hospitals CEOs, even outside the network, is very important because all of us are different, we all have different strengths, so it gives us the ability to share ideas,” she explained.
Competition can produce isolation, though, but with the industry in an extreme state of flux, Herzberg believes that competition shouldn’t be the priority.
“There’s a tendency for all of us to want to compete for the market share, but I really think that the key to moving forward with healthcare reform and how we change healthcare has got to be collaborating together and how do we work together more, rather than competing,” she said. “How can we collaborate better to make sure that our patient needs are being met and that we can still maintain healthcare access in each of our communities?”
For example, three years ago, Davis County Hospital took a “leap of faith” with two other hospitals in the network and employed an orthopedic surgeon who could serve the needs of a large group of elderly patients that simply did not want to travel to the city, regardless of their personal needs.
Focusing on patient experiences
In addition to networking, continuous improvement, especially in all facets of patient safety, is a priority for Davis County Hospital, Herzberg said. Using HCAHPS as its guide, each department leader is given a question that they’re required to answer and implement. Davis County Hospital is also partnered with Press Ganey for its patient-satisfaction surveys and regularly studies the results.
“We’re really focusing on those questions and how our patients are responding to those to make improvements in the care that we are providing to them, whether that’s the sound around their room, or the food that they are brought as a part of our dietary services, or the care and the education that the nurses provide for them,” Herzberg said. “We’re constantly looking at that.”
Herzberg’s nursing background motivates her drive for safety, and lately, she’s been dutifully focused on being a positive influence within the community. Her goal is to steer Davis County away from an illness model to a wellness model. With a limited revenue stream, however, this is a daunting task.
“Figuring out how we are able to do that with the limited resources that we have is probably a challenge that I think I feel a lot of pain in, because we know what the right things are to do,” she said. “It’s just figuring out how do we do it and how do we manage our resources effectively.”
-by Pete Fernbaugh