Coulee Medical Center: J. Scott Graham, Chief Executive Officer

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When HCE last covered Coulee Medical Center of Grand Coulee, Wash.,, the organization had just moved into its brand-new facility and was looking forward with great optimism.

One year later, that optimism is still intact.

The first six months and beyond

J. Scott Graham, chief executive officer, said the first six months after the move were consumed with becoming acclimated to Coulee’s new surroundings.

“Before, we really had the task of working from the build-up to the new building and all that was going to mean,” he explained. “Now, it’s ‘What do we do with the rest of our lives in the new building?,’ especially in sustaining a culture of continuous improvement.”

Since the move, Graham said Coulee has experienced a few leadership changes, further refining the executive and leadership team. Consultants have been brought in from Virginia Mason Institute to train the staff in Lean Management. Graham noted that this was Virginia Mason’s first experience in training at a critical-access hospital.

This training led to the hiring of a Lean consultant from Joan Wellman and Associates, a firm that specializes in applying Lean principles to rural healthcare environments. Coulee’s goal is to go through the entire facility over the next several years and make sure that everything is being run as efficiently and effectively as possible.

Coulee also conducted a comprehensive employee-engagement survey and received mostly positive feedback.

“We were actually quite taken aback by that, especially considering all the upheaval we have been in with the move,” Graham said.

Nevertheless, a few areas of improvement were identified, mainly in communication.

In response to this, Graham has jumpstarted several initiatives to better communicate to the employees what the executive team is doing and facilitate communication back to them with ideas the staff has for improving the hospital. Graham said they’ve also started holding open forums with the staff on a quarterly basis and have what they call a CEO Roadshow where they go to every department meeting on a rotating basis and essentially conduct an open Q&A period.

Lately, these sessions have been centering around Coulee’s mission and vision. The team asks those at the forum to grade how they feel the executive branch is doing in meeting the vision, mission, and goals of the organization.

So far, they haven’t received any Fs or Ds, Graham said, adding, “Everybody generally says they’re seeing a lot of good improvement, so we feel we’re going in the direction that we should.”

Bringing IT home

In May 2011, Coulee took the step of hiring an IT director for the facility. It had previously contracted these services out to an organization in Spokane, Wash. Graham stated that the hiring was somewhat of a departure for Coulee, but the director, Doug McLeod, comes with extensive healthcare and management experience.

Graham said McLeod’s strategic capacity, maturity, and technical expertise is a real find for Coulee, and he has been well-received by the hospital’s staff.

Coulee has also been a member of the Critical Access Hospital Network, a group of critical-access hospitals in the region that collaborate on IT needs. As part of this collaboration, Coulee will lend McLeod out to the other hospitals in the network as their CIO. So far, Graham said some innovative measures have been accomplished thanks to this partnership.

Coulee also signed on with Clarity Medical Systems in an effort to conduct rural health-clinic case management better. Clarity uses a web portal that streamlines an organization’s ability to refer patients elsewhere, but also to find out what happens to them, keep track of outcomes, and bring them back to the hospital when the time is right.

Working with the community and legislature

Graham said it is part of Coulee’s corporate philosophy to help the community not just by providing healthcare services, but also by promoting wellness. To this end, Coulee has been working with its local government to construct a community wellness center. So far, the hospital has secured grant money, signed a consultant with experience in building these facilities around the country, and is actively fundraising for the center.

The hospital has also been dealing with legislative issues that affect critical-access care, especially with regards to Medicare and Medicaid reimbursements. Critical-access hospitals are reimbursed on a cost basis through both programs, and a Washington-state initiative introduced at the end of 2011 would have eliminated cost-based reimbursements for critical-access hospitals.

Graham said that Coulee has been working with legislators to try to reverse that and was grateful that the legislative session came to an end without any of the cuts being enacted. Coulee continues to work on keeping the community informed should this measure ever reenter the discussion and is grateful for the added time to prepare for the inevitable tightening up of resources in the future.

Additionally, Coulee has opposed and will continue to oppose legislative attempts to mandate nurse-patient ratios.

“We’ve seen concerns about breaks and meals for nurses that have gone into the legislature, so we’ve had to be very active and in fact very proactive in making sure that the folks that represent us understand what’s at stake should these measures go into effect,” Graham explained.

Bringing business and healthcare together

With the healthcare paradigm changing, Graham feels that it is increasingly important for organizations to balance business principles with caregiving values.

“My impression is that healthcare is rapidly becoming an arena where we have to be solid business people as well as caregivers,” he stated. “And the technology, the tools, and the methods that make a business viable and well-run need to be applied to healthcare. Technology and IT is one of those fundamental tools. We just think you have to be looking forward all the time and positioning yourself to remain efficient, effective, and competitive.”

-by Pete Fernbaugh

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