Community Medical Center, Inc.: Ryan C. Larsen, Chief Executive Officer

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Community Medical Center, Inc., is a 24-bed critical-access hospital, serving Richardson County, Neb., which has a population of about 9,000. Despite being a small community hospital, CMC has remained financially strong.

By partnering with other agencies and hospitals, the center has built up its healthcare program and expanded its electronic-health records in the hospital and primary-care clinic.

Building relationships in the community

Healing rifts in the hospital’s relationship with the community is one challenge that Ryan C. Larsen, chief executive officer, has faced since he first took the reins of leadership seven years ago. A few years ago, he began to increase communication with the community and bring the governing board into strategic planning.

“We started to do community reports, appear to different groups, and holding employee forums,” Larsen said. “We wanted people to know we were open and willing to talk about issues. And we wanted key groups to know that we count on them to help us make decisions.”

About three years ago, CMC built a new facility. As part of the planning process, administrators went to staff, physicians, and the board to make recommendations and get input for the new building. Larsen said he also involved the board members in physician recruitment.

“I think our governing board members like knowing they would be a part of the decision-making process,” he said. “They don’t always exercise their voice, but they know they have one when they feel like it’s needed.”

Improving community health

A large part of improving the hospital’s relationship with the community has been in meeting the community’s health needs.

Richardson County has a set of health goals the hospital has adopted, and to achieve these goals, CMC has created initiatives to address the six issues identified by the district health department: provision of healthcare to an aging population; the increasing age of medical professionals, clinicians, and volunteers; access to adequate mental-health services; increasing age of population; transportation; and obesity, inactivity, and wellness.

Even before the government started issuing mandates designed to improve people’s overall health before hospitalization, CMC was evaluating and implementing wellness programs. The hospital has an on-site family-medicine clinic and offers community programs, including diabetic-outpatient education; the Fitness Improved Together (F.I.T.) program, which is focused on improving overall health; a home-visitation program to promote healthy families and healthy children; a smoking-cessation program; health fairs; and other community-outreach initiatives.

Addressing quality initiatives

CMC has also been working on improving quality and core measures. The hospital started with obstetrics. Many community hospitals have ended their obstetrics programs because it is typically a loss leader, but CMC determined it is a necessary service for the community and has revamped the program.

Another area of focus is orthopedics, which remains one of the most profitable service areas for the hospital. Larsen said that with increased staff training and measures to improve efficiency, CMC has seen gains in that division as well. With its unique surgical technique, the orthopedic group sees patients from hours away, some who even bypass larger metropolitan hospitals in favor of CMC’s services.

The hospital has also focused on falls and infections. In an effort to improve on quality measures, CMC has hired nurse practitioners and physician assistants to fill a hospitalist role. The program is still in its infancy, but Larsen said it is already gaining traction. To encourage staff to achieve the highest quality, the hospital offers incentives to the physicians’ staffs who get compensation for achieving quality as well as productivity.

Larson said the hospital looks beyond the individual core measures and at the entire patient experience.

“We ask, ‘What is the likelihood you’ll receive 100 percent of every measure?’” he explained. “We look at ways to get the whole experience right and tied that into employee incentives.”

This strategy has worked so far, as the emergency room has received patient-satisfaction scores in the 90th percentile, with other areas receiving scores in the 70th percentile and above. These are improvements over past scores in the 40th percentile. On inpatient core measures, CMC has scored about 98 percent.

With good quality scores, the hospital has begun focusing attention toward improving its employee culture as well. Larsen has instituted communication techniques, team steps, and culture principles to ensure a positive working environment.

Although the fate of healthcare reform is no longer in question, uncertainty still remains. Changes to critical access-hospital status are a big concern for smaller hospitals such as CMC, and the repercussions of those changes are as yet unknown.

Looking toward the future, CMC is focused on ensuring its financial stability, finding the right mix of new medical staff as many older physicians look toward retirement, implementing a hospitalist program, and furthering its work on improving overall community health.

“We need to work on being a partner to the community for health and wellness and shift our structure to support that goal,” Larsen said.

-by Patricia Chaney

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