Okeene Municipal Hospital: Shelly Dunham, Chief Executive Officer

by HCE Exchange on March 26, 2013

Okeene Municipal Hospital is a 17-bed critical-access facility in Northwest Oklahoma that serves a community of 1200 and houses a primary-care clinic. To better serve its patients, two satellite clinics were established in surrounding towns, providing additional healthcare services to those in need.

Developing partnerships across the state

“Over the past several years, the Okeene Hospital began experiencing increased difficulties when transferring patients to larger facilities,” Shelly Dunham, chief executive officer, said.

St. Anthony’s Hospital in Oklahoma City saw an opportunity to assist the smaller rural facilities with a streamlined patient-transfer process that would help patients return to their communities for continuing care closer to home.

This streamlined process became known as the  Saints First Network. Okeene Hospital was one of 12 rural facilities chosen to participate in the network.

“We were very fortunate to have been selected, and our hospital has benefited greatly from the partnership,” Dunham said.

As part of the partnership, Okeene Hospital was able to implement EPIC, an electronic health records (EHR) system, in the medical clinic in May 2012. It looks forward to installing the system in the hospital in early 2013.

According to Dunham, the EHR implementation process was an adjustment for all staff and initially added additional time to patient appointments.

However, once a patient has been seen and all of the medical history has been added to the system, appointment times have slowly started to return to normal. Physicians and nurses feel that EHR lowers their productivity during the day, but they do like having patient medical history so readily available instead of having to search through past charts.

Another important partnership was created by Okeene and the Hospital Engagement Network (HEN) in Oklahoma, an initiative of the Health Research & Educational Trust (HRET). The goal of the network is to help hospitals adopt practices to reduce readmissions and harm to patients.

Okeene has always been very conscious of quality care, and through the HRET, it is able to track and identify areas for patient-care improvements. The HEN contract involves intensive training programs to teach and support hospitals in making patient care safer and implement ways to measure quality improvement.

Dunham said the hospital generally performs well on its quality measures, but feels the numbers do not always accurately reflect the actual quality of care.

“For example, when you only have four patients, it only takes one low scoring item to knock down your overall score,” Dunham explained.

She also stated that compared to other Oklahoma hospitals, Okeene HCAHPS scores are typically very high.

Staffing and recruitment challenges and successes

Dunham has been with the hospital for over 30 years and has served as CEO for 10 years. Recently, she was awarded the Advocacy in Action award from the Oklahoma Hospital Association.

Her lengthy association with Okeene is normal for the organization.

“All of our current physicians have been with us for many years,” Dunham observed. “We don’t typically see a great turnover of physicians. With older physicians looking to reduce hours or retire all in the same time frame, it does pose a challenge. With the shortage of family-practice physicians graduating, the ability to recruit in-house is almost impossible.”

Okeene has used several different recruitment firms, both retained and contingent, in the past with disappointing results.

Several years ago, a full-time physician decided to retire, but the search for a replacement yielded no results. After discussing the situation with the retired physician, he agreed to return to the hospital part-time until a new physician could be found.

After assessing the hospital’s physician needs, the Board of Directors at Okeene made the decision to replace the retiring physician with a physician assistant (PA).

The hospital did an initial internal recruitment search, but soon turned to a contingent-based firm in Dallas that was able to provide three qualified candidates for consideration. After interviewing all three, an offer was made and the new PA began seeing patients in June 2012.

Remaining strong for the community

Okeene faces many challenges as a rural facility in today’s healthcare industry. Beyond Washington’s changing healthcare policies, the organization faces competition with two community hospitals in towns that are each about 20 miles away.

“Everything we do is community-oriented,” Dunham said. “We are located in the middle of town and are a huge supporter of small business. We do our best to keep our tax dollars at home by purchasing locally when possible.”

In 2007, Okeene completed a $7.5-million building and renovation project. The community rallied around the hospital and raised more than $300,000 to expand and update the existing building that was originally constructed in 1951.

The new facility includes additional patient rooms, outpatient services, business offices, imaging, and lab.

Although having so many hospitals serving smaller communities may seem unnecessary, these rural hospitals are vital to the communities they serve.

“Many small facilities will struggle to make the move into a value-based system, and some hospitals won’t survive the next wave of changes,” Dunham said. “The sad part is that there will be huge gaps in rural areas.”

If a small or rural facility closes, the chances of someone expiring on the way to a hospital farther away becomes a stronger possibility.

“We are often a stepping stone for patients who need advanced care,” Dunham observed. “We are able to stabilize patients before they are transferred to another facility. Although small, we are needed.”

Financial concerns are a primary challenge for many community hospitals, and the future impact of reform is uncertain.

Dunham said that Okeene doesn’t have critically high debt numbers, and she is confident that the organization will do everything possible to make sure that quality healthcare is available to those that need it, now and in the future.

-by Patricia Chaney

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