Avera Marshall Regional Medical Center: Mary Maertens, President and Chief Executive Officer

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As recently as October 2008, Avera Marshall Regional Medical Center in Marshall, Minn., did not have a medical group or own any clinics. It was largely concentrated in its own relatively small footprint.

In many ways, Avera Marshall was content to be a local hospital, mainly concerned with the needs of those confined to the city limits.

Fast forward to 2013 and Avera Marshall is growing rapidly and proving to be a competitor in a highly competitive region. A member of the Avera network of hospitals, it is now a $90-million business with 26 hospital-based and mid-level providers, spanning a service area of roughly 123,000 people across several counties. It is state-licensed for 49 beds and operates 25 of those as a critical-access hospital.

Among its service offerings is OB, which is unusual for a critical-access hospital. However, with 460 babies born at Avera Marshall each year, the service is justified, as is its emergency department that hosts 7,600 emergency-medicine visits per year. Its physicians’ group, Avera Medical Group, has rapidly expanded and now comprises a large part of its business.

Symbolic of its rapid growth, Avera Marshall added 22,500 sq. ft. to the main campus of its medical center in 2012. This is comprised mostly of a new physicians’ office building for the medical group.

The organization prides itself on having solid financial performance that allows it to channel even greater resources into growth strategies and differentiates Avera Marshall in the marketplace with advanced state-of-the-art imaging and surgical technology.

Because of its commitment to service excellence and growth, Avera is now a designated Level 3 trauma center.

“We’re poised for really good growth,” Mary Maertens, president and chief executive officer, said. “And we think our primary-care group will drive additional clinical-care business for us. The Level 3 does differentiate us from really every other hospital in our immediate footprint here. We feel very strongly about the steady improvement that the emergency medicine has taken.”

Trying to be more

Looking back, Maertens is candid about Avera Marshall’s past. Having been a city-owned organization for nearly 60 years, she recalls that the hospital had undercurrents of a public-entitlement attitude. As a result, she said, “we were sort of asleep.”

The hospital board, however, began to reexamine the hospital’s potential, and various board members felt the organization didn’t have to limit itself to one service site. They believed Avera Marshall had the potential to be a regional referral center.

“Everyone on our board thought we needed to aspire to something bigger and greater, so that’s been our focus for the last eight years,” Maertens said.

To achieve this would mean awakening the lethargic culture that had gripped the hospital for years. It meant that its tenured staff–every manager, every leader, every staff member–would have to adapt and grow. Expectations would no longer be rooted in the status quo.

Avera Marshall engaged the StuderGroup’s services, working with them to create a culture of alignment, accountability, and action.

As part of this culture change, Maertens said it has now centered its quest for growth on aligning itself with physicians and providers through both employment and acquisitions. The hospital also has a number of service teams who are engaging the direct-care staff, partnering with them to renew focus on the patient, resident, and client experience. They’ve also started operating from a value-based purchasing standpoint.

“Our vision is really based on growth, commitment to market differentiation through technology, and maintaining financial performance so that we can plow it back into growth,” Maertens explained.

Working with less

Given its rural location, Avera Marshall’s goals are ambitious, but in the current healthcare environment, its goals are also daring, especially with less and less money coming into the system from reimbursements and insurance.

“In our world, we’re trying to deal with all of that and reposition ourselves under a value-based purchasing, accountable-care environment, wrapping our head around it, having the decision support that’s fast enough to do these sorts of things, and being able to manage and mitigate enough risk to have enough money to make payroll,” Maertens said.

It’s much more difficult to find capital to pay for new expenditures than it was five years ago, she added. Fortunately, for the last five years, Avera Marshall has had good operational performance thanks to the solid governance of its board and its CFO’s efforts to position them for the difficult times.

“We’re all as healthcare executives challenged to change our own leadership style to be more results-oriented and be more responsive to our communities and patients in a very, very competitive, rapidly changing environment,” Maertens observed.

Because of these difficult times, it would be easy for Avera Marshall to slip back into sleep mode, but as its leader, Maertens is determined to continue on the path of growth in spite of the odds.

It’s important that healthcare executives maintain their sense of mission to the community around them, she said. It’s important that they become increasingly mindful of the healthcare needs in the community. It’s important that they fill gaps in care by partnering with the community in innovative and creative ways.

As part of the Avera network, co-sponsored by the Benedictine and Presentation Sisters, faith and ministry are key to Avera Marshall’s operations. Being a member of that system has motivated Avera Marshall to widen its footprint and increase its dedication to keeping care close to home.

Maertens has been with Avera Marshall for 25 years. However, she has been president and CEO for the last six years, one of its most transformative times. Through these ongoing challenges, her personal values of compassion, hospitality, and stewardship have been reaffirmed. As a registered nurse, she knows firsthand how important it is to be dedicated to the patient.

“I feel very strongly about really putting the patient in the center of our decision making,” she said.

-by Pete Fernbaugh

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