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Success or Failure: Healthcare Can Not NOT Change

By Roger Barnhart

Healthcare Can Not NOT change Roger Barnhart.jpg

One can not, not change – especially in business. And, though not always a popular perspective, healthcare is not only a business, it is big business. With many rural communities, the local healthcare system is the primary economic driver. It may sound harsh, but in business, it has been said that we are either growing, adjusting or dying.  

As an avid fitness enthusiast, I can personally attest that I must either work to improve, or I will lose the progress I have made - requiring almost constant re-assessment and modifications to my programs. Especially as I age. What I was able to do 10, much less 20 or 30 years ago will no longer render the same results today. Very much like rural health. 

Change and growth can be intimidating. It requires making choices on probability weighted outcomes. There must be a willingness to make additional investments, or cutting budget of one area to expand another. And, perhaps the scariest issue is leaving the known (what has been done), to embrace the unknown. 

With any business, we must continuously evaluate our market to make effective strategic adjustments. Our communities’ needs, demographics, reimbursement, regulations and staffing – the only constant within healthcare is change.  

Recently I moderated and presented as a part of a panel discussion on the new model of rural health. The state’s hospital association gave an extensive presentation on changes within Medicare and issues within Medicaid, and discussed the challenges being faced by rural providers.

A Legislative Liaison presented on pending legislation and regulations. A strategic planner offered examples of best practices within rural health systems from across the country - challenges that resonated within each of us. As for my presentation, I addressed points raised by the others, wrapping it into a discussion on continuum of care (regional health systems, rural hospitals, skilled nursing facilities, assisted living, home health, mental health and others) collaborations to improve quality of care with increased satisfaction at lowered cost. 

After all of these presentations and interactions with the audience, there was one question that seemingly brought all our efforts to a screeching halt... 

She ran a rural health system, offering acute care, rural health clinic, home health and long-term care. As a CEO for critical access hospitals and licensed Administrator for skilled nursing, her question was directed to me specifically.  

I was almost dumbfounded when she stood up, and literally asked, “Why does everything have to change?” 

We had presented on what was changing and how to address those, but not on the why. She continued with how she has been with her current health system for more than 20 years, the last 12 years as CEO. According to her, everything was fine until the last few years. 

I paused, standing at the podium in utter disbelief. It took me a few moments to realize that hers was not a rhetorical question.  

Had she not understood the presentation on changes within Medicare and issue with Medicaid, or pending legislation? Likely, no. 

Perhaps she instead heard that more changes are coming, and went into a mode of panic or defiance – I do not know. One would think that examples of best practices would offer some optimism. Hearing how the same challenges have been faced and overcome by other rural health systems.  

Using a technique that has served me well within community town halls, and when meeting with both staff and board members alike - I responded to her question with a few questions of my own. Reinforcing the very points presented that day. 

I asked how long she had lived in her community. She proudly stated she was born and raised there, leaving only to obtain her college degree. I wondered if the community was the same while growing-up as it is today. After discussing the charm and warmth of her small town, she acknowledged it wasn't exactly as it once was. Many of the younger families moved away when a plant closed several years earlier. I asked how big her graduating class was compared to now. The school apparently had gone from a 4A to a 2A over the last 30+ years. Referencing the closing of the plant, I asked if there was farm land available, or any other industrial opportunities within the community to keep locals from moving away after high school.  

No surprise, the health system and school district were the primary employers in town – typical of many rural communities. I then clarified how both of those require the majority of employees to have advanced degrees or certifications. Then, asking if there was local access to obtain the necessary education – there was not. She then offered how those leaving for school often never come back – again, all too typical of many rural communities. 

I then confirmed what I heard – her community had gotten significantly smaller over the last several years. The two major industries in town (health/school) require advanced education unavailable locally. It was experiencing a great out-migration of those 30 years or younger, leaving a primarily elderly population, with fewer staff available to care for them. 

I then offered a rhetorical question of my own. Considering everything shared, how could she possibly think that her hospital – just as the very community it serves – would not have to change? 

My final question was to learn if she had presented to her Board of Directors any alternative models of rural health, or recommended adjustments to service lines so as to optimize reimbursement, ensuring sustainability. Her response made it clear that the Board of Directors was not receptive to change. 

I did not ask, but suspect that her system – failing to address changes within her community – has faced ever narrowing operating margins. 

I completely understand and appreciate the perspective on the charm and warmth of her community. Like her, I too grew up in a small town, and subsequently took over rural health systems as CEO. I consider myself blessed to have grown up in my rural community and the memories it provided. 

But the harsh reality that Board of Directors and CEOs alike must face is, what got us here from the past is not necessarily what will keep us going into the future. 

In subsequent blogs, I will be sharing first-hand accounts of successes and failures by both CEOs and hospital Boards. Not all rural health systems are created equally. Just as she was aware of the changes within her community, success or failure is often dependent upon more than simply understanding that things are changing– we must be able to embrace those changes for continued success in caring for our community.  

Change is scary. Change is inevitable. Change must happen.